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New Research Identifies Game-Changing Uses For AI In Healthcare

Posted on June 27, 2017 I Written By

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

In recent times, the use of artificial intelligence technology in healthcare has been a very hot topic. However, while we’ve come tantalizingly close to realizing its promise, no application that I know of has come close to transforming the industry. Moreover, as John Lynn notes, healthcare organizations will not get as much out of AI use if they are not doing a good job of working with both structured and unstructured data.

That being said, new research by Accenture suggests that those of us dismissing AI tech as immature may be behind the curve. Researchers there have concluded that when combined, key clinical health AI applications could save the US healthcare economy as much $150 billion by 2026.

Before considering the stats in this report, we should bear Accenture’s definition of healthcare AI in mind:

“AI in health presents a collection of multiple technologies enabling machines to sense, comprehend, act and learn, so they can perform administrative and clinical healthcare functions…Unlike legacy technologies that are only algorithms/tools that complement a human, health AI today can truly augment human activity.”

In other words, the consulting firm sees AI as far more than a data analytics tool. Accenture analysts envision an AI ecosystem that transforms and serves as an adjunct to the many healthcare processes. That’s a pretty ambitious take, though probably not a crazy one.

In its new report, Accenture projects that the AI health market will reach $6.6 billion by 2021, up from $600 million in 2014, fueled by the growing number of health AI acquisitions taking place. The report notes that the number of such deals has leapt from less than 20 in the year 2012 to nearly 70 by mid-2016.

Researchers predict that the following applications will generate the projected $150 billion in savings/value:

  • Robot-assisted surgery: $40 billion
  • Virtual nursing assistants: $20 billion
  • Administrative workflow assistance: $18 billion
  • Fraud detection: $17 billion
  • Dosage error reduction: $16 billion
  • Connected machines: $14 billion
  • Clinical trial participant identifier: $13 billion
  • Preliminary diagnosis: $5 billion
  • Automated image diagnosis: $3 billion
  • Cybersecurity: $2 billion

There are a lot of interesting things about this list, which goes well beyond current hot topics like the use of AI-driven chatbots.

One that stands out to me is that two of the 10 applications address security concerns, an approach which makes sense but hadn’t turned up in my research on the topic until now.

I was also intrigued to see robot-assisted surgery topping the list of high-impact health AI options. Though I’m familiar with assistive technologies like the da Vinci robot, it hadn’t occurred to me that such tools could benefit from automation and data integration.

I love the picture Accenture paints of how this might work:

“Cognitive robotics can integrate information from pre-op medical records with real-time operating metrics to physically guide and enhance the physician’s instrument precision…The technology incorporates data from actual surgical experiences to inform new, improved techniques and insights.”

When implemented properly, robot-assisted surgery will generate a 21% reduction in length of hospital stays, the researchers estimate.

Of course, even the wise thinkers at Accenture aren’t always right. Nonetheless, the broad trends report identifies seem like reasonable choices. What do you think?

And by all means check out the report – it’s short, well-argued and useful.

2018 QPP Proposed Rule: What it Means for MIPS & Quantifying the Impact on Specialty Practices – MACRA Monday

Posted on June 26, 2017 I Written By

The following is a guest blog post by Justin Barnes, Board Advisor at iHealth Innovations. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

The Centers for Medicare and Medicaid Services (CMS) recently released a Proposed Rule highlighting recommended updates to the 2018 reporting period of the Quality Payment Program (QPP). Like flexibilities extended in 2017, the proposal seeks to further reduce reporting burdens on small practices and rural providers in the program’s second-year reporting period.

Merit-based Incentive Payment System (MIPS) reporting track updates include:

  • Increased low-volume exemption thresholds (<200 patients or <$90,000 in payments)
  • New virtual group options for solo practitioners and groups with 10 or fewer Eligible Clinicians
  • Extending “pick your pace” flexibilities into 2018
  • Postponing introduction of the Cost category to MIPS composite scores
  • Factoring MIPS performance improvements into quality scores
  • Permissions for facility-based providers to report through the facility where they do most of their work instead of the practice
  • Permitting the use of 2014 CEHRT in 2018 reporting

The Rule introduces new MIPS bonus point opportunities for:

  • The use of 2015 CEHRT
  • The care of complex patients

Recommendations also extend small practice relief including:

  • Up to 5 bonus points for practices with 15 or fewer Eligible Clinicians
  • Hardship exemption for Advancing Care Information category measures
  • Additional points on Quality measures that don’t meet completeness requirements

Comments on the Proposed Rule are due by August 21, 2017. Physicians have until October 2, 2017, to begin collecting performance data for the inaugural 2017 MIPS reporting period.

