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Denmark’s Health System Suffering Familiar EMR Woes

Posted on February 21, 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.

If you’re trying to navigate the US healthcare system – or worse, trying to pay for your care — Denmark’s alternative may sound pretty sweet. The Danish health system, which is funded through income taxes, offers free care to all Danish residents and EU citizens, as well as free emergency treatment to visitors from all other countries. And the Danes manage to deliver high-quality healthcare while keeping costs at 10.5% of its GDP (as opposed the US, which spends nearly 18% of the GDP on healthcare).

That being said, when it comes to health IT, Denmark is going through some struggles which should be familiar to us all. Starting in 2014, the Danish government began modernizing its healthcare system, an effort which includes developing both new hospitals and a modern health IT infrastructure. One of the linchpins of its efforts is a focus on directing care to fewer, more specialized hospitals – cutting beds by 20% and hopefully reducing average lengths of hospital stays from five to three days – supported by its HIT expansion.

You probably won’t be surprised to learn, meanwhile, that Epic has inserted itself into this effort, winning a $1B project to put its systems in place across 20 hospitals with 44,000 concurrent users. Unfortunately for the Danes, who are starting with a few hospitals in one of the country’s five regions, the effort has run into some early snags. Apparently, the Epic installs at these initial test hospitals aren’t going according to plan.

According to one publication, initial hospital go-lives in May and June of last year have seen  major problems, including errors that have put patients at risk, as well as creating erroneous test reports, results and prescriptions. The Epic systems were also having trouble communicating with the Danish health card, which stores patient information on a magnetic stripe.

The questionable rollout has since caused some controversy. As of August 2016, the local doctors’ union was demanding that a planned deployment in Copenhagen, at Denmark’s busiest hospital, be put off until authorities had figured out what was going wrong at the other two.

At first, I was surprised to hear about about Denmark’s IT woes, as I’d blithely assumed that a government-run health system would have a “central planning” advantage in EMR implementations. But as it turns out, that’s clearly not the case. It seems some frustrations are universal.

I got some insight into this yesterday, when I took a call from an earnest Danish journalist who was trying to understand what the heck was going on with Epic. “Things are going badly here,” she said. “There are lots of complaints from the first two hospitals. And the systems can’t talk to each other.”

I told her not to be surprised by all of this, given how complex Epic rollouts can be. I also warned that given the high cost of Epic software and support, it would not be astonishing if the project ended up over budget. I then predicted that without pulling Epic-trained (and perhaps Epic certified) experts into the project, things might get worse before they get better. “Just hire a boatload of American Epic consultants and you’ll be fine,” I told her, perhaps a bit insensitively. “Maybe.”

When I said that, she was clearly taken aback. Even from thousands of miles away, I could tell she was unhappy. “I was hoping you had a solution,” she finally said. “I wish,” I replied. And I had to laugh so I wouldn’t cry.

#MACRA at #HIMSS17 – MACRA Monday

Posted on February 20, 2017 I Written By

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

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

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


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


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


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


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


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


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

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

MIPS APMs and MACRA Small Practice Support – MACRA Monday

Posted on February 13, 2017 I Written By

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

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

As we mentioned previously, there are some benefits to practices that are participating in an APM, but don’t qualify as an advanced APM. These practices can’t participate in the APM program and they need to participate in the MIPS program or they’ll get the 4% penalty for not participating in MIPS. The good news is that there is a benefit to taking part in what is called a MIPS APM (ie. an APM that doesn’t qualify as an advanced APM).

Here’s the list of MIPS benefits for being in a MIPS APM:

MACRA also has a number of opportunities available to small practices. The first example is that many small practices were excluded from participating in MACRA because of their size. Second, the program itself made MACRA easier with Pick Your Pace and they also created more access to advanced APMs. Finally, they created what they call the Transforming Clinical Practice Initiative.

The Transforming Clinical Practice Initiative seems quite similar to the REC program under meaningful use. This program is a network of support for those participating in MACRA and MIPS. You can see a full interactive chart that shows a view of the various support centers around the country for more details on what’s available in your area.

That’s all for this edition of MACRA Monday. Next week we’ll finish off our overview of MACRA Monday and discuss what we think is the right strategy when it comes to MACRA.

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

E-Patient Update: Hey Government, Train Patients Too!

Posted on February 10, 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.

Recently I got a most interesting email from the ONC and A-list healthcare educator Columbia University. In the message, it offered me a free online course taught by Columbia’s Department of Biomedical Informatics, apparently paid for by ONC funding. (Unfortunately, they aren’t giving away free toasters to students, or I definitely would have signed up. No wait, I’m sorry, I did register, but I would have done it faster for the toaster.)

