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Will Rip and Replace EHR Software Ever Be a Thing of the Past?

I heard an interesting statistic a few days ago during a very informative webinar – “The Future of Meaningful Use, EHRs and Accountable Care” – hosted by Greenway Medical’s Justin Barnes. He shared a huge amount of information during the hour-long presentation, but the fact that most stood out to me was that, according to Barnes, between 35 and 50 percent of EMRs will eventually be replaced after just one year of use. (Don’t quote him on the “year,” but I’m pretty sure that’s what he said.) His point being, of course, that providers need to think long and hard about what type of solution they need to fit their workflows before they spend time and money implementing an EMR.

This sentiment was echoed by Kimberly Harding of BCBS Florida in a panel at the iHT2 Summit in Atlanta. As part of a greater discussion on Meaningful Use, she made the comment that just because a healthcare IT product is certified doesn’t mean it’s the best fit for a particular facility.

My takeaway from both of these statements is that providers looking to adopt new healthcare IT tools like EMRs need to take a long, hard look at what their current needs are and what their future needs might be before they even think about demoing products.

They also need to adopt technologies that fit their workflows, not necessarily technologies that have a ton of bells and whistles. Added features won’t do anyone any good if they’re never used properly, never used at all, or used to the detriment of a physician’s productivity.

I kept this sentiment in mind when I read the results of a recent study of 250 hospitals and healthcare systems by consulting firm KPMG. The survey found that “71% of respondents’ organizations are more than 50% finished with their EHR adoptions. Will this 71% be satisfied with their EMRs once fully installed and adopted? How many will realize their product of choice wasn’t the right call? If we apply the Greenway statistic, that could be as many as 125 facilities!

So where is the disconnect? Why are providers making poor choices with presumably the best of intentions? Why has the term “rip and replace” become so well known in healthcare? Are physicians misinformed, or not educated enough? Are they feeling so rushed by Meaningful Use deadlines that they don’t perform proper due diligence? Are vendors part of the problem? If so, shouldn’t they be part of the solution? What role do regional extension centers have to play in all this?

If you have answers, please let me know in the comments below.

April 25, 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.

Are EMRs the Answer to Small-Practice Challenges?

During my recent visit to my daughter’s pediatrician, I was pleasantly surprised to see a computer up and humming along in a corner of the exam room. The last time we had been in, some six months before, that same piece of equipment sat shrink-wrapped (as it had been for a few months even before that), waiting for an eager clinician to tear open its plastic casing and put its digital capabilities to good use.

I had been dreading this particular appointment – our first with the one pediatrician left at the practice. Our usual doctor had left a few month earlier for parts unknown, so I wasn’t sure who – or what – to expect. The advice nurse who made my last minute “work-in” appointment was kind enough to make sure I understood that due to the second doctor’s departure, we would likely wait an extremely long time.

Our wait, which ended up being no longer than usual, gave me time to do a bit of snooping around the new computer. No keys or mouse were touched, but I did notice that NextGen was the practice’s EMR of choice. Yes, the nurse did have her back turned to us as she asked me questions about the reason for our visit and entered responses into the EMR. When I asked her if she liked the new system, she gave a rather noncommittal response in close approximation to “some days I do, some days I don’t.”

I’m guessing she may have bigger issues to deal with, such as assisting the patients of a double-, sometimes triple-booked pediatrician. The single-doc situation made me wonder how much training the practice’s staff had time for before and during go-live. I could certainly believe that follow-up training will take a backseat until a second pediatrician is brought into the fold and everyone gets back to a somewhat normal workload.

So how do small practices in similar situations do it? How do they find time for EMR training when overscheduled? Do vendors often step in and help with extra resources? How long do practices go before hiring additional staff? (That’s an off-topic question, I know, but one I’d still like an answer to.) I’d like to think that in the long run, the new EMR would of course help make everyone more efficient, and us patient parents more satisfied. Let me know what you find out in the comments below.

March 21, 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.

Finding an EMR Job Champion

Earlier this year I had the good fortune (and the support of my employer) to join the Technology Association of Georgia (TAG), an organization that offers interest groups for every possible IT niche you can think of. I’ve attended a few of their health society events, and at every one I’m confronted with statistics and anecdotes surrounding the dearth of qualified healthcare IT professionals in the city and surrounding areas. Much attention at these events is also given to the fact that these professionals are needed now more than ever to help smaller physician practices and larger healthcare systems demonstrate Meaningful Use and achieve associated electronic medical record (EMR) adoption goals.

