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


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.

March 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Homegrown EMRs with Joel Kanick, InterfaceMD

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.

December 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Learning about HealthFusion and MediTouch EHR

The following is an interview with Dr. Seth Flam, Co-Founder and CEO of HealthFusion. If you’d like to hear more from Dr. Flam, he’s doing a Meaningful Use stage 2 webinar today at 9:15 PST (12:15 EST).
DrSethFlam
Tell us a little bit of the history of HealthFusion.

HealthFusion was founded in San Diego in 1998 by two primary care physicians. The company started out as a clearinghouse, but has since evolved into a fully integrated software suite – including MediTouch EHR (Electronic Health Records and Patient Portal) and MediTouch PM (Practice Management and Claims Clearinghouse).

What differentiates the MediTouch EHR from the other hundreds of EHR software out there?

First of all, even though the iPad has been part of our culture now for over three years, there are still very few pure cloud EHRs that work natively on the iPad browser. Native is important because with MediTouch, every EHR function that can be performed on the desktop can also be performed on the iPad. Our product was developed from the ground up for the iPad, so the interface is not a “retrofit” from an older legacy desktop one. Instead the interface is a set of buttons that are sized perfectly for fingertip and even work well on the iPad mini.

Now if you couple that with Meaningful Use 2014 certification, I challenge you to find more than a handful of products that meet this profile. But that is just the tip of the iceberg. We are consistently rated by users on average at around 4.5 stars out of 5, so our doctors love us. Because we are an early adaptor of new technology we have the time to not just present new technologies such as the ones required in Meaningful Use 2014, but we have the time to hone those new technologies and make them usable.

It seems that HealthFusion’s MediTouch EHR has been designed for every specialty, but are there certain specialties where it really excels?

Primary care is of course a focus. We are poised to release our comprehensive Patient Centered Medical Home module this month. Our commitment to Medical Home is very strong and I don’t know of any software that makes becoming a tier three medical home easier. Speaking of primary care, we do great with OB/Gyn and Pediatrics – in fact, Miami Children’s Hospital has selected MediTouch as their exclusive private label solution for their hundreds of admitting providers. For Pediatrics, that’s the best validation of our product, especially since MCH is known as the technology leader among pediatric hospitals.

We service most all of the internal medicine specialties, many of the surgical specialties and some niche providers such as pain management specialists. We are the exclusive EHR vendor for the American Osteopathic Association (AOA) and the first cloud-based endorsed by the American Podiatric Medical Association (APMA ). Needless to say, we are very strong with the Osteopathic doctors from all specialty types and simply the best choice for podiatric physicians. And it’s not just us saying that – we have the endorsement of those associations to back it up.

What’s been HealthFusion’s approach to meaningful use?  Are you ready for meaningful use stage 2?

HealthFusion’s MediTouch was actually one of the first 5 pure ambulatory EHRs to achieve Meaningful Use Stage 2 certification. Our whole system was designed with the government standards in mind, which means Meaningful Use is incorporated into the daily workflows of our EHR.

As an additional resource, we recently started hosting webinars on Meaningful Use. The next one is scheduled for November 26th, and will offer a “deep dive” into Meaningful Use Stage 2.

Most EHR vendors that were certified for 2011 have not achieved Meaningful Use 2014 certification. Buyers should be leery of EHRs that cannot meet government compliance standards. We are beginning what I call the “Great American EHR Consolidation.” Simply stated, if your EHR can’t meet Meaningful Use 2014 by the end of this year, you are at a disadvantage heading into 2014. Remember, 2014 is not just about Meaningful Use – ICD- 10 begins in the fourth quarter. Providers need time to prepare for ICD-10, it is even more important than Meaningful Use since it impacts every dollar. Because Meaningful Use 2014 compliance is behind us, we have been able to focus on developing all of the tools providers will require to make their transition to the new diagnosis coding system easier. A simple list of ICD-10 codes just won’t cut it – the tools need to be more sophisticated and we have them today.

How have your doctors and other doctors responded to meaningful use from your experience?

