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Comical Patient Portal Discussion

Posted on July 14, 2014 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 interested in how offices communicate their use of an EHR and patient portal to their patients. Long time readers might remember this EMR Under Construction sign that one office used.

I had a doctor send me this email exchange which isn’t necessarily a great suggestion for a practice, but it does illustrate many physicians view of what’s happening with EHR and patient portals:
Comical Patient Portal Comments
I’ll call back to Carl Bergman’s post asking “Has EHR Become a Bad Brand?” I think many doctors consider the EHR and patient portal as one thing. Of course they’re not always the same, but emails like this illustrate how the patient portal and EHR brand are doing…not so well. Although, my guess is that meaningful use has an even worse image in the eyes of doctors.

EHR Usability: Is There a Right Path?

Posted on December 9, 2013 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The following is a guest post by Carl Bergman from EHR Selector.

Earlier this fall, the AMA sponsored a Rand Corporation study on physician’s professional satisfaction. Based on interviews with physicians in 30 practices, the study covers a variety of topics from workplace setting to quality of care, EHRs and health reform, etc. At the time, the report generated discussion about dissatisfaction in general with EHRs and MU in particular.

Usability, Part of MU?
Overlooked in the discussion was a new and important recommendation on usability. Here’s what is says:

Physicians look forward to future EHRs that will solve current problems of data entry, difficult user interfaces, and information overload. Specific steps to hasten these technological advances are beyond the scope of this report. However, as a general principle, our findings suggest including improved EHR usability as a precondition for federal EHR certification. (Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, p.142) Emphasis added.

It would be overkill to say that this represents adopted AMA policy, however, it’s not overkill to say that the recommendation is part of a project that the AMA initiated and supports. As such, it is most significant that it recognizes the need to bring some coherence to EHR usability and that the MU system is the logical place to put it.

Changing the Vendor – User Relationship
One commentator who did notice the recommendation was EHR Intelligence’s Robert Green. In his review, Green took a different tack. While agreeing that usability needs improvement, he saw a different way to get change:

Usability remains an enigma in many clinic-EHR vendor relationships because it hasn’t been nearly as important in the recent years’ dialogue as “meaningful use.” But among the competing priorities, usability among physicians and their EHR vendor is a real opportunity to develop shared expectations for a new user experience.

As a patient, I would rather not see the delegation of the “usability” dialogue of EHR to those in the roles of meaningful use certification. Instead, physicians who have spent many years of their lives learning how to “take care of patients” could seize the moment to define their own expectations with their EHR vendor of choice within and beyond their practice. (How connected is EHR user satisfaction to vendor choice?) Emphasis added.

I think these two different paths put the question squarely. They agree that usability needs increased action. Users have gotten their message across with alacrity: all systems fail users in some aspect. Some fail catastrophically. Though some vendors take usability to heart, the industry’s response has been uneven and sporadic.

Where these two approaches differ is tactics. Rand looks at usability, and sees an analog to MU functions. It opts for adding usability to MU’s tests. Green sees it as part of the dialogue between user and vendor.

As a project manager and analyst, my heart is with Green. Indeed, helping users find a system that’s a best fit is why we started the Selector.

Marketplace Practicalities
Nevertheless, relying on a physician – vendor dialogue is, at best, limited and at worst unworkable. It won’t work for several reasons:

  • Nature of the Market. There’s not just one EHR market place where vendors contend for user dollars, there are several. The basic divide is between ambulatory and in patient types. In each of these there are many subdivisions depending on practice size and specialty. Though a vendor may place the same product name on its offerings in these areas, their structure, features and target groups differ greatly. What this means is that practices find themselves in small sellers’ markets and that they have little leverage for requesting mods.
  • Resources. Neither vendors nor practices have the resources needed to tailor each installation’s interface and workflow. Asking a vendor, under the best of circumstances, to change their product to suit a particular practice’s interface approach not only would be expensive, but also would create a support nightmare.
  • Cloud Computing. For vendors, putting their product in the cloud has the major advantage of supporting only one, live application. Supporting a variety of versions is something vendors want to avoid. Similarly, users don’t want to hear that a feature is available, but not to them.
  • More Chaos. Having each practice define usability could lead to no agreement on any basics leaving users even worse off. It’s bad enough now. For example as Ross Koppel points out, EHRs record blood pressure in dozens of different ways. Letting a thousand EHRs blossom, as it were, would make matters worse.