Calculating MIPS: The Financial Impact on Specialty Practices

Results from a crowdsourced survey fielded by Black Book Research among nearly 9,000 physician practices from February through April of 2017 reveal that 94 percent of physician participants were unaware or unsure of how to predict their 2017 MIPS performance scores. Seventy-seven percent of practices with three or more clinicians reported intentions to purchase MIPS compliance technology solutions by the fourth quarter of this year, largely driven by an inability to independently determine earning potential under MACRA.

Orthopedics, cardiology and radiology are among the highest incentivized specialties under MIPS. To help specialty practices quantify the fiscal impact MIPS poses, we evaluated average Medicare earnings by specialty to establish the MIPS calculations below. These estimates are based on bare minimum earnings and losses that could be greater for practices with larger Medicare patient populations and/or more physicians. (Calculations are strictly illustrative estimates.)

Cardiology Practices
Estimated average payment adjustment for a 5-clinician cardiology practice in 2019 alone: $43,601
Number of cardiology-specific QPP measures: 20

Orthopedics Practices
Estimated average payment adjustment for a 6-clinician orthopedics practice in 2019 alone: $34,603
Number of orthopedics-specific QPP measures: 21

Radiology Practices
Estimated average payment adjustment for a 6-clinician radiology practice in 2019 alone: $30,117
Number of radiology-specific QPP measures: 22

Note: The above projections assume the full incentive and penalty will be paid out as outlined in the MACRA law. However, the positive and negative payment adjustments will be scaled so the program is budget neutral. This means that the positive payment adjustments will have to be offset by penalties.

Navigating the Transition to MIPS
As clinicians prepare for reporting under MIPS, establishing specialty-specific expertise on financial, clinical and technical objectives can help practices thrive rather than just survive.

Tips as you for prepare for MIPS:

  • Know your reporting options and pick your path.
  • Choose measures that play to the strengths of your specific specialty practice. Review your current billing codes and Quality and Resource Use Report to help determine these areas.
  • Do a technology asset inventory to make sure you can track the required CQMs.
  • Customize your EHR for track your selected measures or ID an outsource vendor to assist.
  • Work towards minimum reporting requirements to avoid a penalty with a stretch goal to report on the full required measures to maximize positive adjustment earnings potential.

Additional resources:
QPP website
An overview and support documentation is available at the CMS QPP website here.

MIPS EDU Program
A new “Quality Payment Program in 2017: Pick Your Pace Web-Based Training” course with Continuing Education Credit is available through the Learning Management System. Learn more here.

2017 CMS-Approved Qualified Clinical Data Registries
Additional specialty-specific measures are available via approved 2017 QCDRs to meet MIPS reporting requirements. Options for cardiology, radiology and orthopedic practices are included. Learn more here.

About the Author:
Justin Barnes is a nationally recognized business and policy advisor who serves as Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. As Board Advisor with iHealth, Justin assists providers with optimizing revenue sources and transitioning to value-based payment and care delivery models. Justin has formally addressed Congress and the last three Presidential Administrations on more than twenty occasions on the topics of MACRA, value-based medicine, accountable care, interoperability, consumerism and more. He is also host of the weekly syndicated radio show “This Just In.” Justin can be found on Twitter at @HITAdvisor.

Is Your Health Data Unstructured? – Enabling an AI Powered Healthcare Future

Posted on June 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.

If you asked a hospital IT executive how much of their data is unstructured data, most of them would reasonably respond that a lot or most of their data was unstructured. If you asked a practice manager or doctor how much of health data is unstructured, they’d likely respond “What do you mean?”

The reality is that most doctors, nurses, practice managers, etc don’t really care if their data is structured data or not. However, they should care about it and more importantly they should care about how they’re going to extract value out of the structured and unstructured data in their organizations.

The reality in healthcare, as the above tweet and image point out, is that much of the data we have and are going to get is going to be unstructured data. Our systems and software need to handle unstructured data in order to facilitate the AI powered healthcare future. That’s right. An AI powered healthcare future is coming and it’s going to be built on the back of structured and unstructured healthcare data.

