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May 28, 2015 News 26 Comments

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Patient advocate Susannah Fox (Pew Research Center) is named CTO of HHS. She replaces Bryan Sivak, who stepped down last month.

Reader Comments


From Publius: “Re: DoD EHR bid. Consulting firms are already contacting Epic consultants in regards to the IBM/Epic DHMSM bid. The communication is that the decision is anticipated to be made August 1, 2015, and consulting firms want to have a list of consultant resources ready to present as soon as the decision is made.” Unverified, but logical. The DoD project could be the equivalent of HITECH in spurring consultant demand, at least for those chosen to work on the project.

From Frank Poggio: “Re: Mr. H’s observation that patients aren’t Meaningful Users. That’s an idea for a new CMS program since it looks like ONC is struggling to find its next life! Everyone says that patient participation is a key to controlling healthcare costs, so ONC should develop a book of Meaningful Use criteria that is tied to a patient’s insurance premiums. If they don’t hit all criteria each year, their premiums double (or triple?), but if they hit them all, their premiums are cut in half. Since ONC would have to deal with some 100 million participants, they should easily be able to justify massive department budget increases.” I like it. When it comes to health, the customer definitely isn’t always right.


From Freddie Paris: “Re: New York Times article on interoperability. Wonder if Dan Haley would respond to a truth challenge to come up with any references to his assertion?” Athenahealth VP of Government and Regulatory Affairs Dan Haley was quoted in “Tech Rivalries Impede Digital Medical Record Sharing” as saying that IT vendors have business models that impede data sharing, a typical arrangement that he says costs customers $1 million to connect to another system, $500,000 per year to maintain the connection, and $2 each to send records to another system. Dan sent this response to my inquiry, which still doesn’t provide the $1 million vendor and client details the reader seeks:

The information I shared with Mr. Pear came from conversations with our clients and prospects who’ve told us firsthand and on countless occasions over the years about the exorbitant costs imposed by market-dominant vendors for out-of-platform information sharing. These costs are imposed in a number of ways: via one-time interface fees that can total more than a million of dollars for even a medium-sized health system; via annual interface maintenance charges that extend and compound that initial cost; and via per-transaction fees of the kind that one major vendor recently resolved to stop charging under pressure from Congress and others. The specific amounts vary, but are all large. The point is that any significant imposed cost for out-of-platform communication effectively discourages true interoperation and impedes progress toward the bipartisan societal goal of information fluidity in healthcare. As many in the industry know, vendor contracts are usually protected like the crown jewels, but they are sometimes obtainable via Freedom of Information Act requests directed at institutions that benefit from significant federal contracts. Enterprising reporters interested in this issue to should check for themselves. Clearly ONC gathered ample evidence of these business practices when preparing their recent information-blocking report. We are glad that both ONC and Congress are taking action.


From Carrollton Outsider: “Re: Lightbeam Health Solutions. Acquired by Greenway to be their population health solution.” Not true, said CEO Pat Cline when I asked him about the rumor, and he’s not talking to any entity about selling the company, either. Lightbeam announced a non-exclusive partnership with Greenway last year, one of several such agreements it has with EHR vendors to provide a PHM platform, but that’s it. I interviewed Pat a year ago if you want to know more about the company.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Boston Software Systems. The company revolutionizes how healthcare works by providing error-free automation for any application or purpose – EHR migration, streamlined business processes, and improved productivity. Its automation products are the most sophisticated available, giving customers the peace of mind that their critical data is 100 percent error free as it bridges the gap between their technologies. BSS’s reputation for ease of use and customer support is stellar. Check out the interviews with customers CVSHealth (onboarding new MinuteClinics), Unity Health System (improving discharge workflow), Methodist Houston (validating Medicare accounts), Fauquier Hospital (mass Meditech updates following a hospital acquisition), and CIO Kent Henriksen describing how his health system used BSS to migrate millions of clinical records to Epic. Thanks to Boston Software Systems for supporting HIStalk.

My latest grammar pet peeve is when people say something like, “If you have questions, please don’t hesitate to call,” the latter part of which can be equally clearly stated by just saying “call.” How many people would ever use the word “hesitate” except in this awkward form, and why can’t I hesitate if I want to? Peeve #2: a phrase such as “20 different physicians,” where nobody really needs the “different” part to understand that it’s not 20 of the same physician.

