Out with old, in with new

Many providers switch­ing ven­dors, EHR sys­tems

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joseph Conn

Bil­lions of dol­lars of fed­eral stim­u­lus money and a once-derided pro­gram of test­ing and cer­ti­fi­ca­tion of elec­tronic health records sys­tems have com­bined to pro­duce a plethora of health IT choices for hos­pi­tals and of­fice­based physi­cians.

Pressed to par­tic­i­pate in the fed­eral pro­grams to sub­si­dize the cost of health IT and to meet their mean­ing­ful- use tar­gets, providers are buy­ing EHRs for the first time, trad­ing up their cur­rent EHRs for newer ver­sions, and, in­creas­ingly, are dump­ing their ex­ist­ing sys­tems for EHRs from dif­fer­ent ven­dors.

The lat­ter was the case for tiny Blue Moun­tain Hospi­tal in the four-cor­ners re­gion of south­east­ern Utah.

When the 16-bed, crit­i­cal-ac­cess hospi­tal opened in Blanding in July 2009, it had an EHR from a small de­vel­oper, said Jeremy Lyman, the hospi­tal’s chief fi­nan­cial of­fi­cer.

Now, three years later, Blue Moun­tain’s ini­tial EHR sys­tem is gone, re­placed by an EHR from an­other small com­pany. “What prompted us to re­ally eval­u­ate our op­tions was the mean­ing­ful-use in­cen­tive pro­gram,” Lyman said.

Four re­cently re­leased data sets add per­spec­tive to this still- ex­pand­ing and fast- chang­ing health IT mar­ket, fu­eled to date by $ 6.2 bil­lion in fed­eral EHR in­cen­tive pay­ments to providers un­der the Amer­i­can Re­cov­ery and Rein­vest­ment Act, with an es­ti­mated $ 27 bil­lion in in­cen­tive pay­ments expected throughout the life of the pro­gram.

In a re­port based on in­ter­views with 318 buy­ers of EHRs de­signed for use in am­bu­la­tory care, mar­ket re­searcher KLAS En­ter­prises, Orem, Utah, found that 50% of ex­pe­ri­enced EHR users want to re­place their sys­tems, up from the 33% churn rate a year ago.

More than half of the am­bu­la­tory EHR buy­ers in­ter­viewed by KLAS—about 64%— were con­sid­er­ing EHR sys­tems other than those from the top 11 most-of­ten ap­pear­ing ven­dors’ names on these buy­ers’ shop­ping lists. These “other” de­vel­op­ers were clos­ing deals with in­ter­vie­wees 31% of the time, ac­cord­ing to KLAS.

The Na­tional Cen­ter for Health Sta­tis­tics, mean­while, is­sued a re­port based on a much larger sur­vey sam­ple (3,180 of­fice-based physi­cians) find­ing that 38% were “very satis-

fied” with their sys­tems, but 47% were only “some­what sat­is­fied.”

And while seven out of 10 physi­cians in the EHR sur­vey in­di­cated they were happy enough with their cur­rent sys­tems that they would buy them again, one in 20 cur­rent EHR users sur­veyed (5%) told the NCHS they were “dis­sat­is­fied” with their EHRs, and an­other 10% re­ported they were some­what dis­sat­is­fied.

Dr. Farzad Mostashari, who heads the Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy at HHS, wrote in blog posts that the num­bers sug­gest a high level of sat­is­fac­tion with the sys­tems “in spite of the fact that I of­ten hear from providers who are dis­sat­is­fied with their EHR sys­tems” and who grum­ble that their EHRs “don’t work cor­rectly and present sig­nif­i­cant work­flow chal­lenges with lit­tle po­ten­tial to im­prove pa­tient care.”

Ear­lier this month, Jodi Daniel, di­rec­tor of the ONC’s of­fice of pol­icy and plan­ning, pre­sented the July num­bers from its of­fi­cial Cer­ti­fied Health IT Prod­uct List. Ac­cord­ing to Daniel, there are 1,477 “unique” EHR prod­ucts that have been tested and cer­ti­fied for use in the Medi­care and Med­i­caid in­cen­tive pay­ment pro­grams un­der ARRA, in­clud­ing 613 “com­plete” EHRs for use in am­bu­la­tory care, and an­other 87 com­plete EHRs for in­pa­tient use.

In ad­di­tion, the cer­ti­fied list of­fers 777 pieces of EHR sys­tem tech­nol­ogy that can be stitched to­gether with com­puter in­ter­faces to cre­ate a “mod­u­lar” EHR for am­bu­la­tory or in­pa­tient care. All to­taled, 816 ven­dors have prod­ucts on the ONC list.

Not all of these ven­dors have been suc­cess­ful in at­tract­ing ac­tual cus­tomers that have used an EHR to meet their mean­ing­ful-use cri­te­ria and get paid their share of fed­eral in­cen­tive money, ac­cord­ing to the CMS, which pe­ri­od­i­cally re­leases a mashup of data from the ONC”s cer­ti­fied list and its own data­base of paid providers un­der the Medi­care por­tion of the pro­gram.