The course, which is named Health Informatics For Innovation, Value and Enrichment) or HI-FIVE, is designed to serve just about anyone in healthcare, including administrators, managers, physicians, nurses, social workers an care coordinators. Subjects covered by the course include all of the usual favorites, including healthcare data analytics, population health, care coordination and interoperability, value-based care and patient-centered care.

If I seem somewhat flippant, it’s just because the marketing material seemed a little…uh…breathlessly cheery and cute given the subject. I can certainly see the benefits of offering such a course at no cost, especially for those professionals (such as social workers) unlikely to be offered a broader look at health IT issues.

On the other hand, I’d argue that there’s another group which needs this kind of training more – and that’s consumers like myself. While I might be well-informed on these subjects, due to my geeky HIT obsession, my friends and family aren’t. And while most of the professionals served by the course will get at least some exposure to these topics on the job, my mother, my sister and my best girlfriend have essentially zero chance of finding consumer-friendly information on using health IT.

Go where the need is

As those who follow this column know, I’ve previously argued hard for hospitals and medical groups to offer patients training on health IT basics, particularly on how to take advantage of their portal. But given that my advice seems to be falling on deaf ears – imagine that! – it occurs to me that a government agency like ONC should step in and help. If closing important knowledge gaps is important to our industry, why not this particular gap. Hey, go where the need is greatest.

After all, as I’ve noted time and again, we do want patients to understand consumer health IT and how to reap its benefits, as this may help them improve their health. But if you want engagement, folks, people have to understand what you’re talking about and why it matters. As things stand, my sense is that few people outside the #healthit bubble have the faintest idea of what we’re talking about (and wouldn’t really want to know either).

What would a consumer-oriented ONC course cover? Well, I’m sure the authorities can figure that out, but I’m sure education on portal use, reading medical data, telemedicine, remote monitoring, mobile apps and wearables wouldn’t come amiss. Honestly, it almost doesn’t matter how much the course would cover – the key here would be to get people interested and comfortable.

The biggest problem I can see here is getting consumers to actually show up for these courses, which will probably seem threatening to some. It may not be easy to provoke their interest, particularly if they’re technophobic generally. But there’s plenty of consumer marketing techniques that course creators could use to get the job done, particularly if you’re giving your product away. (If all else fails, the toaster giveaway might work.)

If providers don’t feel equipped to educate patients, I hope that someone does, sometime soon, preferably a neutral body like ONC rather than a self-interested vendor. It’s more than time.

Physician EHR Burnout Infographic

Posted on February 9, 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.

Physician burnout is a hot topic and one that’s not likely to go away anytime soon. There are a lot of elements to physician burnout and I was impressed with how well eMedApps captured the issue of physician burnout in the infographic below.

I think the question of the next decade is going to be, “How do we decrease the administrative tasks the doctors perform?” If we don’t find a satisfactory answer, our healthcare system will be permanently damaged. What’s even scarier is that this seems to be trending worse and not better.

What would you propose to help solve the problem of physician burnout?

Physician EHR Burnout and Administration Tasks - eMedApps

Switching Out EMRs For Broad-Based HIT Platforms

Posted on February 8, 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.

I’ve always enjoyed reading HISTalk, and today was no exception. This time, I came across a piece by a vendor-affiliated physician arguing that it’s time for providers to shift from isolated EMRs to broader, componentized health IT platforms. The piece, by Excelicare chief medical officer Toby Samo, MD, clearly serves his employer’s interests, but I still found the points he made to be worth discussing.

In his column, he notes that broad technical platforms, like those managed by Uber and Airbnb, have played a unique role in the industries they serve. And he contends that healthcare players would benefit from this approach. He envisions a kind of exchange allowing the use of multiple components by varied healthcare organizations, which could bring new relationships and possibilities.

“A platform is not just a technology,” he writes, “but also ‘a new business model that uses technology to connect people, organizations and resources in an interactive ecosystem.’”

He offers a long list of characteristics such a platform might have, including that it:

* Relies on apps and modules which can be reused to support varied projects and workflows
* Allows users to access workflows on smartphones and tablets as well as traditional PCs
* Presents the results of big data analytics processes in an accessible manner
* Includes an engine which allows clients to change workflows easily
* Lets users with proper security authorization to change templates and workflows on the fly
* Helps users identify, prioritize and address tasks
* Offers access to high-end clinical decision support tools, including artificial intelligence
* Provides a clean, easy-to-use interface validated by user experience experts

Now, the idea of shared, component-friendly platforms is not new. One example comes from the Healthcare Services Platform Consortium, which as of last August was working on a services-oriented architecture platform which will support a marketplace for interoperable healthcare applications. The HSPC offering will allow multiple providers to deliver different parts of a solution set rather than each having to develop their own complete solution. This is just one of what seem like scores of similar initiatives.

