While there’s a number of  large, publicly-traded EMR vendors out there — General Electric (NASDAQ: GE) and Cerner (NASDAQ: CERN) immediately come to mind — to date we haven’t seen many mid-sized or small companies kick off an initial public offering. But one medium-sized EMR/practice management vendor has broken the mold.

Today, Greenway Medical Technologies (NASDAQ: GWAY) took the plunge , pulling in $67 million to fund its operations. While the company had hoped to raise $100 million, its take is nothing to sneeze at. Health IT is a tricky investment, even for pros like yourselves, readers, and institutional investors in particular are a conservative bunch. The fact that they’re spending on a risky business means a lot.

Greenway, whose EMR is bundled with practice management software, had one heck of a ride today, with its stock climbing 30 percent during its first day of trading. The company sold 6.7 million shares at prices below its expected $11 to $13 range, diluting its intake somewhat, but the stock closed at a promising $13 per share.

The Carrollton, Ga.-based vendor has certainly done well in recent times. According to insider Wall Street blog Seeking Alpha, Greenway revenues shot up 55 percent, to $25.7 million, during the last quarter of operations. Operating margins went from negative to a positive 2 percent, which is at least a start.  Its biggest cash generator during the quarter was licensing revenue, which climbed 49 percent.

What’s interesting about this IPO isn’t just the fact that it ended well for Greenway. After all, it did take in less than planned, and the Wall Street crowd justifiably wonders how it will fare in a mind-boggling competitive market.  But it’s worth asking whether Greenway did better because it bundles both an EMR and practice management tools. Did the fact that Greenway wasn’t relying solely on EMR revenue contribute to its growth and financial success?  It would be interesting to find out, as that might help predict whether the bundled model is especially popular with physicians.

As for those who’d seek to imitate Greenway, they may have a chance if they move soon. Seeking Alpha editors think HITECH will still pump enough money into the EMR market to make these companies a reasonable investment. And given how many doctors and hospitals are still struggling to put EMRs in place, I have to agree.  In fact, given that an amazing number of hospitals and medical practices junk their first EMR, there may be a whole second wave of opportunity within three to five years.

All told, if the market’s response to a smallish IPO is any indication, you can expect a bunch of other EMR players to follow in its footsteps.  I’m thinking it will be companies in the $100m to $200m range, as they’re small enough to need capital (much cheaper capital than banks offer these days!) and nimble enough to benefit from the cash influx. Stay tuned and in coming months, I’ll tell you which other EMR and HIT companies I’m betting will climb onto the launch pad.

I’m not a big fan of reality shows, especially those that involve contestants singing, telling jokes, dancing, or anything else that could potentially result in public humiliation. I’m in the minority, of course, as this style of television programming shows no sign of abating anytime soon. It’s a worldwide epidemic, in my opinion.

I am a fan of creative marketing – applying concepts traditionally associated with one particular medium (like television) to something entirely different (like healthcare). Needless to say, the Big Break job recruitment program – you could also call them auditions – intrigued me.

In a nutshell, pre-screened candidates take part in a one-day audition process put on by recruitment firm Intellect Resources and participating hospitals. Candidates then compete to become trainers and instruct staff on the use of the sponsoring hospital’s electronic medical record system or related healthcare IT system.

Seems like a slam-dunk concept, in my opinion. Those who are unemployed get a job within their community, and also get a taste of what that popular 15 minutes of fame is like. Did I mention that candidates go through video interviews and public presentations during the daylong process?

I recently chatted with Tiffany Crenshaw, President and CEO of sponsoring organization Intellect Resources, about how the program came about and the impact it has had on its participants’ lives (and go-lives).

How did the Big Break come about?
Tiffany Crenshaw: The Big Break spawned out of a project we were working on at Mt. Sinai Hospital last year. Last fall, they were getting ready for their Epic training and called me in a panic. They were expecting to get 90 to 100 trainers, and were going to use nurses, but realized at the last minute that wasn’t a viable idea. So they called us and said, “We have to do something now – we have no budget and we have no time. And we want to do some sort of done-in-a-day type audition. What can you do?”

