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Most Interesting Vendors 2017: What’s Behind the Epic Juggernaut?

May 31, 2017
by Mark Hagland
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Epic's co-founder and CEO Judy Faulkner speaks exclusively to Healthcare Informatics on the company's Verona, Wisconsin campus as part of our Most Interesting Vendors 2017 profiles
Epic's campus in Verona, Wisconsin

This year, as in past years, Healthcare Informatics has designated several vendor companies in healthcare IT as “Most Interesting Vendors,” and is featuring profiles of those companies in its Healthcare Informatics 100 issue, which this year is our May/June issue. The “Most Interesting Vendor” designation is not an award, but simply a recognition. The trajectories of these companies speak to some of the broader trends taking place in healthcare IT in general and in the healthcare IT vendor market, and are thus of interest to readers. Healthcare Informatics’ Editor-in-Chief Mark Hagland’s profile of the Verona, Wis.-based Epic is the cover story of our May/June issue.

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Nine years ago, when we at Healthcare Informatics profiled Epic Systems Corporation, we produced the first major trade-press profile of the Verona, Wisconsin-based electronic health record (EHR) and clinical IT vendor, at a time when the healthcare industry was mesmerized by the company’s rapid rise into the top ranks of EHR vendors nationwide. As we reported in the June 2008 cover story, “Epic: Behind the Curtain,” there was a host of reasons available to explain Epic’s meteoric rise, and its growing dominance among EHR vendors winning the largest number of new and replacement EHR contract bid competitions.

Since then, Epic has only continued to prosper. With revenues of $2.5 billion in 2016, the privately owned company ranked sixth on this year’s Healthcare Informatics 100 list of the top healthcare IT vendors in the U.S., the third EHR/clinical information systems vendor on the list behind Cerner Corporation and McKesson Technology Solutions, and ahead of GE Healthcare, Allscripts Healthcare Solutions, athenahealth, MEDITECH, eClinicalWorks, Greenway Health, Quality Systems Inc. (NextGen), and other major EHR vendors. But Epic’s ranking on the 100 list tells only part of the story, as the company continues to win a considerable percentage of new EHR contract contests, and has become strongly dominant in a number of major healthcare markets, among them the San Francisco Bay Area and the Minneapolis St.-Paul metro area. Indeed, there are markets in which any hospital or health system using a non-Epic EHR is at a strong disadvantage in terms of health information exchange (HIE) and other priorities and activities.

What’s more, several years after the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act first got underway, the chances of significant new entrants coming into the rapidly maturing EHR market and succeeding, are dwindling, as Epic and the other mega-EHR vendors cement their hold on that market. Debates are raging across U.S. healthcare as to whether the ongoing acceleration in this consolidation trend that had already become prominent back in 2009, before meaningful use got underway, is a good thing or a bad thing. Certainly, some are openly questioning the value to healthcare providers (and even patients) of an EHR market with fewer and fewer options for patient care organizations, and many are wondering whether the consolidation trend will end up choking off innovation, particularly in the API (application program interface) market, as providers look for solutions that can leapfrog the limiting architectures of core EHRs and help clinicians and administrators improve population health management, care management, and other processes.

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At a very basic level, is this ongoing consolidation a good thing or a bad thing for U.S. healthcare? Industry leaders and observers struggle to answer that question. But whatever the answer, Epic finds itself inevitably at the center of the discussion, on the industry, strategic, and policy levels, as the company continues to snap up many of the current EHR implementation contracts.

As we noted back in June 2008, one of the core reasons that Epic continues to win a significant plurality of those bids is because, while its prices, depending on numerous factors, are reportedly nearly double those of their main competitors, Epic’s unique methodology—a rigorous one in which Epic implementers tell their customer organizations how and when to follow implementational steps, and not the other way around—continues to get high marks for results, with very few implementations that don’t go as planned. As one CIO told me two years ago after bringing her EHR live, “It’s simple, really: an implementational failure would not only be a job-ender for me, it would be a career-ender. Epic costs twice as much on the surface, but it’s pretty much guaranteed, and I need a guarantee. I simply can’t afford not to do this successfully; I know that, and everyone around me knows that.”

