News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

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Becker’s Health IT Releases Lists of Providers That Paid the Most for Their EHRs

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.

  1. Northwell Health, New Hyde Park, N.Y.:                                          $1.2 billion
  2. Trinity Health, Livonia, Mich.:                                                          $800 million
  3. AdventHealth, Altamonte Springs, Fla.:                                            $660 million
  4. Memorial Hermann Health System, Houston:                                   $500 million
  5. UAB Health System, Birmingham, Ala.:                                           $380 million
  6. Broward Health, Fort Lauderdale, Fla.:                                             $250 million
  7. Wellstar Health System, Marietta, Ga.:                                              $175 million
  8. Health First, Rockledge, Fla.:                                                             $160 million
  9. Sarasota Memorial Health Care System, Sarasota, Fla.:                    $160 million
  10. MultiCare Health System, Tacoma, Wash.:                                       $50 million

Largest Epic EHR Projects Ever

Beyond 2024, here are the “largest Epic EHR projects of all time,” Becker’s Health IT reported separately based on publicly available sources:

  1. Kaiser Permanente, Oakland, Calif:                                                   $4 billion
  2. Mayo Clinic, Rochester, Minn.:                                                         $1.5 billion
  3. Mass General Brigham, Somerville, Mass.:                                       $1.2 billion
  4. Northwell Health, New Hyde Park, N.Y.:                                          $1.2 billion
  5. NYC Health and Hospitals, New York, N.Y.:                                   $1 billion
  6. Sutter Health, Sacramento, Calif.:                                                      $1 billion
  7. New York-Presbyterian, New York, N.Y.:                                        $964 million
  8. Providence, Renton, Wash.:                                                               $800 million   
  9. Trinity Health, Livonia, Mich.:                                                          $800 million
  10. Duke University Health, Durham, N.C.:                                            $700 million
  11. UMass Memorial Health, Worcester, Mass.:                                     $700 million   

Training Key for New EHR: Report

According to a report by research firm KLAS titled, “EHR Implementations 2025: Investing in People to Avoid Pitfalls and Ensure Clinical Success,” in addition to the “tremendous financial undertaking,” healthcare organizations also face implementation challenges following EHR installations.

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.           

—Donna Marie Pocius

Amazon Launches New Telehealth Medical Services for Its Prime Members

Plan offers members transparent pricing for medications and 24/7 virtual consults

Amazon is working to be price competitive in the healthcare products and services it provides. A recently launched plan offers Prime members fixed prices and affordable monthly rates for telehealth visits, treatment plans, and medication delivery for various types of health, beauty, and lifestyle care. Healthcare providers such as office-based physicians, clinical laboratories, and anatomic pathology groups, may once again be impacted by Amazon’s foray into medical care.

This is not the first time that Amazon (NASDAQ:AMZN) has waded into the medical pond. In 2022, the Seattle-based ecommerce company purchased One Medical (NASDAQ:ONEM) for $3.9B while at the same time launching Amazon Clinic (now known as Amazon One Medical Pay-per-visit), a virtual healthcare service, in an attempt to “reinvent” healthcare. Dark Daily covered these events in an ebrief at that time.

Since then, Amazon has offered pay-per-visit telehealth consultations to determine treatments for more than 30 common ailments such as pink eye (conjunctivitis), flu, and sinus conditions. Now, Amazon is adding “low, clear upfront pricing for a clinical visit, treatment plan, and fast, free medication delivery for Prime members for a range of common health, beauty, and lifestyle concerns, including anti-aging skincare treatment, men’s hair loss, erectile dysfunction, eyelash growth, and motion sickness,” according to an Amazon news release.

“We’re committed to giving customers convenient, affordable care options that put them in control of their health,” said Bergen Penhart, general manager for Amazon One Medical Pay-per-visit, in the news release. “This new offering makes it easy for Prime members to get expert clinical advice and prescribed treatments for common health, beauty, and lifestyle needs, all from the comfort of home.”

The platform supports both on-demand messaging and virtual video telehealth visits to address more than 30 common medical issues.

