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Monday Morning Update 8/23/10

August 21, 2010 News 31 Comments

8-20-2010 8-59-14 PM

From The PACS Designer: “Re: Yale’s Epic cost. $250 million!” TPD, who tells me he works for Yale in some capacity, sent over a copy of the Certificate of Need response for Yale New Haven Hospital’s Epic implementation. No wonder it took them awhile to find the money.

8-20-2010 9-07-50 PM

From Anon: “Re: VA and DoD. I’m not sure Epic is the frontrunner, but I think you are close. InterSystems is the likely winner with their TrakCare product. Take a poke around and see the massive size of their new implementation workforce and the sizable country-based contracts. It’s worth noting the rumor that InterSystems is allowed to sell Trakcare in only two ways to avoid waking the sleeping Wisconsin cash cow: outside the US and to the US government.” Interesting … InterSystems is strong at integration and of course has endless expertise in Cache’ and MUMPS, not to mention that as a big and very profitable company can probably make believable promises to the military. I notice they’ve also been steadily increasing their annual lobbying expense, over $200K in 2009 and much of that going to VA database issues. InterSystems acquired the Australia-based TrakHealth in 2007, rolling the Web-based enterprise system into their integration and HIE offerings. You may be on to something. Even if not, I like your thought process.

From Soliloquist: “Re: Epic and the DoD. I just can’t see a scenario for this working. This would be the ultimate culture clash, as you state. I also am having trouble envisioning how the government could take the heat for forking over billions for such a system. It wouldn’t fly when the media got wind of the deal and Epic would be unwilling to cut a deal. They don’t need the business.” See new poll to follow.

From Book ‘em Danno: “Re: HIMSS and Forbes HIT magazine insert. A full-page ad costs $37,000. The lowest price option is a 1/6 page ad for $7,000.” Verified – BED forwarded pricing information.

From Traveler: “Re: Siemens. I heard they are buying [surgery software vendor’s name omitted]. Have you heard anything?” I e-mailed John Glaser now that he’s in charge at Siemens, but I haven’t heard back so far. I’ll leave out the vendor’s name for now since it annoys me that unscrupulous competitors immediately start flashing the rumor to prospects to create FUD, but I’ll update when/if I hear.

From CTCIO: “Re: two Connecticut academics lose data. Our attorney general is on it!” A UConn laptop containing information on 10,000 undergraduate applicants is stolen from an IT department cabinet. Then came another stolen laptop at Yale School of Medicine, that one with information on 1,000 patients. Encryption was not mentioned in either case.

From Irene: “Re: LTC. I am the VP of IS for a small non-profit that serves adults the ages of 20-60 with severe physical disabilities. Although the organization falls under the Long Term Care regulations and is almost solely Medicaid reimbursed, the consumers are not typical of a LTC skilled nursing facility (frail elderly). Average length of stay is 10 years. We are entering work for EHR readiness and I am looking for any/all vendors that implement solutions outside of the Acute Hospital space, that have flexibility in their design and integration between clinical and financials, and ability to data warehouse long term health data. Any information would be appreciated.” If you have advice for Irene, please leave a comment.

8-21-2010 10-31-33 AM

From BackToOurRoots: “Re: EncounterPro EMR. Going open source. Wondering what this means for their current customers …” I don’t get the strategy even after reading their reasons the product went open source, only a couple of which seem to be relevant.

From WNA Wannabe: “Re: paperless at the VA.” What a strange story … a VFW claims representative makes “a unilateral decision to go paperless” and shreds all the files he has without making electronic copies. Or at least that’s the claim – the story gave me headache as everybody involved in handling the paperwork of veterans seems to blame everyone else for missing documents that are shuffled from one group to another. I didn’t realize that VFW helps veterans with that kind of paperwork, either. Paperless, done right, would be an apparent improvement.

From HITGeek: “Re: NHIN. See Twitter #newNHINnames.” Some pundits make up witty NIHN replacement names. My acronyms are always sophomoric semi-profanities, so I’ll keep quiet even though mine are funnier.

