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Telemedicine Not Connecting With EMRs

As smartphones and tablets become a standard part of healthcare as we know it, telemedicine is gaining a new foothold in medicine too.  In some cases, we’re talking off the cuff transactions in which, say, a patient e-mails a photo to a doctor who can then diagnose and prescribe.  But telemedicine is also taking root on an institutional level, with health systems rolling out projects across the country.

The problem is, however, that these telemedicine projects simply don’t integrate with EMRs, according to an article in SearchHealthIT.  The piece’s writer, Don Fluckinger, recently attended American Telemedicine Association’s 2013 Annual International Meeting & Trade Show, where complaints were rife that EMRs and telemedicine don’t interoperate.

I really liked this summary of the situation one executive shared with Fluckinger:

For now, the executive (who asked not to be named) said, telemedicine providers need to keep away from the “blast radius” of EHR vendor conflicts, lest their budgets get consumed by building interfaces to the various non-interoperable EHR systems.

Not only are health systems struggling to integrate telemedicine data with EMRs, telemedicine providers are in a bit of a difficult spot too, Fluckinger notes. As an example, he tells the tale of Seattle-based Carena Inc., a provider of primary care services to patients via phone and video, which provides after-hours support to physicians at Franciscan Health System in Tacoma, Wash.

Carena itself has an EMR which has the ability to share searchable PDF documents for use in patient EMRs, but Franciscan’s seven hospitals are bringing up an Epic implementation which can’t support this trick.  Top execs at Franciscan want to connect Carena’s data to Epic, but that won’t happen right away.  So Franciscan may end up setting up Carena’s after-hours service within Franciscan’s Epic installation to work around the interoperability problem.

This is just one sample of the interoperability obstacles healthcare organizations are encountering when they set out to create a telemedicine service. As telemedicine explodes with the use of portable devices, I can only imagine that this will impose one more pressure on vendors to conquer compatibility problems. (But sadly, I doubt it will force any real changes in the near future.)

June 5, 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 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.

Keys to Successful Telehealth

Rob Sobie wrote a nice post on the Point of Care Corner blog about the 4 Keys to a Successful Telemedicine Launch. These are the 4 keys he offers:

  • Reliability
  • Ease of Use
  • Mobility
  • Flexibility

Most of the ideas are pretty self explanatory, but check out the full post for his explanation of each item. I agree with each item, but I think there are a number of other things that are needed for successful telehealth as well.

Multiple Application Support – While we’d love to have the entire Telehealth experience on one application, it’s unlikely to ever happen. While doing a Telehealth visit, the doctor is going to need access to a number of other applications such as their EHR. This is where the dual monitor Telehealth setup is so beneficial. They can have the Telehealth visit up on one screen while they browse their EHR or other health application on the other screen.

Telehealth Reimbursement – I recently asked an insurance company executive about Telehealth and if they’re really start reimbursing for it. He said they were happy to reimburse a Telehealth visit, as long as they had a way to know that there was indeed a visit that justified payment. You can see where they’re afraid of Telehealth reimbursement fraud. His solution to that was reimbursing Telehealth systems that were their trusted partners. With this in mind, you want to make sure whatever Telehealth solution you use is trusted by the payers so that you get paid.

Device Connectivity – One of the challenges of Telehealth is the ability to get device information from a patient. There’s a new wave of Telehealth technologies that are incorporating medical devices into the Telehealth experience. Integrating Telehealth and devices really takes Telehealth to the next level and since the cost of devices is dropping dramatically we’re going to see more and more integrations. Just be careful because many Telehealth platforms won’t have the forethought to do this type of device integration.

I’m sure there are other keys to Telehealth success. I’d love to hear your additional ideas in the comments. Where are you seeing it implemented? What’s been most successful?

I believe the Telehealth market is set to grow like it’s never grown before. The technology and infastructure are in place for it to become a reality. Things like shared savings will drive adoption of Telehealth as a way to lower costs. The article linked above says that Telehealth is projected to be a $27.3 billion industry in 2016. I’m personally looking forward to the shift to Telehealth.

April 4, 2013 I Written By

John Lynn is the Founder of the 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: and, 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.

New Telemedicine Stats Bode Well for EMRs

With the recent projection that telemedicine will reach 1.8 million patients worldwide by 2017, I think it’s fitting to continue the discussion I started last week pertaining to the current ROI of EMRs. While current utilization based on scrambling to meet Meaningful Use for federal incentives may not be all it’s cracked up to be, I do believe EMRs will ultimately provide a fiscally sensible return on investment, especially if telemedicine technology becomes part of any given vendor’s standard EMR package/offering.