Excelicare, for its part, offers a cloud-based platform housing a clinical data repository. The company says its platform lets providers construct a patient-specific longitudinal health record on the fly by mining existing EHRs claims repositories and other data. This certainly seems like an interesting idea.

In all candor, my instinct is that these platforms need to be created by a neutral third party – such as travel information network SABRE – rather than connecting providers via a proprietary platform created by companies like Excelicare. Admittedly, I don’t have a deep understanding of Excelicare’s technology works, or how open its platform is, but I doubt it would be viable financially if it didn’t attempt to lock providers into its proprietary technology.

On the other hand, with no one interoperability approach having gained an unbeatable lead, one never knows what’s possible. Kudos to Samo and his colleagues for making an effort to advance the conversation around data sharing and collaboration.

EMR Data Use For Medical Research Sparks Demand For Intermediaries

Posted on February 7, 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.

Over the last couple of years, it’s become increasingly common for clinical studies to draw on data gathered from EMRs — so common, in fact, that last year the FDA issued official guidance on how researchers should use such data.

Intermingling research observations and EMR-based clinical data poses different problems than provider-to-provider data exchanges. Specifically, the FDA recommends that when studies use EMR data in clinical investigations, researchers make sure that the source data are attributable, legible, contemporaneous, original and accurate, a formulation known as ALCOA by the feds.

It seems unlikely that most EMR data could meet the ALCOA standard at present. However, apparently the pharmas are working to solve this problem, according to a nice note I got from PR rep Jamie Adler-Palter of Bayleaf Communications.

For a number of reasons, clinical research has been somewhat paper-bound in the past. But that’s changing. In fact, a consortium of leading pharma companies known as TransCelerate Biopharma has been driving an initiative promoting “eSourcing,” the practice of using appropriate electronic sources of data for clinical trials.

eSourcing certainly sounds sensible, as it must speed up what has traditionally been the very long process of biopharma innovation. Also, I have to agree with my source that working with an electronic source beats paper any day (or as she notes, “paper does not have interactive features such as pop-up help.”) More importantly, I doubt pharmas will meet ALCOA objectives any other way.

According to Adler-Palter, thirteen companies have been launched to provide eSource solutions since 2014, including Clinical Research IO (presumably a Bayleaf client). I couldn’t find a neat and tidy list of these companies, as such solutions seem to overlap with other technologies. (But my sense is that this is a growing area for companies like Veeva, which offers cloud-based life science solutions.)

For its part CRIO, which has signed up 50 research sites in North America to date, offers some of the tools EMR users have come to expect. These include pre-configured templates which let researchers build in rules, alerts and calculations to prevent deviations from the standards they set.

CRIO also offers remote monitoring, allowing the monitor to view a research visit as soon as it’s finished and post virtual “sticky notes” for review by the research coordinator. Of course, remote monitoring is nothing new to readers, but my sense is that pharmas are just getting the hang of it, so this was interesting.

I’m not sure yet what the growth of this technology means for providers. But overall, anything that makes biopharma research more efficient is probably a net gain for patients, no?

Advancing Care Information (ACI) Category – MACRA Monday

Posted on February 6, 2017 I Written By

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

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

Time to continue our journey through the MIPS performance categories. For today’s MACRA Monday we’re going to start talking about the Advancing Care Information (ACI) category. Most of you will know this category better as meaningful use. However, it does have some significant changes to what existed in meaningful use.

Some of the major changes include a shift from the “All or Nothing” approach to the EHR meaningful use program. CPOE and CDS objectives were also eliminated along with some redundant measures. ACI also reduces the number of required public health registries.

As we mentioned previously, ACI makes up 25% of your MIPS Composite Scoring. There is a significant hardship exemption available that will change the ACI weighting to zero and apply the 25% weight to other categories. Here’s a look at how the ACI score will be calculated:

The biggest piece of ACI scoring is the 5 required measures that make up the base score as follows:

Much like meaningful use, in advancing care information (ACI) clinicians are required to use a certified EHR. Which EHR certification you use will determine which ACI objectives and measures you will need to use as follows:

That’s the quick overview of the Advancing Care Information (ACI) category. Next week we’ll take a look at the MIPS APM benefits and MACRA small practice support.

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

E-Patient Update:  Portal Confusion Undermines Patient Relationships

Posted on February 3, 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.

I’m not surprised that some medical practice staffers and doctors seem uncomfortable with their EMR system and portal. After all, they’re not IT experts, and smaller practices might not even have any full-time IT staffers to help. That being said, if they hope to engage patients with their healthcare, they need to do better.

