Tag Archives: EHR

4 Health Care Lessons the U.S. Can Learn from Top-Performing Countries

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http://www.commonwealthfund.org/publications/lists/2017/4-health-care-international-lessons?omnicid=EALERT1254143&mid=henrykotula@yahoo.com

The recent Commonwealth Fund report, Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care, compared health care system performance in the United States with that of 10 other high-income countries. The U.S. ranked last in overall health system performance, yet as a nation we spend the most per person on health care. What can we learn from the top-performing countries? Report coauthors Eric C. Schneider, M.D., and David Squires discuss areas where the U.S. can improve in a New England Journal of Medicine “Perspective.” Here are four takeaways:

1

The best-performing health systems use universal coverage to ensure that everyone has access to care.

The United Kingdom, Australia, and the Netherlands provide universal coverage and very low out-of-pocket costs for both preventive and primary care.

2

Strengthening primary care is key to high performance.

Top-performing countries make primary care widely available, so that patients can get health services when they need them. Primary care services are available not just during regular business hours, but also at night and on weekends.

3

Streamlined payment and electronic record systems help patients and doctors.

In the U.S., health professionals and patients spend countless hours trying to sort out what benefits and services are covered by insurance and tracking down payments. The payment systems in other high-income nations use approaches such as paying providers a fee for comprehensive care of patients and standardizing lists of covered benefits and prescription drugs to make choices easier for both patients and doctors.

4

Spending more on the social safety net can reduce disparities in the delivery of care.

Compared to other countries, the United States spends relatively less on social services like affordable housing and transportation and more on medical services, even though research shows that social spending can improve the health of low-income patients, potentially reducing use of costly medical services.

Most Significant Epic, Cerner Health IT Achievements of 2017

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Epic EHR, Cerner EHR

 

Epic and Cerner continue to dominate the healthcare industry and this year the two health IT companies have made key additions to their portfolios.

Epic Systems and Cerner Corporation solidified their status as top dogs in the health IT industry in 2017.

Both health IT companies scored massive contracts this year, with Epic continuing to gain popularity among the private sector and Cerner expanding its presence in the public sphere.

Cerner and Epic have also found success expanding their health IT offerings into other areas of care management, including population health and revenue cycle management. The companies have proven their ability to stay ahead of the curve by continuing to add more products and technologies to their arsenal in keeping with developments in the industry.

Over midway through 2017, here are a few of the most significant achievements of the year by the biggest players in health IT:

EHR installs carry huge financial risks, Moody’s says

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Hospitals run the risk of incurring operating losses, lower patient volumes and receivables write-offs if there are problems, Moody’s says.

Rolling out new electronic health record systems puts hospitals at a significant risk of financial losses, according to a new report by credit rating firm Moody’s.

“Hospitals run the risk of incurring operating losses, lower patient volumes, and receivables write-offs if there are problems with adoption of a new EMR system,” Moody’s said in its Monday report.

Add to that the operational and financial disruptions that typically accompany complex IT projects, and hospitals could find themselves walking an even thinner financial margin than they are used to, Moody’s said.

“In a sample of hospitals that have recently invested in major EMR and revenue cycle system conversions, increased expenses and slower patient volumes contributed to a median 10.1 percent decline in absolute operating cash flow and 6.1 percent reduction in days of cash on hand in the install year,” Moody’s found.

The good news is that many hospitals returned to pre-install levels within a year, owing to strong risk management.

When Epic Systems founder and CEO Judy Faulkner talked with Healthcare IT News at HIMSS17 last February, she said Epic customers had done well financially. True, Epic EHR installations cost millions of dollars. However, from 2004 to 2015, she said Moody’s and Standard & Poor’s statistics showed that Epic customers reaped profitability unsurpassed by clients who implemented her competitors’ EHRs.

Despite the risks, hospitals will continue to invest in EHRs, Moody’s said. Hospital executives want to improve patient safety, clinical quality and provide decision support. IT will also continue to be a selling point in physician recruitment and retention, as new data reporting will be required by Medicare for professional reimbursement.

While hospitals may be exposed to a number of risks during massive IT rollouts, the threats that come with cyber attacks make them even more vulnerable, according to Moody’s.

As example, Moody’s points to Hollywood Presbyterian Medical Center in Hollywood, California, which acknowledged paying ransom after an attack in 2016.

Moody’s expects cybersecurity to become an even stronger focus than it already is.

