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Have You Ever Tried to Cancel an EHR?

Posted on July 15, 2014 I Written By

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

A caller’s attempt to cancel their Comcast service is going around the internet. About 10 minutes into the call, the husband got on the line and started recording the call for all of us to see how the Comcast retention rep acted. You can listen to it embedded below.

I imagine most of us have had an experience trying to cancel our service at one time or another. It’s not a fun experience. Although, I know some people who call to cancel their cable service every 3 months in order to have the customer retention representative give them a lower cost deal. You know that offering you a 3 month lower cost (or something like that) is one way they try to retain you as a customer.

As I listened to the call, I was thinking about some of the experiences I’ve read and heard about clinics cancelling their EHR service. Unlike a cable or TV service where it’s quite easy to switch services, switching EHR software is a much more involved process. In many cases EHR vendors hold you “hostage” more than the Comcast retention rep above.

In most cases, the EHR vendor will go radio silent on you or responses to your inquiries will take a really long time. Plus, when you ask for access to your EHR data, you’ll often get hit with a hefty price tag. It’s a shameful practice that many EHR vendors employ to try and lock their customers in and prevent them from switching EHRs. We’re entering the era of EHR switching and this is going to impact a lot of practices going forward.

I’ve debated for a while now creating an EHR “naughty” and “nice” list which outlines the good and bad business practices by EHR vendors. One of the challenges is defining what’s naughty and what’s nice. There’s a lot of grey area in the middle. Although, I think that aggregating this type of information would be really valuable. I’m just afraid that many EHR vendors won’t want to share.

I’ve written posts before about why I think holding a practice’s EHR data hostage is a terrible business practice. The medical community is small and an EHR vendor that tries to do this will definitely suffer from negative word of mouth. What do you think? Should we create a list of EHR vendors and their policy on EHR cancellations?

Homegrown EMRs with Joel Kanick, InterfaceMD

Posted on December 10, 2013 I Written By

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

I had a chance to sit down with Joel Kanick, President and CEO of Kanick And Company and Lead Developer and Chief Architect of interfaceMD. In this video we discuss the story behind interfaceMD and their custom EHR solution. We talk about meaningful use and the EHR incentive money. We also talk about healthcare interoperability and exchange of patient data. Joel and interfaceMD have a really unique approach to EHR that I think many will find interesting.

I was really interested to hear the story behind how interfaceMD came to be. I wonder if people would be interested in a whole series of videos with EHR founders that cover the background story of EHR companies. Let me know in the comments.

What Really Differentiates EHR Companies?

Posted on February 8, 2013 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.

My post yesterday on EMR and HIPAA called “Does Spending More on EHR Mean You Get More?” started me thinking what does differentiate one EHR company from another. I think there’s a real disconnect between what most people selecting an EHR use to differentiate EHR companies with what really matters to the users of an EHR.

First let’s take a look at some of the many ways that I see doctors and hospital CIO’s using to differentiate EHR companies. Many use price as an indicator of quality. Hopefully this post puts that to bed. Price matters, but it’s not a great indicator of EHR success. Many are swayed by great sales and marketing by EHR companies. It’s hard to deny that seeing an EHR vendor with a full HIMSS booth doesn’t have some effect on what you think of that EHR vendor. Going along with this is having the big, well branded name recognition. Although, what’s in a name if the EHR software doesn’t meet your specific needs?

Another differentiator that many use is KLAS or other ratings. When I’ve dug into all of the various EHR rating and ranking systems, there are flaws in all of them. Some lack enough data to really draw conclusions. Some use bias methods for collecting data. Some EHR ranking services don’t use data at all. It’s amazing how interested we get in a list that may or may not have any legitimate value. Every EHR vendor has some flashy numbers to share with you. Just remember that numbers can lie. You can make them appear any way you want.

I’m a little torn on the idea of EHR certification and access to EHR incentive money being a point of differentiation for EHR vendors. There are so few that can’t get you there, that it’s almost a non-issue. Sure, if you really want to get the EHR incentive money, you could and should talk to the users of that EHR that have gotten the EHR incentive money. However, because almost every EHR vendor is a certified EHR that can get you to meaningful use, not being certified might actually be a more exciting. The story is reasonable: our EHR focused on what doctors care about in an EHR as opposed to some random government requirements. Could be a compelling message. Especially for those doctors who don’t qualify for the EHR incentive money.

What should be used to differentiate EHR companies?

The number one thing that I think doctors should look for in an EHR is efficiency. A large part of the coming Physician EHR revolt is due EHR software’s impact on physician efficiency. Yet, most doctors selecting an EHR pay little attention to the effect of an EHR on efficiency. This data is harder to get, but a good survey of existing EHR users can usually get you some good information in this regard.

