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EHR is More than Software

Posted on July 12, 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.

Far too often when we talk about EHR, we mostly only talk about the software side of an EHR implementation. Certainly selecting the right EHR software is the most important part of an EHR implementation. It will guide and direct many of the other EHR implementation decisions. However, once you’ve selected the right EHR software, you need to make sure and give plenty of attention to the hardware side of an EHR implementation as well. Many don’t and suffer the consequences.

Yes, I know that many clinics and even some hospitals sit back and rely on their EHR vendor to walk them through all their new technical hardware needs. This can work out really well since the EHR vendor knows which hardware will work best with their EHR software. Plus, many EHR vendors have partnered with hardware vendors to provide a really seamless service to their customers. For example, we recently posted to the EMR and EHR video website some HP videos with their EHR partners Greenway and Quest Diagnostics. In fact, at HIMSS I learned about the HP EHReadySM Program which focuses on the seamless EHR implementation experience between EHR software and hardware. I was amazed by the number of EHR partners HP had.

Other clinics have their own in house IT support that deal with all of their EHR hardware needs. In some cases, the doctors themselves act as their own IT support. Regardless of how you approach your EHR hardware, here are some things to consider when it comes to hardware during an EHR implementation:

Consult Other EHR Physician Users – One of the best ways to learn what hardware you need for your EHR is to ask existing users of that EHR. Don’t ask a clinic that’s been using that EHR for more than a year. They’re likely using older hardware you can’t buy anymore and have also forgotten what they bought. Instead ask your EHR vendor for a doctor who’s been using their EHR for about a year.

Existing Infrastructure – Any vendor worth their salt is going to want you to use your existing infrastructure as much as possible. If you just bought a brand new laptop, then there shouldn’t be a need to replace that in order to use the EHR. However, be very careful that you don’t take this too far. I know many clinics who have tried to skate by on old hardware and made their EHR implementation miserable. They finally spend the $500 on a new desktop and EHR satisfaction skyrockets. For some context on when to invest in hardware, read these article on EHR performance issues and EHR slowness. Make sure your lack of investment in hardware isn’t the reason your “EHR is Slow.”

Financing – Yes, the cost of EHR software has dropped dramatically with even a number of high quality Free EHR software offerings. However, many doctors forget to add in the EHR hardware costs including: desktops, laptops, scanners, tablets, printers, cables, network devices, signature pads, cameras, etc. You can and should defray these costs with existing infrastructure as mentioned above, but that only goes so far. All of these hardware costs can add up and especially larger clinics might need to consider financing the cost of all this hardware.

Lifecycle Management – If you’re in a larger clinic you’re going to want to make sure you have a good lifecycle management plan in place for your hardware. A thoughtful replacement cycle for your hardware is so much better than unplanned hardware crashes with no budget plan to replace it. This replacement cycle should also correspond to your EHR vendors ongoing development plans. How much longer will they support your current hardware? When will they support the latest operating system?

Hire Great IT Help – With few exceptions, the best thing a clinic can do is to hire competent IT people to assist them with the selection and implementation of their hardware. A few doctors get a kick out of the latest IT. For the rest of the doctors out there (which is most of you), find great IT support. No, your daughter’s boyfriend who likes computers usually doesn’t match that description.

Hardware Takes Time – When planning your EHR implementation schedule, make sure you give plenty of time to implement the hardware side of the EHR implementation. It takes time to select the hardware, for the hardware to be delivered, for the IT people to implement, configure, and test, the hardware, etc. I’ve seen many EHR implementations delayed while they’re waiting for the hardware to arrive.

Those are a few suggestions to help you out. I hope that readers will offer other suggestions in the comments. My key message for this post is to not forget about the hardware side of an EHR implementation. EHR hardware is completely manageable if you deal with it early. If you wait or skimp, then it can wreak havoc on your EHR plans.

This post is sponsored by HP Healthcare, however opinions on products and services expressed here are my own. Disclosure per FTC’s 16 CFR, Part 255.

EHR Company Funding Risks – Large Company Backed EHR

Posted on June 1, 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.

This is the fifth and final post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Large Company Backed EHR.

Large Company Backed EHR
The companies in this category are quite interesting, because they can often exhibit the characteristics of EHR software in every other category of EHR company. It’s all about the story of the company. For example, I’ve come across some really large companies who have developed their own EHR and only have 1 practice using their EHR. This is very much like a seed company. There are some larger companies who have acquired essentially the EHR software of another company and now they’re trying to grow the user base similar to a well funded EHR company.