I was having odd, persistent “waiting on …” browser site loading messages that I fixed by reinstalling a solution I’ve used previously: OpenDNS. It’s a free, 30-second network connection change that bypasses slow, unreliable DNS lookups in replacing them with its own. It improved site load times quite a bit.

This week on HIStalk Practice: HHS awards $112 million to help primary care practices optimize EHR utilization to improve cardiac health outcomes. Morrow Family Medicine launches NeighborAide app for elderly patients and caregivers. Minnesota will no longer force solo docs to implement EHRs. The Illinois Gastroenterology Group rolls out new technology for Crohn’s patients. Physician practices show cloud-based EHRs some love, but still have reservations about data security. American Well CEO Roy Schoenberg, MD explains why the future of telemedicine is already in physician pockets.

DonorsChoose Project Updates


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Ms. N from California shared photos of her disabled high school seniors using the Chromebook we provided as a DonorsChoose grant to type their essays, complete college applications, and apply for jobs. The second graders in Ms. A’s class in Texas are using the math games we bought to learn to count money, write fractions, measure objects, and tell time, and she adds that they are so popular that the kids make a beeline for them during indoor recess.

The $10,000 Challenge


A vendor executive who shall remain nameless was so moved by the participation and classroom reports that I’ve mentioned here that he/she is putting up $10,000 to match new DonorsChoose donations. If your company donates $1,000 or more (I’ll set up a credit card payment), I’ll feature it here and also apply matching funds from our anonymous benefactor, which will provide double bang for the buck (actually quadruple bang for the buck potentially, since I often find requests that will be matched by charitable groups such as the Bill & Melinda Gates Foundation). DonorsChoose is a stellar charity that spends 94 percent of its income on projects rather than overhead, paying its CEO and genius founder only $240K (and that’s New York city money, a rounding error in the salaries of health system CEOs there). Centura SVP/CIO Dana Moore, who conceived this HIStalk project in the first place and donated his time at HIMSS to encourage donations, has ideas to keep it going as well.


June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Acquisitions, Funding, Business, and Stock


Cloud computing services vendor ClearData closes a $25 million Series C funding round.


Medical image exchange platform provider LifeImage closes a $17.5 million investment round led by non-profit insurance and health solutions company Cambia Health Solutions, which owns several healthcare technology vendors.


A construction company confirms that Allscripts will move its 1,000 Raleigh, NC employees into a new 12-story office tower that will open in the spring of 2017.

Forbes names Epic CEO Judy Faullkner as the wealthiest female in all of technology. The assets of the top 11 women combined ($10.6 billion) is 3 percent of the wealth of the top 11 men.


Community Hospital of the Monterey Peninsula (CA) and University of New Mexico Health Sciences Center choose revenue cycle management products from Experian Health/Passport.

Lakeland Health (MI) chooses ProVation Order Sets for clinical content management.

Announcements and Implementations

Nuance announces PowerScribe 360 Reporting v3.0, which allows radiologists to create higher quality reports using real-time, evidenced-based guidance developed by the American College of Radiology.


ToSense’s CoVa body-worn sensor (thoracic impedance, heart rate, heart rate variability, respiration rate, skin temperature, and posture) earns FDA 510(k) clearance. Elderly patients wear the necklace-type device in their homes for a few minutes each day to allow remote monitoring for heart failure.

CompuGroup Medical US and rehab services company Weston Group will partner to develop rehab modules for CGM’s webEHR.

Privacy and Security

Ohio’s medical board reprimands a radiologist for violating HIPAA by looking up the electronic medical records of a colleague for unstated reasons.



Weird News Andy would enjoy captioning this photo of a virtual butt being used for medical student prostate exam training. In slightly related news, a Florida college will stop requiring female sonography students to perform vaginal probes on each other for ultrasound training and will instead move to simulators.

Bizarre: a father and son in their 70s are married after 52 years together, with the “bizarre” part being that in order to game the system in a state that doesn’t recognize domestic partnerships, one had adopted the other in 2000, a parental status the court agreed to vacate prior to their nuptials.

