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No Shortage of Excitement (This Week) in Healthcare IT

When I began contemplating the subject of this blog earlier in the week, I thought I’d make room for thoughts on recent improvements in EMR adoption in the small practice and physician community, and the general state of optimism and enthusiasm some op-ed pieces would have us believe is finally taking hold of the industry. But then came along the potential delay of ICD-10, which also begs a quick comment or two.

A bill that included an effort to delay the ICD-10 compliance date a full year was passed, but only after partisan drama over the fact that legislators received the proposed bill just a day before the vote on it was to take place. I tend to turn to AHIMA on ICD-10 matters, and its official stance is fairly obvious:

ahimaicd10tweet

Its reasoning is similar to that of the Coalition for ICD-10, which in a letter to the CMS, stated: “ … any further delay or deviation from the October 1, 2014, compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending. By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients. Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

AHIMA has even started a campaign to encourage its constituents to email their senators to urge them to also vote no when it comes to delaying ICD-10. At the time of this writing, the Senate vote is not yet scheduled. I don’t feel the need to restate my support of no further delay. You can read it here.

With regard to the other hot news items of the week, I was intrigued by the findings of the SK&A survey, which found that the EMR adoption rate for single physician practices grew 11.4%. One reason SK&A gave in the survey analysis was due to the “availability of more than 450 different solutions to fit their practice needs, size and budget.” Call me crazy, but I’m willing to bet that many solutions will not exist in the next three to five years thanks to market consolidation. What will these physicians do when their EMR vendor closes up shop? Time will tell, I suppose.

March 28, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Specialty EHR Speaks that Specialty

I’ve long been a proponent of the role of specialty specific EHRs. In fact, at one point I suggested that a really great EHR company could be a roll up of the top specialty specific EHRs. I still think this would be an extraordinary company that could really compete with the top EHR vendors out there. For now, I haven’t seen anyone take that strategy.

There are just some really compelling reasons to focus your EHR on a specific specialty. In fact, what you find is that even the EHR vendor that claims to support every medical specialty is usually best fit for one or a couple specific specialties. Just ask for their client list and you’ll have a good idea of which specialty likes their system the most.

I was recently talking with a specialty EHR vendor and they made a good case for why specialists love working with them. The obvious one he didn’t mention was that the EHR functions are tailored to that specialty. Everyone sees and understands this.

What most people don’t think about is when they talk to the support or sales people at that company. This is particularly important with the support people. It’s a very different experience calling an EHR vendor call center that supports every medical specialty from one that supports only your specialty. They understand your specialties unique needs, terminology, and language. Plus, any reference clients they give you are going to be in your specialty so you can compare apples to apples.

Certainly there can be weaknesses in a specialty specific EHR. For example, if you’re in a large multi specialty organization you really can’t go with a specialty specific EHR. It’s just not going to happen. With so many practices being acquired by hospitals, this does put the specialty specific EHR at risk (depending on the specialty).

Another weakness is when you want to connect your EHR to an outside organization. Most of them can handle lab and prescription interfaces without too much pain. However, connecting to a hospital or HIE can often be a challenge or cost you a lot of money to make happen. Certainly the meaningful use interoperability requirements and HL7 standards help some. We’ll see if it’s enough or if the future of healthcare interoperability will need something more. For example, will specialty specific EHR be able to participate in CommonWell if it achieves its goals?

There’s a case to be made on both sides of the specialty specific EHR debate. As with most EHR decisions, you have to choose which things matter most to your clinic.

June 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Why 2013 Will Be A Good Year For EMRs

Recently, I wrote an article listing some unpleasant, stubborn EMR problems that are likely to cling to the industry like sticky burrs in 2013. Being a fair-minded gal, I also wanted to stop and reflect on what’s likely to work in favor of EMR adoption, maturation and success next year, so here goes:

*  Consolidation will lead to a more-stable vendor market:  With the (in my opinion) wave of new EMR vendors beginning to recede, the shakeout will begin. Vendors that remain may not be the best, sadly, but they’ll be better funded and hopefully better situated to take care of customers.

*  We’ll have a good amount of Meaningful Use experience under our belts:  Starting out with Meaningful Use has been nerve-wracking for all. But by 2013 the industry will have begun to acclimate itself not just to meeting MU standards, but making them work for their particular clinic or hospital.

*  Vendors are likely to offer more mobile options:  Right now, EMR vendors are offering minimal efforts around mobile EMR applications. My gut is that in the coming year, we’ll see some definitive progress on Android and iOS-natve EMR apps. There’s just too much demand to ignore.

