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Monday Morning Update 9/10/12

September 8, 2012 News 13 Comments

From Lickety: “Re: percentage of EPs/EHs achieving MU Stage 1. Does anyone know the percentage of all EPs/EHs to get a feel for where the country is in total?”

From Candy Albicans: “Re: Allscripts. Considering selling its profitable MyWay division to SYNNex, a reseller that has purchased 1 million licenses.” Unverified.

From Eric the Well-Read: “Re: your posts. I’m pretty sure I see another site that you’re writing for under a different name. True?” False. I barely have enough hours in the day to write HIStalk. I suppose I could attempt to pimp myself out in several ways (writing elsewhere being one) and use the proceeds to quit my hospital job, but I like things the way they are, which is they way they’ve been for the past nine years. That represents either high satisfaction or low ambition (probably the latter).

From Mrs. Beasley: “Re: EMR implementations led by hospital business units. This seems to be more common, especially with Epic. I’m curious to hear whether anyone else thinks the role of the CIO is changing because of this. I’m in the middle of one and wondering whether after the install, it will be business as usual for IT.” I’ll expand your original thought a bit for the benefit of the many CIOs whose hospitals are implementing Epic: if your hospital has been live on Epic for more than a year, how did your IT budget, staffing, priorities, consulting budget, staff training costs, and personal responsibilities change? I bet I’m not the only one curious about what happens in the Epic afterlife.

9-8-2012 1-05-31 PM

President Obama would win a close race if the election were held today and my poll respondents were the only voters. New poll to your right: which of the five listed inpatient clinical systems vendors offer the most innovative products? I’m asking since Cerner was just named by Forbes as one of the top 10 innovative companies overall, but I’m skeptical about how the magazine arrived at that conclusion since they didn’t actually say. And note that there’s no “none of the above option” since it’s unnecessary based on the question being asked.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Practice, and HIStalk Mobile in August (click a logo for more information):

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9-9-2012 7-14-20 AM

Listening: new from Katatonia, brooding Swedish progressive metal that is admirably devoid of the characteristics of suckier bands that drive many potential fans away: grunting, screaming, excessive tempo, and a wall of impenetrable noise. Good vocals, minor key melodies, and fine musicianship.

I’m impressed with how openly Farzad Mostashari uses Twitter. Granted the bar was set low by his deadpan predecessors, who probably would have been happy to turn the ONC Twitter account over to a federally contracted, chirpy, 23-year-old marketing ghostwriter with a blissfully empty head, but he’s out there tweeting away with original thoughts at all hours. Here’s a brilliant throw-down he posted Friday afternoon: which vendors are willing to publicly promise that they will roll out View / Download / Transmit capability for patients by the end of 2012? He says he’ll post the names Monday, with takers so far being eClinicalWorks, athenahealth, SOAPware, and Greenway. What say you Epic, Practice Fusion, NextGen, Cerner, McKesson, SRS, Allscripts, and GE? Farzad wants to know whether you own cattle or just big hats.

Speaking of ONC, they decide not to proceed with their intended regulation of NHIN’s “conditions for trusted exchange.” Reason: regulation might slow things down, which is just about the last thing that HIEs need.

9-8-2012 2-37-31 PM

The board of Allscripts approves a $1.9 million 2012 incentive for CEO Glen Tullman. His total compensation in 2011 was $7.2 million. Above is the two-year MDRX share price (blue) compared to Cerner (green), athenahealth (red), and the Nasdaq (brown). Had you invested $10,000 in each two years ago, the value of your holdings today would be worth $6,257, $22,854, $32,844, and $14,025, respectively.

9-8-2012 1-53-40 PM

Orchestrate Healthcare names former Dean Health Systems IT VP Jerry Roberts as VP of its Epic practice.

9-8-2012 4-50-26 PM

Olympic Medical Center (WA) will spend $7.6 million to get Providence Health and Services to implement Epic for its hospital and clinics over the next year. They expect to get $7 million in HITECH money in return. Annual support fees will run around $750K. The CEO says they’re getting a tremendous deal, especially given that Epic will replace five systems. “I think our current systems really don’t help us take care of our patients the way they should. I think Epic is the best system available.”