Sponsor Updates

  • First Databank President Chuck Tuchinda, MD provides advice for career success in a San Francisco TV interview.
  • Nordic posts a video of its Community Giveback Day activities on May 22. Check out the 1:00 mark when the guy recording Nordic employees working on a Habitat for Humanity house asks one of them, “What do you think your KLAS rankings for hammering upside down would be?”
  • VMware posts “New Research Highlights Clinical Benefits of Virtual Desktops.”
  • Healthfinch asks “How does a 21.7 hour work day sound to you?”
  • Impact Advisors posts “The Good, the Bad and the Ugly of Meaningful Use Stage 3: Objective 2 – ePrescribing.”
  • E-MDs will exhibit at the Texas Medical Society event June 1 in Austin.
  • Extension Healthcare and Iatric Systems will exhibit at the AAMI 2015 Annual Conference June 5-8 in Denver.
  • Healthgrades recaps its experience at the Colorado Digital Health Summit.
  • Galen Healthcare posts “Point-to-Point vs Interface Engine: Does your interface setup suit your needs?”
  • InterSystems and Intelligent Medical Objects will exhibit at the e-Health Conference May 31-June 3 in Toronto.
  • Glytec presents several research studies at the AACE 24th Annual Scientific and Clinical Congress.
  • HCS will exhibit at the LeadingAge CA Region Meeting June 3 in LA.
  • The HCI Group posts “PeopleSoft ALM is as Important to Patient Safety as it is to Cost Control.”
  • HDS asks “Are Text-Only Emails Obsolete?”
  • Healthwise will exhibit at the AHIP Institute 2015 June 3-5 in Nashville.
  • InstaMed will present a session at the AHIP Institute 2015 on June 4 entitled, “Positive Member Payment Experience is Critical – See How Health Plans are Delivering.”


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

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Currently there are "26 comments" on this Article:

  1. Just to verify – here’s a sample letter I received from one of these recruiters:

    Hi XXXXXXX – This is exciting. I have great news hopefully for both of us. My company was yesterday chosen to be a source for the Epic/IBM bid for the 10 year, $11 billion Department of Defense EHR (DHMSM) deployment contract and we’re in position now to put our Epic contacts on the Epic/IBM bid. Each separate location, deployment contract should go 2-3 years.

    Current priority needs:
    Epic Bridges certified consultants
    Epic Principal Trainers/IDs (all modules)
    Epic Certified Build Analysts (all modules)
    Cogito consultants

    A little background…
    There are a few different bids but the main two are from Epic/IBM and Cerner/Accenture/Leidos. Epic/IBM is the only Epic bid. We’re on the Epic team and confident our team will be chosen later this Summer. Meantime, IBM and partners need to put together an impressive submission of experienced Epic consultants and I want to invite you to be on the list.

    IBM and partners…
    Two of the main health IT consulting companies that IBM has been partnering with for the past two years to secure Epic to the bid and to work with the DoD to understand and comply with all stipulations for the contract are FCP (www.fcp.com) and Impact Advisors. We have worked with both FCP and Impact Advisors over the years and both are excellent companies. In this case, we are the sole recruiting partner of FCP, and so “authorized to identify and represent a team of interested Epic Certified consultants”. FCP have a strong Federal Health IT presence and have spent about $.5M on the bid already. You would be on the FCP consultant list integral to the Epic/IBM submission.

    What gets me really excited about the FCP consultant list is that if Epic/IBM win, FCP’s list will come under the federal subcontractor quota of 30% of total contracts [$11B] to smaller businesses [under $25M revenue]—and FCP is the primary, small business, health IT human capital resource on the Epic bid—backed by Belle Oaks’ Epic candidates.

    If you are interested in being on the submission for the multi-year Epic DoD project, please send me your resume ASAP and no later than middle next week. I will generate an invite to the Epic/IBM/FCP team. As always, I will keep you posted throughout the process.

  2. The idea that there’s anything but negligible or minimal cost associated with information sharing in this day and age is untenable. It costs virtually nothing to send an email or download an web page, why should life-saving patient information be any different? We can do better.

