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EHR Conversion is About to Get A Lot More Difficult

Posted on October 21, 2016 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 talking to a lot of companies that are getting involved in the EHR conversion space. It makes sense that so many are interested in EHR conversion. It’s an extremely important task and a lot of organizations are going to need this service. While it’s great to think that you can limp along legacy EHR and health IT systems, it just doesn’t become practical when you look at what it means long term to your organization from both a cost and quality of care perspective.

In one of my recent conversations, an EHR conversion expert commented that EHR conversions are about to get a lot more difficult. His argument was that most past EHR conversions were from client server EHR systems that were hosted on a server in the doctor’s office. While those aren’t easy by any means, at least the person doing the conversion had access to the EHR data since it was on a server that you were hosting. It’s not going to be as easy to get to the data with these cloud hosted EHR platforms (or so he argues).

He’s right that a cloud hosted EHR is generally harder to get access to the data in an EHR conversion. In fact, this is why it’s so extremely important that when you select a cloud based EHR you include the right language in your contract when it comes to ownership and access to your data. If you don’t, you could be in real trouble.

It will be interesting to see how this evolves. As more healthcare organizations move to the cloud, will some wise cloud EHR vendors make it easy for healthcare organizations to export all their EHR data from the cloud? Will healthcare organizations demand this service? Will we see vendor neutral archives of EHR data become popular (especially with cloud hosted EHR)?

My fear is that most organizations aren’t that forward thinking. They just can’t imagine ever leaving their current EHR. Given the number of mergers and acquisitions that have happened and will happen in both the EHR world and between healthcare organizations, it would be wise to start thinking about these things earlier rather than later when you won’t have as many options available.

If you want more data on the EHR conversion and legacy EHR system world, be sure to check out the excellent Tackling EHR and EMR Transition series. It’s a great series of posts, infographics, and whitepapers on this important topic. A topic that is only going to become more important over time. Is your organization ready?

Top 10 Reasons for Full EHR Data Migration

Posted on September 26, 2016 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.

EMR switching has become a really hot topic in healthcare IT and I predict that it’s only going to become more important. EHR vendors will continue to consolidate which will force healthcare organizations to switch EHR software. Health systems will continue to acquire healthcare organizations which will also drive EHR switching. Given these trends, it’s important to have a good answer to the question “Should we migrate our EHR data to the new EHR or not?

Galen Healthcare Solutions has put out a detailed whitepaper on EHR data migration that does a great job highlighting best practices for EHR data migration based on their decade of clinical data migration experience. Together with the whitepaper, they offer these 10 reasons a healthcare organization should migrated their EHR data:

  1. Eliminate Legacy Systems
  2. Lower Costs
  3. One System for All
  4. Maximize Productivity
  5. Strengthen Compliance
  6. Prescribe Electronically
  7. Enhance Operational Efficiency
  8. Reduce Human Error
  9. A Greener Solution
  10. Meet Quality Measures

They obviously go into a lot more detail for each of these 10 points in their Free EHR switching whitepaper, but even just looking at the list it’s pretty compelling. At the end of the day for me, the overarching reason to migrate your EHR data is number 7 on the list: Enhancing Operational Efficiency. Is there anything less efficient than limping along an old EHR system that people quickly forget how to use? It’s inefficient for the IT people, but even less efficient for the end users that want access to the clinical data.

Don’t get me wrong. I’m not saying that EHR data migration is easy work. We’d like to think that you just export the data from your old EHR and import it into your new EHR. That’s now how it works. Check out the complex process that Galen uses to do an EHR data migration:
ehr-data-migration-process
You can certainly take out some of the steps in this chart if you don’t care about the integrity of your data. Yep, that’s a reality that exists in no healthcare organization. The integrity of your health data really matters in healthcare. People’s lives are on the line.

The problem is that if the data is stuck in your old legacy EHR and not accessible, then it’s as good as gone. The ideal situation is to migrate your EHR data to your new system in a way that the integrity of the data is maintained. That’s something that takes real experience and expertise to do it right. However, when done right it you can gain all the benefits of accessible data along with the ability to sunset your old EHR application.

Have you switched EHR software? How did you approach EHR data migration? What would you have done the same or different?

