Decommissioning Legacy EHR systems with Data Archival – Tackling EHR & EMR Transition Series

EMR Data Archival

In their latest infographic (Check out the full infographic, Galen Healthcare Solutions provides critical information and statistics surrounding EMR data archival including:

  • Healthcare Data Growth
  • Healthcare Data Archival Drivers
    • Mergers & Acquisitions
    • Legacy System Retention Requirements
  • Healthcare Data Archival Benefits
  • Average Patient Digital Footprint
  • Industry Leading Archival Solution

Healthcare Information Technology leaders face challenges in keeping pace with new initiatives and consequently, managing a growing collection of legacy systems. With drivers including mergers & acquisitions, vendor consolidation, application dissatisfaction and product sunsets, it’s estimated that 50% of health systems are projected to be on second-generation technology by 2020, according to the IDC. As these new systems are implemented, multiple legacy systems are left behind, requiring healthcare IT staff to provide support and maintain access.

The strategy of keeping a patchwork of legacy systems running in order to maintain access to data is risky, resource intensive and can be quite costly given licensing, support, and maintenance needs. Decommissioning legacy systems with a proven archival system reduces cost and labor, minimizes risk, ensures compliance, simplifies access and consolidates data.

  • Reduce Costs: Streamlining the long-term storage of historical PHI now will save money in the long-run. Not only will it reduce costs paid for the support and technical maintenance of the legacy system, but it will also save on training new staff on the new system over the next 7-25 years. In addition, incorporating data archival efforts with a discrete data migration provides significant economies of scale.
  • Minimize Risk: Preserving historical patient data is the responsibility of every provider. As servers and operating systems age, they become more prone to data corruption or loss. The archiving of patient data to a simplified and more stable storage solution ensures long-term access to the right information when it’s needed for an audit or legal inquiry. Incorporating a data archive avoids the costly and cumbersome task of a full data conversion.
  • Ensure Compliance: Providers are required to retain data for nearly a decade or more past the date of service. In addition, the costs of producing record for e-Discovery range from $5K to $30K/ GB (Source: Minnesota Journal of Law, Science & Technology). Check with your legal counsel, HIM Director, medical society or AHIMA on medical record retention requirements that affect the facility type or practice specialty in your state.
  • Simplify Access: We all want data at the touch of a button. Gone are the days of storing historical patient printouts in a binder or inactive medical charts in a basement or storage unit. By scanning and archiving medical documents, data, and images, the information becomes immediately accessible to those who need it.
  • Consolidate Data: Decades worth of data from disparate legacy software applications is archived for immediate access via any browser-based workstation or device. Also, medical document scanning and archiving provides access to patient paper charts.

Because the decision to decommission can impact many people and departments, organizations require a well-documented plan and associated technology to ensure data integrity.

Download the full archival whitepaper to understand the drivers that impact archival scope specific to both the industry and your organization.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit Connect with us on Twitter, Facebook and LinkedIn.

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HHS OIG Says Unplanned Hospital EMR Outages Are Fairly Common

More than half of U.S. hospitals responding to a new survey reported having unplanned EMR outages, according to a new report issued by the HHS Office of the Inspector General, due to a variety of common but difficult-to-predict technical problems. Some of these outages have merely been inconveniences, but some resulted in patient care problems, the OIG report said.

The agency said that it conducted this study as a follow up to its prior research, which found that both natural disasters and cyberattacks were having a major impact on EMR availability. For example, it noted, hospitals faced substantial health IT availability challenges in the wake of Superstorm Sandy, include damage to HIT systems and problems with access to patient records.

According to the survey, 59% of the hospitals reported having unplanned EMR outages. One-quarter said that the outages created delays in patient care and 15% said that the outage lead to rerouted patient care. Only 1 percent of outages were caused by hacking or breaches.

The most common causes, in order, were topped by hardware malfunctions, followed by Internet connectivity problems, power failures and natural disasters. (For more detail on the root causes of outages, see this great post by my colleague John Lynn.)

