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EHR Post Acquisition, 2014 Certified, ICD-10 and the Amazing Charts Future with John Squire, President and COO

Posted on April 30, 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 had the chance to sit down and interview John Squire, President and COO of Amazing Charts. I was interested to learn about the transition Amazing Charts has experienced after being purchased by Pri-Med and the departure of Amazing Charts Founder, Jonathan Bertman. Plus, I wanted to learn why Amazing Charts wasn’t yet 2014 Certified and their plans to make it a reality. We also talk about the value of meaningful use and the ICD-10 delay. Then, we wrap up with a look at where Amazing Charts is headed in the future.

Check out EHR videos for all of my EHR and Healthcare IT interview videos and be sure to subscribe to the Healthcare Scene youtube channel.

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.

What Software Will Replace EHR?

Posted on April 15, 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’m usually a very grounded and practical person. I’m all about dealing with the practical realities that we all face. However, every once in a while I like to sit back and think about where we’re headed.

I’ve often said that I think we’re locked into the EHR systems we have now at least until after the current meaningful use cycle. I can’t imagine a new software system being introduced in the next couple years when every hospital and healthcare organization has to still comply with meaningful use. Many might argue that meaningful use beyond the current EHR incentive money might lock us in to our existing EHR software for many years after as well.

Personally, I think that a new software will replace the current crop of EHR at some point. This replacement will likely coincide with the time an organization is up for renewal of their current EHR. The renewal costs are usually so high that a young startup company could make a splash during renewal time. Add in a change of CIO and I think the opportunity is clear.

My guess is that the next generation of healthcare documentation software will be one that incorporates data from throughout the entire ecosystem of healthcare. I’m not bullish on many of the current crop of EHR software being able to make the shift from being document repositories and billing engines into something which does much more sophisticated data analysis. A few of them will be able to make the investment, but the legacy nature of software development will hold many of them back.

It’s worth noting that I’m not talking about the current crop of data that you can find outside of the healthcare system. I’m talking about software which taps into the next generation of data tracking which goes as far as “an IP address on every organ.” This type of granular healthcare data is going to change how we treat patients. The next generation healthcare information system will need to take all of this data and make it smart and actionable.

To facilitate this change, we could really use a change in our reimbursement system as well. ACOs are the start of what could be possible. What I think is most likely is that the current system will remain in place, but providers and organizations will be able to accept a different model of payment for the healthcare services they provide. While I fear that HHS might not be progressive enough to do such a change, I’m hopeful that by making it a separate initiative they might be able to make this a reality.

What do you think? What type of software, regulations and technology will replace our current crop of EHR? I don’t think the current crop of EHR has much to worry about for now. However, it’s an inevitable part of a market that it evolves.

No Shortage of Excitement (This Week) in Healthcare IT

Posted on March 28, 2014 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.

When I began contemplating the subject of this blog earlier in the week, I thought I’d make room for thoughts on recent improvements in EMR adoption in the small practice and physician community, and the general state of optimism and enthusiasm some op-ed pieces would have us believe is finally taking hold of the industry. But then came along the potential delay of ICD-10, which also begs a quick comment or two.

A bill that included an effort to delay the ICD-10 compliance date a full year was passed, but only after partisan drama over the fact that legislators received the proposed bill just a day before the vote on it was to take place. I tend to turn to AHIMA on ICD-10 matters, and its official stance is fairly obvious:

ahimaicd10tweet

Its reasoning is similar to that of the Coalition for ICD-10, which in a letter to the CMS, stated: “ … any further delay or deviation from the October 1, 2014, compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending. By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients. Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

AHIMA has even started a campaign to encourage its constituents to email their senators to urge them to also vote no when it comes to delaying ICD-10. At the time of this writing, the Senate vote is not yet scheduled. I don’t feel the need to restate my support of no further delay. You can read it here.

With regard to the other hot news items of the week, I was intrigued by the findings of the SK&A survey, which found that the EMR adoption rate for single physician practices grew 11.4%. One reason SK&A gave in the survey analysis was due to the “availability of more than 450 different solutions to fit their practice needs, size and budget.” Call me crazy, but I’m willing to bet that many solutions will not exist in the next three to five years thanks to market consolidation. What will these physicians do when their EMR vendor closes up shop? Time will tell, I suppose.

What if the FDA Started Regulating EHR?

Posted on March 20, 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.

In the world of mobile health, we’ve often talked about what will happen if the FDA starts to regulate the various mobile health apps out there. In fact, the FDA has come out with some pretty detailed guidelines on what mobile health applications and devices need FDA clearance. To date, the FDA has stayed away from any regulation of EHR software.

