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    Google announced expanded partnerships with three blue-chip academic medical centers this past week, where bioinformaticians will explore how its machine learning technology can be deployed in clinical settings to mine EHR data for improved outcomes.

    "Machine learning is mature enough to start accurately predicting medical events – such as whether patients will be hospitalized, how long they will stay, and whether their health is deteriorating despite treatment for conditions such as urinary tract infections, pneumonia, or heart failure," said Google Brain Team researcher Katherine Chou in a blog post.

    [Also: Google's DeepMind developing blockchain-like tech to track health data]

    "Advanced machine learning can discover patterns in de-identified medical records to predict what is likely to happen next, and thus, anticipate the needs of the patients before they arise," she added.

    Google Brain is especially interested in putting machine learning to work predicting and preventing healthcare-associated infections, medication errors and hospital readmissions.

    As it does, the company will be "helping to harmonize the different ways data appears" among its partner hospitals, said Chou.

    Google's deep learning technology, working in tandem with HL7's FHIR interoperability standard, can help automate standardization and data exchange, making the data easier for researchers to access, she said.

    "As part of this research, our healthcare partners ensured that patient data was appropriately de-identified prior to sharing," said Chou. "We then used Google Cloud’s infrastructure to keep the data stored securely with the highest level of protections and to strictly follow HIPAA privacy rules. The records are kept separate from consumer data and will only be used in our partnership research projects."

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    While President Donald Trump’s proposed budget slashes funding to a host of agencies, the Department of Veterans Affairs would see and increase, and that has VA Secretary David Shulkin feeling good.

    “We’ve charted a course for modernization: We need help to improve growth and make healthcare a reality for all veterans,” Shulkin told the House Committee on Veterans Affairs on Wednesday in his opening statement.

    [Also: Congress presses VA secretary on VistA interoperability, costs]

    The proposed budget included $186.5 billion for the VA -- a $6.4 billion increase from last year, and the funding will support the agency’s efforts to modernize and overhaul a system that has been wrought with controversy.

    “Despite the differences we see going on in this administration, it’s nice to see we can come together to ensure care for our veterans and provide the resources necessary to support our veterans,” said Shulkin.

    Part of this effort is a decision on whether to transition the VA’s outdated VistA IT system and EHR with either a commercial off-the-shelf product or hand over the programming to an outside vendor. Shulkin reiterated to the committee this decision will be made by July 1.

    [Also: VA taps DSS for mobile patient scheduling tool]

    In fact, Shulkin is so committed to not continually “ask for money to fix a broken system,” the IT portion of the budget is significantly smaller than the committee expected. He explained that he’ll return to the committee to discuss the necessary procurement after the final fate of VistA is decided.

    And if Shulkin decides to replace VistA with an off-the-shelf EHR, he’ll require additional funding and help from the committee.

    The committee also focused on the continued funding of the Veterans Choice Program. Initially started as a stop gap as the VA responded to the 2015 scheduling and wait time scandals, the President has decided to continue the program through the coming year.

    The program will help the VA “rethink how we do things,” said Shulkin. “We’ve been working on a program redesign that we believe will work better for veterans.”

    The goal is to transform VA healthcare from an administrative system with offices out of reach of patients to more of a “clinical system that meets the clinical needs of the veterans we served.”

    “We need to realign infrastructure modernize the system to increase interoperability,” said Shulkin. “When we talk about a highly integrated, high-performance system, we believe that’s what our veterans want. They want a strong VA system, so it’s important we’re providing strong services to our veterans.”

    “As of now, about a third of all care in the VA is being delivered in the private system,” Shulkin said. And the Choice Program creates an opportunity to shift to a new model that builds private-public partnerships.

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    Calling Cerner’s project to modernize the U.S. Defense Department’s EHR a “resounding success,” Cerner President Zane Burke said that the work also helps the rest of its customers — and he pointed to submarines and cybersecurity in particular.

    “The things we’re doing around security, for instance, the cybersecurity pieces for the Department of Defense benefit our entire client base,” Burke said during Cerner’s annual shareholder meeting on Wednesday.

    Regarding submarines, Cerner has created new ways to handle what Burke called a ‘sometimes connected’ approach, which is distinct from hospitals that are always connected, specifically when it comes to resyncing those apps and data once the submarine connects again.

    That same approach and technology can benefit rural providers and home care specialists that are often in regions or houses with no cell phone connectivity, he said.

    “How do those applications resync? How do we make our applications simplified so people can do the support on a submarine?” Burke said. “That all helps our current client base but also our competitiveness overall.”

    Burke said that after having gone live with the first DoD pilot in February, there are three more pilot sites planned for the summer and early fall.

    “After that point in time there is the potential scope to attack all of the Department of Defense so with success it will let out the remainder of the contract, which includes 55 hospitals, 350 clinics and the theater of care across all of the defense department,” he said.

    Burke also mentioned other potential federal contracts, such as The Veterans Affairs Department and the Coast Guard both needing new EHRs.

    “My comment there is we just really need to keep doing good work for the Department of Defense and we will be well-served in those other cases,” Burke said. 

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    Chicago-based Rush Health has launched the first phase of Rush Health Connect, a platform that makes it possible for members to share health information securely.

    Rush Health’s network includes Riverside Medical Center, Rush-Copley Medical Center, Rush Oak Park Hospital, Rush University Medical Center, and more than 1100 physician members and 300 non-physician network clinicians. The HIE provides its users with aggregated clinical information, customized patient alerts, and the foundation for more advanced analytics.

    [Also: Rush Health taps InterSystems for interoperability, care coordination]

    Rush Health tapped Ready Computing, a consulting firm that specializes in HIE implementations, to customize InterSystems HealthShare, the technology platform that supports the HIE.

    In the next phase of the project, Ready Computing will help Rush expand data-sharing capabilities across more hospitals and physician practices, expand notification by incorporating patient event data from Rush Health payers, and provide advanced analytics and reporting.

    Today, such as eClinicalWorks and athenahealth. Rush also plans to establish connections with other HIEs and interoperability networks.

    [Also: Shafiq Rab will take helm as CIO and vice president at Rush University Medical Center]

    With Rush Health Connect, clinicians can view aggregated patient data within their own existing EHR system, even when it is received from a different EHR. This adaptability, Rush Health executives say, makes it easier and more efficient for clinicians to use patient information to help guide patient care, without changing clinical workflows or being required to sign onto an additional application.

