HIStalk Practice News 8/26/14

Top News

The DoD issues the multi-billion dollar DHMSM RFP to replace many of its legacy healthcare IT systems, including the Armed Forces Health Longitudinal Technology Application (AHLTA), Composite Health Care System (CHCS), and the majority of the Theater Medical Information Program-Joint (TMIP-J). The department expects to select the solution in the third quarter of 2015, with initial operation beginning in the Pacific Northwest in 2016 and other regions added in waves. The new system will enable the DoD to share health data between the VA and private sector, ultimately supporting 9.6 million DoD beneficiaries and over 153,000 military health system personnel.

This news makes me even more eager to tune into the HIStalk mid-day webinar on September 18 featuring DoD insider Dim-Sum, who will describe the DoD’s healthcare reach, current systems, relationships with contractors and other government agencies, and selection process. Stay tuned for registration details.

HIStalk Practice Reader’s Survey

Thanks to all who took the time to fill out the annual HIStalk Practice Reader’s Survey, not to mention those that tacked on an encouraging or welcoming comment. I was pleased to see that 36 percent of respondents work for a health system or physician practice, and a majority of those are providers with purchasing authority (good news for our sponsors and a good indication of the type of news to keep covering). One such reader noted that he or she “picked a new EHR mainly on the basis of information gained here.” (And no, I didn’t make that up.)

News, rumors, and humor top the list of what readers enjoy most about HIStalk Practice (though one respondent did comment that it has become a bit too stuffy). Over 75 percent of respondents noted they have a higher interest or appreciation for companies when they read about them here, and that reading HIStalk Practice has helped them better perform their jobs. Both of those statistics correlate directly with many write-in comments like these:

“Sharing the rumors or news with my executives makes me look like I am ahead of the curve.”

“Kept me in the know, gave me some relevant talking points I could share with leadership. Now I am recognized as someone who is abreast of what is going on in the industry.”

I’m not one to shy away from constructive criticism, and appreciate readers sharing their thoughts on how we can improve coverage. More humor seems to be on the radar of many respondents, so I’ll do my best to keep things light where appropriate. Other suggestions that piqued my interest include:

• Coverage/recommendations of practice-centric healthcare IT trade associations.
• Quarterly recaps of “hot” industry topics and developments.
• How to best utilize clinical decision support.
• Ambulatory healthcare IT coverage from a government insider’s perspective (thankfully, we’ve got Micky Tripathi back on board).
• Interviews with practices dropping out of Meaningful Use.
• Talk to an ambulatory Epic user about strengths and weaknesses.

If you are an expert in any of the above areas, please drop me a line and let me know if you’re up for an interview or the role of guest contributor. Our rumors and interviews are only as juicy as the industry insiders who provide them!

Acquisitions, Funding, Business, and Stock

The state of Vermont signs a revised contract with Optum to the tune of $9.5 million for additional work on the Vermont Health Connect health insurance exchange. Optum will help the state prepare for open enrollment on November 15, and assist it in transitioning away from CGI, whose contract is up on September 20. Optum will continue to fulfill its $5.6 million contract for consulting work at VHC customer service call centers.

Beedie Capital Partners commits to investing $3.5 million in Nightingale Informatix Corp., which develops the Nightingale EHR and related software services. The company plans to use the investment to launch Nexia, its next-generation EHR platform.

After a rough week in which a data center outage caused unplanned downtime for its customers, Practice Fusion announces it will partner with online appointment booking and patient review site Vitals. Patients who visit the Vitals site will now have access to physicians who use the Practice Fusion EHR and consumer-facing website Patient Fusion. Those physicians will in turn have greater exposure to those potential patients.

Government and Politics

A British newspaper points out the correlation between suits and T-shirts when it comes to productivity at the White House, shining a spotlight on Mikey Dickerson, head of the new U.S. Digital Service. “People want to know if I’m wearing a suit to work every day,” Dickerson said. “Because that’s just the quickest shorthand way of asking: ‘Is this just the same old business as usual or are they actually going to listen?’” Dickerson seems to have his wits about him on his first day at the new job, as the short video above shows, though I’m surprised the ubiquitous can of Red Bull was nowhere to be seen.

