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Florida-based AdventHealth plans to replace its Cerner electronic health record (EHR) system with rival Epic’s.

One of the largest faith-based health systems in the country, AdventHealth operates 50 hospital campuses across a dozen states. The health system employs more than 80,000 people who serve more than 5 million patients annually and reports nearly $20 billion in annual revenue.

The health system first signed a deal with Cerner in 2002 when it was known as Adventist Health System.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

AdventHealth will begin the transition in March and will eventually roll Epic’s EHR out to 1,200 care sites. The work is expected to be completed in about three years, the health system said.

In a press release issued Tuesday, AdventHealth said it plans to install a single, integrated Epic EHR and revenue cycle management system across all of its acute care, physician practice, ambulatory, urgent care, home health and hospice facilities.

Epic’s Community Connect program will also allow AdventHealth to extend its EHR system to affiliated providers as part of the integrated platform, according to AdventHealth.

“Our journey to become a consumer-focused clinical company requires a fully connected network throughout our entire enterprise,” Terry Shaw, president and CEO for AdventHealth, said in a statement. “Connecting our network with a robust, integrated health record platform will give our caregivers access to the clinical information they need at the point of care and ultimately advance our consumer promises through a more seamless experience for those we serve.”

In an emailed statement, Cerner confirmed the changeover. “AdventHealth has made the business decision to transition over the next few years management of its EHR and revenue cycle management system to another supplier. The shift is expected to take up to five years and Cerner is committed to working closely with AdventHealth to continue delivering superior health care technology solutions throughout the transition,” the company said.

Anonymous Reddit posters predicted the change months ago, saying that the health system was frustrated with integration issues with Cerner’s ambulatory solution and revenue cycle functionalities. HIStalk first reported the Reddit posts regarding Cerner and AdventHealth.

One Reddit user said AdventHealth staff felt the health system was on the “back burner” since Cerner signed massive projects with the departments of Defense and Veterans Affairs.

It’s unclear what the loss of a big EHR client will mean for health IT company Cerner’s annual revenue or earnings.

The company continues efforts to turn its financial picture around and improve its operating performance.

Almost a year ago, activist investor Starboard Value stepped in, and Cerner reached a settlement with the hedge fund to add new directors to its board and buy back more of its shares. Cerner also agreed to take steps to improve operations and committed to hitting certain operating targets.

The new agreement between Cerner and Starboard Value, which has a 1.2% stake in the company, was seen as welcome news by many financial analysts as a plan to increase the company’s profitability.

Cerner’s full-year 2019 bookings were down 11% compared to 2018 bookings, from $6.72 billion to $5.99 billion. Company executives said during their full-year and fourth-quarter earnings call that the decline in bookings was primarily driven by the company being more selective in the types of contracts it pursues, which led to fewer large, long-term outsourcing contracts.

WASHINGTON, D.C.—Federal health IT leader Donald Rucker, M.D., said an upcoming interoperability rule will include “solid” privacy protections for patients as they share their medical data. 

Speaking at Health Datapalooza on Tuesday, Rucker—who is the head of the Office of the National Coordinator for Health IT (ONC)—acknowledged that privacy in a digital world is a challenging issue. But he reiterated his perspective that patients should be able to easily access and share medical data.

“It is our human right as patients to have access to our data,” he said.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Rucker was pushing back on health IT vendor Epic’s lobbying efforts against the proposed rules, including an email Epic CEO Judy Faulkner sent to customers encouraging them to sign an opposition letter. The letter cited risks to patient privacy and intellectual property if the rules are finalized now.

According to reporting from CNBC’s Chrissy Farr, about 60 health systems signed the letter.

“Most of their customers did not sign on to that letter,” Rucker said. “If you parse out the big academic medical centers, only three out of 100 AMCs signed on.”

He also called out hospitals that signed the opposition letter due to their claims about data privacy concerns but then disregard patient privacy when filing lawsuits for unpaid medical bills.

“One of the signers of the letter is known for taking thousands of patients to court. If you take someone to court, that information becomes public discovery. Their medical care is now public. It’s part of the court record,” he said. “Looking at protecting privacy, we need to walk the walk here as we look at who is saying what and letter-writing campaigns.”

