Practice Fusion | EMR and EHR

simplifyMD New “Free” Patient Room Cartoon

A while back simplifyMD sent me a link to their EHR cartoon gallery. I’ll admit that I was a little underwhelmed with their first set of cartoons. They looked professional, but the content and writing needed some help. I happened upon the gallery again today and found a new cartoon called, ‘Easy Street Family Practice installs a “Free” patient room.’ Check it out (click on the image to see it full size):

I thought this was a hilarious jab at our societal move to “Free” everything. It’s a bit of an exaggeration of what it’s really like to get something for free in return for time spent seeing ads. This is especially true of Free EHR where the ads are as unobtrusive as any ads I’ve seen on anything. However, it does illustrate the reason why many people aren’t comfortable with the Free EHR model.

I did have one user of the Practice Fusion Free EHR recently tell me that if the EHR weren’t free, there’s no way they’d still be using that EHR. I thought it provided an interesting perspective on the value of free. We’ll see how this plays out long term for Practice Fusion and if these type of experiences taint the Free EHR market for everyone else.

Plus, I couldn’t write about Free EHR without mentioning that just because an EHR doesn’t cost money doesn’t mean that there aren’t other costs. Some people are ok with the Free EHR costs of advertising and data. Others are not. The key is to be aware of the hidden costs of using a Free EHR.

Going back to the cartoon, I think I might prefer some in exam room advertising if it would replace my co-pay. I’d be fine with a nice Pepsi ad in the exam room in return for lower healthcare costs. Although like most things in life, it can certainly be taken too far if we’re not careful.

Full Disclosure: simplifyMD is an advertiser on this site.

EMR Vendors Want Meaningful Use Stage 3 Delay

A group of EMR vendors have joined the chorus of industry organizations asking that Meaningful Use Stage 3 deadlines be moved up to a later date. The vendors also want to see the nature of Stage 3 requirements changed to put a greater emphasis on interoperability, Information Week reports.

The group, the HIMSS EHR Association (EHRA), represents 40 vendors pulled together by HIMSS. Members include both enterprise and physician-oriented vendors, including athenahealth, Cerner, Epic, eClinicalWorks, Emdeon, Meditech, McKesson, Siemens GE Healthcare IT and Practice Fusion.

In comments submitted to HHS, the vendors argue that MU Stage 3 requirements should not kick in until three years after a provider reaches Stage 2, and start no earlier than 2017. But their larger request, and more significant one, is that they’d like to see Meaningful Use Stage 3′s focus changed:

“The EHRA strongly recommends that Stage 3 focus primarily on encouraging and assisting providers to take advantage of the substantial capabilities established in Stage 1 and especially Stage 2, rather than adding new meaningful use requirements and product certification criteria. In particular, we believe that any meaningful use and functionality changes should focus primarily on interoperability and building on accelerated momentum and more extensive use of Stage 2 capabilities and clinical quality measurement.”

So, we’ve finally got vendors like walled-garden-player Epic finding a reason to fight for interoperability. It took being clubbed by the development requirements of Stage 3, which seems to have EHRA members worried, but it happened nonetheless.

While there’s obviously self-interest in vendors asking not to strain their resources on new development, they still have a point which deserves considering. Does it really make sense to push the development curve as far as Stage 3 requires before providers have gotten the chance to leverage what they’ve got? Maybe not.

Now, the question is whether the vendors will put their code where their mouth is. Will the highly proprietary approach taken by Epic and some of its peers become passe?

AAFP EMR Survey Offers Food For Thought

Even the authors admit that the following study has got flaws, given that respondents weren’t randomly selected and some vendors screened out by its design. Nonetheless, new EMR satisfaction research by the American Academy of Family Practice gives us some interesting stats to consider.

The study, which was published in the November/December issue of its Family Practice Management journal, draws on 3,088 responses from AAFP members, who responded to a series of questions regarding which EMRs they used and how comfortable they were with those EMRs. Respondents reported using a total of 160 named EMRs, but the study dropped 129 which were used by 12 or fewer practices in an effort to simplify the results, leaving 31 systems for analysis.

The systems with the strongest satisfaction ratings, ranging from roughly 80 percent too over 50 percent, were Praxis, HealthConnect, MEDENT, Amazing Charts and SOAPware. eMDs, Practice Fusion, Point and Click EHR, EpicCare Ambulatory and Vista CPRS followed closely, with scores clustered around 50 percent.

