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ICD-10 Controversy in Wall Street Journal

Posted on September 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed it, I wrote an entertaining (at least I thought it was) post about some of the amazingly specific ICD-10 codes that are out there. I’m headed to AHIMA which starts on Sunday and I’ve had a preview of a vendor, @coniferhealth, capitalizing on some of these codes with some stickers they’re handing out. I’ll embed a picture of one of these stickers at the bottom of this post.

Turns out that not everyone is happy with this light hearted approach to discussing what amounts to a major major shift from ICD-9 to ICD-10. The Wall Street Journal posted some of the responses they got to their original article. Here’s one sample response:

Having a different code for every single artery or the specific bone that’s fractured helps improve continuity of care. A patient who is hemorrhaging can get lifesaving care more quickly when the physician can immediately identify precisely where the broken suture is located. In addition, including the specification that the patient was “bitten by turtle” justifies the patient receiving additional tests or treatments, as turtles carry different bacteria than, say, parrots or turkeys. This and other tidbits of information will support more efficient and effective reimbursement processes.

The benefits we will derive from our global health-care community are tremendous. Once the U.S. finally transitions to ICD-10, we will again be able to share important data with every other civilized country

Although, not everyone is so serious. Arthur Broaderick, M.D. offered the following question, “Doctors closing their practices in droves; is there a code for that?”

Epic, Cerner Best For ACOs? Say What?

Posted on September 29, 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.

I don’t know about you, but I’m not exactly sure what an Accountable Care Organization is. In fact, I’m betting nobody is — there’s a bunch of harrumphing and throat clearing out there, but I haven’t seen any crystal-clear descriptions out there.  Shall we say that ACOs are more honored in the breach than in the observance and leave it at that?

Now, we come to the puzzling part of this piece. If nobody’s managed to define an ACO clearly, how can any particular EMR be a better ACO tool than another?  We’ll have to ask KLAS about this one, since they’re the ones that discovered this “fact.”

Today, KLAS announced that it had interviewed 197 providers at 187 organizations to see how ACOs are forming up. A third of the respondents said that they were pursuing a formal Medicare ACO designation, and the majority were felt ACOs were the future, KLAS reported.

Sure, considering that ACOs are just risk-taking organizations with a capitated feel, some people already have a sense of what to expect. But throw an EMR into the mix and we’re in new territory — hopefully good territory, but new nonetheless.

So, tell me how providers know that Epic and Cerner are the most ACO-ready? Apparently, respondents believe that Cerner already has many of the IT pieces needed to run ACOs; moreover, they say Cerner is working closely with providers interested in the ACO model.

Survey takers also gave a nod to Epic, which they see as being close to ready (though behind in analyics and ability to share data with non-Epic users).

Wait a minute — let me get this straight.  Respondents know Cerner has the right pieces, even though the ACO doesn’t exist yet?  They like Epic, even though it doesn’t share data outside of its walled garden?  KLAS is kidding, right?

At this point, I’ll be kind and say that Epic and Cerner users are a bit brainwashed, which I too might be if I’d spent the kind of money those folks have on an EMR.

But the voice in my suggests that KLAS might have had its finger on the scales just a little bit. I will not publicly state that Allscripts, CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens scored worse because they didn’t pay for play…but something sure isn’t right here.

 

 

 

Searching for the Perfect AHIMA Experience

Posted on September 28, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for Billian’s HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

The American Health Information Management Association’s (AHIMA’s) annual show is right around the corner. HIM professionals will gather in Salt Lake City next week for a few days of educational sessions, exhibits, networking opportunities and even off-site visits to local healthcare facilities such as Intermountain Medical Center and the University of Utah and Cancer Registry.

It will be my first time at an AHIMA show, and truth be told, I couldn’t be more pleased that I’ll get to see Salt Lake City in the Fall. I’ll of course be on the lookout for the latest and greatest healthcare IT, particularly those technologies related to electronic medical records (EMRs). I’m also hoping to chat with AHIMA’s new CEO, Lynne Thomas Gordon, about how AHIMA will be helping its members transition through healthcare reform in the near future. (Look for a wrap up in next week’s post.)

Most of my time will be spent on the show floor, learning about these new technologies and finding out what health information management challenges and solutions providers are dealing with. James Watanabe, Director of Healthcare Business Development at Perfect Search Corp. – a first-time exhibitor this year, recently shared with me his thoughts on what’s he’s expecting and hoping to get out of the event.