9-8-2012 4-54-21 PM

Nuance announces its 2012 Understanding Healthcare Challenge, offering prizes to the top three developers to describe how they would integrate Nuance’s clinical language software into their products. Entries are due October 5.

Crain’s Chicago Business found 10 Illinois physicians who are making at least $1 million per year from Medicaid, with four of them being pathologists (as with most businesses, those higher on the supervisory food chain did better than those doing the actual work). Leading the pack: the head of pathology at safety net hospital Sinai Health System (also their CMO), who pocketed $5.9 million in a three-year period. The second-highest was a urologist who raked in $5 million while being investigated for questionable billing. The third was the medical director of Planned Parenthood of Illinois, who just agreed to a $367K settlement for overbilling. She made $3.9 million in just over one year of the study period before being cut off because of the billing investigation.

Vince finishes up his HIS-tory of Keane with the stories of First Coast Systems and Source Data Systems. As always, he welcomes your contributions about vendors of yesteryear.

A reader sent over an article from the HIMSS cheerleader rag, knowing I wouldn’t have seen it since I don’t read free healthcare IT magazines (they’re mostly just re-worded press releases). The article proclaims, “It’s confirmed. Electronic medical records can indeed yield marked savings for hospitals.” Just to be a contrarian, I dug up the original article to see what they were gushing about (other than everything that’s pro-vendor).

As I expected to find, this is another example of the pitfalls of outsourcing your conclusions to non-experts armed with the dual motivations of (a) not biting the hand that feeds them, and (b) drawing in readers with sexy headlines that the article doesn’t support. I think the work of the study authors was OK, but hardly conclusive or even convincing.

What the paper actually says is that EMRs have provided “mixed performance,” i.e. the paper isn’t suggesting predictive value. The authors tried to prove (unsuccessfully, in my opinion) that the driver of whether hospitals save money as a by-product if implementing an EMR is the availability of local technical expertise, which just doesn’t make a bit of sense given that (a) technical resource availability doesn’t have much impact on cost since it’s a tiny portion of overall hospital cost, and (b) hospitals use remote and/or contracted technical resources all the time, making geographic location only marginally relevant.  

My reactions:

  • The study is just a paper, so it hasn’t gone through peer review or acceptance. I would hardly say it “confirms” anything.
  • This was yet another drawing room study where someone just mashed up conveniently available but questionably relevant data, in this case the HIMSS Analytics database, the Medicare Cost Report, and the AHA Hospital Survey.
  • The databases were current only through 2008, so this is four-year-old information that predates almost every significant EHR event.
  • The study’s main finding is that the average hospital that implemented an EMR during the 12-year period saw no improvement in efficiency, and in fact, saw their costs go up after adoption (“quite high,” the article says). I notice that didn’t make the magazine’s headline.
  • Hospitals located in areas with a lot of IT talent saw costs go down 4% from previous IT cost (those adopting basic EMRs) and no change (those adopting advanced EMRs).
  • Hospitals in low-talent areas increased their costs 2-3% with EMR adoption.
  • I didn’t really understand how they considered hospital ownership, which is a good predictor of both IT utilization and overall cost structure. Or for that matter, separating hospitals that outsource IT functions from those that don’t.
  • I don’t think most hospitals buying an EMR in the early 2000s expected or even wanted to reduce costs, so I don’t really see the value of finding out whether they did.
  • The idea that the likelihood of a given hospital reducing its costs by implementing an EMR is based solely on how many programmers live in its area does not pass any sniff test I can envision.
  • The article’s abstract contains the real conclusion: “Adoption of EMR is generally associated with a slight increase in costs. We argue that this average masks important differences over time, across locations, and across hospitals.”
  • The thrust of the article can be inferred from its title, “The Trillion Dollar Conundrum: Complementarities and Health Information Technology.” It is actually, to a certain extent, debunking the questionable conclusions of CMS and the Cerner-funded RAND study in proclaiming that EMR adoption will reduce healthcare spending. The article says EMR cost savings will be “mixed” until technical resources are more widely available. That doesn’t really sound like the upbeat conclusion the magazine trumpeted.
  • As always, even if you buy the study’s methodology, it at best identifies a slight correlation rather than causation. I would not attempt to predict the impact of a $200 million Epic install in a large academic medical center to generalized, old information of mostly small hospitals (which as a percentage, is most of them).
  • Implementing an EMR to save money is an iffy proposition at best, not to mention that maybe patient outcomes should be the stronger consideration.

