Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Monday Morning Update 4/8/13
From Antares: “Re: HIStalk. Ever since my very first week at Epic, HIStalk has been part of my morning information breakfast :) I think you guys provide a forum that is critical to identifying cutting edge news, trends, and opinions.” Antares is the the co-founder and president of a new consulting firm. Nice comment — thanks.
A somewhat surprising one-third of respondents expect to leave their employer within the next year. New poll to your right, inspired by a reader’s comment: CommonWell Health Alliance is touting interoperability among its members. What grade would you give those members that offer hospital systems (McKesson, Cerner, and Allscripts) for the level of integration among their own hospital modules?
On the Jobs Board: Senior Program Manager – Caradigm Intelligence Platform, Solution Sales Executive, Senior Director Clinical Product Management.
McKesson Chairman, President, and CEO John Hammergren, along with the other longest-serving member of HP’s board, will resign after being pushed out by shareholders angry over a series of botched HP acquisitions approved under their watch. Hammergren’s re-election was opposed by 46 percent of shareholder votes. HP Chairman Ray Lane will also step down, although he will remain on the board.
In the UK, the Cambridge University and Papworth NHS trust hospitals sign a contract to implement Epic and become the company’s first UK reference sites. The 10-year, $250 million contract goes to HP Enterprise Services to manage the eHospital project. Go-live is planned for October 2014. Epic beat Allscripts and Cerner last year because of Epic’s standardized and successful implementation methodology, although the trusts acknowledge that the always-tricky localization of the US product is something they will be watching closely.
Franciscan St. Elizabeth Health (IN) goes live over the weekend with Epic in its three hospitals, part of Franciscan Alliance’s $100 million project.
Wake Forest Baptist Medical Center (NC) admits that some of the $50 million it lost in the half of its fiscal year was caused by its implementation of Epic. The hospital spent $13.3 million on Epic of an unannounced total project cost, but also cited an additional $8 million of expense due to “greater-than-anticipated impact on volumes and productivity” and another $27 million in lost margin because of productivity losses during implementation. OR cases were reduced 4.1 percent, with the time required for Epic training being one of the factors listed. Moody’s, the hospital’s bond rating agency, downgraded the hospital’s debt to A1 in March because of “the unexpected decline in financial performance through the first half of fiscal 2013, largely due to the installation of a new information technology platform (Epic).” The hospital’s CFO issued a statement to the ratings downgrade saying that Moody’s has an overall negative outlook for non-for-profit health systems, but acknowledged the financial hit that its Epic implementation has caused.
In Canada, a high-profile doctor decides to leave the province because quality is declining, wait times are increasing, and Newfoundland and Labrador are among few provinces that does not provide an EMR, which she says is “vitally important.” The doctor has taken a hospital job.
Axial Exchange launches the Patient Engagement Index, which grades hospitals on their deployment of personal health technologies, social media usage, and patient satisfaction results from CMS’s HCAHPS survey.
CEOs surveyed by Gartner name 21 organizations as the most admired for using IT as a competitive advantage, among them Cleveland Clinic, HCA, Intermountain Healthcare, Kaiser Permanente, and Mayo Clinic. The most important indicator, the CEOs said, is providing customer-facing IT.
Philadelphia-based healthcare accelerator DreamIt Health announces its inaugural class of 10 companies that will start four-month boot camp on Monday. They are:
- AirCare (telenursing and readmission prevention)
- Biomeme (infectious disease diagnosis and tracking)
- Fitly (game-based child obesity motivation)
- Grand Round Table (matching EMR information against other cases for diagnosis)
- Medlio (virtual health insurance card)
- OnShift (clinician communication)
- Osmosis (mobile clinician learning)
- MemberRx (drug selection based on EMR information)
- SpeSo Health (online second opinions for diagnosis)
- Stat (patient transport)
Another health accelerator launches, with Louisville, KY-based XLerateHealth opening for business and offering a 10-week mentoring program. Applications for the August class will be accepted through May 17.
PDR Network will present the third annual PharmEHR Summit on Wednesday, April 17 in Philadelphia. The invitation-only meeting of leaders from pharma and EHR vendors will feature panels on EHR leadership, patient engagement, the Wall Street view of the EHR industry, an FDA presentation on EHRs, and several other sessions.
A New Jersey court rules that Warren Hospital can subpoena the records of Internet service providers in trying to identify unknown hackers who accessed the hospital’s e-mail system and sent defamatory messages to all employees in 2010.
Maryland’s Health Services Cost Review Commission will decide this week whether to allow the CRISP HIE to use its confidential patient-level data to support CRISP’s population health management functions.
In Tanzania, the text messaging service of Parents Love Me, a national healthy pregnancy and safe motherhood program, reaches 100,000 subscribers in 15 weeks, with 4 million text messages delivered since it was launched in late November 2012.
An editorial by the CIO of a hospital in Spain urges NHS to continue its quest to go paperless. He says his own all-digital Cerner hospital viewed technology as the essential tool for improving quality and affordability of care. His tips: create the culture for change, get clinicians involved so they can understand the patient benefits, keep it simple, and focus on how training is delivered. His hospital freed up 8,000 physician and nurse hours annually and reduced length of stay by 10 percent.
This story amused Inga, who added a WNA-like title of, “Maybe she was planning to claim a charitable donation.” An Oregon woman is indicted for dumping the clothes of her deceased 89-year-old mother in a Goodwill store dumpster and also including her mother’s body.
More from Vince this week on the HIS-tory of Meditech.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.
More news: HIStalk Practice, HIStalk Connect.
From Winston-Salem: “As a result, the center’s management said it is “focusing significant efforts on optimizing clinic and hospital operations to drive volume growth and cost management.” It has hired two consulting groups, Galloway Consulting and MultiCare Consulting Services, to assist with those efforts.”