  3. Re: DoD EHR bid: Feeling creepy about a private company, where the CEO is the wealthiest woman in the country, where there are countless stories about the cost to ‘share’ with other systems. It’s complicated. I’m a Kaiser patient for many years, happy with my access to my providers, but also an MSN with 30+ years in healthcare IT, Epic certified in several modules, and I walked away from 100 emails a week from recruiting firms to do Epic consulting. Yeah, it’s true. It’s closed. In so many ways. Life is too short to spend time with a company with values I disagree with: no, it’s not ok to send college graduates with no healthcare experience to manage a clinical IT project, no, it is not ok to have non-clinicians teach clinicians, no, it is not ok to only talk to other Epic clients only when Epic is present, no it is not ok to blackmail the CIO with the CEO if the CIO protests against staffing and education essentials, no, it is not ok to make hospitals/health systems spend millions traveling to Verona to train staff and get ‘Epic Certified’, no, it is not OK to charge exorbitant fees for everything, from the contract to interfaces to sharing data. And no, is not ok to force IT staff to swallow the kool-aid that it is a better system. It’s not. It’s good. But it is really not better. Hoping open minds review all details for the DOD contract.

  4. Re: Haley comments. These comments are laughable, lawyer/lobbyist spin. How is it morally superior for athena to charge customers 8-10% of revenues versus other vendors who choose different unbundled pricing strategies? athena has used a classic Washington insider strategy of convincing Congress that their business lapses are industry problems — reminds me of the old saying that business leaders are capitalists during good times and socialists during bad times. The only information blocking going on here is Mr. Haley’s withholding the truth from his hapless Congressional buddies. By the way, I’m not an EHR vendor or a customer of one — just calling it like it is.

  5. Is this article, from a CIO in Oregon, “laughable”?

    “Business practices not technical limitations, holding health care progress back”: http://www.bizjournals.com/portland/blog/health-care-inc/2015/04/business-practices-not-technical-limitations.html

    Some key excerpts:

    Five years into the federal EHR Incentive Program, with billions of dollars invested, patient data is still not moving as it must to support high quality, coordinated care.

    Frustratingly, many of these barriers come from business practices, not technical limitations. In key markets, the presence of a dominant EHR vendor allows large health systems to “box out” clinicians using different EHR systems. The victim in this market strategy is always going to be the patient.

    More specifically, a majority of hospitals in Oregon use the Epic EHR. The techniques used by Epic to “box-out” competitors and gain market share include charging their own customers transaction fees for exchanging data with non-Epic systems and requiring expensive proprietary interfaces designed for long-term profit.

    These strategies generate substantial rewards for some EHR vendors, and make it easier for large health systems to convince some smaller organizations to use a shared EHR platform. While this may seem like positive outcome, it actually perpetuates the problem of critical information locked out of — or locked within — the largest vendor’s system.

    Many practices are feeling forced to scuttle EHR systems they like — more affordable, interoperable systems, better suited to their practices — in order to exchange basic information with users of the dominant regional vendor. This is playing out around the country, just as it is in the Portland metropolitan region.

    We need to stop enabling market dominance, and work for a system structured to support better, safer patient care through real EHR interoperability.

  6. Leonard Kish writes: ” It costs virtually nothing to send an email or download an web page, why should life-saving patient information be any different?”

    I’ll bite: because these are extremely different kinds of transmissions?

    The reason it costs nothing to send Email (not quite true, by the way) is because the standards were developed and accepted many years ago, the data structures are extremely simple and just a few fields, there’s no authentication, no encryption, and no function to block incoming data from unauthorized sources from authorized sources.

    If we were willing to accept unencrypted medical records from sources we can’t verify in wildly different formats, and with it mixed in random garbage from everyone on the planet trying to trick us into letting them into our systems, then we could just cut and paste medical records into Email for the same cost.

    I think there’s a middle ground in this topic; there have been a lot of improvements and efforts to make it easier to share information, the reality is it really is complicated data to pass around with high moral and legal implications, and some vendors do use their cost models to limit the interoperability and not just compensate for their real efforts. But let’s not trivialize the work involved in system integration.

    Note: I react the same way when people compare EHR sharing with ATM use at banks.

  7. An opinion column by a customer of another vendor reiterating the same points that Mr Haley made? Sure, equally laughable if we’re saying that that is somehow worse than burying interface fees in an 8-10 cent charge on every dollar that I earn, which is what athena does. I’m not saying that Epic or athena is right, I’m just saying that each has there own strategies for market domination, and just because one charges a different way doesn’t mean that their total cost of ownership is higher, which is what is being asserted. And by the way, if most of Oregon is on Epic, and Epic doesn’t charge for Epic-to-Epic interoperability, shouldn’t we count on the “plus” side of the ledger the quality and safety and efficiency improvements that have come to Oregonians whose information is being routinely shared among different providers who happen to be using the same EHR?