Meaningful Use and other government compliance programs are here to stay. Sticking your head in the sand simply won’t work. In fact, we would not be surprised if the federal government standards that define Meaningful Use spill over to private sector. I think providers liked getting the front loaded incentive dollars but I don’t think they like some of the compliance requirements, and they definitely don’t like the threat of an audit. I am certain that they will find Stage 2 harder, and that is why they need committed technology vendors to help simplify workflows for them. Patient Engagement requirements such as a Meaningful Use compliant patient portal can simplify Meaningful Use, and of course that should be part of the buying decision for physicians.

How are you approaching interoperability?  What will be the key to cracking the interoperability challenge?

With interoperability, the problem isn’t with the sophisticated EHRs, instead it is with the lack of mandated standards and the adoption of those standards. MediTouch responds quickly when faced with a new standard, a good example is Direct Secure Messaging. This is the new standard for secure email. It’s crazy, we adopted the standard in June and our providers have secure email addresses but hardly anyone to exchange mail with today. In the coming months we hope that will change as more EHR vendors implement this standard.

The government makes interoperability challenging because as an example they use HL7 standards alone to define a way to exchange data, but HL7 is at best a “suggestion, not a standard.” What I mean is that there is too much room for interpretation within the HL7 guide to permit seamless interoperability across multiple exchange points. A good example is the immunization registries that are run by state or regional entities. I like to say, if you connected to one state you connected to one state. The work required to maintain and manage 50-60 connections and standards is wasted time that could be spent on better projects. It would have been simple for the government to tighten the requirements so that there was less variation between states, or to consider a national immunization registry with a single standard and connection.

Are you getting many requests to incorporate accountable care (ACO) features into the EHR?  What’s your thoughts on the future of ACOs in healthcare?

First of all, I hope they work. Sharing savings is not a new concept and there have been failures, occasions where quality was sacrificed for short-term financial gain. With EHR technology, we think that there is enormous promise and it starts with great Patient Centered Medical Homes (PCMH). It will take a new breed or a transformed primary care doctor to really make PCMH work because it changes the role of the primary care doctor significantly. Managing patient populations is different than managing individual visits. MediTouch software is committed to making PCMH work for primary care practices so we expect to play an important role in the interplay between primary care medical homes and the ACOs they relate to. The truth is that without great EHR software that supports PCMH, the ACO initiative will fail and therefore we understand that the effectiveness of our software will contribute to better population management, and ultimately the success of ACOs.

Where is Health Fusion heading 5-10 years from now?

We have a nimble group of engineers and we have found that meeting government mandated compliance standards has not been an obstacle that we cannot easily overcome. By complying with Meaningful Use 2014 early we now have time to do what we love and that is innovate. Our innovation process is simple – we listen to our users. As a physician I know that it is difficult for engineers to understand the complex workflows required to manage just a single day in a doctor’s office, and our culture is built on listening closely to the end user – the medical practice.

There are times though that we innovate or create new features that were never requested by a medical practice. Remember, we were designing an iPad EHR solution one year before the iPad was released, clearly that was way before any physician would have requested a system like the one we designed. Steve Jobs invented the iPad even though there was no market for the device prior to its release. A great EHR combines features that are a reach (like the example of the invention of the iPad) with more everyday solutions that refine everyday workflows. Remember, each year the practice of medicine requires more attention to administrative and compliance issues – our job is to innovate at a faster rate so that provider workflow is continually enhanced, and to make sure that patient care is still rewarding for our docs.

Full Disclosure: HealthFusion is a sponsor of EMR and EHR.

November 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

One Database Has Distinct Advantages for Data

I recently was talking with an EHR vendor and they made the comment that having their EHR all on one database was a distinct advantage over the EHR vendors who install a new database with every new EHR install. I was intrigued by the idea and could easily see some of the benefits of an EHR vendor having all of the EHR data in one database. When you think some of the future quality programs that could come out, I think there could be some advantages there as well.

Considering this advantage, I started to think about ways that multiple database EHR vendors could level the playing field with their single EHR database comrades. One idea I had was using interoperability to level the playing field. If all the EHR vendors have access to all of the data, then not only will single database EHR vendors not have an advantage, but they’ll be at a disadvantage if they don’t work to exchange the EHR data as well.

When I think about this, it makes me wonder why multiple database EHR vendors aren’t accelerating the exchange of health information. This seems like it would be to their strategic advantage to exchange information.

February 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

What Really Differentiates EHR Companies?