    Also, Rush Health Connect incorporates real-time clinical analytics to monitor trends that can be used to improve care. 

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    Queensland Health, in its attempt to protect its computer systems from the major WannaCry ransomware campaign, inadvertently shut down the electronic health records systems at five of its key hospitals on Tuesday.

    Brisbane’s Princess Alexandra and Lady Cilento Children’s hospitals, as well as Cairns, Mackay and Townsville hospitals are experiencing system slowness, after the attempt to patch system security backfired, Australia’s Courier-Mail reported.

    “Over the course of that weekend as part of protecting our systems from cyberattack, a series of security patches provided by software owners such as Microsoft, Cerner and Citrix were loaded to further protect Queensland Health systems from attack,” said Health Minister Cameron Dick.

    [Also: Most consumers would leave a healthcare provider that was struck by ransomware]

    “While those patches have protected the integrity of our systems and data, it appears these protections may be making logging on and off the integrated electronic medical record system difficult for some users,” he said.

    The failure, declared ‘Code Yellow’ for an internal emergency, was described in an internal email. While no surgeries were impacted, 22 outpatient appointments were delayed, explained Dick. The estimated time for full service to be regained was “not known at this time.”

    Problems within the EHR system “could remain current for at least seven days,” as eHealth Queensland worked with its vendor Cerner to fix the issue, Dick told Parliament. But “for all intents and purposes Queensland hospitals are operating like it is business as usual.”

    However, ward patients at the affected hospitals were driven back to pencil and paper, and about 500 clinicians were unable to log in at Princess Alexandra Hospital, said eHealth Queensland Chief Executive Officer Richard Ashby, MD.

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    With eClinicalWorks facing powerful turbulence with its customers, executives are asking stark questions about whether or not it can make it through. 

    “I think they can survive,” said Justin Sleeper, a former eClinicalWorks employee and current HIT consultant. “They’ll retain most of their customer base, lose a few, but they have many conversions from other EHR vendors.”

    Sleeper added that the biggest thing in the EHR maker’s favor right now is exactly how hard it is for any hospital to switch to a different electronic health records vendor. 

    [Also: DOJ demands eClinicalWorks transfer data to rival EHRs]

    eClinicalWorks agreed to pay $155 million to resolve a False Claims Act lawsuit that alleged it gave customers kickbacks for publicly promoting its products and falsely obtaining meaningful use certification.

    That’s a hefty fine for a vendor that claimed annual revenue last year of $440 million. Add to that the financial strain of offering free upgrades or the challenge of transferring customers data to a rival EHR company, both conditions that the DOJ required as part of the settlement. 

    [Also: eClinicalWorks whistleblower: NYC health department was indifferent to EHR flaws]

    “Switching EHR vendors requires a significant amount of patience, planning, coordination and execution; more so perhaps than implementing a greenfield system,” said Vik Nagjee, chief technology officer at cloud vendor PureStorage and the former CTO of Epic Systems. 

    Indeed, provider organizations that choose to move away from eClinicalWorks to another EHR vendor will face a raft of challenges. 

    “While moving data from one EHR to another EHR is difficult enough, migrating workflows from one EHR to another EHR will be even more problematic,” said Charles Webster, MD, president of EHR Workflow. “Once users customize EHR workflows, or force themselves to adapt to EHR specific ways of operation, they are loath to move to another EHR, if only to avoid another painful training, configuration and go-live processes again.” 

    Then again, whenever a vendor hits tough times there is usually the possibility of being acquired. 

    “The damage to eClinicalWorks could put strong pressure on the company in the near term at a time when EHR sales are plateauing,” said John Moore, founder and managing partner of Chilmark Research. “That could end up leading to an eventual sale of the company.”

    Whatever ultimately happens, eClinicalWorks will look much different than it does today. 

    Sleeper, for instance, said that the company might push costs down to customers and to employees in the form of no or smaller annual salary increases. And because of the Health and Human Services Office of Inspector General’s corporate integrity agreement that mandates the EHR vendor retain an Independent Software Quality Oversight Organization that sends report to both OIG and  eClinicalWorks, the vendor look like a like a state-run organization for the next five years. 

    Associate Editor Jessica Davis contributed to this report. 

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    The Federal Communications Commission hasn't yet overturned existing net neutrality rules, but the Republican-led agency is widely expected to soon.

    Even ardent supporters of rules to ensure web traffic isn't subject to preferential treatment by internet service providers seem ready to throw in the towel on the fight, including Netflix CEO Reed Hastings, whose company (along with Google, Facebook and many others) has long fought for stronger regulations on ISPs such as Comcast, AT&T and Verizon.

    "I think Trump's FCC is going to unwind the rules, no matter what anybody says," said Hastings on Wednesday, according to the Washington Post. "That's going to happen, and then we get to see what's going to come out of that."

    [Also: AMIA presses FCC on broadband access as a health issue]

    What comes next wouldn't just affect Hastings, who clearly has vested interest in ensuring Netflix video content can stream without a hitch.

    There are bigger questions about what a reversal of net neutrality rules could mean for healthcare – especially for areas such as telemedicine, remote monitoring and health information exchange.

    More than ever, the internet is essential to care delivery. Just this past week, the American Medical Informatics Association sent a letter to the FCC, urging it to count access to broadband as a key social determinant of health when developing its policies.

    [Also: Health IT groups come out swinging for net neutrality]

    "FCC has a critical role in ensuring that Americans benefit from the electronic health infrastructure that was initiated with the passage of the HITECH Act and supported by the 21st Century Cures Act," said AMIA officials said, noting that the agency could do better at enabling online tools to help manage chronic conditions, for instance, or combat the opioid epidemic.

    A new article in Health Affairs airs similar concerns about "telecommunications policies that may significantly impact the delivery and pace of innovation in healthcare."

    Its four authors – health researchers and technologists at Saint Louis University, Medical University of South Carolina and Harvard – argue that the internet "has basically become a public good" by now, and say the idea that "big telecom giants should be allowed to treat their business partners more favorably than other companies" could be detrimental to healthcare.

    [Also: Net neutrality will benefit remote patient monitoring]

    Specifically, allowing adherence to net neutrality principles to become voluntary could put people, "particularly those at risk for health disparities due to low income or rural residency," at risk, they said.

    A tiered system for digital traffic could impact everything from telemedicine deployments to the use and utility of wellness apps to "cost effective scalable sharing of healthcare data."

