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July 27, 2010 News 14 Comments

From Gregarious: “Re: HCA. They are doing competitive pilots of Meditech 6.0 vs. Cerner, possibly as a move toward displacing the long-term HCA / Meditech relationship.” Verified. HCA will run a Cerner pilot in at least one hospital sometime next year. Meditech 6.0 is a big step from HCA’s Magic (pretty much starting over), so it makes sense to test the waters. The wild card could be how the hosting models compare. Several HCA hospitals have reached EMRAM Stage 6 on Magic, which ironically makes it harder for HCA to switch since you’d need heavy clinical usage from Day One to avoid moving backward. Any change (even to 6.0) will be painful.

7-27-2010 7-49-20 PM

From BeCarefulWhatYouWishFor: “Re: Epic. They are about to pick up another large academic facility in Nebraska. You can only imagine who is going to have the LastWord now.” Unverified, but thanks for the excellent punmanship in any case. As a couple of readers pointed out, it will be interesting to see if Epic can scale its model up to cover all these big implementations going on at once. A CIO reader who knows both systems says Cerner requires clients to take ownership of the design and use outside consultants, while Epic offers a more turnkey implementation at a higher price. It’s also interesting that Epic doesn’t offer hosting and Cerner is runnin hard with that offering, so that’s a key differentiator to some prospects.

From SnagMonkey: “Re: Epic. Not officially announced, but all Providence hospitals and hospitals in Oregon will convert to Epic.” Unverified.

From You’ll Know Who: “Re: Epic. Not only is Epic replacing Eclipsys and Cerner at sites, they are likely removing 30+ year old financial systems from McKesson, such as HealthQuest or the old Ibax product. That again highlights the lack of success with the ‘new’ Horizon ERM. It would be interesting to hear which products the CIOs looked at.” My ears are open if anyone wants to share.

From Ragnar Danneskjold: “Re: your comments about Cerner and corporate bureaucracy. Man, can you turn a phrase! I’m going to have that framed and put on my office wall (and then wonder why my career is not going anywhere :-)). Been loving your work for many years now. I don’t know how you do it, but keep on doing it.” Thanks.

From Cheers Across Atlanta: “Re: Eclipsys. Jay Deady announced today at the Eclipsys sales meeting that he will be leaving concurrent with the Allscripts acquisition.” Unverified.

From Reddy Kilowatt: “Re: PM/EMR in Asia. I’m looking for information (Web sites, articles, databases, etc.) on penetration in the smaller private practice market.” I have readers there, so if you know some sources, let me know.

7-27-2010 7-52-10 PM

From Anonymous: “Re: Merge Healthcare’s ortho imaging products. I’m surprised you didn’t catch wind of this.” I did, earlier this month when a reader tipped me off that Stryker was selling its imaging division (i.e., ortho products) to Merge.

From Lori S: “Re: AirStrip Technologies. They will announce that their cardio and critical care apps have received FDA approval, setting the bar high for other vendors.” Verified. The news just came across the wire Tuesday evening. AirStrip users can monitor patients in real time from their iPhone, iPad, and other mobile devices. That sound you heard was change jingling in the deep pockets of GE, Philips, etc. as they suddenly think AirStrip Technologies looks like something they’d like to get their hands on. I interviewed co-founder Cameron Powell, MD in February.

SRS will offer customers its hybrid EMR bundled with practice management and scheduling systems from Ingenix, calling it SRS CareTracker PM powered by Ingenix. SRS will also offer its EMR customers a migration path to the Ingenix CareTracker EHR. That’s interesting — Ingenix has been promoting CareTracker much more heavily recently, plus rumors suggest that the company won’t stop its HIT-related acquisitions with Picis.

I’m a sucker for hospital music videos, so here’s one from Lake Pointe Medical Center in Rowlett, TX, a top-rated Tenet facility celebrating its 5-Star Patient Satisfaction Rating for the full year of 2009.

Marshfield Clinical lists its CIO job. An advanced degree is not required.

Fisher-Titus Medical Center (OH) is happy with its Cerner implementation, at least according to the local paper. The Smart Room includes a clinical dashboard, an RTLS-powered Room Wizard, integrated medical devices, and an interactive patient station that includes schedules, goals, and entertainment. It sounds pretty cool.

St. John Providence Health System (MI) chooses eClinicalWorks for its 3,000 physicians.

The FCC and FDA will partner to promote wireless-enabled medical technology, including making their respective areas of jurisdiction clear and easing regulatory red tape.

Odd lawsuit: a woman settles her lawsuit against Quantas after claiming the airline is responsible for her deafness because it didn’t protect her from a screaming three-year-old in an adjoining seat. The woman, who wore hearing aids before the incident, told a friend, “I guess we are simply fortunate that my eardrum was exploding and I was swallowing blood. Had it not been for that, I would have dragged that kid out of his mother’s arms and stomped him to death.”

