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Allscripts (MDRX) At Important Moment In Its History

Posted on May 21, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Allscripts has announced plans to move more of its software development and operations to India, while cutting 250 jobs in the U.S., or about 3.5% of its 7,200-member workforce.  While this is significant enough as it is, it’s an even more important leading indicator of how Allscripts may perform going forward. Here’s how I think things will net out.

Making a “rebalancing”:  The company has called the changes a “rebalancing” of staff which will allow it to respond more effectively and efficiently to shifts in its software design and product dev plans.

But the decision didn’t happen in a vacuum, either. Allscripts recently reported taking a $10.1 million loss for the first quarter ending March 31. That’s down from a loss of $20.7 million for Q1 2014, but the company still appears to be struggling. Allscripts’ overall revenue dropped 2% to $334.6 million for the quarter ending March 31, compared with Q1 of 2014.

What’s next? What should providers draw from these numbers, and Allscripts’ plan to shift more development work offshore? Let’s consider some highlights from the vendor’s recent past:

* Despite some recent sales gains, the vendor occupies a difficult place in the EMR vendor market — neither powerful enough to take on enterprise leaders like Epic and Cerner directly, nor agile enough to compete in the flexibility-focused ambulatory space against relentless competitors like athenahealth.

* According to an analysis of Meaningful Use data by Modern Healthcare, Allscripts is second only to Epic when it comes to vendors of complete EMRs whose customers have qualified for incentives. This suggests that Allscripts is capable of being an effective provider business partner.

* On the other hand, some providers still distrust Allscripts since the company discontinued sales of and support for its MyWay EMR in 2012. What’s more, a current class action lawsuit is underway against Allscripts, alleging that MyWay was defective and that using it harmed providers’ business.

* Partnering with HP and Computer Sciences Corp., Allscripts is competing to be chosen as the new EMR for the U.S. Department of Defense’s Military Health System, and is still in the running for the $11 billion contract. But so are Epic and Cerner.

The bottom line: Taken together, these data points suggest that Allscripts is at a critical point in its history.

For one thing, cutting domestic staff and shifting dev operations to India is probably a make or break decision; if the change doesn’t work out, Allscripts probably won’t have time to pull back and successfully reorient its development team to current trends.

Allscripts is also at a key point when it comes to growing place in the brutal ambulatory EMR market. With players like athenahealth nipping at its heels from behind, and Epic and Cerner more or less controlling the enterprise market, Allscripts has to be very sure who it wants to be — and I’m not sure it is.

Then when I consider that Allscripts is still in the red after a year of effort, despite being at a peak level for sales, that tears it.  I’m forced to conclude that the awkwardly-positioned vendor will have to make more changes over the next year or two if it hopes to be agile enough to stay afloat. I believe Allscripts can do it, but it will take a lot of political will to make it happen. We’ll just have to see if it has that will.

Meaningful Use Stage 3 Success Could Rely On Vendors

Posted on May 20, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I was reading a report on the Health IT Policy Committee’s review of pending Meaningful Use Stage 3 rules — which would ordinarily be as about as exciting as watching rocks erode — when something leapt out at me which I wanted to share with you, dear readers.

The overview, brought to us courtesy of Medical Practice Insider, noted that proposed plans for the Stage 3 rule would allow providers to attest in 2017, though attesting wouldn’t be mandatory until 2018. What this means, editor Frank Irving notes, is that it would be up to EMR vendors to be ready for providers wishing to attest a year early.

The folks overseeing this discussion, the Advanced Health Models and Meaningful Use Workgroup, seem (wisely) to have had their doubts that vendors could be relied upon to meet the 2017 deadline. At the session, workgroup members proposed a couple of alternative ways of addressing this timeline. One was to make the 2017 deadline go away, requiring instead that EMRs have full 2015 certification by 2018. Another was to allow optional attestation in 2017, but if need be, with 2014 EMR certification.