    For telemedicine to work well, "there must be a predictable infrastructure connecting patients, care providers and technology," they added. Robust broadband connectivity is essential, but rolling back net neutrality "weakens the infrastructure of reliable low cost connectivity that telehealth systems depend upon."

    Remote monitoring and connected sensors could also be affected. For example, the set-top boxes most consumers rent from their cable ISPs offer a "constantly connected backhaul for smart, connected medical devices," according to the authors.

    "But, development of an ecosystem of devices connected to the set-top box requires an open architecture, not the proprietary model favored by most cable vendors," they said. "It is simply not economically feasible to develop medical devices for each cable system. The open set-top box could provide that one point of access for health data and communications in the home, but this potential is threatened."

    Finally, interoperability among electronic health records could be stymied by lack of net neutrality enforcement, the authors said.

    "EHR systems are increasingly moving to cloud based platforms that require high speed connectivity. High-speed backhaul connections also are important for users with large amounts of data, such as rural hospitals for remote radiology and pathology applications in addition to other telehealth services."

    Especially in rural areas, the options for online access may be limited. Localized monopolies could potentially allow ISPs to charge connection fees to small hospitals..

    "A thoughtless move toward free enterprise on the Internet could have a negative impact on the health of the most medically underserved Americans," they said. "We urge the FCC to investigate the unintended consequences of policy changes to insure that they do not amplify issues of health disparities in lower income and rural populations."

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    The eClinicalWorks National IT Implementation and Architecture group convened on Thursday afternoon to discuss the newest service packs from the EHR vendor — and that conversation took a last-minute twist.

    “The whole story is not out,” Jason Pomaski, a Healthcare Technology Strategist at Microsoft, who co-heads the group, said of the lawsuit eClinicalWorks and the DOJ settled on Wednesday. “Many loose ends and open questions remain and the two letters Girish sent don’t answer them.”

    Pomaski was referring to Girish Navani, the CEO of eClinicalWorks and a pair of emails he sent to customers during the call, which was open to some 1,300 customers.

    [Also: DOJ demands eClinicalWorks transfer data to rival EHRs]

    Healthcare IT News obtained both of those letters and confirmed that they do not answer the most pressing questions of the day. Navani doesn’t actually say much but, instead, struck the legal posture that his company agreed to rigorous federal government demands even though it takes pains to dispute any guilt.

    Safeguard your EHR data today

    But before getting to those questions, what Pomaski advised eClinicalWorks customers to do immediately consists of practical steps that every hospital should be taking regardless of which EHR vendor they use. 

    Whatever you may decide about switching to a new vendor in the future given the settlement mandate that eClinicalWorks foot the bill for transferring your data to a rival EHR, act in good faith today and upgrade to eClinicalWorks Service Pack 2 and newer enhancements. If you use Epic, upgrade to its latest edition, the same goes for Cerner, Allscripts, McKesson and so on.

    [Also: eClinicalWorks whistleblower: NYC health department was indifferent to EHR flaws]

    Then contact eClinicalWorks or your vendor and demand its list of known bugs, press your contacts there for issues corrected and release notes, all of which Pomaski said have been challenging to get in the past.

    Perhaps most important, back up all EHR and patient information eClinicalWorks has access to and retain a snapshot of it on a year-to-year basis. Think of this action item like a tax return and include times before upgrades you’ve done in the past. “The breadcrumbs and forensics aspects should be there,” he added. 

    And get your contracts in order. That means ensuring that you have access to your data in eClinicalWorks software or cloud servers especially if you are thinking about breaking away and finding a new EHR vendor. The trick is to stay at least a step ahead of any vendor lock-in attempts.

    [Also: Not just Epic and Cerner: Hospitals have several EHR options if they abandon eClinicalWorks]

    “eClinicalWorks currently charges SaaS customers to log ship their data from cloud to on-premise for reporting reasons,” Pomaski said. “Data transparency post-settlement is a must and should be free regardless if customers stay with eClinicalWorks or not.”

    Pomaski also recommended expediting hearsay, focusing on facts, getting educated before making any drastic decisions, and that means answering what happens if you stick with eClinicalWorks? Conversely, what are the challenges and unforeseen circumstances of moving to a new vendor?  

    “When will eClinicalWorks tell us what the big picture is?” Pomaski added.

    What every hospital IT shop should be asking its EHR vendor

    Farzad Mostashari, MD, former head of the Office of National Coordinator for Health IT, tweeted in response to the settlement that “there are a lot of doctor’s office staff looking at their EHR today and wondering if there’s $30 million worth of false promises hidden there.”

    That $30 million is the amount that the eClinicalWorks whistleblower, Brendan Delaney, collected in the final resolution.

    This obviously is not just about eClinicalWorks.

    To give other EHR vendor’s customers a taste of what was pulsing through the minds of eClinicalWorks customers during that Thursday afternoon meeting, they began with the matter of whether the now-public allegations of fraud will trigger a class-action lawsuit under the False Claims Act not altogether unlike what happened with Volkswagen, including the possibility of a similar buyback option, only for EHRs instead of automobiles.

    Indemnification. Will practices and hospitals that attested to meaningful use and collected reimbursements be indemnified or have to pay any money back? On the flip side, what about the customers who were previously fined for not attesting, will they be paid back?

    Other issues that the group surfaced include whether eClinicalWorks settlement agreement to transfer data to competing EHRs will also include user and staff training or not, as well as what to happens to customers in the cloud.

    Another one is what kind of power the Office of the Inspector General’s mandated corporate integrity agreement (CIA) that requires the EHR vendor to retain an Independent Software Quality Oversight Organization will give the federal government when it comes to monitoring eClinicalWorks’ customers data.

    It’s not exactly going out on a limb to say that the DOJ deal could ultimately be a precedent-setter and, should that become the case, all the questions that eClinicalWorks proactive customers are asking right now pertain to any hospital executive, administrator, IT leader, privacy and security officers and even EHR users. 

    “I just want them to fix things,” Pomaski said. “And provide a clear and open path.” 

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    Robert Bart, MD, has joined UPMC as chief medical information officer of the Health Services Division.

    In this role, he will oversee the health system's efforts to boost the use of electronic health records and other technologies to improve the quality, safety and efficiency of patient care.

    UPMC has invested more than $1.5 billion in recent years to support technology that advances clinical outcomes and administrative efficiency as the health system continues to pioneer the use of electronic medical records, analytics and “big data.”

