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Why ICD-10?

At least half a dozen folks have asked me to explain why HHS is mandating the transition to ICD-10. So I thought I’d write a blog post about the subject.

First, I’ll examine some of the benefits that proponents of ICD-10 site. Then, I’ll examine the cost of transition from ICD-9 to ICD-10.

There are about a dozen frequently cited reasons to switch from ICD-9 to ICD-10. But they can be summarized into three major categories:

1) The US needs to catch up to the rest of the world.

2) The more granular nature of ICD-10 will lend itself to data analysis of all forms – claims processing, population health, improved interoperability, clinical trials, research, etc.

3) ICD-9 doesn’t support the latest diagnoses and procedures, and ICD-10 does.

Regarding #1, who cares? Coding standards are intrinsically arbitrary. Sequels are not necessarily better than their predecessors.

Although #2 sounds nice, there are a lot of problems with the supposed “value” of more granular data in practice. Following the classic 80-20 rule of life (80% of value comes from 20% of activity), the majority of codes are rarely used. By increasing the number of codes six-fold, the system is creating 6x the opportunities to inaccurately code. There is no reason to believe that providers will more accurately code, but the chances of incorrect diagnosis are now significantly higher than they were before. Garbage in, garbage out.

Below are some specific examples of how increasing the number of codes will affect processes in the healthcare system:

Payers – payers argue that making codes more granular will improve efficiency in the reimbursement process by removing ambiguity. There is nothing further from the truth. Payers will use the new granularity to further discriminate against providers and reject claims for what will appear to be no reason. With 6x the number of codes, there are at least 6x as many opportunities for payers to reject claims.

Clinical trials – ICD-10 proponents like to argue that with more granular diagnosis codes, companies like ePatientFinder can more effectively find patients and match them to clinical trials. This notion is predicated on the ability of providers to enter the correct diagnosis codes into EMRs, which is a poor assumption. Further, it doesn’t actually address the fundamental challenges of clinical trials recruitment, namely provider education, patient education, and the fact that most patients aren’t limited to trials by diagnosis codes, but rather by other data points (such as number of years with a given disease and comorbidities).

Public health – ICD-10 proponents also claim that the new coding system will help public health officials make better decisions. Again, this is predicated on accuracy of data, which is a poor assumption. But the greater challenge is that the most pressing public health issues of our time simply don’t need any more granularity in diagnosis codes. Public health officials already know what the top 20 public health problems are. Adding 6x the number of codes will not help address public health issues.

Regarding #3, why do we need to reinvent the entire coding system and make the entire system more granular to accommodate new diagnoses and procedures? Why can’t we continue to use the existing structure and simply create new branches of the ICD tree using alphanumeric characters? Why do we need to complicate every existing diagnosis and procedure to support new diagnoses and treatments? We don’t. There are plenty of letters left to be utilized in ICD-9 to accommodate new discoveries in medicine.

Next, I’ll provide a very brief summary of the enormity of the cost associated with transitioning from ICD-9 to ICD-10. The root of the challenge is that a string of interconnected entities, none of whom want to work with one another or even see one another, must execute in sync for the months and years leading up to the transition. Below is a synopsis of how the stars must align:

EMR vendors – EMR vendors must upgrade their entire client base to ICD-10 compliant versions of their systems in the next couple of months to begin testing ICD-10 based claims. Given the timescales at which providers move, the burden of MU2 on vendors, and the upgrade cycles for EMR vendors, this is a daunting challenge.

Providers – providers don’t want to learn a new coding system, and don’t want to see 6 times the number of codes when they search for basic clinical terms. Companies such as IMO can mitigate a lot of this, but only a small percentage of providers use EMRs that have integrated with IMO.

Coding vendors – like EMR vendors, auto-coding vendors must upgrade their clients systems now to one that supports dual coding for ICD-9 and ICD-10. They must also incur significant costs to add in a host of new ICD-10 based rules and mappings.

Coders – coders must achieve dual certification in ICD-9 and ICD-10, and must double-code all claims during the transition period to ensure no hiccups when the final cut over takes place.

Clearinghouses – clearinghouses must upgrade their systems to support both ICD-9 and ICD-10 and all of the new rules behind ICD-10, and must process an artificially inflated number of claims because of the volume of double-coded claims coming from providers.