My conclusion is that it’s not a bad study, just not all that conclusive and certainly not worth detailed coverage in an industry magazine. I lost interest in further analysis at this point since it was time to have a beer and watch some college football. If you didn’t, feel free to elaborate further.

E-mail Mr. H.

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Currently there are "13 comments" on this Article:

  1. Are you kidding on the Farzad throwing down the challenge comment? Epic, the VA and other vendors have offered patients the ability to down load their records for years.

    Why on earth would they pledge to sign up for this as though Farzad just discovered it?

    This goofypalooza government we have today needs to refocus on the fundamentals and tone down the showmanship a bit.

    They’re losing friends as well as voters.

  2. Re: EMR implementations led by hospital business units.

    You mean, enterprise clinical resource and workflow control systems. “EMR” is an anachronistic acronym.

    As such, one change those business units need to be prepared for is inclusion in med mal lawsuits where these control systems were contributory or causative.

    I am aware of a few cases like this at this moment.

  3. 1 million licenses? so they have already purchased 2 licenses for every doctor in the US?

    [From Mr. H] I’m trying to confirm with the rumor reporter. I suspect it’s actually $1 million worth of licenses.

  4. Re: EHR installations

    Hospitals are reluctant to disclose the overall costs of the work flow control devices and their maintenance. They do not come cheap and the quality as would be witnessed in improved outcomes is just not there, yet, and probably never.

    Why? Because medical care is a human interaction endeavor and that is compromised by global blanket EHR control of workflow and interaction that sucks up the time of helth care professionals.

  5. Katatonia…very nice. Re: the “which vendor is most innovative” poll, RazorInsights is hands down the most agile, most innovative, best engineered (as in good software engineering foundation) EMR (inpatient and outpatient) I’ve seen. For the better part of the last year, we’ve been drilling down on all the usual EMR suspects as a consequence of the re-compete of our 9-year Cerner contract. Razor is a very small company, but doing very well in small hospitals. They were founded by and are led by pharmacists and the influence of their mindset and personality on the product is powerfully unique and positive. They are seven for seven in recent months with MU attestation within 60 days of going live. We need to do everything we can to prop up these innovators. We need them to succeed for the sake of the industry. All that said, there is no guarantee Razor will be the winner in our procurement. Doing business in a foreign country is very risky and they have no experience in that context. Also, the case for converting from Cerner to Razor will have to be compelling in order to make the pain worthwhile.

  6. Isn’t the view/download/transmit functionality the Blue Button that’s been out for a while now? According the Blue Button website, VA, DoD, Aetna, Humana, UnitedHealth, McKesson, SOAPWare, Walgreen’s RelayHealth, and NaviNet, among others, have already either committed to it or implemented it.

  7. Re Presidential Poll.

    Lots o single issue voters around here…what with Obama dolling out all that tax payer money at HIE’s and “reform”.

    Careful, ya got what ya paid for. How’s that going?

  8. EHR stats. While the link provided shows how many hospitals and EPs have reached stage 1 of MU, they don’t show a total population. Not knowing how many total hospitals or EPs there are, it’s hard to calculate where the country is ( as a % of the total). I just wonder if half the hospitals have made it , or a tenth , etc.

  9. Dave,
    There are about 5,000 Acute & specialty hospitals in US. So they say 3624 have attested and rec’d payments, that’s about 72%, although there may be some double counting in there. Also attestation is done by provider number so a big IDN could have multiple provider numbers they attested for.

    In my opinion, the number will drop after the audits uncover issues with certification /attestation. That’s when the rubber will really meet the road…

  10. Has HCA decided on a full scale Epic implementation? We all know they were doing their pilot hospital, but have they made a decision to convert all to Epic? How would that affect staffing as a whole if the biggest health system in the Country decided to pull 100’s of resources for this initiative in an already tight Epic consulting world?

  11. Why do you appear to have a negative bias towards Siemens? Whenever you have some sort of list of companies in the industry (like this survey), you always exclude them.

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