“As IT investments represent a growing portion of hospital budgets, an increasing amount will be allotted to guarding confidential patient data, which make hospitals a prime target for cyberattacks and ransomware events,” according to Moody’s. “We expect cybersecurity to be a primary focus of hospital management teams and their boards, with annual capital and operating budgets allotting appropriate levels of expenditures to protect patient data and testing vulnerabilities.”

Collaboration, Big Data Help Phoenix Children’s Focus on Value-Based Care

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The exterior of Phoenix Children's Hospital in Arizona

Phoenix Children’s collaborative approach to value-based care relies on community input, big data analytics, and a physician-driven quality measurement program.

Mergers, acquisitions, and new partnerships can be a scary prospect for healthcare organizations, no matter which side of the negotiating table they are occupying.

In addition to potential cultural changes, staffing adjustments, and new workflows to adopt, organizations joining forces in the era of value-based care often have to adopt to new electronic health record systems and accept different strategies for measuring their quality, productivity, and outcomes.

While a successful union can rescue revenue cycles, and bring renewed vitality to flagging providers, healthcare organizations must carefully navigate the delicate acquisition process to ensure that new members of the team have the skills and tools required to reach their full potential.

At Phoenix Children’s, one of the largest pediatric health systems in the country, a desire to offer comprehensive care to the community has led to a firm reliance on big data analytics to gather actionable financial and clinical insights from a rapidly growing provider network.

Over the last three years, Phoenix Children’s has brought more than 100 independent practices into the fold, says Chad Johnson, Senior Vice President and Executive Director of the Phoenix Children’s Care Network – and full data transparency is a fundamental requirement for each and every new member of the team.

The ability to use big data analytics to measure productivity, quality, and financial success within a comprehensive network of care will be vital for Phoenix Children’s as it continues an ambitious move into value-based reimbursements.

“During 2017, we’re moving around 100,000 lives into fully risk-based models,” Johnson explained to HealthITAnalytics.com.  “We’re doing this because we believe that the way to truly influence outcomes is to own the medical management of our populations.  Hospitals will need to have a much larger footprint – a larger, integrated network – that includes independent primary care and specialty groups under one umbrella.”

“We want to move aggressively down this path because we feel that unless you’re willing to take that step, you’re never going to be able to really bend that cost curve,” he added. “We’re confident that we can step up to the plate and succeed in a risk-based environment with the strategies we’re cultivating.”

Number one on the list of challenges as the health network shoulders more financial risk is how to accurately and consistently measure quality across so many disparate locations and provider types.

“We’ve had to integrate data from these practices, which are all using a variety of EHRs, and then figure out how to consume that data and present it so that it can be used for optimizing care and to verify quality improvements across the network,” Johnson said.

“We use this data to target interventions, and to improve the management of our populations, our performance on quality metrics, our utilization, and total cost of care.  That data becomes the number one essential driver of many of the decisions that we’re going to make within our pediatric health enterprise.”

Cerner, Epic, McKesson Among Top 5 Global Health IT Vendors

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EHR Vendors

IDC ranks Cerner, Epic, and McKesson Technology Solutions among the top 5 largest health IT vendors to healthcare payers and provider institutions.

The winners of the IDC Health Insights 2017 HealthTech Rankings released this week named Cerner, McKesson, and Epic Systems among the leading global health IT suppliers.

IDC Health Insights supplied the rankings indicating new benchmarks for health IT hardware, software, and services vendors.

Among the top five largest health IT companies worldwide are Cerner, Epic, and McKesson. This list is the second annual global revenue ranking by IDC Health.

The 2017 HealthTech Rankings comprise the following two lists:

  • The Top 50 features the largest companies that derive more than one third of their revenue from healthcare payer and/or provider institutions. The largest of the Top 50 companies is Optum, a subsidiary of UnitedHealth Group.
  • The Enterprise Top 25 features the largest companies that derive less than one third of their revenues from healthcare payer and/or provider institutions. The largest of the Enterprise Top 25 companies is IBM.

Cerner was listed as the second largest vendor in the HealthTech Top 50.

GE Healthcare ranked third, McKesson Technology Solutions came in fourth, and Epic Systems ranked as the fifth largest health IT vendor to healthcare payers and providers worldwide.

“IDC Health Insights is excited to release the second annual HealthTech Rankings,” said Research Vice President for IDC Health Insights Lynne Dunbrack. “These global revenue rankings offer a valuable industry benchmark of the leading global technology and service suppliers within the healthcare payer and provider services industry.”

