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Smart Home Healthcare Tech Setting Up to Do Great Things

Posted on March 31, 2016 I Written By

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

Today, I read a report suggesting that technologies allowing frail elderly patients to age in place are really coming into their own. The new study by P & S Market Research is predicting that the global smart home healthcare market will expand at a combined annual growth rate of 38% between now and the year 2022.

This surge in demand, not surprisingly, is emerging as three powerful technical trends — the use of smart home technologies, the rapid emergence of mobile health apps and expanding remote monitoring of patients — converge and enhance each other. The growing use of IoT devices in home healthcare is also in the mix.

The researchers found that fall prevention and detection applications will see the biggest increase in demand between now and 2022. But many other applications combining smart home technology with healthcare IT are likely to catch fire as well, particularly when such applications can help avoid costly nursing home placements for frail older adults, researchers said. And everybody wants to get into the game:

  • According to P&S, important players operating in this market globally include AT&T, ABB Ltd, Siemens AG, Schneider Electric SE, GE, Honeywell Life Care Solutions, Smart Solutions, Essence Group and Koninkllijke Philips N.V.
  • Also, we can’t forget smart home technology players like Nest, and Ecobee will stake out a place in this territory, as well as health monitoring players like Fitbit and consumer tech giants like Apple and Microsoft.
  • Then, of course, it’s a no-brainer for mobile ecosystem behemoths like Samsung to stake out their place in this market as well.
  • What’s more, VC dollars will be poured into startups in this space over the next several years. It seems likely that with $1.1 billion in venture capital funding flowing into mHealth last year, VCs will continue to back mobile health in coming years, and some of it seems likely to creep into this sector.

Now, despite its enthusiasm for this sector, the research firm does note that there are challenges holding this market back from even greater growth. These include the need for large capital investments to play this game, and the reality that some privacy and security issues around smart home healthcare haven’t been resolved yet.

That being said, even a casual glimpse at this market makes it blazingly clear that growth here is good. Off the top of my head, I can think of few trends that could save healthcare system money more effectively than keeping frail elderly folks safe and out of the hospital.

Add to that the fact that when these technologies are smart enough, they could very well spare caregivers a lot of anxiety and preserve older people’s dignity, and you have a great thing in the works. Expect to see a lot of innovation here over the next few years.

e-MDs Acquires McKesson’s Portfolio of Ambulatory EHR Software

Posted on March 10, 2016 I Written By

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

This post will likely be a little bit of inside baseball for many, but I think it’s a really important subject to cover since it’s going to impact so many practices and so many doctors. The news just came out that e-MDs was acquiring the suite of ambulatory EHR software owned by McKesson. For those keeping track at home, these are 6 of the assets acquired from McKesson: McKesson Practice Choice™, Medisoft®, Medisoft® Clinical, Lytec®, Lytec® MD, and Practice Partner®.

This shouldn’t be a surprise from a McKesson perspective. At HIMSS I heard multiple stories of people talking with McKesson staff who didn’t even know the names of their EHR software. Sad, but true. The only question for McKesson is will Paragon get sold off next?

For those that aren’t familiar with the history of e-MDs, it was purchased by Marlin Equity Partners back in March 2015 and merged with Marlin’s MDeverywhere company. Marlin then went on to acquire AdvancedMD from ADP in August of 2015 as they started to stock pile ambulatory EHR vendors. With the acquisition of the McKesson assets, Marlin now owns a large number of ambulatory EHR vendors.

This shouldn’t really be a surprise to anyone. We all knew that 300 EHR vendors wasn’t sustainable long term and we know that the EHR market has matured now that the false market meaningful use created is over. Some consolidation was bound to happen and it’s no surprise that a private equity firm is rolling up these companies as they seek to find the benefits of scale. The press release notes that the combined company’s products and services are being used by nearly 55,000 providers nationwide after this latest acquisition. That’s quite a presence in the ambulatory space.

The unfortunate downside of this type of EHR roll up is that not all of these EHR software can survive under one roof. Some of them have got to go. The only question is which one(s) will survive. Unlike EHR vendor founders, private equity companies are disconnected from the original product and so it doesn’t hurt as much for them to shut down a weaker product line as they consolidate users on to what they consider the best software. I’d be shocked if we didn’t see this happen with a number of EHR software that are now under e-MD’s (and Marlin’s) roof.