It’s worth noting that these hospitals were selected for having their act together to some degree. To conduct the study, researchers spoke with 400 hospitals which were getting Meaningful Use incentive payments for using a certified EMR system in place as of September 2014.

Nearly all of these hospitals reported having a HIPAA-required EMR contingency plan in place. Also, two thirds of the hospitals addressed the four HIPAA requirements reviewed by OIG researchers. Eighty-three percent of surveyed hospitals reported having a data backup plan, 95% had an emergency mode operations mode plan, 95% said they had a disaster recovery plan and 73% said they had testing and revision procedures in place.

Not only that, most of the hospitals contacted by the study were implementing many ONC and NIST-recommended practices for creating EMR contingency plans. Nearly all had implemented practices such as using paper records for backup and putting alternative power sources like generators in place.

Also, most hospitals said that they reviewed their EMR contingency plans regularly to stay current with system or organizational changes, and 88% said they’d reviewed such plans within the previous two years. Most responding hospitals said they regularly trained their staff on EMR outage contingency plans, though just 45% reported training staff through recommended drills on how to address EMR system downtime. And 40% of hospitals that activated contingency plans in the wake of an outage reported that they saw no disruption to patient care or adverse events.

Still, the OIG’s take on this data is that it’s time to better monitor hospitals’ ability to address EMR outages. Now more than ever, the agency would like to see the HHS Office for Civil Rights fully implement a permanent HIPAA compliance program, particularly given the mounting level of cyberattacks endured by the industry. The OIG admitted that HIPAA standards aren’t crafted specifically to address these types of outages, so it’s not clear such monitoring can solve the problem, but the agency would prefer to forge ahead with existing standards given the risks that are emerging.

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Apple Is Making a Mistake Acquiring Gliimpse

The big news this week was that Apple has acquired PHR vendor Gliimpse. This was supposedly the first acquisition by Apple’s new Digital Health team. Plus, it’s the first big news since Tim Cook commented that Apple’s opportunity in healthcare “may even make the smartphone market look small.”

Many are touting this as a the start of the move by Apple into healthcare. No doubt it’s interesting that Apple would make a vertical acquisition like this, but it’s a mistake. Unfortunately, it’s a mistake that Apple is likely to do over and over again.

Apple certainly was and in many respects still is in a unique position to be able to innovate in healthcare thanks to its massive iPhone user population. They really could do some interesting things in healthcare since so many people have iPhones and so many healthcare companies want to say they’re working with Apple. The problem is that Apple doesn’t understand healthcare.

If you think this is a small thing, you’ve probably never tried to do a healthcare startup company. Healthcare is a unique market and requires a unique understanding to be successful. All the bravado in the world will only get you so far in the world of healthcare. Then, the harsh realities set in and you realize that the current against you is a lot stronger than you first realized.

Let’s take the example of the PHR Gliimpse (and generalizing to any PHR). This is a hard market with very little consumer demand. That’s been proven over and over again by hundreds of companies who have tried. The harsh reality is that most patients don’t care enough about their health to want to aggregate their health record. It’s worth noting that aggregating your health record is hard work. I even know one company that is paying doctors to send them health records and even then it’s hard to get doctors to act. Plus, there’s little value to healthy patients if they actually did aggregate their record. This is a tough, tough business.

Certainly, a case can be made for chronic patients that it’s worth the effort to aggregate this data into a PHR. Many have been doing this out of necessity. It was happening before cell phones became ubiquitous as people carried around massive folders or binders with their health records. While this value is understood, this makes for an extremely small market. When did Apple last do good in a small market? Is Apple going to really give up iPhone real estate when only a small portion of their users can actually get value from the PHR?

It’s great to have Apple interested in healthcare. However, I think the acquisition of a PHR company is a mistake and won’t yield them the rewards in healthcare that they seek. Of course, when you have a few billion to spend, what’s a few million on a PHR company? No doubt it’s a really small bet by Apple, but one that I don’t think will pay off for them. At least now they’ll have some people with health experience on the team and maybe they can innovate something new.

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Software Selection Done Right Part 2: Presenting a Vision through an RFI

Be sure to check out part 1 in the series.

