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Could Standard Interfaces for EHR Data Kill the EHR Business?

I was reading some people’s comments on a LinkedIn group and it sparked this interesting question:

If you can move healthcare data wherever we want it, then will the EHR’s have to change their business model?

I think this is a really important question. I’m sure that some will question whether we’ll be able to ever move healthcare data wherever we want it. I can’t remember the exact stat, but I recently saw that a huge percentage of the granular health data is stored in lab results. We’re already moving lab result data pretty well between systems. The same can be said for eRX. We’ve kind of cracked those nuts and eventually we’ll make the rest of the data available as well.

I think the answer to the question is that EHR vendors will have to change. I’m not sure they’ll have to change their business model per se, but they will have to change. The fact that a healthcare organization could take their healthcare data and go somewhere else will mean that an EHR vendor will have to be much more accountable to the software they produce and release.

I’ve often used the comparison on my blog. It is powered by WordPress and one of the great features of WordPress is that I can export my entire blog into one file and then import it wherever I want. This makes the cost of switching from WordPress to some other blogging platform simple.

While it’s really simple for me to change, I’m fiercely loyal to WordPress. Largely because WordPress has delivered a high quality product that keeps improving in the 9 years I’ve been using it. Just because I can switch products doesn’t mean I will switch.

The same very much applies to EHR software. Plus, there are other costs that won’t be recovered if I switch. For example, training costs and configuration costs. There are certainly plenty of reasons why someone wouldn’t want to switch EHR software even if they could get their data out. In fact, I’d argue that if you’re to the point where you’re willing to go through the hassle of switching EHR software, you should do it. It’s not easy to get that uncomfortable with an EHR software that you want to go through the hassle. Although, I guess a few might be naive to the EHR switching costs.

Long story short, I think standard interfaces for EHR data wouldn’t kill the EHR business, but it would cause it to change and change for the good. I’d welcome such a change. A few EHR vendors wouldn’t, but that actually is just another reason we should make it a reality. It would be the first thing on my list if I were to create a “meaningful certification.”

May 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

EMR for Analytics, HIT Marketing and PR Junkies, and Hospitals Without Walls


Jennifer is highlighting how challenging it is to get data out of an EHR in order to do healthcare analytics. This is certainly an issue and a challenge. Although, as much of a challenge is the integrity of the data that’s entered in the EHR.


I love Beth’s description of the Health IT Marketing and PR conference we announced. It’s been interesting to see people’s reaction to the conference. So many marketing and PR people are use to going to conferences, but they’re always going there to sell their products. It seems that they’ve rarely gone to a conference where they go to learn. It’s such a change in what the word “conference” usually means to them. By the way, the conference is coming together very nicely. It’s going to be a great event.


I love the concept of a hospital without walls. This is happening. A little slower than I’d like, but we’re getting there in a lot of areas. Of course, this will never replace hospitals, but it will be a great compliment to hospitals.

January 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

Docs Using EMR Data Order Fewer Lab Tests

A new study has concluded that when doctors viewed lab test cost data in an EMR, they decreased their order rates for certain tests, cutting the overall cost of lab tests meaningfully, according a story in Healthcare IT News.

The Atrius health study, published in the Journal of General Internal Medicine, found that docs who reviewed lab test cost data decreased their ordering rates for certain tests and saved up to $107 per 1,000 per month. The study also found that lab test utilization decreased by up to 5.6 lab orders per 1,000 visits  per month, HIN reported.

The study, which was led by Daniel Horn of  Massachusetts General Hospital’s Division of General Medicine, surveyed 215 primary care docs at Atrius Health. Physicians in the intervention group got up-to-date information on lab costs for 27 individual tests when they placed e-orders. There was also a control group of physicians who didn’t get the information.

Researchers saw significant decreases in ordering rates for five out of 27 high and low cost lab tests, and a decrease in utilization for all 27 tests, though not all shifts were statistically significant. Meanwhile, 49 percent of doctors felt that they had enough information to make their ordering decisions.

Thomas Sequist, MD, Atrius Health director of research and co-author of the study, said these findings suggest that seeing lab data in EMRs could scale up in big ways. For example, he notes, in a large physician practice managing 20,000 visits per month, that’s $2,140 per month and more than $25,000 per year.

