Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Physicians Still Struggle To Find EHR Value

Posted on July 18, 2016 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.

A new study by Physicians Practice magazine suggests that medical groups still aren’t getting what they want out of their EHRs, with nearly one-fifth reporting that they’re still struggling with an EHR-related drop in productivity and others still trying to optimize their system.

Physicians Practice surveyed 1,568 physicians, advanced practice providers across the U.S. as part of its 2016 Technology Survey. Nearly a third of respondents (31.9%) were in solo practice, and 34% in 2 to 5 physician practices, with percentages largely dropping as practice sizes grew larger.

Specialties represented included pediatrics (17.5%), family medicine (16.2%), OB/GYN (15.2%), psychiatry (12%), internal medicine (10.6%), surgery (2.9%), general practice (2.7%) and “other” at 22.9% (led by ophthalmology). As to business models, 63.3% of practices were independently-owned, 27.9% were part of an integrated delivery network and the remaining 8.8% were “other,” led by federally-qualified health centers.

Here’s some interesting data points from the survey, with my take:

  • Almost 40% of EHR users are struggling to get value out of their system: When asked what their most pressing technology problem was, 20.3% said it was optimizing use of their EHR, 18.9% a drop in productivity due to their EHR, and 12.9% a lack of interoperability between EHRs. Both EHR implementation and costs to implement and use technologies came in at 8%.
  • EHR rollouts are maturing, but many practices are lagging: About 59% of respondents had a fully-implemented EHR in place, with 14.5% using a system provided by a hospital or corporate parent. But 16.8% didn’t have an EHR, and 9.5% had selected an EHR (or a corporate parent had done so for them) but hadn’t fully implemented or optimized yet.
  • Many practices that skip EHRs don’t think they’re worth the trouble and expense: Almost 41% of respondents who don’t have a system in place said that they don’t believe it would improve patient care, 24.4% said that such systems are too expensive. A small but meaningful subset of the non-users (6.6%) said they’d “heard too many horror stories.”
  • Medical group EHR implementations are fairly slow, with more than one-quarter limping on for over a year: More than a third (37.2%) of practices reported that full implementation and training took up to six months, 21.2% said it took more than six months and less than a year, 12.8% said more than a year but less than 18 months, and 15.7% at more than 18 months.
  • Most practices haven’t seen a penny of return on their EHR investment: While just about one-quarter of respondents (25.7%) reported that they’d gotten ROI from their system, almost three-quarters (74.3%) said they had not.
  • Loyalty to EHR vendors is lukewarm at best: When asked how they felt about their EHR vendor, 39.7% said they were satisfied and would recommend them, but felt other vendors would be just as good. Just over 16% said they were very satisfied. Meanwhile, more than 17% were either dissatisfied and regretted their purchase or ready to switch to another system.
  • The big EHR switchout isn’t just for hospitals: While 62.1% of respondents said that the EHR they had in place was their first, 27.1% were on their second system, and 10.8% their third or more.

If you want to learn more, I recommend the report highly (click here to get it). But it doesn’t take a weatherman to see which way these winds are blowing. Clearly, many practices still need a hand in getting something worthwhile from their EHR, and I hope they get it.

The Case For Dumping EMR Interoperability Goals

Posted on December 22, 2015 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.

The new year is upon us, and maybe we should consider some new approaches, or even throw out accepted wisdom. Why not consider some major pain points and reconsider how we’re handling them?

In that spirit, my question is this: Should we give up on the idea that EMR vendors will ever allow their data will be interoperable? While this conclusion isn’t exactly a no-brainer, many of us have certainly toyed with the idea. So let’s take ‘er out for a spin.

One major consideration is that EMR vendors have some very compelling reasons for keeping things as they are. Perhaps most notably, interoperability would mean that providers wouldn’t be trapped in deals with a single vendor, as they could just shift the data over to a new platform if the need arose. If I sold EMRs I’d fight tooth and nail to prevent my product from being dumped too easily.

As if that weren’t enough of a disincentive, EMR vendors would need to spend big bucks to achieve interoperability, with no direct reward in sight. Somehow, I doubt that they’re ever going to make such an investment to win some “nice guy” award from the industry.