Galen Healthcare Solutions is a sponsor of the Tackling EHR & EMR Transition Series of blog posts on Hospital EMR and EHR.

Finding an EHR With Online Tools

Posted on January 5, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

So, you want to dump your EHR and find another, or about to join the fray? Once you’ve got a handle on your requirements, this review lists some online tools that might help. Ideally, they’ll point to the one that’s best for you. Even if they can’t do that, they should help identify what you don’t want. Along the way, they may also raise some new issues, or give you some new insights.

Full Disclosure: I manage EHRSelector.com, but it’s not included.

Finding EHR Tools

The web has a surfeit of EHR evaluation tools. I’ve only reviewed those that are vendor independent and employ some filtering or ranking. That excludes spreadsheets and PDFs that just list features. I also skipped any that charge. I found the nine shown in Table I and reviewed below. Table II explains my definitions.


EHR Tool Table IEHR Tool Table II

EHR Tools Reviewed

1. American EHR. American’s tool gives you several ways to look at an EHR. Its side by side list compares 80 features. It asks users to rank a dozen features on a 1 to 5 scale. To use the tool, you pick a practice size and specialty. You can also see how users rated a product in detail, which shows how it stacks up against all its others. Unfortunately, its interface is a hit or miss affair. When you change a product choice sometimes it works and sometimes it just sits there.

2. Capterra. Capterra ranks the top 20 most popular EHRs, or at least the most well known. To do this, it adds up the number of customers, users and social media scores. That is, how often they’re mentioned on Twitter, Facebook, etc. Users rank products on a 1 to 5 scale and can add comments. It has a basic product filtering system.

3. Consumer Affairs. It examines ten major vendors using a short breakdown of features and user reviews. Users rate products on a 1 to 5 scale and can add comments.

4. EHR Compare. This tool solely relies on user ratings. Users score 20 EHR features on a 1 to 5 scale. It may add additional features depending on specialty. It only has a handful of reviews, which is a drawback.

5. EHR in Practice. EHR in Practice provides a short list of features and thumbnail EHR descriptions.

6. EHR Softwareinsider. This site uses ONC attestations to rank vendors. Its analysis shows those rankings along with Black Book ratings. Users rank products on a 1 to 10 scale. Interestingly, users can earn a $10 Amazon gift card for their reviews. For a fee, a vendor can move their product to the top of a list, though ES says that does not influence other factors.

7. Select Hub. There is one big if to using this site, if you can get in. As with some sites, SH requires that you register to get to its rankings. The problem is that once you do, you may wait for a day or more for a confirming email link. Even then, it didn’t see the confirmation, so I had to repeat, etc. If you get in, you’ll find some interesting features. Its staff briefly analyzes a product’s performance for each function. The other is that you can set up a project for yourself and others to query vendors.

8. Software Advice. Software Advice is a user rating site based on a 1 to 5 scale. It offers filters by rating rank, specialty and practice size as well as a short product summary.

9. Top Ten Reviews. As the name implies, Top Ten shows just that. There are two problems with its rankings. It doesn’t explain how it chose them or how they are ranked. It provides a thumbnail for each product.

What to Use. Several of the EHR comparison are just popularity contests. They have limited filters and depend on user reviews from whoever walks in the door. Two, however, go beyond that and are worth exploring: American EHR and Select Hub. Both have interface problems, but with persistence, you can find out more about a product than using the others.

With that said, you may also may find it useful to go through the user ranked tools. They may help you cull out particular products or interest you in one you’ve overlooked. Finally, if I’ve left something out, please let me know. I’ll add it in a revised post.

A Lawyer’s Perspective on EHR Vendors Holding EHR Data Hostage

Posted on October 23, 2015 I Written By

The following is a guest blog post by Bill O’Toole is the founder of O’Toole Law Group.
William O'Toole - Healthcare IT and EHR Contracts
The recent post, EHR Data Hostage Wouldn’t Exist if EHR Were Truly Interoperable, on EMR & HIPAA got me thinking, and I wanted to offer a few observations from my experience as an HIT lawyer.

The goal is wonderful. However, it would take years and years to achieve such a goal. Data extraction and subsequent import take time, sometimes lots of it. What if there were a standardized specification to which vendors could design extraction tools and programs? Follow that with contractual commitment that the vendor adheres to those specifications. We did it with HL-7, why not data transport?

