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Could Clinicians Create Better HIE Tools?

The following is a guest blog post by Andy Oram.His post reminds me of when I asked “Is Full Healthcare Interoperability a Pipe Dream?

A tense and flustered discussion took place on Monday, August 11 during a routine meeting of the HIT Standards Committee Implementation Workgroup, a subcommittee set up by the Office of the National Coordinator (ONC), which takes responsibility for U.S. government efforts to support new IT initiatives in the health care field. The subject of their uncomfortable phone call was the interoperability of electronic health records (EHRs), the leading issue of health IT. A number of “user experience” reports from the field revealed that the situation is not good.

We have to look at the depth of the problem before hoping to shed light on a solution.

An interoperability showcase literally takes the center of the major health IT conference each year, HIMSS. When I have attended, they physically arranged their sessions around a large pavilion filled with booths and computer screens. But the material on display at the showcase is not the whiz-bang features and glossy displays found at most IT coventions (those appear on the exhibition floor at HIMSS), but just demonstrations of document exchange among EHR vendors.

The hoopla over interoperability at HIMSS suggests its importance to the health care industry. The ability to share coordination of care documents is the focus of current government incentives (Meaningful Use), anchoring Stage 2 and destined to be even more important (if Meaningful Use lasts) in Stage 3.

And for good reason: every time we see a specialist, or our parent moves from a hospital to a rehab facility, or our doctor even moves to another practice (an event that recently threw my wife’s medical records into exasperating limbo), we need record exchange. If we ever expect to track epidemics better or run analytics that can lower health case costs, interoperability will matter even more.

But take a look at extensive testing done by a team for the Journal of the American Medical Informatics Association, recently summarized in a posting by health IT expert Brian Ahier. When they dug into the documents being exchanged, researchers found that many vendors inserted the wrong codes for diagnoses or drugs, placed results in the wrong fields (leaving them inaccessible to recipients), and failed to include relevant data. You don’t have to be an XML programmer or standards expert to get the gist from a list of sample errors included with the study.

And that list covers only the problems found in the 19 organizations who showed enough politeness and concern for the public interest to submit samples–what about the many who ignored the researchers’ request?

A slightly different list of complaints came up at the HIT Standards Committee Implementation Workgroup meeting, although along similar lines. The participants in the call were concerned with errors, but also pointed out the woeful inadequacy of the EHR implementations in representing the complexities and variety of patient care. Some called for changes I find of questionable ethics (such as the ability to exclude certain information from the data exchange while leaving it in the doctor’s records) and complained that the documents exchanged were not easy for patients to read, a goal that was not part of the original requirements.

However, it’s worth pointing out that documents exchange would fall far short of true coordinated care, even if everything worked as the standards called for. Continuity of care documents, the most common format in current health information exchange, have only a superficial sliver of diagnoses, treatments, and other immediate concerns, but do not have space for patient histories. Data that patients can now collect, either through fitness devices or self-reporting, has no place to be recorded. This is why many health reformers call for adopting an entire new standard, FHIR, a suggestion recognized by the ONC as valid but postponed indefinitely because it’s such a big change. The failure to adopt current formats seems to become the justification for keeping on the same path.

Let’s take a step back. After all those standards, all those certifications, all those interoperability showcases, why does document exchange still fail?

The JAMIA article indicated that failure can be widely spread around. There are rarely villains in health care, only people pursuing business as usual when that is insufficient. Thus:

  • The Consolidated CDA standard itself could have been more precisely defined, indicating what to do for instance when values are missing from the record.

  • Certification tests can look deeper into documents, testing for instance that codes are recorded correctly. Although I don’t know why the interoperability showcase results don’t translate into real-world success, I would find it quite believable that vendors might focus on superficial goals (such as using the Direct protocols to exchange data) without determining whether that data is actually usable.

  • Meaningful Use requirements (already hundreds of pages long) could specify more details. One caller in the HIT Standards Committee session mentioned medication reconciliation as one such area.