8-20-2010 9-19-36 PM

It seems that we can never reach consensus on the CIO education issue, still divided equally among “it doesn’t matter", a BS, or an MS. New poll to your right: would Epic be a good replacement for the DoD’s AHLTA?

A reader sent over the paper evaluating hospital EMR usage in California, which concluded that EMR usage was associated with higher costs and lower nurse productivity. The methodology was as I expected and have seen in other studies conducted by people outside of healthcare (the authors are business school professors): take some conveniently available but questionably useful databases, match them up, and try to find generalizable conclusions. It just didn’t work for me. The analysis started with the HIMSS Analytics database (which I wouldn’t trust too far since it’s a self-reported sampling), assumed that EMR implementation started a year after contract signing since that date wasn’t known, and then matched that information with cost and nurse staffing databases. It covered nine years and ignored all other relevant events that occurred during that time (mandatory nurse staffing laws, changing reimbursement, individual hospital quality improvement projects, shift of patient load from inpatient to outpatient, etc.) Some of the conclusions make the data relationships questionable: EMRs were associated with reduced nurse overtime, sophisticated EMR usage was associated with higher costs and longer stays (ignoring the fact that certain kinds of hospitals are more likely to be sophisticated EMR users), and high-level EMR usage increased complications but decreased mortality. EMRs are categorized only by usage level, not how well they were implemented, what level of integration they have, and which vendor’s product was involved. And of course, the biggest problem: “associated with” is a long way from “caused by.” I just can’t get excited about the article, but if you can, feel free to send in your analysis.

The same primary author, by the way, used similar survey data noodling to conclude that EDs with sophisticated EMRs have a lower length of stay for eventually admitted patients by nearly 25%, but admitted another finding that seems to invalidate the entire premise: basic EMRs didn’t really help. I’m not buying that, either. I’d be more convinced by a short-term, one-hospital case study that measured LOS before and after an EDIS implementation. I’d also be highly wary of assuming that inpatient admission times reflect ED efficiency (instead of inpatient efficiency in having available beds, for example).

Cerner adds nearly 400 employees so far this year, bringing their total to 5,185. 

CEOs of the five largest health insurance companies made $200 million in 2009. Cigna’s outgoing CEO got $111 million in retirement benefits, while the not-retiring CEO of UnitedHealth Group received salary and options worth $108 million. Apparently those of us actually working in non-profit hospitals made the wrong career choice in choosing to deliver care rather than administer it, although wildly overpaid CEOs are hardly unique to healthcare.

8-21-2010 9-56-39 AM

Maybe the folks at Zacks Investment Research need to update their spell check dictionary.

Another stolen laptop containing patient information, this time from Cook County Health and Hospitals System. They vow to review encryption practices. Honestly, can’t someone come up with an encryption method that’s easy to implement and invisible to the end user? Organizations clearly understand the value of encryption but aren’t doing it, so that tells me it’s too much of a pain.

E-mail me.

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Currently there are "31 comments" on this Article:

  1. I like your ideas on encryption: “Organizations clearly understand the value of encryption but aren’t doing it, so that tells me it’s too much of a pain.” Is this not what doctors and nurses are saying about CPOE and EHR devices? Either this technology is not ready for prime time or the users are not ready for systems designed by those who knowledge of the work flow and cognitive needs of health care professionals is inferior and insufficient.

  2. Re: Epic & DoD. From a software standpoint, it’s an excellent fit: Epic has an integrated, established system that can support deployments across the nation that communicate with each other (Kaiser). A patient from Georgia can go to Colorado and their (complete!) chart can be accessed, and the remote encounter remains in the chart.
    From a culture standpoint, it would be nearly impossible and require compromises that Epic has never made before. Judy is very serious about her “don’t do deals” stance (I understand that phrase appears in all of the Verona coffee rooms), and the brass would likely balk at that attitude. The only way I can see it working is if Judy decides that being the foundation of a national health record system is worth making more compromises than usual. I wouldn’t overplay the potential situation on the ground – Epic’s employees are pretty malleable, they would probably adapt to the DoD’s methods even if there is a little grumbling. It’s the leadership that would have to sort things out. I vote “no” for this reason.