I’ve commented before on the disconnect between the increasing number of healthcare IT educational opportunities being created by the government and vendors’ willingness (or unwillingness, as the case may be) to hire fresh grads. EJ Fechenda of HIMSS JobMine posed a question related to this conundrum better than I ever could have: “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 may have found a champion in Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey. Wicker is also an adjunct professor at two HITECH-affiliated community colleges, teaching students who already have strong backgrounds in healthcare or IT the basics of process, analysis, redesign, installation and ongoing maintenance to prepare them for second careers in physician office EMR implementations.

He certainly seems to have a passion for the subject. “I’m devoted to the EMR,” he told me during a recent phone interview. “That’s why I started teaching, really, because I want to see that [adoption] happen so badly.”

He tells me his students are guardedly optimistic about their future job opportunities, which he believes will surge this summer alongside an expected increase in physician adoption of EMRs – six months before the deadline to qualify for Meaningful Use incentives.

As we discussed the state of the HIT job market, we both wondered if what type of organization might have a greater role to play in ensuring that graduate from programs like Wicker’s find jobs.

“We had to really battle our way to get one [software] copy from one EMR vendor,” he explains. “I wish they were more amenable to providing educational software/packages like Apple does throughout all their PCs. I know a few different schools have joined with a vendor. One place I know of is showing Vista, another is showing eClinicalWorks, and another partnered with a local hospital that happens to use Sage.

“I have a relatively limited view, but from what I can see, the vendors are not really engaged with the HITECH student development program. I think they’d probably rather do it themselves.”

“Here’s an idea that I came up with,” he adds. “I’ll throw out the RECs (Regional Extension Centers). That’s another entity that’s funded – it’s kind of their job to get the docs to convert. If they could partner with the colleges and the graduates to possibly divert some of their funding to supplementing the graduates’ income while they worked at a physician practice … So the physician, let’s say, for $5 an hour, they could hire a qualified, certified person. These people are pretty good, too. They know what it is to work. They’ve probably worked 10 or 20 years already, either in IT or in healthcare. So they’re mature employees and highly motivated. They would be great to go in and do a 6-month installation. I think it would be great for the physician if, for $5 an hour, you get somebody that would probably cost you $30 an hour somewhere else.

“Let’s say the student can get another $10 an hour supplemented from the REC or somehow through the government. So they get $15 an hour to go in there … they get four or five months of experience doing an installation and then the physician can make a decision … maybe they ultimately hire the person. That’s just a crazy idea that I had that seemed like the pieces are out there that kind of potentially could work. I sent it into the ONC a couple of days ago.”

Could the RECs have a bigger role to play in ensuring that HITECH graduates gain on-the-job experience and employment? I’d love to hear from any readers out there who may work for or with RECs . Is Wicker’s idea doable? Have we found our champion?

December 14, 2011 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.

Which EHR Certifying Body?

Many of you will probably remember my post about Jim Tate and all his EHR certification experience. As I said in that post, Jim Tate knows his stuff when it comes to the EHR certification bodies (ONC-ATCB). So, I found his advice for EHR vendors on HITECH Answers pretty interesting when it comes to selecting which ONC-ATCB an EHR company should use.

You can go read the whole article, or here’s the Cliff notes version: Responsiveness and Support of the EHR certifying body is most important.

March 3, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

EHR Certification Expert – Jim Tate


I’ve had a number of EMR companies ask me where they can get help to become a certified EHR. There’s certainly plenty of resources online, but I find that most EMR companies want some real hands on experience and help to be able to navigate the EHR certification process. Whenever I’m asked this question, I always tell those people to go and talk with Jim Tate.

I still remember when I first met Jim Tate at HIMSS last year. I was hanging around the HIMSS exhibit floor because I was early to a meeting with a vendor. I’m sure I was in a partially lost state since I was trying to figure out what to do with the few minutes I had available before my meeting when I heard someone say my name.

I looked up from my lost state to see who was saying my name and saw an all too familiar face for which I couldn’t place. The person then said, “You’re techguy right?” (I’m @techguy on Twitter, and @ehrandhit as well). Then, everything clicked and I said, “You’re Jim Tate right?” See the funny thing was that Jim and I had never met in person, but obviously both of us had seen each others healthcare IT tweets many times before (I think he enjoyed reading my rips on CCHIT pre-HITECH). It’s always interesting (and usually fun) to meet someone in person that you feel like you already know online.

