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March Madness and the EHR Vendor Shakeout

Posted on March 29, 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 13 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’m not sure how many of my readers love March Madness as much as I do. I just love the emotion and the all day experience of March Madness. Unfortunately there haven’t been quite as many last minute buzzer beaters for the win as there have been in years past, but I still love the emotions of the games. These young kids have worked almost their entire life for this moment. I love to see the raw emotions from both teams.

As I think about March Madness, I couldn’t help but think about the EHR Madness we’re experiencing right now. We don’t have 68 teams in the EHR tournament. Instead, there are more like 300+ EHR vendors. In fact, in just the last week or two I’ve had two EHR vendors I’d never heard of contact me. Yes, we’ve seen some EHR software put out to pasture, but we still have a long ways to go before the EHR market really shakes itself out.

The nice thing for EHR vendors is that unlike the NCAA tournament which only has one winner, the EHR world is likely going to have many many successful companies. First, because many EHR vendors will likely get acquired by larger EHR vendors. Second, because it’s fair to say that the EHR world is going to be a heterogeneous environment. There won’t be one EHR to rule them all (although some EHR vendors still think they might get there).

Which type of vendors am I putting my money on in the EHR battle?

While many EHR vendors might win some short term battles, I think the big EHR winners are going to be those who end up battling through the mess of regulation while still having a laser focus on the impact to doctors. The most expensive employee in every healthcare institution is the doctors. EHR software that takes these high paid doctors away from seeing patients is going to have a real challenge long term.

I’ve written about the EHR Backlash a number of times before. I think productivity is going to be at the core of the EHR backlash. I’m hopeful that EHR vendors are taking this idea to heart, but I also still see a very long road in front of us to reach EHR nirvana.

I’ve been digging into the idea of a Smart EMR lately. At the core of the idea is how to make a doctor more efficient at what they do while increasing the quality of care provided. That certainly stands in stark contrast to many of the other EHR initiatives we see out there today.

Improving the EHR Interface and Topol Saves Patient’s Life on Flight Home

Posted on March 5, 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 13 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.

As I thought through my day at HIMSS, a theme started to emerge from all the dozens of meetings I’ve already had at the show (with many more still to come). The theme I saw coming out was ways to improve the EHR interface. This is a much needed change in EHR’s, so it was interesting to see a whole series of companies working on ways to make the EHR interface better. Here are some of the highlights from companies I talked to at HIMSS.

SwiftKey – While the SwiftKey product can be used in the consumer space as well, it was interesting to see the technology applied to healthcare. SwiftKey is basically a replacement for your mobile device keyboard. In fact, I’d call SwiftKey a smart keyboard for your mobile device. What does it do to make your mobile device keyboard smart?

First, it offers word suggestions you can easily choose as you start to type. Most people are familiar with this base functionality because it exists in some form in most mobile keyboards (or at least it does on my Android). However, they’ve taken it a couple steps further. They actually use the context of what you’ve typed to predict what word you may want to type next. For example, if you type, “nausea and” then it predicts that you’ll want to type vomiting. If you type “urinary” then it will predict tract and then infection. Plus, they told me their algorithm will also learn your own colloquial habits. Kind of reminds me of Dragon voice recognition that learns your voice over time. SwiftKey learns your language habits over time.

I’m sure some of these predictive suggestions could lead to some hilarious ones, but it’s an interesting next step in the virtual keyboards we have on mobile devices. I’ll be interested to hear from doctors about what they think of the SwiftKey keyboard when it’s integrated with the various EHR iPad apps.

M*Modal and Intermountain – Thinking back on the demos and products I’ve seen at HIMSS 2013, I think that the app M*Modal has created for Intermountain might be the coolest I’ve seen so far. In this app, a doctor would say an order for a prescription, and the M*Modal technology would apply voice recognition and then parse the words into the appropriate CPOE order fields. It was pretty impressive to see it in action. Plus, the time difference between speaking the order and trying to manually select the various order fields on the mobile device was incredible.