I also won’t be surprised if Marlin and e-MDs continue with more acquisitions. There are still a few hundred other ambulatory EHR vendors out there.

Practice Fusion Cuts 25% of Staff

Posted on February 4, 2016 I Written By

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

Following on our post a few weeks ago about the potential Practice Fusion IPO, news just came out that EHR vendor, Practice Fusion, has now cut its staff by 25%. The Techcrunch report says that the cuts were across the board and affected roughly 74 people. Many are suggesting that the two reports are related since cutting staff is a great way to improve your profit numbers before an anticipated IPO.

While I think the IPO could be in mind, I think there are likely some other trends at play too. While Techcrunch notes that it’s a down market for many IT companies, I think it’s fair to say that many EHR vendors have felt the pinch of late. I wrote a year or so ago that the golden era of government incentivized EHR sales was over and we’re entering a much different market. So, it shouldn’t be a surprise that an EHR vendor might go through some cuts as the false market created by meaningful use disappears. I won’t be surprised to see more layoffs from other EHR vendors. Especially ambulatory EHR vendors like Practice Fusion.

No doubt another factor at play is that Tom Langan replaced Ryan Howard as CEO back in August. It’s very common for a new CEO to go through a round of layoffs after taking over a business. Doing so is hard for the previous CEO who’s so connected to the staff. Not that layoffs are ever easy, but it’s much easier for a new CEO to layoff people in order to make the organization more efficient. That’s particularly true when the previous CEO was the original CEO and Founder of the company.

The cynical observer could also argue that Practice Fusion needed to do these layoffs in order to slow their burn rate since they aren’t in a position to raise more capital. You’d think the $150 million they already raised would give them plenty of run way. However, you’d be surprised how quickly that disappears with that many staff on payroll (Not to mention rents in San Francisco). I personally don’t think this is a case of Practice Fusion cutting staff because they can’t go and raise money. However, it could be Practice Fusion cutting its burn rate so that they have some flexibility on when they go public without having to raise more money.

All of this said, 74 people lost their jobs at an EHR vendor. That’s never fun for anyone involved. At least they’ll likely have plenty of job opportunities in silicon valley. Unless that bubble pops like some are suggesting. It will be interesting to see how many now former Practice Fusion employees search for another job in health care IT.

Will New Group Steal Thunder From CommonWell Health Alliance?

Posted on January 26, 2016 I Written By

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

Back in March 0f 2013, six health IT vendors came together to announce the launch of the CommonWell Health Alliance. The group, which included Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth, said they were forming the not-for-profit organization to foster national health data interoperability. (Being a cynical type, I immediately put it in a mental file tagged “The Group Epic Refused To Join,” but maybe that wasn’t fair since it looks like the other EHR vendors might have left Epic out on purpose.)

Looked at from some perspectives, the initiative has been a success. Over the past couple of years or so, CommonWell developed service specifications for interoperability and deployed a national network for health data sharing. The group has also attracted nearly three dozen HIT companies as members, with capabilities extending well beyond EMRs.

And according to recently-appointed executive director Jitin Asnaani, CommonWell is poised to have more than 5,000 provider sites using its services across the U.S. That will include more than 1,200 of Cerner’s provider sites. Also, Greenway Health and McKesson provider sites should be able to share health data with other CommonWell participants.

While all of this sounds promising, it’s not as though we’ve seen a great leap in interoperability for most providers. This is probably why new interoperability-focused initiatives have emerged. Just last week, five major HIT players announced that they would be the first to implement the Carequality Interoperability Framework.

The five vendors include, notably, Epic, along with athenahealth, eClinicalWorks, NextGen Healthcare and Surescripts. While the Carequality team might not be couching things this way, to me it seems likely that it intends to roll on past (if not over) the CommonWell effort.

Carequality is an initiative of The Sequoia Project, a DC-area non-profit. While it shares CommonWell’s general mission in fostering nationwide health information exchange, that’s where its similarities to CommonWell appear to end:

* Unlike CommonWell, which is almost entirely vendor-focused, Sequoia’s members also include the AMA, Kaiser Permanente, Minute Clinic, Walgreens and Surescripts.