At Epic’s ever-expanding headquarters in the Madison, Wisconsin suburb of Verona—once a sleepy farm town, but now that metro area’s Silicon Pasture—there are more buildings, with more conference rooms and offices, and more art, these days than ever; certainly much more development is in evidence since 2008, when Healthcare Informatics first visited. Like the organization and its corporate culture, Epic’s headquarters strongly reflects the personality and preferences of its CEO and co-founder, Judy Faulkner, and to a lesser extent those of its COO, Carl Dvorak. Faulkner and Dvorak both find themselves on the road a great deal of the time, both across the United States and Canada and increasingly, all around the world, including across Europe, the Middle East, Asia and Australia, as Epic continues to expand its empire across more and more international healthcare systems.

Judy Faulkner (courtesy: HIMSS media)

In interviews this spring at the Verona intergalactic headquarters (yes, that’s what the campus is called), Faulkner and Dvorak expressed satisfaction with where Epic is right now in the marketplace, and challenged some of the contentions of critics. Certainly, both believe that their company’s ongoing financial success silences all criticism. The company is expanding so rapidly, in fact, that Faulkner says it’s hard to give a precise number of customer organizations, both because it is winning contracts at such a fast pace, but also because many of Epic’s customers are merging with and acquiring each other. So, Faulkner says, “about 400” is probably the most accurate number one can turn to. “Sometimes you have two customers that merge, and other times, you have a customer that breaks apart, so it really is hard to estimate,” she says. In terms of hospital-based organizations and physician practices active in its “Connect” EHR-share program, “We have 160 hospitals and 32,500 physicians, all connecting, via Connect,” she notes. “Meanwhile, 84 percent of our customers extend out” their contracts to provide EHR functionality to affiliated practices and organizations. What’s more, Epic allows patient care organizations to extend out to federally qualified health centers (FQHCs), free of charge, within certain limits. So a lot of patient care organizations are getting connected.

The Policy Implications of EHR Market Consolidation

By and large, Epic’s customers are satisfied with the functionality and service the mega-vendor provides, a fact that continues to be reflected in ongoing first-place and near-first-place standings in EHR product rankings published every year by the Orem, Utah-based KLAS Research. What’s more, the small number of less-than-fully satisfied customer organization executives out there tend to agree that there is no benefit in publicly expressing dissatisfaction with the company. The broader questions in the marketplace have to do with the confluence of size/consolidation, interoperability, and HIE connectivity. Has Epic become so big now that its size is actually inhibiting progress towards interoperability and data exchange?

“The answer to that question really depends on what hat you wear,” says Julia Adler-Milstein, Ph.D., an assistant professor in the School of Information and in the School of Public Health at the University of Michigan (Ann Arbor). “There are some people who are saying that interoperability is proving to be such a challenge that maybe  we are better off with a few dominant vendors. In markets that Epic dominates, people with Epic are thrilled with CareEverywhere,” Epic’s proprietary, Epic-customers-only HIE service. “On the other hand, others oppose market dominance, because they believe that it hinders interoperability and innovation. It really cuts both ways,” Adler-Milstein adds. “The bigger Epic gets, the more interoperability there is only within the Epic sphere, but the less there is outside it.”

Julia Adler-Milstein, Ph.D.

Does that make Epic’s size a policy issue? “Oh, I absolutely think it’s a policy issue,” Adler-Milstein says.  With regard to the meaningful use program under the HITECH Act, “We as a country made a huge investment in public dollars with the assumption that these systems would improve care. And I think it’s just unclear whether we’ve gotten that in return,” she says. “Policymakers really need to think about whether we’ve gotten what we’ve paid for. And if we haven’t, it suggests that we need a different set of policies to help ensure that that happens. We can confidently say that the policy framework today has gotten adoption of systems. But have we gotten adoption of systems that are interoperable? No. That are easily used by clinicians and other end-users? No. So will the market get us there from here on out, or do we need regulation? I personally am skeptical that the market will take us to that user-friendly, interoperable place. And frankly, that’s why we got 21st Century Cures, because market forces are simply not strong enough to catch up with interoperability.”