The top five largest vendors listed in the HealthTech Enterprise Top 25 in descending order were IBM, Royal Philips, Siemens, Intel, and Microsoft.

A recent KLAS global EHR market share report similarly named Epic and Cerner among the EHR companies enjoying the highest level of worldwide success across the industry in 2016.

While Cerner maintained its hold as a top contendor, Epic Systems and InterSystems gained more clients than any other EHR vendor last year due in part to the technologies’ vast scope of functionalities and usability.

Epic and InterSystems both boast a wide array of functionalities and user-friendly technologies, but InterSystems won more contracts last year due to its more affordably priced product packages.

However, Epic contracted 8,190 beds in 2016—3,000 more than the next closest competitor.

While Cerner was less lucrative abroad in 2016 than it has been in years past, the vendor still earned the majority of the market share in foreign markets including the Middle East.

The recent spike in contracts for EHR vendors both within the US and abroad are indicative of the widespread adoption of EHR technology in healthcare systems around the globe.

EMR v. EHR: Electronic Medical, Health Record Differences

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The differences between EMR and EHR have largely eroded but speak to the maturation of health IT use among providers.

The terms electronic medical record (EMR) and electronic health record (EHR) have become widely synonymous, but they did not start that way and some still argue that a distinction between is necessary to restate.

Healthcare organizations and providers have a greater tendency to still use EMR when discussing the health IT system in use by clinicians in the treatment of patients, but many have gravitated toward saying EHR when describing this technology. And there is ample evidence to suggest that the shift is the byproduct of a nationwide effort to promote health data exchange and interoperability.

While EHR is common parlance nowadays, that was not always the case. With EMR usage waning for a large portion of the healthcare industry, an understanding of the EMR/EHR difference demonstrates how far the industry has come — and the progress still needed to be made.

Top 10 MACRA Considerations for Providers

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Most physician practices are running a race against time to implement Medicare’s value-based payment system, survey data indicates. They have a lot to think about as they go about it.

As Medicare’s reviled Sustainable Growth Rate (SGR) formula for physician reimbursement fades to extinction, its replacement, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, is posing a new set of challenges.

This week Black Book Research identified 10 of the top MACRA challenges that physician practices are facing. The survey is based on responses from 8,845 physician practices collected from February to April.

1. MIPS compliance technology: Physician practices are seeking technological solutions to help them achieve reporting compliance, with 77% of practices that have at least three clinicians mulling the purchase of Merit-Based Incentive Payment System Compliance Technology Solutions (MIPS) software.

2. Electronic Health Record (EHR) optimization: MACRA appears to be a golden opportunity for the largest EHR vendors. For the top eight EHR companies, 83% of their physician-practice users reported working to upgrade their system for MIPS compliance. At physician practices with smaller EHR vendor partners, however, 72% reported they were not working with their vendor partner to upgrade their system for MIPS compliance.

3. Consultant opportunity: The EHR capabilities required for participation in MIPS or Alternative Payment Models (APMs) represent a business opportunity for EHR consultants. Most (80%) of physician practices report that conducting a technology inventory is key to strategic planning for a value-based payment system.

4. Data wrangling: Taming data to conform with the reporting requirements of MIPS and APMs is daunting for many physician practices. At practices with at least four clinicians, 81% of physicians report being unable to align their data with the new reporting requirements.

5. Paying for procrastination: Physician practices that have not developed an in-house strategy for participating in MIPS or an APM are looking for outsourcing options. Of these practice procrastinators, 80% are planning to find turnkey software or a MACRA-administration partner this year.

6. MACRA-induced physician-practice consolidation: Black Book found that three-quarters of independent physician practices surveyed are considering selling their practice to a health system, hospital, or large group practice because of the regulatory and capital-cost burdens of MACRA.

In an equally dour data point, 68% of independent physicians predicted that MACRA would either burden or bankrupt their practice by 2020.

7. Economic incentives: For the first five years of the Quality Payment Program, there are powerful economic incentives to beat the MIPS performance threshold.

In 2019, MIPS is set to redistribute about $199 million from physicians who perform below the performance threshold to physicians above the threshold, and this redistribution mechanism is set to expand over time.

There also is $500 million in supplemental funding available for each of the first five years of MIPS implementation. To chase these opportunities, 64% of hospital-networked physician organizations reported including incentives in physician-compensation packages to boost MIPS performance.