* The Carequality Interoperability Framework includes not only technical specifications for achieving interoperability, but also legal and governance documents helping implementers set up data sharing in legally-appropriate ways between themselves and patients.

* The Framework is designed to allow providers, payers and other health organizations to integrate pre-existing connectivity efforts such as previously-implemented HIEs.

I don’t know whether the Carequality effort is complimentary to CommonWell or an attempt to eclipse it. It’s hard for me to tell whether the presence of a vendor on both membership lists (athenahealth) is an attempt to learn from both sides or a preparation for jumping ship. In other words, I’m not sure whether this is a “game changer,” as one health IT trade pub put it, or just more buzz around interoperability.

But if I were a betting woman, I’d stake hard, cold dollars that Carequality is destined to pick up the torch CommonWell lit. That being said, I do hope the two cooperate or even merge, as I’m sure the very smart people associated with these efforts can learn from each other. If they fight for mindshare, it’d be a major waste of time and talent.

Significant Articles in the Health IT Community in 2015

Posted on December 15, 2015 I Written By

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

Have you kept current with changes in device connectivity, Meaningful Use, analytics in healthcare, and other health IT topics during 2015? Here are some of the articles I find significant that came out over the past year.

The year kicked off with an ominous poll about Stage 2 Meaningful Use, with implications that came to a head later with the release of Stage 3 requirements. Out of 1800 physicians polled around the beginning of the year, more than half were throwing in the towel–they were not even going to try to qualify for Stage 2 payments. Negotiations over Stage 3 of Meaningful Use were intense and fierce. A January 2015 letter from medical associations to ONC asked for more certainty around testing and certification, and mentioned the need for better data exchange (which the health field likes to call interoperability) in the C-CDA, the most popular document exchange format.

A number of expert panels asked ONC to cut back on some requirements, including public health measures and patient view-download-transmit. One major industry group asked for a delay of Stage 3 till 2019, essentially tolerating a lack of communication among EHRs. The final rules, absurdly described as a simplification, backed down on nothing from patient data access to quality measure reporting. Beth Israel CIO John Halamka–who has shuttled back and forth between his Massachusetts home and Washington, DC to advise ONC on how to achieve health IT reform–took aim at Meaningful Use and several other federal initiatives.

Another harbinger of emerging issues in health IT came in January with a speech about privacy risks in connected devices by the head of the Federal Trade Commission (not an organization we hear from often in the health IT space). The FTC is concerned about the security of recent trends in what industry analysts like to call the Internet of Things, and medical devices rank high in these risks. The speech was a lead-up to a major report issued by the FTC on protecting devices in the Internet of Things. Articles in WIRED and Bloomberg described serious security flaws. In August, John Halamka wrote own warning about medical devices, which have not yet started taking security really seriously. Smart watches are just as vulnerable as other devices.

Because so much medical innovation is happening in fast-moving software, and low-budget developers are hankering for quick and cheap ways to release their applications, in February, the FDA started to chip away at its bureaucratic gamut by releasing guidelines releasing developers from FDA regulation medical apps without impacts on treatment and apps used just to transfer data or do similarly non-transformative operations. They also released a rule for unique IDs on medical devices, a long-overdue measure that helps hospitals and researchers integrate devices into monitoring systems. Without clear and unambiguous IDs, one cannot trace which safety problems are associated with which devices. Other forms of automation may also now become possible. In September, the FDA announced a public advisory committee on devices.

Another FDA decision with a potential long-range impact was allowing 23andMe to market its genetic testing to consumers.

The Department of Health and Human Services has taken on exceedingly ambitious goals during 2015. In addition to the daunting Stage 3 of Meaningful Use, they announced a substantial increase in the use of fee-for-value, although they would still leave half of providers on the old system of doling out individual payments for individual procedures. In December, National Coordinator Karen DeSalvo announced that Health Information Exchanges (which limit themselves only to a small geographic area, or sometimes one state) would be able to exchange data throughout the country within one year. Observers immediately pointed out that the state of interoperability is not ready for this transition (and they could well have added the need for better analytics as well). HHS’s five-year plan includes the use of patient-generated and non-clinical data.