I don’t know about you, but this whole thing makes me nervous. By “whole thing,” I mean adjusting the rules to deal with the likely resistance vendors will exhibit to keeping their roadmap in synch with federal requirements.

After all, consider the history of EMR vendors’ relationship with providers. As we’ve noted, HHS has paid out about $30B in Meaningful Use incentives under HITECH without insisting that vendors provide interoperability. And what have EMR vendors done?  They’ve avoided developing shared standards for interoperability with an alacrity which amazes the eye.

In fact, some EMR vendors — including top contender Epic Systems — have been slapping providers with fees for data sharing (even if they’ve kind of dropped them for now), at prices which could leave them millions in the hole. If that isn’t dead opposite to what those in public policy hope to see happen, I don’t know what is.

Bottom line, if the good people overseeing Meaningful Use want to see Stage 3 accomplish good things, they’ll need to see to it that the new rules give regulators some leverage when it comes to controlling vendors.

As the whole sad interoperability saga has demonstrated, vendors will not take actions that advance health IT on their own. Unlike in other IT markets, where interoperability and meeting regulatory deadlines have been the signs of a winner, EMR vendors actually have strong incentives to ignore providers’ business imperatives.

With any luck, however, between tougher rules on Stage 3 and public pressure to achieve interoperability, EMR vendors will do the right thing.  They’ve certainly had long enough.

A “Collaborative Consult” Could Greatly Improve EMR Value

Posted on May 19, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Over the past several years, EMRs have taken some steps forward. At least in some cases, analytics have improved, vendors have begun offering cloud or on-premise install versions of their products and user interfaces have even improved.

But one problem with EMRs that seems to be nearly unfixable is the need for providers to stare at an EMR screen, leaving patients to fidget uncomfortably while they wait for a bit of face-to-face contact and discussion. Sure, you’ll see scribes in hospital emergency departments, allowing ED docs to speak to patients without interruption, but in the outpatient settings where patients spend most of their time, the EMR screen is king.

Such a focus on the EMR display isn’t unreasonable, given the importance of the data being entered, but as critics have noted countless times, it does make it more likely that the provider will miss subtle clues as to the patient’s condition, and possibly end up offering lower-quality care than they would have if they had an old-fashioned computerless encounter.

I have long thought, however, that there’s a solution to this problem which would be helpful to both the physician and the patient, one which would literally make sure that patients and doctors are on the same page. I’m speaking of a new group of settings for EMRs designed specifically to let patients collaborate with physicians.

Such an EMR setting, as I envision it, would begin with a section depicting a dummy patient of the appropriate gender.The patient would touch the areas of the body which were causing them problems, while the doctor typed up a narrative version of the problem presentation. The two (patient and doctor) would then zoom in together to more specific descriptions of what the patient’s trouble might be, and the doctor would educate the patient as to what kind of treatment these different conditions might require.

At that point, depending on what condition(s) the doctor chose as requiring further study, lists of potential tests would come up. If a patient wanted to learn what these tests were intended to accomplish, they’d have the liberty to drill down and learn, say, what a CBC measures and why.  The patient would also see, where possible, the data (such as high cholesterol levels) which caused the doctor to seek further insight.

If the patient had a known illness being managed by the physician, such as heart disease, a tour through a 3-D visual model of the heart would also be part of the collaboration, allowing the doctor to educate the patient effectively as to what they were jointly trying to accomplish (such as halting heart muscle thickening).

The final step in this patient-doctor process would come with the system presenting a list of current medications taken by the patient, and if appropriate, new medications that might address any new or recurring symptoms the patient was experiencing.

The final result would come in the form of a PDF, e-mailed to the patient or printed out for their use, offering an overview of their shared journey. The doctor might have to spend a few minutes adding details to their notes after the patient left, but for the most part, the collaborative consult would have met everyone’s needs.

Now you tell me:  Why aren’t we doing this now?  Wouldn’t it make much more sense, and take much more advantage of the powerful desktops, tablets and smartphones we have, than having a provider stare at a screen for most of their visit with a patient?

