I’ve written many times about the amazing phenomenon that we call the iPad and particularly how EMR vendors are reacting to the widespread adoption of iPads in healthcare. As I’ve written these dozens of articles, talked to hundreds of doctors, and far too many EHR vendors it’s become clear to me that an iPad interface is basically a Must Have feature for an EMR.

No, I’m not talking about some remote desktop type connection from the iPad to an EMR. Yes, every EMR is available on the iPad using a remote desktop type application. While that’s neat that it can do that, EMR vendors whose whole iPad strategy revolves around remotely accessing your PC which can run their EMR software are missing out on the real benefits of the iPad. The love affair that so many people have with their iPad is much more than just remote connectivity and a small touchscreen device. If that was all that mattered, tablets would have gone mainstream in healthcare long ago.

If an EMR vendor wants to leverage what’s made the iPad so popular, they need to create a native iPad app that can interact with their EHR software.

I’m not talking about replicating your entire EHR software on the iPad. That would be a mistake as well. Does your biller really need to do the billing on the iPad? Do you really want to do all your documentation on the iPad? Probably not, but with some thoughtful discussions with your existing EHR users, I think vendors will find some real value in leveraging the iPad technology connected to their EHR software.

I can imagine EHR vendors that create beautifully done iPad EMR apps will do very well in the market. Why? Because the doctors that love their iPad EMR app will start showing it off to their doctor friends.

My biggest fear with this commentary is that far too many EHR vendors are busy coding for meaningful use and EHR certification that they’re not looking for smart ways to leverage technologies like the iPad. Time will tell how this plays out, but I’ll be surprised if the iPad doesn’t play a part.

Could the iPad app of an EMR vendor become a real differentiator between the 300+ EHR vendors out there today? I’ve long believed that the biggest problem with EHR software today was their interface. The iPad is all about a new interface.

On my far-too-frequent visits to my younger daughter’s pediatrician, I’ve noticed pristine new monitors and keyboards wrapped up and sitting in the corner of the exam rooms. Over the last six months, there they’ve sat, waiting patiently to be unwrapped and plugged in. “What’s the hold up,” I think? As a parent, I’m hoping this new system will offer the doctors e-prescribing capabilities. As a healthcare IT observer, I’m wondering why what I presume to be an electronic health record (EHR) is taking so long to come out of the box and into operation. Is it a question of resources? Is the facility waiting for a training team to be made available? Is there back-end infrastructure that has yet to be put in place? These are the things I think about while dealing with low-grade fevers and scheduled immunizations.

Needless to say, my interest is always piqued when I come across stories of pediatricians adopting EHRs and/or realizing the benefits of that technology. So when I came across news that Sandhills Pediatrics had received $184,000 in EHR incentives, I was intrigued. The Columbia, S.C.-based practice has been using an EHR from SRS since 2010.

“Even our initially most skeptical physicians became committed SRS EHR users in a very short period of time,” said Kevin O. Wessinger, M.D., president of Sandhills Pediatrics, in the release announcing the pay out. “All fourteen physicians and their staff value the efficiencies that SRS has delivered and the patient care and practice improvements that SRS has facilitated.”

I recently spoke with SRS CEO Evan Steele to learn more about how Sandhills implemented the EMR back in 2010, and the benefits they’ve realized from it.

This being the practice’s first EHR, what prompted them to make the move from paper to digital?
ES: “The driving force was the quality of care Sandhills was providing. With 4 locations and Saturday and Sunday office hours only at the central location, patient chart review was a big challenge. The patient charts that were housed at the satellite offices, because that’s where the patients were normally seen, and so were not available to review for weekend care. Additionally, the practice provides nurse triage in the evenings until 10:00pm and again, the satellite patients’ charts were not available.”

Did you, as the vendor, encounter any barriers to adoption from the Sandhills staff?
“No, we did not encounter any barriers to adoption. Our implementation plan is highly developed and assures 100% adoption. In addition, the Sandhills team’s dedication to success allowed them to achieve their EHR goals. Furthermore, the decision to implement the SRS EHR was driven from the top down. Sometimes the age of the physicians may impact adoptability. At Sandhills, 12 of the 14 physicians are under the age of 50 so they are more computer-savvy and willing to make the change.”

