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Will New Doctors Hate EMRs the Way Older Doctors Do?

Posted on March 22, 2017 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.

Oh! Just the idiocy of it all!

That’s a quote from an email I got from an older doctor in response to a discussion about EHR software and in particular programs like meaningful use and now MACRA. This is a doctor who I’ve exchanged many emails with over multiple years. Needless to say, he’s not happy with what’s happening with EHR software and sees it as an awful thing for medicine. I think this is the view of most older doctors.

While most older doctors feel this way, I wonder if the next generations of doctors will feel the same. I’ll never forget my med school friend who said he hated rounding at a doctor’s office that didn’t have an EHR because he types faster than he writes. Or the middle-aged doctor that’s been a friend of my family since I was a kid that’s been on EHR so long that he once told me “I’ve never really known anything but an EHR, so I can’t imagine practicing medicine without it.”

I understand the doctors who complain about EHRs and more importantly complain about the regulations which are reflected in the features EHR software companies push out. EHR was a massive change for many of them and that can be brutal. Plus, there are plenty of issues with many EHR software and EHR implementations out there. Some that can be resolved and some that can’t. Not to mention that many regulation requirements aren’t clinically useful. We should be glad doctors are upset over this.

However, will the next generation of doctors care?

Besides the fact that new doctors are digital natives who grew up with technology, there’s also the fact that new doctors won’t know what life in a medical office was like before EHR. EHR documentation will just be part of the status quo for them and when you don’t know about the alternative, then you don’t hate it as much. It’s just a required part of the profession and it’s always been that way.

The reality for most new doctors is that there are so many things that are screwed up with our healthcare system, that the EHR is just one more to add to the pile of things that don’t make much sense. They’ll just consider it a feature of the profession and likely not complain much.

The one thing that could change all of this is for a new EHR or related solution to come out and blow all the current EHR vendors off the map. It would have to be something so dramatically better for organizations that healthcare organizations can’t resist it. Think of the way the iPhone made us rethink cell phones. It needs to be a solution which is that much better. Does such a solution exist? Can such a solution be built? Or do the current healthcare regulations prevent such a solution? Will it take changes in regulation and reimbursement to enable a new EHR that doctors love and not a change by an EHR software vendor?

MACRA and MIPS Training and Resources – MACRA Monday

Posted on March 20, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

While we’ve covered a lot of ground in this MACRA Monday series, there are still a lot of details we haven’t covered. I’ve been debating how deep into the weeds of MACRA and MIPS we should go or not as part of this series. We’d love to hear your thoughts.

We’re partially reticent to go really deep, because there’s a lot of great resources out there to dive deeply into MACRA and MIPS. Plus, we don’t see many people doing higher level strategic decision making content that has opinions about what your organization should or shouldn’t do when it comes to MACRA.

If you’re looking for some deeper training on MACRA and MIPS, we’ll highlight a few courses and trainings out there that we know about.

4Med MIPS and MACRA Training
The people at 4Med have a whole series of training for MIPS and MACRA. They have a lot of past experience doing training for meaningful use and PQRS and they’re continuing that with their latest MACRA and MIPS Training. Here’s a look at some of the courses they have coming up (Note: each of these links automatically gives you a discount on each course):

MACRA-MIPS Quality Project Manager – Starts March 29 – A nice course focused on the quality portion of MIPS.

Patient Centered Medical Home (PCMH) Workshop – Starts May 3 – This goes beyond MIPS and MACRA, but is all part of the related trend.

HIPAA Compliance Officer – Starts April 19 – This isn’t really a MIPS and MACRA course, but they require you to do a HIPAA Risk Assessment, so this course could help you make sure you’re ready to fulfill that requirement. Plus, this is a good course given the importance of security in healthcare these days.

4 Med offers a number of other courses including an Advancing Care Information course as well, but it’s not scheduled right now. We’ll update you in the future as those courses are scheduled. Instead of the live training options above, you can also purchase the online version of these courses. If you use the promo code: HITC you’ll get 20% off those online versions.

MIPS Boot Camp
Another option to consider is this MIPS Boot Camp course offered by Jim Tate and Wayne Singer. The course is only 1.5 hours, but Jim is a true expert in this area and so it will be a great starter course. They obviously are trying to push their MyMipsScore™ App, but that might be something useful for readers as well.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

The Sad State of Healthcare – Fun Friday

Posted on March 17, 2017 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’s Friday and so I often like to do something a little bit more fun as we head into the weekend. We call it Fun Friday. So, today I want to share two healthcare cartoons. They’re pretty funny, but they also kind of make you sick when you realize the truths that they illustrate. Hopefully, these cartoons can help remind us about some of the real problems we need to deal with in healthcare.

