New EHR installations may require new laboratory information system upgrades and interfaces
Electronic health record (EHR) systems continue to be one of the costliest investments healthcare providers can make. And the company that holds the largest portion of the EHR market is Epic, with anywhere from 36% to 44%, according to various published reports and research briefs.
Healthcare executives remorseful about the cost of their hospital’s EHR may take solace in Becker’s Health IT’s recent list of the “most expensive” Epic EHR installations. It is common for the largest projects to cross the $1 billion mark.
Clinical laboratory leaders tasked with interfacing their hospital’s laboratory information system (LIS) with their healthcare system’s EHR may find the following information useful. The investment in time begins months before the actual EHR implementation.
One example is Lake Charles Memorial Health System (LCMHS) Lake Charles, La. In a blog post, the health system reported that it took 18 months for its physicians, clinicians, and staff to prepare for the installation of their new Epic MyChart EHR.
“There are lots of things we wish our customers would do to make sure their system runs well. Making sure every user is trained, for example. Putting in upgrades quickly. Making sure that the hardware runs fast enough,” wrote Judy Faulkner, Epic founder and CEO, in an Epic blog post.
“The LCMHS staff and physicians have championed this project from the beginning, and I have them to thank for the success of this EMR transition and look forward to seeing the positive impacts as we settle into the operational changes and new experiences Epic brings Lake Charles Memorial Health System and those we serve,” said Devon Hyde (above), President and CEO of Lake Charles Memorial Health System, about the provider’s transition to a new Epic MyChart EHR. (Photo copyright: Lake Charles Memorial Health System.)
Top 10 Most Expensive Epic EHR Installs of 2024
While Becker’s noted that the following compilation is “not an exhaustive list,” here’s its list of the top 10 most expensive Epic EHR projects based on publicly available sources.
KLAS reported that among the healthcare leaders KLAS interviewed:
27% had “an above-average EHR post-implementation” likely due to “providing technological foundation needed” at go-live, while,
40% said implementation of the EHR “had significant misses” and,
22% reported “average satisfaction with room for improvement.”
Providing staff with adequate training may smooth the way for new EHRs, according to the KLAS report. “Often, leaders wish they had invested in more training time and workflow-specific training in the context of patient care,” the authors wrote.
New EHR May Mean New LIS
Pathologists and clinical laboratory leaders may need to transition the laboratory information system (LIS) when the healthcare organization moves to a new EHR. At the very least, new interfaces will be required.
While a new EHR and LIS requires significant investments, they also provide opportunities for needed upgrades, competitive advantage, and security.
Patients in health systems that use the Cerner EHR can now track and share specific health metrics with their healthcare providers
In what may be first steps toward becoming a full-service digital healthcare platform, Health information technology (HIT) developer Cerner (NASDAQ:CERN) is partnering with Amazon (NASDAQ:AMZN) to bring cloud-based health tracking services to its EHR customers. People who use Amazon’s Halo service—which includes a wristband device and smartphone app to monitor specific health metrics—can now import that data directly into Cerner electronic health record (EHR) systems for sharing with healthcare providers.
This may turn out to be a pioneering effort by one of the nation’s major providers of EHR systems to pull in useful health data from a variety of non-traditional sources and incorporate them into a patient’s electronic health record. Cerner has a major market share of EHR systems (exceeded only by Epic) and has a laboratory information system (LIS) that is used by many clinical laboratories.
For this fact alone, strategic planners at medical laboratories and anatomic pathology groups should follow this development. That is particularly true of those labs operated by hospitals and health systems that decide to add this new feature to their existing Cerner EHR. If data is flowing into the EHR from patients’ Amazon Halo service, for example, it is not a big leap to imagine that clinical lab test data from the patients’ EHRs might later flow back to the Halo service where it would be instantly accessible to those patients.
This collaboration, according to a Cerner press release, “allows consumers to easily connect vital health and well-being information with their broader healthcare teams. … Historically this type of data has been siloed or difficult to obtain. Wearable technology, such as the Amazon Halo, can help achieve greater interoperability across healthcare when integrated directly into a patient’s electronic health record (EHR).”