The poor state of interoperability was highlighted in an article about fees charged by EHR vendors just for setting up a connection and for each data transfer.

In the perennial search for why doctors are not exchanging patient information, attention has turned to rumors of deliberate information blocking. It’s a difficult accusation to pin down. Is information blocked by health care providers or by vendors? Does charging a fee, refusing to support a particular form of information exchange, or using a unique data format constitute information blocking? On the positive side, unnecessary imaging procedures can be reduced through information exchange.

Accountable Care Organizations are also having trouble, both because they are information-poor and because the CMS version of fee-for-value is too timid, along with other financial blows and perhaps an inability to retain patients. An August article analyzed the positives and negatives in a CMS announcement. On a large scale, fee-for-value may work. But a key component of improvement in chronic conditions is behavioral health which EHRs are also unsuited for.

Pricing and consumer choice have become a major battleground in the current health insurance business. The steep rise in health insurance deductibles and copays has been justified (somewhat retroactively) by claiming that patients should have more responsibility to control health care costs. But the reality of health care shopping points in the other direction. A report card on state price transparency laws found the situation “bleak.” Another article shows that efforts to list prices are hampered by interoperability and other problems. One personal account of a billing disaster shows the state of price transparency today, and may be dangerous to read because it could trigger traumatic memories of your own interactions with health providers and insurers. Narrow and confusing insurance networks as well as fragmented delivery of services hamper doctor shopping. You may go to a doctor who your insurance plan assures you is in their network, only to be charged outrageous out-of-network costs. Tools are often out of date overly simplistic.

In regard to the quality ratings that are supposed to allow intelligent choices to patients, A study found that four hospital rating sites have very different ratings for the same hospitals. The criteria used to rate them is inconsistent. Quality measures provided by government databases are marred by incorrect data. The American Medical Association, always disturbed by public ratings of doctors for obvious reasons, recently complained of incorrect numbers from the Centers for Medicare & Medicaid Services. In July, the ProPublica site offered a search service called the Surgeon Scorecard. One article summarized the many positive and negative reactions. The New England Journal of Medicine has called ratings of surgeons unreliable.

2015 was the year of the intensely watched Department of Defense upgrade to its health care system. One long article offered an in-depth examination of DoD options and their implications for the evolution of health care. Another article promoted the advantages of open-source VistA, an argument that was not persuasive enough for the DoD. Still, openness was one of the criteria sought by the DoD.

The remote delivery of information, monitoring, and treatment (which goes by the quaint term “telemedicine”) has been the subject of much discussion. Those concerned with this development can follow the links in a summary article to see the various positions of major industry players. One advocate of patient empowerment interviewed doctors to find that, contrary to common fears, they can offer email access to patients without becoming overwhelmed. In fact, they think it leads to better outcomes. (However, it still isn’t reimbursed.)

Laws permitting reimbursement for telemedicine continued to spread among the states. But a major battle shaped up around a ruling in Texas that doctors have a pre-existing face-to-face meeting with any patient whom they want to treat remotely. The spread of telemedicine depends also on reform of state licensing laws to permit practices across state lines.

Much wailing and tears welled up over the required transition from ICD-9 to ICD-10. The AMA, with some good arguments, suggested just waiting for ICD-11. But the transition cost much less than anticipated, making ICD-10 much less of a hot button, although it may be harmful to diagnosis.

Formal studies of EHR strengths and weaknesses are rare, so I’ll mention this survey finding that EHRs aid with public health but are ungainly for the sophisticated uses required for long-term, accountable patient care. Meanwhile, half of hospitals surveyed are unhappy with their EHRs’ usability and functionality and doctors are increasingly frustrated with EHRs. Nurses complained about technologies’s time demands and the eternal lack of interoperability. A HIMSS survey turned up somewhat more postive feelings.

EHRs are also expensive enough to hurt hospital balance sheets and force them to forgo other important expenditures.