I’m sure a lot of us have had this experience. It’s sad that it happens as much as it does. We can certainly do better. Doctors and patients need us to do better.

This next cartoon seems appropriate given the current conversation about healthcare reform. It reminds me that there are a lot of factors that influence our healthcare costs and the legislation I’ve seen doesn’t do anything for a lot of the problem areas. To quote my friend Neil Versel from Meaningful Health IT News, “Health insurance is not health care.” He’s right and that seems to be getting lost in the current healthcare reform discussion and legislation.

The Challenge of FDA Clearance

Posted on March 16, 2017 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.

As I’ve talked to 100s of companies creating devices for healthcare, there’s inevitably the question: “Are you FDA cleared?” There answer usually tells me a lot about the company and what their goals are for the product. Generally, it’s a question of if they’re going to go after the consumer space (ie. no FDA clearance) or after the medical market (ie. FDA clearance preferred).

In a few cases, I’ve talked to companies like EarlySense that have an FDA cleared product for hospital beds and a non-FDA cleared product for consumers. It was interesting to hear the reasons why they chose to release a non-FDA cleared product for consumers since they already knew they had the capability to go through the FDA clearance process. Their answer to me was instructive.

The core of their response was that FDA clearance is not a one time event and so this limits their ability to iterate and release product updates.

For anyone working in the startup world, it runs completely counter to the startup culture. The idea of iterating quickly and often is part of the mantra of most startup companies in silicon valley and now around the world. The FDA’s clearance process runs almost completely counter to this idea.

With this type of restriction, it makes sense why so many companies would avoid FDA clearance and just create a direct to consumer product that doesn’t require FDA clearance. The ongoing FDA clearance requirements can be a bear. What company wouldn’t want to bypass it and just iterate as they please?

The challenge with this approach is that there are reasons that FDA clearance is so challenging. First, it searches to provide a level of safety as far as what’s being implemented and the results of the device actually being tested and confirmed. Second, it creates a trust that most doctors (and their malpractice and insurance companies) want to see before using it.

Certainly, we could argue about how effective the FDA clearance is about ensuring safety and results, but that’s a topic for another day. If nothing else, it requires many organizations to think deeply about what the safety of the patients that are impacted by the device and consider the promises they make to customers. Those are two things that are missing in my consumer health devices and apps.

It’s a tough balance and I don’t think we’ve fully figured it out. How do you ensure safety and efficacy while still allowing the entrepreneurial spirit of innovation to thrive?

Is Quality Mutually Exclusive with Profitability?

Posted on March 15, 2017 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 was browsing through some old notes today from past conferences and stumbled upon a really intriguing question from when I met with Infor back at ANI 2014. Thanks to technology I know that I met with Beth Meyers, Healthcare Industry Strategy Director, and Prakash Kadamba, Director of Healthcare Product Management at Infor. The question I jotted down from our discussion is the title for the blog post:

Is Quality Mutually Exclusive with Profitability?

In most industries, the company with the better quality often wins. There are a few exceptions, but for the most part, quality matters a lot in the choices we make. However, if I dive a little deeper I think that value wins out over quality in many industries as well. You know you have a breakout product which provides amazing quality and amazing value.

Unfortunately, I’m sad to say that this isn’t always the case in healthcare. The reason I think it isn’t the case is that patients don’t have a good way to measure quality and I’m not sure we’ll ever get to where we can measure quality. I’d be excited if we could, but I don’t see it in the foreseeable future. We have vague representations and indicators of quality, but none of them effectively represent quality.

The best measure of quality a patient can see is “I got better.” The irony of this statement is that just because you got better doesn’t mean you got quality care. You might have gotten better based on something other than the care you received.

Back to the original question, I think you can provide amazing quality healthcare and still be profitable. Those two ideas aren’t mutually exclusive. However, I also don’t think that all those doctors providing quality care are going to be profitable. Quality care does not directly determine how profitable your organization will be. What makes the difference then?

The big difference I see is how well an organization is run. How effective is your billing department? How effective is your documentation? Do you have tools that engage patients in their billing and in their care? Have you automated many patient experiences to free up time for your staff to work on the things that matter most?