I was a little disappointed it was only a demo system, but it sounds like Intermountain is still doing some work on their end to make the CPOE happen. I’m also quite interested to see if a simple mobile app like this will see broad adoption or if more features will need to be added to get the wide adoption. However, it was almost like magic to see it take a recorded voice and convert it into 5-7 fields on the screen. I’d be interested to see the accuracy of the implementation across a large set of doctors, but the possibilities are quite interesting for transforming the CPOE interface.

Cerner Mobile – One of the new Cerner ambulatory EHR features is an iPad interface for the doctor. I’m sure that many will think this is old news since so many other iPad EHR interfaces are out there. In some ways it is, but there was a slickness to their app that I hadn’t seen a lot of places. In fact, the demo of their ambulatory EHR iPad app reminded me a lot of the features that I saw in this video Jonathan Dreyer from Nuance created (bottom video) that demonstrated some of the mobile voice capabilities. Plus, the app had a nice workflow and some crazy simple features like doing a refill. One swipe and the med was refilled. Almost makes it too easy.

Canon – This is a little different than some of the other EHR interface things I talk about above. In the case of Canon it was interesting to see the tight integration that’s possible between the Canon scanners and EHR software. Instead of the often laborious process of scanning to your EHR and assigning it to a patient, Canon has a scan direct to EMR option including analyzing the cover sheet to have the scanned document attached to the right patient and EHR chart location. While we’d all love to have paper gone, it will be a part of healthcare for the forseeable future. The scan direct to EMR is a pretty awesome feature.

Those are a number of the EHR interface things that I’ve seen so far at HIMSS. I’m sure there are dozens of others out there as well. I think this is a great trend. Sure, each of these things is only a small incremental change, but with hundreds of EHR vendors all doing small incremental changes we’re going to see great things. That’s good, because many of the current EHR interfaces are terribly unusable.

In an related topic, Eric Topol gave a keynote address at HIMSS today. He had glowing reviews from what I could tell. Although, what’s an even more powerful story is to see the message he shared at HIMSS in action. On Topol’s flight home to San Diego a patient was having some medical issue. He did the ECG right on the plane using his smartphone and the passenger was able to make it safely to the destination. You can read the full story here. What’s even more amazing is that this is the second time something like this has happened to Topol. This probably means he flies too much, but also is an incredible illustration of the mHealth technology at work. Truly amazing!

Full Disclosure: Cerner and Canon are advertisers on this site.

Blausen Google Chrome Extension for Health Information

Posted on November 9, 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 13 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 while back, I suggested that EHR vendors might want to integrate Google Search into their EHR. I still think this is a really interesting idea since I’m sure that many are doing Google Searches regularly as part of the care they provide.

While I’m sure that many doctors use Google searches in their care, I was really intrigued by a demo video I saw of the Blausen Google Chrome extension. Rather than try and explain it, you can watch the video demo:

This is a really fascinating product and a simple way to distribute the content that Blausen has available in their library. While the Google Chrome extension is interesting, I could see something similar easily added to an EHR interface.

Imagine a doctor wanting to show a video demonstrating something to their patient. Straight from their EHR, they could pull up the Blausen video and show the patient in a really rich way something about their condition.

Of course, we’re just at the start of what could be done with great visual education like this. Over time I’m sure we’ll be able to get to very specific parts of a video or pieces of education. We’ll be able to publish the educational information you saw in the office in your patient portal. Not only does that reinforce what was said in the office, but it also provides patients a great way to share what’s going on with their loved ones.

I know Force Therapeutics is doing work like this with videos for Physical Therapists and Orthopedics. I think we’re going to see a lot more video integration into our patient care over the next couple years and that’s a very good thing.