And even if they could somehow achieve interoperability without breaking a sweat, we’ve got to contend with inertia. Making changes on that scale takes a great deal of effort, and EMR vendors have very little reason to do so.

Maybe the federal government could achieve interoperability through some kind of epic power play, like refusing to issue Medicare reimbursement to providers whose EMRs didn’t meet some ONC interoperability standard.

But even that kind of brute force wouldn’t solve the interoperability problem with one stroke. Such an approach would come with a raft of serious concerns. What interoperability standard would ONC use, and how long would it take to choose? Then, how long would vendors have to meet the standard?  How long would providers have to decommission their existing EMR — and let’s not forget, quite possibly interlocking HIT systems — and where would they get the money for the new/upgraded systems?

Not only that, it would it cost billions of dollars, without a doubt, to make this transition. It could take a decade before the transition was complete. A lot can happen to derail such an initiative over that amount of time, and market forces could render the premises of such an effort obsolete.

On top of that, any effort which encouraged providers to dump their existing EMR platform would greatly diminish, if not erase, the value of the billions of dollars invested in Meaningful Use incentives. A lot of effort has gone into workflow and interface designs that support MU compliance, and starting from scratch on a new platform would NOT be a walk in the park.  So meeting MU goals might be possible over time, but could fall by the wayside for the short term.

All told, it seems that we may be chasing our tails trying to push through interoperability. In theory it sounds good, but when you look at the details it seems unlikely to happen. That being said, the need to share patient data isn’t going to go away, so what alternatives might work? I’ll follow up with some additional thoughts.

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

If EHR Had a Tech Problem We’d Blame the Vendors

Posted on July 23, 2015 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.

During last week’s #KareoChat, the chat host @GabrielSPerna offered the following tweets from the @PhysiciansPract account for which he is now managing editor (Gabriel Perna was formerly @HCInformatics):

When I saw this tweet, I knew I needed some time to chew on the concept. Do we really blame our vendor when it’s a tech problem? I’m reminded of a time my EHR software ran out of control and was literally chewing up RAM and never spitting it out. I’d restart the server and we’d be fine until the EHR software had chewed up all the RAM again and then the EHR was slow as molasses. You can bet I was blaming my EHR vendor for the tech problems we were having.

However, did I blame them for our cultural challenges as well? I guess the key term there for me is “blame.” I know many practices (and have heard of others) who have switched EHR vendors 3, 4, even 5 times. They loved to blame the previous EHR vendors for their problems. However, by the 2nd or third, you can be sure there are some cultural problems there that need to be resolved. As much as they want to blame the EHR vendor they’re likely not to blame.

Another tweet from today’s #KareoChat seems to also illustrate the challenge is cultural and not technical:

I can already hear Dr. Tom in his EHR product management meetings asking why they’re building a certain feature into the software when it supports a flawed process. The developers respond that it’s what the customer wants. This highlights a major cultural problem.

Back to the original discussion. The fact that many doctors haven’t seen an ROI from their EHR, but less than 20% are dissatisfied with their EHR vendor does seem to say that most EHR vendors have not had tech issues. Instead the EHR dissatisfaction likely stems from a lot of other cultural problems in healthcare.

All of this reminds me of some old posts where I asked “Can An EMR Focus on Patient Care in the Current Reimbursement Environment?” and what would an EHR look like if it was focused on customer requests and not MU? Is the healthcare culture what has created these less than happy EHR users or is that letting the EHR vendors off the hook?

The Same EHR “Chain of Events”

Posted on December 31, 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 recently came across this interesting perspective on the EHR industry on the MGMA blog. Here’s one of the perspectives shared on the blog post:

Miske said his practice’s previous eight EHR selections have followed the “same chain of events”:
*Heavy research, tons of demos
*Implementation
*Training and research
*Relentless tweaking
*Stagnant use
*Systematic bugs reveal themselves
*Issues become unreasonable
*Tech support starts to lack

For his practice’s ninth EHR, Miske refused to settle for inferior quality or employing counterintuitive fixes, such as saying, “let’s hire more people to deal with the inadequacy of the program.”

“Being of the technological mindset that I am, this is unfathomable – the EHR/PM system needs to be a tool and a wonderful tool. Just like our ultrasound machine that allows us to perform 4D miracles without issue daily,” he says.