Gathering a Health Care Industry Around an Open Source Solution: the Success of tranSMART

Posted on May 18, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The critical software driving web sites, cloud computing, and other parts of our infrastructure are open source: free to download, change, and share. The role of open source software in healthcare is relatively hidden and uncelebrated, but organizations such as the tranSMART Foundation prove that it is making headway behind the scenes. tranSMART won three awards at the recent Bio‐IT World conference, including Best in Show.

The tranSMART Foundation is a non‐profit organization that develops creates software for translational research, performing tasks such as searching for patterns in genomes and how they are linked to clinical outcomes. Like most of the sustainable, highly successful open source projects, tranSMART avoids hiring programmers to do the work itself, but fosters a sense of community by coordinating more than 100 developers from the companies who benefit from the software.

I talked recently to Keith Elliston, CEO of the tranSMART Foundation. He explained that the tranSMART platform was first developed by Johnson & Johnson. When they realized they had a big project that other pharmaceutical companies could both benefit from and contribute to, they reached out to Pfizer, Millennium (now the Takeda Oncology Company), and Sanofi to collaborate on the development of the platform.

In 2012, Johnson & Johnson decided to release the platform as open source under the GPLv3 open source license. In early 2013, a group of scientists from the University of Michigan, Imperial College and the Pistoia Alliance gathered together to form the tranSMART Foundation, in order to steward the growing community development efforts on the platform. The growing foundation has garnered support from other major companies, including Oracle (whose database contained the data they were operating on), Deloitte, and PerkinElmer.

Two major challenges faced by open source projects are funding and community management. Elliston demonstrated to me that tranSMART is quite successful at both. The foundation currently receives 95% of their funding from members. In fact, as they develop, they would like to tap into grants and philanthropies, reducing the member funding to about 20%. In pursuit of that goal, the foundation recently gained 501(c)(3) non‐profit status in the US. They currently are sitting comfortably, with 12 months of secured funding, and are in the process of raising monies for both the foundation’s Fellows program and their version 1.3 development program.

Like the Linux Foundation, a model for much of what tranSMART does, it offers two levels of membership. Gold membership costs $100,000 per year and earns the company a seat on the board of directors. Silver membership costs $5,000 to $20,000 per year based on several factors (size of the company, whether it is for‐profit or non‐profit, etc.) and allows one to participate in electing Silver member board directors.

Development is spread among a large number of programmers across the community. The most recent version of the software (1.2) was created mostly by developers paid by member companies. The foundation has set up working groups on which developers and community members volunteer to solve key tasks such as project management and defining the architecture. Developer coordination is spread across three main committees representing code, community, and content. These committees are composed of member representatives, and coordinate the working groups that carry out much of the foundation’s mission.

Consequently, tranSMART evolves briskly and is seen by its users as meeting their needs. A major achievement of the 1.2 release was to add support for the open source relational database PostgreSQL (in addition to the original database, Oracle). Because the many of the large, semi‐structured sets of data tranSMART deals with may be more suited to some sort of NoSQL database, they are exploring a move to one of those options as a part of their research program. The architecture group is beginning to define version 2.0, and coding may start toward the end of this year.

Although headquartered in the US, tranSMART is finding 60% to 70% of its activity taking place in Europe, and is forming a sister organization there. Elliston claims that the current funding environment for genetic and pharma research is far more favorable in Europe, even though they are taking longer than the US to recover from the recent recession. As an example, he compared the 215 million dollars offered by the White House for its Precision Medicine Initiative (considered a major research advance here in the US) with the 3 billion Euros recently announced by Europe’s Innovative Medicines Initiative (IMI).