    [Also: UPMC taps IBM Watson, big data, machine learning, to build better supply chain]

    Bart previously served for five years as CMIO for the Department of Health Services for Los Angeles County, with a population of more than 10 million. There, he oversaw information technology in four hospitals and 18 large, multispecialty ambulatory locations, including hospitals affiliated with the University of Southern California and the University of California Los Angeles.

    Prior to that stint, he was chief medical officer for pediatrics and academics at Cerner.

    “Dr. Bart brings a unique set of technology and people skills that will drive our efforts to adopt smart technology that improves care and the patient experience,” Joel B. Nelson, MD, chief clinical officer, UPMC Health Services Division, said in a statement.”

    “Dr. Bart brings a unique set of technology and people skills that will drive our efforts to adopt smart technology that improves care and the patient experience,” Joel B. Nelson, MD, chief clinical officer, UPMC Health Services Division, said in a statement.”

    In addition to his role as CMIO, Bart has been appointed an associate professor at the University of Pittsburgh School of Medicine’s Department of Critical Care Medicine and University of Pittsburgh Physicians and will work as an intensivist at Children’s Hospital of Pittsburgh of UPMC.

    Bart received his medical degree from the University of Hawaii in 1990, then completed a pediatrics residency, a pediatric chief residency and pediatric critical care fellowship over the next seven years, all at Duke University Medical Center.

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    Vendor eClinicalWorks has to offer customers EHR upgrades and it must transfer client’s data to a competitive EHR if asked, both for free per their settlement agreement with the Department of Justice.

    Healthcare IT News asked readers to weigh in on what eClinicalWorks customers should do. Of the four options - stick with the vendor, take a free upgrade, transfer to another vendor or “other” - the majority of respondents suggested the vendor transfer their data to a competitor's EHR.

    Many are watching closely how eClinicalWorks handles this issue - and the options their customers choose - because as analysts have suggested, the EHR market is poised for consolidation, mergers and acquisitions.

    With so much data and money on the line for IT shops, not to mention the work to manage that data during a potential transitional process, the poll was our most popular with readers and logged more than 1,300 votes.

    [Also: eClinicalWorks to pay $155 million to settle suit alleging it faked meaningful use certification]

    Concern about the cost of a change was noted a couple of times in “other” comments. “Probably stay - issues are now resolved and cost to jump would be counterproductive.” And suggestions to “shop around and then decide to take the upgrade or switch” and “wait and watch” were pragmatic.

    While quips like “Go back to paper” and “light torches, sharpen pitchforks” came up several times. 

    Several readers focused on next steps with comments about how to manage the suit’s mandate that the EHR vendor retain an Independent Software Quality Oversight Organization, essentially providing a watchdog for the Inspector General.

    “Begin a guided customer forum with ONC help. Upgrade and make a migration plan. Stabilize care issues and attestations in process.”

    We’re keeping the poll open for others to weigh in on this closely watched development in the EHR market and will update our results next week if the tide shifts based on new feedback.

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    Are EHR vendors the new villains of healthcare?

    A major electronic health record software player, eClinicalWorks, just got busted for falsely obtaining certification with the meaningful use criteria through its EHR — and suggestions immediately arose that the case was a shot-across-the-bow for the entire electronic health records industry.

    “The DOJ is sending a message here. They imposed personal liability on the CEO and people who were orchestrating the alleged fraud and they went after a couple programmers,” said Robert Ramsey, a healthcare attorney with Buchanan, Ingersoll & Rooney. “That’s a message and so is the fact that they imposed a five-year corporate integrity agreement.”

    [Also: DOJ demands eClinicalWorks transfer data to rival EHRs]

    History shows that similar federal investigations tend to widen in scope.

    DOJ hot on the trail of more EHR vendors?

    Healthcare IT News called the first investigator listed on the eClinicalWorks settlement and asked point blank: Should hospitals executives expect the DOJ to investigate EHR vendors other than eClinicalWorks?

    “I can’t answer any questions about it,” said Owen C.J. Foster, assistant United States attorney in the District of Vermont. “I cannot comment on that.”

    [Also: Concerned the eClinicalWorks fiasco could happen to your EHR? Take these steps now]

    Whereas Ramsey has not heard of any active investigations he said that he doesn’t doubt that the Department of Justice and Office of the Inspector General are scrutinizing all the EHR vendors now.

    “DOJ and OIG naturally look beyond one particular company,” Ramsey said. “Look at the pharmaceutical space. They’ve gone after pharma for years and where they’re coming from is ‘Hey, if one vendor is doing it what’s to say others aren’t doing the same thing or something else that’s non-compliant.’”

    And given that the meaningful use EHR program enabled the federal government to disburse more than $35 billion dollars, Ramsey said, there is plenty of money for federal prosecutors to pursue.

    The new new villains?

    Electronic health records vendors were already under fire business practices such as information blocking. And now that one major vendor has been caught cheating meaningful use criteria that blame will grow hotter than ever before.

    “Every few years, the villains in the healthcare story change,” said Bob Wachter, MD, chair of the University of California Department of Medicine author most recently of The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age. “Over the past several years, we've seen it shift from doctors to hospital execs to radiologists to pharma to ... who knows. One wonders whether EHR vendors will be next.”

    That’s not out of the question.

    Indeed there are plenty of reasons EHR vendors could be singled out for scorn: widespread complaints about poorly-designed systems, causing physician burnout, now this news of skirting of meaningful use regulations and, perhaps what will become worst of all, the practice of information blocking.

    The 21st Century Cures Act, in fact, has provisions that could ultimately make many EHR vendors look a lot like eClinicalWorks does right about now. The law grants Health and Human Services Secretary Tom Price the power to impose stiff fines for data blocking: Up to $1 million for every single incident.

    How widespread is the corruption?

    The truth: We just don’t know. And as a counterpoint, there are some healthcare technologists who think the federal government should take some of the responsibility because it oversees the meaningful use reimbursement program certifying any and all software products that enable hospitals to earn EHR incentives. 

    “Blaming eClinicalWorks and other EHR vendors for this sad situation is shortsighted, unless one also acknowledges the role of the entire meaningful use program, in distorting not just the EHR market, but also the ethical and moral principles of many EHR vendors,” said Chuck Webster, MD, President of EHR Workflow. “It was an expensive mistake, the unintended consequences of which we will be living with for many more years."