I can think of a few EHR acquisitions where the large EHR company acquired a cash flow positive EHR company and they’re continuing to grow that EHR company in a cash flow positive way. Then, of course there are a few large companies that have large EHR install bases as well. There’s also everything in between in this category, so it’s hard to generalize about this group.

With that said, since it has the backing of a large company (in healthcare or not in healthcare) the biggest risk is that they’ll shift their priorities from the EHR software and on to something else in their company. Most large companies trying to get into the EHR software business come quick out of the gate. If they do well, they’ll continue growing it like they did. If they don’t do well, they’ll often throw in the towel by cutting resources to that venture and then eventually a sale of the EHR assets to another company.

Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Large EHR Companies

Posted on May 29, 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.

This is the fourth post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Large EHR companies.

Large EHR Companies
Most of the EHR companies that fit into this category are publicly traded EHR companies (with a few notable exceptions). Each of these EHR companies has their own story, but the majority include some mix of EHR acquisition or EHR merger to get into or expand their EHR market reach. Often this means that the EHR company has more than one EHR software under their purview.

Many of the larger EHR group practices and particularly the multi specialty clinics look to the larger EHR companies because these large EHR companies have usually worked to try and cover every EHR specialty in their EHR. In most cases the EHR software has been around for a very long time. This is good because then the software is often mature, but it’s also bad because it’s often built on old technology.

The large complaint against these large EHR companies is that they’re large and impersonal. That they are out of touch with the customer. Of course, this is kind of the nature of being a large company and having a large user base. Plus, you can imagine the challenge listening across a half dozen different EHR software products.

The risks associated with these large EHR companies software usually has much less to do with cash flow and much more to do with the decisions of the EHR company executives. With multiple EHR software under their umbrella, will they choose to close the one you use down and focus on their other EHR products? Will your EHR product get lost in the corporate shuffle of priorities? Sure, they’ll still support your EHR product if there’s an issue, but have they dedicated the company resources to your EHR or to another product in the company’s portfolio?

One argument that larger EHR vendors have made is that they’re the only companies that have the resources available to create the EHR software of the future. Some argue that many of the smaller EHR companies won’t be able to meet meaningful use stage 3, because they don’t have the resources available to do that. Not to mention when we eventually have to do Watson like Smart EHR software integrations across large data sets. I think the first part about doing MU is overstated. I think the jury is still out on how smart EHR software will become over time and how smart physicians require their EHR to be.

Next up, we’ll look at Large Company Backed EHR. Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Positive Cash Flow EHR Companies

Posted on May 25, 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.

This is the third post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Cash Flow Positive EHR companies.

Positive Cash Flow EHR Companies
This type of EHR company is usually a conservatively funded EHR company (often through non traditional funding mechanisms, or through a private buy out) that have grown large enough that their current user base provides enough cash flow to cover the EHR company’s ongoing expenses. The majority of these EHR companies have been around for a long time. In most cases they started out as EHR only companies (since everyone already had a PM system) and over time were able to grow a large EHR user base.

Instead of going after a large funding round, these EHR companies stayed small and chose to grow slow and steady over time. At this point, most of these companies have a large enough user base and enough cash flow that they’re in it for the long haul. While a sale could happen, most are content to continue growing the way they’ve done for a long time.

The users of these systems are usually happy with the software. Plus, they’ve often been using it so long that the idea of switching is something they wouldn’t even entertain. Even if the EHR software has some issues, the practices know the problems and have found ways to work around them. Plus, I’ve heard from many about the kinship they have with the EHR software that they’ve had for so long.

The real question for these EHR companies is how well they’ll be able to retain their existing EHR user base and/or how well can they acquire new EHR users. At some point if they aren’t maintaining or growing their EHR user base, they won’t have the cash flow needed to continually improve the EHR system with changing technology and clinical requirements. Plus, considering the fast pace of technology, time and their legacy software creation starts to catch up with them.

Many of the best specialty specific EHR companies have been able to reach this category. Some are still in the seed funded or well funded categories, but most of the specialty specific EHR companies I’ve seen have reached the cash flow positive category or are really close to getting there. Most of them realized that they had a very specific EHR market and so they had to grow it slow, steady and focus on revenues early.