Not too surprisingly, EMRs that were ranked easy to use were largely the same ones which got high satisfaction ratings. Topping that list was Point and Click EHR at nearly 80 percent, followed by Amazing Charts, Practice Fusion, Praxis, SOAPware, Aprima, MEDENT,eMDs, HealthConnect, Vista CPRS, with Care360 EHR rounding out the bottom of the top 10 at roughly 47 percent.

The only surprise the authors highlighted came in response to a question asking which EMRs helped doctors see more patients or go home earlier than they could with paper charts. In that case, Praxis stood out, with doctors who agreed hitting about 80 percent. The number who agreed for the next on the list, SOAPware, fell immediately to just over 40 percent, with the other players falling even lower on the scale.

Even with its deliberate statistical laxity — authors described their intent as being more of an “advice from colleagues” format — this certainly offers some stats to chew on. In particular, I’d love to know what Praxis is doing right. After all, when it comes right down to it, productivity is king.

Early Signs Of EMR Consolidation Appearing

Some of you are going to tell me that I’ve jumped the gun, but I’ve got my feeling about this and I’m sticking to it. Though nothing massive has happened yet, I believe we’re officially beginning to see consolidation in the EMR world.

I was struck with this idea today when I came upon the news that physician EMR company Imagine MD was closing. According to MedCityNews.com, the cloud-based EMR company had pulled in $25 million in venture money, $10 million of that in the last 12 months. And until recently, it looked as though it had staying power; Imagine MD had been in business since 2006, well ahead of the pack of competitors pitching small medical practices.

Another sign that we’re seeing consolidation comes in the form of the acquisition of Amazing Charts by Pri-Med, a provider of professional medical education to more than 260,000 clinicians. (I wouldn’t have expected a medical education company to be the one to acquire Amazing, but that’s a story for another time.)

While I admit two examples isn’t exactly a statistical bump, it’s a clear enough sign for me that the market has begun to pull together. After all, with EMR adoption on the rise among medical practices, there’s only so many customers left to compete for, and that can only mean more closings and M&A.

The really important question, if you’re a doctor hoping to avoid a big practice disruption, is whether you can predict which direction your present or future EMR vendor is going. That is, of course, a pretty tricky game.

But if you’d like some food for thought, you might consider checking out a previous post by John, comparing “fast EMR companies” fueled by venture capital to slower-moving types that grow organically and don’t tend to accept venture capital investments.

While there are exceptions — notably Practice Fusion, which seems to have an extremely solid business — the tech business is rife with examples of fast companies that soared high on venture capital drafts then plummeted to earth. I’m not suggesting that you should avoid VC-backed EMR firms, physicians, but I am suggesting that you find out as much as you can about the size of their customer base, finances and strategy before you commit your business into their hands.

Otherwise, you could end up like ImagineMD’s EMR-less customers. And if that’s not a bummer I don’t know what is.

The Fast EHR Companies and the 37Signals EHR Companies

I was recently reading this fascinating interview with Jason Fried, Founder of 37signals. It’s a fascinating read, as was his book Rework. I must admit that I have a similar model for tech entrepreneurship to Jason Fried and it is quite different than what’s written about by most tech websites. Jason is much less about the flash and cash part of entrepreneurship and much more about building something of value in a long term sustainable way.

As I consider on these ideas, I started to wonder about the various EHR companies and which companies fall into the various entrepreneurship buckets.

Fast EMR
The fast EMR company is usually one that’s gone out and gotten a ton of funding from venture capital firms. If you’re an EHR company that’s gone out and raised millions and millions in funding, then you have no choice but to attack the market aggressively so that you can provide a return to your investors. There are actually a number of EHR companies that fit this profile, but the first one that will likely come into everyone’s mind is Practice Fusion. There $64 million in EHR funding means that they have to get a large portion of the EHR market. They no longer have the option of staying small but successful.

Let me be clear that there’s nothing wrong with being a Fast EMR. In fact, there are a lot of good things that come out of fast EMR companies that are trying to push the envelope when it comes to EHR adoption and how EHR should be done. It is entrepreneurship at work.

Slow and Steady EMR
On the opposite end of the spectrum are what I call the slow and steady EMR companies. These companies are often self funded or took in a much smaller investment and then used revenues to grow the company much like 37signals founder described. They slowly and steadily built their product, acquired customers and generated revenue.