ONC Coordinator Karen DeSalvo, MD alerts followers to the fact that National Health IT Week will be held September 15-19, and will revolve around advocacy activities planned largely by HIMSS. Am I right in thinking physicians in the trenches will not be observing the festivities this year?

Announcements and Implementations

Telemedicine kiosk company HealthSpot announces it will install 100 kiosks in community pharmacies across Ohio. The company will target locations that have high ER visit rates and long wait times using information culled from patient focus groups and claims data analysis conducted with CareSource, a health plan that serves 1.2 million consumers in Ohio and Kentucky. (You can read the HIStalk Connect interview with HealthSpot founder and CEO Steve Cashman here. It would seem Cashman has not quite given up on retail clinics, which he is less than enthusiastic about in the interview.)

CarePoint Health System (NJ) selects the eClinicalWorks EHR for its 45 medical practices. It will also utilize eCW’s Care Coordination Medical Record for population health management.

People

Todd Park will reportedly step down as US CTO but will remain a White House employee, moving back to the Silicon Valley to work on brokering relationships between technology companies and the federal government.

Research and Innovation

The Washington Post delves into the impact consumer-generated health data has on public-event and -health reporting. Jawbone’s chart on sleep patterns during the recent California earthquake shows not just what time the quake hit, but also paints a picture of the collective anxiety many users felt for hours afterwards. FitBit is also in on the trend as it attempts to sell its devices to large corporations, promising aggregate group reports on things like how far employees walk and how much they exercise.

Other

Wearable technology company OMsignal and Ralph Lauren partner to outfit ball boys (and presumably girls) at the U.S. Open with connected shirts that broadcast their vitals to a smartphone or display. Given that I am one among many who has ditched a wearable activity tracker shortly after receiving it, I see the commercial allure of skipping accessories altogether and heading straight for apparel. The $200 price tag, however, would definitely give me pause should I ever be in the market to wear something like this to my next ALTA match.

Mr. H has covered the healthcare IT vendor side of the ALS #IceBucketChallenge, so now it’s my turn to showcase the viral attempts of providers. Staff at South Dakota-based Pro Motion Physical Therapy and Black Hills Neurosurgery & Spine take the challenge, and pledge to donate $100 per employee to the ALS Association. They have also officially challenged Black Hills Surgical Hospital, Black Hills Orthopedics, and Black Hills Urgent Care to take on raising awareness of the disease.

A professor at the University of Michigan makes the case for data visualization as a better way for the average patient to understand lab results. Having logged into a few patient portals to view lab results, I tend to agree with his opinion that, “The present situation, in which patients are given direct access to their lab test results in highly numerical tables, is a poor status quo. If we are going to spend money making sure that patients can see their results, we have an obligation to change the way we display them by making the format more intuitive.”

Recently released data from South Korea’s National Tax Service show that companies in that country spent just over $8.5 billion on entertainment expenses between 2009 and 2012. Given that budgets for fall conference season and HIMSS 15 are likely already set, it would be interesting to hear from readers just how much money the healthcare IT complex plans to spend on wooing its customers.

Sponsor Updates

• Atlanta Gastroenterology Associates chooses Greenway PrimeSUITE EHR/PM.
• Hayes Management Consulting is named to Modern Healthcare’s 2014 Best Places to Work in Healthcare list.
• NextGen’s NextGen Share solution achieves full DirectTrust accreditation from EHNAC.
• Kareo executives complete the ALS #IceBucketChallenge.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

5 Questions with Alyson Tiedeman, Director of Practice Management, South Florida Medicine

Alyson Tiedeman is the director of practice management at South Florida Medicine, a large multispecialty group of over 100 physicians in urology, oncology, surgery, surgical oncology, thoracic surgery, and radiation. Tiedman oversees contracting and credentialing, implementations and on-boarding, integration and training, billing and revenue cycle management, practice management, financial infrastructure, accounting, banking and cash management, as well as the operations and administration of SFM’s 70 locations.

