Readers Write 8/9/10

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EHR Exit Strategy
By Robert Doe, JD

While negotiating license agreements for my clients, we typically focus on functionality issues, warranties, uptime representations, support issues, etc. However, with all the distractions in the world of incentive payments and penalties, one thing I suggest my clients give some additional thought to is: will happen when the relationship with the EHR vendor ends? What will be the “exit strategy”? What do you need to include in the contract with the vendor to ensure the transition to a new system?

One significant concern to consider is what will happen to the data contained in the medical records that your organization has entered into the EHR system after the license agreement has terminated or expired? If the system is being utilized by multiple organizations, will you be required to leave a copy of the information in the system? You will also want to have a clear plan as to how your organization will take the data to a new system upon termination of the relationship with the EHR vendor. Can records be easily copied and/or exported electronically with the current EHR system? It is my understanding that this may not always be a simple task.

In addition, what issues might arise if the license agreement terminates abruptly, as may happen in the event of a breach of contract? The main concern becomes business continuity. You may want to consider including a provision in the license agreement obligating the vendor to provide transition services while you transition to a new system. Ideally, you should be able to fully use the EHR system during this period. Typically, the user pays for these services.

While most organizations are focused on finding and implementing an EHR system, I would suggest giving some thought to the life cycle of the system and devising an “exit strategy” for the time when the license is terminated or expires. Your license agreement should include appropriate provisions to allow you to carry out a smooth transition.

Bob Doe is a founding member of BSSD, an information technology law firm located in Minneapolis, MN.

Our Organization’s Comparison: Cerner vs. Epic
By Roe Coulomb

You asked in a previous post why Epic beats Cerner for every important deal. I previously worked at an organization that did a side-by-side comparison between Cerner and Epic, eventually choosing Epic. I thought it might be helpful to your readers to know the factors that went into that decision.

Corporate Culture

What’s not to like about an organization that has a CEO as accessible as Judy? One year at HIMSS, I observed her rearranging the waste baskets in their booth to make it more user-friendly for her staff servicing customers. That’s servant leadership!

Even before they moved to Verona, their corporate headquarters felt like a college campus. That was partly due to the age of the employees, but also their dress code and the eccentric artwork they’ve acquired over the years.

Does Neal or his top echelon of VPs even attend HIMSS? I’ve never seen him. If the suits do attend, I bet you won’t see them at the booth rubbing shoulders with the average Joe.

Their corporate headquarters is your typical Fortune 500. Lots of suits. Stuffy. Need I mention the bad PR from Neal’s e-mail tirade that was leaked a few years back?

Integration of Ambulatory and Inpatient Records

This is a significant factor for any organization that has a large employed physician group and wants an integrated database for their billing/ADT and EMR data. There are huge opportunities for streamlining things like medication reconciliation from physician office to the inpatient setting and back to the primary care doc.  

Not to mention that providers who practice both in an office and do inpatient work as well have only one application to learn. Once they are doing order entry and documentation in their office, implementing CPOE and clin doc in the hospital is far simpler (for those physicians, anyway).

Epic’s got this nailed! Cerner, not so much.

Implementation Philosophy 

Your 7/28 post said, “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."

That’s true to some extent (the Epic turnkey statement), but it wasn’t always that way. Epic got lots of feedback from their customers that there were too many options and decisions of how to implement a specific function. They picked best practices and made that into their model system.

Nevertheless, there are still a lot of consulting firms out there with Epic practices and I am not aware of a major medical center that has installed Epic without using consultants.

Software Usability

At the end of the day, all that other stuff doesn’t really matter if the software sucks. How usable it is for employees and docs is what counts. 

During the evaluation we did at my former employer, Epic was simply easier to use. Cerner’s screens were very busy with all kinds of tabs and lots of clicks and keystrokes. I recall one screen where there were 30 “chart-like” tabs across the top of the screen.

I recently viewed a Cerner demo at my current employer of how a nurse would change one piece of data, like a heart rate, acquired through a monitor device interface. First, click on the cell with the data, click Clear, click Sign to accept the remaining data, go back to the cell, click Edit, enter the new results, click Sign again.

It’s been awhile since I saw this on Epic, but my recollection is that it was like making a change to data in a spreadsheet. First, highlight the data to be changed, over-type with the new results, click Accept. Far simpler!

You said, "… which would seem to indicate that Millennium isn’t up to the task. In other words, a $6 billion market cap company with a single, fairly low-rated product line that’s getting hammered by a smaller and much higher-rated competitor should think about developing a better product."

Isn’t that what Millennium was supposed to do for Classic?  I recall reading about the hit Cerner took to its bottom line the years they put a lot of resources into developing the new Millennium architecture. I guess one measure of how successful that was is how many Cerner customer’s are still using Classic?

Finally, I think you hit the nail on the head: "..Cerner has built a business that could weather Neal’s transition or sale to another organization, but we don’t know that with Epic". Judy won’t be running Epic forever. What happens when she’s gone? Can Carl or whoever replaces her continue to run it as a private company or will they be forced to sell?