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#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Posted on February 26, 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.

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

Mulling Over EMR Market Consolidation

Posted on September 27, 2013 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.

I had the pleasure of attending a Technology Association of Georgia Health Society event last week on mobile health. It offered me a chance to chat with colleagues, and hear from a panel of payers, providers, startups and vendors on the current state of and predictions for mobile health. While networking beforehand, I found myself trying to succinctly answer a colleague’s question of, “Where do you see the EMR market heading in the next few years?”

My short answer was, “It is consolidating and will continue to consolidate.” I had more details and theories on the tip of my tongue, but didn’t get the chance to back up my statements before we were ushered in to the evening’s presentation. It was a big question – one that I think has only one correct answer, but also one that potentially has a variety of explanations behind that answer. Needless to say, I mulled it over that night and into the next day, when, coincidentally, I awoke to news of the Vitera/Greenway Medical deal.

If I had the chance to do it over again, I’d break my response down like this: Meaningful Use obviously provided incentive for businesses to get into the EMR game. Some were already in healthcare, while others were on the fringes. Combine those new industry entrants with companies that have provided EMRs since before HITECH, and you’re left with a crowded market.

Implementations and go lives coinciding with Stage 1 left many providers dissatisfied with the EMR experience thus far, but still willing to forge ahead. As they look to Stage 2, some realize their vendors – whom many are already disenchanted with – will not be up to the task of helping hospitals meet digital patient engagement quotas, among other Meaningful Use guidelines. And so began the rip and replace movement.

Vendors deemed not up to par looked at their options. Many took a step back and reassessed product development and strategy, deciding to either: get out of the healthcare game, close up shop altogether, merge with a competitor, or make themselves available for possible acquisition.

That’s one wave of consolidation. I’m fairly confident we’ll see another wave in the next 12 to 18 months, if it hasn’t already started. (I don’t think we’ll see too many Phoenix-type situations like Google.) As providers dive deeper into using technologies around Stage 2 engagement requirements, they’ll experience a second wave of acceptance or denial. At some point, the EMR replacement market will die down, providers will settle into the technology they’ve settled on, and purchases of new systems will stagnate. EMR sales will thus dry up a bit, forcing vendors to again look at their options. I would think that many will turn into consulting services once the demand for new software has died down.

Now that I’ve put pen to paper and laid out my thoughts, I wonder what readers predict. I encourage you to let me know whether I’m on the mark, totally off base, or somewhere in between.

Getting Your EMR’s UI/UX RIght

Posted on June 4, 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.

A couple of weeks ago, someone posted an interesting question on the buzzing question and answer site Quora.com: Is there room for any more new EMRs in the insanely crowded marketplace we have today? According to one very sharp medical student who’s keeping an eye on the field, the best response isn’t “yes,” or “no,” but “you’ve got the wrong question.”

His answer, which I’d like to share with you, argues that there’s no point whatsoever trying to introduce a new EMR with a shiny new feature set when none of the existing field have a decent UI/UX right now. Jae Won Joh then lays out the steps he believes vendors should take if they want to get the basic UI/UX right (steps excerpted for brevity):

Step 0: Architect the patient data structure carefully
I mention this because you’re going to need to be able to pass this patient data around for clinical use, billing, research, auditing, etc, so design for flexibility and expandability from the get-go. Too many EMRs make it painfully obvious that things were thrown in as afterthoughts.

Step 1: Decide on your market…
…because you need to do everything possible to totally kill it. It’s the only way to go. If you’re going to take on group practices, great, take on group practices. If you’re going to work the hospital scene, fine, work the hospital scene. Stop trying to make something that does everything everywhere. This is not a feature, it’s a horrible bug.

Step 2: Analyze what your market does
If it’s a hospital, you need multiple classes of user, ranging all the way from student to nurse to physician to administrator. You’ll also want a competent notification system, because inpatient things tend to be more urgent and if the ICU patient’s potassium is critically high, you probably want to warn the physician immediately instead of waiting for the physician to check on it manually, because gee, the patient might code and die before that happens….The concerns are different for an outpatient scenario: you don’t need a lot of the stuff that hospitals require in an office. Less orders, more scripts, greater throughput in terms of number of patients, scheduling functionality, etc.