The increase the volume strategy outlined above is not what the POTUS, HHS, or CMS has in mind to reduce health care costs.
We are not surprised by the cost over runs. They are widespread, and there have been other bond rating downgrades after EHR installations. The basic costs for EHR systems are already obscene, and reach the despicable category when one considers that there are not any improvements in clinical outcomes. There are economic outcome benefits for the vendors and consultants of HIT.
What we are most concerned about is the failure of the article or hospital disclosures to comment on the increased length of stays, and adverse events and outcomes (such as, e.g., patient falls from the neglect as the employees attend to the computers rather than the patients).
Does anyone from the credit rating agencies know what percentage of Epic hospitals have had their credit ratings impacted due to the cost of implementation? I have seen this mentioned with reasonable frequency but do not have the broader context.
Alternatively, do any CFOs know how often this is happening?
Epic is bought beause it keeps a lot of executives in place for the next 5 years. You think a CIP or CTO will be fired or replaced int he middle of a 200M Epic project. Its reallya joke. Allscripts/Mckesson/CPSI all charge 1/3 the cost fo Epic with similar outcomes.
This just stupid, we all will look back and see how executives who selected Epic showed no insight or thought process.
I don’t know about anyone else, but unless I’m in the position of having to issue debt, I don’t really care what the ratings agencies say. It’s going to be a good long while before I give any credence to their viewpoints.
I have no idea if it’s really caused by Epic, HIT, or if that’s just a convenient place to peg what might otherwise happen at many hospitals anyway.
I’ve worked in a couple Epic hospitals and my non-finance understanding is that those quoted amounts aren’t what Epic makes, but rather some 10+ year total cost of ownership to feed and water the thing. Some C level executive chime in if I’m wrong, but the number of wins I’ve seen when Mr H has posted KLAS graphics in the past doesn’t add up with stated revenue. There was a year where they had like 50 large wins which would have totaled in the multiple billions of revenue that year.
It seems pretty clear from reading the article, without even having the full financial report, that the revenue went up but cost went up more. What’s the biggest capital expenditure, which also happened to be several million dollars over budget? The Epic EMR implementation. They also specifically cite productivity hits during the EMR implementation. Moody’s seems to agree and specifically cites “the unexpected decline in financial performance through the first half of fiscal 2013, largely due to the installation of a new information technology platform (Epic), encompassing 95 percent of all revenue components of the enterprise.” Wake Forest has nothing to gain or lose in this scenario by acknowledging the Epic impact to their expenses, and aren’t blaming Epic so much as stating a fact.
There’s no reason to question the motives or validity in reporting the Epic impact to the debt rating. It will indeed be harder for the hospital to raise money in the future until it can correct its financial course. Facts are facts.
Sam, don’t think anyone expects that Epic is pocketing the entire amount quoted. Regardless of whose pockets goes to, those costs are a direct result of the Epic software and methodology. And have no fear, Epic pockets a comfortable profit. Only have to go visit their office campus to understand that pretty quickly.
I am not representing an EPIC site, but rather a very large successful Cerner site… And although, one might take the opportunity to state that we had our best financial years during and after our Cerner Go-Live, I do not correlate that directly to Cerner, nor believe the product of EPIC on its negative impact in WFU’s case, truly had the impact, but rather the establishment of expectations and deliverance of a disciplined approach – to plan for the expected, manage the unexpected and effectively run the program sticking steadily to scope, budget and schedule – there should be no significant surprises and one should have a successful outcome regardless of any of the top 3 products/partners.
Cute poll – rating the Commonwell participants on how they integrate inside thier own portfolio. I am sure that Judy will certainly appreciate the opportunity to change the subject back to inside-the-silo performance.
Did I miss the one where we voted on Epic integration outside of it’s portfolio?
I think that with all vendors you have to factor in that they are not unilaterally in charge of every aspect of an install much less how a place operates after go live.
So many organizations floundered prior to a big implementation and needed to bring a Stockamp or similar organization to whip the organization into shape. There are so many healthcare organizations that just struggle to keep status quo on what ever system they have.
It’s good sport to vendor bash from time to time and if the vendor promised perfect outcomes no matter what the health system did and does to manage themselves, then fine, bash away.
When you dig in and read the whole story and get to some of the meatier details, this isn’t just an Epic problem. Maybe they should have told the customer to pull the plug on go live and didn’t, or they customer didn’t listen, but in any case, this is a huge anomaly and it’s silly to think that something like this is entirely the vendors fault.
Plus, if they are going to lose track of the fact that a surgeon can’t be in training at the same time they are operating on a patient and feel surprised by an unexpected revenue impact, then that might be an indicator worth noting.
Never mind the fact that WFB also spent $80 to replace an old hospital with a new one (and add office space and outpatient clinics) and $100M to build a 250K sqft biotech research center. The rush to judgement and blame HIT (Epic in particular) is laughable. It’s a factor, yes, but hardly the deciding one. Many health systems made decisions over 5-7 years ago to start construction on new beds, research space, etc… under the old fee for service rules. They viewed having capacity and the ability to attract researchers/grant dollars as key to their success. Now that the rules are changing, they still have that fixed cost and are stuck in the middle of transitioning from volume to value as well as facing steep NIH cuts. Everyone (the government, private payers, patients) are conspiring to reduce utilization and while that may be the absolute right thing for our nation, it’s lost revenue to health systems. It’s somewhat facetious to blame Epic and uniformed to blame HIT in general as the larger economic pressures hitting providers would have put them in the same spot whether they implemented Epic, Cerner, etc… or nothing at all.