Reasons to Not Use Virtual Desktop Access to Your EMR on an Ipad

Posted on December 8, 2011 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 13 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 found this great article which highlights a number of the reasons I’ve been saying that the iPad needs its own native EMR interface and not just some Virtual Desktop solution to access your EMR.

First it offers two reasons why the Virtual Desktop solution is a good option:
-Security
-Cost

The first benefit of security is a good once since as long as your virtual desktop and access to your virtual desktop are secured, then you don’t have to worry about healthcare related data on the iPad. The second benefit is mostly a benefit to the EMR software vendor. Sure, they could make the argument that the price to develop a native iPad app is passed on to the end user. However, most doctors won’t feel that cost. In most cases it just means that other features on the EMR development roadmap will just get pushed back. Although, even this can be a bad strategy if your developers are good at developing EMR software on your current platform, but aren’t familiar with developing a native iPad app. Then, it’s worth spending some money on an iOS developer who knows which features of the iPad they can really leverage.

Now on to the reasons the article suggests that you develop a native iPad app and not just do the virtual desktop solution:
-Doesn’t Make Use of Native iPad Functionality
-Requires Constant Connectivity
-Virtualized Apps are Not Optimized for the iPad

The first and third in the list are very much related and are the biggest reasons why a native iPad EMR app makes so much sense if you’re going to do something on the iPad. The second item actually doesn’t apply very well to an iPad EMR app which even when created as a native app will likely need to have internet connectivity to have any value. An EMR iPad app could be made that didn’t need connectivity, but I have yet to see one that’s done that.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 56-60

Posted on August 22, 2011 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 13 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 next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

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.

60. Reporting, reporting, reporting, reports
What’s the point in collecting the data if you can’t report on it? I’ve before about the types of EMR reports that you can get out of the EMR system. The reports a hospital require will be much more robust than an ambulatory practice. In fact, outside of the basic reports (A/R, Appointments, etc), most ambulatory practices that I know don’t run very many reports. I’d say it’s haphazard report running at best.

Although, I won’t be surprised if the need to report data from your EHR increases over the next couple years. Between the meaningful use reporting requirements and the movement towards ACO’s, you can be sure that being able to have a robust reporting system built into your EHR will become a necessity.

59. Are the meaningful use (MU) guidelines covered by your product?
Assuming you want to show meaningful use, make sure your EHR vendor is certified by an ONC-ATCB. Next, talk to some of their existing users that have attested to meaningful use stage 1. Third, ask them about their approach for handling meaningful use stage 2 and 3. Fourth, evaluate how they’ve implemented some of the meaningful use requirements so you get an idea of how much extra work you’ll have to do beyond your regular documenting to meet meaningful use.

58. It they aren’t CCHIT certified take a really really hard look
Well, it looks like this tip was written pre-ONC-ATCB certifying bodies. Of course, readers of this site and its sister site, EMR and HIPAA, will be aware that CCHIT Has Become Irrelevant. Now it’s worth taking a hard look if the EHR isn’t an ONC-ATCB certified EHR. There are a few cases where it might be ok, but they better have a great reason not to be certified. Not because the EHR certification provides you any more value other than the EHR vendor will likely need that EHR certification to stay relevant in the current EHR market.

57. What billing systems do you interface with?
These days it seems in vogue to have an integrated EMR and PMS (billing system). Either way, it’s really important to evaluate how your EMR is going to integrate with your billing. Plus, there can be tremendous benefits to the tight integration if done right.

56. How much do changes and customizations cost?
In many cases, you can see and plan for the customization that you’ll need as part of the EHR implementation. However, there are also going to be plenty of unexpected customizations that you don’t know about until you’re actually using your EHR (Check out this recent post on Unexpected EHR Expenses). Be sure to have the pricing for such customizations specified in the contract. Plus, as much as possible try to understand how open they are to doing customizations for their customers.

Check out my analysis of all 101 EMR and EHR tips.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 71-75

Posted on August 5, 2011 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 13 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.