*  Template medicine will get more sophisticated:  When templates merely inconvenienced doctors, nobody seemed that worried about their potential side effects. Now that it appears that templates encourage costly upcoding, however, it’s likely that vendors will be forced to make them smarter and less prone to encouraging cut-and-paste documentation. (How, I  haven’t a clue, but the pressure will force something to happen.)

Now, none of these are exactly raving endorsements of the EMR climate for next year. I’m not suggesting that adopting EMRs will suddenly become easy, training a breeze or ROI will magically appear.  But I do believe that we’re going to be seeing a nice uptick in EMR maturity.

December 14, 2012 I Written By

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

Early Signs Of EMR Consolidation Appearing

Some of you are going to tell me that I’ve jumped the gun, but I’ve got my feeling about this and I’m sticking to it. Though nothing massive has happened yet, I believe we’re officially beginning to see consolidation in the EMR world.

I was struck with this idea today when I came upon the news that physician EMR company Imagine MD was closing. According to MedCityNews.com, the cloud-based EMR company had pulled in $25 million in venture money, $10 million of that in the last 12 months. And until recently, it looked as though it had staying power; Imagine MD had been in business since 2006, well ahead of the pack of competitors pitching small medical practices.

Another sign that we’re seeing consolidation comes in the form of the acquisition of Amazing Charts by Pri-Med, a provider of professional medical education to more than 260,000 clinicians. (I wouldn’t have expected a medical education company to be the one to acquire Amazing, but that’s a story for another time.)

While I admit two examples isn’t exactly a statistical bump, it’s a clear enough sign for me that the market has begun to pull together. After all, with EMR adoption on the rise among medical practices, there’s only so many customers left to compete for, and that can only mean more closings and M&A.

The really important question, if you’re a doctor hoping to avoid a big practice disruption, is whether you can predict which direction your present or future EMR vendor is going.  That is, of course, a pretty tricky game.

But if you’d like some food for thought, you might consider checking out a previous post by John, comparing “fast EMR companies” fueled by venture capital to slower-moving types that grow organically and don’t tend to accept venture capital investments.

While there are exceptions — notably Practice Fusion, which seems to have an extremely solid business — the tech business is rife with examples of fast companies that soared high on venture capital drafts then plummeted to earth.  I’m not suggesting that you should avoid VC-backed EMR firms, physicians, but I am suggesting that you find out as much as you can about the size of their customer base, finances and strategy before you commit your business into their hands.

Otherwise, you could end up like ImagineMD’s EMR-less customers. And if that’s not a bummer I don’t know what is.

November 23, 2012 I Written By

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

EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs Video – Burning Topics with Dr. Nick

I recently sat down with Dr. Nick van Terheyden, CMIO of Nuance to talk about some of the Burning Health IT topics. In the following video Dr. Nick and I talk about EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs. Enjoy and I hope you’ll extend our conversation in the comments.

October 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Patient Advocate, Multiple Screens, EHR Consolidation, and EMR Happening

We’re in the middle of the dog days of summer. I can see the Fall Conference slam around the corner as I plan my various itineraries. Plus, my children just found out who their teachers will be this Fall. So, Fall is just around the corner. In the 110 degree heat of Las Vegas, that’s a very good thing. It’s always hot in the summer in Las Vegas, but this is really hot.

Enough with the digressions. Time to take a quick look at some of the interesting EMR and health IT tweets.

Ariana Markle ‏@GoldAtlantis
Dying for Data: Comprehensive #EMR systems promise to save lives and cut #healthcare costs –but how do you build it? http://spectrum.ieee.org/biomedical/diagnostics/dying-for-data

The article linked in this tweet is really interesting. It starts with a really compelling story. Something that the patient advocates will love if they haven’t seen it already. The problem is that EMR implementation on its own still doesn’t solve the problem that’s described in the story. The real solution is some sort of HIE or portability of patient data. EHR is one step towards that, but is still far away from that state of healthcare portability nirvana.


Nice to see a doctor who loves his EMR. Even better than a 27″ screen in most cases is dual monitors. I can’t imagine life without dual monitors. I’m not sure why doctors do without it as well.


I just don’t agree with all the people talking about widespread EHR consolidation. Here’s a great quote from the article that actually supports the lack of EHR consolidation as well:

Ironically, according to Mercom Capital Group roughly $150m in venture capital has been poured into the EMR/EHR market in the last 18 months, pointing to continued confidence (or overconfidence!) in this space.

It’s not ironic. We’re in the golden age of EHR. We won’t see many folding up shop for quite a while.


The core thing for me in this tweet is that EMR is happening. Doctors can continue to resist, but EMR is going to happen. It was temporarily delayed while doctors waited for meaningful use. Now, many are going after the EHR incentive money. Eventually doctors won’t know life without an EMR.

August 12, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Vendor Consolidation

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.

June 15, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.