  8. Since Epic’s software holds health data from more than half the country’s residents, wondering if Epic would respond to a truth challenge on the cost of an average Epic implementation and upkeep?

    In response to c harris re market domination and total cost of ownership:

    Is the American Academy of Family Physicians’ (AAFP) testimony during the Senate HELP Committee Hearing, “America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care” also “laughable”?

    Excerpt from Testimony of Robert Wergin, MD, FAAFP, President, AAFP:

    Vendors Engage In Data Hoarding. The AAFP also has written to the Federal Trade Commission about anticompetitive practices that hinder interoperability. The AAFP is concerned with the utilization of health
    information technology to create competitive barriers against physicians and patients. The lack of
    interoperability makes it practically infeasible for a physician practice to switch electronic health records should
    the vendor or health care community use anticompetitive methods to limit the practice’s access to needed
    health information on their patients.

    This hoarding of data – this vendor lock – negatively impacts care and distorts market forces trying to decrease health care costs and improve quality. It is critical that health data flow to where patients wish to be treated – in fact, these records are the patient’s records and should be electronically available to any physician or other provider of care at any time. These records and data do not belong to the EHR vendor. The current market forces for EHR vendors and large (quasi-monopoly) health systems limit interoperability to retain customers and patients and to elevate prices artificially. We need to make sure the business incentives are aligned to ensure continuity of care for patients and appropriate access to data by providers.

    How about credit downgrades and layoffs related to EHR implementations?

    Here’s a recent example from last week:

    Lahey Health exec sheds light on reasons for layoffs (Boston Business Journal)

    Lahey Health has had to lay off 130 people, the health system announced Thursday, letting go of 1 percent of its 14,000-person workforce. The layoff follows a trying winter and expensive rollout of its electronic medical record system Epic, which resulted in a $21 million operating loss in the first six months of 2015. Weeks prior to the announcement, Dr. Joanne Conroy, chief executive officer of Lahey Hospital & Medical Center, detailed the expenses and how the flagship institution has grappled with the problems. Lahey Hospital & Medical Center felt the brunt of the layoffs.


  9. The minimalist standards for transporting health records between EHR systems are working, barely. However, once transported, the electronic documents are often delivered without context and are frequently unreadable by either humans or by the receiving system. When this occurs, many EHR vendors tack on extra fees to provide technical support to “fix” the issues for their customers, one by one, creating a nice revenue stream to patch their faulty products. Or, vendors eventually roll out an upgrade, still requiring their users to devote resources to implement at each site, as evidenced recently by the Ebola EHR stories.

    With the exception of true multi-tenant cloud EHR systems, of which there are only a few, there are strong business drivers in place for most EHR vendors to avoid interoperability, despite what their lobbyists or publicists may be saying.

  10. Re: #10. I appreciate your points, but neither of your examples address the original point. Mr Haley is claiming that other vendors, not his, use pricing to block information flow. Just because they use different pricing approaches doesn’t mean that they are blocking information. But making such one-sided claims to feed a political frenzy is, well, laughable. I guess we’ll just have to agree to disagree.

    Re: #11. Yup, agree that lots of vendors do lots of things. Completely disagree that a “true multi-tenant cloud EHR” is any different than the rest. They act the same. It’s not like they are purehearted and all others are not, they just have a different technology approach. In the end they’re all businesses, doing what businesses do.

  11. A”true multi-tenant cloud EHR system” would have the same interop and vendor lock in issues as any other system. The hypothetical cloud vendor could easily develop superior mechanisms for sharing between its own users (just like Epic CareEverywhere) but when it comes to cross vendor sharing, they would run into the same issues every other vendor runs into (limitations of CCD or HL7 standards, lack of common vocabulary).

    Regarding costs…perhaps the costs of interfaces should be integrated into the cost of the application, although I suspect organizations would prefer to only pay for interfaces they use. Either way, interfaces are not as trivial as sending an email. Interfaces are often more complicating than the end user application so it is understandable that they would cost money. In addition, interfaces often need additional changes and/or regression testing with every code change.