What sort of “extras” do the pediatric practices look for when selecting an EMR?
“Unique to pediatrics are immunizations. The SRS development staff worked closely with Sandhills on immunizations and pediatric growth charts. SRS secured the integration between Sandhills and the World Health Organization, developed a table for displaying and storing vaccine information, and enabled Sandhills to provide this information to their patients in a usable format.

“With a patient population of 57,000, Sandhills had to provide every kindergarten, grade school, and day care with proof of immunization. In the past, the practice had to hand-write 20,000 immunization certificates each year. SRS was readily available to provide a solution to this issue and saved the Sandhills staff many hours of aggravation. SRS created a form that auto-populates the immunization information so now the Sandhills staff no longer needs to hand-write each certificate.

The same process and benefits were developed for growth charts. The SRS EHR provides the patient’s age, and the Sandhills staff only has to enter height and weight, and this information auto-populates on the growth charts.

SRS created efficiencies, which coupled with our uniqueness in allowing physicians to continue to document notes as they are accustomed, has led to a successful implementation and positive EHR experience.”

How have clinical outcomes and patient satisfaction been improved since the EMR was installed?
“Clinical outcomes have improved as the physicians have access to pertinent clinical data at any time from any place. Additionally, the staff is quicker to respond to patient inquiries. They’ve experienced tremendous improvements in efficiencies and patient outcomes as a direct result of using SRS Order Management. Sandhills used to have manual paper tracking of lab tests and now with the SRS EHR, an expected date pops up in the system and if a test is not back by then, an alert is shown calling attention to the fact that it needs to be addressed.

“The patients, especially those seen on the weekends and evenings, have commented that they appreciate the improved and quick service. When they call in to the office with questions and concerns, they are comforted and given peace of mind knowing that the Sandhills’ staff is completely familiar and up-to-date with their situation.”

What do you think will be the next evolution of EHRs for pediatrics?
SRS Development recently unveiled vaccine inventory control. This process is entirely manual now, but the new enhancements will automatically track down the vaccine to the lot number. It’s also a double-check for safety that the lot numbers they have match what’s in computer. This is a double benefit – quality control and inventory control. This new development will especially find favor with the nurses, who are so happy that a daily occurrence that used to take 2 hours will now take 2 minutes.”

I came across an article the other day about “10 of Today’s Hottest Jobs” and was not surprised to learn that five of the cited 10 had something to do with healthcare or IT. We’ve all been told time and again that healthcare reform and its incentivized plans for IT implementations will lead to a greater demand for healthcare information management and IT positions, including the much-coveted EMR implementation specialist. But as we’ve all realized, just because industry demand for these types of positions has risen, that doesn’t mean they are being filled quickly – or at all. The same article alludes to what is happening in the healthcare IT job space right now: “Believe it or not, even with the unemployment rate stubbornly high and many industries reluctant to staff up, there are employers out there who still can’t find enough qualified applicants.”

And there’s the rub. Many healthcare vendors and consulting firms, particularly those involved in healthcare IT implementations, are looking for “qualified applicants,” and completely overlooking the enormous pool of talent that newly graduated job seekers have to offer. This certainly isn’t a new observation, but as America – whose citizens are experiencing unemployment at record levels – sits down tomorrow night to watch President Obama address the nation’s employment situation in front of Congress, it certainly is a timely one.

Let’s take a look at two videos that highlight the employment disconnect between higher education in healthcare IT, and the types of firms that would seem to be hiring new graduates.

In the first, Kelly Patterson from Hinds Community College in Raymond, Mississippi, chats with a local news station about the Office of the National Coordinator for Health Information Technology’s (ONC) Community College Consortia Program, which trains individuals in healthcare IT workforce roles, including EMR implementation.

In the second, employees at Cerner Corp. chat about how happy they are to work at the company, and list many benefits of being a Cerner employee. Most are young – many could be recent college graduates – and seem enthusiastic about their careers.

