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Blogging Forces You to Raise Your Standard

Posted on July 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

e-Patient Dave has a great story up about his wife’s knee replacement surgery done by the popular social media orthopedist Howard Luks. There are many items to note in e-Patient Dave’s write up of his wife’s experience with Dr. Luks. However, I couldn’t help but consider the impact that Howard Luks’ blogging has had on his practice.

The most obvious impact is that he’s gotten new patients from his blogging. While e-Patient Dave’s wife is one example, he’s done many posts talking about how new patients have found him through his blog and social media efforts. I won’t dig into this more since I think most doctors realize this can happen.

What I think is less obvious is that I believe blogging holds Howard Luks to a higher standard. Think about what happens when you choose to blog about something. You’re now on the record for how you’d approach something and you’re now accountable to it. By its very nature, this accountability requires a doctor (or anyone in any field) to step up to the plate and make sure that they’re working at the highest level possible. No one wants to blog about something and then be called out for not doing what they were telling other people to do.

This is a scary thing for many people and no doubt it’s why many people choose not to blog. They don’t want to be accountable to their blog. I should also note that blogging about something doesn’t mean that you have to be perfect. Some blogs can be exploratory and can help you learn and grow so that you can reach “perfection.” In fact, one of the best reasons to blog is to help you refine and improve what you’re doing. I’m sure Howard Luks has benefited from this as well. There’s nothing like thousands of people educating you on why and how you’re wrong you can improve.

While this accountability is powerful, what’s even more powerful about blogging is that it requires you to really sit down and think through why and how you do something. This is especially true for physician bloggers. That time spent thinking through and evaluating your processes is powerful. I think you see the results of this type of deep thinking in the results described by e-Patient Dave above. His wife likely benefited from Howard Luks spending time thinking deeply about how he practices medicine and ensuring he is practicing in the most effective way possible.

I’m not saying you have to be a blogger and share your processes publicly to think deeply about the way you practice. However, blogging publicly about how you practice medicine is a great way to force yourself to do this evaluation. Plus, the fact that people are going to read, evaluate, comment, rip to shreds, give feedback, and help you refine your approach forces you to raise your standard.

I’ve seen this happen over and over again with blogging. It’s had that effect on me as a father once I started my daddy blog. I had to start upping my game as a father since I couldn’t write about how I was an average father that had average experiences. I was forced to become the father I wanted to be. My wife has benefited too since who wants to write about being the lazy husband who doesn’t do the dishes? It doesn’t work. However, I can write about the amazing experience of putting the dishes away even though I wanted to sit down with some TV.

How often in medicine do doctors prefer to sit down with TV as opposed to going the extra mile to optimize their practice? Blogging can change that paradigm.

I’ve seen the same happen for healthcare IT and EHR companies. Once these companies blog about the importance of EHR up time or making EHR software usable, they raise the standard for how they approach those two problems. First, they’re not going to blog about those things if they haven’t worked hard to make sure they’ve done a good job in those areas. Second, once they’ve blogged about it, it often becomes part of the culture of who they are at the company. In fact, healthcare IT CEO’s have to be a little careful about what they blog about since it’s a powerful medium that can push their company in the right or wrong direction. A few pointed blog posts can really impact a company’s culture. Although, as a user I definitely prefer a healthcare IT vendor that blogs. I think it forces the company to think critically and deeply about the challenges their customers face. Plus, it gives you a view into the culture of the company.

Going back to where we started. Would e-Patient Dave have written such a glowing article about his wife’s visit to Howard Luks if Dr. Luks wasn’t blogging? The obvious answer is no since it would have been unlikely that e-Patient Dave would have known about Dr. Luks. While this is true, I also think that many of the processes and approaches that e-Patient Dave describes would likely not be in place if Dr. Luks wasn’t such an avid blogger. Blogging about your business forces you to raise your standard.

What Would George Washington’s Electronic Health Record Look Like?

Posted on July 3, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seems appropriate this July 4th to take a look a the medical record of George Washington. The great part is that Amazing Charts has chose to do just that. You can see George Washington’s medical record at 57 in Amazing Charts here or click the image below.