Next up, we’ll look at Large EHR Companies. Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Well Funded EHR Companies

Posted on May 22, 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.

This is the second post in my EHR Company Funding Risks series that was started in response to my original post about the The Current Health IT & EHR Bubble. In this series, we’re looking at the following EHR company categories: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. Next up is Well Funded EHR companies.

Well Funded EHR Companies
These EHR companies are those that have moved past the beta phase of their EHR and have usually gotten a large second round of funding that will allow them to work on scaling their EHR user base. This is where I see the largest number of what most would consider “startup” EHR companies. They usually have a few million in the bank and somewhere between 50-200 doctors on their platform.

With the money in the bank, most of these EHR companies have a number of years of runway to be able to see their EHR company play out. They still haven’t made it to what I call the EHR promise land of 1000+ doctors on their platform, but they have enough money to try and reach that goal over the next couple years.

The risk for a practice choosing one of these well funded EHR companies is what will the EHR vendor choose to do once they reach 1000+ doctors. Will they sell the company off to someone else (which almost never ends well for the practice)? Or do these EHR vendors have the staying power and desire to go after something much larger? The other risk is that the EHR company will only ever have a few hundred doctors. When you’re a well financed EHR company that doesn’t gain traction, this will usually end up in a fire sale of the EHR to some other company who wants to acquire the users you do have.

Despite the risks mentioned above, many really love these “startup” EHR companies that have plenty of funding. They’re usually very responsive companies that are able to have a real personal touch with their users. They usually have some unique selling proposition which the practice found so intriguing in the first place.

Most of the Free EHR vendors fit in this or the previous seed funded category as well. However, the amount of funding that the Free EHR vendors require is a multiple higher because they usually need to be able to reach a certain install base before their revenue model kicks in. The other principles are very much the same. Although, most of the free EHR vendor revenue models require a large user base. The Free EHR promise land is probably closer to 10,000 and some might argue that to really make it work they need 100,000+.

Next up, we’ll look at Positive Cash Flow EHR Companies. Read all the posts in the EHR Company Funding Risks series.

EHR Company Funding Risks – Seed Funded EHR Companies

Posted on May 18, 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 my post called The Current Health IT & EHR Bubble a good conversation was started about the way EHR companies are funded and how many of them are at risk of running out of money. Obviously, this should be a concern to anyone selecting an EHR software. Once an EHR company runs out of money, it’s almost never pretty for their users. The EHR software is usually sold to a larger EHR vendor or other EHR competitor and you can imagine which EHR that vendor chooses to sunset.

Here’s a look at how I define the various funding for EHR companies and the risks associated with each EHR funding situation: Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR. I’m sure some of these categories could be divided other ways too. Plus, some EHR companies fall into the middle of 2 categories. However, hopefully you can use these categories to get an idea of how the EHR software you have or are looking at getting is positioned as far as EHR funding.

Over the next couple weeks, I’ll take each category (Seed Funded, Well Funded, Positive Cash Flow, Large EHR Company, and Large Company Backed EHR) and discuss how I define each category and some of the characteristics and risks associated with each type of EHR vendor. First up is Seed Funded EHR companies.

Seed Funded EHR Companies
This is the relatively new EHR company. In most cases, these EHR companies have a very small set of basically beta EHR users. Most people see these companies as the most risky and that’s probably true. Small funding and small user base means you have less revenue and less cash in the bank. However, most of these companies also have smaller staff and burn through money much slower than large companies.

The question with seed funded companies is can they get to either the next round of funding (the more likely option) or enough users before they run out of money. This is often a hard question to answer. In the current EHR investment market, it seems most EHR companies in this stage have gone and gotten the next round of EHR funding while the funding market is good.

Some physicians love these companies. As one of their beta users, your feedback is heard and incorporated into the product. Plus, it’s exciting for many of us to see something build out over time. This is particularly true when the small EHR software company is doing something innovative and unique. The good part for the EHR market is that if a company like this runs out of money, only a few practices are affected. Plus, those practices that are affected usually knew what they were getting into when they chose the small EHR company.

If a seed funded EHR company is able to build a user base with just their seed funding combined with some good boot strapping, a number of them will be able to kick and scratch their way to profitability with a much smaller group of customers. Although, once they do that, they move from this category into the Cash Flow Positive category of EHR companies

Next up, we’ll look at Well Funded EHR Companies. Read all the posts in the EHR Company Funding Risks series.