I think the reason so many healthcare providers are concerned with this AI powered future is that they know the data they currently have is not very good. That’s going to be a problem for many organizations. Bad data is going to produce bad AI powered support.

We shouldn’t expect technology to solve our problems of bad data but, technology will amplify the state of your organization. If your organization is doing an amazing job creating high quality health data, then the AI powered future will propel you in amazing ways to be an even better organization. However, the opposite is also true. If your health data is poor, then these new AI powered systems are going to highlight how poorly your organization is being run. I get why that’s scary for many people.

This should be one of the big lessons we take away from the EHR experience. Healthcare organizations with poor workflows hoped that implementation of an EHR would help them fix their workflows. Instead of EHR fixing the workflows it just highlighted the poor workflows. Technology accentuates and accelerates your current state. It doesn’t usually fix it. You have to fix your organization and workflows first and then use technology to accelerate your organization.

The next step after that is what Rasu Shrestha highlighted when he said, “How can we move from ‘doing digital’ to ‘being digital’. Let’s not replicate analog workflows. Let’s rethink!”

5 Stages of Provider Dissatisfaction and Happiness

Posted on June 21, 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.

A couple weeks ago I posted an infographic on the 5 stages of patient frustration and the 5 stages of patient satisfaction. This week SCI Solutions came out with a new infographic which looks at the 5 stages of provider dissatisfaction and the 5 stages of provider happiness.

It was interesting that the infographic focused so much on the pains of prior auths. I agree that this is extremely painful for doctors and definitely leads to a lot of dissatisfaction. However, I’m surprised that they didn’t include the EHR and other regulations related to the EHR in their list of provider dissatisfaction. I’m sure EHR and prior auths would fight a good fight as to which is more annoying to doctors.

As for the provider satisfaction, the infographic focused so much on easy access to the right information. I agree that’s a valuable thing, but the most valuable thing is doctors getting quality time that helps their patients. We need to facilitate more of that in healthcare.

A Tribute to Larry Weed

Posted on June 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.

I must admit that I didn’t really know about Larry Weed until in 2013 I saw Neil Versel interviewing him at HIMSS. I’d been getting to know Neil Versel pretty well at this point and I saw him hit the press room full of energy and totally engaged with a man who was 89 years of age. I was new to the press room then, but I now know well the look Neil gets when he has a good interview. It’s how he looked at HIMSS 2013 when I saw him interviewing the 89 year old Larry Weed.

After the interview, I was talking with Neil and he recounted to me that he’d just been able to interview Larry Weed. I could tell that this was a real highlight for him and that he was honored by the opportunity. This month, Larry Weed passed away and Neil Versel offered up this great tribute to Larry Weed’s work.

I love this Larry Weed quote that Neil shared in his tribute:

“The worst, the most corrupting of all lies is to misstate the problem. Patients get run off into the most unbelievable, expensive procedures … and they’re not even on the right problem,” Weed said during that memorable presentation in New Orleans.

“We all live in our own little cave. We see the world out of our own little cave, and no two of us see it the same way,” he continued, explaining the wide deviation from standards of care. “What you see is a function of who you are.”

We should all take a week or so to think about the most corrupting lie of misstating the problem and how our own experiences corrupt our views.

I also didn’t know that Larry Weed was possibly one fo the founding father’s of patient empowerment. As Neil notes:

Indeed, it could be argued that Weed was a founding father of patient empowerment. Back in 1969, Weed wrote a book called “Medical Records, Medical Education, and Patient Care.” In that, he said, “patients are the largest untapped resource in medical care today.”

Larry Weed also co-developed an early EMR and the SOAP note was his idea.

I often don’t think that those of us who take healthcare IT and EHR for granted today realize the rich history and evolution of technology in healthcare. Thanks Neil for sharing a small glimpse into that history and honoring a man who was an important part in it.

Everyone should take 2 minutes and go and read Neil Versel’s full tribute to Larry Weed.

MACRA Video Training – MACRA Monday

Posted on June 19, 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.

I did a quick search on YouTube for the term MACRA and it found 23,300 search results. It’s not surprising to find so much MACRA content. It seems to me that healthcare has an insatiable appetite for MACRA information.