What sort of IT challenges arise with a medical group of SFM’s size? How do you ensure everyone is on the same page when it comes to moving forward with healthcare IT projects, and improving patient experience and clinical outcomes?
Some of our practices are still on paper. Even though we encourage them, we do not mandate that a practice leverages our IT infrastructure. This can present challenges as we look to implement greater connectivity strategies. Today, the majority of our practices have an EHR (there are currently seven different systems in use), and all of our practices are required to use our centralized billing services. SFM has also implemented a best practice in which we measure the success of both our central billing office and CareCloud PM system against a set of core billing and collections metrics. Monthly tracking of first-pass pay rates with payers and days in accounts receivables are not just critical for the overall success of the practice, but for the successful retention and recruitment of member physicians.

How much control does SFM give its physician members in terms of selecting healthcare IT systems?
SFM has embraced a flexible business model that allows physician members to leverage a common administrative and IT infrastructure. SFM’s hybrid IT model has allowed our group to expand rapidly, while negotiating better payer contracts for our members and gaining predictability around administrative costs along the way.

To be a successful group, you need to be able to offer choices to member physicians, especially when you support as many specialties as we do. Meaningful Use has been one of the key drivers of this for our group and getting our members to adopt IT and use it successfully.

Why did SFM decide to move to a centralized cloud-based PM system? Was each location using its own system prior to adopting CareCloud?
SFM has found that one size may not fit all when it comes to IT infrastructure; however, there are certain aspects of the business that need to be standardized, especially for compliance purposes. Given the diversity of our member practices and the speed with which they have joined, SFM offers a flexible model by which members can still choose to use their existing EHR system. At the same time, members can opt to have SFM handle revenue cycle management or stick with their current billing and collections staff. With CareCloud’s technology at the heart, disparate solutions can be integrated into the common platform so all parts work together seamlessly.

What’s next in terms of technology implementations for the practice?
Currently, we want to have all of our practices using an EHR as that lends to stronger clinical outcomes and overall operational benefits. All of our practices are required to use CareCloud’s PM system as we bill under one tax ID, and this helps facilitate that for our group.

It seems that a medical group of this size might be able to tell a compelling story for health information exchange. How are your physicians sharing information amongst each other, local hospitals, and beyond? Is SFM formally plugged into a HIE in Florida at the moment?
Although we encourage HIE for our group, we are not formally involved on the multispecialty side. However, our member physicians do exchange clinical information with outside clinicians and care delivery organizations, and are therefore very much involved in HIE.

Bonus Question: What benefits have you seen result from smaller physician groups joining SFM, especially with regard to healthcare IT?
With the direction that healthcare is going, the trends have changed and a small, one-to-five physician practice can find it very difficult to thrive in this environment, especially with ongoing Medicare cuts. Combining forces leads to many benefits, such as increased profitability by way of reduced overhead costs (IT and otherwise), higher payer contacts, better supply rates, increased referral sources, and the overall support and expertise of a bigger organization, just to name a few.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

HIStalk Practice Interviews Baha Zeidan, CEO of Azalea Health

Baha Zeidan is co-founder and CEO of Azalea Health.

Describe how Azalea Health came to be, its current target market, and your role at the company.
Azalea was started by three founders, including myself, who worked at a regional medical laboratory company. In this role, I had the opportunity to work with many EHRs during the process of interfacing lab results and orders with physician EHRs. We noticed that most EHRs in the industry were clunky, and physicians had a hard time understanding how to use them because they did now follow their workflow.

In 2007, we recognized the opportunity to build a healthcare IT solution that would be truly cloud-based and as simple to use as an email tool. We offer a complete solution that integrates easily with existing systems.