ONC as Facilitator Not Developer
If the vendor – buyer relationship won’t work, here’s a way the MU process could work. ONC would use an existing usability protocol and report on compliance.

Reluctance to put ONC in charge of usability standards is understandable. It’s no secret that the MU standards aren’t a hands down hit. All three MU stages have spawned much criticism. The criticism, however, is not that there are standards so much as individual ONC’s standards are too arcane, vague or difficult to meet. ONC doesn’t need to develop what already exists. The National Institutes of Standards and Technology usability protocols were openly developed, drawing from many sources. They are respected and are not seen as captured by any one faction. (See NISTIR 7804. And see, June 14, 2012.)

As I’ve written elsewhere, NIST’s protocols aren’t perfect, but they give vendors and users a solid standard for measuring EHR usability. Using them, ONC could require that each vendor run a series of tests and compare the results to the NIST protocols. The tool to do this, TURF, already exists.

Rather than rate each product’s on a pass – fail basis, ONC would publish each product’s test results. Buyers could rate product against their needs. Vendors whose products tested poorly would have a strong incentive to change.

EHRs make sense in theory. They also need to work in practice, but don’t. The AMA –Rand study is a call for ONC to step up and takes a usability leadership role. Practice needs to match promise.

NIST’s EHR Usability Conference Breaks Both Old Ground and New Focuses on EMR Patient Safety Protocol

Posted on June 14, 2012 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Regular reader, Carl Bergman from EHR Selector, attended the recent NIST EMR Usability Conference and sent over the following guest post on what was said. Thanks Carl for sharing your experience with us.

A year ago last June I attended NIST’s (National Institute of Standards and Technology) conference on EMR/EHRs usability. [See Carl’s post on the NIST EHR Usability Conference from 2011.] It was a mixed bag. There were several excellent presentations on the fundamentals of usability, how to analyze an EMR and where the field was headed. Unfortunately, NIST’s staff took a narrow view confining their work to EMR error conditions and assiduously avoiding interface, workflow and clinical setting issues. It was odd that an agency that prided itself on redesigning nuclear control rooms after Three Mile Island or the design of airplane cockpits would ignore EMR user interfaces.

New Approach: New Protocol

At this year’s conference at NIST headquarters in Gaithersburg, MD, the past was not prolog. Last week’s conference focus was on a comprehensive EMR usability protocol, NISTIR 7804, that NIST produced last February. (For a good synopsis, see Katherine Rourke’s Design Errors That Cause Patient Harm per NIST.) NIST’s staff pulled together a notable group of speakers on patient safety in general and implementing the protocol in particular. (NIST is posting the presentations here.)

The protocol, designed to review an EMR, is not a trivial undertaking since it has about 180 line item questions. It asks, for example, if the EMR:

  • Keeps patient identities distinct from each other? That is, does the system prevent one record from writing over another or erroneously sharing data elements?
  • Lays out pages in a consistent manner using color, icons and links identically?
  • Uses measurements consistently? That is, if weight is entered in pounds and ounces in one place, do they show that way in other places?
  • Displays fields fully rather than being truncated?
  • Sorts logically based on the subject?
  • Show dosages, etc., with all needed information on the page?
  • Displays multipage entries or lookups with proper navigation choices?
  • Has error messages that state what is wrong and how to cure the problem?
  • Accommodates different levels of user knowledge? That is, does it have extended help for novice users, refresher information for occasional users and short cuts for experienced users?

Developers Present in Force

If NIST’s major intent was to get developer attention, they succeeded. Of the hundred or so attendees, about 20 percent were from major systems. 3m, Allscripts, Athenahealth, Centricity, McKesson, NextGen, etc., each had one or more representatives present. Others present included Kaiser, HIMSS, Medstar, First Choice, ACP, Columbia, etc.

Unfortunately, there is no way to know developer reaction to the protocol. The conference had no comment session. I don’t know if this was by design or if time just ran out. NIST staff did indicate that next year the conference would be two days rather than one. However, a year is a long time to wait for reactions. This is especially pertinent since NIST is not a regulatory agency. Its protocols are strictly voluntary and depend on vendor acceptance.