Step 3a: Abstract workflows to a very high level first
In other words, they are as follows: 
1) read data
2) interpret data
3) input data

There’s really not much else to it. Every workflow is a permutation of those three. For example: a physician orders a lab, and it’s performed. The result is read by the tech who provides the input to the system, where it is then read and interpreted by the physician so they can go from there. Figure out how each workflow revolves around these three abstractions.

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Step 3c: Design for a 5-year-old
If a five-year old couldn’t use your UI, you screwed up. Period.

There’s a lot more to Joh’s answer, and I suggest you hit Quora youself and read his entire piece. When it comes to usability, most EMRs have barely scratched the surface, and talking about these issues more is always a Good Thing.

Breaking up with Your EMR is Hard to Do

Posted on February 13, 2013 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.

In light of this week’s “holiday,” I thought I’d take a look at the current love/hate relationship the healthcare industry seems to have with electronic medical records and Meaningful Use.

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Thanks are due to @mdrache and @EHRworkflow for their inspiration for the title of this week’s post: EMRtweet1

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The nay sayers seem to have become especially vocal lately, which may be due in large part to the passing of time. Those that have implementations under their belt now feel qualified to talk about the efficacy of the solutions they selected. Negative EMR press may also have bubbled up to the service in light of the recent RAND report, which backpedaled on previous predictions of cost-savings associated with healthcare IT adoption. That study broke the ice, so to speak, and perhaps made providers more comfortable with voicing their discontent.

In any case, if current healthcare IT press is any indication, EMR technology currently on the market has often left providers dissatisfied for a number of reasons. No doubt this dissatisfaction will be a subject of many show-floor conversations at HIMSS in a few weeks. I wonder how EMR vendors are preparing their responses. What will be their top three talking points when it comes to EMR benefits? It seems Meaningful Use incentives have lost their luster, and in fact have left many providers disenchanted with healthcare IT in general.

John Lynn posted a very telling reader comment over at EMRandHIPAA.com from a provider who used his Meaningful Use malaise to create a new independent practice business model. Is this an indication that more providers may “revolt” against Meaningful Use and the trend towards hospital employment? If so, what will the private practice landscape look like in three to five years?

Just how easy is it for providers to truly “break up” with their EMRs? We’ve all read the multi-million-dollar rip-and-replace horror stories – talk about a bad breakup. And then there are the providers that stay in dysfunctional relationships with their EMRs because they can’t afford a new one, instead developing copious amounts of workarounds potentially at the expense of clinical care and accurate reimbursement.

As of last summer, KLAS reported that a whopping 50% of providers were looking to replace their ambulatory EMRs, compared to 30% in 2011. A recent Health Data Management webinar noted more than 30% of ALL new EMR purchases are made to replace an existing EMR.

To me, these numbers beg a number of questions. Were first- and perhaps even second-generation EMRs just not mature enough for providers’ needs? Did providers simply not do enough due diligence before making their purchases? Will these impending replacement EMR purchases stick? If you have updated EMR breakup statistics or a crystal ball, please send them my way.

Christmas Scavenger Hunt Inspires EMR Wish List

Posted on December 27, 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.

Happy holidays, dear readers! I hope my latest blog post finds you well, resting comfortably away from your usual place of employment, and not tied to a device despite being “on vacation” or attempting to take “time off.”

My family and I are a bit further South than usual, visiting family in Jacksonville and engaging in a time-honored tradition in nearby St. Augustine – the Holly Jolly Trolley. Never was there a better excuse to turn Christmas lights into a 3-D psychedelic experience.

We turned our annual light-seeing drive through the Blackhawk Bluff neighborhood into a Christmas lights scavenger hunt, checking off images from our list as we came across them during our drive. Suitable for the younger crowd, our checklist had images of traditional holiday décor – snowmen, stars, candy canes, candles, etc. The gingerbread man gave us the most trouble, and eventually we had to settle for seeing a gingerbread man windsock.

