The KHIT Blog: Health IT today. Where do we stand?

Friday, August 29, 2014

Health IT today. Where do we stand?

Relative market shares, in the context of Meaningful Use attestation through Q1 2014.

Recent article by Becker's Hospital CIO:

50 Things to Know About Epic, Cerner, MEDITECH, McKesson, athenahealth and Other Major EHR Vendors
Written by Helen Gregg, July 14, 2014

"To improve the quality of our healthcare while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized." — President-elect Barack Obama, Jan. 8, 2009

Five years later, billions have been poured into the transition to electronic health records. As of May, CMS has paid out a total of $14.6 billion in incentive payments to hospitals and health systems for the adoption and use of EHRs. These incentive payments, coupled with the looming threat of financial penalties for non-adopters and a need to better coordinate care have driven providers to rapidly adopt EHRs over the past few years. The EHR market is expected to reach $9.3 billion annually by the end of 2015.

As the EHR market has matured, a once-crowded field of vendors has narrowed significantly. At the end of 2013, 10 EHR vendors accounted for about 90 percent of the hospital EHR market, based on meaningful use attestation data from CMS: Epic, MEDITECH, CPSI, Cerner, McKesson, Healthland, Siemens, Healthcare Management Systems, Allscripts and NextGen Healthcare.

According to a KLAS report, just three of these vendors expanded their market share in 2013 — Epic, Cerner and MEDITECH — which together account for more than half of the acute-care EHR market.

Several of the big players in the EHR market are led by big personalities, from Judy Faulkner, who founded Epic (and wrote the software's original code) in 1979, kept the company private and is now worth an estimated $3 billion; to Cerner's Neil Patterson, known for his passionate, involved leadership style; to athenahealth's outspoken Jonathan Bush, an advocate for disruptive technologies in the healthcare industry.

Recently, the EHR market has seen an infusion of providers seeking replacements for their current systems. Surveys suggest between 12 and 30 percent of providers are dissatisfied with their EHR. Girish Navani, CEO and co-founder of eClinicalWorks, said in 2013 more than half of his company's new clients came from another vendor.

The 50 points below offer additional facts and insights into the EHR market and some of the most prominent companies. (EHR vendors below are arranged alphabetically.)...

Read on. Very interesting.

Is the Electronic Health Record Defunct?
Jerome Carter, MD

What do you think?

Medscape Medical News
EHR Replacement Trends Reveal Winners and Losers
Robert Lowes, August 28, 2014

Twenty-seven percent of medical practices are looking to replace their current electronic health record (EHR) system, according to a new survey suggesting that some well-known programs are fading in the marketplace.

In addition, another 12% of practices polled by KLAS, a healthcare information technology research firm, said they would like to replace their EHR but can't because of financial or organizational constraints.

These findings speak to more than the animus that many physicians feel toward digital charts, which are criticized for being too click-intensive and time-consuming. Forty-four percent of the 406 practices in the KLAS survey are owned by or tightly affiliated with a hospital. Such groups have little or no choice but to give up their EHR system, even if they like it, for the one deployed by the "Big House" to achieve standardization and integration, said study author Jared Dowland...

__

Nice piece just up on THCB:

Is It Possible That All Healthcare Needs to Know We All Learned In Kindergarten?
By JOSEPH M. SMITH, MD

Fun post. Wish it were all that simple.

Share everything – In healthcare, this means share ALL the data, all the information, all the acquired wisdom. Interoperable systems are essential.

Yeah. Goes to my ongoing "interoperababble" rant.
__

JUST IN

CMS Officially Pushes Meaningful Use Stage 3 To 2017, Offers Flexibility In 2014
It’s happened again. Late on a Friday afternoon — right before a long weekend, no less — a federal agency has dropped a rulemaking on an unsuspecting public.

Today, at 4:15 pm EDT, the Centers for Medicare and Medicaid Services finalized its modifications to Stage 2 of the electronic health records incentive program known as Meaningful Use.

From a cursory first read, it looks like, as previously proposed, Stage 3 is officially delayed until 2017 and providers will be able to use technology certified to 2011 standards to meet Stage 2 requirements this year only. Starting next year, only EHRs certified to 2014 standards will be acceptable...

Stage 3 at 2017? We may have a GOP President by then, and MU could get scuttled.

UPDATE: LATEST SUMMARY MU DATA

$24.666 billion paid out. Not a lot of movement in the reimbursement total relative to the last monthly report. To be expected, given the time of year.

COMING UP SHORTLY

apropos of Labor Day, I guess. Next post.

___

More to come...

No comments:

Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

The KHIT Blog

Search the KHIT Blog

Friday, August 29, 2014

Health IT today. Where do we stand?

No comments:

Post a Comment