So we said this is right up our alley. We created a really cool event – it was at the big Marriott Marquis in Times Square. We had around 500 contestants, and they all went through a timed audition process – stressful for them, but it was still fun.

They had to go through seed interviews and get in front of cameras. They had to get in front of a boardroom of judges and do presentations. At the end of the day, we ended up with 100 trainers that worked at Mt. Sinai to help roll out the hospital’s Epic training and go-live.

So that’s really the model of Big Break. We created it as a solution for Mt. Sinai, and now other folks are getting the word about it. Ochsner Health System is our next one. We’ve got the Big Break event for them in just a couple of weeks (January 21).

Did they reach out to you?
A consultant and dear friend of mine that was actually helping them with their system selection and project planning for their Epic implementation recommended this business model, and brought us in as the vendor to run this product for them. So yes, they did reach out to us, but it was really a consultant that made it happen.

Are you an all-Epic recruiting firm?
At the moment, that’s just about all we’re doing. Through the years, we’ve worked with many other products – with McKesson, Cerner, Siemens. The demand right now is Epic, so by default we’re doing all Epic. That’s just where the demand is, and so that’s where we’re spending our time.

How have you seen this type of program impact sponsoring hospitals and surrounding communities?
We think it’s a business model that works very well for hospitals. It’s a very low-cost way to get good resources. It’s also a good marketing opportunity for them to promote the fact they’re installing an electronic health record to the benefit of their patients, and it’s a great way for them to reinvest in their own community.

At Ochsner, the idea is that this is really for the New Orleans community. They don’t like to hire outside consultants. They really want to empower and revitalize their own community.

Many of the folks that we worked with at Mt. Sinai have gone on to work at other places. Big Break was really their footprint in the door. The end result is that the consultants that come through with really good experiences.  Over 50 percent of them are now working in the industry. Mt. Sinai actually hired four full-time employees. There was a big project up in Rochester, N.Y., that a lot of the people went to after that first project. We redeployed probably 20 of them on several go-lives.

Is there an opportunity for this to work in other cities?
At our very first meeting with Ochsner’s project executive, we talked about the fact that there are several area hospitals in and around New Orleans gearing up for Epic implementations. Our original thought was, let’s do this together, but the go-live timeframes didn’t work.

It would make perfect sense if there were multiple hospitals that could do the event together, do the credentialing together, and then take people from a generic credentialing and deploy them to the individual hospitals to learn the individual builds. I think it’s a model that could be a really good collaboration.

I think one of the neatest things about Big Break is that this industry is so thin on the amount of really good resources that are out there. It’s a great way to breed new talent

Not long ago, I recently posted an item on HospitalEMRandEHR.com discussing how one hospital dropped plans to distribute iPads as front-ends for its Cerner EMR.  Doctors at hospital, Seattle Children’s, gave the iPad very bad reviews as an EMR-connected device, in part because they felt that Cerner’s system was too hard to use via a Safari browser.

Since then, a few readers have commented on the story, and interestingly, they’ve offered more nuanced feedback on what works (and doesn’t) in deploying a tablet as an EMR device for clinical use, including the following:

* Deploying the iPad initially offers a patient “wow factor” — in other words, it may make providers look hip and up-to-date technically — but that doesn’t last very long.

* Even a well-designed, tablet-native tablet app may still be frustrating for clinicians to use, given the high volume of information they need to enter. (Paging through a dozen screens is no fun.)

* When choosing a tablet, be aware that the physical performance of the tablet (especially the touch screen) can be a big issue.  If clinicians “touch” and the screen doesn’t respond, it can throw them off their stride.

It’s hard to argue that hospitals (and medical practices) should take mobile access to EMRs seriously. And anyone here would know, most organizations are.  After all, now that health IT industry is looking hard at mHealth, smart new ways to use mobile devices in care seem to be springing up daily.

But before you dig too deeply into your mobile strategy, you may want to hear more clinicians on how their mobile EMR usage is playing out. Call me a curmudgeon, but it seems to me that it may still be too early to invest big bucks in a tablet for mobilizing your EMR just yet.

Don’t get me wrong: I’m convinced that someday, every doctor will enter and access patient data via some sort of mobile device. But it seems that there’s some fairly important technical issues that still need to work themselves out before we can say “this is how we should do it.”