“This simple care experience was built to meet the needs of today’s customer. At Amazon, we’re working to reduce the burden on patients who’d like to move forward with care, but may be tired of navigating the hurdles of our healthcare system, waiting in a long line at the pharmacy, or worried about a surprise bill or medication cost,” said Harvard-trained lung specialist and chief medical officer for Amazon, Vin Gupta, MD (above). “We’re helping patients re-engage in care and spend time doing what they love instead.” These new medical initiatives from Amazon are meant to be convenient for patients, but have an impact on local healthcare providers, clinical laboratories, and pharmacies. (Photo copyright: Vin Gupta, MD.)

Convenience, Transparency, 24/7 Access to Healthcare

Telemedicine has seen a sharp rise in recent years, aided by necessity during the COVID-19 pandemic. Forbes reports that the percentage of hospitals offering telemedicine rose to 72% in 2021. Since so many Americans today use the Internet for everything from shopping for medications to interfacing with healthcare providers, it makes sense that Amazon, one of the world’s most successful online retailers, would want a cut of the action.

So what is the retail giant offering now that improves upon its previous healthcare services? It is promoting fixed prices and monthly payments with complete transparency. There are also no surprise bills for Amazon One Medical patients. Prime members can see the price for their telehealth consultation and prescription before deciding whether to go forward with the appointment and treatment.

In addition, Amazon One Medical patients can use a smartphone app (available on both Android and Apple iPhone) to review prices for treating five common health conditions and beauty treatments, as well as meeting virtually with a clinician 24/7 from anywhere in the world. In some areas Amazon even offers same-day or next-day medication deliveries.

“This simple, upfront pricing helps customers shop for their healthcare and make informed, confident decisions. Customers only pay for the cost of the consultation and medication (if prescribed). There are no additional fees, expenses, or subscriptions needed beyond Amazon Prime,” the news release states.

First Wrongful Death Lawsuit Filed against Amazon One Medical

However, the road to success in healthcare is not without its potholes. In “Amazon One Medical Call Centers Found Wanting in Washington Post Report,” we covered a 2024 Washington Post story on leaked documents that appeared to indicate Amazon’s One Medical primary care call center was not using trained, certified medical professionals to field patient phone calls and provide telehealth guidance.

This led to disappointment among Amazon One Medical patients, we reported.

According to The Washington Post, Amazon bought One Medical and hired workers for their call centers with “limited training and little to no medical experience.” This allegedly caused serious medical issues such as high blood pressure spikes and blood in stool to go unrecognized.

Caroline O’Donovan, the Washington Post reporter who broke the story, told PBS, “In the documents that were leaked to us, there’s a doctor who wrote a note saying, ‘I don’t think these call center people even realize that they’re triaging patients, which is not something that they’re qualified to do.’”

Amazon acknowledged that initial calls could have been handled more effectively, however the company insisted that no patients were harmed. In an email statement, Amazon spokesperson Dawn Brun said, “We take patients’ feedback seriously and the [Washington Post] story mischaracterizes the dedication we have to our patients and care teams.”

Nevertheless, Amazon One Medical now faces a lawsuit. The Daily Mail reported that Suzanne Tong of Oakland, Calif., is suing Amazon for negligence after her husband died following a video consultation during which he was told to “take an inhaler” for symptoms that included shortness of breath and blue feet.

“Hours later, the 45-year-old was rushed to the emergency department at the Alta Bates Summit Medical Center, where [according to court documents] he ‘collapsed in the waiting room and expired,’” The Daily Mail reported, adding, “The [court] filing claims that ‘to a reasonable degree of medical certainty,’ if Mr. Tong had received the ‘proper care, treatment and follow up’ at his appointment with Amazon One Medical on December 18, 2023, he would have survived.”

Amazon would not comment on the impending litigation citing patient privacy concerns, instead providing a statement to the press. In it, an Amazon One Medical spokesperson said, “While we are prohibited by law from discussing patient records, we refute claims that a change in the duration of visits or location of a virtual visit has impacted the care provided at Amazon One Medical,” the Los Angeles Times reported. “We care deeply about every patient we serve, and the quality and safety of our care are our highest priorities. We’re proud of our extensive quality and safety measures, and of the health outcomes we help our patients achieve. We take concerns about our care extremely seriously, and we’re committed to continuous improvement.”