Driving home I got to thinking about what a similar hunt would look like, say, at HIMSS next year. Gather a group of providers, give them a list of EMR attributes and set them loose in the exhibit hall to find as many as possible within a certain amount of time. I wonder how many vendors/booths they’d have to stop at before they checked everything off the list.

For that matter, it would be interesting to turn the check list into a wish list – pinpoint a number of features providers most want in their EMR and see which vendor offers the most in one package. This would then of course lead to a comparison of price and customer reviews, but that’s another blog entirely.

What would such a check list / wish list look like? Based on the major healthcare trends that have come to light over the last year, I’m willing to bet these features (however pie-in-the-sky they might be) would be included:

  • Guaranteed security / protection, especially with regard to mobile EMR applications
  • Innate knowledge of ICD-9 to ICD-10 code translation
  • Ability to connect to any HIE at the click of a button
  • CPOE
  • Pop-up that suggests, on a patient-by-patient basis, how best to digitally engage with that particular person based on their preferred method of communication
  • Suggested protocols culled from evidence-based medicine analytics

What other features would likely be included? What vendors already offer a majority of these features? Do they exist, or will tomorrow’s start up be next year’s true game changer when it comes to success in the EMR marketplace? Please share your thoughts in the comments below.

Will Meaningful Use Affect M&A In The EMR Space?

Posted on November 19, 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.

As some of you may recall, Allscripts is said to be floating the possibility of selling out to a venture capital firm. This follows several months of tumult at the board level, including some who might have been helpful in keeping its merger with Eclypsis moving forward.

I’ve been thinking about this deal for a while, wondering whether it would come to fruition and if so, what would make it happen. And I’ve realized an Allscripts deal, or other EMR company sale, might give us a window into just how valuable Meaningful Use criteria have proven to be. Let me explain.

If I was a EMR vendor looking for an acquisition or merger, I’d certainly look at the usual metrics, including the customer list, code base my target had in house, maturity of the product line, the extent to which in-house programming talent could support the roadmap and so on. (Naturally, I’d go over its books in depth too.)

But that’s not all. These days we have some new perspectives from which to evaluate the success of EMR vendors, a set of standards which are fairly unique in the software business.  Two important examples: We can look at how successfully a vendor’s customers have been able to meet Meaningful Use goals to date, and how far along the HIMSS EMR Adoption Model customers are as well.

While both are interesting, Meaningful Use is more important, as it’s such a politically fraught, complicated and rapidly evolving set of standards. In short, I’d argue that if a vendor’s customers are doing well with MU, then it’s likely the vendor is doing something right.

Now, you can’t draw a straight line between the quality of a vendor’s product and how well its customers  have done in qualifying  for Meaningful Use. Implementation is ultimately the hospital or doctor’s responsibility, even if the provider pays for EMR vendor consulting to get things going. And there’s lots of ways things can go wrong that have little or nothing to do with the product.

Still, I predict that Meaningful Use success is going to become a more important metric in EMR vendor M&A as time goes by. After all, the more bragging rights a company has regarding Meaningful Use success, the more they can improve the acquiring vendor’s profile. That’s gotta matter.

Charles Woodson, Patient Engagement and EMRs

Posted on October 26, 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.

Just when I feared I’d have nothing to write about for this week’s post (despite the interesting news of the NFL’s love of electronic medical records), my husband unfortunately breaks his collarbone. This mountain biking mishap necessitated a variety of healthcare-related trips – a clinic for X-rays, orthopedic surgeon’s office for prognosis and treatment, and our local pharmacy with a handwritten prescription for a much-needed painkiller.

Perhaps the most important visit my husband made was to the World Wide Web, looking up all the information he could find about treatment, length of recovery, worst-case scenarios (which the Web is great at providing), and words of encouragement. Being that this happened on Sunday, Oct. 21st, he had to sift through quite a few Google pages to get through all the news surrounding Charles Woodson’s broken collarbone. Normally, we don’t pay any attention to football, unless it has to do with the Georgia Bulldogs (hoping for a win over Florida this weekend!), but it was pretty hard not to read up on the Green Bay player’s predicted six-week recovery.