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Currently there are "14 comments" on this Article:

  1. Let’s be clear about this:
    Your tagline said: St. John Providence Health System (MI) chooses eClinicalWorks for its 3,000 physicians.
    But reading further into the article….
    St. John Providence has pre-purchased 250 licenses to start and plans to purchase additional licenses to meet demand

    That’s a nice sale, but 250 is a far cry from 3,000 licenses! Let’s hear it for “spinning the news”! Nonetheless, congrats, eCW, but let’s tell it like it really is! (And, NO, I don’t work for a competing vendor!)

  2. RE: your response to BeCarefulWhatYouWishFor. I know both Cerner and Epic quite well (better than most). Cerner does not require the use of third-party consultants and much prefers to drive the design (take a look at their Solution Center). On the other hand, while Epic shuns the use of third parties they by no means drive the design. They leave the majority of design up to the client, often with little guidance. Neither has perfected their methodology.

  3. EPIC have a few different methodologies. You can choose to do a big bang install with their model system or you can choose to customize more.

    As for EPIC shunning third parties; there seem to be a lot of big consulting companies making millions of these installs, so that doesn’t quiet gel with reality. There are also many smaller ones. If I go to dice.com and search on EPIC and Cerner there are 3 pages (of mostly consulting positions) for EPIC and 1 for Cerner for today. EPIC has a far greater selection of consulting companies to choose from as well.

    I think they are handling growth very well. The installs I have been apart of just seem to get easier and easier. The quality of the technical services people is still very high. Yeah they don’t have much experience in healthcare, but they can execute the chosen methodology very well. I am glad they will never float, that’s a huge plus for me.

    And as for this “old technology” people keep railing against. One of the big wins with M (apart from speed and track record in some of the biggest databases in banking, healthcare, shipping, trading and telecoms) is the update issue. Go to hospitals with SQL databases and they are several versions behind because the update process is long, difficult and most hospitals have been stung by downtime at some stage. With Cache and EPIC this is not the case. Downtime is typically a few hours. Indexes are updated in the background. For this reason most EPIC hospitals are up to date. Now meaningful use is going to force the hand of some really old technology, clunky SQL hospitals. This is great news for the vendors who use SQL as they wont have to support these older version, but will it be great news for the hospitals? I am expecting to be hearing some downtime stories over the coming few years as very old systems are updated.

  4. If you have ever worked with Epic, it’s really hard to not like them. They get it right the first time and once you become a customer, they do what they need to do to make you successful. From sales, demoes, etc. you get what you see and they tell you what the product does and does not do. They partner with you during the installation and support you afterwards. I haven’t worked with a better vendor in my 30+ years in healthcare. One word that comes to mind when I think of Epic is “quality”.

  5. The Foundations team at Epic is quite aware that an eventual conversion from M may/will be needed. They have people working on the optimal time/way to do such a task. They are constantly evaluating the pros and cons. It cracks me up when pundits talk like Epic is unaware. It is all calculated. Same with the growth. Have you seen the size of the farm?

  6. The Foundations team at EPIC would be far better served by looking to move away from KBSQL to native Cache mapped globals. They would receive a huge boost in speed.

    But Certifiable isn’t making any sense. When you understand the architecture, his comment doesn’t make any sense.

    EPIC, all the reports and functions in EPIC are written in MUMPS. All the extracts are written in MUMPS. It’s not like switching out a database. It’s a complete re-write. It would take a decade or so.

    Me thinks you are misunderstanding something you heard.

  7. I’ve worked with both Epic and Cerner. From my experience Epic isn’t as good as everyone says and neither is Cerner as bad as said. We have been successful with Epic and accomplished a lot. I am very familiar with their methodologies and while they try “to make everything right” they are not always successful. They do not perform uniformly across all apps. The results have been good, the processes average. They don’t always get it right the first time or the second time either.

    Blah is right, shun is not the right word. But when we are measured on our use of third-parties and given lower marks if Epic believes we are using too many, it doesn’t appear that they encourage their use.

  8. Certifiable/Blah – If Epic were to decide to move away from MUMPS they would move to MUMPS. The use of proprietary routines from InterSystems Cache is costing all Epic customers $800+ initially and $15/month per concurrent user. Let’s say there are 125,000 people around the world logged into Epic right now, that represents 100 million in license fees and an ongoing stream of 1.88 million each month for InterSystems. If Epic were able to convert to an open source MUMPS – considerably less work than a complete re-wire it would take considerably less time than a decade or so.

    Anyone care to guess how many concurrent users there are on Epic right now?

  9. Just re-writing a single major application in a new object-oriented type software can take many, many months. And, you more than likely will either need, or take the opportunity, to modify the architecture (data model design) while you do it. It is a natural by-product of porting to a new platform. Some of it is a necessity.

    This is NOT a simple thing to do. And, if you have to re-write ALL of your applications that work in harmony, and pass data between each other, at the same time – that is a HUGE, monumental thing to do.