Note:  The following is not to be taken at face value, exactly — I’m not literally convinced that it’s time for a revolution — but you might see a point or two here that are worth considering further.

Doctors, are you sick of having an EMR pushed down your throat by administrators and IT leaders that don’t care how disruptive or painful the change may be?  Do you feel like your complaints and concerns aren’t being heard?  Are you actually afraid a patient will be hurt someday because of the EMR’s limitations?

Well, I say it’s high time you get radical and OccupyYourEMR!  Get in there and resist until your (absolutely critical) voice is being heard.

If you don’t, you know you’re going to be steamrolled into using a platform that’s awkward, ugly, inflexible and slow — in short, a system only the IT admin and hospital board who funded it could love.   Maybe you’re not ready to stop working, but what if you refused to log in?

As things stand, you have little to gain and a lot to lose by blindly kowtowing to EMR adoption demands.

Hey, if Hospital X installs an EHR and it seems to work, the CIO and the CEO and the board of directors look like geniuses. Some of them will probably get big bonuses if everything falls into place just right.

You, on the other hand, will be lucky if the new system doesn’t cut your work pace in half, confuse you and make charting a painful chore. Oh, and if things really go badly, you’ll harm or kill a patient because you didn’t read the EMR right.  Of course, the hospital will be right there beside you offering the best legal defense money can buy, right? (Uh, not really…)

Yes, there are some stories out there about EMRs that actually improve patient care and make doctors’ lives easier, but let’s face it, there’s a reason we don’t publish a ton of those here (or on sister blog Hospital EMR and EHR).  I’m not suggesting that all EMR rollouts are a mess, but few are a walk in the garden either. And it’s more common than you might think for a provider organization to go through a second or even a third installation before everything works.

Hey, don’t misunderstand me, I still believe EMRs are going to be a positive force over the long term.  In the mean time, though, some clinicians will be casualties — either becoming burned out by new work expectations, hating the new process or even making dangerous mistakes. Don’t be one of them.

Demand an EHR that helps your workflow, helps you provide better patient care, makes your life better, and lives up to the expectations the EMR salesperson made. An EHR that does those things will be welcomed by almost all doctors and other staff.

I don’t know about you, but I’m not exactly sure what an Accountable Care Organization is. In fact, I’m betting nobody is — there’s a bunch of harrumphing and throat clearing out there, but I haven’t seen any crystal-clear descriptions out there.  Shall we say that ACOs are more honored in the breach than in the observance and leave it at that?

Now, we come to the puzzling part of this piece. If nobody’s managed to define an ACO clearly, how can any particular EMR be a better ACO tool than another?  We’ll have to ask KLAS about this one, since they’re the ones that discovered this “fact.”

Today, KLAS announced that it had interviewed 197 providers at 187 organizations to see how ACOs are forming up. A third of the respondents said that they were pursuing a formal Medicare ACO designation, and the majority were felt ACOs were the future, KLAS reported.

Sure, considering that ACOs are just risk-taking organizations with a capitated feel, some people already have a sense of what to expect. But throw an EMR into the mix and we’re in new territory — hopefully good territory, but new nonetheless.

So, tell me how providers know that Epic and Cerner are the most ACO-ready? Apparently, respondents believe that Cerner already has many of the IT pieces needed to run ACOs; moreover, they say Cerner is working closely with providers interested in the ACO model.

Survey takers also gave a nod to Epic, which they see as being close to ready (though behind in analyics and ability to share data with non-Epic users).

Wait a minute — let me get this straight.  Respondents know Cerner has the right pieces, even though the ACO doesn’t exist yet?  They like Epic, even though it doesn’t share data outside of its walled garden?  KLAS is kidding, right?

At this point, I’ll be kind and say that Epic and Cerner users are a bit brainwashed, which I too might be if I’d spent the kind of money those folks have on an EMR.

But the voice in my suggests that KLAS might have had its finger on the scales just a little bit. I will not publicly state that Allscripts, CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens scored worse because they didn’t pay for play…but something sure isn’t right here.