George Washington's Medical Record

It’s pretty fun to look back in time and think about what would have been included in George Washington’s medical record. Amazing Charts also points out that he had a lot of diseases that have since been eradicated.

Here’s the press release Amazing Charts put out about the George Washington’s medical record:

Electronic Health Record of First U.S. President Sheds New Light on Progress of Healthcare

Fictional Electronic Health Record for President George Washington Is Based on Historical Accounts of Infections, Injuries, and Other Serious Medical Ailments

BOSTON, MA–(Marketwired – June 30, 2015) – How healthy was the Father of Our Country? That was the question asked by Amazing Charts when it constructed a fictional Electronic Health Record (EHR) for President George Washington at the age of 57, ten years before his death, based on historical accounts from physicians, family members, and other eyewitnesses.

President Washington experienced a wide variety of diseases, including tuberculosis, malaria, and smallpox. With the perspective of today’s medical knowledge, this clinical documentation sheds new light on the progress of healthcare over the past 200 years. The record was created using Amazing Charts EHR software and includes President Washington’s demographics, review of past medical history, medications list, and present complaint.

According to Marc L. Mosier, MD, Chief Medical Officer of Pri-Med/Amazing Charts, a leading provider of medical education and electronic health record (EHR) systems: “This historically reconstructed medical record highlights some noteworthy facts about President Washington. He was afflicted by a long list of health concerns, most of which have been nearly eradicated by the progress of medicine. His health record also dramatically illustrates the amazing evolution of medicine over the past two centuries and our ability to better manage disease and illness today.”

The Amazing Charts EHR for President George Washington can be viewed on a web browser at http://amazingcharts.com/GeorgeWashington.

About Amazing Charts

Amazing Charts provides Electronic Health Records (EHR/EMR), Practice Management, and other Health IT solutions to healthcare practices. Based on number one user ratings for usability, fair pricing, and overall satisfaction, Amazing Charts EHR has been adopted by more than 10,000 clinicians in over 6,800 private practices. Founded in 2001 by a family physician, today Amazing Charts, LLC operates as a subsidiary of Pri‐Med, an operating division of Diversified Communications (DC) and a trusted source for professional medical education to over 260,000 clinicians since 1995. For more information, visit: www.amazingcharts.com.

Happy 4th of July! I hope everyone has a fun and safe weekend.

Key Processes and Functions to Meet the Aims of ACOs

Posted on July 2, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In the last Kareo Twitter chat I hosted, we dug into the topic of ACOs and value based reimbursement. I learned a lot in the discussion. In case you missed the chat, you can review the transcript of the chat here.

One of the tweets in the chat came from Steve Sisko (@shimcode) and included the following image (click on the image to see a larger version):
Key Processes and Functions in an ACO

When you see the beautiful complexity of that chart, is it any wonder why we have a hard time understanding and implementing ACOs?

Combating Physician Burnout – Let’s Stop Treating Physicians Like Factory Workers

Posted on July 1, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Have you ever seen the Love Medicine Again website? I hadn’t either until yesterday, but it says something that someone would need to create a website like that in the first place. Many doctors are quite unhappy with their life as a doctor and where medicine is heading. I actually came across this website thanks to their article titled “5 Ways to Use Creativity to Combat Physician Burnout.” Here’s the 5 suggestions they make to put creativity to work to reduce physician burnout:

  1. Allow your staff to help you with your schedule
  2. Voice your concerns about something that isn’t working to your colleagues
  3. Give credit where credit is due
  4. Engage your patients to help you help them
  5. Think outside of the box about how to bring improved satisfaction to your job

I wasn’t that impressed with the list. It seems to gloss over the core of what’s burning physicians out. I do love the idea of providing opportunities for physicians to be creative. That has definitely been pushed to the side in many offices.

One of the most common complaints I hear from doctors is “Stop making me be a data entry clerk.” I think this was largely true in the paper world, but it has been made even more so in the world of EHR thanks to things like meaningful use that require a lot of hoop jumping and box clicking to comply. We could certainly do more to make the data entry work easier, but that still just masks the problems.

I think that doctors saying they don’t want to be a data entry clerk is really a proxy for “I want to be creative and thoughtful in how I approach medicine. I don’t have time to be creative.”