Cerner’s integration of the Amazon Halo Band and smartphone app (above) into its electronic health record (EHR) system allows users to share collected healthcare metrics with doctors in health systems that use the Cerner EHR. How long will it be before clinical laboratories that use Cerner’s laboratory information systems (LIS) will be able to incorporate similar metrics into their LIS as well? (Photo copyright: Amazon.)
Using Artificial Intelligence to Empower Healthcare Consumers
The Halo wristband, along with its accompanying smartphone app, “combines a suite of AI-powered health features that provide actionable insights into overall wellness … [and] uses multiple advanced sensors to provide the highly accurate information necessary to power Halo,” an Amazon press release states.
Data collected by Amazon Halo that are now importable into Cerner EHRs, according to the press release, include:
Activity: Informed by American Heart Association physical activity guidelines and the latest medical research, Amazon Halo awards points based on the intensity and duration of movement, not just the number of steps taken.
Sleep: Amazon Halo uses motion, heart rate, and temperature to measure time asleep and time awake; time spent in the various phases of sleep including deep, light, and REM; and skin temperature while sleeping.
Body: Amazon Halo lets customers measure their body fat percentage from the comfort and privacy of their own home, making this important information easily accessible.
Tone: This feature uses machine learning to analyze energy and positivity in a customer’s voice so they can better understand how they may sound to others, helping improve their communication and relationships.
Labs: Amazon Halo Labs are science-backed challenges, experiments, and workouts that allow customers to discover what works best for them specifically, so they can build healthier habits.
Leveraging Patient Generated Health Data
In the Cerner press release, David Bradshaw, Senior Vice President of Consumer and Employer Solutions at Cerner, said, “The healthcare industry is undergoing a digital revolution, where physicians are increasingly looking to leverage patient-generated health data to help keep them healthier and out of the doctor’s office.
“Our work with Amazon Halo,” he continued, “highlights the importance of using artificial intelligence and other leading-edge technologies to accelerate healthcare innovation and improve health outcomes. Cerner is focused on continuing to lead a wave of breakthrough innovation, and this integration with Amazon Halo is a step toward this goal.”
The first healthcare provider to offer the Amazon Halo service to its Cerner EHR users is Sharp HealthCare of San Diego. Some Sharp Health Plan members will participate in wellness programs and eventually have the option to link their Sharp and Halo data directly into the healthcare system’s Cerner EHR.
Sharp HealthCare includes 2,600 physicians, four acute care facilities, and three specialty hospitals.
“Technology is revolutionizing the way we care for patients and how consumers care for themselves, and at Sharp we strive to embrace innovative ways to leverage leading technology to engage consumers in managing their health,” said Michael Reagin, SVP and Chief Information and Innovation Officer at Sharp HealthCare, in the Cerner press release.
“With more relevant information at their fingertips, our populations will be empowered to make more informed decisions about the health and well-being of themselves and the communities they serve,” he added. “We are pleased to work with Cerner and Amazon Halo to offer our members, patients, and clinicians an opportunity to have a more connected health record.”
Cerner Expanding to Include Population Health and Precision Medicine
Cerner may be evolving toward a cloud-based platform that pulls in data from hospital and doctors’ office EHRs—as well as data gather by wearable devices—and uses that information for population health and precision medicine analysis to guide healthcare providers.
Last year, Cerner announced a collaboration with the Amazon Web Services (AWS) cloud platform, reportedly in an effort to pivot beyond its traditional health records business.
“Moving forward, I think Cerner will look more like a health platform company and less like an EHR company,” Dan Devers, SVP, Cloud Strategy, and Chief IP Officer at Cerner, told Fierce Healthcare. “As you play out the trend in healthcare, I see Cerner very much operating at the health network level—so beyond the enterprise of a single health system. Given the power of the cloud and the work we’re doing, I see Cerner having much more relevance into broader networks and providing nationwide capabilities.”
Cerner is aiming to provide consumers with more power regarding their own healthcare by equipping them with easy, fast, and efficient methods to access their personal information and provide healthcare professionals with useful data about individual patients.