According to The Daily Mail, this is the first wrongful death lawsuit brought against Amazon One Medical.

Warning to Clinical Labs, Pathology Groups

Stories like these raise questions as to whether the quality of care delivered by various telehealth services is being sacrificed for the sake of convenience and price transparency. Americans are increasingly living more online. Medical services moved online out of necessity, and many healthcare providers who stayed online have expanded their offerings due to customer demand.

Clinical laboratories and anatomic pathologists would be wise to stay informed on this growing trend. These business launches are a warning shot for lab managers and pathology groups to invest time and money becoming more patient/consumer friendly providers with websites that feature price transparency.          

—Ashley Croce

Related Information:

Amazon Introduces Low Upfront Pricing for a Telehealth Visit with Treatment Plan and Fast, Free Medication Delivery for Men’s Hair Loss, Eyelash Growth, Anti-Aging, ED, and Motion Sickness for Prime Members

Study Finds Rapid Rise of Telehealth Use in US Hospitals

Amazon’s Health Clinic Pushed a Misleading Account of Call Center Errors

Patient Safety Concerns Arise over Amazon’s One Medical Call Centers after Document Leak

Mom Sues Amazon One Medical after ‘Virtual Doctor’s Appointment Leads to Husband’s Death’

Amazon Signs Agreement to Purchase One Medical for $3.9 Billion, Aims to “Reinvent” Healthcare

Amazon One Medical Call Centers Found Wanting in Washington Post Report

Covenant Medical Center Creates Pilot Program to Help Alleviate its Nursing Shortage

New care model uses a ‘virtual nurse’ to interact with the patient in ways appropriate to the level of care

Clinical laboratories and pathology groups aren’t the only healthcare organizations currently experiencing critical industrywide shortages. A chronic nursing shortage is prompting hospitals like Covenant Medical Center in Lubbock, Texas, to invent unique ways to circumvent this issue while still managing to provide exemplary patient care.

Covenant, an affiliate of Providence—a 51 hospital/1,000 clinic healthcare network spanning Alaska, California, Montana, New Mexico, Oregon, Texas and Washington—piloted a hybrid nursing model called “Co-Caring.”

The model “uses virtual nursing to care for patients and support the bedside team through two-way audio and video telehealth technology,” according to a Providence news release. This allows nurses to focus on more vital roles, such as administering medication and assessing patients’ conditions, while day-to-day tasks are performed by assistants and virtual nurses.

After operating successfully for one year at a 30-bed unit within the 381-bed Covenant, the Co-Caring model was expanded to 10 other units in hospitals operated by Providence where it reduced the workload for bedside nurses, increased caregiver collaboration, and resulting in financial benefits for the facility.

“This pilot is not about one unit in one hospital,” Julie Wright, RN (above), who at the time was a Nurse Manager at Covenant, in a Providence news release. “It is about taking the first steps to changing how we care for our patients. We are working on creating an environment where burnout is the exception and not the rule, and where joy is the expectation.” Clinical laboratories might use a similar approach to enable pathologists and clinical laboratory scientists to dedicate their time to higher-value tasks. (Photo copyright: LinkedIn.)

Elevating the Practice of Nurses

“The past three years dramatically transformed our industry and workforce in ways that accelerated the modernization of care,” said Providence SVP and System Chief Nursing Officer Sylvain Trepanier, RN, in the news release. “Co-Caring represents an innovative solution to one of healthcare’s most pressing issues—the increased need for nurses, which for the United States is currently estimated at more than 200,000 new nurses required each year to account for population growth.”

The roots of the Co-Caring model were created by nurses for nurses. Under the Co-Caring initiative, a support team of certified nursing assistants (CNAs), patient care technicians (PCTs) and nurse technicians (NTs) perform routine functions, reducing demand on nurses.