Personal stories aside, I’ve still gotten to know Jim Tate more online than I did in person. I hope that will change at HIMSS this year. Even if it’s just running across Jim on the HIMSS exhibit floor or one of the various parties. Jim has an incredible amount of knowledge and experience in EMR certification. I’m not sure what it says about me that I find the idea of sitting around with Jim listening to old EMR certification “war stories” to be really interesting.

Of course, what prompted my storytelling about Jim Tate? A tweet Jim recently sent that said he’d worked with 90+ HIT vendors. He has a great EMR certification page on his website which has over 75 Ambulatory and Inpatient EMR vendors that he’s worked with. That’s A LOT of EMR companies. You can see the image of EMR companies he’s helped at the bottom of this post.

One ONC-ATCB recently told me that many of the EHR companies that come to them are incredibly well informed, others are just missing some of the details and others are just completely lost. I’m quite sure Jim Tate’s EMR companies fall into the first category.

Now Jim Tate is starting to share his expertise even more broadly as he partners with HITECH Answer and their Virtual Extension Center. Seems like meaningful use consulting will be Jim Tate and EMR Advocate’s next step and probably a very good one. Or as Jim said it:

Jim also gets my funniest tweet of the year award too. In response to @motorcycle_guy’s tweet about who should replace Dr. Blumenthal as ONC head? Jim replied:

February 17, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

329 Certified EHR Companies and More Being Added

I’m not sure how many of you find it interest, but I know I have at least a reasonable number of EHR vendors out there that read this site. Plus, the number of available certified EHR vendors should be interesting to anyone that participates in the industry.

The EMR Daily News recently did a post breaking down the official ONC CHPL list of certified EHR vendors. Here’s my general summary of the numbers:
Total EHR Certifications: 329
Certified Ambulatory EHR: 234
Certified In Patient EHR: 95

I just checked the list myself and found 350 total EHR vendors, 250 ambulatory certified EHR, and 100 Certified In Patient EHR. Although, since those numbers are so round, I’m going to assume that EMR Daily News did a better job looking at the list. I just went off the numbers that the website provided.

Either way, 329 EHR companies is a lot of companies. Granted, that’s not 329 full comprehensive EHR vendors, but the majority of them are or will be. Is there any wonder that there’s such a thirst for tools to help people narrow down the EHR vendor selection process?

EMR Daily news also broke down which ONC-ATCB companies are certifying the 329 EHR vendors:
CCHIT: 54%
Drummond Group: 35%
InfoGard: 11%

I know that SLI is talking to a lot of EHR vendors and I imagine the Verizon associated ATCB is too. Of course, this says to me that there’s still a lot of EHR vendors that are going to be added to this list.

I talked to one industry person about the number of EHR vendors and they said they had 600 on their EHR vendor list. From the looks of this, they might not be all that far off with that number.

February 4, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

Getting Your CMS EHR Certification ID Number

Drummond Group has updated their FAQ with an interesting question about how to obtain a CMS EHR certification ID and the difference between the CMS EHR certification ID and the ONC EHR Certification ID that Drummond Group issues.

Q: How do I obtain a CMS EHR Certification ID? Is it the same as my ONC EHR Certification ID I received from Drummond Group?

A: The unique ONC EHR Certification ID issued by Drummond Group is associated with the CMS EHR Certification ID but distinct from it. The ONC EHR Certification ID is one of the “inputs” into the calculation and creation of the CMS EHR Certification ID. However, it is ultimately the CMS EHR Certification ID number which EPs and hospitals will use for the incentive payments.

The ONC Certified Health Product Listing functionality was updated December 24, 2010 and it now has the addition of a shopping cart to create CMS EHR Certification ID number. Users can obtain the CMS EHR Certification ID number by following these steps:

1. Go the ONC CHPL website: http://onc-chpl.force.com/ehrcert

2. Following the instructions on the site, search for the certified EHR products. There are many ways to search, but one option is to search by the ONC EHR Certification ID assigned to the vendor.

3. When the EHR product(s) is found, select the link on its row called “Add to Cart”. There is a shopping cart icon next to it.

4. When all EHR products used by the EP or hospital have been added to the cart, select the “View Cart” link at the top right which also has a shopping cart icon next to it.