I believe that SOAPware and Amazing Charts are the epitome of this type of company. They were both physician founded EMR companies that have built their user base slowly over time. They’ve never gone out and gotten the millions in funding. Instead they’ve grown organically over time.

Why Does This Matter?
In my e-Book on EHR selection, I talk about why it is important for you to understand the type of EHR company you are choosing. Would you rather “marry” the EMR tortoise or the EMR hare? The choice could change your EHR experience dramatically.

Disclosure: Practice Fusion, Amazing Charts and SOAPware are all advertisers on this site, but I didn’t discuss this post with them before posting it. Although, since they’re advertisers they were likely top of mind for me when I was writing this post.

SCOTUS Decision, Combating Mobile Health Threats, and a Video from RockHealth: This Week at HealthCareScene.com

EMR and HIPAA

Medicaid Doctors and Dentists Gaming the EHR Incentive Program

In order to get the EHR incentive money, Medicaid Doctors and Dentists are only required to purchase the equipment. They can, technically, just buy it and do anything with Meaningful Use. Recently, Dentrix recently partnered with Henry Schein to get access to this money. In this post, the legality of doing this, with no intention of actually passing Meaningful Use standards, is discussed.

SCOTUS Decision and Healthcare IT

The recent decision on the “Affordable Health Act” has gotten the attention of many people across the country. Will this decision affect the IT and EHR world? This post delves into that question, as well as addresses how the SCOTUS decision will impact healthcare reimbursement.

Wired EMR Doctor

My Presentation Submission to 2012 mHealth Summit

Many doctors are hesitant to embrace mHealth. Dr. Michael Koriwchak submitted a talk to the 2012 mHealth Summit, explaining why he feels this is the case. This post gives a basic overview of his talk, which is split into three sections: 1) addressing practicing physicians concerns about mHealth, 2) addressing the culture differences between physician and HIT communities and, 3) outlining the concessions both physicians and the HIT community need to make in order to facilitate communication, promote adoption of mHealth, and improve the quality of mHealth products.

Smart Phone Health Care

Combating Mobile Health Threats: 13 Tips Everyone Should Read

There is a big concern for the security of mHealth, and rightfully so. With all the intelligence to create this technology, there’s people out there wanting to steal information from it. An article a mhimss.com created a list of 13 tips for “combating mobile health threats”. Read the tips and other commentary this week over at Smart Phone Health Care.

App Created to Connect Patients With Doctors Immediately

Consult-a-Doctor is a program designed to connect users with a doctor without ever leaving their home. This cloud-based program is available for the iPhone and requires a subscription. Patients are able to access live medical consultations, treatment, and even receive prescriptions through this program.

EHR and EMR Videos

RockHealth Startup Elements: Product Design with Dave Morin

RockHealth has created a series of videos concerning the elements of starting up a healthcare company. The video featured this week on EHR and EMR Videos features David Morin talking about Product Design. To check out other videos in the series, some of them are posted here.

EMR and EHR Thoughts

$34 Million Series C Funding for Practice Fusion

Practice Fusion brought their total funding to over $64 million, with $34 million coming from recent Series C Funding. Although Practice Fusion seems to be one of the major players in the EHR world, there are some complications that may make it difficult to live up to this $64 million financing.

Swimming in Too Much EMR Data

I don’t know about you, but the long holiday weekend was far too short for me. The majority of my family’s time was spent kicking off summer at various pools (with the appropriate sunblock, of course). Pools and swimming are somewhat second nature to me. The smell of chlorine takes me back to my high school and early college days of year round swim team, coaching summer swim league and sitting in a lifeguard chair in the brutal heat, whistle dangling around my neck.

As we gear up for my oldest daughter’s first summer swim meet this week (picking the appropriate swim cap, finding those goggles that fit just right and painting our toes the appropriate team color), I’m hoping that she’ll come to love the sights, sounds and smells of the pool as well. She certainly seemed to enjoy herself at one of the Memorial Day weekend pool parties we attended.

One family affair in particular found me wading into a conversation about Salesforce.com. Turns out a soon-to-be new member of the family works for the company, and I told him that, as part of my day job, I had been dabbling in using it. He quickly asked me about my likes and dislikes, at which point his fiancé chimed in with the lament that yes, Salesforce is an awesome tool, but more often than not, sales team do not have the time (and in some cases the inclination or training) to fully make use of all its bells and whistles.