The HIT Standards Committee agonized over whether to pursue broad goals, necessarily at a slow pace, or to seek a few achievable improvements in the process right away. In either case, what we have to look forward to is more meetings of committees, longer and more mind-numbing documents, heavier and heavier tests–infrastructure galore.

Meanwhile, the structure facilitating all this bureaucracy is crumbling. Many criticisms of Meaningful Use Stage 2 have been publicly aired–some during the HIT Standards Committee call–and Stage 3 now looks like a faint hope. Some journalists predict a doctor’s revolt. Instead of continuing on a path hated by everybody, including the people laying it out, maybe we need a new approach.

Software developers over the past couple decades have adopted a range of ways to involve the users of software in its design. Sometimes called agile or lean methodologies, these strategies roll out prototypes and even production systems for realistic testing. The strategies call for a whole retooling of the software development process, a change that would not come easily to slow-moving proprietary companies such as those dominating the EHR industry. But how would agile programming look in health care?

Instead of bringing a doctor in from time to time to explain what a clinical workflow looks like or to approve the screens put up by a product, clinicians would be actively designing the screens and the transitions between them as they work. They would discover what needs to be in front of a resident’s eyes as she enters the intensive care ward and what needs to be conveyed to the nurses’ station when an alarm goes off sixty feet away.

Clinicians can ensure that the information transferred is complete and holds value. They would not tolerate, as the products tested by the JAMIA team do, a document that reports a medication without including its dose, timing, and route of administration.

Not being software experts (for the most part), doctors can’t be expected to anticipate all problems, such as changes of data versions. They still need to work closely with standards experts and programmers.

It also should be mentioned that agile methods include rigorous testing, sometimes to the extent that programmers write tests before writing the code they are testing. So the process is by no means lax about programming errors and patient safety.

Finally, modern software teams maintain databases–often open to the users and even the general public–of reported errors. The health care field needs this kind of transparency. Clinicians need to be warned of possible problems with a software module.

What we’re talking about here is a design that creates a product intimately congruent with each site’s needs and workflow. The software is not imported into a clinical environment–much less imposed on one–but grows organically from it, as early developers of the VistA software at the Veterans Administration claimed to have done. Problems with document exchange would be caught immediately during such a process, and the programmers would work out a common format cooperatively–because that’s what the clinicians want them to do.

August 13, 2014 I Written By

Data Ownership Disputes, Not Tech Challenges, Slow Interoperability

Most of the time, when we discuss obstacles to interoperability, we focus on the varied technical issues and expense involved in data sharing between hospitals and doctors. And without a doubt, there are formidable technical challenges ahead — as well as financial ones  – on the road to full-on, fluid, national data exchange between providers.

But those aren’t the only obstacles to widespread interoperability, according to one health IT leader. There’s another issue lurking in the background which is also slowing the adoption of HIEs and other data-sharing plans, according to HIMSS head H. Stephen Lieber, who recently spoke to MedCity News. According to Lieber, the idea that providers (not patients) own clinical data is one of the biggest barriers standing in the way of broad interoperability.

“There is still some fine-tuning needed around how technology is adopted, but fundamentally it’s not a technology barrier. It’s a cultural barrier and it’s also a lack of a compelling case,” Lieber told MedCity News.

In Lieber’s experience, few institutions actually admit that they believe they own the data. But the truth is that they want to hold on to their data for competitive reasons, he told MedCity News.

What’s more, there’s actually a business case for not sharing data. After all, if a doctor or hospital has no data on a patient, they end up retesting and re-doing things — and get paid for it, Lieber notes.

Over time, however, hospitals and doctors will eventually be pushed hard in the direction of interoperability by changes in reimbursement, Lieber said. “Work is already being done in Washington to redesign reimbursement. Once Medicare heads down that path, commercial insurers will follow,” Lieber told the publication.

