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Balancing EHR Change vs Train

I was talking with Heather Haugen from The Breakaway Group (A Xerox company) today and in our discussion she used the word “train”, but I heard the word “change”. I always love a good play on words and so it was interesting for me to consider the difference between change and train in an EHR implementation.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.

May 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

What flows through you into the world?

On this lovely Friday I thought I’d throw out something that I heard at TEDMED that was quite profound. One of the organizers asked the following question that had impacted his life:

What flows through you into the world?

It’s a powerful concept to consider what we’re doing of good in the world. In fact, he asked some follow up questions for those of us in healthcare.

Are you in healthcare to do good? Or just to make money? Or just to provide for your family? Or just because you have no other choice?

I remember when I first got my job in healthcare I was really empowered by the idea that maybe something I did could help save someone’s life. It’s amazing how the mundane gets in the way of that broader vision. Although, I feel pretty good about what flows through me into healthcare IT and EHR. It just can always be more. I hope you’ll join me in thinking about this idea this weekend.

May 17, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

When Patients Know More Than Doctors

With a title like that, I know I’m bound to get a visceral response from some doctors, but hear me out. As someone told me today, the thing I love about John is that you know he’s going to tell you what he really thinks. He’s not going to hold back. Hopefully that’s true. Plus, I certainly welcome other people to provide opposing viewpoints so that we can all learn together.

First I should make it clear that I’m a great patient. I have extreme respect for the doctors I work with and follow their care plans to a T. For example, as a child I took accutane. That requires you to take pills twice a day. I think there may have been 1 or 2 times I missed taking my pills in 6 months. That’s pretty good if I say so myself. Regardless, I’m quite good at following the doctors care plan for me. Over time I have developed what I call a trust but verify approach. I trust that the doctor is doing what’s best, but I do like to confirm my understanding of why it’s being done when its a complicated situation. I don’t do this for things like common coughs and colds.

With this in mind, I was kind of blown away recently when someone told me about their 20 year old son who’s a diabetic. This patient and his parents had been dealing with his disease for about 15 years. As part of dealing with the disease they’d studied it and the various treatment and management options in depth. As he said, “we set a Google Alert and have read every study and discussion about the topic for 15 years.”

After moving, this diabetic patient went to see a new doctor who had just gotten out of medical school. A short discussion started and the patient quickly realized that he knew a lot more about his condition than his new doctor. What a challenging situation this must be for the new doctor.

I think most doctors are ok with this situation and have been dealing with chronic patients that know a lot about their disease for a long time. However, the availability of medical information is helping a lot of patients to be very well informed on their health issues. I wonder if a doctor use to treating well informed chronic patients has lessons we can apply to well informed general patients.

No doubt we’re in the stage of learning a new dance with a new partner. I’m not suggesting that we should change who’s leading the dance. The doctor should still be the lead for a lot of reasons. However, I am saying that the leader shouldn’t be surprised when their dance partner wants to provide some feedback on the choreography they’re doing. The leader might just find that working together they can produce even better results.

Side Note: It seems appropriate that I should use a dance analogy with the So You Think You Can Dance premiere tonight.

May 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EHR Adoption Percentage, EHR Story, and Future of EHR


I always love to grab the various EHR adoption numbers. Seems like most are hovering around the 60% number now. This one says 57% EHR adoption.


Of course, this is coming from ONC’s Twitter account, but I’m always happy to read someone’s story. If you’re willing to put your name to it, I’m willing to read it and see what you have to say. Plus, he takes a realistic look at some of the benefits of an EHR in a real matter of fact way.


This is probably the most focused and well written description of the real reasons why EHR software is a disappointment today. Unfortunately, the issues described are a fundamental problem with the healthcare system and something unlikely to change in the near future.

