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How Does Your EHR Vendor Solve Challenging Situations?

Posted on July 22, 2015 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.

Today I was asked if I thought a specific EHR feature (in this case it was cloud hosted) was one area practices should consider looking at to avoid having a short sighted view of their EHR vendor. The specific feature and question are interesting, but I think it’s a short sighted way to look at an EHR vendor.

My immediate response was that when I look at an EHR vendor, I look at how they solve challenging situations and if they’re still solving those problems. I’m more interested in the EHR vendors direction and approach than I am any specific feature or function they offer today.

Let’s take them in the inverse order. Is your EHR vendor still solving your problems? This is a hard one to evaluate since meaningful use and EHR certification has hijacked the EHR development process. However, when you dig into an EHR vendor you can tell which ones are really investing in improving their platform and which ones are just doing the minimum necessary to retain their customers. It’s a totally different mindset. A forward thinking EHR vendor is trying to push the envelope, is interested in user feedback and is working towards a brighter future. An EHR vendor that’s doing the minimum necessary is just barely meeting the EHR certification and meaningful use requirements and never really responds to customer requests. Sure, they’ll do a bug fix here or there or fix anything major, but there’s no real investment in the future.

One easy way for you to start evaluating which vendors are investing in their future and which aren’t is to talk to their sales people. Does the salesperson have something new to sell you (like RCM or some other service)? If they do, it’s quite possible your EHR vendor has started focusing (and investing) on some new product and not the EHR anymore. Just remember that it’s really hard for a company to focus and invest in more than one area.

Sadly, I think many EHR users know that their EHR vendor has stopped innovating their product. They know this based on the release cycles of the EHR vendor. When was the last time your EHR vendor put out something that made your life as a clinician or a practice easier and it didn’t have to do with MU?

Related to the above is something that’s even more telling when it comes to the future of your EHR. Ask yourself the question, how does my EHR vendor approach solving challenging situations? If you talk to a lot of EHR vendors like I do, you can pretty quickly tell how an EHR vendor approaches problems. Unfortunately, many of them do the minimum work possible to solve the problem. The best EHR vendors dive deeply into the problem and not only solve the problem, but try to think of a better way to optimize everything surrounding the problem.

I still remember sitting down with an EHR vendor for breakfast one day. As they described their ePrescribing solution, they described how they could have implemented ePrescribing really quickly. However, they didn’t just want to have ePrescribing. They wanted to take the time to really understand ePrescribing and ensure that the doctor could ePrescribe with as few clicks as possible. They wanted to make sure that the process was efficient and accurate. It wasn’t enough to just be able to ePrescribe, but they wanted their doctors to be efficient while doing it too.

Reminds me of many of the ICD-10 implementations I’ve seen. I’d describe EHR vendor implementations as ok, better, and best. The “ok” implementation is that they have a search box which can search by word or code. Theoretically, this works. It just means you’re going to have a big book next to you or an app on your phone which lets you really find the code and then all you’re doing is entering the code. Not good!

The “better” implementation is the vendors that group codes so that when you search you can choose the group of codes and then essentially drill down into the group and find the code you need. In most cases, I’ve seen this type of implementation done by integrating a third party vendor. The EHR vendor often passes that third party cost on to the end user (imagine that). I’ll admit that a third party vendor integration for this feels kine of lazy. I’m all for third party integrations, but your EHR vendor won’t ever be able to take coding to the next level if they’re working with a third party. This kind of “grouping” approach is better, but it’s not the best.

The best type of ICD-10 implementation I’ve seen is one that integrates deeply into the EHR documentation. The documentation essentially narrows down the ICD-10 code list for you as you document the visit. Then, when it’s time to do your assessment, the hard work of identifying the right codes is already done for you. Sure, you’ll need to verify that the machine approach to ICD-10 identification is right, but it’s the best approach I’ve seen to ICD-10.

Hopefully this ICD-10 example gives you a view into what I mean when I say that you have to evaluate how an EHR vendor works to solve a problem. Are they just trying to get by or do they take their solution to the next level of automation? I feel sorry for the doctors who are stuck on EHR software that’s no longer investing in their EHR and just take the minimal necessary approach to EHR development.

Going back to the person’s initial question about cloud hosted EHR, it’s easy today to say that every EHR vendor should be on the cloud. The cloud has won in every industry and it will eventually win in healthcare as well. However, cloud or not is not what concerns me. I’d be more interested in hearing an EHR vendors reason for going cloud or not. Not to mention their reasons for moving to cloud or not. That will tell you how an EHR solves a problem and how an EHR works with new technology. Their direction and approach to those challenges is much more important than the specific choice they make.

Will Meaningful Use Stage 3 Continue to Kill EHR Innovation?