Almost a year ago, ONC issued a proposed interoperability and information-blocking rule that defines the demands on healthcare providers and electronic health record (EHR) vendors for data sharing. The rule also outlines exceptions to the prohibition against information blocking and provides standardized criteria for application programming interface (API) development. 

Department of Health and Human Services (HHS) leaders have not offered a timeline for when the rule will be published, but many have speculated it will be released during the Healthcare Information and Management Systems Society conference in March.

While Epic and many hospitals have come out against the interoperability rules, many technology vendors, including Apple and Microsoft, along with health plans and consumer advocacy groups have urged HHS to move forward with publishing the rule.

Four healthcare leaders recently penned an op-ed in Health Affairs calling for ONC to publish the rule immediately. Omada Health’s Lucia Savage and University of California, San Francisco’s Aaron Neinstein, Julie Adler-Milstein and Mark Savage said the ONC rule will not make the current consumer privacy protections worse.

“All health care stakeholders who are concerned about that issue should raise it with Congress and state legislatures, which have authority to act, rather than request to delay the ONC’s rule, delaying critical improvements to interoperability, access, innovation, and ending information blocking,” the authors wrote.

APIs are the technology used to link IT systems, such as EHRs, with apps and will help bring healthcare into the modern app economy, according to Rucker.

ONC’s vision is for patients to choose what apps to use, he said

“We’ve often looked at interoperability in a narrow view, which is just as a replacement for moving the patient’s chart. Modern computing and APIs offer a vastly richer and more empowering global computing environment. Well-built APIs can do almost anything that your creativity allows,” he said.

Before Rucker took the stage at Health Datapalooza, HHS Secretary Alex Azar also addressed the upcoming interoperability rules and the Trump administration’s commitment to putting “patients in charge of their data” and called out industry stakeholders who are “defending the status quo.” They are protecting a health records system that is “segmented and Balkanized,” he said. 

“We have a serious problem—and scare tactics are not going to stop the reforms we need,” Azar said.

For the past few weeks, Epic’s opposition to the Department of Health and Human Services’ (HHS’) interoperability and information blocking rules has dominated the digital health news cycle and continued to draw ire from the industry.

Rightfully so, much of the focus has been on patients’ rights to their health data—especially given Epic CEO Judy Faulkner’s apparent opposition to making patient data access easier.

But much less attention has been given to solving for provider-to-provider information exchange, despite the enormous challenges and barriers that still exist in that arena. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

With the Trusted Exchange Framework and Common Agreement and information blocking rules, the Office of the National Coordinator for Health IT (ONC) has an undoubtedly admirable goal: Create a “single onramp” for nationwide health information exchange and interoperability using a variety of policy levers. 

What’s missing from the policy levers, however, is an understanding of the role and nature of networks, also called multisided platforms (MSPs), or what most in healthcare will recognize more generally as health information exchanges. Specifically, how networks create value, how they compete and what they need to make various interoperability use cases a reality. 

ELATED: Epic’s Judy Faulkner: ONC data blocking rule undermines privacy, intellectual property protections

Also missing from consideration? The underlying issue that, with these policies, the ONC is attempting to regulate a market into existence—and with this approach comes a ripple of negative effects standing to undermine the very result the ONC is trying to achieve. 

MSPs: Policy design versus time to develop

While they may be dominant in their respective markets today, Amazon, Uber and Lyft and Airbnb—all examples of networks/MSPs—were certainly not overnight success stories. Each network took time to grow, amass users and evolve into the well-oiled versions we know today. 

Similarly, to build a successful network for health information exchange, any policies or implementation frameworks must provide enough time and flexibility for the networks to develop and scale. Unfortunately, this is not the case in the latest ONC guidance, which has the first group of Qualified Health Information Networks up and operating by August 2020.

This accelerated timeline does not provide nearly enough of an on-ramp for proper network setup and development, let alone growth and optimization. And this isn’t the first time the industry has seen this play.

For instance, while e-prescribing between doctors and pharmacies may now be routine (85% of all prescriptions were e-prescribed in 2018), remember that Surescripts—the health information network responsible for routing the majority of the country’s e-prescriptions—started on its interoperability journey nearly 20 years ago and took about a decade to scale. 

Policy design versus market demands

On top of a lacking understanding of MSP development and optimization, perhaps the biggest issue with the federal guidance is that ONC is attempting to regulate a market into existence.