The primary driving document of a software selection is often the RFI or RFP, the invitation to vendors to participate in the process.. In future articles in this series, we will discuss the process of software selection and obtaining buy-in from stakeholders after the RFI has been received. For this week, we will focus on that centerpiece document, the RFI. This document sets the stage for the process, creating the tone and establishing the way that the hospital will work with the vendor during the selection.

However, far too often creating this document becomes the focus of the process rather then the actual selection. Creating an RFI should not be a large effort and done properly, can be one of the easier steps, allowing the journey to begin much faster.

The purpose of an RFI should not be to provide a laundry list of needs and wants to the software vendors. An RFI that includes pages of checklists of features can take a considerable effort to create and an even more considerable effort for the vendor, and actually adds little value. When it comes to mature software solutions, such as ERP and EHR solutions, it is very likely that the vendor understands your needs better than you do. They demonstrate software to hospitals every day, and have numerous customers who have been through the same changes and challenges that you have.

Several years ago I was working alongside an ERP software sales team and joined a meeting in which a potential customer had allowed them to present their solutions following completion of an extensive, laundry list style RFI. During the discussion the potential customer’s CIO was present and was looking through the response to the RFI carefully, with a frown on his face.

Then he looked up and asked a question. “I am reviewing your response to our RFI”, he said, “and I see that you answered no to many of the items in our requirements. Why should we choose you over another vendor who met more of those needs.” The salesperson from the ERP team was not only a seasoned salesperson, but also well versed in the business processes of ERP and was well prepared with an answer that I often reference to this day.

“Do you know what a Japanese auction is?”, he asked the CIO. “Actually”, he continued, “does anyone here know what a Japanese auction is?.” Everyone looked confused, but no one spoke.

“I don’t, but why would you ask that?” inquired the CIO.

“Because it is a requirement of the software in your RFP”, the salesperson responded, “and one of the examples where we said no”. He then went on to explain what a Japanese auction was to the hospital team, and asked if they would ever use that functionality. They all agreed that they would never have a use for it. In closing the salesperson asked what consulting firm wrote the RFI for them and if they were advised that they needed to include it, or if the consultant simply forgot to remove it from the template they were using.

This story highlights that the software vendor is well aware of the features and functionality that a hospital would typically use, and does not need a list of those features. It also demonstrates that paying a third party to develop an RFP does not always lead to a more effective document – and in some cases leads to a less effective document.

Rather than a laundry list of features, an RFP should tell a story. The story of who you are, where you are now, and where you want to go. It should explain the vision and objectives of your project, the organization’s current challenges, and your future vision for the hospital with the new software. The RFP should invite the vendor to participate and present how they will help you to achieve those goals. Each vendor can then present why their solution is the best to get you to your desired destination.

Specific features and functions are much less of a key difference between software solutions today. Feature lists have actually led many vendors to write and acquire software for the purpose of being able to check boxes in an RFP rather than reacting to actual customer needs or with the intent of producing a quality product. It is increasingly unlikely that a “smoking gun” will be found with a specific absolutely necessary feature existing in one vendor option but not the other. Rather, it is the design and the quality of the solution that is important, as well as confidence in the vendor and their ability to partner with you effectively and capability to deliver on their promises.

Indeed there is more to an RFP – and in a future article we will discuss how to define the rules of the road of the selection process and to make sure those rules are reflected in the RFP and that the vendors and staff follow those rules. However, the core content of an RFP is expressing that vision to your potential software partners.

Therefore rather than spending months of creating lists of checkboxes of features that you may or may not need, just tell your story. Explain the vision of where you want to go and invite the potential solution providers to explain to you how they will help you to achieve that vision. The result will not only be a significantly faster selection process, but also a better relationship with your vendor partners during the selection and beyond.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

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Olympic Polyclinics – the Future of Healthcare?

The first Olympic Village was built in Los Angeles In 1932. To help ensure the health and safety of athletes, a small hospital was built in the Village and provided care free of charge to the athletes.