Payers – payers must upgrade their systems to receive both ICD-9 and ICD-10 claims, process both, and provide results to clearinghouses and providers about accuracy to help providers ensure that everyone will be ready for the cut over to ICD-10.

The paragraphs above do not describe even 10% of the complexity involved in the transition. Reality is far more nuanced and complicated. It’s clear from the above that the likelihood that all of the parties can upgrade their systems, train their staff, and double code claims is dubious. The system is simply too convoluted with too many intertwined but unaligned puzzle pieces to make such a dramatic transition by a fixed drop-dead date.

Lastly, switching to ICD-10 now seems a bit shortsighted in light of the changes going on in the US healthcare system today. ICD-10 is already a decade old, and in no way reflects what we’re learning as we transition from volume to value models of care. It will make sense to change coding schemes at some point, but only when it’s widely understood what the future of healthcare delivery in the US will look like. As of today, no one knows what healthcare delivery will look like in 10 years, let alone 20. Why should we incur the enormous costs of the ICD-10 transition when we know what we’re transitioning to was never designed to accommodate a future we’re heading towards?

At the end of the day, the biggest winners as a result of this transition are the consultants and vendors who’re supporting providers in making the transition. And the payers who can come up with more reasons not to pay claims. Some have claimed that HHS is doing this to reduce Medicare reimbursements to artificially lower costs. Although the incentives are aligned to encourage malicious behavior, I think it’s unlikely the feds are being malicious. There are far easier ways to save money than this painful transition.

The ICD-10 transition may be one of the largest and most complex IT coordination projects in the history of mankind. And it creates almost no value. If you can think of a larger transition in technology history that has destroyed more value than the ICD-9 to ICD-10 transition in the US, please leave a comment. I’m always curious to learn more.

March 24, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

#HIMSS14 Highlights: the Snail’s Pace of Interoperability

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:

interoppanel

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interoptweet1

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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.

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.

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


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.

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

Mulling Over EMR Market Consolidation

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.

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.

Breaking up with Your EMR is Hard to Do

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.

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.

11 Reasons Why Healthcare is So Screwed Up

If you don’t read the GetReferralMD blog, you should go and check it out now. It is always chock full of strong opinions and thoughts on healthcare that will make you take a step back and consider what’s really going on in healthcare. This post I found on the 11 Reasons Healthcare is Messed Up is a good example. Here is the list of 11 reasons for those that don’t want to go read the full post:

1. Insurance Companies
2. Excessive Regulation
3. Shortage of Doctors
4. Medical Advances
5. Paper
6. Ignorance
7. Choice to Die
8. McDonalds
9. Cluster $#@! Of EMR’s
10. Healthcare Vs. Military
11. Pharmaceutical Companies

Of course, you should click over and read the full post. It’s chock full of commentary and explanation for each post. He basically brings out the big guns and says what a lot of people don’t say about healthcare. I don’t necessarily agree with all of them, but he does provide something interesting to chew on. Although, I do particularly like his call out of paper and the fax machines that continue to print out that paper at an extraordinary rate in healthcare.

As an entrepreneur, I also look at this list and think that it’s the perfect time for some companies to come and disrupt the current model. Any time there is pain in a system, there is also opportunity to relieve that pain.

December 28, 2012 I Written By

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

Christmas Scavenger Hunt Inspires EMR Wish List

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.

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.

EMRs Investors Stuck In Old Patterns

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

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

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

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

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

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

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

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

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

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

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

November 7, 2012 I Written By

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

AT&T/IBM Deal Pushes Cloud Back into the Healthcare Spotlight

I remember 2010 as if it were yesterday. I was somewhat new to the healthcare industry, attending my first Healthcare IT Summit, and trying to make sense of all the buzzwords flying around as a result of the HITECH Act being passed the year before. Cloud computing was definitely a hot topic – one that seems to have stood the test of time in the intervening years. Granted, I think its popularity has been somewhat superceded by phrases like mobile health, accountable care, patient engagement and electronic medical records (of course) over the last 18 months, but a recent flurry of cloud-related headlines may forecast a resurgence.

