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May 31, 2015 Headlines 23 Comments

Federal Court rules in favor of Teladoc, blocking Texas Medical Board rule and preserving telehealth in Texas

Dallas-based Teladoc wins an early victory in its anti-trust lawsuit against the Texas Medical Board, which passed a rule earlier this month requiring a face-to-face consultation before any telehealth services could be provided in the state. A US District Court has blocked the rule from going into effect until after the trial.

Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs

The American Medical Informatics Association publishes the recommendations of its EHR 2020 Task Force in a report on the status and future direction of EHRs.

Erlanger spending $91 million on major IT overhaul

Erlanger Health System approves a $91 million contract to implement Epic across its system, with an additional $97 million budgeted to maintain the system over the next 10 years. The hospital’s selection committee, made up of clinical and operational leaders, voted in favor of Epic 28 to two over Cerner.

Big Data Beats Cancer

IEEE Spectrum profiles John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, who helped pioneer several big data initiatives in healthcare and in 2011 turned to big data to help create a personalized treatment plan for his wife when she was diagnosed with stage III breast cancer.

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Currently there are "23 comments" on this Article:

  1. RE: Erlanger announcement- whoever convinced the Board that Epic will be less expensive than Cerner needs to trade in their Abacus.

  2. to annouce their 200% budget overun, poor financial performance, lowered bond rating/higher borrowing cost and layoffs once they go live on Epic. Craziness–the C Suite should put their jobs on the line to backup their vote.

  3. This one isn’t rocket science. Cerner takes more cash out of customer pockets than Epic ever will.

    Epic’s embarrassed to charge and Cerner is excited to charge.

    Erlanger made a solid choice.

  4. RE: Good at Math

    Are you serious, EPIC is more that Cerner? In what world? I have NEVER seen a Cerner implementation cost what EPIC implementation’s cost…. Tell me the last Cerner Implementation that was $100M+ plus for a site as small as Erlanger’s…

  5. It seems a bit hard to compare apples to apples with recent data. Not too many customers the size of Erlanger signing with Cerner lately in the news. Athens Regional, which seems about 1/3 the size of Erlanger by my estimate, cost 31M. Ventura County Health Care seems about comparable in size to Athens, and cost 32M.

    So does anyone have any real market numbers to justify a claim that Cerner is markedly cheaper for comparable organizations? Otherwise, it seems like more of the usual smoke-screen.

  6. Cerner and Epic are currently the two best choices on the market if seeking a robust integrated EHR for a health system. So pick Epic if you want, but claiming it is cheaper than Cerner is erroneous based on my knowledge and experience. You could send less total money to Epic than Cerner, but only because Epic offers fewer solutions and services and requires more money to be spent with other vendors to try to approximate the full solution set of Cerner. Once you go Epic, staff salaries typically go substantially higher as well. Most organizations do not care to retrospectively analyze their initial rosy Epic TCO projections, which wouldn’t matter anyway since by then the Kool Aid has already been consumed.

  7. If I’m reading correctly, the cost isn’t just $91M…it is $91M capital PLUS another $97M in operating over the next 10 years…so $188M over 10 years. Does anyone know what consulting firm did the cost analysis on this? Given Epic’s history of overruns, you’d want someone who knows how to look for the hidden costs. And in my experience, there are always hidden costs.

  8. IT projects always overrun. That’s not an Epic specific issue. Trying to compare Cerner to Epic implementation costs is tricky as Epic typically deploys to much larger facilities making it impossible to do an apples-to-apples comparison.

  9. Well, you’re not the only confused one. It’s pretty hard to find figures making a similar cost analysis including projected ten year operating budget for any of the recent Cerner implementations of which I’m aware. As far as the “full solution” offered by Cerner, I’m sure you must be joking Experienced. My wife used Cerner at one of their hospital clients, and they had every bit of third party vendors for specialized systems I’ve seen with Epic, not to mention no viable Ambulatory solution. So either back your claims up with something firm about cost of ownership, or lay off the BS.

  10. Re Obfuscator: Just because your wife worked at a Cerner Hospital that happened to use 3rd Party Vendors, doesn’t mean Cerner doesn’t have a full solution Offering. Absolutely Cerner has a full solution offering but that doesn’t mean that every client will purchase it. Also Cerner has had a very robust Ambulatory Solution offering for years, its called PowerChart Ambulatory (I know, not very creative) and it is in use as several major sites and IDN’s, such as Banner Health. Also, just because a site may not currently be using Cerner’s ancillary solutions, doesn’t mean they haven’t purchased the software licensing and are just waiting for the right time for implementation. Not every Cerner site goes “Big Bang”

    Yes, PM_From_Haities, you bring up a valid point, EPIC traditionally installs at Larger single facilities (based on Bed Size) but Cerner’s focus has for the most part been on the IDN Side. It may surprise many to know that Cerner is the preferred vendor at the majority of Large IDN’s in the US: Dignity Health, Banner Health, Tenet Health, Community Health Systems, Catholic Health Initiatives and recently more and more of the Ascension Family hospitals are moving to Cerner..So yes, a true apples to apples comparison is difficult.

    However, one that stands out is Cerner’s Managed Service offerings, which i believe is where A) EPIC is still lacking and B) what helps keeps the cost of ownership down for Cerner via EPIC. Cerner’s Remote Hosting, AMS and Upgrade Center (among other offerings) helps keep the long term cost of Cerner ownership down as Clients do not have to hire additional resources to do the day to day operation activities of the system. True, EPIC is in the process of building their own Data Center for Remote hosting, but i don’t believe they have an Application Managed Services offering yet, but correct me if I am wrong.