So if national training programs abound, and vendors seem eager to hire fresh talent, where is the disconnect? Why do statements like the one below seem like a dime a dozen these days?

“Training and certification do not seem to be enough. As in all new fields, experience comes from experience.” – Nachum Greenspan via LinkedIn

EJ Fechenda at HIMSS JobMine gave her two cents on how to bridge this employment gap in a recent blog: “With federal deadlines looming, healthcare organizations need to get moving and there are a lot of job seekers out there ready for the challenge. Are there organizations or companies willing to extend opportunities to these candidates? Is there a training or job-shadowing program that can be used as a best practice for other organizations to implement? Who are the champions already doing this or willing to lead the charge?”

I’d love to hear from any recent healthcare IT graduates who have been hired recently and have an employer willing to help train and mentor them. It takes champions, of course, but every champion needs someone to fight for.

I still remember the first time I heard about Practice Fusion offering a Free EHR. My first response was, “Really?” Of course, having Practice Fusion as an advertiser, being on stage at the Practice Fusion User Group meeting and a number of other interactions with other Free EHR vendors like Mitochon Systems (also an advertiser) has opened my eyes into the real business model behind the “Free EHR” software.

As I thought on the Free EHR business model, I wondered whether some EHR vendor will come out and actually pay doctors to use their EHR software. Yes, that’s right…

An EHR Vendor that Pays Doctors to use EHR.

I haven’t seen one yet, but I could see it happening. It’s not a business model that I would navigate, but I wonder how the Free EHR vendors would react if a well funded venture backed EHR company came out and offered to pay doctors to use their software. Basically, this new company would be doing to the Free EHR vendors what Free EHR vendors did to the rest of the EHR industry.

Would someone really have the moxie to do such a move?

Would the ads, research or other revenue models play out so well that someone could pay doctors to use an EHR?

I’m not talking about the government paying doctors to use an EHR. That’s a different thing all together. Maybe the EHR vendor that does it could be one that’s a sinking ship and making a last ditch effort to somehow monetize their EHR since their EHR software is great, but their EHR marketing is lacking. What better way to improve the marketing of your EHR than paying doctors to use it?

Earlier this Summer, I came across news that Greenway Medical Technologies – a developer of electronic health records (EHRs) and practice management and interoperability healthcare IT solutions located just outside of Atlanta – had taken to endorsing pro golfer Jason Dufner. It came as no surprise to me that a healthcare IT company was seeking to increase its profile among the general public. There has been a noticeable shift in increasing the public’s awareness of the impact of healthcare IT solutions on the patient care they will one day inevitably receive. It’s been a smart move on the part of providers and vendors alike to acquaint people with the technology that our government has spent so much time and energy on promoting. I was surprised, however, that Greenway Medical had chosen the celebrity endorsement route. (Golf wasn’t surprising, though. Greenway Medical’s CEO goes by the name of Tee Green.) How much increased visibility, not to mention interest, could a spokesperson bring while swinging a club on the fairway?

His first sponsorship outing at the British Open garnered little fanfare, as Dufner didn’t advance very far. Greenway Medical’s luck changed, however, as Dufner’s skill – and Tiger Woods’ ultimate absence – led him to place second at the PGA Championship last week. Held in Atlanta, the event offered a good excuse for my some of my colleagues at Billian’s HealthDATA, Porter Research and HITR.com to take a field trip to the Atlanta Athletic Club, where I suspect much of the local healthcare industry put in appearances over the tournament’s several days.

I’d have to agree with the Steve Campbell at EMRDailyNews.com, who offered congratulations to Dufner in a recent post “for a wonderful performance at the PGA and to whoever at Greenway made the decision to sponsor Mr. Dufner. The return on investment for that sponsorship just turned very positive.”

I’d also have to agree with one of the post’s commentators that “[r]egardless of his finish, Dufner and Greenway’s [credibility] rocketed this weekend with all of the primetime PGA coverage. Hours of it. And both Dufner and Greenway are classy and humble, in victory and defeat. Bottom line: EHR industry was another winner this weekend simply based on these associations.”