I asked Elliston how the tranSMART Foundation achieved such success in a field known to be difficult to open source projects. He said that they approached the non‐profit space with an entrepreneurial strategy learned in for‐profit environments, and focused on staying lean. For instance, they built out marketing and communications departments like a venture‐backed start‐up, using contractors drawn from their startup experience. Furthermore, they have assembled a team of highly experienced part‐time employees who spend most of their time in other organizations. Elliston himself devotes only 10 hours a week to his job as tranSMART CEO.

We could pause here to imagine what could be achieved if other parts of the health care industry adopted this open source model. For instance, the US contains 5,686 hospitals, of which half have installed what the government calls a “basic EHR system” (see page 12 of an ONC report to Congress). What if the 2,700‐odd hospitals saved the hundreds of millions each had spent on a proprietary API, and combined the money to spend a few billions developing a core open source EHR that each could adapt to its needs? What sort of EHR could you get for a couple billion dollars of developer time?

Naturally, technical and organizational obstacles would stand in the way of such an effort. Choosing an effective governing board, designing an open architecture that would meet the needs of 2,700 very diverse organizations, and keeping the scope reasonable are all challenges that go beyond the scope of this article. On the other hand, many existing projects could serve as a basis. VistA is used not only throughout VA hospitals but in many US hospitals and foreign national health care systems. OpenMRS is also widely ensconced in several African countries and elsewhere.

I believe tranSMART’s success is hard to reproduce in the clinical environment for other reasons. tranSMART deals with pharmaceutical companies first and foremost, and biomedical academic researchers as well. Although neither environment focuses on computer technology, they work in highly technical fields and know how heavily they depend on computing. They are comfortable with trends in modern computing, and are therefore probably more comfortable conforming to the open source development model that is so widespread in computing.

In contrast, hospitals and clinics are run by people whose orientation is to other people. You can walk through one of these settings and find plenty of advanced technology, all driven by embedded computers, but the computing tends to be hidden. Anything that brings the clinician into close contact with the computer (notably the EHR) is usually cumbersome and disliked by its users.

The main users and managers in these environments are therefore not comfortable discussing computing topics and don’t have any understanding of the open source model. Furthermore, because the EHRs are mostly insular and based on legacy technologies, the IT staff and programmers employed by the hospitals or clinics tend to be outside the mainstream of computing. Still, open source software is making inroads as support tools and glue for other systems. Open source EHRs also have seen some adoption, as I mentioned. The tranSMART Foundation persists as a model that others can aspire to.

Warm, Fuzzy EHR Selection Website Looking for a New Best Friend

Posted on May 15, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

After 15 years running the EHRSelector, a free, interactive app for finding an EHR, my partner, Cali Samuels and I want to sell or give it to someone who can help it meet its potential.

What’s the Selector?

The Selector’s idea is simple: Give those looking for an EHR an objective way to find a new EHR that centers on what it can do.

Here’s how it works. You go down an extensive EHR feature list. As you click what you want, it instantly shows which products match. You can then compare them like this: EHR Selector Side by Side.

Here’re its major categories. Each has a clickable feature list. For example, you can choose among 50 medical specialties. We also show which features are HIPAA or MU required.

EHRSelector Major Categories

What’s the Problem?

So, why do we want to sell it or give it away? Simple, we can’t crack two problems. Vendors don’t update their profiles and, consequently, there’s low user interest.

The selector depends on vendors subscribing to it and keeping their product lists up to date. Even though it’s free, we can’t convince vendors to update their information.

We’ve written and called, but we run into several problems. Often it’s impossible to get through to a person. When we do, we get bounced among sales, marketing and technical types. Contacts who we’ve dealt with are often gone and no one knows who can speak to all product features.

Then there’s the connected question of driving users to the site. If our vendor list isn’t up to date, we can’t expect a high user volume. As it is, we get some users who understand that while not everything is current, few EHRs take out features. Occasionally, whole college classes sign up. We’re pleased to serve them, but that rarely interests vendors.

How Does It Make Money?

It doesn’t. For several years, we ran the selector on a subscription basis for both users and vendors. This paid for hosting and maintenance, but the marketing firm that ran it lost interest and it began to lose subscribers.