The 15 minute (or less) per appointment hits this same pain point. Doctors want to get paid and so they feel the economic reality is that they need to see as many patients as possible. This economic reality leaves no time for doctors to be creative. I think they feel more like factory workers than highly educated leaders.

If we want to solve the physician burnout problem we need to find ways to tap into a physician’s creativity. We need to free them up for churning out patients so they can leverage all their education and experience to solve the larger problems of healthcare. It’s not very often that overworked factory workers are able to solve massive problems. They’re too busy working to think about the larger context. We need to stop treating our doctors like factory workers to solve healthcare’s larger problems.

Healthcare Costs and the New Cost Conscious Patient

Posted on June 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My favorite health economist, Jane Sarasohn-Kahn, has put out a really interesting post on her Health Populi blog talking about what the SCOTUS ACA ruling means for health consumers (Side Note: Here’s the lesson I took from the ruling.). Jane offers an important perspective that we should think about as we look to the future of healthcare. Here’s an excerpt from her article:

There are still tweaks and adjustments to be made to the law, and market supports that must deal with the ever-rising price of health care. While optimists report health care cost increases moderated to 6.5% in 2015, this growth rate is nonetheless many times greater than peoples’ wage increases (relatively stagnant for a decade) and the Consumer Price Index which in the previous year was actually negative (due to lower costs of petrol and other decreasing costs in the household budget). The one cost households can count on going up, up, up is….healthcare.

And so with the growth of high-deductible health plans and health savings accounts, health consumers must become health care shoppers — that is, if people want to gain some control over their financial wellness.

What does this new cost conscious patient mean for healthcare? What systems are we going to need to be able to handle the patient? Will we be able to continue providing care to patients without any real idea on how much that care will cost? Or will we need systems that help us know what the cost of care will be so the patient can choose to buy that care or not? Will cost conscious patients want to be kept well instead of just having their current complaint treated?

There are these and a lot of other questions that are raised by this shift in patient consumption of healthcare services. Understanding these changes is going to be extremely important for healthcare organizations to survive.

Specialty Specific EHR

Posted on June 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long been a fan of the specialty specific EHR vendor. I’ve seen over and over again how much of a difference a specialty specific EHR can make in a practice. It’s a slippery slope when a specialty specific EHR starts entering other specialties. We’d like to think that every doctor is the same, but the variation in the needs of different specialties is rarely given the attention it deserves.

What scares me is that if we’re not careful, the specialty specific EHR vendor might be a dying breed. This isn’t because the specialty specific EHR vendors aren’t loved by their users more than the alternatives. Instead it’s the shift towards hospital owned medical practices that puts the specialty specific EHR in danger.

While hospital systems would love to support a best of breed approach to EHR software and allow each specialty to choose their own, I’ve never seen it actually happen. When push comes to shove, the hospital system starts rolling out an EHR vendor that “supports” every one of their specialties. It’s hard to blame an executive for making this choice. The logistics of supporting 20+ EHR vendors is onerous to put it lightly. The efficiency of one EHR vendor for a large multi specialty organization is just impossible to ignore. Long term however, I wonder if the downsides will cause major issues.

I should also declare that I don’t think a specialty specific EHR is always the best option. Some specialty specific EHR software aren’t very good either. In fact, I was recently thinking through the list of medical specialties and there were a lot of specialties where I didn’t know of a specialty specific EHR for them.

The one that struck me the most was that I didn’t know of an OB/GYN specific EHR. Is that really the case? I’ve seen hundreds of EHR and I couldn’t think of ever seeing an OB/GYN specific EHR. Maybe I’ve missed it, and if I have then I’d love to learn about one. I imagine the reason there isn’t one is because many of the larger All in One EHR vendors have put a decent focus on OB/GYN functionality. So, maybe no one wanted to compete with what was out there already? That’s speculation. What’s odd to me though is that OB/GYN seems like the perfect case where a specialty specific EHR could really benefit that specialty. They have some really unique needs and workflows. I’d think there would be massive competition around their specific challenges.