This is a problem because, outside of the growing patient desire (PDF) for health data access and utility, there hasn’t been sufficient industry demand for this level of information exchange, as evidenced by a lack of willingness to pay. 

Case in point: Almost a decade after the U.S. government invested more than $35 billion in the creation of the meaningful use program to spur electronic health record (EHR) adoption, a seamless exchange of health information between providers is a rarity, despite the fact that the majority of providers today use an EHR.  

Moreover, under ONC’s information blocking rule, health systems, EHRs and health information networks would be required to “open up” their APIs to improve the exchange of health data. The problem with this is networks compete on a variety of measures, including price, business model, quality, governance and how they uniquely facilitate the exchanges between users.

By attempting to commoditize and regulate the means and methods of health information exchange (e.g., through fees), the ONC is establishing a network value “ceiling” and thus effectively short-circuiting the way networks compete and develop.

Lastly, by removing an economic upside for MSP developers/operators, rather than having the “best network win” in the market, the industry may be left with: 1. a handful of “zombie” networks (unable to invest in improving the quality and value of exchange), or 2. a monopoly or duopoly situation, as smaller regional health information networks find themselves unable to compete with larger, national networks.

More time, fewer constraints: Interoperability depends on proper MSP development

Creating a single on-ramp for nationwide health information exchange is a commendable goal, worthy of industry action and investment in a solution. 

But taking a rushed, “one-size-fits-all” approach to MSP development—one that stands to undermine the very goal the policies were designed to achieve—is not the right way to do it.  

Will MSPs be the prescription nationwide interoperability needs to succeed? Only time will tell.

Seth Joseph is managing director of Summit Health, a recognized expert in digital health technology and author of several articles on the space. He has spent more than a decade helping companies successfully bring novel digital technology to healthcare markets. Previous to founding Summit Health, Seth led corporate strategy at Surescripts. Prior to Surescripts, Seth led eHealth strategy for Caremark, part of CVS Health. 

As the industry waits for a landmark rule aimed at opening up access to patient data, Donald Rucker, M.D. said Wednesday that regulators are challenged with balancing data privacy and transparency.

The proposed interoperability rule will be coming out “relatively soon,” Rucker, who is head of the Office of the National Coordinator for Health IT (ONC), said during a Health IT Advisory Committee meeting Wednesday.

Many have speculated that the rule will be released during the Healthcare Information and Management Systems Society conference in March.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

A year ago, ONC, which is part of the Department of Health and Human Services (HHS), proposed an interoperability and information-blocking rule that defines the demands on healthcare providers and electronic health record (EHR) vendors for data sharing. The rule also outlines exceptions to the prohibition against information blocking and provides standardized criteria for application programming interface (API) development. 

HHS officials say the rule, which promotes the use of application programming interfaces (APIs), will help bring healthcare into the modern app economy.

The proposed rule has created an industry rift—EHR vendor Epic, many health systems, and some privacy groups have voiced strong opposition to the rule. About 60 health systems signed an opposition letter circulated by Epic CEO Judy Faulkner that was sent to Azar. The letter cited risks to patient privacy and intellectual property if the rules are finalized now.

Meanwhile, newer technology entrants to healthcare such as Apple and Microsoft, some EHR companies like Cerner and consumer advocates are backing the rule. Google Health’s David Feinberg, M.D. has met with HHS officials about the rule, Politico reported.

Rucker was asked by members of the Health IT Advisory Committee about the status of the rule.

“There are complicated issues balancing the various interests of the American public to get a good deal in healthcare, to have transparency, to do this in a way that doesn’t prevent innovation and allows vendors to be able to build products in a practical way and draws the right balance on protecting privacy, yet addressing what is ultimately the biggest issue, which is simply the vast amount of healthcare costs that are out there and lack of patients having agency.”

As the lobbying battle over the rule goes on, Politico reported Tuesday that ONC’s rules gained a rare endorsement from a hospital system: the University of California, San Francisco. The “nation needs ONC’s proposed regulations,” the leaders of UCSF and its health system wrote to HHS Secretary Alex Azar, according to Politico.

All the lobbying efforts and public debates could have some positive results, Rucker said.

“Maybe it’s had the unintended benefit of getting people to focus on how this all will play out and part of a broader dialogue about what we want to do with technology in our lives,” he said.