May 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

A Thoughtful Approach to EHR Implementation – 5 Tips

While many in the EHR industry have started moving beyond EHR implementation, it’s worth realizing that only 55% of physicians have adopted an electronic health record (EHR). Yes, that means that 45% of physicians are still working on selecting and adopting an EHR. Ok, it’s probably more like 40% of doctors are looking to implement an EHR. The other 5% will stick with their paper.

Plus, along with the 45% of doctors who don’t use EHR, there are a whole slew of existing EHR users that are selecting and implementing an EHR as well. For example, 2 days ago I was at my son’s cub scout event where an opthamologist friend of mine cornered me and asked me about how he should go about selecting an EHR for his practice. He had just decided to go out on his own and open his own opthamology practice. What a perfect time to select and implement an EHR.

With this in mind, today I came across this whitepaper by ADP AdvancedMD called A Thoughtful Approach to EHR Implementation. They provide a number of stats, charts, and graphs using data from the CDC about EHR satisfaction and EHR use. The most intriguing number to me was the number of physicians that reported accessing the patient chart remotely using their EHR. That’s an EHR benefit that I don’t see talked about very often.

The whitepaper also offered these 5 tips for a successful EHR Implementation:

  1. Stay committed to your goal, but flexible in your approach
  2. Don’t short-change your training opportunities
  3. Don’t underestimate the impact to your workflow
  4. To pilot or not to pilot
  5. Optimizing the EHR

A lot more could be said about each point and they cover each point in detail in the full whitepaper, but the first and third ones really stand out to me. EHR is a commitment, but requires some flexibility. The best way to have a failed EHR implementation is to not be committed or to be inflexible. Your workflow will be impacted, but if you take a thoughtful approach to your EHR implementation it can be impacted for good.

May 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Does adding all these EHR and other tech add or subtract to healthcare?

Such a compelling and tough question to consider. Let me repeat it again so you can let it roll around in your mind for a minute:

Does adding all these EHR and other tech add or subtract to healthcare?

This was one of the off hand comments I heard someone make in their presentation at TEDMED and I think it’s a serious question that every EHR company and healthcare IT vendor should consider.

The simple answer to the question is that some companies add to healthcare and some take away from healthcare. That’s just the nature of markets. However, there’s a deeper part of the question which fundamentally asks if the shift to electronic is helping healthcare or hurting it.

As I’ve mentioned previously, at my core I believe that technology has an overall positive impact on any industry. In my heart I believe that technology has the potential to improve most things.

My fear with the above question is whether we’re implementing the right technology that will help us have a positive impact on healthcare or whether we’re currently implementing dated technology which will set us back for years to come.

I got in a heated discussion today on LinkedIn about the MUMPS database. A HUGE portion of healthcare is built on the back of MUMPS. Nothing against MUMPS (although it does sound like an STD), but is it going to be powerful enough to “add” to healthcare or will we reach a point that its limitations start subtracting from what could be possible?

I don’t necessarily want this post to become a MUMPS pros and cons post, but I think it’s a great illustration of why I’m reticent to say that the technology foundation that healthcare is building today is providing a platform for an amazing healthcare IT future.

On the other side of the spectrum is the plethora of smart phone apps and devices in healthcare. You can’t tell me that the Alivecor device or AirStrip’s work in the mobile field isn’t incredibly exciting. They’re leveraging the latest technology in a beautiful way.

One challenge we do face is the HUGE number of EMR companies and mobile health apps. With so many companies, we’re bound to have a healthcare software graveyard soon. Hopefully the companies we find in the graveyard are those who were subtracting from healthcare instead of adding to it. Unfortunately, that’s still just a hope and may not be the reality.

Many of our newer readers might not be familiar with my reference to Jabba the Hutt EHRs. The concept would seem to apply well to this post. For those not familiar with the concept, Jabba the Hutt was a really powerful individual, but it’s safe to say that he wasn’t very nimble. Does this sound a bit like some of the healthcare IT and EHR companies that dominate the market today?