I’m here to argue that training staff and doctors to help patients with portal use is not only feasible, it’s important to customer service, care quality and ultimately a practice’s ability to manage populations. If you accept the notion that patients must engage with their health, you can’t leave their data access to chance. Everyone who works with patients must know the basics of portal access, or at least be able to direct the patient immediately to someone that can help.

Start with the front line

If I have problems with accessing a practice portal, the first person I’m likely to discuss it with is someone on the front lines, either via the phone or during a visit. But front office staffers seldom seem to know Thing One about the portal, including how to access it or even where to address a complaint if I have one.  But I think practices should do at least the following:

* Train at least one front-desk staffer on how to access the portal, what to do when common problems occur and how to use the portal’s key functions. Training just one champion is probably enough for smaller practices.

* Create a notebook in which such staffers log patient complaints (and solutions if they have one). This will help the practice respond and address any technical issues that arise, as well making sure they don’t lose track of any progress they’ve made.

* Every front desk staffer (and every doctor) should have a paper handout at hand which educates patients on key portal functions, as well as the name of the champion described above.  Also, the practice should provide the same information on a page of their site, allowing a staffer to simply email the link to patients if the patient is calling in with questions.

* All doctors should know about the champion(s), and be ready to offer their name and number to patients who express concerns about EMR/portal access. They should also keep the handout in their office and share it when needed.

Honestly, I don’t regard any of these steps as a big deal. In fact, I see them as little more than common sense. But I haven’t encountered a single community practice that does any of them, or even pursued their own strategies for educating patients on their portal.

Maximizing your investment

For those reading this who think these steps – or your own version – are too much trouble, think again. There’s plenty of reason to follow through on patient portal support.  After all, if nothing else, you’ve probably spent a ton of money on your EMR and portal, so why not maximize the value it offers?

Also, you don’t want to frustrate patients needlessly when a little bit of preparation and education could make such a difference. Maybe this wasn’t the case even a few years ago, but today, I’d submit, helping patients access their data is nothing more than good customer service. Given the competition every provider faces, why would you ignore a clear opportunity to foster patient loyalty?

Bear in mind that a little information goes a long way with patients like me. You don’t have to write a book to satify me – you just have to help me succeed. Just tell me what to do and I’ll be happy. So don’t miss a chance to win me over!

Practice Management Market To Hit $17.6B Within Seven Years

Posted on February 1, 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.

A new research report has concluded that the global practice management systems market should hit $17.6 billion by 2024, fueled in part by the growth of value-adds like integration with other healthcare IT solutions.

The report, by London-based Grand View Research, includes a list of what it regards as key players in this industry. These include Henry Schein MicroMD, Allscripts Healthcare Solutions, AdvantEdge Healthcare Solutions, athenahealth, MediTouch, GE Healthcare, Practice Fusion, Greenway Medical, McKesson Corp, Accumedic Computer Systems and NextGen Healthcare.

The report argues that as PM systems are integrated with external systems EMRs, CPOE and laboratory information systems, practice management tools will increase in popularity. It says that this is happening because the complexity of medical billing and payment has grown over the last several years.

This is particularly the case in North America, where fast economic development, plus the presence of advanced research centers, hospitals, universities and medical device manufacturers keep up the flow of new product development and commercialization, researchers suggest.

In addition, researchers concluded that while PM software has accounted for the larger share of the market a couple of years ago, that’s changing. They predict that the services side of the business should grow substantially as practices demand training, support and system upgrades.

The report also says that cloud-based delivery of PM technology should grow rapidly in coming years. As Grand View reminds us, most PM systems historically have been based on-premise, but the move to cloud-based solutions is the future. This trend took off in 2015, researchers said.

This report, while worthwhile, probably doesn’t tell the whole story. Along with growing demand for PM systems,I’d contend that vendor sales strategies are playing a role here. After all, integration of PM systems with EMRs is part of a successful effort by many vendors to capture this parallel market along with their initial sale.

This may or may not be good for providers. I don’t have any information on how the various integrated practice management systems compare, but my sense is that generally, they’re a bit underpowered compared with their standalone competitors.

Grand View doesn’t take a stand on the comparative benefits of these two models, but it does concede that emerging integrated practice management systems linking EMRs, e-prescribing, patient engagement and other software with billing are actually different than standalone systems, which focus solely on scheduling, billing and administration. That does leave room to consider the possibility that the two models aren’t equal.

Meanwhile, one thing the report doesn’t – and probably can’t – address is how these systems will evolve under value-based care in the US. While appointment scheduling and administration will probably be much the same, it’s not clear to me how billing will evolve in such models. But we’ll need to wait and see on that. The question of how PM systems will work under value-based care probably won’t be critically important for a few years yet.

(Side note:  You may want to check out John’s post from a few years ago on practice management systems trends. It seems that the industry goes back and forth as to whether independent PM systems serve groups better than integrated ones.)