Perhaps Greg Fulton, Public and Media Relations Manager at Greenway Medical, puts it best: “Our main motivation was we felt it was time to continue to bring recognition to the entire health IT industry, now that initiatives like meaningful use are proving to be successful, and we have industry partners who have had good experiences being involved with the PGA TOUR.

“With Jason, we felt like we were partnering with a person first, a golfer second. He really does believe in the goals of innovative and sustainable care coordination that EHRs and healthcare IT can bring. He set up a foundation in his home state of Alabama following the tornado damage there to help people needing ongoing health services, for example.”

When I asked if Greenway Medical would consider entering into other celebrity endorsement deals sometime in the near future, Fulton explained the company’s celebrity strategy a bit further: “At HIMSS10 [in Atlanta], we did have Atlanta radio station deejay Melissa Carter, then of Q100, speak at a Greenway reception to her definite need for EHR data exchange and automated referrals, because she is a kidney transplant patient who needs that constant care coordination. And that’s what would make sense for what type, you ask, of celebrity or sports partnerships to undertake – ones that have a foundation in or can bring industry recognition and tell the story of the advancement of healthcare.”

Is it any wonder that Greenway Medical just announced its customers have secured more than $1 million in Meaningful Use incentives? How many more providers – many of whom are, it’s safe to say, avid golfers – are now aware of the company and will soon look into its products?

I’ll be interested to see what sort of healthcare IT celebrity endorsement pops up next, and where. NASCAR seems a likely candidate. I wonder if Danica Patrick has a coordinated care story to tell?

Guest Post: Diane Matthews, MHA, is a the CEO of Laser Logics and Suitemed Solutions.  Laser Logics focuses on providing comprehensive IT services to healthcare.  SuiteMed Solutions helps doctors looking for comprehensive EHR Solutions.

Rural healthcare providers seem to be facing more obsticles with the following issues regarding EHR: cost, functionality to cost, effective training, implementation, support, IT hardware backend.

Strengthening the rural areas with technology advances in healthcare increases positive healthcare outcomes and reduces associated costly risks attributable to chronic diseases. I have lived in rural farm country side nearly all my life and I see the struggles of these rural healthcare providers. But, I also see the impact of lack of healthcare to children and elderly persons who simply have no means to travel 90 miles round trip for a doctor’s appointment. This is a crisis!

If we do not empower our rural healthcare providers with usable beneficial technology that is cost advantageous, then combined with reduced healthcare reimbursements and higher out of pocket costs that most rural families simply cannot afford, we are going to be losing our rural healthcare providers simply because they can afford to keep the doors open.

Cost is a huge factor. But a good healthcare EHR consultant not only focuses on the EHR software itself it is showing healthcare providers a wealth of avenues that can be effectively leveraged together to bring those implementation costs significantly down. Depending upon the healthcare facility this could be Section 179, American Disabilities Act, Green Tax Incentives, Federal 340B programs – it isn’t just one stimulus program – it is leveraging them all collectively and effectively together to yield the most advantageous outcome for the rural healthcare provider.

Something else I am seeing is a lot of rural healthcare providers are going with brand well known names in commercial EHR.  However, once the check is written the interest and commitment to the rural healthcare providers dwindles to non-existent. Then, what has happened is money that couldn’t afford to be thrown away in essence has possibly leaving no room to try again.

Rural healthcare providers need to invest their research into not EHR vendors but EHR consultants who look at the bigger picture of the healthcare entity and the community at large with focus on their unique needs. Organize group on-site training to reduce costs. An outstanding EHR consultant is going to view this as an opportunity to bring cutting technology to the hands of those who might not otherwise have an opportunity to receive it. Done right, while the EHR consultant may not have a high profit margin, the payoff will be seen with positive referrals from happy rural health entities, development of long term professional relationships, and being a responsible source in narrowing the gap in rural America between technology and healthcare.

What specific challenges do rural healthcare providers face with EHR?

What proposed resolutions to these challenges can be had to reduce EHR barriers for the rural healthcare providers?