I came across an article the other day about “10 of Today’s Hottest Jobs” and was not surprised to learn that five of the cited 10 had something to do with healthcare or IT. We’ve all been told time and again that healthcare reform and its incentivized plans for IT implementations will lead to a greater demand for healthcare information management and IT positions, including the much-coveted EMR implementation specialist. But as we’ve all realized, just because industry demand for these types of positions has risen, that doesn’t mean they are being filled quickly – or at all. The same article alludes to what is happening in the healthcare IT job space right now: “Believe it or not, even with the unemployment rate stubbornly high and many industries reluctant to staff up, there are employers out there who still can’t find enough qualified applicants.”

And there’s the rub. Many healthcare vendors and consulting firms, particularly those involved in healthcare IT implementations, are looking for “qualified applicants,” and completely overlooking the enormous pool of talent that newly graduated job seekers have to offer. This certainly isn’t a new observation, but as America – whose citizens are experiencing unemployment at record levels – sits down tomorrow night to watch President Obama address the nation’s employment situation in front of Congress, it certainly is a timely one.

Let’s take a look at two videos that highlight the employment disconnect between higher education in healthcare IT, and the types of firms that would seem to be hiring new graduates.

In the first, Kelly Patterson from Hinds Community College in Raymond, Mississippi, chats with a local news station about the Office of the National Coordinator for Health Information Technology’s (ONC) Community College Consortia Program, which trains individuals in healthcare IT workforce roles, including EMR implementation.

In the second, employees at Cerner Corp. chat about how happy they are to work at the company, and list many benefits of being a Cerner employee. Most are young – many could be recent college graduates – and seem enthusiastic about their careers.

So if national training programs abound, and vendors seem eager to hire fresh talent, where is the disconnect? Why do statements like the one below seem like a dime a dozen these days?

“Training and certification do not seem to be enough. As in all new fields, experience comes from experience.” – Nachum Greenspan via LinkedIn

EJ Fechenda at HIMSS JobMine gave her two cents on how to bridge this employment gap in a recent blog: “With federal deadlines looming, healthcare organizations need to get moving and there are a lot of job seekers out there ready for the challenge. Are there organizations or companies willing to extend opportunities to these candidates? Is there a training or job-shadowing program that can be used as a best practice for other organizations to implement? Who are the champions already doing this or willing to lead the charge?”

I’d love to hear from any recent healthcare IT graduates who have been hired recently and have an employer willing to help train and mentor them. It takes champions, of course, but every champion needs someone to fight for.

Our next edition of EMR and EHR interviews covers the experience of Jan Patterson and the West Broadway Clinic’s path to meaningful use. The full EMR interview with Jan Patterson can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our Contact Us page.

West Broadway Clinic is one of the first clinics to show Meaningful Use. Jan Patterson, the office manager of West Broadway Clinic explained it was the clinic’s desire, from day one, to start using an EHR. The EHR certification is a vital piece for meeting the CME incentive requirements. Additionally the providers felt by using an EHR on day one they could ensure a continuity of care, regardless of which provider a patient might see in the clinic.

The clinic had heard about Cerner Corporation through one of the local hospitals. After interviewing several other vendors it felt that the integration of Cerner’s Practice Management System and Ambulatory EHR would suit its needs best.

West Broadway began using its EHR in May of 2008 and Patterson stated it was able to meet at least 9 of the meaning use requirements because of its EHR. Patterson felt two of the major factors contributing to meeting those requirements so easily were the elements already built into the EHR and the use of the Cerner EHR. As the clinic encountered issues it was able to contact Cerner’s Meaning Use team to assist in the process of attestation.

Additionally, attending Webinars set up by Cerner Corporation, examining materials provided by Medical Group Management Association (MGMA), and attending an MU Summit set up by Cerner Corporation to highlight some of the more important segments of MU, all played an integral role in ensuring West Broadway Clinic would meet Meaningful Use requirements.

The most challenging Meaningful Use requirement was encouraging all of the providers to use the electronic prescriptions function. After reaching MU in just over three months, just two days after attestation opened, Jan Patterson states the clinic continues to maintain its high level of entering the patients’ correct and necessary data and the numbers of electronic prescriptions being sent to pharmacies are increasing.