Two years ago, my partner and I took it back, put on a new home page, added a blog and made it free for everyone. We hoped to get enough traffic to sell ads. That hasn’t worked out. We get a few hundred hits a week, but we don’t have the user or vendor interest to justify ads.

What Are We Looking For?

We would like to turn the site over to someone who shares our interest in an objective, interactive EHR selection tool. Obviously, we want someone who has the marketing clout to get vendors interested.

The Selector’s written in classic ASP. Its functions work, but it could stand a good rewrite making it more intuitive and less 2001. Finally, we’d love to add a mobile app, user ratings and graphics comparing products.

Sell or Buy?

Cali and I have enough cash and sweat equity in the selector to build a Tesla. It’s never paid, but we’ve been content to run it break even or even at a loss, because we believe it’s an important service.

We’d love someone to dump goo gobs of dough on us for it, modernize it, etc., – are you listening Google? However, we’re realistic enough to look for someone who shares our interest in giving users a useful EHR tool finding tool and who has the wherewithal to carry it on. You can reach me at:

Blind Woman Enjoys 3D Printed Ultrasound of Her Baby

Posted on May 14, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Since I’ve been focusing on patient stories this week, I thought that I’d share this viral video that I’m sure many of you have seen. If you haven’t seen it, this is the video of a lady who is blind as she gets to touch and feel a 3D printed ultrasound of the shape of her baby. It’s a pretty amazing video and the ladies reaction to it is quite extraordinary.

I love this video because he provided me a new understanding of the challenges people with disabilities can have in their patient experience. However, as a tech junkie, I also totally love how all these technologies could come together in such a tremendously beautiful way. This is why I’m so optimistic about the next 10 years of healthcare. We’re just getting started when it comes to technology improving healthcare.

A Patient’s Perspective on Accessibility – Carly Medosch

Posted on May 13, 2015 I Written By

The following is a guest blog post by Carly Medosch. You can find more about Carly on her blog and on Twitter @carlyrm.
It seems like every day there is a new use of technology available to assist patients. The just-launched Apple Watch already includes several health and fitness features, and the company shows promise for more scientific breakthroughs with the ResearchKit for iOS. There are smartphone apps and websites for patients to research medication costs, identify pills, and find help from patients with the same diagnosis. Some patients can visit their doctor virtually using telehealth platforms.

This week I have been reading Regina Holliday’s memoir “The Writing on the Wallwhich details her husband, Fred’s, struggle to get appropriate care for his stage IV kidney cancer. In the book, Regina mentions going home from caring and advocating for her husband in the hospital, caring for her two young boys, and then spending hours on the Internet doing health research. Regina Googles words the oncologist says during his quick stop by the room. She uses Facebook and other websites to coordinate support care for her children. She researches medical and legal issues large and small.

You may think that it is great that just a wondrous resource exists, but I am saddened by the fact that this hard working woman, a wife, mother, caregiver, art teacher, and toy store manager, was forced to pull a night shift as a medical researcher. This was precious time that took her away from her dying husband, her young children, and her own important need for proper rest.

I am upset about these things because they have affected me, too. At age 13 I was diagnosed with Crohn’s disease. This year my chronic illness turns 21 years old. I’ve lived far longer as a sick person than a well one. I spend my spare time doing advocacy work supporting patients.

It is endlessly frustrating for me to hear very smart people, with excellent academic pedigrees, and gobs of VC funding, tell me about their exercise app for dogs. Or their plan to let patients research endless information about their doctor’s conflicts of interest. Or a map for patients to find outdoor activities to increase public health.

These are products created by people who do not understand illness. Originally I thought they just didn’t understand chronic illness, the endless parade of doctors, medical appointments, medications, and bills. The piles of paperwork and the endless to do lists, to which we now add the incessant intrusion of electronic alerts.