I have to start by addressing that the above comments are by someone who has done 8 EHR selections. Sure, that means they’ve had a lot of experience with EHR implementations, but from my experience it also likely indicates an internal issue that all 300 EHR vendors would likely face with that practice.

I was recently talking to an EHR implementation manager at an EHR company. They recounted to me how their sales people would bring them a new sale and comment that “this EHR implementation should be easy since they’ve already had 3 EHRs previously.” He then commented that those always end up being the worst implementations since there’s likely some organization problem that needs to be fixed before doing the EHR implementation. Certainly having some understanding of how EHR and software work helps during an EHR implementation, but so many failed EHR implementations often means that something else is at play beyond the EHR.

Personally, I haven’t seen the chain of events that he describes. I’ve seen certain pieces of what he describes, but not all EHR implementations follow that pattern. The last 3 items on the list are things I’ve seen a lot of places with a bunch of EHR vendors.

Bugs are a reality of software use. The key is how the EHR vendor reacts to your bug reports. That will make all the difference in your organization. This is why I’ve said many times that you should cultivate a close connection to your EHR vendor. When you find and report these bugs, having a good relationship with your EHR vendor will be critical to make sure your report is heard.

In the beginning of your EHR implementation, you’re likely to get special attention. So, take the time early to really figure out any pain points the software is causing you. You’ll likely get a quick response. As you become a long time user, you’ll have to rely on a deeper relationship.

If all else fails, remember that the squeaky wheel gets greased. Be careful not to ruin your relationship, but there are a lot of ways to get your concerns heard and addressed. Don’t be shy if a change really matters to you and your organization.

What Would You Do If your EHR Vendor Shut Off Access to Your EHR?

Posted on September 25, 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.

Anne Zieger at Healthcare Dive has an interesting summary of a practice who just had their EHR access shutdown by an EHR vendor. Here’s the summary of what happened:

*A small medical practice in northern Maine has been blocked from accessing patient medical records because its EMR vendor has shut them off.
*Vendor CompuGroup says the practice, Full Circle Health Care, won’t get access to its records back until it pays $20,000 in overdue charges to the vendor.
*The medical group acknowledges that it stopped paying CompuGroup $2,000 per month in monthly fees 10 months before the July shut off, but said that was after months of attempting to address what the practice considered to be exorbitant, unexpected maintenance fees and charges for hardware that didn’t arrive.

This is a really challenging situation. No doubt the vendor wants to make sure it gets paid and needs some sort of recourse. Although, if you’ve ever had an EHR on which you relied, you know how important it can be to the care you provide. Just ask anyone who has had their EHR go down. Unless you have great EHR downtime procedures it can get a little crazy. Now just imagine that your EHR was taken down with no sign of when it will be back up.

Of course, we’re a little short on the exact details of what happened with Full Circle Health Care and CompuGroup. I’d love to know how many warnings CompuGroup gave Full Circle Health Care before they turned it off. If they gave them the right number of warnings over a certain period, then I don’t begrudge them for making the decision they made. If they just pulled the plug without very specific warnings about what was going to happen, then CompuGroup should get some of the blame.

This would make for an interesting court case. I imagine there’s previous case law from other industries that would illustrate what would happen. Although, in healthcare we’re not just talking about lost business and financial impact. Turning off someone’s EHR could literally kill someone. That’s pretty scary to consider.

I’m surprised that CompuGroup hasn’t gotten ahead of the story. That’s what I’d want to do if I were in their shoes. Unless the facts don’t put CompuGroup in a very nice light. However, it’s hard to put them in a worse light than they already are in with the story above.

Do you think it’s ok for an EHR vendor to turn off someone’s EHR if they stop paying? Should there be laws that say that an EHR vendor can’t do that? What would you do if you were in this practice’s situation?

For me this is really hard to think about, because if I were at that practice I would never let it get to this point. I’ve heard of a few cases where EHR vendors have become a black hole of unresponsiveness. However, that’s really rare and usually only happens when other really major and scarier things are happening at the company.

If You Were an EHR, Which Would You Be?