What health information management challenges are your customers currently facing?
JW: “At Perfect Search, our clients are typically utilizing our unique indexing and search technology to deal with the challenges associated with extreme data growth and complexity. One of the challenges in the industry is that in addition to the explosion of digital data, there seems to be no clear direction in terms of standardization and policy. Given this uncertainty, vendors must not only help facilitate compliance now, but be nimble enough to support changes in the future. We see Perfect Search as a core technology that can be utilized to help organizations deal with these challenges as they come, and believe that the implications for such a technology are truly deep and profound.”

How does your team plan on addressing these challenges at the AHIMA show?
“We will be demoing our deep data-mining tools and highlighting some of our key strategic partnerships that showcase how the technology is being utilized today. We are able to provide at least a 10x improvement in indexing and search speed, be much more comprehensive in terms of the data we search (structured EMR, unstructured clinical notes, lab data, DICOM radiology images, etc.), and operate on up to 90% less hardware. Using our solution, clients gain real time insight into their data to improve quality scores, help mitigate fraud, improve billing processes, better facilitate clinical trials, and any other deep data mining they might require.”

What does Perfect Search hope to get out of the show as a whole?
“Despite some key partnerships such as Dell, Fujitsu, CA and Nuance, Perfect Search is relatively unknown in the healthcare space. We intend to use AHIMA as a way to raise awareness of our unique technology, it’s many applications in healthcare, move business deals forward, and seek out new partnerships in the space.”

How does Perfect Search’s Medical Record Search technology integrate with providers’ interoperability efforts?
“Perfect Search is the only indexing and search technology that is able to deal with both structured EMR content and unstructured clinical notes data equally well, to produce true semantic search. There is currently a disconnect between what most EMR vendors are pushing and what physicians and other users are wanting. EMR vendors push structured data, and clinicians are interested in utilizing their existing business practices, which for many means producing and utilizing unstructured clinical notes data. We believe that the ability to connect to all critical data needs to be a component of any good EMR or health information exchange (HIE) solution and is something that we can provide today.”

Can this technology search or be integrated into EMRs or HIEs?
“Absolutely.”

It would also seem that this technology might be useful from a business intelligence perspective – a much-needed solution in terms of providers determining what healthcare IT systems might be right for their facility.
“Definitely. 80% of business intelligence reporting and analytics is connecting to data. In large pharma and research, the deep data-mining tool we have created enables users to create and run complex ad hoc queries in real time and without IT. This tool is the difference between getting data now versus 12 hours from now, tomorrow, next week, or even next month, which is standard for most companies of significant size.”

How do you see Perfect Search technology evolving to meet the needs of healthcare providers?
“The Perfect Search team continues to work with industry experts to build new applications around the technology and strengthen existing products. Ours is a unique technology that enables users to connect to critical data at least 10 times faster, be much more comprehensive in terms of the content we search, and operate on up to 90% less hardware. “

I’m looking forward to speaking with the Perfect Search folks from the show floor. Know of any other exhibitors I should check out? Salt Lake sites I should see? People I should bump into? Let me know in the comments below.

John’s Comment: Along with Jennifer, I’ll be at AHIMA as well. I’m definitely happy to meet with people at AHIMA also and enjoy attending the event for the first time.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 36-40

Posted on September 27, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

40. Do NOT let the finance department drive the EMR choice or deployment
I’m far too much of a physician advocate to even imagine a finance department driving the EMR choice and deployment plan. Ok, I understand that it happens, but it’s a travesty when it does. Considering the finance department will almost never use the system, it should make sense to everyone to have the users of the system help drive the EMR choice and deployment. After all, they will have to use the system once deployed.

Let’s not confuse what I’m saying. I’m not saying that finance shouldn’t be involved in the EMR choice. I’m not saying that finance can’t provide some great insights and an outside perspective. I also am not saying that users of the EMR should hold the hospital hostage with crazy demands that could never be met. It’s definitely a balance, but focus on the users of the EMR will lead to happy results.

39. Ensure work flow can be hard coded when necessary, and not hard coded when necessary
Related to this EHR tip is understanding when the EHR company has chosen to hard code certain fields or work flows. You’ll be surprised how many EHR have hard coded work flows with no way to change them. In some cases, that’s fine and even beneficial. However, in many other cases, it could really cause you pain in dealing with their hard coded work flows.

Realize which parts of the EHR can be changed/modified and which ones you’re stuck with (at least until the next release..or the next release….or the next release…).

38. You can move to population based medicine
You’re brave to do population based medicine on paper. Computers are great at crunching and displaying the data for this.

37. Safety is created by design
Just because you use an EHR doesn’t mean you don’t need great procedures that ensure safety. Sure, EHRs have some things built in to help with safety, but more often than not it’s a mixture of EHR functionality and design that results in safety. Don’t throw out all your principles of safety when you implement your EHR.