My post yesterday on EMR and HIPAA called “Does Spending More on EHR Mean You Get More?” started me thinking what does differentiate one EHR company from another. I think there’s a real disconnect between what most people selecting an EHR use to differentiate EHR companies with what really matters to the users of an EHR.

First let’s take a look at some of the many ways that I see doctors and hospital CIO’s using to differentiate EHR companies. Many use price as an indicator of quality. Hopefully this post puts that to bed. Price matters, but it’s not a great indicator of EHR success. Many are swayed by great sales and marketing by EHR companies. It’s hard to deny that seeing an EHR vendor with a full HIMSS booth doesn’t have some effect on what you think of that EHR vendor. Going along with this is having the big, well branded name recognition. Although, what’s in a name if the EHR software doesn’t meet your specific needs?

Another differentiator that many use is KLAS or other ratings. When I’ve dug into all of the various EHR rating and ranking systems, there are flaws in all of them. Some lack enough data to really draw conclusions. Some use bias methods for collecting data. Some EHR ranking services don’t use data at all. It’s amazing how interested we get in a list that may or may not have any legitimate value. Every EHR vendor has some flashy numbers to share with you. Just remember that numbers can lie. You can make them appear any way you want.

I’m a little torn on the idea of EHR certification and access to EHR incentive money being a point of differentiation for EHR vendors. There are so few that can’t get you there, that it’s almost a non-issue. Sure, if you really want to get the EHR incentive money, you could and should talk to the users of that EHR that have gotten the EHR incentive money. However, because almost every EHR vendor is a certified EHR that can get you to meaningful use, not being certified might actually be a more exciting. The story is reasonable: our EHR focused on what doctors care about in an EHR as opposed to some random government requirements. Could be a compelling message. Especially for those doctors who don’t qualify for the EHR incentive money.

What should be used to differentiate EHR companies?

The number one thing that I think doctors should look for in an EHR is efficiency. A large part of the coming Physician EHR revolt is due EHR software’s impact on physician efficiency. Yet, most doctors selecting an EHR pay little attention to the effect of an EHR on efficiency. This data is harder to get, but a good survey of existing EHR users can usually get you some good information in this regard.

Another area of differentiation with EHR companies should be around their EHR support and training. How quickly an EHR vendor answers support requests and how well an EHR gets you up and running on an EHR is extremely important. As someone on LinkedIn mentioned today, EHR is not plug-n-play software. There’s more to an EHR implementation than just plugging it in and going. It requires some configuration and learning in order to use an EHR in the most effective way.

How come we don’t use the quality of care that an EHR provides as a method of differentiating EHRs? The answer is probably because it’s a really hard thing to measure. I wonder if any EHR has found a way to show that their EHR provides better care. There’s plenty of anecdotal examples, but I wonder if anyone has more data on this.

Another point of differentiation that I think matters is how an EHR company approaches its relationship with the users. Does the doctor, practice and hospital feel like a partner of the EHR company or are they a distant customer. You can imagine which situation is better than the other. This relationship will matter deeply as you run into problems that are unique to your environment. I assure you that this problems will come.

I also see technology approach as a really important factor for EHR companies. When I say this, I think most people start to think about SaaS EHR vs Client Server EHR. Certainly that is one major component to this idea, but it should go much deeper. You can tell by the way an EHR’s technology approach if they’re focused on the right things. Do they take shortcuts when they implement technology? Are they thoughtful about what really matters to the EHR user? Do they implement something on a whim or do they think deeply about the impact of a feature? While every EHR company has limits on what they can put out in a release, they can still provide a great roadmap of the current release and their plans for future releases which shows that they understand the needs of the users.

I’m sure there are many more good ways to differentiate an EHR company. I look forward to hearing more of them in the comments. We just need to expand the discussion to things that really matter as opposed to basing our EHR decisions on vanity metrics.

February 8, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EMRs Investors Stuck In Old Patterns

Today I read an intriguing piece in The New York Times which looked at different ways capital can be invested, and how over-reliance on one style may be cramping our economy.

In the piece, Harvard professor Clayton Christensen asserts that there are three main models for investing in innovation:

Empowering: These innovations “transform complicated and costly available to a few into simpler, cheaper products available to many,” Christensen says.  Obviously, the reduction of the mainframe into consumer desktops is one example.  These products open up new markets.

