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The Same EHR “Chain of Events”

Posted on December 31, 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.

I recently came across this interesting perspective on the EHR industry on the MGMA blog. Here’s one of the perspectives shared on the blog post:

Miske said his practice’s previous eight EHR selections have followed the “same chain of events”:
*Heavy research, tons of demos
*Implementation
*Training and research
*Relentless tweaking
*Stagnant use
*Systematic bugs reveal themselves
*Issues become unreasonable
*Tech support starts to lack

For his practice’s ninth EHR, Miske refused to settle for inferior quality or employing counterintuitive fixes, such as saying, “let’s hire more people to deal with the inadequacy of the program.”

“Being of the technological mindset that I am, this is unfathomable – the EHR/PM system needs to be a tool and a wonderful tool. Just like our ultrasound machine that allows us to perform 4D miracles without issue daily,” he says.

I have to start by addressing that the above comments are by someone who has done 8 EHR selections. Sure, that means they’ve had a lot of experience with EHR implementations, but from my experience it also likely indicates an internal issue that all 300 EHR vendors would likely face with that practice.

I was recently talking to an EHR implementation manager at an EHR company. They recounted to me how their sales people would bring them a new sale and comment that “this EHR implementation should be easy since they’ve already had 3 EHRs previously.” He then commented that those always end up being the worst implementations since there’s likely some organization problem that needs to be fixed before doing the EHR implementation. Certainly having some understanding of how EHR and software work helps during an EHR implementation, but so many failed EHR implementations often means that something else is at play beyond the EHR.

Personally, I haven’t seen the chain of events that he describes. I’ve seen certain pieces of what he describes, but not all EHR implementations follow that pattern. The last 3 items on the list are things I’ve seen a lot of places with a bunch of EHR vendors.

Bugs are a reality of software use. The key is how the EHR vendor reacts to your bug reports. That will make all the difference in your organization. This is why I’ve said many times that you should cultivate a close connection to your EHR vendor. When you find and report these bugs, having a good relationship with your EHR vendor will be critical to make sure your report is heard.

In the beginning of your EHR implementation, you’re likely to get special attention. So, take the time early to really figure out any pain points the software is causing you. You’ll likely get a quick response. As you become a long time user, you’ll have to rely on a deeper relationship.

If all else fails, remember that the squeaky wheel gets greased. Be careful not to ruin your relationship, but there are a lot of ways to get your concerns heard and addressed. Don’t be shy if a change really matters to you and your organization.

EHR Requires You to Reconsider Your Workflow

Posted on November 19, 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.

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.

Which Parts of an EHR Implementation Should Be Their Own Project?

Posted on September 29, 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 really great discussion has been started on this post about staged patient portal implementations. Here’s one comment that really struck a chord with me:

I think that on a lot of strategic roadmaps “patient portal” is listed as a goal…a one time deadline without understanding how the patient portal works; what information flows into a fully functioning portal and to the patient; and what the system, risk, and security requirements are to consider.

This will require C level suite and decision makers to ask questions that might be getting them “into the weeds” a bit or questions that they may not know to ask. This is why a several strong consultants that are specialists in individual subject matter might be needed – instead of one project manager expected to move the project plan forward on the road map and to know everything.

This comment is right that the patient portal is often seen as a line item on a project plan that just needs to be completed. That couldn’t be farther from the truth. As one person said, sometimes you can get a grand slam, but most of the time you have to do a bunch of little things along the way. A patient portal is a great example of this. You don’t just implement a patient portal one time and then it will run forever. There’s more you can do to leverage a patient portal for your institution.

Are there other parts of an EHR implementation that exhibit similar characteristics? Maybe you implement them, but there’s always more that could be done to improve its use in your organization? Templates and workflow are one that come to mind. There should be an ongoing evaluation of your templates and workflow in order to ensure that it’s as optimized as possible.

What other pieces of your EHR project could benefit from a separate staged project plan? Of course, this assumes you’re starting to think more strategically than just trying to check off the MU check boxes.

When an EHR Pilot Makes Sense

Posted on May 6, 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.

I’ve been a real fan lately of Dr. Jayne’s in the trenches commentary on the EHR implementations she’s apart of as CMIO. In her latest post she offered some really valuable insight into the integration of a physician group her health system purchased. The physician group wanted a bunch of custom content and Dr. Jayne’s team had convinced them of half of their recommendations and then she offers this insight:

At this point and given their resistance, I can get on board with half. It’s certainly more than none. Through discussion of their actual needs and observing their workflow, we’ve even identified a handful of customizations that we’re going to advocate that our vendor incorporate into the product out of the box. Ultimately, what allowed us to get the agreement we achieved was the idea they will be piloting the changes for a couple of months after the upgrade and then we’ll revisit them.