What NIST did do is offer several presentations that emphasized how fragile patient safety can be in an HIT world. One breakout session used an actual, unnamed product’s screen that had dozens of misleading or ambiguous fields. For example, the screen’s fields cut off drug names, used red to indicate several different findings and used a pop up that blocked a view of a pertinent entry.

In another more broadly based patient safety presentation, University of Pennsylvania’s voluble Ross Koppel drove home how common elements in EMRs such as blood pressure – he’s found 40 different ways to show it so far – are subject to many formats for capture and display. Moreover, if you think EMRs have problems, Koppel shows how bar codes and work arounds can play havoc with workflow and patient safety.

Wanted: One Good Policy Compass

For those of us possessed of an EMR design demon, it was both a good chance to wonder out loud just what it all meant and where, if anywhere, things were headed. Sadly, the most common answer was who knows? There were some common points:

  • It’s better to have NIST’s protocol than not.
  • You can forget the FDA playing a bigger role. It’s under funded and over worked.
  • HIMSS will wait for the industry and the industry has shown no hurry.
  • EMR adverse incident reporting would be great, but who would do it and how open would it be?

In short, if you’re shopping for an EMR, regardless of your size, don’t count on anyone handing you a usability report on an EMR anytime soon. Moreover, don’t try to run NIST’s protocol on your own unless you have full access to the proposed EMR, lots of time on your hands and a good grasp of the protocols details.

There are some things you can do. You can ask potential vendors questions such as these:

  • Have they run the NIST protocol and what did they do as a result?
  • If not NIST, do they have a written usability protocol and, if so, can you see it? How have they implemented it?
  • Have they tested their EMR’s usability with outside, independent users? What were the results?
  • Have they used any interface designers?
  • What usability changes do they plan?

There is no guarantee that you’ll get a great product, but it could mean that you get one that doesn’t bite your patients or you.

A Gilbert and Sullivan Take on Meaningful Use

Posted on November 6, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

A little video to brighten your weekend.

*Thanks to Carl Bergman from EHR Selector for pointing it out to me. For those unfamiliar with Gilbert and Sullivan, here’s their wikipedia page.

If you’re someone who loves watching EMR and Healthcare IT related videos as opposed to reading about it, be sure to check out this EMR & EHR Video website.

Here are the lyrics in case you want to take your time reading them:
I am the model user of an EMR that’s meaningful
My patient’s information is computerized and digital
Each visit note and test result is easily retrievable
With speed and accuracy that is almost inconceivable!
It’s shared by every health provider who should need to see it all
And yet it’s safely kept behind a well-protected firewall
If somebody should hack into it that would be a federal crime
And if I share my password it’s for sure I’ll do some prison time

The demographic information I collect may seem absurd
There’s date of birth, race, gender, ethnic group and languages preferred.
In short, in matters medical, computerized and digital
I am the model user of an EMR that’s meaningful.

I reconcile each medication, noting every single pill
Except for controlled substances, I electronically refill
I check for interactions for each single drug I may prescribe
And allergies to medications that my patients may describe.
I take blood pressure, weight and height, and calculate their BMI
And check the box that says I told them if it is too low or high.
The system plots a growth chart I don’t need to do it manually
I ask each patient’s smoking status and update it annually.

I keep a current and updated patient diagnosis list
I send reminders to my patients to prevent appointments missed
I’m typing better than my Mom who once worked in a steno pool
I am a model user of an EMR that’s meaningful.

At each encounter’s end I print an after visit summary
I’m tracking 14 core objective measurements of quality
Plus 5 of 10 more menu set objectives chosen just for me
Will this improve the care I give or is it just frivolity?
It does not matter, ’cause my data pretty soon will be online
And patients who can see it will be judging me in no short time
Deciding if I am a doctor who provides them decent care
Based only on the numbers that the CMS report puts there.

It’s been 5 years since I have looked a patient straight into the eyes
Without my finger on the keys or else a laptop on my thighs
Though I have carpel tunnel syndrome, trigger thumb and shoulder pull,
I am a model user of an EMR that’s meaningful.