What I’ve also found is even the EHR vendors that are happy to sell to any specialty and probably have a few templates for that specialty (Yes, that’s how many EHR vendors “support” every specialty), even the All In One EHR vendors work better for certain specialties. This is often based on which specialties the EHR vendor had success with first. If 80 of your first 100 EHR sales are to cardiologists, then you can bet that your EHR is going to work better for cardiologists than it will for podiatrists.

With this in mind, let’s work as a community to aggregate a list of specialty specific EHR vendors. I’ll be generous and say that if an EHR vendor works with more than 10 EHR specialties, then it’s not a specialty specific EHR (5 is probably a better number). If you’re an EHR vendor and want to admit which specialties you work better for, then I’d love to hear that too.

Can we find a specialty specific EHR for every medical specialty? I look forward to seeing if we can in the comments.

EMR and EHR Goes Mobile

Posted on June 26, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I know. I’m a little late to the party. Ironically I created the first mobile version of EMR and EHR about 3+ years ago, but the options that were available weren’t very good and so I abandoned it and went back to the general theme. Plus, phone sizes got so big that I’ve always felt like most websites could be viewed on a modern smartphone without issue.

The people at Google (who are much smarter than me) have chosen otherwise and have started penalizing websites (in their search ranking) that aren’t mobile optimized. I still don’t think it’s a huge deal for my readers since only 10-15% of them read it on mobile devices and a big portion of that is on an iPad or tablet which is large enough to enjoy the normal website. Plus, an even larger portion of the EMR and EHR readership reads it in their email and that’s optimized for mobile already.

Of course, now that you’ve heard my excuses for why it took so long to create a beautiful mobile version of EMR and EHR, I’m happy to say that I’ve finally bit the bullet and rolled out a nice mobile theme for EMR and EHR. In fact, if you’re reading this post on your mobile device, then you’re experiencing the mobile optimized goodness already.

I’m still working on a few more changes to the mobile version of EMR and EHR, but I think you’ll enjoy reading our great content on your mobile device much better now. Let us know what you think in the comments. We’re happy to hear any problems, suggestions, and any praise (who doesn’t like a little ego stroke?) you have about the new mobile version of the site.

Above all else, thanks so much for reading and all your support!

Some Methods For Improving EMR Alerts

Posted on June 25, 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 FierceHealthcare.com 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.

A new study appearing in the Journal of the American Medical Informatics Association has made some points that may turn out to be helpful in designing those pesky but helpful alerts for clinicians.

Making alerts useful and appropriate is no small matter. As we reported on a couple of years ago, even then EMR alert fatigue has become a major source of possible medical errors. In fact, a Pediatrics study published around that time found that clinicians were ignoring or overriding many alerts in an effort to stay focused.

Despite warnings from researchers and important industry voices like The Joint Commission, little has changed since then. But the issue can’t be ignored forever, as it’s a car crash waiting to happen.

The JAMIA study may offer some help, however. While it focuses on making drug-drug interaction warnings more usable, the principles it offers can serve as a model for designing other alerts as well.

For what it’s worth, the strategies I’m about to present came from a DDI Clinical Decision Support conference attended by experts from ONC, health IT vendors, academia and healthcare organizations.

While the experts offered several recommendations applying specifically to DDI alerts, their suggestions for presenting such alerts seem to apply to a wide range of notifications available across virtually all EMRs. These suggestions include:

  • Consistent use of color and visual cues: Like road signs, alerts should come in a limited and predictable variety of colors and styles, and use only color and symbols for which the meaning is clear to all clinicians.
  • Consistent use of terminology and brevity: Alerts should be consistently phrased and use the same terms across platforms. They should also be presented concisely, with minimal text, allowing for larger font sizes to improve readability.
  • Avoid interruptions wherever possible:  Rather than freezing clinician workflow over actions already taken, save interruptive alerts that require action to proceed for the most serious situation. The system should proactively guide decisions to safer alernatives, taking away the need for interruption.

The research also offers input on where and when to display alerts.

Where to display alert information:  The most critical information should be displayed on the alert’s top-level screen, with links to evidence — rather than long text — to back up the alert justification.

When to display alerts: The group concluded that alerts should be displayed at the point when a decision is being made, rather than jumping on the physician later.