Posted on July 7, 2015 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 recent post on EMR and HIPAA titled “The Current EHR Reality,” L Parada, a product manager at an EHR vendor, offered this insightful and scary comment:

Looking at the 137 proposed certification requirements for MU3, I again see all innovation in 2016 slipping through the fingers of all specialty EHR companies. That stings.

I’ve occasionally mentioned that we’re finally at a more stable place with meaningful use that EHR vendors might be able to have some breathing room to innovate. Is that time frame for innovation going to be limited to 2015? Will meaningful use stage 3 ruin EHR innovation in 2016? I also don’t think that it just applies to specialty EHR companies either. That many government requirements is going to kill innovation at every EHR company of every size.

This would make me really sad. I’m tired of writing blog posts about the lack of EHR innovation. Can we just let the 300 EHR vendors get to work on listening to their customers and doing some creative solutions to really improve the efficiency of healthcare and improve doctors’ outcomes?

I think we all might feel different if we thought that the meaningful use stage 3 requirements were innovative and really pushing forward amazing initiatives that were going to transform healthcare. I don’t know anyone who really feels that way. At best they see it as a good step forward towards some noble goals. Should we kill innovation in the entire EHR industry for that?

With meaningful use stage 3 around the corner, it’s starting to feel a lot like meaningful use groundhog day. Does it feel that way to anyone else?

The Impact of Meaningful Use on EHR Development

Posted on July 22, 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 getting a really strong response to my post calling for EHR vendors to expand their definition of customer service. Although, the title doesn’t do the post justice since I also talk about the impact of meaningful use on EHR development. Many of the readers of EMR and HIPAA (and if you don’t read EMR and HIPAA you should go subscribe to the emails now) have highlighted some important points I wanted to share with a broader audience.

First, Peggy Salvatore provides this insight about the impact of billions of dollars of EHR incentive money:

Almost 15 years ago, I wrote material for Intel (the computer chip company) based on research they were doing on physician workflow to make EHRs more usable. It was one of the early efforts to tackle this issue. I mention this to say that a lot of spade work has been done in this field but (in my humble opinion) government regulation has gotten in the way of software businesses trying to build electronic patient record products that work for the end users. Experience has shown time and again that customers will drive product improvements, and the same is true in the healthcare industry as in all others. The government has wasted tens of billions of dollars requiring systems be installed to meet timelines that were not realistic given the budgets and time available, or, to this point, to install products that were not really ready for prime time. Let the customers – in this case – the providers and the patients – drive development and you will end up with products that solve problems, not create them.

Brenden Holt, CEO of Holt Systems, offers this startling commentary on the EHR industry:

To me it is more clear. EHR Vendors, large and small and all points in between are currently working on the support nightmare (R&D and Direct Support) of Meaningful Use. It is the same when CCHIT was coming out, and not much different then the 100′s, if not 1000′s, of current copy cat products, all in one way or another a copy of the master Logician (GE).

Innovation does not bring in customers in the current environment. Government Adherence and more importantly relationships (Marketing and Sales) accomplish this. That is to say products need to be improved upon, but only to the extent of meeting the Government Regulatory Demands and the demands of the Large Organizations that are buying these things in bulk.

Innovation is available, but more then likely will take some time, as will thinking of how we document patient care as a whole, which is antequated methodology.

So as a CEO of a software company, one in the sea of many, I will say, innovation will happen when the phones get off the hook form highly demanding end users who want to make sure the MU is met and a Government Final Ruling that will get Government out of Development. Government is a terrible manufacture of innovation. One other major issue is that the end users don’t really want to pay for the innovation, if the EHR is working they are happy with the LOB application. That in and off itself is a issue, new features don’t translate to higher fees, the opposite is the case, less features in a Free Package can be much more attractive as both meet the basic LOB requirements.

We are the US, as much as the rest of the world tries, inguinity is what makes us great, our leading export, but in this vertical it is all but dead.

Catherine Huddle offered this insight about MU not just derailing EHR development innovation, but also possibly making things worse:

As for MU, as an EHR vendor I would agree that it and related government programs such as PQRS and PCMH have significantly derailed most other product development. Not only was Stage 2 a development “hog” but it brought in required changes that are often unnatural in a practice’s workflow and overly complicated.

MU has changed the goal from delivering what providers need to finding the best way to deliver MU to make it easiest for the providers and other staff – while still trying to make other improvements to the EHR. Unless the government repeals MU and the Medicare penalties the winning EHRs will be the ones that make MU as easy as possible.

While there’s plenty to be pessimistic about what’s happened with EHR, I’m still optimistic that we’ve passed through the meaningful use waters and that the future will bring forth opportunity for EHR development innovation. I’m hopeful (although not 100% certain) that the people in Washington have seen the toll that meaningful use has paid on the industry and they’ll lighten the load so that EHR vendors can start listening to end users instead of regulators.

