University Health System—a 617-bed health gadget based in San Antonio—recently kicked off a systemwide digital health document set up, scrapping its cutting-edge Allscripts EHR in choose of one from Epic Systems Corp. It’s a luxurious project: between costs such as purchasing the EHR, training personnel and retiring outdated systems, University Health is putting $one hundred seventy million in the direction of the transition.

The breadth of Epic’s client base played an important function in its choice, especially as the academic fitness machine’s primary associate, the University of Texas Health Science Center at San Antonio, has used Epic for several years. The majority of other public fitness structures in Texas also stays on an Epic EHR, which University Health hopes will enhance nearby interoperability.

“Data-sharing changed into a motive force,” stated Bill Phillips, senior VP, and chief records officer at University Health.

Despite carriers spending untold marketing dollars pitching their products’ status on scores produced by way of Black Book Research, KLAS Research and others, CIOs seem to be more pushed by way of what’s going on in the market and good-old-fashioned peer networking.

“I’ve been in the industry for a long time, and I recognize plenty of the human beings,” said Chuck Christian, leader era officer at Indiana-primarily based Franciscan Health, describing one of the key steps he is taking when considering a brand new software purchase. “So I’ll select up the phone and get in touch with those who use the identical software.”

Software purchases aren’t a choice to take gently, as imposing a new gadget—such as an EHR—can involve thousands and thousands of dollars. More than 90% of acute-care hospitals record being stayed on one or extra EHRs, however hospitals often need to consolidate a couple of products onto one system. That’s becoming a commonplace case with growing prices of mergers and acquisitions.

Given the multimillion—if not multi-billion—greenback stakes, it makes feel IT leaders could turn to the reports of their peers. Nearly -thirds of clinic executives suggest that both they or their peers have felt their task safety changed into in jeopardy all through an EHR transition, in step with a seven-yr survey of sanatorium leaders performed through Black Book. At the manager degree or above, 5% of respondents claimed they or a peer were fired or requested to renounce because of EHR substitute charges or productiveness issues.

“With as tons money as (new software program) fees, the ones can be profession-restricting selections in case you make the incorrect one,” said Christian, who joined Franciscan Health April 8. He spoke with Modern Healthcare at the same time as at his preceding role, vice chairman of technology on the Indiana Health Information Exchange.

Lisa Grisim, partner CIO at Palo Alto, Calif.-based Stanford Children’s Health, additionally highlighted the attitude she gains from the CIO network—with an electronic twist. IT leaders at Stanford Children’s have moved many of these conversations online, with the aid of participating in group email lists with their colleagues.

One of the electronic mailing lists Grisim is most lively in is devoted to CIOs at pediatric hospitals, which is coordinated through the Children’s Hospital Association.

“We’re very connected inside the healthcare IT enterprise, specifically amongst specialty and excessive-acuity kids’ hospitals,” Grisim said. “We’ll regularly send out questions about what people are doing in ERP (employer resource planning), PACS (photograph archiving and communique system), or something it might be.”

Epic benefit
This focus on peer-to-peer connections can also, conceivably, supply a leg as much as enterprise leader Epic.

Epic and Cerner are actually neck and neck in the deployment of EHRs, in step with the Office of the National Coordinator for Health Information Technology. Epic’s internet site boasts that everyone 20 of U.S. News & World Report’s pinnacle-ranked hospitals in 2018-19 used its EHR, as nicely.

Add that to clinical personnel’s familiarity. When Rochester, Minn.-based Mayo Clinic determined to put in force a new EHR kind of 5 years ago, it looked for a machine that could manage the instructional clinical center’s scientific, billing and sales-cycle systems throughout all of its sites. Bringing in providers to perform usability and functionality tests with health center group of workers also performed a prime function in its very last choice to pick out Epic.

“Because Epic is so heavily represented in large instructional medical facilities, a lot of our newer staff, citizens, fellows, have practiced in an Epic medical center,” said Dr. Steve Peters, co-chair of the Plummer Project, Mayo’s nickname for the EHR set up. Mayo delivered its final sites live on Epic in 2018, greater than 12 months after launching the systemwide assignment in July 2017.

But the one’s ratings from studies groups and input from consultants are not completely discounted. Grisim said Stanford Children’s makes use of the yearly “Best in KLAS” scores as part of its decisionmaking process, both before developing a request for proposals or after receiving responses, as a short first-class check.