    Re: California study. They ignored a mandatory nurse staffing change, and then drew conclusions about nursing time? Once again, a poor study misses then chance to teach anything.

    Suzy, you’re a caricature. I also support getting the government involved in EHRs, but your comments reveal that you’re not really concerned about patient safety, you just think software stinks.

  3. Cerner has about 8,000 employees. The number quoted is supposedly just the employees in Kansas City, in/around HQ.

  4. Hmmm. “Info of 7,000 hospital patients may be on stolen laptop”
    That is just one of the reasons for the nickname, “Crooke County”.
    This is downright scary. The repercussions will be insidious and obfuscated for years going forward. There is no end in sight for these horrific violations of privacy. People are no longer in control of their privacy. Despicable.

  5. “From a software standpoint, it’s an excellent fit: Epic has an integrated, established system that can support deployments across the nation that communicate with each other (Kaiser). A patient from Georgia can go to Colorado and their (complete!) chart can be accessed, and the remote encounter remains in the chart.”

    Just so you realize, nearly every major vendor can do this, not just Epic. There are many multi-hospital systems running off common databases. It’s relatively easy for software to interface with itself nd to scale for multiple facilities. What remains to be seen is whether Epic and the other major vendors are capable of linking together disparate systems in a way where there is seamless flow of information between different software systems.

    “That works out to $35,000 per employee.
    Is it just me or does that seem really, really high?”

    That’s shockingly high. How a teaching hospital can justify this kind of expenditure, I’ll never understand. If they truly have that kind of money to spend, could they not have bought a cheaper system and used the extra cash to hire more nurses or buy new technology for advanced procedures?

  6. HCA named Andy Draper Division CIO for the Houston based division covering approximately a dozen hospitals. The search was conducted by SSi-SEARCH.

  7. The money is what it is and the vast majority of it doesn’t every go to Epic. It is the all in number, which is what Epic always makes sure people know about ahead of time. It includes all the Y/NH staff, equipment, interfaces, backfill for training nurses, etc.

    Everyone thinks these numbers line Epic’s pockets, but not so.

    Yale’s direct costs to Epic are a very small part of that number.

    Epic just doesn’t low ball the real impact to an organization to automate properly. Most others do and then when the project spirals into a disaster they blame the hospital and it’s staff and walk away from the mess to do it over again somewhere else.

  8. Re: Yale implementation cost

    It seems a lot of people don’t realize that:

    1. The Yale New Haven Health System has more than 16,000 employees and medical staff

    2. The Yale New Haven Health System had over $1.5 billion in revenue for 2007

    3. The amount of $250 million is not the cost of the Epic software, but the cost of the complete implementation over probably 5 or 10 years (of which the cost of the software is maybe 10%)

    So those who claim that the cost is “astronomical”, what are you comparing it to? Can you show an implementation of a comparable size with comparable features that was successful and cost significantly less?

  9. @Irene – you might consider Matrix (MDI Achieve) and Point Click Care. I work for MDI Achieve and so I will write about the Matrix product – Point Click Care is our biggest competitor.

    Matrix offers clinical documentation tools for long term care facilities with clinical and financial integration. While, we do not currently meet the EHR certification standards (and long term care doesn’t currently qualify for the stimulus $), development is full speed ahead to meet them. The product is web based (SaaS) and very user friendly.

  10. Anonymous-I think you can go to Eclipsys, McKesson and Cerner and they will all show you significantly less costs. And if you think that the other $225million is to implement, train and support, you probably weren’t close to the contract.