But these products are not created for the acutely ill, either, not really. Even if you are a perfectly healthy adult a vehicle may strike you as you cross the street. In that example, are you going to research the best doctor, the hospital with the best safety score, the emergency room with the shortest wait time? No. If you are able to do anything, you will try to call 911. Most likely someone else will call for you. You are powerless and all the technology in the world won’t help you.

I believe technology could help us. But I think there’s an image problem. I don’t think it’s seen as sexy to market a product for the chronically ill. Companies are trying to sell an image, and that image is easier to sell if it’s world-class athletes, women in high heels, and health. A product is presented as making regular people feel powerful, in control of their lives and their health. You can use your fitness tracker to become healthier. It will reward you for taking the actions of healthy people. A fitness tracker could easily be tweaked to offer a warning for people that need to limit their steps. Some people with chronic fatigue syndrome are advised to get a small amount of activity – a sweet spot that’s “some” but not “too much.” A fitness tracker could be programmed to encourage more activity up to a point, and then warn the user to slow down as the step count grew too high. But the marketing campaign for that type of product would discourage sales growth.

We are given products and features that are billed as empowering, but seem to translate to just being more work. More items on our endless to do list, more things to squeeze into our maxed-out budgets, less time with the people and activities we love. The products are more sleek and beautiful (which is quite an improvement), but they are rarely designed for people with vision issues, or arthritic hands, or jittery movements. The more we need technology, the harder it is to grasp.

Recently I was struck with a terrible migraine. At home I would go to the clinic across the street, receive an injection, and go home to sleep it off. I would lose the day, but I would only pay about $30 with my insurance. The treatment was in my chart, so although I may not see the same clinician each time, they could easily look up what to administer.

This time I was in Chicago, a city I’d never visited. I took out my smart phone and used Google Maps to see the locations of walk in clinics. Google Maps has a rating feature for businesses and I could see this one has several stars. My vision was blurry, and my body was weak and racked with nausea, but I was able to call one. With some difficulty I asked the wait time and if they did injections for migraines. The voice on the other line asked me if I had the medicine. Of course I didn’t have the medicine! If I had it, why would I go to a clinic? Then they asked what the medicine was called, and that is when my brain decided it had functioned enough. I stammered. I paused. I couldn’t think of the word and I couldn’t think of the other words to explain the confusion was caused from my medical distress. Powerless, I hung up.

I walked to a first aid station in the building and was advised to go to the emergency room. I was assured that the hospital was close and good. The man in the first aid station gave me an ice pack, which I pressed firmly to my head as I staggered out to find a cab.

The world spun and my stomach churned, but eventually I got to the hospital. I arrived to a packed waiting room full of people who looked like they had been there a long time. The care was poor, but it seemed due to overcrowding and underfunding. The staff was kind. I was in the loud, bright waiting room for hours. I’ve received a bill for over $100 from the hospital, and I suspect I will receive another from the physician who eventually saw me.

There was no app to tell me the wait times, but I’m not sure I could have endured the cab ride to a hospital farther away. I could barely use my smart phone to make a call, so there was no way I was going to be able to research facilities, or prices. It was difficult for me to seek help from family and friends, as both light and noise made the pain worse, and anyway I was so far from home.

When people develop technology for patients, they often don’t even consult with a single patient. It is my dream that this not only be completely reversed, but that a variety of symptoms and conditions be considered when developing and testing the product. Can the product be used by a 40 year old healthy man, can it be used by a child with smaller hands, can it be used by a person with poor eyesight, can it be used by someone in severe pain, can it be used quickly in an emergency? Are your product solving actual problems and enhancing life for your customers, no matter their health status?

Comprehensive vs. Complete: Creating a Truly Representative Health Record

Posted on May 12, 2015 I Written By

The following is a guest blog post by Stacey (@coffeemommy), an empowered patient and breast cancer survivor.

According to my EHR, I had breast cancer. And I had two mastectomies and I’m currently on Tamoxifen. If you read a little deeper, you’ll discover I also had a colonoscopy at age 39. It was clean.