I pondered her statement a bit further as I watched my daughter practice swimming with her new flippers, and realized that those of us that use SaaS (software as a service) technologies – like electronic medical records – tend to have the same complaint. Bells and whistles are great, but if I never have the time to learn to use them effectively to accomplish goals specific to my tasks, then I’m not going to use them at all. And I’m never going to pay much attention to the constant updates and add-ons these sorts of technologies usually come with.

I wonder if some EMR end-users feel the same way. They love the idea behind the technology, and certainly the government incentives that typically come along with using it, but after implementation find themselves with only enough time to utilize the EMR’s basic functions. I’d assume this might be a bigger problem for private practice physicians than for those working within a hospital.

I’m certainly not the first to ponder the relationship between Salesforce and EMRs. Our fearless leader John Lynn wrote about Practice Fusion building a personal health record on top of Salesforce way back in 2009, seemingly not long after Salesforce invested in the HIT company.

What I’m talking about, however, is the amount of time and energy required to truly take advantage of the vast oceans of meaningful data that can be culled from an EMR. Big data is great. Lord knows we’ve all been convinced of the value of that and the business intelligence tools that help us decipher it. I’d be interested to hear from doctors that have pondered the same thing. Are providers swimming in too much EMR information? Are they faced with more than they could ever possibly utilize? Does it come down to user experience and user-centric design?

Let me know what you think in the comments below. In the meantime, I’ll be helping my daughter perfect her backstroke.

Working Offline When Your EHR Isn’t Available

Many of you will likely remember my series of posts on EHR down time: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. Needless to say, it’s pretty much inevitable that sooner or later you’re going to encounter EHR down time. The key to EHR down time is to think ahead about how you’re going to deal with your EHR being inaccessible.

I started thinking about this a bit more when I came across this FAQ item on Practice Fusion’s EMR user forums.

When there’s a planned maintenance ahead:
•Print your daily calendar for the next day’s schedule
•Know your offline alternatives for handling labs and prescriptions
•Have a plan to document your patient visits so you can input them in the EMR later
•Clear out your To do list and complete any pending Rx refill requests the day before
•Update your web browser and Adobe Flash to the current version

Preparing your office:
•Have a prepaid wireless 3G hub or other back-up internet system ready to go in the event your main internet is down
•Use laptops with good batteries and connect computers to surge protectors and battery back-ups for short term power interruptions
•Identify a second location that you could use temporarily in the case of a serious, long-term outage such as a fire or flood

I’ll always remember the reaction of the director of the health center where I first implemented an EMR to the discussion about “What do we do if the EMR is down?” She basically said, “We can still take care of the patient. We just might have to ask a few more questions.”

Now I’m sure there are cases where a physician might choose not to treat a patient without access to their EHR. There are certainly also cases where you can treat a patient better, faster and with more information with an EHR, but those can either be rescheduled if that’s the case. It’s certainly bad customer service and you should employ techniques to minimize EHR downtime as much as possible. My point is that it’s usually not life or death when the EHR is down. Think about how many patients are treated in an ER every day with no access to the patient’s medical record.

With that said, it is a disruption to the clinic and will be a BIG disruption to your clinic if you don’t have a solid plan of attack for when (not if) your EMR is inaccessible.

I’d focus your efforts in two areas:
•Minimize EMR Down Time
•Plan of Action for When Your EMR Goes Down

Most people do a pretty decent job with the first part. The second part people don’t often give much thought. You can start with some of the comments from Practice Fusion above to build out your plan. I also think it’s worth making a plan for short down time versus long down time. It’s quite different to deal with 5 minutes of down time than 5 days. You should consider both options.

Would National Patient Identifiers Work?

Right now, healthcare organizations have to go through some pretty tricky maneuvers to link patient data across varied systems and settings. It’s possible to connect patient info electronically through database hacks, but more often than not, matching patients to clinical data gets done by hand.

Given the insane complexity of the existing system, would it make sense to create a national patient identification number for every U.S. patient? The question is worth revisiting, given the immense level of error and wasted time generated by the existing system. After all, not only would putting an NPI in place make it easier to track patients within a hospital or health system, it would simplify the rollout of HIEs dramatically, wouldn’t it?