I decided to bounce the idea off Sande Olson, a Twitter friend (@sandeolson) and Senior Healthcare Consultant at Olson & Associates. Being a healthcare professional that has worked in telemedicine long enough to witness its evolution, Olson seemed a fitting expert to speak with on the subject of EMRs, telemedicine and the bottom line.

How have you seen the telemedicine landscape change over the last few years?
Olson: Until recently, telemedicine has been a niche industry. Early users recognized the potential value of telemedicine, but successful business models (showing a viable ROI) didn’t exist, and technology was costly. The challenge was reimbursement; who was going to pay for it?  Without reimbursement or a viable business model, telemedicine could not go viral.

The telemedicine landscape began to change with advancements in information and communication technology on the heels of The Affordable Care Act. The push for healthcare reform provided financial incentives to “nudge” healthcare providers towards EMRs. Reform mandates and the availability of government funding created new opportunities around technology. Telemedicine, a valuable if fledgling technology, became a buzzword around technology and healthcare reform.

Industries saw business opportunity as solution providers for an “industry poised to undergo radical change.” Entrepreneurs, inventors, investors and healthcare visionaries followed new and sometimes disruptive ideas. Care delivery tools moved from PCs to tablets, along with mobile apps.

The confluence of all these influencers is creating a potential tipping point for telemedicine; it only needs wider reimbursement and licensure portability. Our aging population and forecasted physician shortage will help continue to thrust telemedicine into the forefront of change. Telemedicine is already being used successfully; reimbursement is still a challenge. But, healthcare innovation is just getting started. We have challenging times ahead, but this is also the most exciting time to be in healthcare ever!

Do you think there’s been a trickle down effect from the Affordable Care Act in terms of increasing interest in and adoption of telemedicine?
There has been a trickle-down effect on telemedicine. The Affordable Care Act has increased interest in exploring the possibilities of telemedicine outside of previous niche markets. As I noted, it is the confluence of influencers around healthcare reform that continues to push the tipping point for telemedicine.

Do you think EMRs will prove their worth in the coming years by better facilitating more novel methods of healthcare delivery, like telemedicine, or integrating with consumer-friendly mobile health apps?
Will EMRs prove their worth? Well, data silos do not support healthcare’s philosophy of providing a continuum of care from cradle to grave. And, you cannot provide care without a medical record; you can’t measure outcomes. So, interoperability– across all silos– is critical to successful healthcare reform. EMRs today may fall a bit short, but they will create efficiencies and improve patient outcomes. They will get simpler to use. EMRs will assist in improving reimbursement and revenue cycles. And, future EMRs will push and pull data from HIEs, PHRs and mobile health apps; we are just not there yet.

January 24, 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.

Finding the Silver Lining in EMR Investment

It’s been a week of doom and gloom news as far as healthcare IT goes. Apparently, providers aren’t seeing the ROI they’d hoped for from EMRs, and as I’m sure you’ve heard, RAND researchers have found that, despite predictions to the contrary some years ago, healthcare IT does not actually save money. Couple these with the 2% hike in social security tax everyone is seeing in their paychecks this month, and it’s easy to understand why the healthcare community might be a bit grumpy.

I’m here to propose that providers try to look on the bright side when it comes to recouping some of that EMR investment. Telemedicine programs may hold a ray of hope for providers looking to find additional value in their EMR. These programs, in my opinion, have gained a strong foothold in the healthcare industry – providers, payers and patients are certainly showing interest, especially given the industry’s stance on readmissions these days; the government seems supportive; and vendors are always eager to provide more product to willing customers.

Here are just a few of the telemedicine highlights I’ve come across in the last few weeks:

* A proposed bill in the House backed by the American Telemedicine Association – The Telehealth Promotion act of 2012 – would potentially expand telemedicine programs in Medicaid and Medicare programs, federal health employee plans, the VA, and others

* The federal government has set aside $1.9 million as part of its Telehealth Resource Center Grant Program in the hopes of expanding its current network of 14 centers to 20.

* The FCC will offer qualifying healthcare facilities up to $400 million annually as part of its Healthcare Connect Fund, which seeks to accelerate development of broadband networks in rural areas.