Given the value and importance of clinical laboratory data, innovative lab managers should strive to be aware of collaborations like the one between Cerner and Amazon Halo. Remaining alert for opportunities to participate in these types of arrangements could provide labs with added revenue streams and inventive ways to offer customers value-added services.
Cerner and Epic are the industry’s revenue leaders, though smaller vendors remain popular with physician groups
Sales of electronic health record (EHR) systems and related hardware and services reached $31.5 billion in 2018. And those sales will increase, according to a 2019 market analysis from Kalorama Information. This is important information for clinical laboratories and anatomic pathology groups that must interface with the EHRs of their physician clients to enable electronic transmission of lab orders and test results between doctor and lab.
Kalorama’s ranking includes familiar big EHR manufacturer names—Cerner (NASDAQ:CERN) and Epic—and includes a new name, Change Healthcare, which was born out of Change Healthcare Holding’s merger with McKesson. However, smaller EHR vendors remain popular with many independent physicians.
“We estimate that 40% of the market is not in the top 15 [in total revenue rankings],” said Bruce Carlson, Kalorama’s publisher, in an exclusive interview with Dark Daily. “There’s a lot of room. There are small vendors out there—Amazing Charts, e-MDs, Greenway, NextGen, Athena Health—that show up on a lot of physician surveys.”
“The EHR is really important,” noted Bruce Carlson (above), Publisher at Kalorama. “Since there are a variety of systems—sometimes different from the LIS [laboratory information management system]—you want to make sure you know the vendors and the space.” Carlson says opportunities remain for new entrants in the 700-plus competitor space, which is expected to see continued mergers and acquisitions that will affect clinical laboratories and their client physicians. (Photo copyright: Twitter.)
Interoperability a Key Challenge, as Most Medical
Laboratories Know
Interoperability—or the lack thereof—remains one of the
industry’s biggest challenges. For pathologists, that means seamless electronic
communication between medical laboratories and provider hospitals can be
elusive and can create a backlash against EHR vendors.
Kalorama notes a joint investigation by Fortune and Kaiser Health News (KHN), titled, “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong.” The report details the growing number of medical errors tied to EHRs. One instance involved a California lawyer with herpes encephalitis who allegedly suffered irreversible brain damage due to a treatment delay caused by the failure of a critical lab test order to reach the hospital laboratory. The order was typed into the EHR, but the hospital’s software did not fully interface with the clinical laboratory’s software, so the lab did not receive the order.
“Many software vendors and LIS systems were in use prior to
the real launching of EHRs—the [federal government] stimulus programs,” Carlson
told Dark Daily. “There are a lot of legacy systems that aren’t
compatible and don’t feed right into the EHR. It’s a work in progress.”
Though true interoperability isn’t on the immediate horizon, Carlson expects its arrival within the next five years as the U.S. Department of Health and Human Services ramps up pressure on vendors.
“I think it is going to be a simple matter eventually,” he
said. “There’s going to be much more pressure from the federal government on
this. They want patients to have access to their medical records. They want one
record. That’s not going to happen without interoperability.”
Other common criticisms of EHRs include:
Wasted provider time: a recent study published in JAMA Internal Medicine notes providers now spend more time in indirect patient care than interacting with patients.
Physician burnout: EHRs have been shown to increase physician stress and burnout.
Not worth the trouble: The debate continues over whether EHRs are improving the quality of care.
Negative patient outcomes: Fortune’s investigation outlines patient safety risks tied to software glitches, user errors, or other flaws.
There’s No Going Back
Regardless of the challenges—and potential dangers—it appears EHRs are here to stay. “Any vendor resistance of a spirited nature is gone. Everyone is part of the CommonWell Health Alliance now,” noted Carlson.
Clinical laboratories and pathology groups should expect
hospitals and health networks to continue moving forward with expansion of
their EHRs and LIS integrations.
“Despite the intensity of attacks on EHRs, very few health systems are going back to paper,” Carlson said in a news release. “Hospital EHR systems are largely in place, and upgrades, consulting, and vendor switches will fuel the market.”