While it’s great that so many organizations are producing MACRA content, no doubt some of it is not all that valuable and a bunch of it isn’t accurate. Case in point, the first video returned in the YouTube search for MACRA was a video from eClinicalWorks (eCW). Is there anyone that would want eCW to train them on government regulations after the recent eCW settlement that revolved around their decision to not properly certify their EHR and the meaningful use program? Maybe all the information is accurate, but that’s not where I’d go to for my source of MACRA information.

If you wanted a really brief, high level overview of MACRA, I found this 2 minute cartoon video from MediSync to be a nice intro to the intent of MACRA:

If you want a much more in depth look into MACRA’s MIPS program, you’ll want to check out Answers Media’s 25 videos in their The ABCs of MIPS series:

We all know that the government MACRA website is the first place to go for really high quality MACRA information. Do you have another go to source for your MACRA information that we should know about? Let us know in the comments.

Will the eCW Settlement Impact MACRA? – MACRA Monday

Posted on June 12, 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.

In case you missed it, eCW settled a whistleblower lawsuit for $155 million. At the core of the lawsuit were the Medicare meaningful use payments that were paid to eCWs customers. The lawsuit alleged that eCW had been inappropriately certified as an EHR and told their customers that they were appropriately certified.

Many in the industry including myself are suggesting that eCW isn’t the only EHR vendor that could run into these types of issues. It’s quite easy for an EHR vendor to pass the EHR certification test. It’s another thing to have actually implemented all of the EHR certification requirements. We’ll see what other lawsuits come forward.

What does this settlement mean for MACRA?

Before the eCW settlement, many in the EHR industry didn’t realize their risk profile because their customers were getting government money. Once your customers start taking government money, the legal framework really changes. This is going to be true with the MACRA program as well.

It behooves every EHR vendor to really make sure they are following the spirit of the law and not just trying to game the EHR certification process (which we all know is easily gamed). I expect that most EHR vendors will step up their game and make a good faith effort to comply. I think this is the hope of the US Attorney’s office given their press release about the settlement.

We’re still waiting to see if the eCW settlement will cause any issues for eCW users who attested with the inappropriately certified eCW software. My prediction is that they’ll be fine, but some have argued that their meaningful use incentive payments could be pulled too. If that happens, that could really impact participation in the MACRA/MIPS program.

You can be sure that healthcare organization’s compliance officers are going to spend more time verifying their EHR vendor’s certification. I wouldn’t be surprised if we saw some new contracts that include some new language to cover the healthcare organization if their EHR has issues similar to eCW.

One other thing that might be an issue is those organizations that choose to switch to a new EHR from eCW. EHR switching has always been an issue when it comes to meaningful use and now MACRA and MIPS. We’ll have to dive into EHR switching and MACRA in a future post.

What impact do you think the eCW settlement will have on MACRA?

Do We Need Stricter Scribe Standards?

Posted on June 9, 2017 I Written By

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

As most readers will know, scribes have gone from a neat idea to a fixture in many clinical settings. Though the long-term effect of their participation has yet to be determined, so far it seems that scribes have been proven to be quite useful. Not only are they saving time, they’re helping physicians connect with patients again, rather than their computer screen.

That being said, when you hire a scribe you don’t always know what you’re getting. After all, there’s no such thing as a scribe certification accepted by the healthcare industry as a whole. There are schools which offer aspiring scribes a thorough education in the essentials of medical terminology and practice, but they don’t need to adhere to a single national standard.

This lack of standardization could turn out to be a problem, according to Dr. Jeffrey Gold. In an article for The Doctor Weighs In, Dr. Gold concedes that scribes seem to be offering real benefits, noting that researchers have found that scribes can enhance physician efficiency, boost physician satisfaction and even increase billing. And he notes that scribes may improve patient satisfaction, as they make it easier for physicians to connect with patients during visits.

But despite the benefits they offer, Dr. Gold says he’s concerned about the lack of regulation concerning how scribes participate in healthcare. For example, he notes that researchers haven’t yet assessed scribes’ ability to interface safely with the EMR.

His concerns seems to be shared by the Joint Commission, which requires that providers signed all scribe-generated orders prior to implementation, that healthcare organizations document the ability of scribes to perform their assigned tasks. These concerns arise because scribes aren’t held to a common standard, Dr. Gold contends.