    Another part of the problem is that EHR vendors can effectively demonstrate specific functionalities during the certification process that do not necessarily perform that same way in production environments, according to Jim Tate, President and founder of EMR Advocate, which consults with numerous EHR companies during the certification process.

    “There is a lot of risk out there for some of the major vendors,” Tate said.

    Enter the bounty hunters

    Now that whistleblower Brendan Delaney has collected $30 million from the eClinicalWorks settlement there is reason to think other whistleblowers might step forward and federal investigators might pursue additional vendors.

    “This sort of bounty hunting is now incentivized — and that’s a good thing,” said Justin Sleeper, a former eClinicalWorks employee who is now a health IT consultant.

    That is not to call Delaney a bounty hunter. Indeed, as the healthcare attorney Ramsey noted whistleblowers, particularly in healthcare where patient lives are at stake, are usually in it for more than the money. 

    But one can imagine that the size of this reward has gotten the attention of other EHR users and hospital employees, who could be imagining similarly lucrative payouts. 

    “Will we see more whistleblowers in this same space?” Sleeper asked. “I believe so.” 

    Associate Editor Jessica Davis contributed to this report. 

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    After weeks of speculation about where the agency will land, The U.S Department of Veterans Affairs has chosen Cerner to replace its ailing VistA electronic health record. For many, including Black Book, the news wasn't a surprise. Many expected them to choose Cerner since the vendor is already working on modernizing the health record for the U.S. Department of Defense. But others thought the VA had a real chance to advance interoperability had it chosen a different off-the-shelf product.

    [Also: VA picks Cerner to replace VistA; Trump says EHR will fix agency's data sharing 'once and for all']

    So, what do you think about the deal?

    Answer our anonymous poll below:

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    NEW YORK — The time has come for hospital IT executives to become much more demanding customers of their electronic health records vendors to bolster clinical decision support, reduce medical errors and ultimately improve patient safety.

    “It’s up to us to demand that EMR vendors provide us with good decision support,” Mount Sinai President and COO David Reich said at the HealthImpact East Conference Monday. “Interacting with Epic or other EMR vendors presents certain challenges because they tend to want things in their domain, so we have to innovate outside their domain.”

    Part of the issue is that the healthcare industry currently has a lot more innovation than it does validation, according to Neil Carpenter, Vice President of Strategic Planning and Research at LifeBridge Health.

    [Also: What would the end of net neutrality mean for healthcare?]

    Reich added that hospitals also need to help EHR vendors develop the technologies and tools they need. Mount Sinai, for instance, has a number of projects underway to advance clinical decision support — though they are done outside Mount Sinai’s Epic EHR.

    In one use case, Mount Sinai turned an Epic best practice alert into a more active feature that pushes the information out to VOIP badges nurses wear. Another project is the medical early warning system Mount Sinai developed to enhance the process of activating rapid-response teams for when a patient gets sepsis, for instance.

    Mount Sinai is also piloting a more sensitive and specific tool for falls prevention that Reich said it hopes at some point to share its information with other around the country.

    The final innovation Reich mentioned is an app that Mount Sinai created, and its physicians prescribe, to track patients discharged after heart failure service to try and reduce readmissions.

    “It is incumbent on us to be very demanding customers,” Reich said. “It’s nice you made these multi-million dollar tools that capture data. Now we need to turn it into something useful that physicians accept and embrace.”

    Carpenter added that near-ubiquitous EHR implementation was the first inning of healthcare’s digital transformation.

    “We’re in the second inning now,” Carpenter said. “We still have a long way to go.” 

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    Veterans Affairs Secretary David Shulkin, MD, said he was speaking as a physician when he said choosing Cerner to replace VistA was "the right thing to change veterans' healthcare."

    Addressing reporters at the White House daily briefing on Monday, Shulkin said that "having an electronic health record that can follow a veteran during the course of his treatment is one of the most important things you can do to ensure their safety, health and well-being."

    For 17 years, Congress has called on VA to "not only modernize its system but work more closely with the Department of Defense," he said – but still each agency has forged ahead with different EHR systems.

    [Also: VA picks Cerner to replace VistA; Trump says EHR will fix agency's data sharing 'once and for all']

    "We've been able to advance interoperability – at the cost of hundreds of millions to the taxpayers – but today we still have separate systems that do not allow for the seamless transfer of information," said Shulkin.

    After "years and years, we're able to read each other's records," he added, "but what we're not able to do is be able to work together to plan treatment – to go back and forth between the Department of Defense and VA."

    By making the decision to not put the EHR project out to bid and instead "do a direct acquisition of the EHR currently being deployed by the Department of Defense," Shulkin said speed and efficiency were among his top motivations.

    [Also: VA to Congress: Trump's budget will modernize veterans care]

    "I'm not willing to put this decision off any longer – 17 years has been too long," he said. "I don't think we can wait that long with the health of of our veterans."

    In moving the Cerner Millennium-based MHS Genesis system, patient data for active-duty service members and veterans alike can "now reside in a common system, so you will have this seamless link between departments without the manual exchange of information," said Shulkin.  

    Such seamless interoperability will have many clinical benefits.

    By enabling one single lifetime record from the time a service member enlists, "there will never be a need to go back and forth and say, 'Records aren't there for me,' or, 'My doctor isn't able to have input into what the Department of Defense is doing,'" he said.

    Shulkin hopes to improve quality and care coordination for one area in particular.

    "My top clinical priority is to reduce veteran suicide," he said.

    "One of the areas we've identified is a gap in the transition – when you leave the military, and all of a sudden you no longer have that structure you were used to," he said. That liminal period, after active duty but "before you get enrolled either in VA healthcare or community healthcare," can be dangerous to vulnerable veterans.

    "That no longer is going to happen," he said. "We're going to have a seamless ability to know if the information is there. So to a veteran who is experiencing emotional disorders, when they reach out for help, it's going to be easier to get them help. To other people with physical problems, that same information is going to be there so you can develop a coordinated care plan."

    Other vendors called upon to join in

    For all the critical similarities in their patient populations and clinical imperatives, "VA has unique needs that are different from the Department of Defense's," said Shulkin. "And for that reason, VA, while it's adopting an identical EHR to DoD, needs additional capabilities to maximize interoperability with our community providers."

    One-third of VA patients receive care out in the community, after all. So it's "critical," he said, "that we have the same interoperability with our community providers."