Maybe I’m wrong, but the nimble innovative companies are the ones that usually add the most to healthcare versus subtracting. Luckily history is on my side. I’m just not sure we have enough Princess Leia companies that are in a position to wrap their chain around the neck of Jabba the Hutt companies.

I’ll let you decide which companies you believe add to healthcare and which ones subtract from healthcare. Although, I think we’d all benefit if every company focused on adding to healthcare.

May 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EMR UX, Flagler Hospital EMR Video, and Antiquated EMR Screenshots


I don’t think Nick was being a cynic with this comment. He’s right. Nothing has pushed EHR vendors to do a good UX and I don’t see that changing any time soon. The #EHRBacklash hasn’t reached a critical mass (yet?). As a side note, I recorded a video chat with Nick Dawson this week as well. He’s a smart man.


Kudos to Flagler Hospital for celebrating their EHR in a fun way for their staff. It’s interesting to see their list of EHR benefits in thew video as well. Although, the dancing is absolutely the best part of the video. Nice work Flagler and a great follow up to your EHR launch video.


I’ll admit that this tweet is quite nostalgic for me. The Medical Quack is one of the first people I met in my online EMR world. I still remember an early Skype video chat we did just after Skype video came out. We were both surprised that it actually worked. It was almost midnight and for some reason we were both up doing EMR related stuff. It was amazing for me to consider one lady on her own trying to develop an EMR. My how far we’ve both come since then. It’s great to see the screenshots from her original EMR. Too bad I didn’t have my EHR screenshots website back then.

May 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Supporting EMR and EHR

It’s time to recognize all the great companies that have been supporting the work we do here at EMR and EHR. We have a really amazing list of advertisers that support the writing we do here on EMR and EHR. As you’ll see from the list below, many of them have been advertising with us for many years. Their continued support is much appreciated.

New EMR and EHR Advertisers
Xerox Healthcare – Over the past month I’ve started to work with Xerox on a number of fronts. Many of you will likely remember my blog post about TEDMED. My trip to TEDMED was made possible thanks to Xerox. Plus, Xerox has been advertising on my site as well. It’s impressive how Xerox has shifted from being a copier company to a major player in healthcare. I should also mention, I’m doing a Google Plus Hangout with Xerox to wrap up the TEDMED experience. Come join in live.

simplifyMD – Besides doing some cool EHR cartoons, they also offer a different approach to EHR than many EHR vendors out there. They have a clear focus on the productivity of the physician. They have a solid team behind the product and we’re glad to have their support.

Canon – I imagine many people’s first thought with Canon is their excellent line of cameras. However, Canon also has an excellent line of scanners as well. For example, I previously reviewed the Canon imageFORMULA DR-C125. It’s an excellent scanner that can handle the heavy scanning workload of healthcare.

Forerunsystems – One of the specialty specific areas of EHR has always been the ED. Forerun’s FlexChart specializes in clinical documentation solutions for the ED. FlexChart provides quality care enhancements that are usable, flexible, and work with any style of documentation and workflow, as well as supporting safe hand-offs with enhanced provider communication. FlexChart is designed to work with and enhance any existing hospital-wide system, while enabling ED physicians with the tools they need that are unique to emergency medicine.

Chetu – The best introduction I can make to Chetu is this interview with Craig Schmidt, Director of Global Sales for Healthcare and Pharmaceuticals at Chetu. As that interview illustrates, Chetu has developing software for the healthcare industry for a very long time. It’s really amazing to see the depth of healthcare expertise combined with broad tech knowledge.

ZH Healthcare – For those who wonder how mature open source is in the EMR world, all you have to do is take a look at ZH Healthcare. They offer an EHR product based on the community version of OpenEMR along with ZH Healthcare’s proprietary enhancements and support services. I’m a huge proponent of open source software in general and so I’m really happy that a company built on the back of OpenEMR’s open source software is supporting us. If you like open source, then take a look and see what ZH Healthcare is doing with OpenEMR.