Electronic health records also took a hit from ONC’s Sentinel Events program. To err, it seems, is not only human but now computer-aided. A Sentinel Event Alert indicated that more errors in health IT products should be reported, claiming that many go unreported because patient harm was avoided. The FDA started checking self-reported problems on PatientsLikeMe for adverse drug events.

The ONC reported gains in patient ability to view, download, and transmit their health information online, but found patient portals still limited. Although one article praised patient portals by Epic, Allscripts, and NextGen, an overview of studies found that patient portals are disappointing, partly because elderly patients have trouble with them. A literature review highlighted where patient portals fall short. In contrast, giving patients full access to doctors’ notes increases compliance and reduces errors. HHS’s Office of Civil Rights released rules underlining patients’ rights to access their data.

While we’re wallowing in downers, review a study questioning the value of patient-centered medical homes.

Reuters published a warning about employee wellness programs, which are nowhere near as fair or accurate as they claim to be. They are turning into just another expression of unequal power between employer and employee, with tendencies to punish sick people.

An interesting article questioned the industry narrative about the medical device tax in the Affordable Care Act, saying that the industry is expanding robustly in the face of the tax. However, this tax is still a hot political issue.

Does anyone remember that Republican congressmen published an alternative health care reform plan to replace the ACA? An analysis finds both good and bad points in its approach to mandates, malpractice, and insurance coverage.

Early reports on use of Apple’s open ResearchKit suggested problems with selection bias and diversity.

An in-depth look at the use of devices to enhance mental activity examined where they might be useful or harmful.

A major genetic data mining effort by pharma companies and Britain’s National Health Service was announced. The FDA announced a site called precisionFDA for sharing resources related to genetic testing. A recent site invites people to upload health and fitness data to support research.

As data becomes more liquid and is collected by more entities, patient privacy suffers. An analysis of web sites turned up shocking practices in , even at supposedly reputable sites like WebMD. Lax security in health care networks was addressed in a Forbes article.

Of minor interest to health IT workers, but eagerly awaited by doctors, was Congress’s “doc fix” to Medicare’s sustainable growth rate formula. The bill did contain additional clauses that were called significant by a number of observers, including former National Coordinator Farzad Mostashari no less, for opening up new initiatives in interoperability, telehealth, patient monitoring, and especially fee-for-value.

Connected health took a step forward when CMS issued reimbursement guidelines for patient monitoring in the community.

A wonky but important dispute concerned whether self-insured employers should be required to report public health measures, because public health by definition needs to draw information from as wide a population as possible.

Data breaches always make lurid news, sometimes under surprising circumstances, and not always caused by health care providers. The 2015 security news was dominated by a massive breach at the Anthem health insurer.

Along with great fanfare in Scientific American for “precision medicine,” another Scientific American article covered its privacy risks.

A blog posting promoted early and intensive interactions with end users during app design.

A study found that HIT implementations hamper clinicians, but could not identify the reasons.

Natural language processing was praised for its potential for simplifying data entry, and to discover useful side effects and treatment issues.

CVS’s refusal to stock tobacco products was called “a major sea-change for public health” and part of a general trend of pharmacies toward whole care of the patient.

A long interview with FHIR leader Grahame Grieve described the progress of the project, and its the need for clinicians to take data exchange seriously. A quiet milestone was reached in October with a a production version from Cerner.

Given the frequent invocation of Uber (even more than the Cheesecake Factory) as a model for health IT innovation, it’s worth seeing the reasons that model is inapplicable.

A number of hot new sensors and devices were announced, including a tiny sensor from Intel, a device from Google to measure blood sugar and another for multiple vital signs, enhancements to Microsoft products, a temperature monitor for babies, a headset for detecting epilepsy, cheap cameras from New Zealand and MIT for doing retinal scans, a smart phone app for recognizing respiratory illnesses, a smart-phone connected device for detecting brain injuries and one for detecting cancer, a sleep-tracking ring, bed sensors, ultrasound-guided needle placement, a device for detecting pneumonia, and a pill that can track heartbeats.

The medical field isn’t making extensive use yet of data collection and analysis–or uses analytics for financial gain rather than patient care–the potential is demonstrated by many isolated success stories, including one from Johns Hopkins study using 25 patient measures to study sepsis and another from an Ontario hospital. In an intriguing peek at our possible future, IBM Watson has started to integrate patient data with its base of clinical research studies.