That having been said, David Muntz, who served as CIO at Baylor Health System in Dallas from 2006 through 2011, before becoming Deputy National Coordinator for Health IT at the Office of the National Coordinator for Health IT (ONC) from 2012 to 2013, and who is now a principal in the StarBridge Advisors consulting firm, notes that “What the government could do to avert that problem [of massive EHR vendor consolidation] is to force interoperability now; they could shorten the intended 10-year-timeframe for interoperability and could accelerate it. If vendors were forced to accept data from other vendors, and decision trees via APIs, then no vendor would be able to continue its dominance, because it would have to accept the bolt-ons or other elements that could compete favorably on features and functions. I’d prefer to see a private-sector approach” to achieving true healthcare system-wide interoperability among EHR and clinical information systems, the Dallas-based Muntz says, “but the incentives for the vendors to keep the APIs in a disclosing information-only mode, while continue to refuse to accept information from them, presents a challenge. So I would think if we see an aggressive embrace among vendors that would truly compete on features, functions, service, and community, then we could be successful in that regard.”

Many blame the current situation of massive consolidation in the EHR sector and its subsequent drag on interoperability, on the meaningful use program, which had the unintended effect of freezing EHR vendors relatively in place in terms of market competition, as vendors rushed to meet the federal government’s requirements for EHR certification, and became locked in cycles of upgrade work with provider organizations. Faulkner herself shares that view. Asked whether meaningful use overall was beneficial to the industry or not, she says, “It’s done some good in that it helped organizations afford technology. Now, in some cases, they installed rapidly and had to go back. What I would really like to do is to unwind some of what’s been done. There are too many things that a physician has to fill out that physicians in other countries say, why is that in there?” she says in relation to elements put into EHRs to satisfy program requirements.

And Epic COO Dvorak adds, “We did very, very well in that era where doctors and nurses got together and picked out an EMR without government subsidy. That’s our core strength, listening to customers and working out problems for them. We and they do that much better than folks from ONC.”

The University of Michigan’s Adler-Milstein makes a point about the meaningful use program’s actually rigidifying sub-optimal characteristics of all the commercial EHR products. “Was Epic pre-meaningful use a dream product?” she asks. “There’s not a lot of evidence to me that that alternative reality would have happened”—that, without MU intervening, Epic, or any of the other major EHR vendors, for that matter, would have moved to optimize their EHR solutions. “We like to think that, and that’s very clearly the vendor narrative, but it’s just not obvious to me that the market forces were in place to get these incredible, user-friendly EHRs. Would we be in a marginally better position? Maybe. But I don’t see us having moved into some kind of dream world” in lieu of MU’s ever happening.

Still, Epic’s top executives hold a largely anti-regulatory view. “I wouldn’t mind if meaningful use went away in its entirety, and we went back to the trajectory of doctors and nurses collaborating to move things forward,” Dvorak says.

Does Price Matter Anymore?

One of the more fascinating aspects of the Epic story is how its unique methodology, devised in the company’s early days by Faulkner and maintained into the present, has seemingly defied traditional market dynamics. Epic has always been more expensive at the front end, and Faulkner makes no apologies for that. But its strong record on implementation success has at least until now buoyed the company in the contract-bid sweepstakes, even as patient care organizations reel from the double hit of continually tightening reimbursement and increased operating expenses. Up until now, Epic’s higher pricing has only had the paradoxical effect of adding to the company’s mystique; some have compared Epic’s EHR to a Coach purse—a pricey version of a necessity, whose cachet is only enhanced by its higher price.

Of course, not everyone is willing to pay. David Higginson, chief administrative officer and CIO at Phoenix (Az.) Children’s Hospital, who says he admires Epic’s EHR, ended up going with the Chicago-based Allscripts instead, after a “bake-off” involving several of the leading EHR vendors a couple of years ago. “The thing is, if you’re able to buy the best in everything, that’s great,” Higginson says. “But a lot of people have to make tough choices. And people might pick a building over a software over something else. We also did like Allscripts, they’re very open. And their solution runs on SQL server.” So in the end, he reports, his organization’s physicians, who found Epic’s EHR very appealing, told him that they would prefer that the hospital take the savings differential between the Epic and Allscripts bids, and build out their hyper-crowded emergency department instead. As the CAO and CIO of a children’s hospital that has to work on very narrow margins because of its high Medicaid census, he says he has no regrets.