5. Now in the Certification Cart section, verify the products in the cart are correct. Then, select the “Get CMS EHR Certification ID” button in the top right corner to request a CMS EHR Certification ID. However, the button will not be activated until the items in your cart meet 100% of the required criteria. If your EHR product(s) do not meet 100% of the Meaningful Use incentives, then a CMS EHR Certification ID number can not be issued.

6. Finally, you will see the CMS EHR Certification ID. It is typically a 15 digit string made up alphanumeric characters.

Interesting that the CHPL website has been redesigned to be able to know which EHR are certified to which module and knows if you’ve reached a 100% certified set of software.

Looks like it also pays off to have a number for your EHR product name so that you’re listed first on the CHPL site.

January 19, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

ONC ATCB EHR Certification Process

Ok, was that enough abbreviations in the title of a post? Well, if you care about this post, you’ll probably recognize all of the abbreviations.

In a post I did on EMR and HIPAA about SureScripts as an ePrescribing ATCB, there was a comment made that possibly some of the ATCB were “in bed” with ONC in order to get their EHR certification body status. In response to the comment, Mark Joyce from SLI Global Solutions (an ATCB) provided some good insight into the process and costs associated with becoming an ATCB that can certify EHR software.

As the team lead for SLI’s application to the ONC I can assure you that our company has no political connections, traded favors or made contributions that won us our certification by the ONC. It was 10 weeks of grueling research by two independent companies (one company focusing on testing and the other certification) that resulted in a 1200 page application.

The application was in two parts: part one required both companies to expand and/or create a Quality Management System for the new process. It’s no easy task to develop both a 17025 and a Guide 65 conformant QMS. Part two required the applicant to have a thorough understanding of EHR architectures as well the NIST testing procedures and tools.

It was evident by the followup questions from the ONC that the application had been very carefully reviewed.

Obtaining certification from the ONC was no easy task. I am proud to be a part of our companies significant investment in the ATCB testing and certification process.

Yes, becoming an ONC-ATCB is definitely not a walk in the park to achieve. Anyone that says otherwise, likely hasn’t ever been through the process.

January 3, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

Two More ONC-ATCB EHR Certification Bodies

Today, HHS announced two more organizations that have been approved as ONC-ATCB for EHR certification:
SLI Global Solutions – Denver CO
Date of authorization: December 10, 2010.
Scope of authorization: Complete EHR and EHR Modules.

ICSA Labs – Mechanicsburg PA
Date of authorization: December 10, 2010.
Scope of authorization: Complete EHR and EHR Modules.

I’ve actually met with both of these organization. I met with SLI Global Solutions in Denver when I was attending AAFP. I wrote this blog post about SLI Global Solutions as an ONC-ATCB EHR Certification body after my visit with them. I’ll be getting more information from them which I’ll post on this or EMR and HIPAA as I get it.

ICSA Labs is an Independent Division of Verizon Business. I met with the CMO of Verizon at last year’s HIMSS where he told me that ICSA labs would become a certifying body (sorry I can’t find the post right now).

Both are very legitimate organizations with some definite interest and expertise in the healthcare space. For example, Verizon is making a big play with their Verizon HIE product offering.

I’ll see about getting more details on each of these new EHR certifying bodies so that we can see how they compare against the other ONC-ATCB. 5 EHR Certifying bodies. That’s probably enough to keep it competitive.

December 10, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.

ONC-ATCB Certified EHR Breakdown by EHR Vendor

This is the third post in the series of posts(see the previous ONC-ATCB Certified EHR Breakdown and ONC-ATCB Certified EHR Breakdown by Certifying Body) looking at the EHR certification numbers put together by HITECH Answers. The following is a list of Certified EHR products by vendor:

Top 3 Vendors by number of Products Certified
- Cerner Corporation – 13 products
- Siemens Medical Solutions USA Inc – 9 products
- Epic Systems Corporation – 4 products

I guess these are the EHR software you want to avoid. Ok, that’s partially facetious. Just, can you imagine trying to battle the other 12 certified EHR to get support. Granted, most of them are likely hospital EHR and so there are usually support contracts in place to deal with this kind of thing. Don’t worry though, Allscripts should be on this list soon. I think they have something like 7 EHR software for just ambulatory right now. I guess that’s the nature of acquisitions.

It will be interesting to continue to see this evolve.

December 4, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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. Healthcare Scene can be found on Google+ as well.