Frustrated enough with 2015? To end on an upbeat note, envision a future made bright by predictive analytics.

Ways to Not Rank EHR Vendors

Posted on September 16, 2015 I Written By

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

One of my pet peeves is organizations that put out rankings for EHR vendors that are based on really low quality factors and metrics. I’ve put a graphic I recently found at the bottom of this post. The graphic uses user adoption level, search traffic, and social media presence to rank “The 10 Most Popular EHR Products.” Yes, the image is at the bottom of the post, because I don’t think you should pay much attention to the ranking. Let’s talk about why.

First, I’ll give credit to them for putting their factors in the graphic itself. Many organizations that put out these rankings don’t even share their methodology for ranking EHR vendors. Although, this compliment falls flat on the first factor: user adoption level.

EHR User Adoption Level
They obtained this ranking and score from a survey of software users. Of course, they don’t say anything about how this survey sample was collected, how they selected who participated in the survey, etc. Long story short, I can think of probably 1000 ways that this sample is going to be biased. There are literally 300 EHR vendors out there. I need to consult my statistician friends, but I can’t imagine the random sample you’d need to get in order to estimate the users of 300 EHR vendors. Plus, there are so many ways to bias this sample based on region, hospital EHR or ambulatory EHR, hospital size, practice size, specialty, etc etc etc.

I also am not sure what they consider “regular users” of the system. Does that mean my 5 front desk staff count as well or is it just providers? Plus, if you look at the scores for the vendors taht are listed, Cerner and Meditech should be much higher when it comes to user adoption level. In fact, it’s possible they have more users than Epic which has the highest ranking possible for user adoption level.

I do think that user adoption level is an ok way to rank EHR vendors. The fact that many healthcare organizations have spent a bunch of money on an EHR vendor is one sign of an EHR vendors popularity and it’s worth considering what’s popular when evaluating software of any kind (including EHR software). However, does anyone have a really good way of analyzing how many users an EHR vendor has? The closest I’ve seen is meaningful use attestation data and it has its weaknesses. Long story short, I’m not buying the user adoption level rankings below.

EHR Search Traffic
Google has a great tool where you can compare search traffic for various keywords. I’ve used it before to compare the popularity of terms like EMR and EHR (They’re about even with EMR still ahead). While this tool is cool and very interesting, is that how you determine how popular an EHR vendor is? What if that EHR vendor has had some major security breaches and everyone is searching their name to find out about the breaches? That seems to be a sign that the EHR vendor is popular, but not for good reasons. Plus, how do you know when someone is searching for the Epic EHR versus Epic the movie and a few million variations of the word epic? Not to mention, if you have Jonathan Bush as your CEO, you’re going to get more searches than other EHR vendors just because of his vibrant personality (was that the politically correct way to describe it?).

Long story short, search traffic is an awful measure to use when ranking EHR vendors. I know some really amazing EHR software that have very little search traffic. I don’t think that’s a bad thing. They’ve focused on creating great software, partnering with doctors, and creating direct relationships with their users. Their search traffic certainly won’t reflect that piece of the puzzle.

EHR Social Media Presence
What’s in a like or follow? Yes, those are the factors the graphic below used to evaluate EHR vendors social media presence. They do weigh this factor less than the others. Does a like or follow on Twitter, LinkedIn or Facebook mean you’re popular? Do you know how easy it is to buy followers if you want to look like you have a lot of followers? $5 per 1000 followers is easy to get. Plus, these counts don’t matter as much as which people are following you and how engaged they are with you on social media. That matters a lot more than follower counts.

I don’t want to totally discredit an EHR vendors involvement in social media. That might be a sign that the company stays up to date and involved with the latest technology changes. It might mean that they’re engaged with and interested in their customers. Then again, it might not. Many EHR vendors just use it as a way to broadcast their company and not actually engage with people. Some EHR vendors don’t even participate in social media at all. That’s not an evil thing, but it might be worth investigating more and seeing if their lack of involvement in technology is seen in other aspects of their product offering.

So while I see value in evaluating an EHR vendor’s social presence, you can’t evaluate and rank it based on likes and followers. A much more complicated assessment is needed.