In fact, StarBridge Advisors’ Muntz says, “I think Epic is vulnerable because of its reputation for higher pricing,” in the evolving vendor market. “The fact is that people have to be so conservative about expenses. And there are other alternatives. I’ve seen great packages fail and modest or average products excel.” What’s more, he says, “I think that there’s enough expertise on how to do implementations well that the more expensive ones will ultimately lose, that it’s really the implementation, not the fact of having features and functions itself.” Still, he says, Epic retains a very special advantage in the market. “Epic has a really good product,” he says, “but it has a great community.”

David Muntz, Ph.D.

One Epic customer organization executive, Michael Hogarth, M.D., a professor in the Departments of Internal Medicine and Pathology and Laboratory Medicine, and a practicing internal medicine specialist, at the University of California Davis Health System, sees all this in a historical context. “They are very polarizing,” he says of Epic, “but I’m not sure that they’ve done anything that would make them so. It’s interesting to me: Epic started as a company in the mid-70s with a vision that was not compatible with the market at the time. And Judy stuck with it. The market really wasn’t about putting everything into the central repository, with data coming from multiple places, and doctors using the computer, at that time. If she had gone to an investor in the 1970s, they would have laughed her out of the room. But she was visionary and passionate. And she’s still the same. And people see that as, she’s pushing the world. Now that she has big market share, people perceive that vision and passion as pushing the market. But where were those people 25, 30 years ago?”

What’s more, Lydon Neumann, a vice president at the Chicago-based Impact Advisors consulting firm and a consultant who has been in the industry for nearly 40 years, says, “We do a lot of cost modeling” of EHR solutions, for the firm’s hospital and medical group clients, “and their premium is actually not as large as is perceived. They’re not automatically the most expensive, though they are expensive for smaller hospitals.” Judy Faulkner’s genius, Neumann says, was that at the time that Epic came fully into the inpatient EHR market, “People were selling on price, i.e., doing deals to win customers. And Judy priced it [Epic’s EHR] correctly. She raised the price, but that price was less about maximizing revenue and more about what this really cost; she raised the acquisition cost to what it really requires. She was also committed to quality. When I was a vendor, we were OK with getting to a 6 or 7 on a scale of 1-10, because the cost was so high to achieve, say, a 9. Now, she charged more, but she was committed to a high level of quality in terms of usability, and everyone’s moving towards that level.”

Of course, as StarBridge Advisors’ Muntz notes, that relatively high level of pricing could prove to be a point of vulnerability at this point, in a rapidly maturing EHR vendor market. In that context, industry observers note, a number of scenarios are possible for that market, depending in part on the federal healthcare IT policy landscape. With a change in presidential administration, and in particular with a change in leadership at the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, the chances are that the regulatory framework around health IT could be loosened over the next few years, and with that potential new regulatory looseness playing out in any number of ways. Certainly, Epic’s senior executives are well-positioned for the moment, if such turns out to be the case.

But longer-term, with the near-universalization of EHR implementation in patient care organizations and the massive shift towards population health management and care management, Epic finds itself in the same position as the other dominant EHR vendors—saddled with technology that was originally designed primarily to build and maintain data repositories, rather than responding in an agile way to the U.S. healthcare system’s shift from volume to value. Still, given Epic’s market success to date and its vast resources, it would be foolish to count the company out at all; Epic has continued to thrive in a rapidly changing market. In that context, the next five years should be most interesting, indeed.


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Study: EMR Interventions Help in Providing High-Value Medical Care

October 19, 2018
by Rajiv Leventhal
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By implementing electronic medical record (EMR)-based interventions, Boston Medical Center was able to reduce unnecessary diagnostic testing while increasing the use of postoperative order sets.

These actions signal two markers of providing high-value medical care, according to hospital officials. Indeed, the data from Boston Medical Center’s efforts demonstrates the impact of deploying multiple interventions simultaneously within the EMR as a way to deliver high-value care, they attest. This study was published in the Joint Commission Journal on Quality and Patient Safety.

The focus on providing high-value medical care was renewed in 2012 with the release of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation that identifies common tests and procedures that may not have clear benefit for patients and should sometimes be avoided. Many institutions have responded to this campaign by developing EMR-based interventions that target individual recommendations.