    That's going to "require integration with other vendors," he said, "to create a system for veterans, so they can get care within the community as well as at the Department of Defense. That's going to take the active cooperation of many companies and thought leaders, and it will serve as a model – not only for the federal government but for all of healthcare, which is trying to seek this type of interoperability."

    From the early stages, Shulkin said, "we're going to have our VA clinicians very involved in how we design this system, and how we implement it. Because in many ways VA is actually well ahead of DoD in clinical IT innovation, and we're not going to discard all the things we've done in the past."

    In fact, he said, "that's how we're going to help DoD get better. This is a system that's going to care for veterans and our active service members."

    [Also: How the Coast Guard’s ugly, Epic EHR break-up played out]

    Shulkin thanked President Donald Trump (whose administration has done well "eliminating silos and turf battles"), the DoD (Defense Secretary Michael Mattis has shared some key DoD execs who are already at the VA and sharing institutional knowledge to help smooth the transition, he said) and Jared Kushner's American Office of Innovation for helping the project along.

    There are "no guarantees," he said. "This is high-risk." But by working with DoD, "we are lowering our risk," he added. "This is the most cost-effective way to go to an off-the-shelf product.

    "This mission is too important for us not to get right," said Shulkin.

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    NEW YORK – Population health management is approaching an impasse triggered by the difficulty for private and nonprofit hospitals, social welfare systems and public health entities to understand exactly who is responsible for what.

    “Population health is like six blind men looking at an elephant and trying to figure out what the elephant looks like,” Northwell Health Senior Vice President Ram Raju said Monday at the Health Impact conference.

    One of the biggest challenges is that the responsibility demarcation that once existed between private health providers and public health departments is now blurred and riddled with far too many care managers, said Shahid Shah, a healthcare consultant.

    [Also: 4 population health must-haves: goals, leadership, organization, analytics]

    “That line is gone. That part is killing us. If we can’t decide who picks up what responsibility where, it’s completely unsustainable,” Shah said. “Population health vs. public health — we have to solve that together or IT systems are not going to do anything.”

    Today’s EHRs, in fact, were not built to handle non-clinical data types, notably social determinants of health, which speakers agreed are a big opportunity for treating patient populations.

    Shah suggested that moving beyond the federal government’s meaningful use EHR incentive program will open new opportunities and resources for providers to pursue population health management initiatives. 

    “We should leave CMS out of this. Hopefully with the death of meaningful use after stage 3, we can get back to some semblance of reality,” Shah said. “Let’s do this proactively. The smartest thing we can do is come together and say ‘this is our job.’”

    [Also: Should IT or doctors lead population health programs? It's not so clear cut]

    Saint Barnabas Health is already doing just that.

    “You don’t need the government for everything,” Jitrenda Barmecha, CIO of Saint Barnabas said.

    He added that Saint Barnabas is planning to unveil by 2019 low-income housing with kitchens so it can educate people, based on a community needs assessment, about eating habits and chronic conditions.

    It’s not just about doctors and hospitals. Barmecha said that population health programs should include anyone with a touch-point on its system, and that includes social workers, community care providers, those people helping find food of shelter for patients.

    “If systems can come together it will have a big impact on the health of the population,” Barmecha said. “It’s a huge culture change because we’ve been siloed. There has been a huge change away from episodic toward longitudinal care. It wasn’t there 7 years ago.”

    Whether such population health programs will be widespread five years from now, however, comes down to finding innovative business cases, Shah said.

    “We need a different business model than the sick care model,” Shah said. “I don’t see the idea of pop health if we don’t drive it through business models. All we’re going to say five from now is ‘oh pop health didn’t work.’ We need to reorient for pop health.”

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    Now that Veterans Affairs Secretary David Shulkin, MD, revealed that VA has officially opted to replace its VistA EHR with one from Cerner, the overarching question: Is Cerner now a shoo-in for the Coast Guard’s upcoming EHR implementation?

    USCG, after all, listed interoperability with DoD and VA as among the top attributes it is seeking in an electronic health record platform.

    “The solution will protect Personally Identifiable Information and Personal Health Information and will markedly enhance core and priority USCG health care services and improve interoperability with both the Department of Defense (DoD) Military Health System and the Department of Veterans Affairs (VA) health systems,” the Coast Guard said in the request for information that closed in the last week of May.

    [Also: The submarine effect: Cerner pres says DoD modernization benefits all customers]

    The agency also noted in the RFI that it was interested in exploring the possibility of sharing a hosted EHR with another federal agency — something it originally tried to do when it embarked on an Epic EHR implementation. USCG effectively ended that ugly 7-year break up when it opened the RFI.

    Cerner, for its part, has been designing its software to perform in what President Zane Burke described in the company’s annual shareholders meeting as a ‘sometimes connected’ capacity to be used on submarines, for instance, and other realms where users are disconnected for long periods of time.

    [Also: How the Coast Guard’s ugly, Epic EHR break-up played out]

    Burke also touched on other open contracts, VA and Coast Guard being the obvious ones at the time, and said that Cerner just needed to keep doing good work for DoD and “we will be well-served in those other cases.”

    Two weeks later, Shulkin revealed VA’s plans and explained that it skipped the request for proposal stage as a way to accelerate procurement.

    The Coast Guard has not said yet whether it will take a similar tack or go through a comprehensive RFP process but insiders are already speculating that if USCG does ultimately choose Cerner then Indian Health Service might follow suit as well. 

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    It's been almost two years since Cerner was awarded the most lucrative electronic health record contract in history by the U.S. Department of Defense. Now, as champagne pops in Kansas City celebrating its new U.S. Department of Veterans Affairs win, we remember what, for its time, was a pretty big deal.

    On July 29, 2015, Cerner – along with bid partners Leidos and Accenture – secured the much-coveted DoD Healthcare Management System Modernization contract, more than two years after it was first announced in 2013.

    The many months between had seen no shortage of jockeying from the biggest technology vendors in healthcare industry and beyond, with Cerner ultimately edging Epic/IBM and Allscripts/Computer Sciences Corp/Hewlett-Packard for the DHMSM contract. The prize? An initial payout of $4.3 billion, perhaps increasing to $9 billion by the end of the contract.

    It's a massive deal in more than its price: Cerner is still piloting what's become known as the MHS Genesis system at Fairchild Air Force Base in Spokane, Washington, but the system rollout will ultimately expand to impact more than 204,000 health professionals at 1,230 locations, serving 9.5 million patients in 16 countries worldwide.