I understand that many organizations are grabbing hold of any means to differentiate the 300+ EHR vendors out there. It’s certainly a challenge I know first hand. However, I hope that healthcare organizations don’t get led astray by poorly done rankings like the graphic below. There’s always more to the story. If EHR rankings were easy, I would have done them myself a long time ago.

Top 10 Most Popular EHR Vendor Infographic

Accenture: “Zombie” Digital Health Startups Won’t Die In Vain

Posted on August 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 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.

I don’t know about you, but I’ve been screaming for a while about how VCs are blowing their money on questionable digital health ventures. To my mind, their investment patterns suggest that the smart money really isn’t that smart. I admit that sorting out what works in digital health/mHealth/connected health is very challenging, but it’s far from impossible if you immerse yourself in the industry. And given how much difference carefully-thought out digital health tools can make, it’s exasperating to watch failing digital health startups burn through money.

That being said, maybe all of those dollars won’t be wasted. According to no less an eminence grise than Accenture, failing digital health ventures will feed the stronger ones and make their success more likely. A new report from Accenture predicts that these “zombie” startups — half of which will die within two years, it says — will provide talent and technology to their surviving rivals. (OK, I agree, the zombie image is a bit unsettling, isn’t it?)

To bring us their horror movie metaphor, Accenture analyzed the status of 900 healthcare IT startups, concluding that 51% were likely to collapse within 20 months.  The study looked at ventures cutting across social, mobile, analytics, cloud and sensors technologies, which include wearables, telehealth and remote monitoring.

While most researchers try to predict who the winners will be in a given market, Accenture had a few words to say about the zombie also-rans. And what they found was that the zombies have taken in enough cash to have done some useful things, collecting nearly $4 billion in funding between 2008 and 2013.

The investments are part of an ongoing funding trend. In fact, digital health dollars are likely to pour in over the next two years as well, with healthcare IT startups poised to take in $2.5 billion more over the next two years, Accenture estimates. Funding should focus on four segments, including engagement (25%), treatment (25%), diagnosis (21%) and infrastructure (29%), the study found.

So what use are the dying companies that will soon litter the digital health landscape? According to Accenture, more-successful firms can reap big benefits by acquiring the failing startups. For example, healthcare players can do “acqui-hiring” deals with struggling digital health startups to pick up a deep bench of qualified tech staffers. They can pick up unique technologies (the 900 firms analyzed, collectively, had 1,700 patents). And acquiring firms can harvest the startups’ technology to improve their products and services lineups.

Not only that — and this is Anne, not Accenture talking — acquiring healthcare firms get a wonderful infusion of entrepreneurial energy, regardless of whether the acquired firm was booking big bucks or not. And I speak from long experience. I’ve known the leaders of countless tech startups, and there’s very little difference between those who make a gazillion dollars and those whose ventures die. Generally speaking, anyone who makes a tech startup work for even a year or two is incredibly insightful, creative, and extremely dedicated, and they bring a kind of excitement to any company that hires them.

So, backed by the corporate wisdom of Accenture, I’ve come to praise zombies, not to bury them. While they may give their corporate lives, their visions won’t be wasted. With any luck, the next generation of digital health companies will appreciate the zombies’ hard work and initiative, even if they’re no longer with us.

Are EMRs Getting Worse Or Doctors Getting Smarter?

Posted on August 20, 2015 I Written By

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

I know it sounds crazy — it’s hard to imagine doctors being more annoyed with EMRs than they already are — but according to one study that’s just what’s happening.

A newly-published study by the American Medical Association and the American College of Physicians’ AmericanEHR division suggests that doctors like the current crop of EMRs less than ever.

About half of study respondents said that their EMR was having a negative impact on costs, efficiency or productivity, the groups reported. Only 22% said they were satisfied with their EMR, and a scant 12% said they were “very satisfied.”

Doctors’ happiness with their EMRs has dropped substantially since five years ago, when 39% reported being satisfied and 22% said they were very satisfied, according to a prior study by AmericanEHR.  In other words, nearly 4 out of 10 doctors surveyed seem to have been content with what they had. But conditions have clearly changed.

