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Should Healthcare Institutes Perform “Rip-and-Replace” to Achieve Interoperability? Less Disruption, Please!

Posted on October 7, 2014 I Written By

The following is a guest blog post by Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr Voltz
A KLAS Research Report on the EMR buying trends of 277 hospitals with at least 200 beds has identified that almost half will be making a new EMR purchase by 2016.  Of the providers considering a change, 34 percent have already selected a vendor and another 44 percent are strongly leaning toward a specific vendor. Driving factors include concerns over outdated technology and health system consolidation.

But is the technology really outdated and health system consolidation necessary, or is the real issue lack of interoperability?  And if you are a hospital looking for a new EMR, let’s not forget the history of technology before we jump to conclusions that the greatest market share means the best of breed.

When we look at EMR adoption over the past number of years, we need to be careful with the data we use. Implementations, and now rip and replace switching to other venders, has been the only choice offices, clinics, hospitals and health systems had to address the issues with interoperability.

Most of current deployed EMRs are designed as a one-size-fits-all, leading to the situation where today out-of-the-box functionalities fit none of the care providers’ requirements. Besides that, EMR vendors have been designed with proprietary data where patient medical sharing (or exchange) becomes the biggest roadblock for patient care continuum. The reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data with a single integrated and consolidated database approach.

A 50 percent turnover of EMRs is an incredibly high numbers of hospitals and clinics who have either replaced or are looking to replace their current EHR’s. Being that the majority of the initial implementations were supported by the HITECH act, one would think the government would raise issue with vendors to address this high turnover of EHR’s. There seems to be a general misperception that if our current systems do not meet the demands and needs of providers, administrators, and financial arms of a healthcare delivery system, ripping out the system and implementing a new one will solve the issues.

What is the True Total Cost of Ownership of an EMR?

Healthcare management must look beyond the actual cost paid to an EHR vendor as the only cost but they must look into the total cost, much beyond the normal Total Cost of Ownership (TCO). TCO only includes the initial license cost, maintenance cost, IT support cost, but in healthcare, there is another cost – it is the disruption of the care providers’ workflow. That disruption is directly correlated to healthcare system revenue and patient care outcomes.

Stop this disruption and let’s look for another solution where we integrate disparate systems since many of them are built upon databases that can address the needs of health. The cost to providers in time to learn a new system, the migration and loss of patient data that has been collected in the current systems, the capital expense of system software, the hardware, trainers, IT personnel, etc. all add to the burden, something that is currently being looked at as a necessary expense.

Interoperability Saves Resources

This need not be the case when platforms exist to connect systems and improve access for providers. Having a consistent display of data allows for more efficient and effective management of patients and when coupled with a robust collaborative platform, we close many of the open loopholes that exist in medicine today, even with EHR’s.

2.0 EMR connectors like Zoeticx and others have taken the medical information bus, middleware platform, to solve the challenges that current EHR’s have not.  This connection of systems and uniform display of information that physicians depend on for the management of patients is crucial if hospitals want their new EMRs to succeed. In addition, a middleware platform allows for patients to access their medical information between EMR’s in a single institution or across institutions, a major issue for Meaningful Use.

Fragmentation Prevents Some EMRs From Connecting With Their Own Software

Large EMR vendors’ lack of healthcare interoperability only reflects on how they compete against each other. Patient medical data and its proprietary structure is the tool for such competition where the outcome would not be necessarily beneficial for the hospital, medical professionals or patients. There are plenty of examples where healthcare facilities with EHRs even from the same vendor fail to interoperate with each other.

Such symptoms have little to do with the EMRs that have the same data structure, but about the fragmentation being put in place over the years of customization. We believe that the reason for this is to address fragmentation of the software product. Fragmentation is a case where deployments from the same software products have gone through significant amounts of customization, leading to its divergence from the product baseline.

To believe that ripping the whole infrastructure – inpatient and outpatient–as the method to reach interoperability would only cause a lot of disruption, yet the outcome would be very questionable down the road. Appreciating the backlash of calling the implementation of EMR’s a beta-release, we have much data to use in looking for the next solution to HIT.

As with much of medicine, we are constantly looking for the best way to take care of our patients. Like it or not, EMR’s have become a medical device and we need to start to evaluate them as we would any device used to manage health and disease. As we move forward, there will be an expansion in the openness of patient data, and in my prediction, a migration away from a single EHR solution to all of the requirements of healthcare, and into a system of interconnected applications and databases.

Once again, we have learned that massively engineered systems do not evolve into complex adaptive systems to respond to changing environmental pressures. Simple, interrelated and interdependent applications are more fluid and readily adaptable to the constantly changing healthcare environment. Currently, the only buffer for the stresses and changes to the healthcare system are the patients and the providers who depend on these systems to manage healthcare.

About Dr. Donald Voltz
By Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.  A board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Have You Ever Tried to Cancel an EHR?

Posted on July 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A caller’s attempt to cancel their Comcast service is going around the internet. About 10 minutes into the call, the husband got on the line and started recording the call for all of us to see how the Comcast retention rep acted. You can listen to it embedded below.