This isn’t the only evidence that access to lab test costs and info reduces ordering. A study published last year in the Archives of Internal Medicine concluded that during the period between January 1, 1999  and Dec. 31, 2004, during the test of a health information exchange, there was a 49 percent reduction in number of tests for patients with recent off-site tests.

That being said, other studies — such as this one appearing in Health Affairs — have found that doctors who see earlier tests and images actually tend to order more follow up tests.

It seems clear that this is an important area for further study, as needless tests are a big cost driver. In the mean time, we’ll have to make do with contradictory evidence.

December 2, 2013 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.

Patients Benefit From Access To EHR Data

While doctors may not be completely comfortable with granting patients access to their EHR data, new evidence suggests that doing so produces significant benefits.  A new study published in the Journal of Medical Internet Research has concluded that granting patients such access “overwhelmingly” yields positive results, according to a report in FierceEMR.

To track the benefits of patient data access, researchers studied the My HealtheVet EHR pilot program, which gave access to the initial PHR established by VA. The pilot recruited 7,464 patients at nine VA facilities between 2000 and 2010.  An enrolled patient completing in-person identity proofing could access clinic notes, hospital discharge notes, problem lists, vital signs, medications, allergies, appointments, and laboratory and imaging test results. They could also as enter personal health data, access educational content and authorize others to access the PHR for them.

To evaluate the impact of the pilot, researchers from within and outside of the VA conducted focus group interviews at the Portland, Ore.-based VA Medical Center, which had 72 percent of pilot enrollees.

In discussing the program with patients, researchers found that they did have some negative experiences, such as reading uncomplimentary or offensive language in notes, concerns with inconsistencies in content and some technical problems with the EHR, FierceEMR reports. On the other hand, having access to their data improved patients’ communication with clinicians, coordination of care and follow-through on key items such as abnormal test results, the study found.

That being said, there are some repercussions to offering this access, researchers found. Though having access to notes and test results seems to empower patients, increase their  knowledge and improve self-care, it does have an impact on how physicians practice. “While shared records may or may not impact overall clinic workload, it is likely to change providers’ work, necessitating new types of skills to communicate and partner with patients,” the authors said.

April 8, 2013 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.

One Database Has Distinct Advantages for Data

I recently was talking with an EHR vendor and they made the comment that having their EHR all on one database was a distinct advantage over the EHR vendors who install a new database with every new EHR install. I was intrigued by the idea and could easily see some of the benefits of an EHR vendor having all of the EHR data in one database. When you think some of the future quality programs that could come out, I think there could be some advantages there as well.

Considering this advantage, I started to think about ways that multiple database EHR vendors could level the playing field with their single EHR database comrades. One idea I had was using interoperability to level the playing field. If all the EHR vendors have access to all of the data, then not only will single database EHR vendors not have an advantage, but they’ll be at a disadvantage if they don’t work to exchange the EHR data as well.

When I think about this, it makes me wonder why multiple database EHR vendors aren’t accelerating the exchange of health information. This seems like it would be to their strategic advantage to exchange information.

February 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

EMR Data Often “Inaccurate” Or “Missing”, Study Says

EMR adoption continues to march forward, spurred not only by Meaningful Use requirements but also the need for doctors to access data remotely and the rise of cloud infrastructure to support such initiatives.  According to research firm IDC, 80 percent of healthcare organizations should adopt EMRs by 2016.  Pretty much what you might expect.

Hopefully, this will have a positive impact on clinical care. However, EMRs may be less useful than they should be for population health research, as data is often inaccurate or missing, according to a new report published in the Journal of  The Medical Informatics Association.

Researchers behind the report said that while data from EMRs can be useful, it’s prone to certain types of errors which undermine its value.  For example, EMR data accuracy varies depending on whether the patient was treated during the day or during the night, in part because patients at night are often sicker, according to Dr. George Hripcsak, a professor of biomedical informatics at Columbia, who recently spoke with eWeek magazine.

Another issue of concern is that patient symptoms are often poorly documented in EMRs before death. For example, patients with community-acquired pneumonia who enter the ED and die quickly don’t have symptoms entered into the EMR before they die. Later on, their medical records make it look as though a healthy patient died, the researchers note.

Dr. Hripcsak told the magazine that researchers in informatics, computer science, statistics, physics, mathematics, epidemiology and philosophy will need to work together to get an accurate read on EMR data and avoid biases. (Whew!)