The reasons for this are unlikely to be the result of mere peevishness. After all, with EMRs being a reality of doing business today, it seems unlikely that physicians would simply revert into sulking. Actually, my own unofficial survey — of several docs I’ve actually seen as a patient — suggests that most have gone through their stages of grief and decided that EMRs aren’t unholy. (My PCP said it best: “You get used to them, then they’re not so bad.”)

Instead, I’d argue, something good is actually happening, though it may not look that way on the surface. Having adapted to the need to use EMRs, physicians are engaging with them deeply, and beginning to expect more from them than a kludgy interface slapped on a slow database can provide.

Some are actually proposing that EMRs go beyond traditional medical record paradigm, something I see as an exciting development. For example, Dr. Arlen Meyers, CEO of the Society of Physician Entrepreneurs, argues that it’s time to “unbundle and re-engineer the care processes model” by introducing new templates into EMRs. In fact, he’s a fan of rethinking the hallowed SOAP (symptoms, objective findings, assessment and plan) approach to patient notes:

Given how things are changing, it might be time to give the pink slip to SOAP. The main problems are that 1) the model does not prioritize information by levels of urgency, 2) it does not provide decision support when it comes to how one disease affects the other or how one medicine affects another, and 3) it does not add efficiencies to taking care of increasingly complex patients.

And Meyers is not the only one. In fact, a recent paper published in JAMA Internal Medicine suggests that a new format flipping the elements of the SOAP note and reordering them as APSO (assessment, plan, subjective, objective) works well in the EMR age.

According to a 2010 study detailed in the paper, APSO notes were fairly successful at the University of Colorado ambulatory clinics. The study, which looked at APSO use in 13 clinics, found that 73% of participants were “satisfied” or “very satisfied” with the new format, and 75% “preferred” or “strongly preferred” reading APSO notes.

I’m betting that physicians will only be satisfied with EMRs again when EMRs are reshaped to embrace new ways of working. Since new workflow demands are generated by using EMRs, in turn, this cycle may never end. But that’s a good thing. If physicians are engaged enough with their EMRs to propose new ways of working, it will benefit everyone.

Specialty Specific EHR

Posted on June 29, 2015 I Written By

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

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.

EMRs Should Include Telemedicine Capabilities

Posted on May 22, 2015 I Written By

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

The volume of telemedicine visits is growing at a staggering pace, and they seem to have nowhere to go but up. In fact, a study released by Deloitte last August predicted that there would be 75 million virtual visits in 2014 and that there was room for 300 million visits a year going forward.

These telemedicine visits are generating a flood of medical data, some in familiar text formats and some in voice and video form. But since the entire encounter takes place outside of any EMR environment, huge volumes of such data are being left on the table.

Given the growing importance of telemedicine, the time has come for telemedicine providers to begin integrating virtual visit results into EMRs.  This might involve adopting specialized EMRs designed to capture video and voice, or EMR vendors might go with the times and develop ways of categorizing and integrating the full spectrum of telemedical contacts.

And as virtual visit data becomes increasingly important, providers and health plans will begin to demand that they get copies of telemedical encounter data.  It may not be clear yet how a provider or payer can effectively leverage video or voice content, which they’ve never had to do before, but if enough care is taking place in virtual environments they’ll have to figure out how to do so.

Ultimately, both enterprise and ambulatory EMRs will include technology allowing providers to search video, voice and text records from virtual consults.  These newest-gen EMRs may include software which can identify critical words spoken during a telemedical visit, such as “pain,” or “chest” which could be correlated with specific conditions.

It may be years before data gathered during virtual visits will stand on equal footing with traditional text-based EMR data and digital laboratory results.  As things stand today, telemedicine consults are used as a cheaper form of urgent care, and like an urgent care visit, the results are not usually considered a critical part of the patient’s long-term history.

But the more time patients spend getting their treatment from digital doctors on a screen, the more important the mass of medical data generated becomes. Now is the time to develop data structures and tools allowing clinicians and facilities to mine virtual visit data.  We’re entering a new era of medicine, one in which patients get better even when they can’t make it to a doctor’s office, so it’s critical that we develop the tools to learn from such encounters.