Lieber’s comments make a great deal of sense, and what’s more, focus on an aspect of interoperability which is seldom discussed. If hospitals and doctors still cling to a culture in which they own the clinical data, it’s most definitely going to make the task of building out HIEs more difficult. Let’s see if CMS actually comes up with a reimbursement structure that directly rewards data sharing; if it does, then I imagine you will see real change.

August 13, 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.

Specialty EHR Speaks that Specialty

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

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

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

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

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

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

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

June 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 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.

Telemedicine Not Connecting With EMRs

As smartphones and tablets become a standard part of healthcare as we know it, telemedicine is gaining a new foothold in medicine too.  In some cases, we’re talking off the cuff transactions in which, say, a patient e-mails a photo to a doctor who can then diagnose and prescribe.  But telemedicine is also taking root on an institutional level, with health systems rolling out projects across the country.

The problem is, however, that these telemedicine projects simply don’t integrate with EMRs, according to an article in SearchHealthIT.  The piece’s writer, Don Fluckinger, recently attended American Telemedicine Association’s 2013 Annual International Meeting & Trade Show, where complaints were rife that EMRs and telemedicine don’t interoperate.

I really liked this summary of the situation one executive shared with Fluckinger:

For now, the executive (who asked not to be named) said, telemedicine providers need to keep away from the “blast radius” of EHR vendor conflicts, lest their budgets get consumed by building interfaces to the various non-interoperable EHR systems.

Not only are health systems struggling to integrate telemedicine data with EMRs, telemedicine providers are in a bit of a difficult spot too, Fluckinger notes. As an example, he tells the tale of Seattle-based Carena Inc., a provider of primary care services to patients via phone and video, which provides after-hours support to physicians at Franciscan Health System in Tacoma, Wash.

Carena itself has an EMR which has the ability to share searchable PDF documents for use in patient EMRs, but Franciscan’s seven hospitals are bringing up an Epic implementation which can’t support this trick.  Top execs at Franciscan want to connect Carena’s data to Epic, but that won’t happen right away.  So Franciscan may end up setting up Carena’s after-hours service within Franciscan’s Epic installation to work around the interoperability problem.

This is just one sample of the interoperability obstacles healthcare organizations are encountering when they set out to create a telemedicine service. As telemedicine explodes with the use of portable devices, I can only imagine that this will impose one more pressure on vendors to conquer compatibility problems. (But sadly, I doubt it will force any real changes in the near future.)

June 5, 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.

EMR Vendors Want Meaningful Use Stage 3 Delay

A group of EMR vendors have joined the chorus of industry organizations asking that Meaningful Use Stage 3 deadlines be moved up to a later date.  The vendors also want to see the nature of Stage 3 requirements changed to put a greater emphasis on interoperabilityInformation Week reports.

The group, the HIMSS EHR Association (EHRA), represents 40 vendors pulled together by HIMSS.  Members include both enterprise and physician-oriented vendors, including athenahealth, Cerner, Epic, eClinicalWorks, Emdeon, Meditech, McKesson, Siemens GE Healthcare IT and Practice Fusion.

In comments submitted to HHS, the vendors argue that MU Stage 3 requirements should not kick in until three years after a provider reaches Stage 2, and start no earlier than 2017. But their larger request, and more significant one, is that they’d like to see Meaningful Use Stage 3′s focus changed:

“The EHRA strongly recommends that Stage 3 focus primarily on encouraging and assisting providers to take advantage of the substantial capabilities established in Stage 1 and especially Stage 2, rather than adding new meaningful use requirements and product certification criteria. In particular, we believe that any meaningful use and functionality changes should focus primarily on interoperability and building on accelerated momentum and more extensive use of Stage 2 capabilities and clinical quality measurement.”

So, we’ve finally got vendors like walled-garden-player Epic finding a reason to fight for interoperability. It took being clubbed by the development requirements of Stage 3, which seems to have EHRA members worried, but it happened nonetheless.