Clearly, the kind of teamwork Dr. Hripcsak has in mind will take a great deal of resources. They’re on their way, it seems. For example, I’m betting that the new Johns Hopkins center for population health IT will serve as a model for the kind of interdisciplinary efforts he’s describing. But that’s just one effort. It will be interesting to see whether other universities follow in Johns Hopkins’ footsteps.

September 17, 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.

Switching EMR and EHR Software

I’ve long been concerned about the challenge of switching EHR software. I’ve recently got into some discussions with people asking why EHR certification and meaningful use didn’t require EHR data portability as part of the requirement.

I’d forgotten that Jerome Carter had pointed out in a previous EHR switching post where HHS asked for comments on EHR data portability in the proposed certification rule for EHR (PDF) under the section “Request for Additional Comments”. Here’s his comment with the page number that addresses it:

John, this series of posts on changing EHR systems is interesting. The data issues that arise when switching EHRs can catch providers off guard. In reading through the proposed certification rules for EHRs, I found a section on data portability that you might find interesting. It is on page 13872.

Link: http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4430.pdf

It’s an interesting section to read. The key is that they acknowledge the need to have some EHR data portability if you’re a doctor. Then, they look at these 4 questions:
1. Is the consolidated CDA enough?
2. How much EHR data do you need to move to the new EHR?
3. Could they start with an incremental approach that could expand later?
4. What are the security issues of being able to easily export you EHR data?

These are all good questions. I’d answer them simply:
1. Is the consolidated CDA enough?
No, you need more.

2. How much EHR data do you need to move to the new EHR?
All. Otherwise, you have to keep the old EHR running and what if that old EHR is GONE.

3. Could they start with an incremental approach that could expand later?
I think they need to go all in with this. The consolidated CDA is basically an incremental approach already.

4. What are the security issues of being able to easily export you EHR data?
I always love to follow it with the opposite, what are the issues of not having this EHR data portability available? You do have to be careful when you can export all of your EHR data, but the security is manageable.

What are your thoughts on EHR data portability? I’d still love to find a way to help solve this problem. It’s a big one that would provide amazing value.

August 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

Genomics Based EHR

This is a pretty old tweet that I’d stored away, but I’m completely interested in the idea of a Genomics based EHR. I meant to reach out to Don Fluckinger to see what he was talking about. I don’t think that there is any EHR that is based on Genomics. Although, if there is I’d love to know about it. Instead, I’m pretty sure that Don is just talking about integrating Genomics into EHR software.

I’ve made this prediction for a number of years now: Genomics will be part of the EHR software of the future. Genomics is one of the core elements that I think a “Smart EMR” will be required to have in the future. I really feel that the future of patient care will require some sort of interaction with genomic data and that will only be able to be done with a computer and likely an EHR. I love some of the quotes by Shahid Shah in this eWeek article about Digital Biology and Digital Chemistry.

As I think about genomics interacting with EHR data and the benefits that could provide healthcare going forward, I realize that at some point doctors won’t have any choice but to adopt an EHR software. It will eventually be like a doctor saying they don’t want to use a blood pressure cuff since they don’t like technology.

January 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

PricewaterhouseCoopers Finds EMR Data to be Health Industry’s Most Valuable Asset

The following is an expert from the press release by PricewaterhouseCoopers (PWC) about EMR data:

Hundreds of billions of gigabytes of health information are now being collected in electronic medical records, and three-quarters (76%) of more than 700 healthcare executives recently surveyed by PricewaterhouseCoopers LLP agree that the secondary use of this information will be their organization’s greatest asset over the next five years. The data that could be mined from the health system can improve patient care, predict public health trends and reduce healthcare costs, but PricewaterhouseCoopers finds lack of standards, privacy concerns and technology limitations are holding back progress.

According to PricewaterhouseCoopers, the healthcare industry won’t see the full value of investments in electronic medical records and other health IT investments until it finds secondary uses for the information being gathered. Yet 90 percent of executives surveyed feel the industry needs better guidelines about how health information can be used and shared, and 76 percent feel that national stewardship over, or responsibility for, the use of the health data should be regulated.

In its newly published report “Transforming Healthcare through Secondary Use of Health Data,” PricewaterhouseCoopers calls for public-private collaboration and a role for government in creating incentives for the private sector to collect, share and use health data; to establish standards; and to redefine technical architecture to allow interoperability.

October 2, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.