Since 1932, every Olympic Village has featured a dedicated 24-hour healthcare facility – now called the Olympic Polyclinic – that provides free healthcare to anyone involved with the Olympics. The Polyclinic at this year’s Games in Rio de Janeiro is once again a marvel of modern medicine, much like the one at 2012’s London Games represented the pinnacle of medicine four years ago.

At 3,500 sq ft, the Rio Polyclinic is the largest ever constructed. It features a state-of-the-art equipment including: MRI scanners, x-ray machines and even cryotherapy pools (for low temperature treatments). All the equipment and the EHR that holds it all together is donated by Olympic sponsors. The staff are all volunteers.

I find the Polyclinics fascinating and the more I read about them, the more I am convinced they are a providing us a glimpse into the future of healthcare.

Health-Aware Patients

The doctors and nurses at the Polyclinics see some of the most health-aware patients on the planet. Olympic athletes track everything from their diet to their sleep patterns to resting heart rates. When they show up at the Polyclinic they often have a very good idea of what is wrong and come armed with lots of baseline health data. The Polyclinic staff expect this and collaborate with their patients when they walk in the door.

As more and more people track their fitness through apps and trackers, we too are becoming more and more health-aware as patients. In the future we will have a lot of digital information about our own health – information that can and should be shared with our care team. Physician practices will have to learn to collaborate as the Polyclinic staff have learned – or they risk alienating potential health-aware patients.

Health-Abstaining Patients

The Olympic Polyclinics also see patients that are at the complete opposite end of the spectrum. For many athletes (and support staff) from developing countries, the Polyclinics are the only opportunity they have to receive quality healthcare.

According to a piece in USA Today the MRI suite, x-ray machines and ultrasound machines at the Rio Polyclinic has been running non-stop. In addition, the Polyclinic has provided:

  • 1,000 dental checks
  • 450 dental x-rays
  • 300 specialized mouth guards
  • 1,730 eye exams
  • 1,410 sets of prescription glasses

…and it’s only the mid-point of the Games.

Due to lack of access and high cost, many Olympians are forced to forgo medical care. This is the same phenomenon that is happening in the United States as high deductible plans and increasing healthcare costs are forcing many to abstain from seeking care. Because of this, staff will see more and more patients with higher and higher acuities – something that the Polyclinic staff see often at the Games.

Completely Autonomous

The Polyclinics are self-contained healthcare facilities. They have an onsite lab, a full imaging suite and a full staff of specialists. It takes less than an hour to get blood test results and image readings. Short of major surgeries, the Polyclinics can handle most patient needs without need to refer them to another facility.

This one-stop approach is what patients want. They want to go to a single nearby facility and have access to all the specialists and equipment they need. It would be impractical to build Polyclinics in every rural town, but through the magic of telemedicine, it may one day be possible to access needed specialists without having to drive hundreds of miles.

With the advances in remote testing and telemedicine coupled with patient preference for one-stop shopping I expect to see more multi-specialty, completely autonomous clinics open in the next few years.

Culturally Aware

Being in the middle of Olympic Village, the staff at the Polyclinics have to be very culturally aware. Instead of insisting on a “Western Approach”, doctors and nurses are encouraged to listen to the patient and take into consideration their religion as well as cultural norms.

It will not be long until smart healthcare organizations realize that catering to cultural differences in their communities is a differentiator. The same has happened in the grocery industry with the rise of halal meats and ethnic food aisles. Being culturally aware will attract more patients.

Admittedly, the Polyclinics, like the Olympic Games themselves, exist within their own reality bubble. There is little concern over finances, there is no shortage of clinicians, they have a completely captive audience and they don’t have to care for their patients for more than two weeks.

Despite this, I see the Polyclinics as a barometer of things to come – especially in terms of the types of patients they see. It’s going to be fun to read more stories from the Polyclinic after the Rio Games end. Now back to watching synchronized swimming.

For an insider look at life inside the Polyclinic, I would highly recommend this post from Trisha Greenhalgh who documented her experience at the London Games Polyclinic in 2012.

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Has the Smartphone Become So Usable that Anyone Can Use One?