One Former Practice Fusion Consultant’s Issues and Practice Fusion’s Response

Posted on August 18, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

As most of you know, I don’t often point out individual vendors all that much. However, on occasion I get something sent to me that I think could add to the conversation around various EHR software. I got one of those emails from long time reader, Carl Bergman. He chose to no longer be a Practice Fusion consultant and wanted to share the issues he had with the current Practice Fusion EHR product.

I haven’t had the time lately to be able to dig into Carl’s comments myself, so that I could make an assessment of his comments about the Practice Fusion EHR. However, in the interest of sharing both sides of the story I asked Practice Fusion to comment on Carl’s thoughts on their EHR software. So, below you’ll find Carl and Practice Fusions comments.

As with most things in life, take everything you read in this post with a grain of salt and evaluate what each side says for yourself. Either way, I think it could start a helpful discussion for those considering the Practice Fusion EHR.

Letter sent from Carl Bergman to Practice Fusion:

I have been a certified Practice Fusion Consultant for several months. I’m writing to ask that you remove me as a PF consultant.

I have given this decision a great deal of thought, but I do not believe that I can market PF in good conscious. This is not due in any way to how I have been treated, nor is it any reflection on the support that PF offers to its consultants, which is considerable.

Rather, it is based on what I believe are important, missing product features. This lack of features makes it impossible for me to recommend PF to any of the leads that you have generously shared with me. (Please note, I have not and will not approach any of those leads due to your referral.)

I was initially attracted to PF due to its web basis, ease of use and, simple set up and good support. However, as I went through PF I saw that it was lacking in four important areas: Workflow, Billing, Security and Reporting.

Workflow. Each patient in a medical practice presents a different set of circumstances, attributes and issues. These require that the practice be able to respond in a concerted and orchestrated way. PF lacks this ability. Specifically:

Appointment Type. PF has six fixed appointment types, New, Recurring, etc. They may not be changed, deactivated or added to. Appointment duration is set separately for each appointment. An appointment’s specifics are kept in a note.

Appointments are key to a practice’s workflow. For example, PF has a wellness appointment type. However, there is no ability to link the appointment type to look for outstanding labs before the appointment is set. Nor can appointment type reserve a room or assign a tech to take vitals, etc., as part of an exam. As a result, a practice is left to its own, non traceable, ad hoc methods for preparing for and carrying out the exam.

Shared Task List. When a practitioners decides on a course of treatment, this can set a number of things in motion:
• Labs
• Rx
• Recurring Appointments
• Procedures
• Referrals
• Billing

Each of these also is an assignment to someone else to carry out a portion of the plan. While PF has lists for a patient and individual task lists for each person, it does not have an overall view of pending tasks so a manager can see bottlenecks or assign workloads.

Security. PF has four fixed levels of security: Staff, Nurse, NP/PA and PA. Users are assigned to one or more of these levels and optionally as administrators. As with appointment types, the categories may not have their attributes modified or may new ones be added.
I found a definition of the categories in the Support Forum/Getting Started, which defines different user’s edit rights. It is silent about how, if at all, access is limited. Apparently, any user may view all parts of a record. Allowing any user to view anything in an EMR is a dangerous policy because it allows confidential information, such as an AIDS test result, to be known by those who have no need to know it.
Billing. PF includes elements, such as insurance plans, copays, etc., that are usually associated with practice management and billing systems, so it is surprising that it does not include billing as well. Instead, it integrates with third party billing systems, such as Karo.

I have long been biased against systems that tie an EMR from one vendor with billing from another. No matter how well designed, the attempt to integrate two different data structures just doesn’t work well. While PF states that is it fully integrated with Karo, an on line subscription based billing system, but neither site has much detail on the integration much less a data model. I think a user should also know what, if any, terms, relationship, contract, etc., exist between PF and Karo or other billing services.

Aside from detracting from the free nature of PF, the question of the degree of integration is major. For example, who is responsible for the interface’s operation PF or Karo?

Is a demographic change in either reflected in the other? From what I read in the PF Community Forum, the answer is no. I would like to know whose reporting module, if either, can access the combined data from the two systems?

Also, if I use Karo, does that mean I have to set up a separate security system. To look at billing do I have to go from PF and log into Karo?

Reporting. A major advantage of an EMR over a manual system is not only the ability to find and retrieve a specific record, but also the ability to find and report on a selected set as well. For example, if the FDA notifies physicians that they should review all cases of Crone’s disease that are more than three years old who are on a specific dose of a particular antibiotic, PF could not do this.