Thus, it behooves clinical laboratory managers and
stakeholders to anticipate increased demand for interfaces to hospital-based
healthcare providers, and even off-site medical settings, such as urgent care
centers and retail health clinics.
According to Damo Consulting’s 2019 Healthcare
IT Demand Survey, when it comes to spending money on information
technology (IT), healthcare executives believe AI and digital healthcare
technologies—though promising—need more development.
Damo’s report notes that 71% of healthcare providers
surveyed expect their IT budgets to grow by 20% in 2019. However, much of that
growth will be allocated to improving EHR functionality, Healthcare Purchasing News reported
in its analysis of Damo survey data.
As healthcare executives plan upgrades to their EHRs,
hospital-based medical laboratories will need to take steps to ensure
interoperability, while avoiding disruption to lab workflow during transition.
The survey also noted that some providers that are considering
investing in AI and digital health technology are struggling to understand the
market, the news release states.
“Digital and AI are emerging as critical areas for technology spend among healthcare enterprises in 2019. However, healthcare executives are realistic about their technology needs versus their need to improve care delivery. They find the currently available digital health solutions in the market are not very mature,” explained Paddy Padmanabhan (above), Chief Executive Officer of Damo Consulting, in a news release. (Photo copyright: The Authors Guild.)
Providers More
Positive Than Vendors on IT Spend
Damo Consulting is a Chicago-area based healthcare and
digital advisory firm. In November 2018, Damo surveyed 64 healthcare executives
(40 technology and service leaders, and 24 healthcare enterprise executives). Interestingly, healthcare providers were more
positive than the technology developers on IT spending plans, reported HITInfrastructure.com, which
detailed the following survey findings:
79% of healthcare executives anticipate high
growth in IT spending in 2019, but only 60% of tech company representatives
believe that is so.
75% of healthcare executives and 80% of vendor
representatives say change in healthcare IT makes buying decisions harder.
71% of healthcare executives and 55% of vendors say
federal government policies help IT spending.
50% of healthcare executives associate
immaturity with digital solution offerings.
42% of healthcare providers say they lack
resources to launch digital.
“While information technology vendors are aggressively
marketing ‘digital’ and ‘AI,’ healthcare executives note that the currently
available solutions in these areas are not very mature. These executives are
confused by the buzz around ‘AI’ and ‘digital,’ the changing landscape of who
is playing what role, and the blurred lines of capabilities and competition,” noted
Padmanabhan in the survey report.
The survey also notes that “Health systems are firmly
committed to their EHR vendors. Despite the many shortcomings, EHR systems
appear to be the primary choice for digital initiatives among health systems at
this stage.”
Some Healthcare
Providers Starting to Use AI
Even as EHRs receive the lion’s share of healthcare IT
spends, some providers are devoting significant resources to AI-related
projects and processes.
For example, clinical
pathologists may be intrigued by work being conducted at Cleveland Clinic’s Center for
Clinical Artificial Intelligence (CCAI), launched in March. The CCAI is using
AI and machine learning in pathology, genetics, and cancer research, with the
ultimate goal of improving patient outcomes, reported Becker’s Hospital Review.
“We’re not in it because AI is cool, but because we believe
it can advance medical research and collaboration between medicine and
industry—with a focus on the patient,” Aziz Nazha, MD, Clinical
Hematology and Oncology Specialist and Director of the CCAI, stated in an
article posted by the American Medical Association (AMA).
AI Predictions Lower
Readmissions and Improve Outcomes
Cleveland Clinic’s CCAI reportedly has gathered data from
1.6 million patients, which it uses to predict length-of-stays and reduce
inappropriate readmissions. “But a prediction itself is insufficient,” Nazha told
the AMA. “If we can intervene, we can change the prognosis and make things
better.”
The CCAI’s ultimate goal is to use predictive models to “develop
a new generation of physician-data scientists and medical researchers.” Toward
that end, Nazha notes how his team used AI to develop genomic biomarkers that identify
whether a certain chemotherapy drug—azacitidine (aka,
azacytidine and marketed as Vidaza)—will work for specific patients. This is a
key goal of precision
medicine.
CCAI also created an AI prediction model that outperforms
existing prognosis scoring systems for patients with Myelodysplastic
syndromes (MDS), a form of cancer in bone marrow.