Dr. Robert Rowley of EMR vendor Practice Fusion notes that the biggest enemies of establishing a National Patient Identifier are privacy advocates who feel that an NPI would expose patients to greater risk of breaches or misuse of data.

But is that a realistic concern? Probably not. I agree with Dr. Rowley, who asserts that it’s hard to imagine that PHI would be at greater risk simply because of how it’s indexed. As he notes, PHI breaches are nearly always often haphazard affairs in which a laptop is stolen than Big Government or corporate conspiracies. (If you’re afraid the government is covertly siphoning your health data off to study it, not having an NPI won’t protect you, anyway.)

No, the real barrier to this kind of administrative simplification measure is time, money and resources, the same barriers that hold back any other proposed HIT project. It’s hard to imagine the resources that would be involved in instituting such a system — the idea makes my head hurt — and I have to assume it’d be several years before it was anything like mature.

Still, it’s good to bear in mind that at least some members of the public are afraid that creating an NPI would compromise their privacy. If the only barrier to improving patient matching in our EMRs is technical, that’s one thing — but if it’s patient fears, that’s another thing entirely. Sometimes, it’s good to remember that most of the world doesn’t think like a health IT exec.

The Online Medical Visit … For Free

In every situation online it seems like at some point someone takes the business model as deep as it goes and then someone just finally says, “Let’s make it free.” Readers of this site will be familiar with the leading Free EHR companies Mitochon and Practice Fusion (both advertisers on this site). They both seem to be doing really well and are working on some really interesting business models.

With my familiarity with the Free EHR business model, I was intrigued when I read about HealthTap’s model for basically providing an online medical visit for free. This was particularly interesting since I knew that HealthTap had received $11.5 million in funding recently.

Andy Oram summarizes what HealthTap is trying to solve really well:

In this digital age, HealthTap asks, why should a patient have to make an appointment and drive to the clinic just to find out whether her symptoms are probably caused by a recent medication? And why should a doctor repeat the same advice for each patient when the patient can go online for it?

Plus, he makes two important observations of what HealthTap has found:
1. Doctors will take the time to post information online for free.
2. Doctors are willing to rate each other.

It’s pretty interesting when you think about how many doctors visits could be saved using something like HealthTap. On face, I’d think that a site like this wouldn’t make much sense. Although, as I think back on my medical experiences I can think of about a dozen or so times where I tapped into my physician friends before going to the doctor. Basically, I wanted to know if going to the doctor would be worth my time or not. In about 90% of those cases I ended up not going to the doctor since the doctor wouldn’t have really been able to do much for me anyway.

As I think through these experiences, I realize that many people aren’t lucky enough to be like me and have lots of physician friends around to ask the casual medical question. I could see how HealthTap could fill that role.

One key to this model is that it doesn’t always replace the visit to the physician. In fact, in a few cases I was told that I’d need an X-ray and that I better go see the doctor. In that case I was more likely to go to the physician since I knew I needed to get something done. I already knew the physician would do something for me when I went so I didn’t have the fear that they just tell me to take some Tylenol and be careful with it.

I’m not quite sure if doctors would be glad to actually have only people that are sick visiting their office or not. Maybe they enjoy the break of the easy patient that doesn’t require any effort on their part.

I think there are still questions about the quality of information that patients will get on HealthTap. This is going to be the most interesting issue to follow. No doubt they’re going to be toeing a fine line called medical advice. However, whether it’s HealthTap or some other online source that someone likely finds through Google, people are going to be looking for this kind of health information online. The idea of a free online medical visit sounds good to me.

Let’s also not be surprised if the Free EHR vendors eventually get into online visits as well. Seems like a natural progression for them to offer this service if they wanted to go that direction. From what I understand they have plenty on their plates right now, but a few years from now it could get pretty interesting.

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simplifyMD New “Free” Patient Room Cartoon

EMR Vendors Want Meaningful Use Stage 3 Delay

AAFP EMR Survey Offers Food For Thought

Early Signs Of EMR Consolidation Appearing

The Fast EHR Companies and the 37Signals EHR Companies

SCOTUS Decision, Combating Mobile Health Threats, and a Video from RockHealth: This Week at HealthCareScene.com

Swimming in Too Much EMR Data

Working Offline When Your EHR Isn’t Available

Would National Patient Identifiers Work?

The Online Medical Visit … For Free

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