Well-known EHR ven­dors in the hospi­tal and am­bu­la­tory mar­kets are grab­bing shares of these fed­er­ally in­cen­tivized in­stal­la­tions, as expected, but the CMS data also show the game is still very much afoot for many lesser­known firms, par­tic­u­larly those sell­ing to of­fice-based physi­cians.

Ac­cord­ing to a Mod­ern Health­care anal­y­sis of the CMS data, through May 31 this year, 27 ven­dors have shared in the sale of 1,027 com­plete EHR sys­tems to hos­pi­tals that have used those sys­tems to re­ceive Medi­care EHR in­cen­tive pay­ments. Al­most a quar­ter of those hospi­tal in­stal­la­tions used EHRs from those 22 de­vel­op­ers of com­plete EHRs not in the top five on the CMS list.

Mean­while, in am­bu­la­tory care, 319 ven­dors have pro­vided 71,183 com­plete EHRs to el­i­gi­ble pro­fes­sion­als paid un­der the Medi­care in­cen­tive pro­gram. Nearly a quar­ter (24%) used one of the 304 ven­dors’ sys­tems not in the top 15, ac­cord­ing to CMS data.

The size and diver­sity of the EHR mar­ket might come as a shock to even many vet­eran

“Those of us who were around 20 years ago couldn’t imag­ine this in­dus­try (would grow) in the way it has.”

—Dr. Ja­cob Rei­der, ONC

health IT mar­ket watch­ers, and to crit­ics of fed­eral ef­forts to test and cer­tify EHR sys­tems. A pro­gram of vol­un­tary test­ing and cer­ti­fi­ca­tion be­gan at the urg­ing of the first ONC chief, Dr. David Brailer, back in 2004.

“We’re all sur­prised by the large num­ber of op­tions that could be cer­ti­fied,” said Dr. Ja­cob Rei­der, act­ing chief med­i­cal of­fi­cer at ONC. “Those of us who were around 20 years ago couldn’t imag­ine this in­dus­try (would grow) in the way it has.”

Rei­der said sim­ply hav­ing a test­ing and cer­ti­fi­ca­tion pro­gram has helped de­fine as well as shape the mar­ket. “No­body was track­ing the breadth of this mar­ket in the way that a cer­ti­fi­ca­tion pro­gram would track it,” he said. “Un­less there is a fun­nel though which all must pass, there isn’t any way to know.”

In 2010, the year af­ter Blue Moun­tain Hospi­tal opened, the fed­eral gov­ern­ment pub­lished its first set of mean­ing­ful-use cri­te­ria un­der which EHRs would need to be tested and cer­ti­fied to qual­ify for use by providers in the stim­u­lus in­cen­tive pay­ment pro­grams.

To qual­ify for those in­cen­tive pay­ments, Blue Moun­tain’s EHR ei­ther had to be up­graded or re­placed, Lyman said, and “in our ex­pe­ri­ence, it was an older, an­ti­quated plat­form and not user friendly. To go with an up­grade was go­ing to cost as much as a new sys­tem.”

Blue Moun­tain of­fi­cials de­cided in­stead to shop around. They also col­lab­o­rated with sev­eral other hos­pi­tals in com­pil­ing a list of needs and eval­u­at­ing ven­dors, tak­ing se­ri­ous looks at about 10 sys­tems, Lyman said.

Sev­eral po­ten­tial ven­dors were large com­pa­nies that his­tor­i­cally had been fo­cused on much larger hos­pi­tals but are now branch­ing out into the small hospi­tal mar­ket. Big- ness was no as­set to Lyman and his col­leagues at Blue Moun­tain.

“They have peo­ple who are pay­ing them 10 times what we ever will,” Lyman said. “They could de­cide to turn on a dime and not need us any more.”

In­stead, Blue Moun­tain of­fi­cials chose an EHR and a fi­nan­cial sys­tem from Prog­no­sis Health In­for­ma­tion Sys­tems, a pri­vately held Hous­ton-based com­pany founded in 2006. It has 17 com­plete EHR in­stal­la­tions that have been sub­si­dized with fed­eral pay­ments, CMS data show, rep­re­sent­ing a 2% mar­ket share.

“We found that Prog­no­sis is fo­cused on our size,” Lyman said. “We in­ves­ti­gated their fi­nan­cial po­si­tion and met with their key ex­ec­u­tives, all of that stuff, so we felt com­fort­able go­ing with a lesser-known com­pany.”

The new EHR is in­stalled, and the hospi­tal is a month into its 90-day pe­riod to meet Stage 1 mean­ing­ful-use cri­te­ria to qual­ify for a pay­ment, Lyman said. “We’re con­fi­dent we’ll be able to meet that.”

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