We’ve long heard about how seniors didn’t have smartphones and so they wouldn’t have access to all these incredible mobile health apps and sensors that are tied to the smartphone. In some respects this is true and I’ve always argued that it didn’t really matter, because their caregivers (often their children) is going to be the one using it and they use smart phones. It’s an important discussion since our seniors make up a large chunk of healthcare spending.

This tweet from David Doherty had me stop and think about this subject again.

It’s true that in many ways the tablets and smartphones have gotten so easy to use that even older people are using them for all sorts of amazing things. Would you rather teach a senior to use an iPad or a desktop computer? As someone who once was hired by an elderly couple to teach them how to use their computer in college, I’d much rather have taught them how to use the iPad or smartphone. It would have been so much easier.

We have to remember that Seniors still have an insatiable desire to be connected to the ones they love. That’s why they care about these technologies and are willing to learn them. Adding on some health related applications is an easy next step.

I still think there’s an interesting market out there for customized tablets for seniors that make them even easier, but like David it’s interesting to see how tablets and smartphones have become so usable that seniors of all ages are using them. This trend will only increase and more seniors will be using this technology.

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Managing Health Information to Ensure Patient Safety

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Electronic Medical Records (EMRs) have been a great addition to healthcare organizations and I know many would agree that some tasks have been significantly improved from paper to electronic. Others may still be cautious with EMRs due to the potential patient safety concerns that EMRs bring to light.

The Joint Commission expects healthcare organizations to engage in the latest health information technologies but we must do so safely and appropriately. In 2008, The Joint Commission released Sentinel Event Alert Issue 42 which advised organizations to be mindful of the patient safety risks that can result from “converging technologies”.

The electronic technologies we use to gather patient data could pose potential threats and adverse events. Some of these threats include the use of computerized physician order entry (CPOE), information security, incorrect documentation, and clinical decision support (CDS).  Sentinel Event Alert Issue 54 in 2015 again addressed the safety risks of EMRs and the expectation that healthcare organizations will safely implement health information technology.

Having incorrect data in the EMR poses serious patient safety risks that are preventable which is why The Joint Commission has put this emphasis on safely using the technology. We will not be able to blame patient safety errors on the EMR when questioned by surveyors, especially when they could have been prevented.

Ensuring medical record integrity has always been the objective of HIM departments. HIM professionals’ role in preventing errors and adverse events has been apparent from the start of EMR implementations. HIM professionals should monitor and develop methods to prevent issues in the following areas, to name a few:

Copy and paste

Ensure policies are in place to address copy and paste. Records can contain repeated documentation from day to day which could have been documented in error or is no longer current. Preventing and governing the use of copy and paste will prevent many adverse issues with conflicting or erroneous documentation.

Dictation/Transcription errors

Dictation software tools are becoming more intelligent and many organizations are utilizing front end speech recognition to complete EMR documentation. With traditional transcription, we have seen anomalies remaining in the record due to poor dictation quality and uncorrected errors. With front end speech recognition, providers are expected to review and correct their own dictations which presents similar issues if incorrect documentation is left in the record.

Information Security

The data that is captured in the EMR must be kept secure and available when needed. We must ensure the data remains functional and accessible to the correct users and not accessible by those without the need to know. Cybersecurity breaches are a serious threat to electronic data including those within the EMR and surrounding applications.


Organizations must be ready to function if there is a planned or unexpected downtime of systems. Proper planning includes maintaining a master list of forms and order-sets that will be called upon in the case of a downtime to ensure documentation is captured appropriately. Historical information should be maintained in a format that will allow access during a downtime making sure users are able to provide uninterrupted care for patients.

Ongoing EMR maintenance

As we continue to enhance and optimize EMRs, we must take into consideration all of the potential downstream effects of each change and how these changes will affect the integrity of the record. HIM professionals need prior notification of upcoming changes and adequate time to test the new functionality. No changes should be made to an EMR without all of the key stakeholders reviewing and approving the changes downstream implications. The Joint Commission claims, “as health IT adoption becomes more widespread, the potential for health IT-related patient harm may increase.”