Boston Medical Center (BMC) specifically focused on five areas in the Choosing Wisely recommendations:  the overutilization of chest x-rays, routine daily labs, red blood cell transfusions, and urinary catheters, and underutilization of pain and pneumonia prevention orders for patients after surgery. To do this, the researchers worked with the hospital’s IT team to incorporate new recommendations into the EMRs that would alert the provider to best practice information. The researchers examined data between July 2014 and December 2016 to look at how the interventions played out clinically.

At six months following BMC’s intervention, which was activated hospital-wide for specific patients using the Epic EMR, the proportion of patients receiving pre-admission chest x-rays showed a significant decrease of 3.1 percent, and the proportion of labs ordered at routine times also decreased 4 percent. Total lab utilization declined with a post-implementation decrease of 1,009 orders per month, the study revealed.

The researchers found no significant difference in the estimated red blood cell transfusion utilization rate or the number of non-ICU urinary catheter days, but the proportion of postoperative patients who received appropriate pain and pneumonia prevention orders showed an absolute increase of 20 percent, according to the researchers.

“The results from our interventions suggest that they alone show promise in improving high-value care, but using only an electronic medical record intervention may not be adequate to achieve optimal outcomes emphasized by Choosing Wisely,” said Nicholas Cordella, M.D., the study’s corresponding author, a fellow in quality improvement and patient safety at BMC, and an assistant professor at Boston University School of Medicine.

Cordella added, ““In order to move the needle on reducing unnecessary healthcare costs, we need to consider multi-pronged approaches in order to engage providers in ways that can truly make a difference in how we deliver exceptional, high-value care to every patient.” He suggested that future efforts aimed at increasing high-value care should consider other elements, such as clinician education, audits and feedback, and peer comparison.

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Industry Groups Urge ONC to Reorient Goals of EHR Reporting Program, Focus on Health IT Safety, Security

October 18, 2018
by Heather Landi, Associate Editor
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Many healthcare industry groups would like to see the Electronic Health Record (EHR) Reporting Program for health IT developers include a strong focus on patient safety-related usability, EHR training, transparency on EHR vendors’ cybersecurity practices as well as cost transparency.

This feedback came in response to a request for information (RFI) issued by the Office of the National Coordinator for Health IT (ONC) in late August seeking public input on reporting criteria under the EHR Reporting Program for health IT developers, as required by the 21st Century Cures Act. The public comment period ended Oct. 17.

ONC issued the RFI on criteria to measure the performance of certified electronic health record technology (CEHRT). The Cures Act requires that health IT developers report information on certified health IT as a condition of certification and maintenance of certification under the ONC Health IT Certification Program.

According to the Cures Act, the EHR Reporting Program should examine several different functions of EHRs and reporting criteria should address the following five categories: security; interoperability; usability and user-centered design; conformance to certification testing; and other categories, as appropriate to measure the performance of certified EHR technology.

In its comments to ONC, the Bethesda, Md.-based American Medical Informatics Association (AMIA) questioned what it views as the “constrained scope” of the EHR Reporting Program to “provide publicly available, comparative information on certified health IT,” to “inform acquisition upgrade, and customization decisions that best support end users’ needs.”

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Rather, AMIA urged ONC to develop the EHR Reporting Program to measure performance to improve CEHRT security, interoperability, and usability, and not be used simply to provide data for “acquisition decision makers.”

“Especially when viewed alongside the additional provisions in newly developed CEHRT Conditions of Certification, the EHR Reporting Program should be leveraged to bring transparency to how CEHRT performs in production environments with live patient data,” AMIA stated.

“ONC should develop an EHR Reporting Program that more closely approximates a post-implementation surveillance ecosystem, not a government-sponsored ‘consumer reports’,” AMIA wrote in its comments.

Such an ecosystem, AMIA stated, would “illuminate CEHRT performance used in production and would generate product performance data automatically, without users having to submit reporting criteria.”

As proof of concept, AMIA pointed to ONC’s existing nascent surveillance and oversight program for CEHRT that could be leveraged for the EHR Reporting Program. The group also referenced the Food and Drug Administration’s (FDA) Digital Health Software Precertification Program as another example of a federal program that looks to utilize real-world production data.