Those clinics that are profitable and providing quality care are usually the ones that are looking beyond the EHR. They realize where the EHR fits into their larger strategy, but the EHR isn’t their entire strategy. That’s a big shift in mindset for many that were so myopically focused on implementing EHR as they chased after government handouts.

If you know you’re providing high quality care, but you’re not profitable, take a step back and evaluate your business. I’m sure you’ll find a lot of shortcomings on the business side that if you addressed would make you more profitable. Just don’t expect your EHR vendor to give you all the answers. They’re an important piece of the puzzle, but just one piece.

What Do Doctors Need to Know About MACRA and MIPS? – MACRA Monday

Posted on March 13, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

While at the HIMSS 2017 conference, I had a chance to do a video interview with MACRA expert, Alexandria (Alex) J. Goulding, Public Policy Manager at iHealth. We cover a broad range of MACRA topics focused on the practical things that doctors should know about MACRA and MIPS.

You can find the full MACRA video interview at the bottom or click any of the links below to skip to a specific answer:

Do you have other perspectives and insights that you’d add to what Alex Goulding offered above? Please share them in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

A New MACRA Tools Market – MACRA Monday

Posted on March 6, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

One thing we’ve realized writing MACRA Monday is that there’s an insatiable appetite for MACRA right now. Webinar signups are through the roof when it’s on the topic of MACRA and MIPS. MACRA and MIPS training courses are selling like hot cakes. Everyone is trying to get the information they need to deal with MACRA and MIPS.

After talking with many companies at HIMSS, there’s a whole new market being created for tools that help organizations track and attest for MACRA as well. Of course, every EHR vendor is creating a solution for their providers. However, there are a lot of other companies that are looking at this as a big opportunity for them to provide tools to make tracking and reporting MACRA and MIPS easy.

Two companies that I ran into recently in this space are SA Ignite and SPH Analytics.

Both of these companies are focusing on MACRA, APM, and MIPS reporting at the higher end. We’re talking about hospital systems that have 100 medical practices and so they have a few hundred doctors who need to do MACRA reporting. Can you imagine managing that many attestations on Excel or something? That’s why I think these tools are going to become so popular.

A part of me hates that entire companies are being created around government attestation. However, the realist in me understands that these tools are needed by large health systems that have to comply with government requirements or lost a lot of money.

What do you think of this trend? Is it a microcosm of our current healthcare system? Do you know of other tools that can help organizations trying to handle MACRA reporting?

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

The Future of MACRA – MACRA Monday

Posted on February 27, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

As mentioned in my previous MACRA Monday post, MACRA was a hot topic at the HIMSS 2017 conference. No doubt it was on pretty much everyone’s minds. A few people I talked to said that there’s an insatiable appetite for MACRA related content and they’re right. It’s amazing how many people still need to learn about MACRA and how many who know the basics still need to get into the nitty gritty. I loved one tweet from the conference that said that the line to the CMS booth was longer than the line for ice cream which is saying something.

Despite all this interest in MACRA, there is a growing rift in how organizations and doctors are approaching MACRA. There seems to be universal hatred of MACRA by doctors. I have yet to find a doctor out there that likes MACRA. The best I’ve found is doctors who don’t like it but don’t have a major issue with it either. If there’s a practicing doctor out there that likes MACRA, I’d love to meet you.

On the other hand, I don’t know a single large organization that is planning to opt out of MACRA. Every organization I’ve talked to is planning to participate in MACRA in some shape or form. They usually argue some mix of the following reasons for their participation:

  • We can’t take the penalties to our reimbursement.
  • The incentives are relatively small, but across 100s of providers that’s a big chunk of change.
  • What happens to our doctors when the MACRA results are put on the physician compare website? We don’t want to take the reputation hit.
  • This is just the start of these programs. If we opt out of them, we’ll just be behind in the future.

These large organizations are going to participate. I just don’t see them with any other options. Plus, if I were being really cynical I would say that a new administrative program from the government is great for administrators’ jobs.