My thinking is that we’ll see these telemedicine initiatives grow as physicians become more scarce (at least in non-metropolitan areas), coordinated care programs increase, payers look to play a part in wellness programs and preventing readmissions, and everyone continues to look for ways to drive down costs. And from what I’ve read, I don’t see how a hospital or physician’s practice can successfully or meaningfully (pardon the pun) participate in a telemedicine program without an EMR.

Which brings us back to the bad news above. EMRs in recent years have mostly been designed with Meaningful Use measures in mind, not telemedicine, and so might not be adequately equipped to integrate data from teleconsultations. This is where vendors come in. If BCC Research’s prediction of the telehospital market growing to $17.6 billion in 2016 is true, they’ll come in droves. They’ll get to that value by working with hospitals and physicians that want to further their telemedicine programs, and will likely be looking for ways to increase the functionality of their EMRs as a result.

As many of us head to HIMSS in a few weeks, it will be interesting to see if providers really are as disgruntled with HIT expenditures as the media would have us believe, and how much play is being given to telemedicine in the educational sessions and on the show floor.

What is your opinion? Do you currently participate in any sort of telehealth program? Do they have the ability to make EMRs more useful? Please share your thoughts in the comments below.

January 17, 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.

Doctors Dump Small Practices To Join Large Providers

Intimidated, in part, by the health IT expenses they’re expected to bear, doctors are leaving private practices to seek jobs with large healthcare organizations, according to a new study by Accenture.  The need to purchase EMRs certainly isn’t the only reason doctors are jumping ship, but it is one of the most important reasons, the firm found.

Accenture interviewed 204 doctors in May, drawing from an even mix of primary care docs and specialists across equally-divided sections of the U.S.

The study results projected that only 36 percent of doctors will remain part of an independent practice by 2013, down from 39 percent this year and 57 percent in 2000. (I knew doctors were streaming into integrated health systems but that blew my mind.)

According to the Accenture survey, 53 percent of doctors responding said that EMRs requirements drove them to look for employment with big health organizations.

Doctors are also spending big on updated practice management, billing and scheduling applications. My guess is that in some cases mobile health spending is beginning to rear its head as well, even in smaller practices. After all, while doctors generally bring their own devices to the party, practices may see it as in their interest to own mobile gear and applications as they become more central to care delivery.

On the other hand, health IT may also be the saving grace for some. Doctors who do remain independent are likely to offer telemedicine or online consultations to help keep their profits at an acceptable level, researchers found.

Readers, I doubt any of you are too surprised by Accenture’s findings. I doubt public policy planners are either.

Given these realities, I’ve always wondered why no one has proposed re-structuring Meaningful Use for smaller organizations to account for the disproportionate effect such investments have on the smallest practices, say those with five doctors or less.  Incentives are all well and good, but if we don’t want to see independent practice all but wiped out, perhaps some up-front grants are in order.

November 5, 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 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.

Verizon’s Take: How HIT Can Transform Healthcare

Every day, readers here wrestle with how health IT can improve patient care and remove costs from our monstrously bloated system.  And even though we share many of the same conclusions, the struggle is likely to continue for quite some time.

That being said, it never hurts to find out what big, super-mega-deep-pocketed giants of IT and telecom have to say on HIT trends, if only as an exercise. Not only does it tip their hand a bit as to where they’re headed, it adds more fuel to the fire. Here’s some trends Verizon’s big thinkers see as leading to care transformation:

  • Telemedicine:  An also-ran for decades, has telemedicine finally come into its own with abundant cheap bandwidth and relatively cheap mobile devices available?  Verizon says yes. The big V says telemedicine can suck $31 billion in annual costs out of the system.
  • mHealth:  This is a obvious one. But for the record, Verizon agrees that mHealth’s flexibility — with 10K health apps in the iTunes store alone — can do much to manage chronic disease, monitor patients and suchlike.
  •  Fraud detection becomes fraud prevention:  Interesting. Verizon, which, naturally, has a fraud prevention solution, argues that today’s claim analysis can catch fraud and abuse well before the claims are paid. Is Verizon thumping its chest or can this realistically be done folks?
  • Cloud computing spreads patient information: Verizon’s honchos say cloud computing will not only make healthcare businesses more efficient, it will make sharing of patient EMRs easier. (Methinks there may be a technical problem there, though; don’t you still need to be using compatible subsets of, say, HL7 to communicate, cloud or no? And isn’t that the problem overall?)