36. Medication Reconciliation should be a simple process
I’m not sure we’ve hit the holy grail of medication reconciliation in an EHR yet, but we’re getting closer. It’s worth the time to make this happen and will likely be required in the future.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

EMR Software and EHR Audit Trails

Posted on September 26, 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.

This morning, I read about a case that engaged me on many, many levels. On the Health Care Renewal blog, blogger InformaticsMD has a fascinating post on a medical malpractice and how EMRs allow this to happen. Here are the key points noted by the blogger:

  • Samuel Sweet, a health 62 year old, was admitted to University of Pittsburgh Medical Center (UPMC) with a headache. It turned out to be a treatable amount of bleeding in the brain. He died three days after he was admitted, on May 16, 2009, much to the surprise of his family with whom he had been conversing only six hours earlier.
  • Apparently, Mr. Sweet had been intubated. His breathing tubes were removed on the day of his death, and it was soon apparent that he could not breathe on his own. Doctors tried to intubate him again, but could not do so, and this resulted in his death.
  • At UPMC, difficult intubations cases must be flagged as such in the EMR. The patient’s record from the EMR then displays a bright yellow banner on top, noting the intubation problems. This is done so that when physicians change, the attending physician is alerted to the problem, and consults with prior notes in order to fix the problem. “Difficult intubation” was not noted in Mr. Sweet’s record.
  • A civil case against UPMC was filed by Mr. Sweet’s family. Some detective work later, their defense team alleges that a full three days after Mr. Sweet’s death, after a post-mortem meeting, Dr. Simmons, a QA official from UPMC “accessed” the UPMC EMR system, and apparently entered data stating that Mr. Sweet was a patient with difficult intubation. The defense has audit trail evidence from the EMR to back their claims. They further allege that when that action failed to post-facto flag his existing records with yellow warning banner, Dr. Simmons tried to retract the “diff intub” entry, and unfortunately for him, even that cancellation of status was logged.

While I am fascinated by InformaticsMD’s write-up, I don’t fully agree with the apparent conclusion reached – namely that “EMR’s can detract from a clear narrative, and facilitate spoliation and obfuscation of evidence presented.”

I would argue to the contrary – that because there is an EMR, there is even an audit trail possible. And rather than facilitating “spoliation and obfuscation of evidence”, the EMR audit trail has shown up whatever tampering was involved. If UPMC simply had a paper based system, think about how much easier it would be to create paper records on official stationery, without date/time stamps I may add, post-facto.

EMRs can also be designed to meet certain additional needs – for example, a lock-down feature that locks down patient records from editing once a patient is flagged as deceased. There is no real counterpart for such a feature in the paper records world. Other lessons learned: If you’re springing for an EMR, it makes sense to know what metadata is being logged, and how you can access them – a pickle Dr. Simmons would have clearly avoided had he been IT savvy enough.

But a word to the wise: even an audit trail isn’t fool-proof. And if you’re in the market for an EMR, here’s a key difference between a “free” EMR somewhere on the cloud, or a pricier product on your own servers, administered by a savvy IT administrator on your payroll. Who administers the data makes a huge difference – if you own the database and your IT administrator has access to the database itself, you *can* manipulate any audit records generated from the EMR front end. Conversely, you must research what your vendor administered EMR is doing with your data, and what checks the vendor has on its IT staff.

Read more about the Sweet case on the Health Care Renewal blog.

Modular Software Unleashes Innovation – Major EHR Developments Per Halamka

Posted on September 23, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my ongoing series of Major EHR Developments from John Halamka (see my previous EHR In The Cloud post), his second major EHR development from the Technology Review article is: Modular Software Unleashes Innovation. The following excerpt from his article sums it up well:

Until very recently, innovation in medical IT has depended upon the development schedules of a few very large vendors who sell hospital systems with $100 million price tags. In the future, electronic health records will become increasingly modular, similar to the online app stores where consumers download games or programs for their phones.

The idea of modular healthcare IT has been around for a long time. I think I first saw this concept when I learned about a group called the Clinical Groupware Collaborative. I haven’t heard much out of them recently, but every once in a while I see that they’re still working to make Halamka’s comments about modular EHR software a reality.

I’m certain that Judy from Epic would argue that such modular EHR software is a risk to the healthcare industry. She’s probably right. There are risks to modular software. However, there are even more risks and disadvantages associated with a monolithic EHR vendor that won’t interact with other modular clinical software. I believe that one day this will come back to bite Epic as new CIO’s who weren’t part of the $100 million hospital software purchase will start to embrace a more modular strategy.