Eventually, around page six of Google search results, my husband came across several mountain biking forums that had active discussions around riders’ recent collarbone injuries. My husband was in heaven – all of a sudden his six weeks of recovery now didn’t seem so long, now that he had fellow injured cyclists to commiserate with. (He’s taken to posting daily updates about his progress, and has received positive feedback already!)

Forums like these seem like perfect opportunities for patient engagement. The odds of a doctor weighing in on any given forum are probably pretty slim, but I wonder if those odds would increase if a healthcare institution sponsored the forum. For example, the practice of my husband’s orthopedic surgeon could offer an online community/forum for patients and non-patients to discuss the challenges around a particular problem, such as broken collarbones. The doctors within the practice might be tasked with posting a comment or two each week. Perhaps an alert or message could be programmed to pop up in a patient’s EMR, reminding the doctor to let patients know about these online resources. A service like this would certainly have saved my husband time in connecting with fellow patients, and it seems like a great marketing opportunity for providers.

I’m sure there are HIPAA-related concerns with an idea like this, and I wonder if the providers’ participation could somehow be tied into meeting patient engagement requirements as they pertain to some future stage of Meaningful Use, or accountable care requirements.

Are you aware of any vendors offering technology like this? Do you know of any physicians offering/sponsoring online communities? Please let me know in the comments below, especially if they pertain to collarbones!

Greenway Medical (GWAY) Keeps Momentum Post-IPO

Posted on October 23, 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.

As readers may know, Greenway Medical Technologies is a health IT vendor that sells an integrated EMR and practice management solution, as well as interoperability tools.  The mid-sized vendor excited some criticism earlier this year when it decided to launch an IPO, as few vendors in its size class have done so to date. Naysayers argued that the moment wasn’t right for a company its size to compete with big health IT players for investors.

A few quarters later, Greenway’s stock is doing well, at about $18 per share, having started out at a $10 per share offering price. Analysts, myself included, aren’t surprised to see a well-positioned company in the ambulatory care space do well, but the $550 million firm has done better than expected.

Wall Street was taken by surprise by Greenway’s release of its 4th quarter results for fiscal 2012, in which the company reported revenue growth at 24 percent and raw profit margins at 60 percent (though overall profit stood at 16 percent after all other factors were considered).

What ‘s keeping the stock going seems to be nothing more than plain old fashioned dealmaking — and notably, larger deals that extend beyond lighting up one physician office at a time:

*  Greenway cut a deal with HIT vendor Relay Health (a McKesson subsidiary)  in which the two are offering HIE services.

*   Walgreens chose Greenway’s EHR to wire up its pharmacies for immunizations and health testing.

* Greenway snagged an agreement with Michigan Health Connect, the state’s largest HIE, to provide its technology for practices and clinics using the vendor’s solution.

If you’re seeing a pattern here, you’re not alone. Greenway isn’t just flogging its EMR/PMS to hospitals and medical practices, it’s providing the “last mile” HIE connectivity which has most providers scratching their heads.

Without a doubt, Greenway has formidable competition on the HIE technology side — a story we don’t have space for here — but it seems to me that the combo of having a EMR, PMS and HIE technology to offer is a huge plus.  Like the Wall Street folks, I’m interested to see if this combo keeps Greeway afloat. Things look pretty good at the moment.

Vendor Hopes To Create Market For Windows 8-Based Tablet EMR

Posted on October 17, 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.

So far, Microsoft  has played its cards pretty close to the vest when it comes to the launch of its new tablet line (and iPad wannabe Surface. But news is trickling out on Surface, which will officially go to market October 26th.  That includes news of the first EMR built for the Surface, EMR Surface, which appears for sale in the new Microsoft Windows Store online for $499 a download.