While there’s obviously self-interest in vendors asking not to strain their resources on new development, they still have a point which deserves considering.  Does it really make sense to push the development curve as far as Stage 3 requires before providers have gotten the chance to leverage what they’ve got?  Maybe not.

Now, the question is whether the vendors will put their code where their mouth is. Will the highly proprietary approach taken by Epic and some of its peers become passe?

January 29, 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.

EHR Benefit, Goodhart’s Law, and EHR Interoperability


Thanks to Sherry for pointing us out to this example of the benefit of EHR. I hope that Sherry’s dad does well in surgery and recovers well.


I think that Charles might be on to something here. The interesting thing to me is that it’s very likely that looking back on the HITECH act, the most valuable part will just be shining the spotlight on EHR. It’s woken a lot of healthcare organizations up to EHR and what was happening with EHR that were in a cozy slumber. I think that’s the most important thing we can do to move healthcare IT forward.


I don’t see this getting better any time soon. Check out the entire Twitter thread for this message to get the full context of the discussion. I’m still bamboozled by why we can all see the value of exchanging data, the technical details have been solved (see HIMSS interoperability showcase) and yet we’re still not sharing data.

January 27, 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.

Will Big EMR Vendors Use Healthcare Standards As A Weapon?

Standards are a tricky thing. Some times, they bring a technical niche to its senses and promote innovation, and others, they’re well-intentioned academic efforts which gain no ground.  From what I’ve seen over the years, the difference between which standards gain acceptance and which end up in trash bin of history has more to do with politics than technical merit.

But what the EMR industry did neither? From the mind of my crafty colleague John, here’s a scenario to consider.  What if rather than going with an industry-wide standard for interoperability, the big EMR vendors agreed on a standard they’d share and more or less shut out the smaller players?

Yeah, I already hear you asking: “Wouldn’t that be an antitrust violation?”  While I am not and probably never will be a lawyer, my guess is if a bunch of big vendors deliberately, obviously shut the smaller players out, it would be. But standards are so slippery that I bet it’d be a while before anyone outside of our industry saw something funny going on.

Besides, the government is doing everything in its power to get EMR vendors to help providers achieve interoperability. Right now ONC is not getting much cooperation — in fact, I’d characterize the big vendors’ stance as ‘passive aggressive’ at best.  So if Epic, Cerner, Siemens, MEDITECH and their brethren found a way to make their products work together, they might get a gold star rather then an FTC/DoJ slap on the wrist.

Besides, it would be in the interests of the bigger firms to include a few smaller players in their interoperability effort, the ones in the big boys’ sweet spots, and then “oops,” the smaller companies would get acquired and the knowledge would stay home.

Right now, as far as I can tell, it’s Epic versus the rest of the world, and that rest of the EMR world is not minded to play nicely with anyone else either. But if John can imagine a big-EMR-company standards-based coup d’etat happening, rest assured they have as well.

John’s Comment: Since Anne mentions this as my idea, I thought I’d weight in a little bit on the subject. While it’s possible that the big EHR vendors could adopt a different standard and shut out the small EHR vendors, I don’t think that’s likely. Instead of adopting a different standard, I could see the large EHR vendors basically prioritizing the interfaces with the small EHR vendors into oblivion.

In fact, in many ways the big EHR vendors could use the standard as a shield for what they’re doing. They’ll say that they can interface with any EHR vendor because they’re using the widely adopted standard. However, it’s one thing to have the technical capability to exchange healthcare information and a very different thing to actually create the trust relationship between EHR vendors to make the data sharing possible.

Think about it from a large EHR vendor perspective. Why do they want to be bothered with interoperability with 600+ EHR vendors? That’s a lot of work and is something that could actually hurt their business more than it helps.