Thankfully I have not yet represented a vendor that withheld data solely due to the departure of a customer. I have however been involved in very tough situations where the vendor treads a fine line in not releasing data until customers fulfill their obligations (such as paying for use of the software). I like to believe that there is more to the story in the vast majority of data hostage disputes, and in my experience, this has always been the case.

The emergence of the hosted subscription model has resulted in a control shift to the vendor, as opposed to the on premises model where the customer is in control and a vendor can be shut out. That said, vendor assistance is usually required to extract data.

“HIPAA vs. vendor rights” is a very hot topic for me. Providers must provide patient data on request. Vendors have a right to be paid. The contractual right of a vendor to suspend customer access to a hosted EHR butts head-on against HIPAA. I have discussed this with ONC and while the problem is recognized, there is no solution at the present time.

Bill O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com

Have You Ever Tried to Cancel an EHR?

Posted on July 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.

A caller’s attempt to cancel their Comcast service is going around the internet. About 10 minutes into the call, the husband got on the line and started recording the call for all of us to see how the Comcast retention rep acted. You can listen to it embedded below.

I imagine most of us have had an experience trying to cancel our service at one time or another. It’s not a fun experience. Although, I know some people who call to cancel their cable service every 3 months in order to have the customer retention representative give them a lower cost deal. You know that offering you a 3 month lower cost (or something like that) is one way they try to retain you as a customer.

As I listened to the call, I was thinking about some of the experiences I’ve read and heard about clinics cancelling their EHR service. Unlike a cable or TV service where it’s quite easy to switch services, switching EHR software is a much more involved process. In many cases EHR vendors hold you “hostage” more than the Comcast retention rep above.

In most cases, the EHR vendor will go radio silent on you or responses to your inquiries will take a really long time. Plus, when you ask for access to your EHR data, you’ll often get hit with a hefty price tag. It’s a shameful practice that many EHR vendors employ to try and lock their customers in and prevent them from switching EHRs. We’re entering the era of EHR switching and this is going to impact a lot of practices going forward.

I’ve debated for a while now creating an EHR “naughty” and “nice” list which outlines the good and bad business practices by EHR vendors. One of the challenges is defining what’s naughty and what’s nice. There’s a lot of grey area in the middle. Although, I think that aggregating this type of information would be really valuable. I’m just afraid that many EHR vendors won’t want to share.

I’ve written posts before about why I think holding a practice’s EHR data hostage is a terrible business practice. The medical community is small and an EHR vendor that tries to do this will definitely suffer from negative word of mouth. What do you think? Should we create a list of EHR vendors and their policy on EHR cancellations?

Could Standard Interfaces for EHR Data Kill the EHR Business?

Posted on May 14, 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 was reading some people’s comments on a LinkedIn group and it sparked this interesting question:

If you can move healthcare data wherever we want it, then will the EHR’s have to change their business model?

I think this is a really important question. I’m sure that some will question whether we’ll be able to ever move healthcare data wherever we want it. I can’t remember the exact stat, but I recently saw that a huge percentage of the granular health data is stored in lab results. We’re already moving lab result data pretty well between systems. The same can be said for eRX. We’ve kind of cracked those nuts and eventually we’ll make the rest of the data available as well.

I think the answer to the question is that EHR vendors will have to change. I’m not sure they’ll have to change their business model per se, but they will have to change. The fact that a healthcare organization could take their healthcare data and go somewhere else will mean that an EHR vendor will have to be much more accountable to the software they produce and release.

I’ve often used the comparison on my blog. It is powered by WordPress and one of the great features of WordPress is that I can export my entire blog into one file and then import it wherever I want. This makes the cost of switching from WordPress to some other blogging platform simple.

While it’s really simple for me to change, I’m fiercely loyal to WordPress. Largely because WordPress has delivered a high quality product that keeps improving in the 9 years I’ve been using it. Just because I can switch products doesn’t mean I will switch.