Our target market has been focused on physician offices in small towns and rural areas. Our clients typically don’t have the resources or expertise to implement EHR and billing technologies that are now required by the Affordable Care Act. We help them with their workflow, revenue cycle, and compliance with government regulations like Meaningful Use and ICD-10.

I am the CEO and co-founder, and in this role I am responsible for driving the strategic direction of the company. With my team, I ensure Azalea Health is on track to meet its product development, customer service, and performance goals, as well as community goals. I have also, in many ways, become an ambassador for Azalea Health in our local community and in the healthcare IT community. Although I am the CEO and the visionary, every single person on the team has a say and contributes to our direction and success.

What is the status of the Azalea Health / simplifyMD partnership? Isn’t it really more of an acquisition on the part of Azalea Health?
Azalea Health has acquired and merged the simplifyMD team with our team. We are thrilled that simplifyMD customers are joining the Azalea family. simplifyMD customers will now benefit from an even greater variety of solutions and expanded capacity to support their needs. Azalea Health benefits from the addition of the highly talented simplifyMD team. It’s been a smooth transition and we are all excited about our future opportunities.

The current simplifyMD Atlanta office will continue to be in the Atlanta area. Azalea Health has its main office in Valdosta, Georgia, with satellite offices in Macon, Georgia and Gainesville, Florida. simplifyMD staff will not have to re-locate to Valdosta. We see the company as strengthening sales operations out of Atlanta with support and product development mostly in Valdosta. 

One of the great benefits of this merger is how well the products complement each other. The product teams are working to interface products immediately and to determine the combined product road map.

Mike Brozino, simplifyMD’s former president and CEO, will continue to provide guidance and input in an advisory capacity. As the transition occurs, management team and roles will be determined and announced. We will continue to use Azalea Health and simplifyMD names and branding during the transition.

It seems that the EHR market, especially vendors that serve smaller practices, is living up to predictions of consolidation. What do you foresee your part of the market doing over the next three to five years? Are additional acquisitions in the company’s future?
You are absolutely right on your consolidation view. Actually, the recent transaction of Azalea and simplifyMD is a testament of that consolidation. The market is still highly fragmented, and companies with simple/scalable end-to-end solutions and with excellent customer service will continue to win.

I also foresee that physicians will start to work more with a vendor that can help them not only with the EHR software, but also with how to navigate the complexity of the financial side of our healthcare system.

We see ourselves as a leader in the industry, and we will continue to focus on growing our customer base organically and through mergers and acquisitions.

When do you think the replacement market will settle down? What do you think Azalea Health’s role will be once this happens?
Healthcare software is going through a major revolution, likely accelerated by healthcare reform. We see customers that are on a third replacement of their EHR. This trend will likely continue through the next decade as vendors attempt to keep up with the constant changes in ICD-10 and Meaningful Use.

Some vendors have not prepared their solutions to keep up with rapidly evolving payment changes, and many will have difficulty in providing mobile applications for the providers and their patients. Also, as healthcare is becoming more and more interconnected, you will see some vendors not able keep up with the interoperability needed between systems – mobile, wearables, and clinical devices.

What are your customers’ biggest challenges at the moment with regards to healthcare technology?
Innovation and government regulation are causing healthcare technology to be in a constant state of flux. Navigating through the regulatory environment while simultaneously taking advantage of the most recent advancements from cutting-edge solutions is a daunting task for physicians and hospitals.

Providers are challenged by increasing costs, reduced reimbursements, escalation of regulatory oversight, and a need to ensure that their patient’s private health information remains private, all while providing the best quality of care possible. Our philosophy is to reduce the complexity of operating a medical practice by streamlining clinical and financial workflows, and providing services that assist with maintaining compliance and ensuring that the practice is adequately reimbursed for the services provided.