Posted on August 6, 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 recently watching a video of Derek Hough, Dancer on Dancing with the Stars (and much more). In the interview Derek was asked which dance best fit various periods of his life. As an #HITNerd, I thought we could do something similar with EHR vendors. So…

If You Were an EHR, Which Would You Be? Are you…

Epic – Single minded, focused and dominating in their sphere. Closed to outside discussions, but very thoughtful and caring of those in your inner circle. A bulldog if someone comes after something you consider important. Built on an aging system that’s done well, but many question how much longer they can be successful on top of such an old platform.

Cerner – The second child who’s done really well for themselves, but wonders why the older brother gets all the attention. They’re successful, well educated, built on a strong foundation, open to improvement. They’ve recently taken on a little bit of baggage. They decided to marry someone who’s been divorced and has four children. We’re not sure how this new marriage is going to work out and how it’s going to impact the family structure.

MEDITECH – This is the middle child. Ahead of their time, but no one notices them anymore. They’re quiet and mostly stay to themselves in their corner. Sure, they’d like to be noticed and get more attention, but they don’t mind too much since they’ve been so successful.

Allscripts – Flashy. Exciting and unpredictable. They’re the one that wears the flashy green jacket to the party. They’ve worked on so many things in their life that it’s hard to really place who they are and what they do. They’ve seen a lot of success, but don’t make us predict what they’ll do next. They seem to have a clear vision of where there going (albeit different than it was 2-3 years ago), but that could change so you have to stay on your toes.

athenahealth – Despite some ADD tendencies, they’ve largely stayed the course on what they want to do and what they want to become. They’re always interesting to be around, because they’re never shy to say what they think or feel about anything. While not as successful as some other people, they still have a lot of potential that could blow up for good or bad. If nothing else, they’re the life of the party and always keep things interesting.

I could keep going, but that’s a good start using a few of the larger or more well known EHR vendors. Which one is most like you? Also, I really hope that many of you will join me in the comments and revise/improve upon what I’ve written or do something similar for another EHR vendor. Let’s have some fun and learn about people’s perceptions of these companies in the process.

Note: Cerner is an advertiser on this site.

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?

Physician Designed EHR, EHR MU Documentation, and Top EHR Ratings Lists

Posted on March 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.


I really hate this discussion. It reminds me of the republican-democrat debates. They always go too far and both sides (in this case Physicians and EHR vendors) often only see their side and miss the opposite viewpoint. It’s very polarizing. The best situation is the mix of both sides of the equation. Plus, you usually need someone who can help translate and moderate between the two viewpoints. That’s much easier said than done. You can definitely learn a lot about an EHR vendor when you learn if they’re more physician designed or tech designed.


Many people unfamiliar with these standards probably don’t undstand this tweet from Mandi since they assume it’s a standard and so the ONC documentation should be good enough, no? The reality is that every implementation of the ONC standard is different and you have to have documentation of how that EHR vendor implemented the standard.


I appreciate Chandresh’s tweet more than most. I’ve often considered the idea of starting an EHR rating site. They are a dime a dozen and I don’t think any of them are very good. The best ones use some high level filters to help you narrow the search. This has some value, but isn’t really an EHR rating site. The problem with an EHR rating is the sheer scale of responses that you need to collect for it to be valuable. There are 300+ EHR vendors. There are 40+ specialties. There are practices from solo doctor up to hundreds in a multi specialty clinic. There are 50 states. There are hundreds of insurance plans. You get the picture. The number of randomly collected quality ratings you would need is impossible. I enjoy a good list as much as the next person, but just remember what I mention above when you see the next list of Top EHR vendors.

Then again. Maybe Chandresh and I should get together and do an EHR rating service based on if the EHR was a physician designed or tech designed EHR.

Homegrown EMRs with Joel Kanick, InterfaceMD

Posted on December 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 had a chance to sit down with Joel Kanick, President and CEO of Kanick And Company and Lead Developer and Chief Architect of interfaceMD. In this video we discuss the story behind interfaceMD and their custom EHR solution. We talk about meaningful use and the EHR incentive money. We also talk about healthcare interoperability and exchange of patient data. Joel and interfaceMD have a really unique approach to EHR that I think many will find interesting.

I was really interested to hear the story behind how interfaceMD came to be. I wonder if people would be interested in a whole series of videos with EHR founders that cover the background story of EHR companies. Let me know in the comments.