Another area of differentiation with EHR companies should be around their EHR support and training. How quickly an EHR vendor answers support requests and how well an EHR gets you up and running on an EHR is extremely important. As someone on LinkedIn mentioned today, EHR is not plug-n-play software. There’s more to an EHR implementation than just plugging it in and going. It requires some configuration and learning in order to use an EHR in the most effective way.

How come we don’t use the quality of care that an EHR provides as a method of differentiating EHRs? The answer is probably because it’s a really hard thing to measure. I wonder if any EHR has found a way to show that their EHR provides better care. There’s plenty of anecdotal examples, but I wonder if anyone has more data on this.

Another point of differentiation that I think matters is how an EHR company approaches its relationship with the users. Does the doctor, practice and hospital feel like a partner of the EHR company or are they a distant customer. You can imagine which situation is better than the other. This relationship will matter deeply as you run into problems that are unique to your environment. I assure you that this problems will come.

I also see technology approach as a really important factor for EHR companies. When I say this, I think most people start to think about SaaS EHR vs Client Server EHR. Certainly that is one major component to this idea, but it should go much deeper. You can tell by the way an EHR’s technology approach if they’re focused on the right things. Do they take shortcuts when they implement technology? Are they thoughtful about what really matters to the EHR user? Do they implement something on a whim or do they think deeply about the impact of a feature? While every EHR company has limits on what they can put out in a release, they can still provide a great roadmap of the current release and their plans for future releases which shows that they understand the needs of the users.

I’m sure there are many more good ways to differentiate an EHR company. I look forward to hearing more of them in the comments. We just need to expand the discussion to things that really matter as opposed to basing our EHR decisions on vanity metrics.

Purpose of Meaningful Use

Posted on August 8, 2012 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.

Lately I’ve been quite disturbed as I’ve read all sorts of commentary about the “Purpose of Meaningful Use.” Here’s one such comment on meaningful use that I read recently:

My impression is that EMRs and meaningful use were about getting Americans to practice evidence-based and comparative effectiveness medicine towards a more streamlined and cost-effective US Healthcare System

Some of you might remember when I questioned the “meaning” of meaningful use as described by Farzhad Mostashari. So, this is not a new subject for me to consider.

Here’s the problem:

The purpose of meaningful use was to be sure the ARRA money was spent on software that doctors actually end up using. Everyone has then taken meaningful use whatever direction they want.

We can certainly talk about the possible impacts and unintended consequences of meaningful use, but let’s not confuse the possible impacts with the purpose of the legislation.

It turns out that meaningful use is actually accomplishing its purpose as I describe it above. At least in Medicare where meaningful use is a requirement there aren’t EHR companies gaming the EHR incentive money like they are in Medicaid. Sure, with self attestation you could lie about your “meaningful use” of an EHR, but I have yet to see it and think it is very unlikely.

You may have noticed that I don’t write about meaningful use as much here on EMR and EHR. That’s because on EMR and HIPAA I (with some great help) have been doing a weekly Meaningful Use Monday series over the past year. Check it out if you’re interested in the details of meaningful use.

EHR Vendor Consolidation

Posted on June 15, 2012 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.

Katherine Rourke recently did a post on EMR and HIPAA entitled, “Major EMR Vendor Consolidation On The Verge.” This is an incredibly important topic, and so I’m glad that she’s writing about it. However, I have a number of differing views on EHR consolidation.

Probably the two biggest differences of opinion is how quickly she believes we’re going to see EHR consolidation and how much EHR consolidation will happen. Sure, we all know that the current mass of EHR companies isn’t sustainable (I personally put us at about 600 EHR vendors, versus her 1000+ EHR company projection).

In my EHR Company Funding Risks series I looked at all the various type of EHR companies. In that analysis, I realized that each type of company seems to be really well funded through at least the next stage of meaningful use stage 2. Sure, there might not be a few that make it that far, but I believe that most of them will. So, yes EHR consolidation has got to happen, but I don’t see EHR companies falling like flies until at least after meaningful use stage 2 and possibly after meaningful use completely.

I also don’t believe that we’ll ever see the MASS EHR consolidation that many predict. The reason I believe this is that healthcare is very regionalized and so I think there could be many regional EHR companies that are quite successful. Plus, there are such a wide variety of practices including things like: specialty, practice size, billing method, etc on top of local that I believe each of these factors are likely to make it that each factor could have its on EMR market.

Plus, the other challenge I see is that there are a large number of EHR vendors that I know that have no interest in consolidation. In many cases they’re what I call Cash Flow Positive EHR companies and so they are in a good position to last for a long time to come and don’t have any need to sell their company to someone else. I believe they’re in a very good position to be around for a long time.