The same very much applies to EHR software. Plus, there are other costs that won’t be recovered if I switch. For example, training costs and configuration costs. There are certainly plenty of reasons why someone wouldn’t want to switch EHR software even if they could get their data out. In fact, I’d argue that if you’re to the point where you’re willing to go through the hassle of switching EHR software, you should do it. It’s not easy to get that uncomfortable with an EHR software that you want to go through the hassle. Although, I guess a few might be naive to the EHR switching costs.

Long story short, I think standard interfaces for EHR data wouldn’t kill the EHR business, but it would cause it to change and change for the good. I’d welcome such a change. A few EHR vendors wouldn’t, but that actually is just another reason we should make it a reality. It would be the first thing on my list if I were to create a “meaningful certification.”

From 5 EHR to the Cloud, EMR Is Just a Tool, Startups to Improve EMR Usability

Posted on February 16, 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.


This is a big preview of coming attraction. EHR vendors are going to have to be ready for this type of EHR purchase going forward. Well, maybe not 5 EHR, but it could be close to as complex. Add in all of the practice acquisitions and the EMR switching is happening.


This is a good reminder. EMR is a tool and how you use it determines its real value.


The real question is whether the EMR systems will allow it or at least which EMR vendors will support it. If they don’t, startups won’t be able to do much. Even if they do open it, I’m still not confident that a startup built on top of today’s EMRs can solve what pains EMR.

A List of Key Insights for EHR Data Conversion

Posted on December 17, 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.

Healthcare Scene sat down with Sean West, VP of Data Conversion at HealthPort, to discuss EHR data conversion. EHR data conversion is quickly becoming a hot topic for many organizations that rushed their initial EHR selection and implementation. In our video discussion embedded below, Sean West offers a number of key insights including the following:

  • Convert the Data Close to the EHR Conversion
  • Ensure You Have Enough Time to Make the Conversion
  • Consider How Much Data Needs to Be Converted
  • Look at the Impact on Performance of Converting All EHR Data
  • Evaluate Your Legacy EHR Vendors Willingness to Work with You on Data Conversion

Check out the following video for all the details:

We also asked Sean West about when an organization would want to consider a vendor neutral archive for their EHR. While the vendor neutral archive is incredibly popular with PACS systems, we’re just now starting to see the idea crop up with EHR data. In the following video, Sean West provides some good insight into when an organization might want to consider a vendor neutral archive for their EHR data.

A Do-Not-Forget Checklist for EHR Switchers on the Hook for Meaningful Use

Posted on November 21, 2013 I Written By

The following is a guest post by Tom S. Lee, PhD, CEO and Founder at SA Ignite.

According to a recent survey by Black Book rankings, as many as 16 percent of ambulatory EHR users may become  EHR switchers within the next 12 months.  Large health systems such as Intermountain (a client of ours) and the Department of Defense have recently announced that they are switching EHRs or are currently evaluating a change. Many such organizations are planning to switch EHRs while continuing to meet increasingly difficult Stage 2 Meaningful Use (MU) requirements.  According to past National Coordinator  Dr. Farzad Mostashari, there will be no delay of MU Stage 2. That means your health IT road map may now include switching EHRs, managing Stage 2 attestations, and achieving ICD-10 compliance.

How do you switch jugglers while the number of balls in the air increases at the same time?

We have encountered a common set of issues and questions in our work with clients, discussions with prospects, and exchanges with thought leaders in the industry related to the EHR switching scenario, especially as it relates to Meaningful Use.  Here are some things to consider:

1. Assess and properly store data from your old EHR for future MU audits. A recent wave of MU audit notices has been sent by CMS to some of the country’s leading health systems. Each MU attestation is subject to audit 6 years after the attestation date.  With this in mind, be sure to pull out and securely and centrally store all supporting data from your old EHR before its license expires.  Get expert assistance if needed to understand how to build a comprehensive and solid audit trail.  One great place start is the guidance on audit documentation provided by CMS.

2. Optimize the timing of the EHR switch relative to government reporting timelines.  For example, in 2014 there is a one-time opportunity to report on only a calendar quarter’s worth of data for many eligible providers, rather than the entire year.  This modification to MU was originally made to accommodate delayed Stage 2 certifications by the EHR vendors.  However, it can also be leveraged by EHR switchers who can time the switch to happen within 2014 to benefit from a lower compliance bar while the massive impacts of switching EHRs are absorbed by the organization.