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Posted in clinical decision support, CPOE, Health Information Governance, Healthcare Leadership, Healthcare Optimization Scene, HIM, HIPAA, Hospital CIO, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT, Hospital HIPAA, Hospital IT Systems, Hospital Patient Flow, Hospital Security, Order Sets | Tagged , , | Comments Off on Managing Health Information to Ensure Patient Safety

Xerox Research Finds Patients and Healthcare Professionals Divided on Responsibility and Cost in Healthcare

NORWALK, Conn., Aug. 15, 2016 – Healthcare research released today from Xerox shows large disconnects between patients and healthcare professionals providing and insuring their care. This research suggests that across all participants in the U.S. healthcare system, there is still much to be settled regarding the transformation driven by the Affordable Care Act (ACA).

Who is responsible for consumers’ health?

Nearly 50 percent of consumers say they take complete responsibility for their health, whereas less than 6 percent of healthcare professionals believe this to be true. In addition, less than 5 percent of consumers say they don’t know how to take charge of their own healthcare, but nearly 40 percent of payers and providers say consumers don’t know how to take charge.

Moreover, 90 percent of payers and providers say patients need encouragement and help from their healthcare provider to make living a healthier lifestyle a priority, but only 55 percent of patients say they need such encouragement.

The study, conducted by Y&R’s BAV Consulting on behalf of Xerox[1], surveyed 761 U.S. adults who purchase health insurance and are healthcare decision makers for their households and 204 healthcare payers and providers.

“Consumers and healthcare professionals have very different views on patient empowerment and control,” said Rohan Kulkarni, vice president of Strategy and Portfolio, Xerox Healthcare Business Group. “Payers and providers are much less likely to believe patients are taking responsibility for their health than what patients perceive to be true. The results suggest that improved communication could allow healthcare professionals to better showcase to their patients how they’re a partner in their health.”

One solution that can help is Xerox’s Virtual Health Solutions that allows providers to communicate and connect with their patients anytime and anywhere by overcoming interoperability challenges and powering front and back office services.

Are patients shopping around?

The research also found discrepancies between patients and professionals regarding a patient’s willingness to shop for healthcare.

  • Only 34 percent of consumers are more likely to shop around for a provider than they were one year ago, but more than 71 percent of payers and providers think patients are shopping.
  • When asked what consumers consider the top priority when selecting a provider, consumers said quality of care is number one. But payers and providers believe whether or not they take the patient’s insurance plan is the top consideration.
  • Ninety-five percent of payers and providers believe patients are not seeking or delaying treatment due to cost concerns, but only 42 percent of consumers say this is true.

“A lot of payers and providers think patients are shopping around for the best healthcare, but it simply is not the case,” continued Kulkarni. “The industry is clearly still adjusting to the shift toward consumer-centricity, and payers and providers may be best served to focus on patient retention by enhancing their communication channels.”

What is the solution?

Over 63 percent of consumers wish their pharmacist, healthcare provider and insurance company were more connected on their personal health. While interactions with each stakeholder are often transaction-based, Xerox’s Health Outcome Solutions offering can help the effort to coordinate care. The solution, currently available for providers and accountable care organizations with a payer solution coming in the future, offers a customized combination of analytics, clinical, technology and administrative services that help improve the health of patient populations.

Xerox also offers Care Integration Services that help healthcare payers identify members who need support and engage them with timely and personal clinical interventions. This enhanced member outreach service increases payers’ ability to assist their members in maintaining wellness and managing chronic medical conditions.

Xerox Healthcare helps healthcare organizations focus on improving lives through better, more affordable and accessible care by designing processes that work for the people delivering, enabling and receiving care.

About Xerox

Xerox is helping change the way the world works. By applying our expertise in imaging, business process, analytics, automation and user-centric insights, we engineer the flow of work to provide greater productivity, efficiency and personalization. Our employees create meaningful innovations and provide business process servicesprinting equipmentsoftware and solutions that make a real difference for our clients and their customers in 180 countries. On January 29, 2016, Xerox announced that it plans to separate into two independent, publicly-traded companies: a business process outsourcing company and a document technology company. Xerox expects to complete the separation by year-end 2016. Learn more at

[1] Study conducted by Y&R’s BAV Consulting on behalf of Xerox among 761 U.S. adults who are healthcare decision makers for their households and 204 healthcare payers and providers. Full results and methodology available upon request.