  12. In speaking to one senior executive of the dominant healthcare system in the city I live, ask him about their Epic implementation and plans for their affiliated practices – basically, will they ask affiliates to switch to Epic?

    His response: If they wish to participate in our contracts with commercial payers, CMS, self-insured employers, etc., then they must move to Epic.

    This kind of forced march Is not exactly illegal, but it sure does smell bad and is not in the best interests of the market.

    As an aside, spoke to a specialists in town who is on eCW. He has gotten the word from the dominant HCO to move to Epic or else. His challenge however is that his five physician practice also works with several other HCOs that are not Epic. He’s decided to force the hand of the dominant HCO, sticking with eCW and telling them they must connect to him if they want his referrals.

  13. Re c harris comment on information blocking and pricing approaches

    I’m sorry -if your business model is set up so you only continue to make money from existing customers by building interfaces and installing new software, you have more of an incentive to create data silos. Also, Epic sharing information to Epic and using this as a way to continue to consolidate the market does nothing good for consumers. I think we all know the economics of monopolies.

    I’ve included a recent post from Julia Adler-Milstien, PhD, Assistant Professor of Information, School of Information and Assistant Professor of Health Management and Policy, School of Public Health

    Information Blocking: A New Term and The Promise of A New Era in Electronic Health Information Sharing
    on the Health Affairs Blog, May 20, 2015.

    Some key take aways:
    -The key actors needed for health information exchange to occur (EHR vendors and provider organizations, like hospitals and physician practices) have incentives not to share information
    -For vendors and providers to be considered as engaging in information blocking, have to meet the following criteria, which will be extremely hard to prove in practice:
    There must be “an act or course of conduct that interferes with the ability of authorized persons or entities to access, exchange, or use electronic health information.”
    “The decision to engage in information blocking [must be] made knowingly.”
    No reasonable justification:
    Conduct must be “objectively unreasonable in light of public policy

    While not sufficient to ensure that we achieve broad-based interoperability of health IT systems (and realize the substantial potential value from the $28 billion public investment in these systems), reducing information blocking is not only a necessary step, it is perhaps the most critical step. Now that we have a clear statement that public benefit and public policy goals take precedent, and there is serious talk about enforcement mechanisms, providers and vendors may finally be convinced to shift their business practices and business models to deliver on these.

    When the C-suite truly believes that they can be most successful by competing on the basis of sharing and using data, rather than hoarding and controlling data, we will know that we have succeeded.


    Epic has a responsibility to lead on the sharing of information, not use this as a way to make even more money.

    I reiterate my request for a truth challenge.

  14. Dan Haley needs to come up with a real example or he should correct the record.

    Not only did he assert it, he assert it was common.

    He is either clueless or a lier. Time to decide which.

    Cool to see the Cloud “vapor” crowd (i.e. athenahealth summer interns) posting in support of Dan.

    When you listen to Jonathan, he open says he wants to charge for this. He filed with the OIG to charge for this.

    What two faced BS.

  15. Re talking about BS –

    If you think the only people interested in this discussion are interns that work for athena, perhaps start reading the news and also take a look at what Congress is doing.

  16. Hell, data locking is a problem within pretty much every EHR, let alone interfacing to another vendor’s system. The data structures are not very compatable, but superior data structures are expensive to evolve and a major competitive advantage. You want a company to give away their data structures to cheap stuck in the mud competitors or competitive start ups?

  17. There are always lots of talk of “interoperability”, but the reality is no one asks a bank to take your account record and transfer each transaction into a different bank. You only transfer the money. With C-CDA document types, this problem is largely solved for health care. A patient can transfer their C-CDA using the transmit function of VDT. Granted some vendors charge for the creation of a C-CDA, but it’s up to the hospital how they negotiate their contracts with said vendors.

    So why is “interoperability” still a discussion point? It’s a simple Fear, Uncertainty, and Doubt situation.

    Epic is in a unique situation where it’s way a head in the race. Competitors have very few items they can point to in an attempt to disillusion decision makers. Interoperability is one of them. So competitors yell, “BUT WE”RE OPEN!!! THEIR SYSTEM IS CLOSED” in much the same way Linux users used to do the same to Windows. What these competitors are missing is that an EHR is about far more than interoperability. I’ve seen few vendors live up to their commitments like Judy and Epic. Other vendors simply make promises that they don’t deliver. Interoperability isn’t that big of a factor in this scenario.