  11. For Irene: I work for a similar organization. We use MEDITECH, as they offer a LTACH product. Their clinicals & financials are integrated & you only need to purchase the pieces you need. Don’t implement the EMR & PCS if you don’t need it at this point. Start out w/the basics. Our pt population is similar to yours w/a long length of stay & are mostly Medicaid reimbursed. You can contact them via their website telling them that you’re a LTACH and they’ll put you in touch with the correct sales person. Big recommendation: Get consultants to help you with the build & build it right from the get go & train your folks correctly up front. This will eliminate a LOT of headaches down the road.

  12. RE: LTC – we currently use Meditech, and it is not robust. I agree with Yulia… look at products like PointClickCare, MDI Achieve, HealthmedX, Carevoyant, etc. They have Practice Management, Clinicals, and Assisted Living modules. Most are SaAS, too.

  13. RE: LTC
    InteHealth is an HIT company that provides web based applications for “niche” healthcare environments. InteHealth is recognized by KLAS as an HIE vendor and is very flexible and affordable with regard to integration/interoperability and specialized application solutions. InteHealth also has a partner relationship with a software company in the Behavioral Health Software environment. Please visit us at www. intehealth.com

  14. @Irene, My company HCS also offers EMR and revenue cycle management for LTC providers. Our client base also includes providers like yours that provide services for , TBI, developmental diabilities, and pediatric LTC.

  15. Skeptical – I’m in the middle of negotiating a deal with one of the other EMR/Rev Cycle vendors you mentioned. The numbers are pretty much what they would be under Epic. We’re looking at Total Cost of Ownership over five-10 years. Capital, operating, etc.

  16. Irene – simplifyMD is configurable, stores structured as well as unstructured data, and offers everything for one low monthly price. No capital budget required and runs securely over the internet, iPad, iPhone, smart phone, etc. You will save more than you spend. We’re ideal for LTC and require only minutes to learn the basics.

    simplifyMD dot com

  17. I can’t believe no one has commented on the EncounterPro OSS release!

    First, EPro was – 2006? 2007? – CCHIT certified. And there are a lot of real, valid operating practices who really like it. And that code just got released to the wild. This isn’t like another announcement that there’s an OpenEMR reseller.

    For people in that market, it’s an interesting curve ball.

  18. RE: JMJ / EncounterPro:

    As someone in the business said to me today, “They’ve finally figured out a way to align their software with their support!”

  19. Re Epic cost..

    Act I Scene 6
    The lights come up on an eclectic richly appointed conference room at a compound outside of Madison..Judy enters from a door on stage right. Team members are sitting around the table. “Does anyone have any questions?” One of the team members raises her hand and says “I’m sorry, I just don’t understand this strategy.” Judy responds “Look, we are going to create a perception that our company, products and services are unique in the industry. And anyone who does business with us are the elite of health care providers because we are only going to do business with who we choose to and we are going to charge them whatever we want in order to have the priveledge of doing business with us…and they will pay it. We’re then going to get as many of them to advertise I mean provide interviews and release announcements mentioning how much they are spending on our products and services. This will help us to create a perception in the industry the exhorbitant fees and cost of doing business with us is what everyone should be paying. In a few years they will all be clamouring to do business with us and will be more than happy to do so.”

    The team member raises her hand again and says “I’m sorry are the people running Hospitals that naive?” Judy smiles and responds “You have no idea”

    An excerpt from the Broadway Musical scheduled to open on May 23, 2016 “Masters of the Universe, How Epic Corporation Changed the Face of Healthcare IT and Bankrupted an Industry or How I Learned To Love Spending Other People’s Money And Walk Away From My Fiduciary Responsibilities”

  20. Hurtful? That was hilarious! Right on the heels of them opening a $550+ Million building on their massive & top of the line campus (easily over $1B for their full campus). Nope…lets keep poking fun of the other vendors out there because Epic is off limits…

  21. $250 million for an EMR at Yale? That’s enough to build a new 250 bed hospital.

    What might the imporversihed in New Haven and surrounding area have to say about that?

  22. Re: DOD
    If anyone knew about this procurement they would see that DOD cannot sole source this puppy. So, the Epic everywhere model will not work. It will have to be split up between three vendors and most likely be complex and cost more than it should.

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