My hope is that I’m completely wrong with this, but I’ve already seen the large EHR vendors getting together to make data sharing possible. The question is whether they’re sincerely doing this out of a desire to connect as many health records as quickly as possible or whether it is good strategy. My gut feeling is that it’s probably both. It just works out that the first is better to say in public and the second is just a nice result of doing the first.

October 9, 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.

The Epic EMR Giant Challenge, EHR Alternatives, EMR Go-Live Tweets, and Patient-Centric Health

As I mentioned on EMR and HIPAA today, I’ve decided to trade off posts between this site and EMR and HIPAA each Sunday. On one site I’ll do a post looking at various EMR and Healthcare IT related tweets. On the other site, Katie will be taking a look around the various Healthcare Scene blogs to highlight some of the important posts that people might have missed.

This will be the first round up of EMR related tweets on EMR and EHR. I hope you enjoy the posts. It’s always fun and interesting to see what people are saying and hopefully I provide some valuable commentary alongside the tweets.


While this article has a catchy headline (Anything with Epic in it’s headline seems to do well), I was disappointed by the article. Any discussion of Epic’s dominance that revolves around a discussion of interoperability as this article does is really missing the target. I’m not sure how the author of this article missed that even different Epic installs can’t share information. Epic has done very well at a lot of things, but interoperability is not one of them.


I don’t agree completely with The Nerdy Nurse. You can still get paid without using an EMR. ARRA hasn’t drastically changed that situation. Although, down the road that might become the case.


If you are an EHR lover, you’ll love the Live Tweeting that John Showalter did of his EHR Go Live. I love the transparency and the energy he has. Another great John in the healthcare IT space. I should start a Healthcare IT John’s list.


I’m not sure anyone would argue that Epic is a patient-centric platform. I’d be interested to hear someone who’d like to give it a try.

June 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.

Meaningful Use Solidifies EHR as the Database of Healthcare

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.

March 20, 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.

Specialist EMRs: Pros and Cons

Right now, the bulk of well-known vendors are fighting for hospital and multispecialty/primary care group business.

But specialist EMRs are a thriving market, too, and one analysts like myself don’t cover often enough. To get an idea of how many specialist EMRs are out there, check out this list of EMR specialties my colleague John Lynn compiled. Though it’s from 2009, it should give you an idea of what we’re dealing with here.

Is it really necessary for specialty physicians to buy an EMR dedicated to their profession?  One specialty vendor offers a thoughtful argument as to why their approach is better:

 Clinical content is required to sufficiently document exam findings, diagnoses, and medical plans. To be truly effective, an EMR must possess a comprehensive library of information that alleviates the need for physicians to document from scratch. Otherwise, both the workflow efficiencies and the documentation improvements touted by EMR vendors suffer.

But, according to [Peter] Waegemann, “most medical specialty societies simply are not ready to ‘come up with the data’ around which vendors can design specialized systems.” Therefore, most generalized EMR vendors put the responsibility for developing clinical content on the shoulders of their customers. But, therein lies the problem.

Writing a comprehensive, usable library can take up to 400 hours of a physician’s time – time that is already in very short supply and very expensive. The sheer amount of time required for such a task oftentimes delays implementations, frustrates users, and is one of the top reason behind EMR failures. Some vendors rely on third party resources to sell libraries to specialty customers, but doing so oftentimes raises the overall cost and complexity of the solution to unacceptable levels.

On the other hand, I can think of at least a few reasons why a specialty EMR might not be the best choice for a practice:

* Interoperability:  If your practice joins a health information exchange (and let’s face it, that day is coming for most physicians) will your specialty EMR be able to link up comfortably with mainstream systems?

* Connections with hospital systems:  Another interoperability issue. If the hospital where you do most of your business is an Epic shop, and you’re using, say, the

* Workflows that don’t fit with major systems:  It’s all well and good to be really comfortable with your specialty EMR, but how will that work when you’re forced to “switch gears” and use mainstream systems in settings outside your practice.

So folks, which side do you come down on in this discussion?

March 19, 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.