Sustaining:  These innovations replace old products with newer ones that improve on the old (his example: The Toyota Prius hybrid).  They don’t necessarily open new markets, as people often buy the improved model instead of the previous version, but they do keep the market moving.

Efficiency:  These innovations reduce the cost of making and distributing products and services, making capital available to keep the improvement process. They generally don’t expand markets at all.

In Christensen’s model, industries cycle through each of these stages and create new markets and jobs in the process. But that engine seems to be stuck in neutral of late, he suggests.

At this point, he argues, VCs and companies with excess cash are focused on a new finance model which discourages investment in brand new, empowering innovations. Capitalists want to make big money but are being channeling into spending only on the third stage of the cycle.

So, why all of this economic analysis in an EMR publication?  Well, because I’d argue that the EMR business has already fallen into just such a stall.  Rather than come up with paradigm-shifting innovations which really empower doctors, vendors are falling over themselves to create more efficient models of the same basic thing.

Not only is that bad for the health IT economy, it’s bad for end users, few of whom are rapturously happy with the basic EMR paradigm.  It discourages innovations that are patient-facing — such as a fascinating three-dimensional avatar I just heard about which can be used as a PHR — since there’s little if any funding for such projects.

Worst of all, focusing on efficiency doesn’t inherently improve patient care either, something we’d hope would be the fundamental goal of any EMR.

Given the stakes involved, let’s hope investors decide that chasing efficiency by reworking old models isn’t the best way to keep the EMR business alive.  Otherwise, we may stay bogged down for many years to come.

November 7, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

EHR Vendors Using EHR Certification Excuse

As most of you have probably figured out by now, I’m not really a fan of EHR certification because I believe there is very little value provided by EHR certification. An interesting additional problem that comes from EHR certification and meaningful use has to do with how EHR vendors are using this as an excuse for why their EHR sucks doesn’t work the way doctors want it to work.

Don’t just think that I’m making this idea up. I first thought about this idea when a doctor wrote me about his experience with an EHR vendor that used EHR certification as an excuse for why their EHR software’s workflow was terrible.

The interaction went something like this:
Doctor: Why do I have to do these extra 5 clicks?
EHR Vendor: That’s required by EHR certification.
Doctor: That provides no value to the care I provide a patient.
EHR Vendor: Sorry, we have to do that for EHR certification.
Doctor: What about this other prompt I get in your EHR? Why does that come up and disrupt my workflow?
EHR Vendor: That’s another EHR certification and meaningful use requirement.

You’ll notice that I made the complaints generic, because they likely could apply to almost any measure in meaningful use and EHR certification requirement.

I’ve seen first hand the efforts that some EHR vendors have put forward to try and make sure that their doctors don’t have this discussion with them. You can be sure it takes a lot of time, energy, and skilled professionals to make meaningful use and EHR certification a seamless part of a practitioner’s EHR experience.

The problem is that many many EHR vendors just ran the EHR certification race and in an attempt to win that race they just slapped something together to meet the requirements. This I want to be the “first” EHR vendor certified mentality is causing many doctors to pay the price today.

Is it any wonder that many doctors look at meaningful use and are upset by the way it’s changing the way they practice medicine?

October 11, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Retail Clinics Buddy Up with HIT and MU Lessons from a 3 Year Old

It seems I can’t read a blog, tweet or even old-fashioned newspaper these days without coming across some headline having to do with retail health clinics buddying up to healthcare IT. Announcements from two companies come to mind.

The first involves SoloHealth – developer of health and wellness kiosks. It received FDA approval for its product earlier this summer, and followed that development up with news of financial investment from benefits company WellPoint. It also has announced plans for a national rollout of its kiosks sometime this fall. Assuming its website is up to date, there are SoloHealth Stations across the country at retailers like Walmart, Safeway, Publix, Sam’s Club and Schnucks. CVS appears to be its only traditional retail clinic customer at the moment.

The second involves Greenway Medical – well-known developer of electronic health records for a variety of healthcare organizations, including Walgreen’s Take Care Clinics. It currently has placed its PrimeSuite EHR in more than 700 Take Care pharmacies, and just this week announced plans to implement a custom EHR – WellHealth – to coordinate other types of care in Walgreen’s locations. I’m assuming the two EHRs will play nice with other from an interoperability standpoint. Implementation of all WellHealth systems is expected to be finalized by the end of next summer.