The rest of their big 10, well, you read and tell me whether you think they’re worth noting. If this represents the cutting edge of Verizon’s thinking, I’m not impressed. But I’ll give a call to the Verizon press contact and see if I can get more info. I’ll keep you posted.

July 27, 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 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.

Virtual Doc Kiosks – A Giant Leap for Telehealth

Just a couple of weeks ago, I wrote about doctors who FaceTime or video Skype with their patients. I’ll freely admit that while I’m as addicted to my Smartphone as the next person, I generally feel as if these healthcare innovations will result in overworked doctors and demanding patients.

And now, here’s something else to think about. According to a recent article in Computerworld, pharmacy chain Rite Aid, in conjunction with healthcare provider OptumHealth, is rolling out online physician chat rooms. Patients can virtually chat face-to-face for 10 minutes with a physician for $45. Virtual chats with OptumHealth nurses are free.

Pros of this system:
- Shorter Wait Times: No more Waiting Area blues, and no more wondering if the paper robes cover you adequately enough.
- Doctor-Pharmacy Cross Referencing: If Rite Aid already has a patient’s pharmacy history, the provider/nurse can access it any time. No need to rely on a patient’s memory any more.
- Electronic Capture of Medical Records: These can be communicated to the patient’s PCP in needed.
- No more scheduling tag: Walk in for a chat when YOU are ready.

- Steep price: $45 for a 10 minute chat is a tad high in my book. But when you look at it in terms of what the uninsured have to do to get any medical attention at all (either pay the high consultation rates, or negotiate with a kind-hearted doc for lower fees, or wait till their conditions become full-blown emergencies), it doesn’t look as pricey. I would also be really interested in seeing how insurance companies will react to telehealth initiatives like these. Will they, for example, reduce co-pays for such visits?
- Revolving cast of physicians: The advantage of this system is you get to see a medical professional; you’ll probably not be able to ask to be connected to that incredibly insightful Dr. Smith you saw last time. Also if this takes off in a big way, maybe it’ll be a Dr. Reddy located in Hyderabad, India (though I should go on record at this point – I have absolutely no problem in being seen virtually by a Dr. Reddy or Dr. Khan in Pakistan, or anywhere else in the world)
- Unclear logistics: Say, you have an abcess that you have to get checked on your er… backside. Are the kiosks private enough for truly comfortable patient-doctor interaction? Is there anyone else just offscreen at the doctor’s office, watching the video chat?

Definitely things to think about. I want to leave you with anecdotes from a different field – education. A few years ago, tutoring companies in the US figured out that American kids could really benefit from one-on-one tutoring from teachers. VOIP technology became cheap, even international video calls via Skype were free or for pennies a minute. I heard about this phenomenon when I enquired about a teacher at my high school in India. Many teachers at my school had quit to join such companies, and the school was making do with either substandard teachers or filling teaching gaps with part-timers on an ad-hoc basis.

It’s too soon to know what route these TeleHealth initiatives will take, but the scenario I described is not impossible with medicine too. While I’m excited about the convenience of these kiosks, I also think it would be a sad day if all/majority of our interaction with our providers is done online.

October 3, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

EMRs Are A Transitional Technology

OK, I’m probably going to raise some people’s blood pressure, but here it is:  Is it possible that EMRs are a transitional technology which the industry will outgrow within the next several years?

I contend that with telemedicine  expanding rapidly, connected/remote health changing the focus of care and smart phones evolving along their own path — just to name a few factors — that which we call an EMR might not be up to managing care of the future.  Given the need for corporate and medical security, EMRs are also ill-equipped to give the emerging class of e-patients the data access they demand.

Yes, you can connect telehealth sites with a health system or clinic network.  You can burn through developer time making sure  your EMR supports the latest developments in mobile health applications.  You can find ways to integrate the data generated by remote patient monitoring and make it usable. But will the final result, the application which governs all of this, be the EMR we know today?

Today’s EMR, let’s face it, is not great at connecting beyond the institution where it lives. Sure, we’re building HIEs, but there’s a reason why so many are still at an embryonic stage;  forming such networks is a damnably hard job.

So what will happen when medical interactions and care shift decisively to environments and platforms outside of a hospital or clinic?  I don’t know, but I think it will take a different type of system — focused on coordination rather than just data storage and analytics.  It will need to be wherever patients are, collect data in whatever form it’s generated and support care delivery in ways that are in their infancy today.

So, that’s my opinion and I’m sticking to it.  What about you?

May 2, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.