Renewing EMR and EHR Advertisers
Ambir – Advertiser since 1/2010
Amazing Charts – Advertiser since 5/2011
Cerner – Advertiser since 9/2011
Quest Quality Solutions – Advertiser since 9/2011

Check out our EMR and EHR advertising page for more information on supporting EMR and EHR. I’m also almost ready to announce a few new advertising options beyond just traditional banner advertising.  Send me a message on our contact us page if you’re interested in learning more.

May 1, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

BYOD Deploying a Mobile Device Management Strategy

The following is a guest blog post by Marcus LaFountain.
Marcus LaFountain Headshot
LaFountain has worked in IT for the last 10 years as a PC Technician, Help Desk Analyst, and System Administrator. He is currently a Healthcare IT Consultant specializing in Cerner and HIM implementations.

A recent Ovum study showed that almost 60% of employees bring some type of mobile device into the workplace. There are a few names for this, Bring Your Own Device (BYOD), Bring Your Own PC (BYOPC), Bring Your Own Phone (BYOP), User Introduces Unsecure Device onto My Network and Then Loses My Secure Data (UIUDOMNTLMSD). Alright, so I made that last one up, but that is how most IT Managers feel when the discussion is started about BYOD. An end user bringing a device to work is both a gift and a curse for any sized company. We see an increase in productivity but also the increased threat of data being lost or stolen. Having a strong Mobile Device Management (MDM) strategy can help companies reap the benefits of BYOD while limiting the consequences.

Let’s start by going over some numbers. By 2014, the number of mobile devices (mostly mobile phones) in the workplace is expected to reach 350 million globally. A remarkable 57% of full time employees are already using mobile devices for work related tasks. Out of that 57%, about half is unmonitored, unmanaged BYOD activity. Another study shows that in 2011, 78% of companies did NOT have a BYOD policy and only about 20% of employees actually sign a BYOD policy.

There are many reasons to justify a BYOD policy:

Productivity:  An employee who uses their personal device for both work and play is on average likely to work an extra 240 hours per year than those who do not. They can answer emails on the go, answer phone calls while on the road (using a hands-free device of course!) and receive that last minute meeting update. . Most employees won’t want to bring a work laptop home just to check emails after dinner or during downtime at home. Letting them receive push emails may empower them to write a quick mail back to a client in a different time zone rather than having to wait until the morning.

Cost: There is also a cost justification. Not having to provide every employee with a business only device can save not only the cost of the device but the monthly service plan that goes along with it. The number of devices can be reduced as well. A mobile phone is a cheaper and sometimes more convenient alternative than a laptop with a 4G cell card. Employees can still stay connected when not physically at their desk.

User Experience: Tech Savvy employees tend to have strong preferences when it comes to the technology they choose to use. Forcing an Android user to use a BlackBerry device may not be an ideal situation. Giving employees the ability to choose their mobile operating system, screen size and other technical specs may make them more likely to use the device rather than it sitting in a desk drawer unused.

However, it isn’t all sunshine and rainbows in the world of BYOD. As the use of mobile devices increase in the work place, so do the number of malicious attacks. According to the Ponemon Institute, 6 out of 10 security breaches were traced back to mobile devices. Apple and Google are constantly removing mobile malware from their app stores. And as always, attackers are trying to pick the low hanging fruit of the mobile community first. Businesses must have policies and security measures in place to protect their data. In 2009, the US Government enacted the Health Information Technology for Clinical Health Act (HITECH) that requires healthcare companies to notify patients if they have had their health records compromised. Similar acts were also put in place in the financial industry.

Constructing a comprehensive Mobile Device Management (MDM) policy is imperative when users are allowed to bring and use their own devices. As with many policies, the contents may vary greatly by company. However, almost every company from small businesses to enterprises will need to focus on security and support.