Have you seen any of your customers drop out of Meaningful Use, or avoid it altogether? Why have they done so, and has this been the best business decision in the long run?
We do see physicians dropping out of Meaningful Use, and we still see some that are avoiding it altogether. Some of them have avoided it because they see it as another layer of complexity in accommodating Stage 2, and they don’t see the advantage in doing more for less incentive.

Some are still on the fence thinking that they have a few more years to practice and maybe they’ll be able to dodge Meaningful Use altogether. This has not been a good decision for them for many reasons. More patients want to be engaged with their healthcare, and they are demanding that their clinical information be available electronically. Second, more providers are wanting to electronically send referrals and clinical data between health systems to different providers. Third, the healthcare payment system is going through changes (ICD-10, pay for performance, pay for outcome, pay for reporting). Those changes can be much easier to adopt if the provider is using a certified EHR and participating in Meaningful Use.

What are the company’s plans for next-generation product features? How will you ensure Azalea Health’s products stand out from the rest?
Azalea has a patent pending on “collaborative charting.” We are excited about this concept, which allows healthcare providers to collaborate in real time on a patient chart and see what each healthcare provider is documenting about the patient.

Also, we are very thrilled about our future mobile development. The next generation EHR is lightweight and mobile-focused. I can go on and on about our future development, including more tools for telemedicine – a key differentiator for us, as well as enabling device makers, patients, and other systems to easily and securely connect with the Azalea platform.

What is the company doing to foster innovation in your area of healthcare IT? Any future hackathons planned?
We had great success earlier this year with our first Azalea-sponsored hackathon in cooperation with local colleges and universities. We are making this an annual tradition. Also, we are planning this year on hosting an internal hackathon within the Azalea Research and Development Team!

Our VP of Technology, Duncan Kabinu, is starting a continuous learning and collaboration program within our R&D team that will look at potential innovations in new technologies, and not just those in healthcare. We’ll look to see how other industries have solved problems, and how we can learn from and apply those solutions in healthcare.

How do you see your customers responding to increased industry interest in telemedicine? Do you anticipate Azalea Health making a play in that area in the near future?
Telemedicine has been part of our strategy for several years. We have a project underway in which we are implementing the Azalea EHR in 40 schools in South Georgia in collaboration with the Georgia Partnership for Telehealth. This effort will help those schools use telemedicine in the school rather than taking the student patient out of school to see a provider or specialist.

We are also working on providing real time video chat within our platform to enable telemedicine and patient engagement. 2015 will be very exciting year for us, as we will continue to provide innovative tools for telemedicine and help connect rural patients with specialists from anywhere in the country.

It seems the company has a number of community service endeavors. Is there one service project in particular that has left a lasting impression?
Azalea Health has its roots in rural Georgia (Valdosta). We have been a huge supporter of United Way local projects. However, the most interesting and longest lasting projects we are involved in are related to helping our local schools, technical colleges, and state universities. We mentor interested students in programs designed to educate them about healthcare IT to help build and foster a local workforce that will fill our need for future innovators in the healthcare IT industry.

Any concluding thoughts?
The healthcare IT industry is going through a lot of change. It’s been very exciting to be able to help providers navigate those changes, and provide them with solutions that encourage them to focus more on patient care. Also, it is an honor for Azalea to be a company that helps patients learn more about their condition, while engaging them with their providers, and ultimately improving their overall healthcare.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

News 8/21/14

Top News

After some industry speculation and a trade group letter-writing campaign, CMS confirms it will withhold until next June nearly one-third of submitted records on drug and device industry payments to physicians and teaching hospitals because of suspected inaccuracies with data included on its Open Payments website. The agency will move forward with plans to make the site accessible to the general public by September 30, and has extended the review period to September 8.

HIStalk Practice Announcements and Requests

Don’t miss the following HIStalk webinars:

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This webinar will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results. 

Acquisitions, Funding, Business, and Stock

Telemedicine Solutions company Avizia closes an equity funding round led by NextGen Angels, Blu Venture Investors, and Middleland Capital. The company will use the investment to further expand its sales channels, extend its product line, and grow market awareness. The company also announced that Edward Kennedy (Tollgrade Communications) has joined its Board of Directors.