Turns out that I think providers will actually be the strongest proponents of the modular strategy. They’re already buying mobile devices with money out of their own pockets and so they’re going to start using apps that will help them provide better care. Hospitals will have a hard time controlling it and they’ll eventually realize that the best way to control it is to embrace it.

The most unfortunate part of this EHR development is that it’s going to take a long time for this development to become a reality. However, little by little we’ll get there.

It’s Official – I’m Attending the Connected Health Symposium in Boston

Posted on September 22, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: I’m also going to be doing a healthcare IT event in Boston with ScratchMM if you’re not going to the conference and still want to come meet me. Just register for the event here so we know how many are coming.

I’ve finally finished the plans for my trip to Boston for the 2011 Connected Health Symposium that’s done by Partners Healthcare. The Connected Health Symposium is October 20-21, 2011. I think I’ll enjoy the event.

A quick look at the agenda and the people on the agenda illustrates why I’m excited to attend the event.

The organizers of the event also sent a discount code for $400 off the regular rate for all HealthcareScene.com readers. The coupon code is: HealthcareScene (all one word) and you can register here. Word is that you might even get a special HealthcareScene.com ribbon if you use that code to register.

I’ll have a bit of free time in Boston the day before the event and Thursday evening I may have a little meetup. So, if you’re close to Boston, I’d love to meet you in person and hear your story. It’s always great fun for me to meet the readers of my sites.

What’s Next in Health Information Exchange (HIE)?

Posted on September 21, 2011 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.

There seem to be three big acronyms when it comes to healthcare IT and interoperability – EMR (electronic medical record), HIE (health information exchange) and ACO (accountable care organization). Implementing one does not always necessarily lead to the implementation of another. I’m sure everyone will agree, however, that an EMR most likely leads to connectivity to a HIE, which increases the likelihood of participating in an ACO or coordinated care program. I consider these technologies and concepts to be the interoperability triumvirate, if you will.

Of these three, the HIE seems to have seen its day in the sun. Enthusiasm for the concept and its surrounding technologies – at a fever pitch at tradeshows and in the media last year, in my opinion – seems to have been eclipsed by Meaningful Use incentive payments for EMRs and the general consternation related to ACOs. Which is why my interest was piqued when I came across news from a company called NexJ and its new Health Exchange solution.

In order to learn more about the product, touted by the company as one that “brings together the numerous electronic health records systems and applications that exist within healthcare organizations – many of them old, out-dated legacy systems – into one place so that healthcare providers can deliver better, safer, more comprehensive care,” I reached out to Oz Huner, Vice President of Health Solutions at NexJ Systems.

JD: What type of healthcare facility would be the typical customer for your new HIE solution?
OH: “The NexJ Health Exchange solution facilitates the sharing of patient information between healthcare organizations such as hospitals and healthcare providers, ACOs, HIEs, and public health and government agencies.

“Our customers are choosing our solution because it enables them to move from paper-based workflows to electronic workflows and gain such benefits as complete access to accurate information, improved quality of care and patient empowerment.”

Can you give me a specific example of how this HIE can potentially (or has already) improve patient outcomes at a client facility?
“In a current project we’re working on, NexJ is helping meet the challenges emergency department physicians and staff face by providing timely access to the patients’ primary care provider records when they arrive at the hospital admitting department. The NexJ Health Exchange solution connects the patient’s medical record directly with the emergency department systems, improving information sharing between community health providers and the hospital, and improving patient safety.”

Is there a limit to the number of EMRs and applications that can be connected within the NexJ health exchange?
“No, there is no limit to the number of EMRs and applications that can be connected using NexJ Health Exchange. It is highly scalable and can address the needs of the even largest healthcare organizations.”

Does it work with some EMRs better than others?
“No. NexJ Health Exchange provides open, standards-based integration to any EMR system. Its secure, Web-based portal and flexible architecture enables connectivity with legacy and proprietary systems, support for global messaging standards (HL7v2.x and HL7v3.x), exchanging of clinical document formats (CCR and CCD), and support for multiple standardized clinical terminologies (SNOMED, LOINC).

Based on your interactions with providers, do you feel that more and more are finally coming around to the idea of adopting EMRs and eventually HIEs? Or do you find that many providers still think they aren’t worth the expense?
“It is our opinion that EMRs have historically been of great value to healthcare organizations, but since they’re often siloed, such information technology has not been ubiquitously adopted. As an element of a HIE, however, we believe there will be greater EMR adoption as government incentives and programs encourage healthcare providers across the country make the switch to EMRs. As more physicians move to EMRs and become net receivers of patient information, they will realize the benefits of access to accurate information, improved quality of care and patient empowerment.”