One regular reader of this site, meltoots, makes this passionate plea from the doctor perspective:

You know me John,
CMS is completely unaware of how bad it is out here on the front lines. MACRA is dead. They can try to implement, but it will fail. The front liners that are left have had enough of the fraud of reporting “quality” as a measure of success. Does not work at all. Its a sham. ACOs failing left and right. Does CMS REALLY think that if i report a 100% preop antibiotic rate is quality? We do that 100% already. Do they really think that CPIA is “value” or is it just reporting “value”. Lets get real. All the small practice incentives are going to 11 companies, NOT the actual practices. For “education” and “training” on MACRA. Thanks. Right. There is a HUGE disconnect between CMS/HIT and front line MDs. Again this week 2 more people gave up medicine in our hospital. I’m telling you this is a crisis and cannot be ignored. Its time to unburden MDs from all these distractions, let EHR companies innovate without being shackled to cert requirements. Wash DC cannot solve this. They have set us back 10 years already. Time let go and get out of the way.

The problem is that I think he’s missing the point. CMS does think that MACRA will improve quality. Trying to illustrate that you disagree is likely going to fall on deaf ears.

The comment about MACRA being dead could be taken a lot of different ways. However, I can assure you that it is not dead and not even showing signs of death. Doctors can complain and moan all they want, but if they don’t get their large practice colleagues on board as well, then MACRA will not only survive, it will thrive when it comes to participation numbers.

I personally think that the battle to kill MACRA is a waste of effort since it will likely never happen. Instead, doctors should focus their energy on improving MACRA so that it’s simplified and focused on things that do improve healthcare. Sure, it will never get their 100%, but the all or nothing approach to trying to kill MACRA will likely lead to even worse results (ie. wasted energy and no changes).

What do you think about the future of MACRA? I look forward to hearing your thoughts in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Ambulatory EHR Vendors Are Now Distribution Channels

Posted on February 23, 2017 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 been thinking about this idea since MGMA and it was illustrated even more deeply at the HIMSS 2017 Annual conference as well. EHR vendors with a reasonably sized user base have made a really big shift. Instead of selling EHR software, they’ve become a really interesting distribution channel.

Sure, you can still go to any of the EHR vendors and buy an EHR. They all can do that and they have some effort to sell EHR, but not really. Instead, you can see that the focus of many EHR software vendors have shifted to retaining their existing customer base and selling them new products. Some of them integrate smartly with the EHR software, but many of them have very little to do with the EHR.

Think about it from the EHR vendor perspective. They could churn their wheels trying to sell EHR software to a bunch of clinics that have basically chosen to not do EHR. Sounds like fun, right? They could also try and get people to switch EHR companies. Another really fun task, right? No, it’s a really challenging thing to do.

Instead of the really hard challenge of selling EHR software to people that don’t want it or don’t like the one they have, they instead sell something of value to their existing user base. It’s no wonder that EHR vendors have chosen to become distribution channels. If you have a sizable user base in a saturated market, it’s much easier to become a distribution channel to your users than it is to try and take users from your competitor.

Does this not describe where we are in the ambulatory EHR market? I’m seeing that play out across a whole lot of EHR vendors. This dynamic will be extremely interesting to watch. It will also be interesting to see what this means for smaller EHR vendors who don’t have a large enough user population to be a good distribution channel.

What do you think of this shift?

#MACRA at #HIMSS17 – MACRA Monday

Posted on February 20, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

We’re taking this week kind of off from covering MACRA because we’re at the HIMSS 2017 Annual Conference. However, there’s been a lot of discussion about MACRA at the conference. It’s a hot topic and one of great concern for many organizations that stand to lose millions if they get it wrong. Here are just a few of the high level tweets about MACRA that I found interesting.


This is something we have written about before. Whether you like MACRA or don’t, I can’t imagine it’s going away. I think this is part of a long term change and it’s just the start. Where it will go will depend on a lot of factors. The factor we need most is more doctors to give input. And the input of just get rid of it is likely to fall on deaf ears. So, dive a little deeper and use the data to illustrate why and/or how it can be changed so it is effective.


I’m really happy that CMS added these MACRA APIs. I’m still interested to see how effective they are and how people use them, but I think they could streamline things for a lot of companies. What do you think?


This graphic is confusing to me, but I understood the output was improved patient experience and improved outcomes. Do you think MACRA will improve results? I think that’s a bit of stretch. It may get there eventually. Hopefully that’s the long term process that Andy Slavitt mentioned above.


I think we’re seeing a proliferation of tools. Will it be a whole market of tools for MACRA?


I need to chew on this one a bit more. What do you think?


Not really MACRA, but I know many are wondering about CMMI. I hope he’s right.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.