The paper offers a great deal of additional information, and if you’re at all involved in addressing alerting issues or designing the alerts I strongly suggest you review the entire paper.

But even the excerpts above offer a lot to consider. If most alerts met these usability and presentation standards, they might offer more value to clinicians and greater safety to patients.

Doctors, Not Patients, May Be Holding Back mHealth Adoption

Posted on June 24, 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 FierceHealthcare.com 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.

Clearly, mHealth technology has achieved impressive momentum among a certain breed of health-conscious, self-monitoring consumer. Still, aside from wearable health bands, few mHealth technologies or apps have achieved a critical level of adoption.

The reason for this, according to a new survey, may lie in doctors’ attitudes toward these tools. According to the study, by market research firm MedPanel, only 15% of physicians are suggesting wearables or health apps as approaches for growing healthier.

It’s not that the tools themselves aren’t useful. According to a separate study by Research Now summarized by HealthData Management, 86% of 500 medical professionals said mHealth apps gave them a better understanding of a patient’s medical condition, and 76% said that they felt that apps were helping patients manage chronic illnesses. Also, HDM reported that 46% believed that apps could make patient transitions from hospital to home care simpler.

While doctors could do more to promote the use of mHealth technology — and patients might benefit if they did — the onus is not completely on doctors. MedPanel president Jason LaBonte told HDM that vendors are positioning wearables and apps as “a fad” by seeing them as solely consumer-driven markets. (Not only does this turn doctors off, it also makes it less likely that consumers would think of asking their doctor about mHealth tool usage, I’d submit.)

But doctors aren’t just concerned about mHealth’s image. They also aren’t satisfied with current products, though that would change rapidly if there were a way to integrate mobile health data into EMR platforms directly. Sure, platforms like HealthKit exist, but it seems like doctors want something more immediate and simple.

Doctors also told MedPanel that mHealth devices need to be easier to use and generate data that has greater use in clinical practice.  Moreover, physicians wanted to see these products generate data that could help them meet practice manager and payer requirements, something that few if any of the current roster of mHealth tools can do (to my knowledge).

When it comes to physician awareness of specific products, only a few seem to have stood out from the crowd. MedPanel found that while 82% of doctors surveyed were aware of the Apple Watch, even more were familiar with Fitbit.

Meanwhile, the Microsoft Band scored highest of all wearables for satisfaction with ease of use and generating useful data. Given the fluid state of physicians’ loyalties in this area, Microsoft may not be able to maintain its lead, but it is interesting that it won out this time over usability champ Apple.

We’re Hosting the #KareoChat and Discussing Value Based Care and ACOs – Join Us!

Posted on June 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ACO and Value Based Reimbursement Twitter Chat
We’re excited to be hosting this week’s #KareoChat on Thursday, 6/25 at 9 AM PT (Noon ET) where we’ll be diving into the details around Value Based Care and ACOs. We’ll be hosting the chat from @ehrandhit and chiming in on occasion from @techguy and @healthcarescene as well.

The topic of value based care and ACOs is extremely important to small practice physicians since understanding and participating in it will be key to their survival. At least that’s my take. I look forward to hearing other people’s thoughts on these changes on Thursday’s Twitter chat. Here are the questions we’ll be discussing over the hour:

  1. What’s the latest trends in value based reimbursement that we should know or watch? #KareoChat
  2. Why or why aren’t you participating in an ACO? #KareoChat
  3. Describe the pros and cons you see with the change to value based reimbursement. #KareoChat
  4. What are you doing to prepare your practice for value based reimbursement and ACOs? #KareoChat
  5. Which technologies and applications will we need in a value based reimbursement and ACO world? #KareoChat
  6. What’s the role of small practices in a value based reimbursement world? Can they survive? #KareoChat

For those of you not familiar with a Twitter chat, you can follow the discussion on Twitter by watching the hashtag #KareoChat. You can also take part in the Twitter chat by including the #KareoChat hashtag in any tweets you send.

I look forward to “seeing” and learning from many of you on Twitter on Thursday. Feel free to start the conversation in the comments below as well.

Full Disclosure: Kareo is a sponsor of EMR and EHR.