EMR Surface is produced by a company called Pariscribe, based in Toronto, which says it was key in building Canada’s first Web-based EMR. Its existing products include a radiology system, physiotherapy suite, dental suite, patient registration software for kiosks and an EMR.

What makes EMR Surface interesting isn’t just that it’s based on a new tablet. Far more interesting is that it runs on Windows 8 which, according to a piece in  MobiHealthNews, the company sees as a major competitive advantage in the corporate world.

As readers know, the majority of mobile devices in healthcare run on iOS or Android, and last I checked, there’s been little discussion of the notion that a Windows 8 device could slip between the cracks.  That doesn’t mean Pariscribe is whacky to think so, however; in fact, it’s an intriguing idea.

According to article author Neil Versel, Pariscribe president and CEO Manny Abraham believes that Surface and Windows 8 and Surface will do a better job of bridging the gap between mobile and desktop computing.  If he’s right, the company is really on to something.

The thing is, iOS and Android have an iron grip on the mobile device market right now. Even the might of Microsoft might not be sufficient to break the market’s preference for these two operating systems.

That being said, if Pariscribe has come up with a particularly nifty solution, it could give Surface-based (and Win 8 based) EMRs a foot in the door. I’m eager to see how they do!

Will Big EMR Vendors Use Healthcare Standards As A Weapon?

Posted on October 9, 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.

Standards are a tricky thing. Some times, they bring a technical niche to its senses and promote innovation, and others, they’re well-intentioned academic efforts which gain no ground.  From what I’ve seen over the years, the difference between which standards gain acceptance and which end up in trash bin of history has more to do with politics than technical merit.

But what the EMR industry did neither? From the mind of my crafty colleague John, here’s a scenario to consider.  What if rather than going with an industry-wide standard for interoperability, the big EMR vendors agreed on a standard they’d share and more or less shut out the smaller players?

Yeah, I already hear you asking: “Wouldn’t that be an antitrust violation?”  While I am not and probably never will be a lawyer, my guess is if a bunch of big vendors deliberately, obviously shut the smaller players out, it would be. But standards are so slippery that I bet it’d be a while before anyone outside of our industry saw something funny going on.

Besides, the government is doing everything in its power to get EMR vendors to help providers achieve interoperability. Right now ONC is not getting much cooperation — in fact, I’d characterize the big vendors’ stance as ‘passive aggressive’ at best.  So if Epic, Cerner, Siemens, MEDITECH and their brethren found a way to make their products work together, they might get a gold star rather then an FTC/DoJ slap on the wrist.

Besides, it would be in the interests of the bigger firms to include a few smaller players in their interoperability effort, the ones in the big boys’ sweet spots, and then “oops,” the smaller companies would get acquired and the knowledge would stay home.

Right now, as far as I can tell, it’s Epic versus the rest of the world, and that rest of the EMR world is not minded to play nicely with anyone else either. But if John can imagine a big-EMR-company standards-based coup d’etat happening, rest assured they have as well.

John’s Comment: Since Anne mentions this as my idea, I thought I’d weight in a little bit on the subject. While it’s possible that the big EHR vendors could adopt a different standard and shut out the small EHR vendors, I don’t think that’s likely. Instead of adopting a different standard, I could see the large EHR vendors basically prioritizing the interfaces with the small EHR vendors into oblivion.

In fact, in many ways the big EHR vendors could use the standard as a shield for what they’re doing. They’ll say that they can interface with any EHR vendor because they’re using the widely adopted standard. However, it’s one thing to have the technical capability to exchange healthcare information and a very different thing to actually create the trust relationship between EHR vendors to make the data sharing possible.

Think about it from a large EHR vendor perspective. Why do they want to be bothered with interoperability with 600+ EHR vendors? That’s a lot of work and is something that could actually hurt their business more than it helps.

My hope is that I’m completely wrong with this, but I’ve already seen the large EHR vendors getting together to make data sharing possible. The question is whether they’re sincerely doing this out of a desire to connect as many health records as quickly as possible or whether it is good strategy. My gut feeling is that it’s probably both. It just works out that the first is better to say in public and the second is just a nice result of doing the first.