    For example, I’ve seen vendors promise dates then simply have no part of a feature ready at that date. I’ve seen vendors make up stories about other competitors being purchased or up-for-sale to sway decision makers. I’ve even seen a CEO of an EHR vendor promise a job to an employee of the health system while an evaluation of his company’s EHR was occurring against Epic and others. Better yet I’ve even seen vendor employees involved in “performance improvement plans” for project managers of their deployment to try to shift the lack of delivery to someone else. Given the magnitude of shenanigans that non-Epic vendors partake in, it’s easy to see how Epic is winning (because INTEROPERABILITY isn’t as important as RELIABILITY!).

    The message needs to be load and clear to other EHRs. Deliver on your promises and commitments and you might stand a chance. The problem is SO few have in the past customers have come to expect them to fail. In most cases, the other vendors EHR roll-out turns into an EPIC fail with a swift replacement by Judy and friends.

  18. re: Mr Haley’s comments

    Here’s link to Office of Inspector General report denying athenahealth proposal to charge transaction fees for certain types of health information exchange transactions:


    athenahealth wanted to charge both sides of the transaction, and to charge more for trading partners not contracted with the athena network.

    Hmm. If athena charges transaction fees it’s “a promising path forward to sustainable health information exchange,” but woe to any other vendor who tries to do so, because Mr Haley will sic his Congressional buddies on them for information-blocking.

  19. Dan Haley – what is your response? Where is your example? Where is your “truth” if it exists at all?

  20. Everyone knows vendors create cost barriers to interoperability. Those who ignore the underlying issues at hand – which affect every single person who touches the American health system – likely have reason for doing so.

    In fact, this issue has been the subject of a lot of congressional interest as of late. In my attempt to take this forum away from mudslinging and personal attacks below is an excerpt from the Senate HELP Hearing on IT Transformation (3/17/2015).

    Senator Warren:
    Dr. Adler-Milstein, even once we have consistent standards, what barriers will stand in the way of health information exchange?

    Dr. Adler-Milstein:
    I think one of the key ones are these issues around competition. Some of my research has shown that in more competitive markets, hospitals are less likely to share data with each other. So I think it’s, in some ways, an obvious point, which is when you say, “This is an entity you’re used to competing with. Now share all your data with them,” most organizations are going to say that makes no sense.

    Senator Warren: Wait. And why do they not want to share the data?

    Dr. Adler-Milstein: Because they’re competitors. They’re competing for the same patients. So if you share the data, it makes it easier for patients to go get care from your competitor.

    Senator Warren: So, basically, it’s a way to tie a patient to a system, to say the system is not going to share data anywhere else.

    Dr. Adler-Milstein: Exactly, and I actually think it gets factored in on the margin. When interoperability is expensive, you have to justify that expense, and it makes it hard to justify when there are these potential competitive implications that get played in. So the two barriers relate to each other.

    If interoperability were cheap — hospitals and doctors may be more willing to take that risk. But as long as it’s expensive, as I said, I think it’s an expense that becomes hard to justify.

    Senator Warren Thank you.

    You know, the federal government has invested nearly $30 billion in electronic health records, because exchanging health information in real time improves patient safety, it saves lives, and it can reduce healthcare costs.

    We now have the technology, as you rightly point out, to create an electronic records system that lets one part talk to another. Soon we’re going to have data standards that will make the connection to the system both easier and cheaper. It seems past time to eliminate the perverse incentives and administrative barriers and just get this done.

  21. It’s rather disingenuous to talk about vendors “creating” cost barriers before there are any interoperability standards in place. Without the standards, the costs are real, so it’s not exactly rocket science to expect that someone has to pay for them. The bulk of the testimony you cite doesn’t support your assertions in any way.

  22. Re: PM_FROM_HAITIES comment about other vendors promising dates:

    I do, for the most part, think your statement is possibly true. But it is not completely true. My own experience is Epic has not always lived up to their own development promises. So while I’m guessing from your bias you are fan of Epic (and I realize you didn’t say Epic is perfect), I wanted to make it clear for everyone that they are indeed not. I cannot speak about other vendors.

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