Private equity firm Apax Partners LLP is looking for a buyer for payer and revenue cycle vendor TriZetto, according to rumors. Apax took TriZetto private in 2008 for $1.4 billion and hopes to sell it for up to $3 billion. TriZetto made $190 million in profit in the most recent fiscal year.

Investment company HealthQuest Capital closes its debut fund to the tune of $110 million, more than double its original target. The company is looking to invest in such target sectors as healthcare IT, mobile health, patient care products, consumer health, diagnostics, and medical devices.

A Baltimore technology site profiles Maven Medical, an eight-employee startup that offers a medical procedure price transparency app to help doctors choose cost-effective tests based on average Medicare reimbursement rates.

Cerner comes in at number 22 out of 100 on the Forbes list of the World’s Most Innovative Companies. Salesforce claimed the number-one spot for the fourth year in a row. It will be interesting to see whether the Siemens acquisition will help or harm Cerner in next year’s rankings.

Announcements and Implementations

Denton County, Texas commissioners approve a new $95,000 EHR system from eClinicalWorks that will consolidate and enable easier access to records from all of the county’s health services. The county expects to go live on the new system in a few months.

CDC selects Dell Services to provide it with IT infrastructure, application, and user-support services as part of a five-year, $120 million Information Technology Infrastructure Support Services contract. Dell has worked with the federal agency in a similar capacity for the last 11 years.

Government and Politics

A judge rules that Iowa regulators were within their authority when they voted to ban a first-in-the-nation videoconferencing system that allows urban doctors to dispense abortion drugs to women in rural clinics. Planned Parenthood of the Heartland (IA) started using the system in 2008. More than 6,400 women have used it to obtain abortion pills at outlying clinics, mainly in rural areas. Planned Parenthood has announced it will likely file an appeal.

Registration is now open for ONC’s 4th Annual Consumer Health IT Summit, taking place September 15 in Washington, D.C. Confirmed speakers that caught my eye include Mark Heaney of Get Real Health, Laura McCrary of the Kansas Health Information Network, and patient Alexis Barries.

Research and Innovation

Greenway Health is granted a patent for billing and claims generation in clinically driven revenue cycle management. The patent applies to “location-driven bill coding,” and will enable the company’s PrimeSUITE EHR to automatically assign an allowed service cost consistent with the payer fee schedule for that physician’s location.

Apple is granted a curved touch display patent, which it originally filed for in 2010. Industry insiders expect the patent pertains to development of the iWatch, or a similar wearable or fitness-tracking device.

People

Duke Reilly (Pfizer) joins Amazing Charts as director of industry business development.

Tom Skelton (Foundation Radiology Group) joins Surescripts as CEO.

Other

Alaska Public Media reports on the regulatory burdens facing many small practices in the state. Independent physician Oliver Korshin, MD attempted to apply for an exemption out of the Meaningful Use program due to the financial hardship his practice would face. When selecting an exemption category, the 71 year-old said, “The only one that possibly applied to me was disaster. So I picked disaster and I described my disaster as old age and I submitted as my supporting document a copy of my passport.”

Practice Fusion responds to recent media coverage of its two-day outage, telling Politico that, “Last week, Practice Fusion’s platform was never down, but its third-party data center provider, QTS, experienced 512K issues with their primary and secondary networking equipment.” Two days without access to digital patient records left many of the company’s 112,000 customers understandably frustrated, as evinced by comments culled by Mr. H and this story on affected physician practices.