I imagine some would make the argument that there could be some market forces that could come into play that would change this situation. The most likely argument I’ve heard is the new ACO (accountable care organization) model requiring a large EHR company that can support the entire ACO. This is an important change that should be considered, but I personally don’t think this will drive EHR consolidation. We’re going to have a heterogeneous EHR environment and so ACOs will have to be possible across EHR companies. I don’t see a small set of EHR companies creating a virtually ACO monopoly and shutting out certain EHR companies from that ACO. Although we’ll see how that plays out.

I am interested to hear what other forces people see that could cause EHR market consolidation to happen faster.

I also concur with Katherine’s suggestion that practices have a plan if (and in many cases when) something happens to their EHR company. Maybe I should start seeking out and publishing experiences of practice who’ve gone through this and can share what they learned.

EHR Company Funding Risks – Large Company Backed EHR

Posted on June 1, 2012 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 is the fifth and final post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Large Company Backed EHR.

Large Company Backed EHR
The companies in this category are quite interesting, because they can often exhibit the characteristics of EHR software in every other category of EHR company. It’s all about the story of the company. For example, I’ve come across some really large companies who have developed their own EHR and only have 1 practice using their EHR. This is very much like a seed company. There are some larger companies who have acquired essentially the EHR software of another company and now they’re trying to grow the user base similar to a well funded EHR company.

I can think of a few EHR acquisitions where the large EHR company acquired a cash flow positive EHR company and they’re continuing to grow that EHR company in a cash flow positive way. Then, of course there are a few large companies that have large EHR install bases as well. There’s also everything in between in this category, so it’s hard to generalize about this group.

With that said, since it has the backing of a large company (in healthcare or not in healthcare) the biggest risk is that they’ll shift their priorities from the EHR software and on to something else in their company. Most large companies trying to get into the EHR software business come quick out of the gate. If they do well, they’ll continue growing it like they did. If they don’t do well, they’ll often throw in the towel by cutting resources to that venture and then eventually a sale of the EHR assets to another company.

Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Large EHR Companies

Posted on May 29, 2012 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 is the fourth post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Large EHR companies.

Large EHR Companies
Most of the EHR companies that fit into this category are publicly traded EHR companies (with a few notable exceptions). Each of these EHR companies has their own story, but the majority include some mix of EHR acquisition or EHR merger to get into or expand their EHR market reach. Often this means that the EHR company has more than one EHR software under their purview.

Many of the larger EHR group practices and particularly the multi specialty clinics look to the larger EHR companies because these large EHR companies have usually worked to try and cover every EHR specialty in their EHR. In most cases the EHR software has been around for a very long time. This is good because then the software is often mature, but it’s also bad because it’s often built on old technology.

The large complaint against these large EHR companies is that they’re large and impersonal. That they are out of touch with the customer. Of course, this is kind of the nature of being a large company and having a large user base. Plus, you can imagine the challenge listening across a half dozen different EHR software products.

The risks associated with these large EHR companies software usually has much less to do with cash flow and much more to do with the decisions of the EHR company executives. With multiple EHR software under their umbrella, will they choose to close the one you use down and focus on their other EHR products? Will your EHR product get lost in the corporate shuffle of priorities? Sure, they’ll still support your EHR product if there’s an issue, but have they dedicated the company resources to your EHR or to another product in the company’s portfolio?

One argument that larger EHR vendors have made is that they’re the only companies that have the resources available to create the EHR software of the future. Some argue that many of the smaller EHR companies won’t be able to meet meaningful use stage 3, because they don’t have the resources available to do that. Not to mention when we eventually have to do Watson like Smart EHR software integrations across large data sets. I think the first part about doing MU is overstated. I think the jury is still out on how smart EHR software will become over time and how smart physicians require their EHR to be.

Next up, we’ll look at Large Company Backed EHR. Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Positive Cash Flow EHR Companies

Posted on May 25, 2012 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 is the third post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Cash Flow Positive EHR companies.

Positive Cash Flow EHR Companies
This type of EHR company is usually a conservatively funded EHR company (often through non traditional funding mechanisms, or through a private buy out) that have grown large enough that their current user base provides enough cash flow to cover the EHR company’s ongoing expenses. The majority of these EHR companies have been around for a long time. In most cases they started out as EHR only companies (since everyone already had a PM system) and over time were able to grow a large EHR user base.

Instead of going after a large funding round, these EHR companies stayed small and chose to grow slow and steady over time. At this point, most of these companies have a large enough user base and enough cash flow that they’re in it for the long haul. While a sale could happen, most are content to continue growing the way they’ve done for a long time.

The users of these systems are usually happy with the software. Plus, they’ve often been using it so long that the idea of switching is something they wouldn’t even entertain. Even if the EHR software has some issues, the practices know the problems and have found ways to work around them. Plus, I’ve heard from many about the kinship they have with the EHR software that they’ve had for so long.