Meanwhile, at Johns
Hopkins Hospital, AI applications track availability of beds and more. The
Judy Reitz Capacity Command Center, built in collaboration with GE Healthcare Partners, is a
5,200 square feet center outfitted with AI apps and staff to transfer patients
and help smooth coordination of services, according to a news release.
Forbes described the Reitz command
center as a “cognitive hospital” and reports that it has essentially enabled
Johns Hopkins to expand its capacity by 16 beds without undergoing bricks-and-mortar-style
construction.
In short, medical laboratory leaders may want to interact
with IT colleagues to ensure uninterrupted workflows as EHR functionality evolves.
Furthermore, AI developments suggest opportunities for clinical laboratories to
leverage patient data and assist in improving the diagnostic accuracy of providers
in ways that improve patient care.
Despite the widespread adoption of electronic health record (EHR) systems and billions in government incentives, lack of interoperability still blocks potential benefits of digital health records, causing frustration among physicians, medical labs, and patients
Clinical laboratories and anatomic pathology groups understand the complexity of today’s electronic health record (EHR) systems. The ability to easily and securely transmit pathology test results and other diagnostic information among multiple providers was the entire point of shifting the nation’s healthcare industry from paper-based to digital health records. However, despite recent advances, true interoperability between disparate health networks remains elusive.
One major reason for the current situation is that multi-hospital health systems and health networks still use EHR systems from different vendors. This fact is well-known to the nation’s medical laboratories because they must spend money and resources to maintain electronic lab test ordering and resulting interfaces with all of these different EHRs.
Healthcare IT News highlighted the scale of this problem in recent coverage. Citing data from the Healthcare Information and Management Systems Society (HIMSS) Logic database, they note that—when taking into account affiliated providers—the typical health network engages with as many as 18 different electronic medical record (EMR) vendors. Similarly, hospitals may be engaging with as many as 16 different EMR vendors.
The graphics above illustrates why interoperability is the most important hurdle facing healthcare today. Although the shift to digital is well underway, medical laboratories, physicians, and patients still struggle to communicate data between providers and access it in a universal or centralized manner. (Images copyright: Healthcare IT News.)
The lack of interoperability forces healthcare and diagnostics facilities to develop workarounds for locating, transmitting, receiving, and analyzing data. This simply compounds the problem.
Pressure from Technology Giants Fuels Push for Interoperability
According to HITECH Answers, the Centers for Medicare and Medicaid Services (CMS) has paid out more than $38-billion in EHR Incentive Program payments since April 2018.
Experts, however, point out that government incentives are only one part of the pressure vendors are seeing to improve interoperability.
“There needs to be a regulatory push here to play referee and determine what standards will be necessary,” Blain Newton, Executive Vice President, HIMSS Analytics, told Healthcare IT News. “But the [EHR] vendors are going to have to do it because of consumer demand, as things like Apple Health Records gain traction.”
Another solution, according to TechTarget, involves developing application programming interfaces (APIs) that allow tech companies and EHR vendors to achieve better interoperability by linking information in a structured manner, facilitating secure data transmission, and powering the next generation of apps that will bring interoperability ever closer to a reality.
TechTarget reported on how University of Utah Hospital’s five hospital/12 community clinic health network, and Intermountain Healthcare, also in Utah, successfully used APIs to develop customized interfaces and apps to improve accessibility and interoperability with their Epic and Cerner EHR systems.
Diagnostic Opportunities for Clinical Laboratories
As consumers gain increased access to their data and healthcare providers harness the current generation of third-party tools to streamline EHR use, vendors will continue to feel pressure to make interoperability a native feature of their EHR systems and reduce the need to rely on HIT teams for customization.
For pathology groups, medical laboratories, and other diagnosticians who interact with EHR systems daily, the impact of interoperability is clear. With the help of tech companies, and a shift in focus from government incentives programs, improved interoperability might soon offer innovative new uses for PHI in diagnosing and treating disease, while further improving the efficiency of clinical laboratories that face tightening budgets, reduced reimbursements, and greater competition.