PF’s reports are limited to searching and reporting on specific topics. In this, it compares unfavorably to a host of other EMRs on the market. If it did have a well developed reporting function, it could make up for some of its lack of workflow abilities, but it does not. This lack of reporting ability when combined with the lack of an internal billing function is a deal killer.

I regard each of the issues that I’ve listed to be a major problem any one of which would cause me to be skeptical of a product. Taken as a whole, and I am aware of the wide adoption of PF, I find that I cannot recommend PF as an EMR.

Carl Bergman
SilverSoft, Inc.

And Practice Fusion’s response:

Here’s some notes back. In general, Carl doesn’t seem to have a very deep understanding of the product. A failure on our part, perhaps, but these answers are easily given from our support team:

– Appointment type: EHR accounts come with six default appointment types, but any Admin level user is free to create their own to match their workflow. This setting is under the “admin” tab in the EHR.

– Task list: Each practice manages the passing back and forth of tasks a little bit differently. Most use the secure message feature to send follow-up, billing, lab messages, etc. A practice manager could review these messages or, more easily, could use the Live Activity Feed to see where there are bottlenecks. Since most of our practices are small (under 10 doctors) this doesn’t seem to be a big issue.

– Security: Each user has just one level of permission inside the EHR. Their individual login dictates the level of access they have. It is certainly not true than any user has the same access rights to any record. Plus, our activity feed gives an added level of transparency where you can see exactly who has accessed what, any actions they’ve taken, etc. That’s a unique Practice Fusion feature. However, it is a great suggestion to add more customization to these edit levels, that’s a popular request from our users as well and we have it on our development roadmap.

– Billing: We have the opposite bias from Carl here. We believe that being billing agnostic gives Practice Fusion users a great deal more flexibility in how they choose to manage their billing and an easier transition to EHR since they don’t have to change their billing process at the same time. Kareo is just one option that we provide our users, they are free to use whichever biller then would like. Their low-cost, integrated billing software is popular with our users. The integration today is fairly light, but we are working on ways to make it a more robust connection.

– Reporting: Practice Fusion does have some basic reporting features built in to the EHR today. For example, the reporting feature has assisted doctors with managing the Darvocet recall and with identifying H1N1 high-risk patients. The Crohn’s (note the spelling) disease example he gives would actually be fairly easy to run within PF. You would just do a report on ICD-9 code 555.9 with the date range set and then filter the resulting patients based on prescription (or run a second Rx report and merge). I don’t have any Crohn’s patients in my test account, so I ran a report on chronic migraine instead, below. However, we are in the process of upgrading the reporting feature for both Meaningful Use and our own planned enhancements.

There you have it. I’ll let you be the judge for yourself. Plus, I’m interested to hear what other Practice Fusion users have to say about the various opinions stated in this post. One thing that Practice Fusion has going for them is they at least don’t charge anything for their EHR. So, it’s not like a doctor using it can complain that they didn’t get what they paid for.

I have a feeling that this conversation will continue in the comments. See you there.

Full Disclosure: Practice Fusion is an advertiser on EMR and EHR. Although, I’d provide the same opportunity to any EHR vendor that would like to respond to comments I get about them.

Subsidiary Modules in Certified EHR Products

Posted on June 2, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Carl Bergman, from, sent me the following email which poses some interesting questions about various certified EHR vendors and the software that they depend on to be certified.

Many of the [certified EHR] products relied on several other software companies to function. Usually this was Dr. First’s Rocopia, Surescripts, etc. However, many others had required several subsidiary modules to work. For example, Pearl EMR lists: MS .NET Framework 3.5 Cryptographic Service Provider; SureScripts; BCA Lab Interface; Oracle TDE.

There is nothing inherently wrong with this, but it raises three questions. Does the vendor include the price, if any, for subsidiary software? More importantly, how well integrated are these programs integrated into the main program? Does the vendor take responsibility if the subsidiary software changes making them incompatible?

He definitely asks some interesting questions. I’d say that in most cases, there will be little issues with the dependent software. Any changes by the dependent software are going to have to be dealt with or in some cases replaced by the EMR vendor. That will just be part of the EMR upgrade process that the EMR vendor does for you.