John’s Note: I got the following message from an EMR vendor a while back. I’ve removed the specific names of the EMR vendors to protect the innocent (and guilty in some cases). Plus, the names of the specific companies are tangential to the issue of ratings services like KLAS.

I’m sure this post will drive some interesting discussion in the comments.

I have been talking with [someone] at KLAS since HIMSS about WHY the KLAS data is either 1) Losing Relevance, or 2) Actually Misleading Providers.

[KLAS representative] told me in April that the average annual “accesses” to the KLAS data was about 17,000, while in 2010, they had over 14,000 through mid-April. Big trend change. ONC-driven, no doubt.

I had a discussion with [KLAS representative] at HIMSS and since, outlining how the KLAS data can and probably IS misleading clients. How? For instance….[EMR Vendor A] gets high marks…almost as high as [EMR Vendor B]
.
They have two “konfidence” checks on their data for the 6-25 provider practice size category (KLAS has 1-5, 6-25, and 25+, I believe as their categories, and vendors must submit their reference accounts in those partitions).

If you are a provider who sees high marks for [EMR Vendor A] in the 6-25 provider space…with all the good supporting comments…..well above the other vendors….you would probably rely on that data to decide they have to be on your short list. But everyone knows that [EMR Vendor A] serves mostly primary care and ob/gyn practices. They have adapted templates and have references for those accounts. What if you are an orthopedist or ophthalmologist…or other specialist. They have almost NO references for that. The KLAS data does not break it out. You may be badly mislead….and find out shortly after spending tens of thousands of dollars…that it wont work at all for you.

We have asked them to break out the data by specialty… they know who they are talking to. They know what each practice is. Not hard to add the question…so the data can be sliced that way. Tremendous value-add for ALL practices to know how the vendors break out. Guess what they are going to find out when they do that? And by the way…they ONLY gather data from accounts that have been installed and live for a certain period of time….no data on failed attempts or those that gave up using products.

KLAS agreed in principle it was a good idea to add specialty to their data. They even agreed to start doing it with the last reporting cycle, but didn’t have much time. All the data they have….not normalized by specialty.

LIKE THE GOVERNMENT, THEY ARE ASSUMING ALL SPECIALTIES CAN BE TREATED THE SAME AS FAR AS EMR ADOPTION GOES. Why do they think there is a 50-83% failure rate in the industry? Why has “meaningful use” not been defined for specialties before “certification” of a product can be decided? Does an orthopedist who does hip replacements, rotator cuff surgery and meniscus revisions…..report the same thing as doctors who treat diabetes, liver disease or other costly chronic-care conditions? Heck No.

I don’t think the market fully realizes how “homogenized” the KLAS data is….after all, if the average depth of the Mississippi River is only three feet…..why are there so many different size boats—-barges to sailboats—sailing in it each day?

Rob Tholemeier from Crosstree Capital Partners had an interesting article a while back on the Health Data Management blogs about ways that EMR vendors succeed. He provides 5 approaches that these EMR companies take to the EMR and EHR market. Here’s the 5 methods he identifies with a few of my thoughts after each:
Leveraging Size – I call these the Jabba the Hutt EHR vendors. They’re really big and powerful and no doubt will continue to sell a bunch of software since they have “leading vendor” name recognition. Rob correctly notes that they’ll continue to grow through mergers and acquisitions.

Specialization – I find this segment of the market really interesting. I’ve been seeing more and more of these specialty specific EHR vendors carving out their niche in the market. I still think the best play for a “leading EHR vendor” is likely to acquire a number of specialty specific EHR.

Regional Focus – Many people to want to “buy local.” There’s something really powerful about knowing your EHR vendor’s office is down the street and you can go and wring their neck personally if something goes wrong. < sarcasm >Not that anything would ever go wrong with an EMR. < end sarcasm font>

Suite Selling – I found this one interesting. Although, I think that it’s more of a factor for hospital EMR selection. I guess you could make the case that practices purchasing their EHR based on the hospital system purchase might fall into this category as well. Basically, the practice adopts a certain EHR because their hospital is subsidizing it or has a nicely built connection to that specific EHR company.