We added the pilot approach when we sensed they were stuck in analysis paralysis. The reluctance of the identified physician champions to make decisions was palpable. They feared backlash from their colleagues and claimed to be unable to reach consensus.

I had a somewhat similar situation happen to me on my first EHR implementation. The clinic had real fears about the transition to EHR. However, they needed to replace some old bubble scanning sheets which were no longer supported on this really old system. So, instead of going all in with a full EHR implementation, we did a partial EHR implementation as a kind of “pilot” for the clinic.

What resulted from this was really amazing. A week or so into the partial EHR implementation, the providers started asking us why we weren’t using the rest of the EHR features. In fact, some of them started using the other features before we even asked or trained them on it. I still remember walking into the director’s office and saying, “They’re asking me why we aren’t using all of the EHR features.” We quickly corrected that and implemented the full EHR a few weeks later.

You should never underestimate the value of jealousy. If you let a few people play with the shiny new toy, the others will be jealous. Of course, you better make sure that the shiny new toy works as proposed. Plus, don’t get sick with Pilotitis either.

Dr. Jayne also offered this powerful insight which says a lot about her as a leader in her institution:

I’ve been through this enough times to know what kinds of darts their colleagues might start throwing, so I was happy to offer myself as a virtual human shield. If using the larger health system as the scapegoat for required change is what it takes to move them ahead, so be it.

There are a lot of ways to deal with the “darts” of colleagues. Although, the best answer to the problem is having a real leader with a vision and understanding of where you want to take your EHR. Having a great leader at the helm of an EHR implementation has been the key difference between the good and bad EHR implementations I’ve seen.

EMR Customer Service, EMR Not Meeting ACOs Needs, and Patient Centered EMR Rollout

Posted on April 13, 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.


Zappos is in Las Vegas, and I can assure you that this story is true. I’ve always wondered how they’d scale that policy if thousands of people called for pizza. The key I think is that they do focused customer service. Chandresh asks an important question. Which EHR vendors have delightful customer service?


If EHR vendors don’t make the ACO possible, who will?


I’d be more interested in seeing an EHR roll out that considered the patient.

Dealing with Old Paper Charts in an EHR World

Posted on January 10, 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.

To preview this post, start by enjoying this quick 1 minute video preview:

Such a well done video by ChartCapture. Plus, it intrigued me enough to get me interested in what they had to offer. I think I’d actually met them at the Canon booth at HIMSS before, but somehow I did’t capture the full simplicity of their chart scanning solution until I saw this video demonstrating how their solution works:

I love really simple and straightforward appliances and chart capture is the perfect solution for an appliance like this. It’s beautiful to have a plug and play appliance with no server, no setup, and just ready to go without having to get IT to make it a priority.

As I talked to Scott Ferguson from ChartCapture, I asked him when most customers chose to start using their product during an EHR go live. He responded, “Most customers typically drop us in 90 days prior to go live (or as soon as the have the “realization moment”).”

I love the concept of the realization moment and anyone who’s worked on an EHR implementation knows what I’m talking about. It’s that moment during the EHR implementation that the users ask the question “what about the paper charts?” For some reason many people just think that the EHR vendor will somehow magically just deal with the paper charts. The realization moment is when they realize that they’re going to figure out what to do with the paper charts.

I’ve long been a proponent of scanning in your old paper charts. I still love the outsourcing option because some of the quality they can provide in the scanning process. However, that option is cost prohibitive to many. So, an appliance like ChartCapture is a nice alternative solution for scanning your paper charts at a lower cost. Just be sure if you choose to scan in house that you make sure you hire detail oriented people for the job. It’s a monotonous job and requires detailed effort to do it right.

What Our Kids Can Teach Us About EMR Implementations

Posted on October 25, 2013 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.

I occasionally help out in my church’s children’s worship and education areas, and so sometimes receive emails with helpful articles and words of advice from the children’s ministry. These usually focus on how to best interact with kids who are not shy about asking big questions that often leave even senior pastors stumped.

The most recent email had to do with “How welcoming is your ministry to children and their parents?” As I read through the message, I realized much of it could be applied to the healthcare setting, particularly an EMR implementation. With the switch of a few words, the headline could read, “How welcoming and inclusive is your EMR implementation game plan to your end users?”

Tips on being welcoming include:

1. Build Communication: Sometimes what scares kids is other kids. They need to learn how to talk to one another. By playing simple icebreaking games and including time for conversation, you’re fostering friendship and a sense of community.

The EMR Implementation Twist: While I can’t speak to what individual participants in an EMR implementation team might be scared of (each other? Higher ups? The EMR itself?), I can get behind the need for communication. Simple icebreaking exercises and time for conversation seem like great first steps in building a cohesive team looking to be able to successfully get through a go live.