On my ride to the airport after the Dell Healthcare Think Tank event, we had an interesting and engaging conversation about the FDA when it comes to EHR software. Some of the discussion was around whether the FDA would start regulating EHR software.

Shahid Shah suggested that it was extremely unlikely that the FDA would touch EHR software at least until meaningful use was complete and the current President was out of office. He rightfully argues that this administration has hung their hat on EHR and the FDA wasn’t going to step in and stop that program. Plus, Shahid suggested that ONC wouldn’t let the FDA do it either. Janet Marchibroda from the Bipartisan Policy Center was hopeful that Shahid was right, but wasn’t as confident of this analysis.

After hearing them discuss this, I asked them the question:

What would happen to the EHR Market if the FDA started regulating EHR?

Shahid quickly responded that the majority of EHR vendors would go out of business and only a small handful of companies would go through the FDA clearance process. Then, he suggested that this is exactly why the FDA won’t regulate EHR software. FDA regulation of EHR would wipe out the industry.

This is a really interesting question and discussion. The reality is that there are a lot of similarities between EHR software and medical devices. One could make a really good case for why the FDA should regulate it like medical devices. One could make a case for the benefit of some rigor in the development of EHR software. However, there’s no appetite for such a change. In fact, the only people I’ve seen calling for it are those who think that EHR is unusable and potentially harmful to patients. I’m not sure FDA regulation will make them more usable though.

Now, juxtaposition the above conversation with this post by William Hyman titled “A Medical Device Recall of an EHR-like Product” In this case, the FDA announced McKesson’s voluntary recall of it’s Anesthesia Care system. This software was tightly integrated with other FDA regulated medical devices. I wonder what this means for other EHR software that is starting to integrate with a plethora of FDA cleared medical devices and other non FDA cleared medical devices.

I’m personally with Shahid in that I don’t think the FDA is going to touch EHR software with a long pole. At least, not until after meaningful use. After meaningful use, I guess we’ll see what they decide to do.

Replacement EHR Trend

Posted on June 10, 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’m a huge numbers guy even if numbers can lie if you’re not careful. However, what I love most is the change in numbers which often can tell an important story of trends. One trend we knew was coming is the replacement EHR trend, so I was quite interested when I saw the tweet above that said that 31% of EHR buyers are purchasing a replacement EHR. That’s a huge number and up from the previous 10% replacement EHRs in 2010.

The report linked above also has a number of other interesting EHR numbers. 30% of respondents reported that their practice would replace their current practice management or EHR solution if their current vendor was purchased by another vendor. Considering we’re about to enter an unprecedented stage of EHR consolidation, this should be quite unsettling to any company looking to acquire an EHR vendor.

I was also fascinated to see that 60 percent of hospital-owned groups reported purchasing their current practice management solution before 2006. Is the age of some of these systems going to lead to many of them being replaced? You’d think that 7 years isn’t that long for a system, but in the tech world it’s not young either. With that said, I wonder what EHR or PM systems have been created in the past 3-5 years. I can’t think of many. If we use meaningful use as a point of demarcation, I can’t think of any EHR or PMs that came after meaningful use. I wonder if we’ll see this change.

One thing I’m certain of is that we’re going to get really good at replacing EHR software. Hopefully EHR vendors will embrace the liquidity of data for those who choose to switch EHR, but I’m not too hopeful on this.

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 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’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.

The Fast EHR Companies and the 37Signals EHR Companies

Posted on September 4, 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.

I was recently reading this fascinating interview with Jason Fried, Founder of 37signals. It’s a fascinating read, as was his book Rework. I must admit that I have a similar model for tech entrepreneurship to Jason Fried and it is quite different than what’s written about by most tech websites. Jason is much less about the flash and cash part of entrepreneurship and much more about building something of value in a long term sustainable way.

As I consider on these ideas, I started to wonder about the various EHR companies and which companies fall into the various entrepreneurship buckets.

Fast EMR
The fast EMR company is usually one that’s gone out and gotten a ton of funding from venture capital firms. If you’re an EHR company that’s gone out and raised millions and millions in funding, then you have no choice but to attack the market aggressively so that you can provide a return to your investors. There are actually a number of EHR companies that fit this profile, but the first one that will likely come into everyone’s mind is Practice Fusion. There $64 million in EHR funding means that they have to get a large portion of the EHR market. They no longer have the option of staying small but successful.

Let me be clear that there’s nothing wrong with being a Fast EMR. In fact, there are a lot of good things that come out of fast EMR companies that are trying to push the envelope when it comes to EHR adoption and how EHR should be done. It is entrepreneurship at work.

Slow and Steady EMR
On the opposite end of the spectrum are what I call the slow and steady EMR companies. These companies are often self funded or took in a much smaller investment and then used revenues to grow the company much like 37signals founder described. They slowly and steadily built their product, acquired customers and generated revenue.