In addition, AMIA recommends ONC develop interoperability reporting criteria for the EHR Reporting Program by building on previous RFIs meant to “measure interoperability,” including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and ONC’s “Proposed Interoperability Standards Measurement Framework.”

And, the industry group also urged ONC to prioritize an additional measure that demonstrates a capability to provide patients with “a complete copy of their health information from an electronic record in a computable form.” “This focus would align with top-level HHS priorities to improve patient access to their data,” AMIA noted.

AMIA also recommends alignment between the EHR Reporting Program and other aspects of the Cures-mandated Conditions of Certification.

“The EHR Reporting Program is one more vital piece in improving both EHR performance and care quality,” AMIA president and CEO Douglas B. Fridsma, M.D., Ph.D., said in a statement. “We have a tremendous opportunity to leverage Cures provisions if we hone our focus on EHR performance in the real world.”

In its comments, the College of Healthcare Information Management Executives (CHIME) advises ONC against establishing any complex rating methodologies for scoring vendors. ONC should also consider establishing benchmarks by which to monitor interoperability progress among vendors, CHIME wrote. The organization noted that patients need better education on the risks of using application programming interfaces (APIs), and ONC should partner with their federal partners and stakeholders on this issue, CHIME said.

Many organizations, including CHIME, would like more information about vendors' ongoing support practices, such as the estimated costs of maintenance and software. The Medical Group Management Association (MGMA) recommended making software pricing structures for upfront and ongoing software, training and maintenance costs part of the Reporting Program, as well as all interoperability “connection” fees. MGMA also urged ONC to consider incorporating into the Reporting Program testing criteria that focused on the effectiveness of the EHR’s integration with practice management system software, and costs associated with it.

The American Health Information Management Association (AHIMA) recommended that comparative information made publicly available under the EHR Reporting Program should also contain reporting criteria that reflects the entire lifecycle of the certified health IT product, including acquisition, implementation, ongoing maintenance, upgrades, additional product and/or application integration, and replacement.

Focus on Patient Safety-Related Usability and EHR Training

In its comments, AMIA also urged ONC to view health IT safety as a measurable byproduct of usable CEHRT deployed in live environments. “To understand CEHRT usability performance in situ, ONC should supplement user-reported measures with measure concepts that reflect the safety of health IT,” AMIA wrote.

MGMA recommended that the Reporting Program report on the ability of the software to identify and address patient safety issues. “Poor usability and inefficient clinician workflow can not only fail to prevent adverse events but can actually contribute to them,” the organization wrote.

In comments it submitted to ONC, Pew Charitable Trusts noted that the establishment of the EHR Reporting Program “has the potential to give health care providers, EHR developers, and other organizations better data to address barriers in the effective, efficient, and safe use of health information technology, and improve systems accordingly.”

“In particular, this program could unearth key details on how clinicians utilize EHRs to meet ONC’s goal of reducing clinician burden while improving patient safety. ONC should ensure that the reporting criteria focused on usability—which refers to the design of systems and how they are used by clinicians—also incorporate safety-related provisions,” Pew wrote in its letter.

Pew recommended reporting criteria focus primarily on testing EHR usability to promote patient safety. To this end, Pew identified four principles to guide usability-related reporting criteria—the adoption of a life-cycle approach to developing usability-related criteria; incorporating quantitative, measurable data; limiting burden on end-users; and ensuring transparent methods that prevent gamesmanship.

Pew also provided ideas for existing sources of information that could be adapted into or utilized as safety-related usability reporting criteria, such as the Leapfrog CPOE tool, safety surveillance data from ONC, the ONC SAFER Guides or a 2016 health IT safety measure report from NQF.

“As ONC implements this program, the agency should ensure that the usability aspects of the program focus on the facets of EHR usability that can contribute to unintended patient harm. To achieve that goal, ONC should consider the aforementioned principles in identifying reporting criteria, and data sources that could become part of the program,” Pew wrote in its comments.

Orem, Utah-based KLAS Research and the Arch Collaborative recommended the EHR Reporting Program include criteria focused on EHR training, as better clinician training is critical to EHR usability and clinician satisfaction, the two groups said. The Arch Collaborative is a KLAS-affiliated initiative with more than 130 provider members.