8. Reputation risk: A majority (54%) of those surveyed did not know that MACRA would result in performance data being reported publicly through Medicare’s Physician Compare website and other rating systems.

9. ACO appeal: Joining an accountable care organization can increase the odds of MIPS success through penalty avoidance and resource utilization bonuses. Small physician practices have taken notice, with 67% considering joining an ACO to increase the likelihood of MIPS success.

10. Cost and quality transparency: Based on its physician-practice survey and other research, Black Book Research expects MACRA to be one of the market factors driving healthcare cost and quality transparency.

One survey noted 52% of large group practices, independent practice associations, ACOs, and integrated delivery networks reported they were preparing to release cost and quality measures for individual physicians by next year.

 

Epic, Cerner hold majority of EHR market share in acute care hospitals

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Epic, Cerner hold majority of EHR market share in acute care hospitals

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A new report from KLAS found Epic and Cerner each held about one-quarter of the acute care hospital EHR market share in 2016. Epic had 25.8 percent of the market, while Cerner had 24.6 percent. Meditech followed close behind, claiming the next biggest share of the market at 16.6 percent. McKesson and athenahealth were closer to the bottom of the pack, with 4.6 percent and 1.6 percent respectively.

These findings come as small hospitals are increasingly making EHR purchasing choices. KLAS found hospitals with less than 200 beds made 78 percent of EHR purchasing decisions in the United States in 2016.

Despite claiming their own unique portions of the market, each vendor went through a different experience in 2016.

With the largest market share, Epic is the “[s]ix-year leader in net acute care hospital growth.” Additionally, KLAS identified only two hospitals that left Epic in 2016, both of which did so involuntarily because they were spun off or acquired.

Cerner had the second-largest percentage of the market, primarily due to its wins in the small hospital space. “Small hospitals moved to Cerner more than any other vendor in 2016,” the KLAS report said. Though these hospitals seem to like Cerner CommunityWorks due to its integration functionalities, many community hospitals lamented both Cerner’s and Epic’s lack of customization capabilities.

Meditech claimed nearly 17 percent of the market, but many of its customers were wary of its ability to provide for their needs going forward. Still, Meditech snatched 17 new hospitals in 2016, and according to KLAS, “there are early indications that the release of Meditech’s integrated ambulatory offering and new development on the inpatient side are changing the market’s perception” of the vendor.

McKesson had 4.6 percent of the market. However, the vendor saw a “[s]ignificant decline in Paragon market share.” KLAS found few of McKesson’s Paragon EHR users were pleased with the system’s functionality.

athenahealth only claimed 1.6 percent of the market in 2016. Nevertheless, the vendor “[h]as maintained significant energy since entering the acute care market in 2015.” In fact, the “number of hospitals that contracted with athenahealth more than doubled in 2016,” according to KLAS. While one-third of its wins were in hospitals with more than 25 beds, the other two-thirds were in critical access hospitals.

Other notable vendors include CPSI, Medhost and Allscripts. Though it held 10.8 percent of the market, KLAS found CPSI wasn’t frequently considered among community hospitals. Medhost, which held 4 percent of the market, had a slight decrease in its overall acute care market share. Allscripts, however, had a net gain in 2016 and possessed 3.5 percent of the market.

California Senate Health Committee approves universal healthcare bill: 5 things to know

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A California single-payer healthcare bill is one step closer to passage after approval from the Senate Health Committee, according to a Los Angeles Times report.

Here are five things to know.

1. The bill in question, SB 562, would create a government-run healthcare plan, covering people living in America illegally and all other California residents, according to the report.

2. California would foot the bill for all medical expenses, according to the report. The measure, the report notes, states the program would be paid for by “broad-based revenue,” although exact details on how the program would be funded were not included.

3. Lawmakers had a few ideas on how to implement the single-payer system, including the use of EHRs and securing federal waivers to administer Medicaid and Medicare monies, according to the report.

4. Among the bill’s supporters are labor groups, such as the California Nurses Association, as well as consumer groups and the grassroots group Our Revolution, reports the Los Angeles Times. Opposing groups cited in the report include insurers, manufacturers and the California Chamber of Commerce.

5. One of the bill’s co-authors, Sen. Ricardo Lara, D-Bell Gardens, said a detailed financial study would be completed next month, according to the report.