Are you working with any regional extension centers around the country to promote your EMR and HIE solutions?
“Indirectly, yes. Through our partnership with Open Health Tools, NexJ is a member of the Platform Implementation Project (PIP), which is working on an open HIE solution for state agencies. The focus is currently on southeast Texas, but is by no means limited to that region.”

NexJ will be at the Health 2.0 conference in San Francisco next week. If you plan on going, stop by their booth and let me and your fellow readers know what you think about this new health exchange solution. Is HIE the buzzword worth bringing back?

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 41-45

Posted on September 20, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

45. Think about ICD-10 compliance sooner than later
ICD-10 goes into effect October 1, 2013. (barring them postponing it again). Can you imagine if you’ve implemented an EHR and then find out that the EHR isn’t ready to support ICD-10? Sure, we’re still a little ways out, but ICD-10 has been on the docket for a long time coming.

44. Make sure your revenue cycle process is as clean as possible
Cleaner processes are easier to implement. Your revenue is going to take a hit when you first implement an EHR in your office just based on the learning curve of EHR. You don’t want to add to the changes by having to change any issues with revenue cycle at the same time.

43. Don’t underestimate the time necessary to be compliant with 5010
This won’t be as bad as ICD-10 for most practices, but you want to be ready for it.

42. Keep transcription in mind
Make sure you have a good understanding of the costs associated with cutting out transcription. Notice that I said costs and not savings. I already know that you’re aware of the savings of cutting transcription. What you might not have taken into account is the costs of ending transcription. If you’re doing voice recognition then you’re going to need the software, a great microphone, and possibly faster/newer computers. If you’re doing voice recognition there will be more manual corrections that you’ll have to do than in transcription. If you’re cutting out all voice input of data, then just be aware that you may hate “all the clicks” and want to go back to transcription in some form. Is your EMR conducive with that change if you decide to go back to transcription?

41. Watch your insurance claim denials
Of course, most clinics are doing this already. However, a whole new set of claim denials will happen because of how your EMR files those claims. You don’t want to miss out on the insurance money because you can’t handle the claim denials in a timely manner.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Free EMRs, Ads and EMR Pricing

Posted on September 19, 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.

Last week, I wrote about a conversation with a physician friend on the costs of moving to an EMR. That conversation segued into a discussion of free EMRs and how they can be a good thing for small (definitely a game changer for solo or two-practitioner) practices. This week, I’m analyzing free EMRs from the advertising angle. My friend made a comment during our discussion that gave me pause. He said he didn’t want advertisements distracting him when he was talking to a patient, he’d rather spring for a package that charged him a few dollars a month than one that had ads embedded inside it.

I think the ad question is pertinent to both sides of the equation. As a physician, I don’t want the 15 minutes I spend per patient cut down even more, because I want to get rid of those pesky pharmaceutical ads. As a patient, I don’t want to get the feeling that I’m the third wheel in the space between my doctor and his iPad.

And frankly, the low or no-cost, high volume Walmart strategy doesn’t make much sense to me in the long term. This is not based on some well-pedigreed consumer behavior study but what I’ve generally witnessed, or done myself. I’ve trained myself on the art of selective blocking. When I’m on Google, I studiously avoid looking at the highlighted links on the right, and top of the page. The same way, on eBay, when I’m looking for job opps, I generally skim past the purple highlighted vendors. If you’re a TV junkie, think about when you take your bathroom breaks.

In other words, we all have our own blocking strategies to ignore ads, which is probably not such good news for advertisers. This is not to say that advertisers won’t advertise, or vendors won’t make money.

If doctors already have some amount of natural reticence to ads, how are free EMR vendors going to make money? (I’m not sure if the ad model in free EMR packages is click/pageview driven, or a set price for simply being placed on the page, like magazine ads.) Free EMR vendors might then also offer ad-free versions, for additional dollars a month. At this point, they become just like other EMRs – i.e. when the costs are non-zero, price will not be the only differentiating factor when you’re judging EMR quality.

And yet, if my friend spends $100 a month for an ad-free EMR, as one vendor is offering, he’ll spend only $1200 a year personally for EMR, and be able to avail his Medicare 44K, as opposed to the 80K-100K EMR bids he’s currently getting. Even when ads (or lack of them) are factored out of the EMR pricing, the ad-removal-for-a-price model tends to work better for smaller practices.

Based on this, I feel like we’re going to see some steep discounting in EMR prices.