Sponsor Updates

• Billian’s HealthDATA discusses five hospital hiring trends in the C-suite.
• South County Radiologists (MO) selects McKesson Business Performance Services for its 14-physician practice.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

Pretzel Logic 8/20/14

EHR Musical Chairs

As EHR use grows across the market, we see the replacement market starting to grow, too. Depending on whom you believe, the EHR replacement market could range from 40 to 80-plus percent of existing users. (The latter seems like a stretch, but to paraphrase John Maynard Keynes, in the long run we’re all dead, which I suppose applies to EHRs as well as people.) There is obviously a large and looming replacement market in front of us, and one characteristic that separates replacement customers from first-time buyers is that they are more seasoned (embittered?) and are usually adamant about not repeating the youthful indiscretions of their past.

Until recently, it’s been hard to find hard industry data on trends like EHR replacement. There are plenty of places to go for advice on how to manage EHR replacements, but the pickings are pretty sparse (OK, barren) when it comes to real data on the buying behavior of seasoned EHR users. It’s worth noting that the one thing the Meaningful Use program has given us is better industry data than we’ve ever had before. Jamie Stockton’s excellent analyst reports for Wells Fargo Securities offer some really fresh insights on industry dynamics using CMS data (a testament to the benefits of opendata.gov and crowd-sourcing). A professor of mine used to say that there is no Geneva Convention for data, and it’s fair to say that Jamie and his colleagues have sadistically extracted a lot of confessions from the CMS Public Use Files on MU attestation.

The Wells Fargo EHR replacement report (referenced in HIStalk) looks at the results of 6,000 physicians using over 500 EHR systems who attested to MU in 2011 or 2012 and then switched to a different vendor in 2013. These 6,000 physicians represent about 4 percent of the total physicians who attested during that time period and represent an early view of the choices being made in replacing one EHR with another.

One of the most interesting pieces of information in the report is head-to-head analyses between different EHR vendors – which systems are people running from and which systems are they running to? The data is in the report, but it takes a little work to calculate, and I’m guessing that few people have the time to drill into the data to this level. Luckily, I’ve done the work for you, and here are my conclusions:

There is growing consolidation in a smaller set of vendors.

• Physicians used over 500 vendors for MU in 2011/2012. Yet, relatively few of these vendors had net gains among physicians switching vendors, with the biggest gainers being Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
• Over 50 percent of all physicians who changed vendors switched to these five vendors.
• The number of certified EHR systems has dropped almost 60 percent from MU Stage 1 (about 3,800) to MU Stage 2 (about 1,600). (I got this from the ONC CHPL site, not from the Wells Fargo report.)

Physicians fled from small vendors.

• Over 2,000 of the physicians who switched EHRs went from a small vendor to a larger, established vendor

Everyone except Cerner lost customers to Epic.

• Cerner was the only vendor to have a net gain against Epic.
• The biggest losers to Epic were NextGen, GE, and Allscripts.

Athenahealth and eCW both lost to Epic. They fought each other to a draw, and both made significant gains against smaller vendors.

• Athenahealth and eCW each lost two physicians for every one they gained from Epic.
• Athenahealth and eCW lost as many as they gained against each other.
• Athenahealth and eCW took more customers from small vendors than any other vendors, even Epic.

Physicians left Allscripts more than any other vendor.

• Allscripts had the biggest net loss of physicians among all 500+ EHR vendors.
• Allscripts lost head-to-head against every major vendor except McKesson.

I should note that there are limitations to this data. It covers only physicians participating in Meaningful Use, and it addresses only the market for replacement EHRs, not the entire market. And, while 6,000 physicians sounds like a big number, once you slice and dice the data down to the EHR-vs-EHR level, the numbers can get pretty small and thus less statistically reliable. I don’t want to make too much of this data, but to ignore it would be to make too little of it.

Is this data consistent with broader trends we’re seeing in the market? Darned if I know, but I’ll give it a shot.