The real question for these EHR companies is how well they’ll be able to retain their existing EHR user base and/or how well can they acquire new EHR users. At some point if they aren’t maintaining or growing their EHR user base, they won’t have the cash flow needed to continually improve the EHR system with changing technology and clinical requirements. Plus, considering the fast pace of technology, time and their legacy software creation starts to catch up with them.

Many of the best specialty specific EHR companies have been able to reach this category. Some are still in the seed funded or well funded categories, but most of the specialty specific EHR companies I’ve seen have reached the cash flow positive category or are really close to getting there. Most of them realized that they had a very specific EHR market and so they had to grow it slow, steady and focus on revenues early.

Next up, we’ll look at Large EHR Companies. Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Well Funded EHR Companies

Posted on May 22, 2012 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 is the second post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Well Funded EHR companies.

Well Funded EHR Companies
These EHR companies are those that have moved past the beta phase of their EHR and have usually gotten a large second round of funding that will allow them to work on scaling their EHR user base. This is where I see the largest number of what most would consider “startup” EHR companies. They usually have a few million in the bank and somewhere between 50-200 doctors on their platform.

With the money in the bank, most of these EHR companies have a number of years of runway to be able to see their EHR company play out. They still haven’t made it to what I call the EHR promise land of 1000+ doctors on their platform, but they have enough money to try and reach that goal over the next couple years.

The risk for a practice choosing one of these well funded EHR companies is what will the EHR vendor choose to do once they reach 1000+ doctors. Will they sell the company off to someone else (which almost never ends well for the practice)? Or do these EHR vendors have the staying power and desire to go after something much larger? The other risk is that the EHR company will only ever have a few hundred doctors. When you’re a well financed EHR company that doesn’t gain traction, this will usually end up in a fire sale of the EHR to some other company who wants to acquire the users you do have.

Despite the risks mentioned above, many really love these “startup” EHR companies that have plenty of funding. They’re usually very responsive companies that are able to have a real personal touch with their users. They usually have some unique selling proposition which the practice found so intriguing in the first place.

Most of the Free EHR vendors fit in this or the previous seed funded category as well. However, the amount of funding that the Free EHR vendors require is a multiple higher because they usually need to be able to reach a certain install base before their revenue model kicks in. The other principles are very much the same. Although, most of the free EHR vendor revenue models require a large user base. The Free EHR promise land is probably closer to 10,000 and some might argue that to really make it work they need 100,000+.

Next up, we’ll look at Positive Cash Flow EHR Companies. Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Seed Funded EHR Companies

Posted on May 18, 2012 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.

In my post called The Current Health IT & EHR Bubble a good conversation was started about the way EHR companies are funded and how many of them are at risk of running out of money. Obviously, this should be a concern to anyone selecting an EHR software. Once an EHR company runs out of money, it’s almost never pretty for their users. The EHR software is usually sold to a larger EHR vendor or other EHR competitor and you can imagine which EHR that vendor chooses to sunset.

Here’s a look at how I define the various funding for EHR companies and the risks associated with each EHR funding situation: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. I’m sure some of these categories could be divided other ways too. Plus, some EHR companies fall into the middle of 2 categories. However, hopefully you can use these categories to get an idea of how the EHR software you have or are looking at getting is positioned as far as EHR funding.

Over the next couple weeks, I’ll take each category (Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR) and discuss how I define each category and some of the characteristics and risks associated with each type of EHR vendor. First up is Seed Funded EHR companies.

Seed Funded EHR Companies
This is the relatively new EHR company. In most cases, these EHR companies have a very small set of basically beta EHR users. Most people see these companies as the most risky and that’s probably true. Small funding and small user base means you have less revenue and less cash in the bank. However, most of these companies also have smaller staff and burn through money much slower than large companies.

The question with seed funded companies is can they get to either the next round of funding (the more likely option) or enough users before they run out of money. This is often a hard question to answer. In the current EHR investment market, it seems most EHR companies in this stage have gone and gotten the next round of EHR funding while the funding market is good.

Some physicians love these companies. As one of their beta users, your feedback is heard and incorporated into the product. Plus, it’s exciting for many of us to see something build out over time. This is particularly true when the small EHR software company is doing something innovative and unique. The good part for the EHR market is that if a company like this runs out of money, only a few practices are affected. Plus, those practices that are affected usually knew what they were getting into when they chose the small EHR company.

If a seed funded EHR company is able to build a user base with just their seed funding combined with some good boot strapping, a number of them will be able to kick and scratch their way to profitability with a much smaller group of customers. Although, once they do that, they move from this category into the Cash Flow Positive category of EHR companies

Next up, we’ll look at Well Funded EHR Companies. Read all the posts in the EHR Company Funding Risks series.