    Even if you try and do it in pieces, you have complexity in having half of your apps on the newer architecture and half on the old.

    No matter how you slice it, it’s a task that will grind new development into the ground. Just writing the data conversion programs, and figuring out how to time all the application conversions and end user training, can boggle your mind.

    The day of reckoning will come – when you do not stay current and competitive with your technologies – you will ultimately have to pay the piper. They have milked that cow for a LOT of years – but I still think that there is a HUGE bill that is coming due, both for EPIC as well as their users. It won’t be a cheap conversion from any standpoint.

    If you do not get this point – you have never developed software of any complexity and had to maintain it over many years.

  10. Cache$$$ That’s an interesting thought. Intersystems licensing is quiet frankly crazy. As a startup I can buy licenses from Intersystems for $100 each, but a large hospital who has tens of thousands of licenses pays $1000? Something is wrong there. If MSM was still out there and wasn’t bought up by Intersystems to create a monopoly those prices would be far lower. However Cache is a decent product and EPIC would be well served removing the interpreted KBSQL and reduce the hardware costs due to the reduction of burden on the database. That in its self would help offset some of the licensing.

    Ruminating, indeed. I would go as far as saying many years. It took over 10 years to get EPIC to this stage. The other side to that is EPIC allows customers to write custom code, within the framework of “Programming points” written in MUMPS. These may be business logic, reports, patient list information, HL7 overrides etc. How would they undo that work when moving to a different platform? It would certainly be difficult. Unfortunately even if they wanted to get out of MUMPS, they are too invested. And if they really were planning on getting out of the MUMPS game they would have stopped digging a deeper hole for themselves by giving customers new places to plug in M code, they haven’t.

  11. Blah Agreed – way too invested. What do you do with 2000+ developers, TS, and interface programmers that are proficient/experts at MUMPS. Not to mention the overhaul required in updating all training and release documentation. MUMPS it will be, Cache or otherwise. Anyone writing custom code does so at their own risk – any updates to code released from Epic and/or InterSystems cold potentially affect it.

  12. I iike how everyone talks about re-writing Epic. Attempting to re-write Epic from its present state to a different platform within any of our professional lifetimes would mean that they most likely would have to hire seasoned, experienced developers in whatever the “new” technology is in order to accomplish it.

    As we all well know, Epic only hires people fresh from college (or is it high-school? I can’t remember) to populate their castle. They eschew hiring any “older people” because we’re a little less pliable at swilling the Kool-Aid or more likely – we have families, etc., and require something a little more than minimum wage. They don’t allow telecommuting and require everyone to live no further than something like 30 to 45 minutes away from the mothership. Yep. Verona Wisconsin is a happenin place, woo hoo! (or is that, Moo Moo?)

    They never embraced any of the more advanced Cache Objectscript coding methodologies – but quite frankly, they don’t have to.

    People are still buying their product in droves, Judy Faulkner has learned how to try and make the sites rely less on certified consultants and more on new hires that can pass a multi-hour test (and still pay the uber $$$ for training – only now their incentive to train and work somewhere else is being taken away) and they are making money hand over fist.

    Sure, there are sites whining about “Epic should do _____” and you know what? If Epic listens to you then be grateful. If not – tough.

    Part of buying in to the homogenized “one-size-fits-all” suite with Epic means you have given up any leverage you ever had by working with multiple vendors trying to provide best-of-breed. You simplified your books by cutting one big check. Oh, and you probably spent so much on that first check that trying to swing enough cash to buy your way back into a best-of-breed situation wouldn’t fly with the board.

    So any speculation about them enhancing, fixing, or converting their suite – sure, they might – but it will probably have less to do with any input from customers who have already signed their pact with the devil and more to do with their ultimate plan to dominate the universe.

    Cheers!

    The Integrator

  13. Yes, I had overlooked the custom code against their existing data model, routines, etc. That is another nightmare that would keep them from moving forward.

    But, I still say – and you may still disagree – they can’t stay on MUMPS forever. It’s just not a sustainable model. Who else uses MUMPS, Cache or otherwise? Not many. They have to train their own engineers because it’s not taught in any schools. And most engineers want to work with the latest/greatest toolkit. I mean, who wants to code in COBOL any more?

    Just my .02







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Reader Comments

  • Allscripts watcher: I agree with Goose Island. I have no dog in the hunt (and am uncomfortable with the Epic/Cerner duopoly - we need as mu...
  • Boy Wonder: More CareOtter (Allscripts side EHR) observations...CareOtter's webpage is suddenly down and the YouTube video reference...
  • Peg Leg Pete: The Allscripts Sunrise implementation at Baptist Pensacola is officially off the rails. The project is now two years out...
  • Redwood: Sounds like Care Otter’s secret sauce is running on top of Microsoft Azure. Not sure that warrants a special project t...
  • Andrew (Hedgeye): Hi Goose Island - Thank you for the comment. You are right about Jefferson Health and Epic. We believe Allscripts is a...

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