I can’t help but point out that both of these companies are based in Atlanta, and I know for a fact that their team members congregate at similar networking events, so I wonder if we’ll see some synergy between them in the near future.

In any case, if predictions of retail clinic growth prove to be true – a recent Rand Report notes that use of retail health clinics quadrupled between 2007 and 2009, and will continue to grow – it seems likely that we’ll see HIT companies popping up in clinics across the country.

On a completely unrelated note, my daughters and I joined the rest of my company’s team members at the annual Lekotek Run 4 Kids last weekend. We had a great time and enjoyed helping out a great cause. I was a bit apprehensive that my youngest would enjoy it. Before the race began, she came up to me with number in hand and asked, “Is it okay if I lose?” Happily, she declared herself a winner after crossing the finish line and receiving a medal along with her sister and all the other kids.

I wonder if this is a sentiment physicians in smaller practices sometimes have as they consider implementing an EHR in the hopes of receiving Meaningful Use incentive money. Do some just want to throw in the towel and “lose?” Do some not want to even start the race? I’m always looking for additional Meaningful Use wisdom from the under-6 set, so please enlighten me in the comments below.

August 23, 2012 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.

Too Many EHR Mouseclicks and Keystrokes – A Solution for EHR Vendors

I love the never ending discussion of the number of mouseclicks and keystrokes that an EHR requires. I’ve heard this discussion for all 6+ years I’ve been blogging about EMR. While I don’t want to make an excuse for EHR companies to create crappy software, I think that there’s a few problems with just stating that an EHR software has too many clicks. Let’s take a deeper dive into the idea of too many clicks and keystrokes in an EHR software.

I once heard in a discussion the comparison of a piano player being able to quickly tap out a song on a piano with a doctor tapping and clicking out his medical notes in an EHR. They then posed the question, “Why can a piano player easily play so many notes so quickly?

It’s an insightful question and comparison which I believe could help an EHR vendor deal with the issue of too many “EHR mouseclicks and keystrokes. As I think about why it’s not a burden for a piano player to play so many notes so quickly, I think it boils down to two areas: responsiveness and training.

One of the unique characteristics of a piano is that as soon as you tap the key, it makes a sound. Imagine trying to play the piano if when you tapped the key sometimes it would instantly make a sound and other times there’s a slight half a second or one second delay. It would be impossible to play a song and to get a rhythm that would allow you to play so many notes so quickly.

Unfortunately, the terrible situation I described above is what we experience with EHR software. Sometimes when you click you get an instant response and sometimes when you click you have to wait a little bit. The same goes with a keyboard on a computer. I recently had a bug on my computer that would basically tie up all the memory on my computer. When that happened I could type, but the letters would show up on the screen at varying intervals. I’m a pretty fast typer, but when this was happening it was terrible. I had to just stop until the problem was resolved.

While I’d love to just say that an EHR should always respond instantly to any request made, that’s not reasonable. The key for EHR vendors to think about is doing everything they can to ensure that their EHR responds in a consistent manner. The faster the better for sure, but don’t undervalue the benefit of a consistent response.

The second piece of this puzzle is training. We don’t assume that someone can step up to a piano and play all the right notes to a complicated piece of music with no training. Yet, for some reason we think that a doctor can step up to a complicated piece of software (EHR for those following at home) and quickly navigate all of the features of the software. Training matters and can make the world of difference in how you feel about the number of “clicks” you have to do in your EHR.

I’m sure that many EHR vendors love the above paragraph, but they also see the reality of many doctors not wanting to take the time or make the effort to train on an EHR properly. Doctors reasonably offer that they can’t just shut the doors on their clinic for a week of EHR training. While the politicians in DC can’t seem to do this, the solution to these two extremes is somewhere in the middle.

I’m not naive to the challenges that we face with click happy EHR systems. I’m certain that every EHR software could improve its software to decrease the number of clicks and make them more intuitive. I’m also certain that there are many doctors that don’t and won’t train themselves on the EHR software. Instead, they’ll sit back and blame their lack of training on “too many clicks.”

I have little doubt that both sides of the equation could and will get better. EHR software will become less click happy. Doctors will become better at clicking quickly. Although, until the software captures are thoughts automagically, we’re going to continue battling with these issues.

July 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Vendor Consolidation

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.

June 15, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.