    The contract price for the new VA deal has yet to be set. In announcing the deal on June 5, VA Secretary David Shulkin, MD, said he expects a three-to-six-month process during which the agency will develop "both the implementation plans and the cost of this system." 

    Will the price tag exceed Cerner's $4.3 billion DoD contract? 

    "I would love to do it for less, but I think that would be unrealistic," said Shulkin. "We have not agreed upon any pricing but I can assure you that before we were to sign off on a contract, we are going to make sure that this is the best value for taxpayers."

    As those numbers get tabulated, we look back at our years-long coverage of what – for a moment, at least – was the largest EHR deal in history.

    DoD to go to market for its EHR(May 22, 2013)

    Then-Secretary of Defense Chuck Hagel told Under Secretary of Defense for Acquisition, Technology and Logistics Frank Kendall to start looking for a commercial, off-the-shelf EHR product to replace the Defense Department's self-developed Armed Forces Health Longitudinal Technology Application (AHLTA) system. 

    "I am convinced that a competitive process is the optimal way to ensure we select the best value solution for DoD," Hagel said.

    DoD EHR modernization set to rock marketplace(July 24, 2015)

    After more than two years, during which many of the biggest names in technology teamed up, jockeyed for position and sometimes dropped out (a Medsphere/PwC/Google team was once in the mix, as was one from InterSystems), speculation over what was expected to be an $11 billion contract was at fever pitch.

    The sheer size of the project suggested its gravitational force would extend beyond DoD to affect the rest of healthcare – including, ideally, an advance in interoperability and information sharing industry-wide.

    DoD awards Cerner, Leidos, Accenture EHR contract(July 29, 2015)

    At last, the big day had arrived. One of the biggest surprises was the adjusted overall price tag for the massive project – a total of $9 billion, down 20 percent from the initial estimates. "We feel comfortable that we made a good source selection. Costs are coming in lower than our estimates," said Kendall. "Competition has worked for us."

    "Today is just the beginning," added Chris Miller, program executive officer, DoD Healthcare Management Systems Modernization and Integrated Electronic Health Records. "Now the hard part is going to start." 

    Cerner data sharing may have been difference-maker(July 30, 2015) 

    Cerner's reputation in recent years has been one of supporting interoperability – at least, that is, in comparison to its chief competitor Epic, which felt compelled in 2015 to hire a lobbyist to help counter the narrative that it doesn't play well with others.

    "Cerner’s demonstration of wide-ranging provider interoperability on multiple, different platforms were the huge differentiator over Epic’s garden-walled methodology to system user data sharing," said Doug Brown, managing partner of Black Book.

    7 things DoD sought in Cerner EHR(August 4, 2015)

    Indeed, interoperability, customizability and cybersecurity were among Cerner's biggest selling points.

    So was training, said Miller: "Over 25 percent of the contract goes to training users and clinicians," he said. "An EHR is not just a simple piece of software."

    CIOs 'surprised' at Cerner DoD win(July 31, 2015)

    "I really thought it was going to Epic because they seem to be winning everything," said one private-sector hospital CIO. Another shared the sentiment, but added: "I don’t think it is a bad choice. Overall, they wouldn’t have gone wrong with either." 

    The good, the bad and the ugly: social media's response(July 30, 2015)

    One Twitter user wondered whether a project of this size and scope might soon echo the horribly bungled rollout of the UK's massive NHS modernization initiative: "Sorry, Epic, you lost the DoD contract," he tweeted. "Sorry, Cerner, you won the DoD contract. #GhostOfNHS" 

    Cerner rides high with DoD deal(August 5, 2015)

    But Cerner President Zane Burke was confident in his company's ability to keep many balls in the air at once. "We believe this is a positive development for our clients, and they should have confidence that Cerner will continue to execute to meet all of our current and future commitments." The DoD contract "is big and complex and hard, but it's not new to Cerner to do big and complex and hard projects," he added.

    Is $9B Cerner deal good for DoD (July 30, 2015)

    Some expressed concerns that by choosing single-platform technology, and eschewing open-source or cloud-based products, the DoD was needlessly hemming itself in for the future. One report said the military needed an EHR that's "extensible, flexible and easy to safely modify and upgrade as technology improves and interoperability demands evolve," and feared the choice of a "single commercial 'winner,' closed and proprietary, will inevitably lead to vendor lock and health data isolation."

    What will DoD-Cerner mean for EHR ROI?(September 2, 2015) 

    Nonetheless, IDC Health Insights thought the DoD deal would have ripples across the rest of the healthcare IT industry. The contract was a bellwether – ending a the incentive-driven post-meaningful use period of "open-ended and premium pricing" for EHR systems. From here on in, the report argues, most IT investments will be driven by considered calculation of business value: "For buyers of EHR technology, the DoD award outcome focuses attention on the ROI of EHRs and increases the expectations placed on all EHR suppliers in the market."

    DoD gives Cerner EHR implementation a name: MHS Genesis(April 8, 2016)

    "The meaning of 'genesis' is the origin or process of origin," said DoD officials, noting that the Cerner rollout represents "the initial stage of the developmental process of building and implementing an electronic health record by organizing the critical medical and business administrative data needed to provide quality and safe medical care."

    It's a "new beginning," enabling a process for "providing greater population health data, tracking, and alerting capabilities, enabling healthcare professional to more easily monitor beneficiaries' health status and encourage healthy behaviors."

    Cerner ups the cost of hosting MHS Genesis data center for Defense Department's new EHR(July 8, 2016) 

    A year into the project, Cerner surprised some observers by upping the cost of hosting the data center from the initial $50 million estimate up closer to $75 million. DoD responded by saying that it might reopen bids for the data center portion of the broader DHMSM contract.

    DoD delays Cerner EHR modernization(September 1, 2016)

    Originally scheduled to launch in December 2016, the Department of Defense said it would push back its first pilot go-live by at least a few months. "During the testing of the system, we identified the need for more time before initial deployment to ensure we are providing the best possible user experience to our beneficiaries and health care providers,” DoD Program Executive Officer Stacy Cummings said in a statement. “We collaborated closely with our vendor, the Leidos Partnership for Defense Health, to make the best overall decision for the successful deployment of MHS Genesis.”