The benefits to patient care are immediate access to the most current visit information and patient history at its finger tips. Patients receive more continuity of care due to the fact that regardless of what provider they are seeing within their office , the provider can quickly and easily track what services and/or medications a different provider has provided the patient. Components such as eprescribe, medicine/drug interactions, allergy checks, complete documentation, immunization schedules and growth charts etc., have made the clinic more efficient throughout the office.

Patterson’s advice to anyone starting the MU process is to make sure you have gathered all the information and facts first and ensure all physicians/staff are not only fully advised of what is required to meet MU but are also committed to following the process through to its completion. It is important they understand the benefits and necessity of Meaningful Use. After three years of being on an EHR, Patterson cannot imagine functioning as efficiently on a paper system. Although Patterson acknowledges the money as an incentive, the real benefit in successfully attesting is the benefit to their patients. As Patterson suggests, “The increased benefits of safety cannot be undersold. With the assistance of the EHR, we are practicing better, safer medicine than we could on paper records.”

Read the full transcript of Jan Patterson’s interview.

Few would argue that Epic is one of the two or three most visible enterprise EMR vendors on the market today. There’s little doubt that these days, Epic is shortlisted when hospitals plan an EMR rollout, alongside of giants like GE and Cerner.

It’s hard to imagine that Epic isn’t in a sweet financial position, practically stuffing warehouses full of the revenue they’re generating in this pivotal period of HIT history. (For a sense of the scale involved, bear in mind that Kaiser Permanente’s reportedly $4 billion to $6 billion EMR rollout was an Epic installation.)

That being said, we really don’t know. Why? Well, while Cerner and GE and McKesson are public companies, Epic remains privately held. Looked at another way, health systems that sink half a billion dollars over five years to implement Epic know far less about its financial situation than they would about Cerner’s.

So, maybe I’m wandering out on a limb here, but if I were a big health system, wouldn’t it be a little bit concerning not to know some details on how robust the company’s financial picture is? Does it really make sense, despite its strong reputation and impressive customer list, to spend a staggering sum on Epic without some third-party analysis of its prospects?

After all, when you spend the kind of money health systems are spending, that vendor becomes an incredibly important partner. But if the vendor’s not open to Wall Street scrutiny , it might get away with fibbing about its ability to deliver.

Mind you, I’m not saying that health systems that go with Epic — or any other privately-held vendor — are behaving irresponsibly. It’s just that in this climate, more information can’t hurt.

P.S.: I began thinking about this when I saw a question (posted on Quora.com) asking what Epic would be worth if it went public. Could the poster know something we don’t?

A new user poll suggests that vendor support is more important than ever to providers  searching for EHRs.  New research from the Black Book Rankings concludes that late adopters of EHRs  are especially concerned about finding vendors who will support their products  through implementation.

Researchers surveyed roughly  30,000 medical  records professionals, hospital execs and medical practice administrators, asking them how vendors rated on 18 performance indicators useful  in comparing customer experience.

The study found that:

* CPSI, Healthland Clinicals  and HMS were rated as offering the best customer  experience for hospitals under 100 beds

* Cerner, Dell and Quadramed  got top rankings for community hospitals  of 101-249 beds

* Dell, Epic  and Siemens were rated best  among major medical centers of 250+ beds and academic medical centers

EHR vendors, are you ready to do a  lot of handholding?  If not, it seems you may get edged out by EHR developers who are. Consider yourself warned.

This is the third post in the series of posts(see the previous ONC-ATCB Certified EHR Breakdown and ONC-ATCB Certified EHR Breakdown by Certifying Body) looking at the EHR certification numbers put together by HITECH Answers. The following is a list of Certified EHR products by vendor:

Top 3 Vendors by number of Products Certified
- Cerner Corporation – 13 products
- Siemens Medical Solutions USA Inc – 9 products
- Epic Systems Corporation – 4 products

I guess these are the EHR software you want to avoid. Ok, that’s partially facetious. Just, can you imagine trying to battle the other 12 certified EHR to get support. Granted, most of them are likely hospital EHR and so there are usually support contracts in place to deal with this kind of thing. Don’t worry though, Allscripts should be on this list soon. I think they have something like 7 EHR software for just ambulatory right now. I guess that’s the nature of acquisitions.

It will be interesting to continue to see this evolve.