I imagine most of us have had an experience trying to cancel our service at one time or another. It’s not a fun experience. Although, I know some people who call to cancel their cable service every 3 months in order to have the customer retention representative give them a lower cost deal. You know that offering you a 3 month lower cost (or something like that) is one way they try to retain you as a customer.

As I listened to the call, I was thinking about some of the experiences I’ve read and heard about clinics cancelling their EHR service. Unlike a cable or TV service where it’s quite easy to switch services, switching EHR software is a much more involved process. In many cases EHR vendors hold you “hostage” more than the Comcast retention rep above.

In most cases, the EHR vendor will go radio silent on you or responses to your inquiries will take a really long time. Plus, when you ask for access to your EHR data, you’ll often get hit with a hefty price tag. It’s a shameful practice that many EHR vendors employ to try and lock their customers in and prevent them from switching EHRs. We’re entering the era of EHR switching and this is going to impact a lot of practices going forward.

I’ve debated for a while now creating an EHR “naughty” and “nice” list which outlines the good and bad business practices by EHR vendors. One of the challenges is defining what’s naughty and what’s nice. There’s a lot of grey area in the middle. Although, I think that aggregating this type of information would be really valuable. I’m just afraid that many EHR vendors won’t want to share.

I’ve written posts before about why I think holding a practice’s EHR data hostage is a terrible business practice. The medical community is small and an EHR vendor that tries to do this will definitely suffer from negative word of mouth. What do you think? Should we create a list of EHR vendors and their policy on EHR cancellations?

Epic Go Live Impossible Without #Web25

Posted on March 13, 2014 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.

The World Wide Web turned 25 this week, which gives us all cause to stop and reflect on its role in healthcare IT. It goes without saying that systems like electronic medical records would have a hard time really taking off without the Internet. Yes, they probably could exist without it, but if you think providers have workflow issues now …

I found out about the Web’s birthday on the very day I called my daughters’ pediatrician to schedule their annual well visits. The receptionist (who didn’t sound stressed at all) kindly informed me that they will be scheduling all future appointments into the new electronic medical record (Epic). Since that isn’t scheduled to go live until April 1, she took my appointment date and time down, and told me another staff member would call me back to let me know my appointments had been made in the new system.

It sounded like they are trying their hardest to avoid duplicate data entry into the old and new systems, but are having to rely on paper and pen to make sure everything ends up where it’s supposed to be come go live. Oh, the irony. I’ve got April 1 (April Fool’s Day, no less) circled on my calendar. I think I’ll give them a call back then to see if anyone sounds remotely stressed, or if things seem to be going smoothly.

This particular healthcare system probably won’t be in the “EMR Buying Frenzy” you may have read about recently. The numbers are downright shocking to me. HealthcareITNews.com reports, “[O]ne-third to half of all large hospitals are looking to trade out their old EMRs by 2016.” That is a ridiculous amount of money set to be spent by facilities that likely made similar investments in the not-too-distant past.

As a patient, I have to wonder how those second-round EMR purchases will affect the cost and quality of care. Will the price of procedures go up to help hospitals pay for these new systems? The money has got to come from somewhere. Just how frustrated will my physician be with new workflows, especially if they’ve JUST gotten used to the previous EMR? If any provider wants to chime in, please do in the comments below.

In another wonderful twist of irony, it is the World Wide Web that now allows me and other cost-conscious patients to research healthcare costs at our local facilities, not to mention come together online to commiserate about similar experiences. It will be interesting to see where the Web and healthcare IT are in another 25 years. Surely we’ll have achieved true interoperability by then!

From 5 EHR to the Cloud, EMR Is Just a Tool, Startups to Improve EMR Usability

Posted on February 16, 2014 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is a big preview of coming attraction. EHR vendors are going to have to be ready for this type of EHR purchase going forward. Well, maybe not 5 EHR, but it could be close to as complex. Add in all of the practice acquisitions and the EMR switching is happening.


This is a good reminder. EMR is a tool and how you use it determines its real value.


The real question is whether the EMR systems will allow it or at least which EMR vendors will support it. If they don’t, startups won’t be able to do much. Even if they do open it, I’m still not confident that a startup built on top of today’s EMRs can solve what pains EMR.

A List of Key Insights for EHR Data Conversion

Posted on December 17, 2013 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare Scene sat down with Sean West, VP of Data Conversion at HealthPort, to discuss EHR data conversion. EHR data conversion is quickly becoming a hot topic for many organizations that rushed their initial EHR selection and implementation. In our video discussion embedded below, Sean West offers a number of key insights including the following:

  • Convert the Data Close to the EHR Conversion
  • Ensure You Have Enough Time to Make the Conversion
  • Consider How Much Data Needs to Be Converted
  • Look at the Impact on Performance of Converting All EHR Data
  • Evaluate Your Legacy EHR Vendors Willingness to Work with You on Data Conversion

Check out the following video for all the details:

We also asked Sean West about when an organization would want to consider a vendor neutral archive for their EHR. While the vendor neutral archive is incredibly popular with PACS systems, we’re just now starting to see the idea crop up with EHR data. In the following video, Sean West provides some good insight into when an organization might want to consider a vendor neutral archive for their EHR data.