Advanced Technology – I’ve seen a few companies that have made this pitch. I still find this a challenge for an EMR company to make this pitch and be heard above all the EMR noise. However, I think if anyone is going to do it, I think it will likely come in the user interface.

An interesting way to stratify the various EMR companies. Are there any other categories of approaches that he missed?

In all my years writing about healthcare and technology, I’ve never seen such a storm of enthusiasm over a new medical device.  If the newspaper and blog coverage is any indication, we have no less than a moral duty to give an iPad to every practicing physician, stocked with a variety of the coolest medical apps.

In fact, Apple itself has jumped on the bandwagon, with its most recent iPad2 commercials displaying medical apps.

This, of course, has serious implications for EMR developers.  If the iPad is eclipsing even the desktop and smartphone as a primary means of accessing medical information, their focus will have to shift from a traditional client-server model — and perhaps even existing SaaS options — to one which is more modularized.  Their assumptions  about users’ interaction with their interface will need to be different as well.

The thing is, despite all of this discussion, I’ve seen no stats to back up the notion that even tech-friendly doctors see iPads as indispensable.

Where the iPhone (or at least smartphones generally) are concerned, sure, there seems to be plenty of research documenting that most physicians rely on them. But while there’s lots of anecdotes circulating about the iPad’s central future in medicine, none of the research firms covering the healthcare industry seem to have documented this trend.

What’s more, as a consumer whose family sees a lot of specialists — a few of us have chronic illnesses — I’ve never seen an iPad in anyone’s hands.  Walk into a coffee shop in the prosperous D.C. metro suburbs where I live, and sure, at least one consumer will have one.  But in DC medical offices, not so much.

Now, don’t get me wrong, if I were a product manager with an EMR vendor, I’d create an iPad interface and trumpet its existence to the world — it makes marketing sense if nothing else. One vendor which has already taken this tack is DrChrono, which prominently advertises the iPad version of its free EMR.

Regardless, I’m still waiting to see more evidence that the buzz around the medical iPad is more than just the expertly-crafted legends Apple creates around its products.  (Should we sense some Pixar magic here?) Anyway, just because everyone says something’s cool doesn’t mean it is.  I mean, we learned that in high school, didn’t we?

If I were running a medical practice — and knew I had to roll an EMR soon — I’d be banging my head against a wall.  While there’s plenty of talk about the reasons for EMR adoption (in some cases, 44,000 reasons) what consistent, reliable, accessible sources of information can physicians find on the subject?

You may think, “doubtless there’s plenty of colleagues to talk with, not to mention news stories and how-to sites out there, for physicians wanting an EMR,”  but it’s really not that simple:

*  Sure, physicians trust their peers, but with so few having gone whole-heartedly into the EMR game, there’s not a ton of peer support available — and that holds adoption down. You gotta love the whole chicken-and-egg dilemma here.

* Medical practice journals toss off the occasional article on the subject, but they’re often just highlighting a study on how many their peers are also looking into buying in (big help!)

*  Consultants of unknown bias pump out advice on how to choose an EMR, but it’s scattershot and often goes too technical or gets long-winded

*  Bibles of the medical news industry may pop out a case study or two on EMR adoption, but they’re usually focused on big players like the Cleveland Clinic, not the two- to five-physician practices that really need feedback.

* Sure, there’s the Regional Extension Centers, but I’m having trouble visualizing how an already intimidated doctor would bring him or herself to spend enough time with them to benefit.

* Of course, vendors are happy to tell nice stories about EMR use by small practices, but everyone takes those with a grain of salt, with good reason.

In other words, for a problem of such importance, there’s far too little appropriate guidance out there.

In truth, some medical societies probably are reaching out, not to mention hospitals, health plans and government, with reasonably useful suggestions.  But it’s still like a violent info thunderstorm out there.  Unless physicians find an ongoing source of reassuring guidance, which seems relatively unbiased and thorough, many are likely to hang back.

It comes down to this.  Incentives or no, no small business in or outside of medicine makes such a significant purchase without feeling comfortable — and if I was a low-tech doctor, I wouldn’t know how to get there. This can’t be good.