“Scribes have a wide variety of backgrounds, including premed students and certified medical assistants,” he notes. “…Unfortunately, few rules or standards currently exist that designate appropriate scribe activities.”

Scribe training varies a great deal as well, he notes. To make his point, Dr. Gold cites a study by medical malpractice insurer The Doctors Company and Oregon Health and Science University which looked at scribe capabilities and backgrounds. He notes that the survey, which had 335 respondents, found that 44% of scribes had no prior experience, and that only 22% of scribes have had any form of certification.

Under these circumstances, using scribes might come with some unexpected risks, he suggests. “The combination of rapid growth in scribe use, lack of standardized training, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises the concern that scribes may introduce potential negative unintended consequences to either workflow or documentation,” he writes.

It is worth noting that another of Dr. Gold’s fears is that scribes will be asked to take on more complex EMR work which, if handled badly, could also lead to problems. He’s concerned that scribes may simply accumulate such duties due to “functional creep.”

For myself, while I understand Dr. Gold’s concerns, I don’t feel the situation is as dire as he suggests. Yes, it would probably be appropriate and beneficial to standardize scribe training, as it never hurts to boost the professionalism of any party participating in the care process. At the same time, though, with many scribes being trained largely by their employers, there will be a lot of variation in outcomes anyway.

But maybe I’m wrong. What do you think? Is it important to give scribes or standardized training and ask them to meet national certification standards? Or are they working effectively as is?

5 Stages of Patient Frustration and Satisfaction Infographic

Posted on June 8, 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.

SCI Solutions sent me a really interesting infographic that looks at the 5 stages of patient frustration, but also the 5 stages of patient satisfaction. Check it out below:

I’m not sure that it’s best to describe these as stages since I’m not sure that they always flow through the various stages. Instead, I would rather describe them as patient states or even patient emotions. Regardless of the semantics, I like how this graphic explains the emotions patients feel both good and bad. It’s worth looking at your workflow and seeing where you can move from the frustrated patient emotions and into the happy patient emotions.

The EMR Vendor’s Dilemma

Posted on June 6, 2017 I Written By

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

Yesterday, I had a great conversation with an executive at one of the leading EMR vendors. During our conversation, she stressed that her company was focused on the future – not on shoring up its existing infrastructure, but rather, rebuilding its code into something “transformational.”

In describing her company’s next steps, she touched on many familiar bases, including population health, patient registries and mobile- first deployment to support clinicians. She told me that after several years of development, she felt her company was truly ready to take on operational challenges like delivering value-based care and conducting disease surveillance.

All that being said – with all due respect to the gracious exec with whom I spoke – I wouldn’t want to be a vendor trying to be transformed at the moment. As I see it, vendors who want to keep up with current EMR trends are stuck between a rock and a hard place.

On the one hand, such vendors need to support providers’ evolving health IT needs, which are changing rapidly as new models of care delivery are emerging. Not only do they need to provide the powerhouse infrastructure necessary to handle and route massive floods of data, they also need to help their customers reach and engage consumers in new ways.

To do so, however, they need to shoot at moving targets, or they won’t meet provider demand. Providers may not be sure what shape certain processes will take, but they still expect EMR vendors to keep up with their needs nonetheless. And that can certainly be tricky these days.

For example, while everybody is talking about population health management, as far as I know we still haven’t adopted a widely-accepted model for adopting it. Sure, people are arriving at many of the same conclusions about pop health, but their approach to rolling it out varies widely.  And that makes things very tough for vendors to create pop health technology.

And what about patient engagement solutions? At present, the tools providers use to engage patients with their care are all over the map, from portals to mobile apps to back-end systems using predictive analytics. Synchronizing and storing the data generated by these solutions is challenging enough. Figuring out what configuration of options actually produces results is even harder, and nobody, including the savviest EMR vendors, can be sure what the consensus model will be in the future.

Look, I’m aware that virtually all software vendors face this problem. It’s difficult as heck to decide when to lead the industry you serve and when to let the industry lead you. Straddling these two approaches successfully is what separates the men from the boys — or the girls from the women — and dictates who the winners and losers are in any technology market.

But arguably, health IT vendors face a particularly difficult challenge when it comes to keeping up with the times. There’s certainly few industries are in a greater state of flux, and that’s not likely to change anytime soon.

It will take some very fancy footwork to dance gracefully with providers. Within a few years, we’ll look back and know vendors adapted just enough.