3. Plan to merge data across EHRs to meet MU reporting requirements.  Even with the 2014 calendar-quarter reporting reprieve, for many hospitals and eligible providers to achieve Meaningful Use in an EHR-switching year it’ll be necessary to stitch together Meaningful Use data across the old and new EHRs in order to meet many MU reporting requirements.  For example, this may be required simply to meet the minimum certified EHR usage threshold to be eligible for the MU program in that year.  Assume merging data will be necessary, prepare how to do so before your old EHR license expires, seek help, or do both. An interesting contingency we have seen is to drive eligible providers to “over perform” on their MU measures on the old EHR in anticipation that MU performance will drop at the outset of adapting to the new EHR.  This will increase the chances that providers’ total MU performance within a reporting period spanning both EHRs will end up above threshold.

4. Plan to be supporting two EHRs at the same time.  Although it is sometimes possible to do a “big bang” switchover to a new EHR across an entire organization, we often see that rollout plans for the new EHR are phased across specialty, location, or other sub-groups.  During those periods when the organization could be supporting two different EHRs, such as two ambulatory EHRs in different geographic regions, it is important to organize and align teams to not only handle the immediate demands of MU but also transition completely to supporting the new EHR.  For example, MU data reporting and attestation can be hard enough for just one ambulatory EHR, much less two.  It takes preparation well in advance of the EHR switch and government attestation deadlines to avoid 11th hour fire drills.

Is your organization juggling MU requirements while switching EHRs? If so, I’m sure that you’ve found there are additional considerations surrounding an EHR switch that are important to keep in mind. I’d love to hear your suggestions in the comments.

Why One Doctor Switched EMRs

Posted on August 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Over the last several months, we’ve been flooded with statistics spelling out the reasons why doctors are choosing to dump their current EMR and invest in a new one and we’ve been writing about switching EMR for a while.  To bring some perspective to this discussion, I’ve reached out to physicians who have made the Big Switch and attempted to learn a bit about why they chose to move from one EMR to another.

Today, I bring you Dr. Christy Valentine, a New Orleans-based physician practicing internal medicine and pediatrics. Dr. Valentine operates a small practice consisting of herself and a nurse practitioner.

Back in 2007, as part of opening her own practice, Dr. Valentine decided to invest in an EMR from a company better known for hospital systems. (She’s asked me not to name the vendor — let’s call them Vendor X.) Having seen generations of paper medical records wiped out by Hurricane Katrina, she was eager to go digital and enjoy the peace of mind that backup storage offers.

Dr. Valentine looked at several EMRs but was most interested in Vendor X’s product, which was in use at the local academic medical center and under consideration by couple of major health systems in her area. “I felt I’d have a better chance of hiring people who were familiar with the technology,” Dr. Valentine recalls. “Being a small practice we really wanted to save time training individuals on the computer system.”

Dr. Valentine had purchased not only Vendor X’s EMR but also the billing system that went with it. She soon came to regret that choice, however. For one thing,, she said, Vendor X was slow to respond to customer service requests; she and her staff had to leave a message and wait for a response which sometimes never came.

Perhaps even worse, despite investing years in trying to make things right, the practice management system was a wash-out. “I had to scrap it completely and move to an outside billing service because it wouldn’t work for our practice,” Dr. Valentine said. And to top things off, the system never got easier to use despite Dr. Valentine’s sincere efforts to make things work.

In retrospect, she feels that her practice should have gone with a vendor that focuses on practices her size, she says. “I learned that you if you go for a vendors whose big fish is the hospital, you won’t be important to the vendor,” she said.

About a year ago, Dr. Valentine decided once and for all to dump Vendor X, largely because she was opening her second office and didn’t want to bring Vendor X over. Instead, her practice  brought up athenahealth’s EMR and practice management system a few months ago

Dr. Valentine has been happy ever since. She’s very pleased with the athenahealth customer service and finds the product easy to use. She feels that her system, unlike the old one, is easy to use and to customize with specialized templates. Even better, she feels ready to steam into Meaningful Use Stage 3 with athena as a partner.  “As soon as they tell us what they need we’ll be ready to jump right into it,” Dr. Valentine says.