EHR Is Not Disruptive…And Never Will Be

Posted on April 28, 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.

Ben Wanamaker and Devin Bean have an outstanding blog post on the Disruptive Innovation blog (Clayton Christensen Institute for those following at home) called Why EHRs are not (yet) disruptive. If you care about the EHR market, you should go and give it a slow thorough read. Well worth pondering what they’re saying. For those who don’t want to read the whole article, here’s a small excerpt:

The reason EHRs are not “roiling the health care landscape” with disruption is not that the technology is bad—rather it’s the business model in which they are being implemented. While there is some evidence that EHRs can help increase clinical quality, the technology is by and large being crammed into sustaining business models and used as an expensive sustaining innovation to replace paper records with complex electronic systems. Implementing new technology to sustain the way you already make money almost always keeps costs high and prevents true disruption. Indeed, the history of innovation is littered with companies that had a potentially disruptive technology such as EHRs within their grasp but failed to commercialize it successfully because they did not couple it with a disruptive business model.

Plus, this powerful quote:

EHRs have little reason to use the new electronic system differently from the old paper system, and so EHRs often neither decrease cost nor increase quality. They’re just next year’s more expensive model of paper-based patient records.

As I read this I thought, EHR weren’t meant to be and they won’t ever be disruptive. In fact, they cement in the status quo. I think we see this playing out more and more every day.

To be disruptive, we’ll need something to come from outside of EHR. It likely will have to buck the current reimbursement model. Payers and government really control the environment. As Steve Case said at SXSW V2V, government is the biggest customer of healthcare. That makes disruption difficult unless you go outside the current system.

The disruptive technology that comes will in many ways feel like an EHR, but it won’t be an EHR like we know it. My point is that technology will disrupt healthcare and many in the EHR world will see the disruptive technology and say that it looks very much like the EHR software of today. However, what they won’t realize is that it’s not the technology, but the business model that’s paired with the technology that’s so disruptive.

EHR Regulation Vs. Innovation

Posted on February 19, 2014 I Written By

The following is a guest blog post by Marina Simonian, Product Manager and Jessica Naftaniel, Sales & Marketing Coordinator at gMed. Check out gMed’s whitepaper on Independent Gastroenterology.

In the past few years EHR technology vendors and healthcare providers alike have struggled with a myriad of regulatory requirements, from PQRS and eRX incentive programs, to ASC quality reporting, to Meaningful Use, ICD-10 and beyond. The next few years are set to bring even more challenging requirements for interoperability, patient engagement, quality metrics and clinical decision support. Being a technology and services vendor, we always strive to provide the most efficient, innovative and high quality products to our clients.

But how innovative can you get in this era of regulatory overload?

On one hand, innovation on a deadline is almost an oxymoron. Especially with such restrictive guidelines. One could only imagine what type of innovative, amazing solutions could be developed with the amount of time and resources that have been thrown in to meeting regulatory requirements.

On the other hand, necessity is the mother of invention.

As a direct result of numerous new regulatory measures and government requirements, many EHR providers are simply throwing components together to meet requirements and pass a certification.  Features which are put together hastily may make life more difficult for the people using their products, and might not last long on the market.

However, keeping your eye on the long term goal and looking beyond regulation helps to see some of the great benefits that can still arise from this race. When, for example, the DirectTrust and similar organizations come together to facilitate sharing of patient information securely across various healthcare entities, this may be a huge step to, perhaps, someday in the future, being able to tap into a centralized patient record and get the data you need, exactly when you need it, regardless of your location or affiliation.

And while for some vendors it makes perfect sense to focus on a limited number of features and bring value with those few, there are some others who choose to bring the value of integration and are a one-stop-shop for all of their users’ Electronic Health Record software needs. It is not an easy task by any means. And the best attestation to that is in the astounding difference in complete certified EHRs between 2011 and 2014.  In the end, whichever path one chooses, only those who are able to keep the long term focus on innovation above regulation, to put efficiency and ease of use above merely meeting a requirement, and to remember that improvement of patient care and overall population health is the ultimate goal, will be able to withstand the regulatory storms.

For more information on gMed’s innovative technology, visit us at gmed.com. gMed provides the gastroenterology industry with a fully integrated platform consisting of an Electronic Health Record, Endoscopy Report Writer, Practice Management solution, Patient Portal and a Data Analytics tool. Fully scalable through the cloud or using an on-site server, gMed’s products are all Meaningful Use Certified and ICD-10 ready.

Full Disclosure: gMed is an advertiser on this site.

Meaningful Use Solidifies EHR as the Database of Healthcare

Posted on March 20, 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.