The only exception might be things like the third party ePrescribing software. Depending on how this is integrated it could be an issue. In most cases, integration with the ePrescribing software can be very much like an interface with a PMS system or even a lab interface. If you’ve had the (begin sarcasm) fun (end sarcasm) of dealing with these types of interfaces you know how it can be problematic and often a pain to manage. I believe the interface with an ePrescribing module is less problematic, but it will exhibit similar issues depending on how the EMR software works with the ePrescribing.

Personally, I don’t have much problem with these types of integrations. As long as the EMR vendor is providing all of the software for you. The reason this is important is because if you get the EMR software from one vendor and the ePrescribing software from another vendor and then tell them to work together, you’re just asking for a lot of finger pointing. However, if your EMR software chooses to integrate a third party software to flesh out the certified EMR requirements and provides you all of the software, then you’re in a much better position. As they say, then you only have one neck to ring if something goes wrong. You don’t want to have to call both vendors and have each vendor point the finger at the other. That’s a position that no one enjoys.

Types of EMR Reporting

Posted on April 28, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Guest Post: Carl Bergman of SilverSoft, Inc. is a principal of

My wife and I play a game called Write Only Files. The only rule is who’s first to notice that something’s been stored never to be retrieved. They come in all sorts of places. I once visited a nursing home that dutifully kept all the residents jewelry in a closet, but without any IDs. It didn’t matter; the owners never came back to claim them.

EMRs are not as dismal, but sometimes I think all we talk about is how to put data in an EMR without dealing with how to get it out. You’d think that the entire function of an EMR is to put in and retrieve single patient records.

Yet, a versatile, intuitive reporting system is absolutely necessary. Not only can it answer questions that paper systems cannot approach, but it also can produce insights into both medical and financial issues fundamental to a practice.

Stage 1 has changed some of this by requiring reporting on populations, not just retrieving single patient records. To deal with this, vendors have put on a full court press to modify their systems for Stage 1 reports. Their efforts, which often required new capacities, point out how neglected EMR report writers have been.

The need for more sophisticated and user oriented report writers is only going to increase. Stage 2, ACOs and other HIE initiatives will make even greater demands not to mention increased use of EMRs.

These external demands will be complimented by user demands for more information about the practice both medically and financially. Meeting these demands are a mixed bag of current systems. Some products will grow into these new roles while other vendors will need to rethink their approach or fail.

Current EMR report writers fall into three basic groups, of which only one can fulfill their role. These are:

•      Wired Reports. These EMRs don’t have a real report writer; instead, they have single purpose “push button” reports for specific purposes. Users have little or no control over what they find or present. A typical report might show no show patients for a day.

•      Parameter Reports. A step up from wired reports, these allow users a fair degree of control over what the report finds and some control over formatting. For example, the user may choose sorting order. These are often built in a tools such as Crystal Reports. Depending on the development effort, the result may be a robust tool. However, the use of third part tool can have major drawbacks. These include:

     o   Rigidity. Modifying a report may require an on site programmer or paying the vendor

     o   Cost. The user often has to pay for the tool, its annual license and maintenance. If there are problems, the user may be caught between the EMR vendor and the tool vendor.

     o   Conflicts. These tools are generalized applications designed to work on many different systems not just the particular EMR. Problems can range from not having the desired function to the tool ending support for the application type.

     o   Learning Curve. Users will have to master both the EMR and the tool’s way of doing things.

•      Built In Report Writers. These are designed as an integral portion of the system. These overcome the problems of the other two classes; assuming they are built to meet a variety of reporting tasks. Even if a report writer can carry find and sort the desired data, it must also meet other requirements. For example, if the FDA issued a bulletin requiring practices to notify all their patients who have Crohns disease and take acetaminophen. The report writer should be able to identify these patients, email or prepare letters to them.

Even if an EMR has a crackerjack system, its mission can still fail if it does not have access to all practice financial data. Systems with a single database can do this. Those that link or coordinate the EMR database and the practice management db have a harder, but possible task. Those systems that have separate, uncoordinated, datatbases are out of luck regardless of how good the individual report writers may be. If a report writer can’t cross the EMR and PM line, it is not taking full advantage of practice data. Each time it can’t produce the needed reports it’s creating write only files for my collection.