Security:  A lost or stolen device is the most common type of security breach. A company must have measures in place to combat this. While an entire article can be written about mobile security, I will touch on some common features.  Both Android and Apple offer AES 256 – Bit encryption as a standard on their devices.  Lock screens, passwords and certificates all play a role in device management as well. Microsoft Active Sync and other software also allow administrators to perform a remote wipe of a compromised device. This is a necessary requirement when employees have company data on their mobile phones.  Samsung has developed an Enterprise suite called SAFE that allows the user to partition company data with personal data. It also gives administrators the ability to perform a complete or selective wipe, tracking of the device and local password enforcement.  Apple and other mobile providers are starting to or already have incorporated these features as well. If your company is using application virtualization, you may need to define new rules for allowing mobile devices. Users will also need a way to get a hold of someone 24/7 in the event of a lost or stolen device.

Support:  This may be a slippery slope for some. Most IT policies only allow for support of company devices. So who supports a personal device that is used for business? Depending on the size of your company, you may want to assign a dedicated resource from your IT Security team to manage your MDM policy. If you are an enterprise, you may need a small team to manage different aspects of the policy. Your Help Desk will need training on the various mobile operating systems and communication will need to be sent out to end users on how to stay on top of security. Documentation will need to be created on how to setup email, VPNs and passwords. Do you need to setup an approved device list or will you allow any manufacturer or mobile OS on the network? A pilot group (usually IT) will need to be put in place to test your new systems and policies as well. Audits should also be enabled to check for OS updates, application updates and security updates.

In a growing mobile market and the on demand nature of business today, IT Management will need to be one step ahead of its users by developing a MDM policy. When developing an MDM strategy, you must take into account your business needs as well as infrastructure requirements. Like any new implementation it is ideal to begin testing your technology and policies with a small subset of users and conducting a review process before rolling out corporate wide. Doing so may limit mistakes while in a beta phase instead of having them on a mass scale. Focusing on security and support will allow for a comprehensive strategy that will allow employees to operate efficiently and productively but most importantly safely.

Related Whitepaper:
How Technology Executives are Managing the Shift to BYOD
This white paper looks at the growing adoption of BYOD in healthcare and the possible benefits and hurdles of enabling employees to use their own consumer devices in the workplace.

Download Whitepaper or see More EMR and Health IT Whitepapers

April 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

simplifyMD New “Free” Patient Room Cartoon

A while back simplifyMD sent me a link to their EHR cartoon gallery. I’ll admit that I was a little underwhelmed with their first set of cartoons. They looked professional, but the content and writing needed some help. I happened upon the gallery again today and found a new cartoon called, ‘Easy Street Family Practice installs a “Free” patient room.’ Check it out (click on the image to see it full size):
simplifyMD Ad Supported Patient Rooms

I thought this was a hilarious jab at our societal move to “Free” everything. It’s a bit of an exaggeration of what it’s really like to get something for free in return for time spent seeing ads. This is especially true of Free EHR where the ads are as unobtrusive as any ads I’ve seen on anything. However, it does illustrate the reason why many people aren’t comfortable with the Free EHR model.

I did have one user of the Practice Fusion Free EHR recently tell me that if the EHR weren’t free, there’s no way they’d still be using that EHR. I thought it provided an interesting perspective on the value of free. We’ll see how this plays out long term for Practice Fusion and if these type of experiences taint the Free EHR market for everyone else.

Plus, I couldn’t write about Free EHR without mentioning that just because an EHR doesn’t cost money doesn’t mean that there aren’t other costs. Some people are ok with the Free EHR costs of advertising and data. Others are not. The key is to be aware of the hidden costs of using a Free EHR.

Going back to the cartoon, I think I might prefer some in exam room advertising if it would replace my co-pay. I’d be fine with a nice Pepsi ad in the exam room in return for lower healthcare costs. Although like most things in life, it can certainly be taken too far if we’re not careful.

Full Disclosure: simplifyMD is an advertiser on this site.

April 24, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.