The trouble with scores

KLAS Research’s scores had been dogged over the years via questions about its methodology and a notion of pay to play. The 2019 “Best in KLAS” rankings were based totally on interviews that the market research firm’s analysts performed with C-degree executives, managers, and health practitioner leaders at 4,500 hospitals and 2,500 clinics, however many of the reports the firm releases are primarily based on a whole lot smaller samples. In a report on patient engagement published in February, Epic became indexed as the top affected person portal solution based on interviews with representatives from just 37 consumer companies.

Epic scored ninety-two on the firm’s a hundred-factor provider pleasure scale. Athenahealth changed into the second-highest supplier indexed in the record, with a score of eighty-four. Eight, based totally on interviews with representatives from 30 client businesses.

KLAS will flag while it has restricted survey responses on a solution that’s included in a record, leaving a word that reads “insufficient information.” For a maximum of the company software equipment that KLAS evaluates, insufficient statistics approach that the firm surveyed 15 or fewer purchaser groups. Taylor Davis, government vice chairman of strategy and improvement at KLAS, stated these thresholds are based on confidence durations.

“At 15 interviews, the self-assurance interval for any person’s KLAS rating tends to be plus or minus about eight points,” Davis stated. “If KLAS reviews that your product is a seventy-six on the 100-factor scale, you might be as low because the excessive 60s—it’s unlikely—otherwise you might be as excessive as the low 80s, however, you’re possibly someplace in the 70s. In approximately 15 interviews is statistically the first point, if we’ve performed our activity and randomly sampled, that we can start to mention ‘Here’s in which you’re, normally.’ ”

The firm’s goal for sample sizes is better, within the high 20s or 30s. At 30 interviews, the self-assurance c programming language goes right down to plus or minus three to 4 points, he introduced. “We include (pattern sizes) in each document,” Davis stated. “We’re certainly open approximately what we do on our reviews, and we know vendors look at the ones (sample sizes) and take the comments primarily based on what they see.”

KLAS has also been pressured to address criticism that its ratings use a pay-to-play system. KLAS addresses the priority on its internet site’s “regularly asked questions” phase. The organization expenses companies expenses to buy its reports and to enroll in KLAS membership—as a member, a dealer has got right of entry to to the company’s data and the opportunity to satisfy with analysts for remarks into its answers. KLAS says that these payments do now not have an effect on a seller’s overall performance rating.

Cost of participation

Allscripts CEO Paul Black stated the employer paid KLAS $455,000 in 2018. That includes subscription expenses, which KLAS determines based on a vendor’s annual healthcare sales, in addition to charges related to attendance at KLAS’ summits.

“I consider that KLAS must divulge how they receive a commission, much like enterprise analysts expose if they have a role in an employer,” Black stated.

When requested to touch upon how Epic—this 12 months’ “Best in KLAS” average software suite—works with KLAS, which includes whether it had made bills to the firm in 2018, an Epic spokesperson said: “As with all carriers, we are charged an annual subscription fee to get admission to to the information on their website, and the price is based on our sales.”

A Cerner spokesperson declined a request for comment, saying it’s the organization’s corporate policy to not divulge settlement amounts with companions due to an affordable assumption of confidentiality between the parties.

Many health center leaders, along with Grisim, said they overview KLAS’ reports for access to the firm’s studies—the loose-shape responses companies supply to the firm’s survey questions, which KLAS consists of at the cease of its reviews—in addition to the ratings. That’s par for the route, consistent with Davis.

“Providers document to us overwhelmingly that the maximum useful research that we offer to them is the information and consumer comments,” he said. It’s “the views from their peers.”

For these medical institution IT leaders, the reviews offer a pulse-take a look at on their colleagues, adding views that they might not have been capable of attaining without delay. “It’s stuff you want to hear approximately from others who have used the technology you’re not presently the use of,” said Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston.

“I study these things to apprehend what others have skilled, however, I’m a piece careful no longer to jump to concrete conclusions if sample sizes are small,” he stated.

There are many resources a CIO might recollect—peer views, market studies, 1/3-celebration consultants. But there’s no unmarried, magic bullet that health facility CIOs can depend upon. It’s approximately weighing all of this enter throughout the board.

“It’s searching at the KLAS research, choosing up the cellphone and calling others you realize within the industry, searching at (industry) blogs,” said Christian, who runs his very own fitness IT opinion weblog is known as the Irreverent CIO. “You ought to take all of those as grains of salt as you piece the tale together.”