    DoD quietly rolls out EHR pilot MHS Genesis at Fairchild Air Force Base(February 9, 2017)

    Thankfully, a few months was, in fact, a few months: DoD launched a slightly scaled-back rollout in early 2017 at Fairchild AFB in Spokane. "Providers at Fairchild are treating patients while the government and contractor team are quickly implementing fixes to issues as they are identified," said Cummings. The next rollout is slated for June 2017 at the Oak Harbor Naval Hospital in Ault Field, Washington.

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    Verona, Wisconsin-based healthcare technology giant Epic Systems is in the midst of developing a medical appointment and scheduling system for U.S. Department of Veterans Affairs.

    But, with its rival Cerner having won two major military contracts recently – one from the Department of Defense and another coming from Veterans Affairs, it raises the question: Will it affect the VA work Epic has underway? It’s hard to tell.

    Epic landed the five-year VA contract to build a scheduling system from scratch in 2015.

    [Also: VA secretary: Cerner EHR choice brings big clinical gains]

    Already, the Epic work for the VA has suffered a year of lost time, not through the vendor’s fault, but because the VA cancelled the work, saying it would fix its existing program instead. However, the VA resumed its work with Epic a year later.

    Epic had been working on the medical appointments and scheduling project with Systems Made Simple, which at the time was a subsidiary of government contractor Lockheed Martin. Systems Made Simple has since been acquired by Leidos, Cerner’s main partner on military contracts.

    The June 5 announcement by Veterans Affairs Secretary David Shulkin that the VA had selected Cerner and Leidos to develop its EHR system. The Department of Defense work on a new EHR system is already underway with the same vendors.

    [Also: Coast Guard next to pick Cerner? Vendor is already prepping its EHR for the high seas]

    The VA did not solicit bids for the VA work, and whether Epic would have bid, Epic founder and CEO Judy Faulkner has not said.

    Shulkin did not reference the appointment and scheduling work underway with Epic when he announced the department’s choice of Cerner and Leidos for the VA system EHR.

    [Also: VA picks Cerner to replace VistA; Trump says EHR will fix agency's data sharing 'once and for all']

    “As the largest electronic health record vendor in the United States, covering two-thirds of the nation’s patients, we are proud to serve our veterans both through the VA scheduling project and through our customers that care for millions of veterans across America,” Epic said on June 5. “These customers are the top health systems in America and we stand with them, committed and eager to ensure veterans get the very best medical care regardless of where they receive it.”

    With the statement, Epic may be trying to head off at the pass speculation of the kind that occurred when the U.S. Coast Guard abruptly ended its EHR contract with Epic in April 2016 – a move that reportedly had the Coast Guard back to using paper documentation.

    Epic executives posted a timeline of Coast Guard actions regarding the project break down. It includes two incidences of data corruption, Epic executives said had never occurred on any other project.

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    Healthcare information network Surescripts on Wednesday reported big jumps in the number of transactions and electronic prescriptions across its system since a year ago.

    “We started with e-prescribing, and we’ve expanded our support of prescription decisions to include patient-specific authorization, benefits and cost information, said Surescripts CEO Tom Skelton. “The progress we’re seeing reinforces the value we’re delivering by increasing patient safety, lowering costs, and ensuring quality care.”

    [Also: Surescripts to unveil new Sentinel e-prescription monitoring system at HIMSS17]

    The report shows the adoption of electronic prescribing of controlled substances is growing, with 45.34 million prescriptions for controlled substances delivered electronically in 2016 – a 256 percent increase over the year before.

    Four new states – North Dakota, South Dakota, Minnesota and North Carolina – entered the top 10 for e-prescribing of controlled substances. In New York, where an e-prescribing mandate took effect last April, prescriber enablement grew 45.5 percent, resulting in a 54.2 percent jump in the number of controlled substances prescribed electronically.

    The new numbers are part of Surescripts 2016 National Progress Report.

    They show, 10.9 billion secure transactions – 12 percent more than in 2015. And included in those transactions are 1.6 billion electronic prescriptions, or 180,000 every hour.

    Surescripts said the network connected 1.3 million healthcare professionals -- 21.5 percent more than in 2015 -- providing secure patient data for 230 million Americans, or 71 percent of the population.

    Also, more than 1.08 billion medication history transactions containing critical patient data were made available to providers at the point of care, and it provided more than 2.2 million documents on where patients received care, including information from more than 43 million patient visits to more than 165,000 clinicians.

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    As EHR vendors are adding features and functionality for value-based and patient-centric care, hospitals will increasingly turn to those platforms for population health management initiatives instead of implementing standalone products.

    “With Cerner and Epic holding 51 percent of hospital EHR market share, and Allscripts also deep into fully-funding integrated PHM, I would expect there will be fewer and fewer large systems adopting new standalone PHM products,” BlackBook Managing Partner Doug Brown said.

    Brown predicted a coming wave of consolidation as hospitals move from best-of-breed to integrated platforms for population health management and leading EHR vendors acquire pure-play PHM companies and technologies.  

    Indeed, HIMSS Analytics ranked EHRs as the most common tool that hospitals are using for population health management projects currently underway in its second annual population health survey. The other commonly-used technologies include portals, patient engagement tools, manual care management, data aggregation software, analytics and business intelligence programs. 

    [Also: Allscripts, Cerner, Epic signal more open EHRs ahead]

    The course of natural market maturation would suggest that the number of products will be whittled down considerably and, while it’s not clear exactly how many tools hospitals will need to successfully run population health management programs, HIMSS Analytics Research Director Brendan FitzGerald previously said that “it doesn’t have to be 30 products.”

    Brown said that EHRs — particularly those equipped to handle managed care, longitudinal patient records and billing — will be more appealing to hospitals than pure-play population health platforms. And he said that Epic, Cerner and Allscripts are investing seriously into new population health platforms that enable patient-centric and quality-based care that hospitals need to transition away from fee-for-service. 

    BlackBook found that 90 percent of surveyed CIOs, CFOs and hospital managers, in fact, anticipate that population health platforms will operate as next-generation patient accounting systems encompassing care collaboration and coordination as well as patient engagement features and functions for measuring outcomes and overall system performance. 

    That said, standalone PHMs won’t disappear anytime soon and, instead, will battle for market share among smaller healthcare organizations with the likes of Meditech, athenahealth, CPSI, and HMS, Brown said.

    “Those customers are up for grabs,” Brown said, “but far less lucrative for standalone PHM vendors than the market presented 2 years ago.” 

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