According to my EHR from another institution, I had a colonoscopy at age 37 and two polyps were removed. I also had a series of ideopathic headaches. Beyond my verbally sharing this information with my current care team, they would have no record of these activities.

According to my EHR from yet another institution, I had a miscarriage in 2000 and went on to have two full-term healthy deliveries after that. More headaches and migraine medication. Again, these items are not reflected in detail in my current healthcare record.

And there are more health records of mine spread across the country.

Everything in those respective EHRs is accurate but my “electronic health record” is not really a record at all. My EHRs are snippets of time spanning several states of residency and ultimately dating back to a thick paper folder that, as a child, I remember checking out from the ground floor before appointments at the now defunct Wilford Hall Medical Center.

Beyond my memory of surgeries, inoculations and well visits past, I question whether documentation of my early health history really exists at all at this point.

And therefore, the burden of tying the highlights of my health history together for every new health care provider, falls on my shoulders. A doable task but certainly not an easy task in the typical 15 minute visit window.

Electronic health/medical records lack true interoperability and therefore are not comprehensive for most of the population. Teams of no doubt brilliant people are allegedly working on solutions and voices demanding interoperability and advances in the health IT space are loud.

However, even if my EHR were comprehensive tomorrow in the above context, it would still be incomplete. While every physician who treats me has read/write access to the record I, as the very subject of the record, am unable to add my two cents.

And my two cents would add a lot of context.

As an example, for the past 22 months, I have been on Tamoxifen to keep my estrogen-loving breast cancer from recurring. For 21 of those 22 months, I have had random soft-tissue swelling, random bilateral rashes and a face tingling turned numbness that progressed to such a point I was running to a mirror to see if my left side was drooping. Since there is no documentation of these symptoms as a side effect of Tamoxifen, I’ve been told to take Loratadine for swelling and have had two brain MRIs to rule out a tumor.

What my current team struggles to understand is that historically, I am reactive to many things. Soaps, shampoos, penicillin, sulfa drugs, ciprofloxacin, lanolin and a variety of other substances trigger rashes and soft tissue swelling in my body. So, starting on a new drug and having ‘undocumented’ side effects was not an unusual series of events for me.

When I asked to take a half dose and was told, “We don’t have a protocol for that.”

Again, what is missing from my EHR is the history of my taking half doses of many of the drugs I have been prescribed and having therapeutic results. As a child this was never a problem. For the first 22 years of my life, I was considered a US military dependent and the continuity of care, regardless of what base we were stationed at, was solid. The next twenty years has been a scatter shot of services across zip codes, providers and payors.

A comprehensive (including all of my past) and complete (including my two cents) would save time, money and headaches. Instead of emailing pictures and bringing a written diary of skin rash and swelling, I could simply upload directly to my own record. Instead of emailing a physician with my side effects and saying, “Please add this event to my record” I could add it myself for no cost to the healthcare system treating me. Patterns could be clearly seen and treatment could be modified appropriately if the situation was warranted. Side effects could more accurately be documented and communicated to other patients as trends were noticed.

The idea of patient reported outcomes being included in the EHR seems incomprehensible to some. I’ve heard, “But you can’t trust patient data” and “Patient supplied data is unreliable.” Really? To me it seems that patients themselves are the only ones who could supply this level of data to enrich the health record. And they have the biggest interest in comprehensive care. And, by the way, providers trust my input when I document my health history on the long sheet of paper on an initial visit – why is my information suddenly invalid as a patient?

To be clear, I’m not asking that patients have the ability to edit or rewrite what the healthcare practice has so diligently recorded. I am simply asking that our record reflect more than the set of symptoms we present with at any given visit. Tracking trends real-time will prevent the dreaded question, “How long has this been going on?” The answer will be front and center.

So as the great minds gather to create the interoperable EHR, please consider the patient voice. Interoperability may allow for a comprehensive record but, until my side of the story is reflected, the documentation will remain incomplete.