75. Find out how easy it is to do process improvement
This could be phrased another way. How much with the EMR you’re considering improve your processes and how much will the EMR cause you to change your EMR processes for the worse? I love when EMR vendors like to say that they’re EMR makes it so the clinic doesn’t have to change their processes. It makes me laugh, because just the fact that you have to enter something electronically instead of on paper means you’re changing something. Even if the doctor still writes on paper and scans it in, that means they’ve changed their process since now they have to scan it and view the documents in a scanned format.

The point obviously being that any and every EHR implementation requires change. The question you should consider is how many of the changes will improve your clinic and how many of the changes will cause heartache. I’d guess that every EHR vendor will have quite a few of both types of change.

74. Predictive analytics are a huge benefit
I’ll let Shawn’s words speak for themselves on this one: “Everyone wants to know what volumes are going to like like next year. How many encounters will I have? How many admissions? If the analytics are built straight into the EMR you will have a much easier time trying to estimate the costs and resources necessary for the upcoming years. This improves your ability to do strategic planning, and should lower your costs from 3rd party applications or consultants.”

73. Automatic trending with graphing is a huge help
As they say, a picture is worth a thousand words. It’s amazing the impact a graph can have on seeing trends. This is true if the graph is about an individual patient or across all your patients. Look for EHR vendors that do a good job capturing the trends you want to watch as a doctor.

72. Evaluate process flows that come directly from the application
This relates to EMR tip #75 above. Many process flows in an EHR are flexible, but other things are hard coded and can’t be changed. Make sure the hard coded EHR processes are ones that you can live with before you sign your EHR contract. If you can’t see any hard coded processes in the EHR you’re evaluating, you probably haven’t looked hard enough or in the right places.

71. Are we integrating or interfacing
This topic is particularly important in the hospital setting where you always have multiple systems running. How well you integrate or interface those systems matters a lot. Plus, every EHR vendor has different abilities to integrate or interface. Be aware of what’s possible and more importantly the limitations of those integrations or interfaces.

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.

VitalHealth iPad Like EHR Interface

Posted on April 14, 2011 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 13 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.


During my time at HIMSS, one EHR vendor, VitalHealth EHR, made the pitch to me that they’ve really created an EHR from the ground up that was more innovative and usable than all the other EHR software out there. They described the doctors that stopped by their booth and saw a demo loved their interface and wondered why all the EHR software companies hadn’t done something similar. While an interesting pitch, I asked them whether such a pitch would be able to be heard above all the EMR noise.

After such a pitch I was certainly interested to see the product demo myself. I should say that going into the demo they’d told me that it was still in beta (maybe even alpha). Their website says it will become generally available in Q3 of 2011.

They did a demo of their product on a touch screen computer (I think they should have done it on the iPad. Especially with all the iPad Mania in Healthcare). However, the thing that struck me most was that even on this touch screen computer it looked and felt like an iPad. I’m not sure if they got their inspiration from the iPad and iPhone or if the iPad and iPhone stole it from them (I think I know which), but I was pretty amazed at how similar the interface and navigation felt to that of the iPad.

Unfortunately, outside of the interface, the feature set of the product was pretty disappointing. I asked them to do what I thought would be some pretty simple things (I think it was something with diagnosing) and that feature wasn’t quite built. Not all that surprising since they’re still in beta. Plus, I imagine they were trying to get something together before HIMSS. What will be more interesting is to see them after a year of development under their belt. Will they be able to get the required feature set for it to be a viable alternative? I’ll be certainly keeping an eye on it.

A post like this wouldn’t be worth anything without some screenshots of this “iPad” like interface. I’m not sure these screenshots quite do it justice since the navigation matters too, but you’ll notice some specific design things they’ve done to enable the touch screen capabilities of an iPad and similar devices. Either way, I love seeing EHR screenshots, so here’s a bunch of the VitalHealth EHR screenshots (click on them once to see a bigger shot. Click a second time to see it full size):