I believe that SOAPware and Amazing Charts are the epitome of this type of company. They were both physician founded EMR companies that have built their user base slowly over time. They’ve never gone out and gotten the millions in funding. Instead they’ve grown organically over time.

Why Does This Matter?
In my e-Book on EHR selection, I talk about why it is important for you to understand the type of EHR company you are choosing. Would you rather “marry” the EMR tortoise or the EMR hare? The choice could change your EHR experience dramatically.

Disclosure: Practice Fusion, Amazing Charts and SOAPware are all advertisers on this site, but I didn’t discuss this post with them before posting it. Although, since they’re advertisers they were likely top of mind for me when I was writing this post.

EHR Vendor Consolidation

Posted on June 15, 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.

Katherine Rourke recently did a post on EMR and HIPAA entitled, “Major EMR Vendor Consolidation On The Verge.” This is an incredibly important topic, and so I’m glad that she’s writing about it. However, I have a number of differing views on EHR consolidation.

Probably the two biggest differences of opinion is how quickly she believes we’re going to see EHR consolidation and how much EHR consolidation will happen. Sure, we all know that the current mass of EHR companies isn’t sustainable (I personally put us at about 600 EHR vendors, versus her 1000+ EHR company projection).

In my EHR Company Funding Risks series I looked at all the various type of EHR companies. In that analysis, I realized that each type of company seems to be really well funded through at least the next stage of meaningful use stage 2. Sure, there might not be a few that make it that far, but I believe that most of them will. So, yes EHR consolidation has got to happen, but I don’t see EHR companies falling like flies until at least after meaningful use stage 2 and possibly after meaningful use completely.

I also don’t believe that we’ll ever see the MASS EHR consolidation that many predict. The reason I believe this is that healthcare is very regionalized and so I think there could be many regional EHR companies that are quite successful. Plus, there are such a wide variety of practices including things like: specialty, practice size, billing method, etc on top of local that I believe each of these factors are likely to make it that each factor could have its on EMR market.

Plus, the other challenge I see is that there are a large number of EHR vendors that I know that have no interest in consolidation. In many cases they’re what I call Cash Flow Positive EHR companies and so they are in a good position to last for a long time to come and don’t have any need to sell their company to someone else. I believe they’re in a very good position to be around for a long time.

I imagine some would make the argument that there could be some market forces that could come into play that would change this situation. The most likely argument I’ve heard is the new ACO (accountable care organization) model requiring a large EHR company that can support the entire ACO. This is an important change that should be considered, but I personally don’t think this will drive EHR consolidation. We’re going to have a heterogeneous EHR environment and so ACOs will have to be possible across EHR companies. I don’t see a small set of EHR companies creating a virtually ACO monopoly and shutting out certain EHR companies from that ACO. Although we’ll see how that plays out.

I am interested to hear what other forces people see that could cause EHR market consolidation to happen faster.

I also concur with Katherine’s suggestion that practices have a plan if (and in many cases when) something happens to their EHR company. Maybe I should start seeking out and publishing experiences of practice who’ve gone through this and can share what they learned.

US EMR Market to Exceed $8 Billion in 2016

Posted on January 2, 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.

In case you missed it, I’ve moved a lot of my discussion of the EMR and Health IT markets to my site: EMR Thoughts. I’ve done a lot of posts on that site that look at the EMR market, the health IT investments, the Health IT incubators (or accelerators if you prefer), and other movement in the EMR, EHR and Health IT markets. If you like that type of content, you should definitely subscribe to the EMR Thoughts email list.

Even though, I’ve moved a lot of my EMR market discussion to the other site, every once in a while I’ll drop in some EMR market stuff on here as well. In the article linked in my Costco EMR post, they discussed the size of the EMR market:

Millennium Research Group said in its November report, “U.S. Markets for Electronic Medical Records 2012,” that the U.S. market for EMRs will exceed $8 billion by 2016, with the fastest-growing segment occurring in the small-practice market. Web-based EMRs that don’t require an expensive information technology infrastructure are contributing to the growth, the report said, because they are an affordable option for small practices on tight budgets.

I always hate when they don’t split the EHR market into ambulatory EHR and hospital EHR. I also still haven’t figure out a good way to reconcile that the EMR market in the US will be $8 billion in 2016, but we’ll have spent a good portion of the $36 billion of EHR stimulus money by 2016. Those two numbers don’t jive very well.

I also find it interesting that the fastest-growing segment of the EMR market is the small-practices. I’m not sure I agree with this. I think the larger sales and hospital EHR sales are brisker than the small practice EMR market. Much of the small practice market is still “waiting and seeing.”