“By creating a new team that would share responsibility and accountability with a nurse that would be working virtually, we have people showing up every day doing the work that they love to do and removing some of the barriers that they had in doing it the old traditional way,” Trepanier told the Catholic Health Association of the United States (CHAUSA).

“Quite frankly, when we embraced this, even if we could cover our costs and it would be cost neutral, it would be a great proposition,” he continued. “The pleasant surprise of this is that we’re elevating the practice of nurses, the technicians feel a part of the team, and the patients are having a good experience. We’re having great operational outcomes and decreasing the total cost of care.”

Virtual Nurses

Virtual nurses are utilized through a bi-directional audio/video telehealth platform to support the bedside team in caring for patients. These virtual nurses assist with tasks like admission processes, discharge preparation, pre-procedural checklists, and medication reconciliation. Interdisciplinary Team Meetings, which include the virtual nurses alongside charge nurses, physicians, and case managers, are held daily to ensure the best patient care.  

The Co-Caring model increased patient and caregiver satisfaction while simultaneously having positive financial significance. The first-year turnover rate (FYTO) among registered nurses decreased by 73% and by 55% for all staff involved in the program. Covenant was also able to decrease the amount of travel nurses it needed, which enabled it to hire more nurses, CNAs, and PCTs.

“On a 30-bed unit, we ended up having a return on our investment of roughly $450,000,” Trepanier told CHAUSA. “Our patients are happier, our nurses are happier, and we’re decreasing our total cost of care, which is what everyone should be after.

“If we don’t do this, we are going to run out of time in healthcare,” he continued. “I recognize that not everyone has the resources and not everyone has the capability of pulling something off like that. I also am very cognizant that the status quo is not an option. For the sake of our patients and for the sake of the health of the communities that we serve, we all need to lean in and figure out how to approach the work differently.”

Lessons for Clinical Laboratories

This innovative approach identifies which tasks need to be performed by skilled individuals and which can be done by lesser qualified personnel. Tasks are then assigned accordingly. Clinical laboratories may be able to take advantage of similar types of opportunities.

By reorganizing workflows, pathologists and clinical laboratory scientists could devote their time to higher value tasks, while the lesser tasks could be performed by pathology assistants. At a time when the number of laboratory professionals appears to be decreasing, it is imperative that lab managers develop ways to operate labs more efficiently.               

—JP Schlingman

Related Information:

Covenant Medical Center, a Providence Affiliate, Revolutionizes the Way Nurses Deliver Care

Co-Caring Uses Virtual Nurses to Help Caregivers and Patients

Hybrid Nursing Model Expands Following Successful Pilot

Providence to Expand Co-Caring Model That Adds Virtual Nurses to the Team

The Joint Commission Launches Accreditation Program for Telehealth Providers

Program is open to providers that exclusively offer telehealth services, and those providers that offer the telehealth services to other hospitals

In another sign that telehealth is now an established presence in the healthcare marketplace, The Joint Commission recently implemented a new Telehealth Accreditation Program. The initiative, which took effect on July 1, 2024, aims to provide “updated, streamlined standards” enabling “safe, high-quality” delivery of telehealth services to patients, according to a press release. The organization announced the program in April.

Dark Daily has regularly commented on the importance for clinical laboratories to recognize this trend and add the necessary services to meet the expectations and needs of telehealth/virtual doctor visits where the physician orders medical laboratory tests for the patient.

“The use of telehealth in the United States increased 154% during early stages of the COVID-19 pandemic and stabilized at levels 38 times higher than levels in 2019,” said Joint Commission President and CEO Jonathan B. Perlin, MD, PhD, in the press release.

“As telehealth continues to evolve, it was imperative to create a new accreditation program to provide a framework to support the integrity of patient safety regardless of the care setting,” he added.

The new program replaces current telehealth offerings in the organization’s Ambulatory Health Care and Behavioral Health Care and Human Services accreditation programs, The Joint Commission said in the press release.

The accrediting organization is reacting to market demand. Patient and doctor acceptance of virtual doctor visits and telehealth consults is now an established fact.