1. The industry is slowly starting to consolidate on a smaller number of vendors. The financial injection of Meaningful Use Stage 1 put the market on steroids for a while, with lots of new EHR companies forming overnight to meet surging demand, but the inevitable industry shakeout now seems well underway. It’s unclear whether this is mostly a supply-side phenomenon (i.e., failures of startup vendors whose flaws were masked by MU dollars) or a demand-side phenomenon (i.e., physicians choosing to move to a smaller set of vendors, or hospital consolidation driving physicians to their enterprise vendor). Regardless, technology life cycles in every industry follow similar patterns. There is lots of product innovation at the outset, but the market eventually settles on a smaller set of dominant models that narrows market choices but enables more industry standardization. Process innovation starts to dominate over product innovation as users feel confident about investing in new organization processes that embed these new technologies. Which brings me to point #2.

2. There is growing separation between the enterprise EHR segment and the retail, small-practice EHR segment. With growing consolidation in ambulatory healthcare delivery from hospital acquisition of physician practices, as well as ACO formation, EHRs are increasingly being run by hospitals and ACO-like organizations who are trying to engineer fundamental process innovation for accountable care and patient-centric care. Are these still mostly just buzzwords? Yes, definitely. But an EHR vendor who doesn’t have management, products, and services to meet the needs of a complex array of enterprise users – such as IT, care and quality management, revenue cycle, security and compliance, and C-suite – doesn’t stand a chance in the enterprise space and may as well just focus on the market for small, independent physician practices. I got to peek over someone’s shoulder at a recent KLAS report on EHRs in the large practice space (11-75 physicians) that rated products not only according to what clinicians think, but also according to what IT and C-suite personnel think. More often than not, vendors that did well with clinical users did not do so well with IT and C-suite personnel, and vice versa. Athenahealth, Epic, and Greenway stood out as the only vendors who scored solid cross-enterprise ratings. Increasingly, EHR purchasers are in enterprises, and they value staff maturity and accountability, project management, product stability, and user support at least as much as nice user interfaces. In addition, clinicians within these enterprises seem to be gaining more respect for their IT and administrative counterparts as they become aware that those nice user interfaces are really ugly when they’re slow or unreliable.

3. Epic and Cerner seem to be moving ahead of the pack in reaching down into the enterprise ambulatory segment, while athenahealth and eCW seem to be battling it out in reaching up into the enterprise ambulatory segment. It’s unclear whether it’s better to start with a hospital product and step it down into the large ambulatory space, or start with a small office product and scale it up into the large ambulatory space. Deeper integration with hospitals than just lab results delivery is a fundamental requirement in this space, so the larger hospital vendors have a leg up there, as well as in their experience working with professional IT and administrative staff. The ambulatory vendors have the hearts of many clinicians though, which is important, but as noted above, will only go so far if they can’t scale their management and technology to work in higher-level settings.

4. If you’re an enterprise purchaser, your choices are mostly limited to a relatively small set of mature vendors. There are hundreds of EHR systems out there, but how many of them are backed by mature and robust implementation processes, deep technical bench-strength, strong support teams, and administrative features to centrally manage multiple practice EHRs? That takes more than a few Ruby programmers and a year’s supply of Mountain Dew. In looking to buy or replace an EHR, put a lot of emphasis on testing the vendor staff’s depth, experience, maturity, and professionalism. They will support you in the face of the unexpected, which in healthcare these days is just around the next bend.

5. If you’re a small-practice purchaser, you have more choices, but buyer beware. The small practice space is where a lot of product innovation will still take place for some time to come, but that comes at a price – lots of small vendors who are incredibly creative on the technology side don’t have the scale or backing to provide a lot of development and user support. That may be fine, because as a small practice your needs are easier to support because you don’t need complex interoperability, or population health, or IT administrative control, or high-powered analytics. You still want a vendor who will come running when you’re down and who will be around in the years to come, so don’t get too dazzled by shiny screens with no real people behind them.

It’s amazing what conclusions one can draw from a little data and a lot of artistic license! As more data is released by CMS, I’ll be sure to steal more insights from Wells Fargo Securities’ data analyses and share them with all of you.

Micky Tripathi is president and CEO of the Massachusetts eHealth Collaborative. The views expressed are his own.

Contacts

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

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