  11. Re: Cerner/Epic

    I fully appreciate different customers rolling out different scopes of the Vendor’s offerings. I think the same could be said of virtually every Epic customer.

    I asked you for examples of services or products that Cerner offered that Epic didn’t such that Epic’s price tag would appear lower. You gave me an example of a service that Cerner offers which might reduce cost of ownership for that system, and I appreciate that. What it really illustrated for me at least is the difficulty in making a direct comparison in cost between these two vendors. If someone thinks cost is such a slam dunk for one or the other, it seems to me like they need their head examined.

  12. Re: Obfuscator…the mere fact that you have to ask for examples of services or products that Cerner offers and Epic doesn’t have, shows your own ignorance about this topic — unless you just have an axe to grind against Cerner or are an Epic apologist hoping your general and incorrect statements will be read by others and assumed as fact, thereby perpetuating the misinformation.

    On the services side, Cerner offerings include CernerWorks (remote data center hosting), Application Management Services (AMS, app support/maint), Upgrade Center (manage and perform upgrades, including most of the testing), ITWorks (onsite IT services, up to full IT dept outsourcing), RevWorks (revenue cycle business management/performance), and ERP (PeopleSoft implementation, support, hosting). I may be forgetting some others, but those quickly come to mind.

    On the products side, Epic lacks things such as medical device integration middleware, document scanning/imaging, PACS, fetal monitoring, patient flow/bed mgmt, workforce mgmt, med cabinets, and more. Cerner has those product solutions and more. Epic Lab (called Beaker) is also still relatively weak for complex laboratories, so a number of Epic clients still use other lab solutions (even Cerner’s in some cases) though some have finally started to migrate Lab to Epic.

    The real point here, Obfuscator, is that it would be easy to write a larger check to Cerner than to Epic while still spending more on the Epic “solution” given all the additional products and services one might need or choose to acquire to round out their Epic “solution.” TCO for it all is still going to be higher with Epic/3rd parties, unless Epic has finally decided to start discounting heavily which is not their historical approach. If one only buys the limited products of Epic and their Cerner counterparts, the Cerner cost will likely always be lower. Folks do still decide to go with Epic for reasons other than cost and that is fine. I can assure you that Partners HealthCare doesn’t feel that their now $1.2B Epic solution is cheaper.

  13. Erlanger.. The cost is actually a combination of one time, plus recurring, plus the additional 100 new employees in IT required to support the solution.. Based on that Math cost is more than $260m over 10 years. Start assessing the real cost of implementing Epic and see if it can be justified..

  14. Somehow I don’t feel like the one grinding an axe . . . I simply asked for real data. But spin on, friend.

  15. Cerner vs Epic costs
    Good off the napkin comparison between 2 AMCs of comparable size ($2-3B revenue, IP and OP, 600 physician practice plan etc)

    Wake-Forest Baptist, Winston Salem, NC
    Epic – all in (clinical & rev cycle) – approx $350M over 5 yrs

    VCU Health, Richmond, VA
    Cerner – all in (including 100+ OP specialty clinics) – approx $170M over 5 yrs (albeit they started in 2004)
    GE/IDX Rev Cycle (HPA) – approx $30M

  16. Is it too tacky to ask for a source on that? I can’t find figures on VCU through google. Interesting, if it’s closer to an apples to apples comparison. Of course, I’m not sure how we’d ever fully correct for the drift between “good” and “bad” implementations separated by roughly ten years, but it certainly looks like a closer comparison than Erlanger:Athens:Ventura.

  17. Re: Obfuscator…not sure how giving you what you asked for — a list of many products and services that Cerner offers and Epic doesn’t — equates to spinning, but it seems pretty clear you are not actually interested in “facts” and don’t know enough about the topic to have a reasonable conversation about it. Your moniker is quite apropos.

  18. This banter is futile. Perhaps Mr H could find a health system that converted from Epic to Cerner or Cerner to Epic, and just establish which was more expensive.

  19. Well we are about to see an Epic to Cerner conversion at University of Arizona Medical Center (now Banner). I would love to know how much money was thrown at Epic since the disastrous launch in 2013 and how much of that is a complete waste after Banner uproots Epic and replaces it with Cerner.
    I hear Partners (Mass Gen) is having a great time with their Epic launch. Will be interesting to see how that all works out.

  20. Mr Histalk why don’t you do 10 mins of investigative journalism and find out what the Cerner proposal for Erlanger amounted to? My guess is something in the half of that $200M from Epic.

    [From Mr H] It wouldn’t be an apples-to-apples comparison (internal staffing costs, most notably) without seeing both proposals and I can say with 100% percent certainty that the Epic one will not see the light of day — I’ve tried to get their executed customer contracts before (even using the Freedom of Information Act for government-owned facilities) and their legal team and contract wording makes that impossible unless you’ve got a lot of time and lawyer money, which no one to my knowledge has ever done without getting a document that is 75% redacted.

  21. Epic doesn’t have bed management or patient flow? They do, although reporting isn’t so hot, like everything else Epic. Some of the other apps, there have long been stories about why Cerner has them, and not flattering stories.

  22. That’s only somewhat true. if you know the capital and operational spend for Epic and you have the Cerner numbers you at least know what the hospital looked at correct? I agree you won’t have a true apples-to-apples comparison but those numbers would be compelling either Cerner is over and I’m wrong or Cerner is under and…

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