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Is It a Hot or Cold Hospital EHR Buying Market? – Response

This article is in response to John Lynn’s recent posting, Is It a Hot or Cold Hospital EHR Buying Market?

In his recent posting, John Lynn asked the question “Is it a Hot or Cold Hospital EHR Buying Market?”. In it he highlights a recent KLAS report that over 490 hospitals, a staggering 10% of the entire market, were involved in an EHR decision in 2015. After reading his posting, I wanted to take a moment to share my observations.

2015 was indeed an amazing year for EHR sales, partly driven by the pending sunset date of Mckesson Horizon forcing many customers to switch EHR solutions. Some of those customers are going to Paragon, but many more purchased or are evaluating other solutions. During a recent trip to Epic University, I was surprised to find that nearly half of the attendees of the classes were hospitals switching from Mckesson Horizon to Epic – and all had just recently completed their purchases (late 2015/early 2016) and were facing the same live dates of late 2017/early 2018.

Hospitals who have purchased and implemented Epic or Cerner are very unlikely to make a change. Regardless of which solution is preferred, the investment in these solutions and the level of effort required to switch from one to another is so high, that it would take a significant triggering event for a hospital to make that change. Therefore it is likely that customers on these solutions will not be making a change in the near future.

However, KLAS reports that nearly 40% of MEDITECH customers would change EMR’s if they could, and that Paragon customers also report unrest. Therefore in addition to the shrinking number of those that have not implemented a viable EHR solution, the possibility that there will be a wave of customers switching from one of these solutions to Epic or Cerner remains a consideration. There is also the question of how the recent spin-off of Mckesson’s software division will impact the future of Paragon. If Paragon were discontinued or sold, it could lead to another explosion of EHR decisions. If instead there was a significant investment in the solution, it could become a more viable alternative as customers look to switch from one EHR to another.

I suspect that 2016 will be another strong year from EHR sales in general and for Epic and Cerner in particular. Beyond that, much will depend on the strength of the other solutions and which ones break out into the top tier. Regardless, the recent explosion of EHR sales and the rush to replace Horizon will in many cases lead to minimized installs – where the bare minimum work was completed and there is significant opportunity to improve business processes, implement new modules, and roll out advanced functionality within those solutions. As a result I believe that within a few years, the market will be more stabilized with fewer customers switching solutions, and instead focusing on maximizing what they have.

Unless another player comes in and disrupts the marketplace or a significant shift in the industry creates a reason to make a change yet again…

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

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Is It a Hot or Cold Hospital EHR Buying Market?

In a recent blog post by Erik Bermudez, he asks the question about whether the Hospital EMR market is heating up or cooling down. He suggests that it’s heating up and offers this commentary as proof:

In 2015, KLAS validated that over 490 acute care hospitals were involved in an EMR contract decision of some kind, which represents an increase of almost 200% over 2014. That’s nearly 10% of the entire US hospital market making an EMR decision in 2015 alone.

We’ll see if this trend continues. No doubt there was a cooling off of the market as meaningful use matured in 2014. Given that cooling off period, it’s not really a surprise that it would start to heat up.

Eric also points out that buzzwords like population health and interoperability are dominating the conversation as opposed to EHR. I’d in the healthcare analytics buzzword to that list. These are indeed hot topics, but what’s interesting is that each of these topics really requires an EHR. You’re not likely to buy a healthcare analytics system if you don’t have an EHR. You need the data to be electronic (presumably in an EHR) to do the analytics (yes, I know there are edge cases where you don’t).

Given this dependency on EHR, we shouldn’t be surprised that many organizations are making an EMR decision. No doubt some healthcare organizations have an EMR that doesn’t support the advanced population health, interoperability and analytics initiatives they’d like to do. No doubt these advanced efforts are going to drive adoption of new EHR vendors that can support these efforts.

What do you think? Is the EHR buying market hot or cold? Let us know your thoughts in the comments.

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