The KLAS-Arch comment cited research findings based on responses by more than 50,000 physicians from more than 100 provider organizations around the globe that suggests EHR satisfaction and usability are directly related to the extent and quality of training users have received. The research indicates that organizations that focus on training to support clinician workflows have higher EHR satisfaction than those that don’t. What’s more, the higher the levels of personalization tool use by the clinicians, the higher the EHR satisfaction score, according to KLAS.

“EHRs are not simple enough to be operated efficiently without ample instruction. It is essential that new providers spend enough time learning how to use the EHR, and it is requisite that providers have the option to participate in ongoing training each year,” Taylor Davis, vice president of innovation at KLAS Research, wrote in the letter. “When an EHR training program is well designed, there will be a demand to attend. A trend that has been noted is that success begets success; when providers share how EHR training has improved their efficiency, their peers become more likely to participate. The key is that the providers must have the option to choose what works for them.”

Need for Greater Focus on Security Posture

The Healthcare and Public Health Sector Coordinating Council's cybersecurity working group highlighted, in its comments on the RFI, the need for more transparency on EHR vendors' cybersecurity posture as part of the criteria of the EHR Reporting Program.

“The challenges to our sector are abundant and we believe these attacks pose direct threats to patient safety,” the group wrote in its comments. The group urged ONC to factor into the EHR Reporting Program the growing incidences of cybersecurity attacks on the sector and the need to work collaboratively to address the threats.

The group outlined a number of items that would better inform providers of a vendors’ security practices, such as access to an auditor’s statement regarding the security posture of the vendor and its products, upon provider request, as well as a software security analysis, whether two-factor authentication is in use, information on role-based access controls and how roles are configured, and, with each release and update, the number of patches provided to address security-related issues.

The group also recommended ONC consider developing a more standard way for vendors to report vulnerabilities with health IT upgrades and releases.

 


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UnitedHealth Group Plans to Unveil Health Record for Members, Providers in 2019

October 17, 2018
by Rajiv Leventhal, Managing Editor
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Health insurer UnitedHealth Group will be unveiling a “fully integrated and fully portable individual health record,” CEO David Wichmann said on the on the company’s third-quarter earnings call yesterday.

Speaking to the insurer’s broader digital health strategy, Wichmann stated on the earnings call that the company’s consumer digital health platform, Rally—which is a website and mobile app—is now serving over 20 million registered users and will leveraged to help develop the health record.

“Rally is synthesizing information and engaging people to better manage their health, helping consumers save money by selecting the highest quality care providers, understanding their out-of-pocket costs up front, and in some markets even scheduling appointments for care. We will soon be releasing at scale a first-of-kind, fully integrated and fully portable individual health record that delivers personalized next-best health actions to people and their caregivers,” Wichmann said on the call.

While many more details are not yet known about the health record, Wichmann did say that by the end of 2019, the insurance giant has the goal of developing individual health records for the 50 million fully benefited members that it serves, as well as for their care providers.

He noted, “We would use the Rally chassis…to provide individuals in a way in which they can comprehend a tool, if you will, not only outlining their individual health record, but also giving them next-best action detail. That's what I mean by when I say it's deeply personalized. It's organized around them, not based upon generic criteria. It also assesses to what extent that they've been, and how they've been served by the health system broadly, and whether or not there's been any gaps in care that have been left behind.”

Giving a little bit more information about the vision UnitedHealth Group has in regard to the health record, Wichmann said, “You might imagine what that could ultimately lead to in terms of a continuing to develop a transaction flow between the physician and us and the consumer and us, as we us being the custodian to try to drive better health outcomes for people, but also ensure that the highest level of quality is adhered to.”

As of now, the platform appears to be more geared toward consumers than providers. Steven Halper, an analyst for financial services company Cantor Fitzgerald, noted in an update that “The Rally EHR should be able to tap into different EHRs that use APIs [application programming interfaces] and other interoperability standards, which are being more-widely adopted. Rally EHR should be viewed as a consumer engagement tool and not as a threat to legacy provider EHR products.”

UnitedHealth Group already has its Optum business line, a health innovation company that provides health services in an array of different ways, including through its growing data analytics capabilities.

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