2. Ownership: Allow kids to take ownership of their ministry. Give them jobs and responsibilities they enjoy. Letting kids form a welcoming team or allowing them to help set up for snack are simple and easy ways for them to be a part of the team.

The EMR Implementation Twist: The takeaway here is that team members need to feel valued, which will likely engender pride in the implementation. Many of you have heard of the need for physician champions during times of HIT implementation; these are the types of team members that can be tapped to take ownership of the project and share their enthusiasm with less-involved (or downright stubborn) colleagues.

3. Get to Know Your Kids: All of them. Make them feel loved. Not just with a prize or a piece of candy for coming. Get down on their level and talk with them. Let them know that you’re their friend. It sounds simple, but for a kid who feels like an outsider, this could mean the world.

The EMR Implementation Twist: Get to know your teammates. All of them. Make them feel appreciated. If you’re a project leader, make a point to check in with them every so often, and not just about the implementation. It could be via email or text, but a phone call or quick chat in the hallway might make more of an impact. Let everyone know that the lines of communication are always open. An open door is even better.

I have to add a fourth tip: Give thanks. Everyone likes to feel appreciated. Kids light up when I tell them, “I’m so glad you’re here!” Frankly, I’m not that much different. Remember to take the time to thank your teammates for the job they are doing, even though it may be bumpy at times.

These are obviously simple tips, but sometimes we need to take a step back and reassess the fundamentals before moving on. Are there any additional tips you’d like to share? Know of an effective way to put team members in time out? Let me know via the comments below.

Halamka on Google Glass, Wrong EHR, and EHR Customer Support

Posted on July 29, 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.


Always great to read John Halamka’s view on the latest technology like Google Glass. I think there’s a place for wearable computing in healthcare. Plus, I’m excited that we’re just at the very early stages of its development.


Are the wrong EHR vendors going to die off?


I think it always has made or broken an EHR implementation. It’s not an easy task implementing an EMR. Many underestimate the effort required to do it right.

EMR Usability Point Difference, Us vs Them in EHR Adoption, and EMR Companies Don’t Care About Usability

Posted on July 7, 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 can’t believe there’s a 30 point difference in usability. Really? No, I’m not talking about the difference. I’m talking about trying to put a number on EMR usability. Think how ridiculous that idea really is. An EMR is made up of 100s of functions and you’re going to take an EMR vendor’s usability and try and quantify it to a number. That’s just insane.


This is an awesome point that really highlights a bunch of the key challenges that happen in EMR implementations. There’s definitely a lot of blame and finger pointing that can happen. You have to battle against this for it not to happen.


This is a great article that can be summed up with: because they don’t have to care. That’s right. EHR sales are doing just fine, so they don’t have to worry about usability. Healthcare really has reached a point of acceptance of crappy technology. This will change one day, but I don’t see it changing at least until after meaningful use.

A Thoughtful Approach to EHR Implementation – 5 Tips

Posted on May 9, 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.

While many in the EHR industry have started moving beyond EHR implementation, it’s worth realizing that only 55% of physicians have adopted an electronic health record (EHR). Yes, that means that 45% of physicians are still working on selecting and adopting an EHR. Ok, it’s probably more like 40% of doctors are looking to implement an EHR. The other 5% will stick with their paper.

Plus, along with the 45% of doctors who don’t use EHR, there are a whole slew of existing EHR users that are selecting and implementing an EHR as well. For example, 2 days ago I was at my son’s cub scout event where an opthamologist friend of mine cornered me and asked me about how he should go about selecting an EHR for his practice. He had just decided to go out on his own and open his own opthamology practice. What a perfect time to select and implement an EHR.

With this in mind, today I came across this whitepaper by ADP AdvancedMD called A Thoughtful Approach to EHR Implementation. They provide a number of stats, charts, and graphs using data from the CDC about EHR satisfaction and EHR use. The most intriguing number to me was the number of physicians that reported accessing the patient chart remotely using their EHR. That’s an EHR benefit that I don’t see talked about very often.

The whitepaper also offered these 5 tips for a successful EHR Implementation:

  1. Stay committed to your goal, but flexible in your approach
  2. Don’t short-change your training opportunities
  3. Don’t underestimate the impact to your workflow
  4. To pilot or not to pilot
  5. Optimizing the EHR

A lot more could be said about each point and they cover each point in detail in the full whitepaper, but the first and third ones really stand out to me. EHR is a commitment, but requires some flexibility. The best way to have a failed EHR implementation is to not be committed or to be inflexible. Your workflow will be impacted, but if you take a thoughtful approach to your EHR implementation it can be impacted for good.