Earlier this month I wrote a post describing EHR as the Database of Healthcare. I believe this is a powerful and important thing to understand. It also led to some good conversation in the comments. As an entrepreneur I’m always interested to see the trends in the industry to hopefully better understand what is going to happen in the future. I think that this is one of those trends.

Just to make the case clearer, consider the effects of meaningful use on EHR software. Meaningful use stage 1 and EHR certification has already hijacked at least one EHR development cycle and you can be sure that meaningful use stage 2 and stage 3 will be hijacking another couple EHR development cycles. You heard me right. In order to meet the EHR certification and meaningful use requirements, most EHR vendors have to put a whole development team focused just on meeting those government requirements.

Meaningful use has codified EHRs into a box.

Instead of allowing EHR software to create innovative solutions it requires standards be met for storing and accessing info. Sure it also adds in security and tries to work towards interoperability, but those aren’t innovations that doctors want to see.

I expect many of the best healthcare innovators will build on top of the EHR base, not try and build the base again.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 66-70

Posted on August 8, 2011 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.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

70. Hard coded work flows CAN be your friend
EMR vendors are constantly playing the game of out of the box functionality versus unlimited workflow design. This is one way to look at hard coded work flows. Sometimes they have benefits since it’s one less thing that you have to configure on your system.

The other way to look at the above EMR tip is when it comes to reporting. Often if you’ve customized a workflow in your EMR, then you lose out on the benefit of the reporting that’s available with a hard coded work flow. Sometimes you can get the benefit of both, but some advanced reports really benefit from a hard coded work flow.

69. Social Media integration – the way business is done today
No EMR system has really deep social media integration….yet!? Although, it’s worth checking with your EHR vendor to see their views of the future of social media integration. Especially if you’re in a market that has a lot of physicians. You can be sure that future patients will want some sort of social media integration as part of their visit.

68. Determine how the EMR vendor encourages innovation
This EMR tip can be taken a number of different ways. The first is how does your EMR vendor innovate internally. Take a look at their last 3-5 release cycles to get an idea of how quickly they release features and how innovative those features are. It will tell you a lot about future releases of their EHR software.

The second way to take this is by asking the question, how do they take feedback and innovation from their community? Do they have an open API that would allow you (or some developer you pay) to be able to extend their EHR functionality? If you’re someone who likes to tinker with your practice, then an open API that will let you do that would be essential.

67. Determine how innovation is actually put into the practice
This EMR tip highlights the subtle difference between an EHR vendor that talks the talk and the EHR vendor that walks the walk. Every time your EHR vendor says, “That feature will be in the next release.” a red flag should go up in your mind. Maybe this company thinks and talks big, but can’t actually perform big. Although, age of the EHR vendor should play some part in this evaluation as well.

66. Is the patient portal comprehensive
Meaningful Use has almost made patient portals a requirement. It’s hard to say exactly what future meaningful use stages will require, but I won’t be surprised if a patient portal plays a large part in the future of healthcare. Plus, the new digital generation is going to be very interested in using a patient portal. You’ll want to make sure your EHR vendor is ready for both of these trends.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Medical Care and Primary Care without Insurance Allows Technology to Flourish

Posted on June 30, 2011 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 previously posted that I believe the real EMR innovation will likely have to come together with healthcare innovation. The basic premise being that our current insurance reimbursement system is a weight on the backs of EMR software. The insurance requirements cause much of the unwieldy interfaces that are put out by EMR software and insurance requirements and limitations are a huge limiter on the technology innovation that could occur in healthcare.

Imagine how much more streamlined the EMR interface could be if EMR companies worried about patient care and not reimbursement. Imagine the new technologies that would be implemented if you weren’t so worried about the office visit reimbursement model we have today.

This premise is why I was so intrigued by this post on the popular Tech Startup blog, Techcrunch, called “The Most Important Organization in Silicon Valley That No One Has Heard About.” In the article, Dr. Samir Qamar has been putting together a different model for healthcare. “For only $49 per month and $10 per visit, MedLion is able to provide high quality medicine at a price point nearly any family can afford.”

How is he able to do this? Here’s a quote for part of how he’s able to accomplish it:

Part of MedLion’s value proposition has been availability to its patient base. Like many direct primary care practices, they find more than half of their patient interaction is via electronic means, as they aren’t forced by reimbursement rules to have a patient come to their office for something that could be done simply over phone or email. We want to be available for our patients whether they are in the Bay Area, Bali or Boise.”

I’m not sure if Dr. Qamar has found all the healthcare Innovation secret sauce, but I’m grateful for pioneering entrepreneurs like Dr. Qamar that are willing to try something different. Plus, there’s no better place for the application of technology than in these new models for healthcare. It’s exciting to consider what technology could really do when it’s not shackled by the 100 pound gorilla.