[PHOTO OF PERLIN HERE]

“Our new Telehealth Accreditation Program helps organizations standardize care and reduce risk so that all patients, including those obtaining services remotely, receive the safest, highest-quality care with outcomes consistent with traditional settings,” said Jonathan B. Perlin, MD, PhD (above), President/CEO, The Joint Commission, in a press release. Clinical laboratory accreditation nationwide is also handled by the not-for-profit organization. (Photo copyright: International Hospital Federation.)

Eligibility

The Joint Commission describes itself as “the nation’s oldest and largest standards-setting and accrediting body in healthcare.” The not-for-profit organization certifies more than 22,000 healthcare providers in the US, according to its website, including hospitals and medical laboratories. Its evaluations are based on surveys in which qualified experts conduct inspections of the facilities to ensure compliance with patient safety and quality standards.

Accreditation is not mandatory, however many states have licensing, certification, or contracting requirements that mandate accreditation by The Joint Commission or other accrediting bodies.

The program is open to providers that exclusively offer healthcare services “via telehealth or remote patient monitoring, with no in-person visits or encounters,” according to The Joint Commission website. This can include organizations that provide:

  • Primary care, specialty care, or urgent care,
  • Medical or behavioral consultation,
  • Remote patient monitoring, and
  • TeleICU, telestroke, telepsychiatry, or teleimaging services to hospitals.

Hospitals or other healthcare providers can also apply if they have contracts to offer “care, treatment, and services via telehealth to another organization’s patients,” The Joint Commission states. Examples include acute care or psychiatric hospitals that provide telehealth services to other facilities. In this case, the hospitals can obtain telehealth accreditation for the contracted services while maintaining their current accreditation for services provided onsite.

Requirements for Certification

The requirements for accreditation are similar to those in other Joint Commission programs, the organization says. This includes “requirements for information management, leadership, medication management, patient identification, documentation, and credentialing and privileging.”

In addition, it includes requirements specific to telehealth. For example, emergency management requirements have been streamlined to account for services provided remotely. It also contains standards related to telehealth equipment as well as provider and patient education about use of the technology.

“Additionally, the program’s standards may be filtered based on the telehealth modality or service provided,” the organization’s website notes.

Other Accrediting Organizations

The Joint Commission is not the only organization that offers telehealth accreditation or certification. The Utilization Review Accreditation Commission (URAC) provides accreditation programs for telehealth and remote patient monitoring, as well as a certification program for telehealth support services.

The telehealth accreditation program consists of three modules accounting for different forms of delivery:

  • Consumer-to-provider (patient initiates services).
  • Provider-to-consumer (healthcare provider initiates services).
  • Provider-to-provider (one provider offers services such as consultation to another provider).

The accreditation process takes up to four months, URAC says.

The Accreditation Commission for Health Care (ACHC) offers what it describes as a telehealth “Distinction” for certain kinds of healthcare providers that it has accredited, including:

Additionally, in April 2022, ACHC announced a telehealth certification program open to “any healthcare provider or organization that delivers health-related services via electronic information and telecommunication technologies,” regardless of whether they are accredited, according to a press release.

“The pandemic really pushed healthcare providers to adopt and grow telehealth services to maintain access for patients and, as a result, many of our clients were seeking ways to optimize this offering in the context of providing quality services,” said program director Teresa Hoosier, RN, in the press release. “ACHC Telehealth Certification establishes national standards. It promotes best practices for digital healthcare services. Certification confirms quality, safety, and consistency—strengthening trust in an organization and assuring patients that they are receiving the best care possible.”

This development is a reminder that clinical laboratory managers need a consumer/patient focused strategy and operational capability to collect specimens and provide medical laboratory tests for telehealth visits when the doctors order tests. It confirms that the trend of consumers/patients using remote healthcare is real, robust, and has legs.

—Stephen Beale

Related Information:

The Joint Commission Launches Telehealth Accreditation

Joint Commission Launches New Telehealth Stamp of Approval for Virtual Healthcare Providers

The Joint Commission Announces New Accreditation Program for Telehealth Providers

Joint Commission Intros New Telehealth Accreditation Program

The Joint Commission Unveils New Telehealth Accreditation Program

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