A report released earlier this year from MarketsandMarkets predicts that conditions are ripe for cloud computing to grow at an annual rate of 20.5 percent from this 2012 to 2017. (Bloomberg Businessweek puts the current market for cloud services at $14 billion.) The forecast makes a lot of sense when you look at it from the healthcare angle of Meaningful Use and EMRs. Providers, despite a few legislators’ recent objections, will likely continue to implement and attest during the next few years, leaving healthcare IT vendors – including those who put their EHRs in the cloud (Allscripts, NextGen and athenahealth are just a few that come to mind) – with no shortage of business opportunity.

And there are even more vendors behind those – the infrastructure folks like Verizon (See their recently announced HIPAA compliant cloud service) and Dell that provide the cloud’s backbone, so to speak. You may by now have seen headlines announcing that AT&T has partnered with IBM to offer a new model whereby “IBM … will provide the data-storage facilities and services, and AT&T will … offer the global network that clients will use to retrieve the data,” according to the Bloomberg write up. It is the closest relationship IBM has ever had with a phone carrier.

Undoubtedly, this new model will be tapped for healthcare purposes, but it’s still speculation as to just how it will be adopted for secure exchange of patient health information. I sent out a few feelers via my social networks to see if anyone related to either IBM or AT&T could provide more detail, and got back this statement from an IBM representative: “I would assume that there will be a HIPAA compliant component. It goes without saying that the healthcare industry is a HUGE segment for IBM.”

“Huge” just might be an understatement, as IBM has stated it wants to attain $7 billion in cloud revenue by 2015. In today’s terms, that’s just one vendor making up the current market value for cloud services.

I’ll be interested to see how this plays out, especially as previously lower profile (at least in the healthcare space) technology companies like Dell and IBM, and companies like AT&T and Verizon that are more widely known in the consumer market, continue to make healthcare IT headlines.

October 10, 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.

How To Grill An EMR Vendor

Today I found a nice blog piece on how providers — largely medical practices, the blog’s core audience — can grill EMR vendors effectively prior to sinking their money into a product. I say “grill” because the questions will force vendors to put up or shut up on several levels, something a lot of non-techy doctors wouldn’t know how to do.

Here’s the five questions, courtesy of the EMR and EMR Insights blog (with a few comments on each):

When did your company start operations, and can I have 2 references from each year you have been in business?

I don’t know about you, folks, but assuming older companies will produce better results involves some significant risks too.  Sure, a high-flying venture-funded partner might go out of biz next week, and that would be pretty terrible. On the other hand, many companies grow less creative and less flexible over time, and take their customers for  granted — even if it’s not part of a doofus big vendor’s lineup.  What about: “Can I have five references for clients in my specialty?” and “Please sign this contract addendum which addresses how you’ll handle it if your product is discontinued or you close you doors.”

* How many developers are assigned to work on your core EHR product? Where do the developers reside?

I like the Q regarding the size of the development team, which can be  make-or-break factor in keeping your product updated and bug-patched.  But as for where the developers reside, again, that’s a toss-up.  You could hire a vendor with a large but poorly-managed development team, or a small vendor whose team is overseas — but well-managed and effective nonetheless.

* How was your product and company ranked in the Best in KLAS Awards — Software & Services Report – December 2011, and the KLAS Ambulatory EMR Specialty Report 2012?

Interesting. In theory asking about rankings is a good idea, unless you don’t respect the people doing the ranking. (I know my colleague John Lynn isn’t a raving KLAS fan.)  I suppose rankings like these can be a touchstone, but they probably shouldn’t be a primary factor in EMR investment decisions.

* Do you have a whitepaper that explains your interoperability platform?

Definitely a good question, but the answer is probably over the heads of many clinicians and office managers making the EMR call. If a medical practice has someone on staff who’s geeky, or an IT consultant is on your selection team, sure, get the whitepaper. Otherwise, I believe medical practices would do better simply studying the literature and asking for a thorough, plain-language presentation explaining these features.

* What are your specific plans for meeting all the Meaningful Use requirements of Stages 2 and 3?

What can I say but yes, yes and more yes. A company that can’t answer this question should be toast.

One final note.  How about throwing in “If I can’t get to Meaningful Use within x days, do I get my money back?”  Seeing how your vendor reacts should be, um, educational.

June 4, 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.