Why One Doctor Switched EMRs

Posted on August 29, 2013 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.

Over the last several months, we’ve been flooded with statistics spelling out the reasons why doctors are choosing to dump their current EMR and invest in a new one and we’ve been writing about switching EMR for a while.  To bring some perspective to this discussion, I’ve reached out to physicians who have made the Big Switch and attempted to learn a bit about why they chose to move from one EMR to another.

Today, I bring you Dr. Christy Valentine, a New Orleans-based physician practicing internal medicine and pediatrics. Dr. Valentine operates a small practice consisting of herself and a nurse practitioner.

Back in 2007, as part of opening her own practice, Dr. Valentine decided to invest in an EMR from a company better known for hospital systems. (She’s asked me not to name the vendor — let’s call them Vendor X.) Having seen generations of paper medical records wiped out by Hurricane Katrina, she was eager to go digital and enjoy the peace of mind that backup storage offers.

Dr. Valentine looked at several EMRs but was most interested in Vendor X’s product, which was in use at the local academic medical center and under consideration by couple of major health systems in her area. “I felt I’d have a better chance of hiring people who were familiar with the technology,” Dr. Valentine recalls. “Being a small practice we really wanted to save time training individuals on the computer system.”

Dr. Valentine had purchased not only Vendor X’s EMR but also the billing system that went with it. She soon came to regret that choice, however. For one thing,, she said, Vendor X was slow to respond to customer service requests; she and her staff had to leave a message and wait for a response which sometimes never came.

Perhaps even worse, despite investing years in trying to make things right, the practice management system was a wash-out. “I had to scrap it completely and move to an outside billing service because it wouldn’t work for our practice,” Dr. Valentine said. And to top things off, the system never got easier to use despite Dr. Valentine’s sincere efforts to make things work.

In retrospect, she feels that her practice should have gone with a vendor that focuses on practices her size, she says. “I learned that you if you go for a vendors whose big fish is the hospital, you won’t be important to the vendor,” she said.

About a year ago, Dr. Valentine decided once and for all to dump Vendor X, largely because she was opening her second office and didn’t want to bring Vendor X over. Instead, her practice  brought up athenahealth’s EMR and practice management system a few months ago

Dr. Valentine has been happy ever since. She’s very pleased with the athenahealth customer service and finds the product easy to use. She feels that her system, unlike the old one, is easy to use and to customize with specialized templates. Even better, she feels ready to steam into Meaningful Use Stage 3 with athena as a partner.  “As soon as they tell us what they need we’ll be ready to jump right into it,” Dr. Valentine says.

Being Moral and Right, ACOs, and Medical Bills: #HITsm Chat Highlights

Posted on March 2, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: Will 2013 by the “Year Of The Great #EHR Switch” as predicted by Black Book Rankings. Why or Why not?

Topic Two: @Farzad_ONC told #healthIT vendors they must do what is “moral and right” or face consequences.” What acts cross the line?

Topic Three: A recent WSJ article said “#ACOs hold caregivers accountable without requiring patient accountability.” Do you agree?

Topic Four: What are your thoughts on the recent Time magazine article Bitter Pill: Why Medical Bills are Killing Us?

Topic Five: #HIMSS13 Free-For-All. What are your key sessions, conference suggestions and restaurant recommendations?

#eHealth100, Single EMR, EMR Adoption, and Wrong EMR Decision

Posted on December 30, 2012 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You know what time it is if the post begins with a hashtag. That’s right. We’re taking a quick look at some of the interesting, insightful, fun, entertaining, beautiful or otherwise thought provoking tweets related to EMR and EHR.

We’ll lead off with a tweet nomination to the #eHealth100:


Yes, I was happy that Anneliz thought of me with this tweet nomination. Although, I must admit that I wasn’t sure what I was being nominated for, so I asked and got the following response about the goal of the #eHealth100


I appreciate being mentioned in this group. Considering the many people that make up the healthcare world, I just hope that each day I can make a small difference in people’s lives. It’s a beautiful thing when I can do that and provide for my family at the same time.


I love and hate the sarcasm in Dr. May’s tweet. I love the irony, but hate that it seems to be a major medical breakthrough.


I’m always looking for more numbers on EMR adoption. Although, then I realized that the article is from Venture Beat. Unfortunately, the people at Venture Beat don’t follow healthcare IT and especially EHR very well (they do follow other startups well). This can be seen in their reference to ZocDoc and Castlight as EHR companies likely to go public. They might go public, but they are definitely not EHR companies. I also love that they also have a quote saying that 90% of doctors don’t have an EMR which totally contradicts the CDC EMR adoption numbers they put at the beginning.

The long story short: 1. Don’t read Venture Beat for healthcare IT info. 2. We don’t really know how we’re doing with EHR adoption. We just know EHR adoption is on the rise.


I’ve sadly been predicting major EMR switching for a year or more. There are a number of reasons for this, but I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.