My body, my data and my health. Please allow me to participate.

Stacey is a strategy and communications consultant inspired to empower patients and caregivers through collaborative education and community building. Runner. Cyclist. Coffee drinker. Organic gardener. Wife to one. Mom to two. Empowered patient and breast cancer survivor almost two years NED. Connect with her on Twitter @coffeemommy

The Patient Voice

Posted on May 11, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For years I’ve been hearing over and over from various places that we need more of the patient voice in healthcare. These messages have come largely from prominent patient advocates like Regina Holliday and ePatientDave. The Society for Participatory Medicine has also had a strong voice in the fight to include the voice in healthcare and in particular in healthcare IT. While each of these people and organization have compelling stories to share, I’ve wondered if they’re really making the impact they want to achieve.

One problem I’ve seen with this effort is that Regina and ePatientDave are seen over and over and over again at conferences. While it’s great that each of them is advocating for the patient voice to be included in healthcare, I wonder if the healthcare IT community has basically tuned out the message because they’ve heard it over and over and from the same two people. If this was a really massive movement, then why don’t we have dozens or even hundreds of patients that are sharing their stories in prominent places?

I’m sure there are some really compelling reasons why we don’t hear from more patients and not the least of which is that they’re not invited. I don’t think that Regina and ePatientDave really want the lime light. They just want the message they espouse to be heard. So, I wonder if their goal wouldn’t be better served if they started sharing their spotlight with hundreds of other patients. I realize this can be a tricky proposition.

However, I first saw this happening at HIMSS where Regina worked together with HIStalk to have a number of patients attend HIMSS and share the patient voice with the healthcare IT Community. I thought this was a great idea and a really good step forward to diversifying the number of patient voices we hear.

As I’ve thought about this a bit, I decided that I wanted to do more to share the patient voice on my network of blogs as well. So, I decided to reach out to a number of patients and provide them a platform where they can tell their story. In some cases this will be about healthcare IT and how it impacted patients. In other cases it might just be a story about the healthcare system in general. Some will be good. Some will be bad. I told them that my goal was to add a little more of the humanity back into what we think about when we think about healthcare.

I’ve got a couple of these patient stories queued up for this week and hopefully we can make this a monthly (at least) fixture across the network of Healthcare Scene blogs. If you are a patient with a story to share, or know someone who does, we’d love to hear about it on our contact us page. I’m especially interested in hearing stories from lesser known patients. Hopefully we can use this platform to share more of the patient perspective. Be sure to let me know what you think of the patient stories this week.

HHS’ $30B Interoperability Mistake

Posted on May 8, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. A staggering amount of money has been paid out under HITECH to incentivize providers to make EMR progress, but we still have countless situations where one EMR can’t talk to another one right across town.

When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay.

Now, don’t get me wrong, I realize that “interoperability” is an elastic concept, and that the feds couldn’t just demand that vendors bolt on some kind of module and be done with it. Without a doubt, making EMRs universally interoperable is a grand challenge, perhaps on the order of getting the first plane to fly.

But you can bet your last dollars that vendors, especially giants like Cerner and Epic, would have found their Wilbur and Orville Wright if that was what it took to fill their buckets with incentive money. It’s amazing how technical problems get solved when powerful executives decide that it will get done.

But now, as things stand, all the government can do is throw its hands up in the air and complain. At a Senate hearing held in March, speakers emphasized the crying need for interoperability between providers, but none of the experts seemed to have any methods in their hip pocket for fixing the problem. And being legislators, not IT execs, the Senators probably didn’t grasp half of the technical stuff.

As the speakers noted, what it comes down to is that vendors have every reason to create silos and keep customers locked into their product.  So unless Congress passes legislation making it illegal to create a walled garden — something that would be nearly impossible unless we had a consensus definition of interoperability — EMR vendors will continue to merrily make hay on closed systems.  It’s not a pretty picture.