Narrowing it down

Hospital systems, especially those that are purchasing physician practices and expanding outpatient clinics to pursue greater care coordination, face a pressing need to track patients no matter where they receive care. Interoperability between EHRs has become crucial for their successful integration of operations—and sometimes requires dumping legacy systems that can't talk to each other.

Achieving interoperability is what drove Gail Carlson, chief nurse executive at 54-bed Alegent Creighton Health Midlands Hospital in Papillion, Neb., to attend Epic Systems Corp.'s annual user group meeting last week in Verona, Wis. The Alegent system, which includes 11 hospitals in Nebraska and Iowa, has been using multiple EHRs since 2001. But now they are switching to Epic's integrated ambulatory and inpatient EHR systems and scrapping their existing systems, which came from multiple vendors.

“The clinics are going up as we speak,” Carlson said. “Next March, we will roll out with three facilities and the rest in May 2014.”

As the demand for interoperability grows, many hospital IT officials are struggling to knit together legacy systems that often have multiple and non-communicative EHRs. That is forcing many to consider switching from multiple vendors to a more comprehensive vendor that can serve all their facilities' EHR needs.

“I think we do well with all of our quality metrics, fabulously, actually,” Carlson said. Midlands hospital recently showed the greatest improvement among U.S. hospitals in reducing penalties imposed by the CMS for excessive 30-day readmission rates. “But I feel we've been trying to get ahead and we ended up needing something that crossed over to all areas,” she said.

Today, clinicians at Alegent are primarily served by a Siemens EHR for inpatient and NextGen for ambulatory care. “We have a lot of different ancillary services that have their own programs” Carlson said. The EHRs may be “best-of-breed,” highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between them is “inconvenient,” she said. “Using Epic will eliminate that.”

Epic competes against 37 other developers of federally designated “complete” EHR systems for inpatient use by hospitals and more than 400 developers of complete EHRs for ambulatory-care use by physicians and other eligible providers in the Medicare EHR incentive payment program under the American Recovery and Reinvestment Act, according to federal data. Epic has the leading market share in both the hospital inpatient complete EHR and eligible professional ambulatory complete EHR categories, with 19% and 21.7%, respectively, of the providers who have been paid federal incentives.

The other top players in the hospital inpatient complete EHR niche are Computer Programs and Systems, or CPSI, 14.9%; Meditech, 14.3%; Cerner Corp., 10.7%; and McKesson Corp. and Healthcare Management Systems, tied at 7.3% (For a list of top vendors of complete EHRs for eligible professionals in ambulatory care, see the chart on p. 34.)

Meanwhile, 99 different developers of so-called “modular” EHR systems, including those considered “best of breed,” have at least one client hospital that has used its software in an inpatient setting to meet its Medicare meaningful-use targets under the EHR incentive payment program. All told, these hospitals have used 4,186 modular systems for that purpose, according to the federal data. The top five vendors in the hospital modular inpatient EHR category, according to federal data, are Meditech, 23.5%; Cerner, 21.4%; HCA Information & Technology Services, 12.9%; McKesson, 7.6%; and Iatric Systems, 4.6%.

Could this pressing need for interoperability finally drive a stake through the heart of the “best of breed” strategy used by so many healthcare organizations, and as a result, drive many developers of modular systems out of business?

Dr. Michael Sheinberg, an OB/GYN and associate medical director of the 800-physician medical group at Lehigh Valley Hospital in Allentown, Pa., thinks so. He came to the Verona meeting in preparation for its switch to an Epic EHR. Sheinberg said Lehigh Valley clinicians have been using a modular EHR system for about a decade.

“We were probably king of best of breed,” Sheinberg said. “But it was at a time when that was the best of what you could get.” Since then, according to Sheinberg, developers of comprehensive systems such as Epic have greatly improved their specialty modules.

“We sort of maximized out the best of breed concept,” Sheinberg said. “We sort of outgrew it. Most of us did.”

Follow Joseph Conn on Twitter: @MHJConn