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States Lagging Behind in Medicaid Meaningful Use Payments

Posted on March 30, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If I were part of CMS, I’d be pretty annoyed right now: Apparently, state Medicaid programs are beginning to be a wet blanket in the race to get providers up to Meaningful Use standards.  According to InformationWeek, a dozen states aren’t yet paying out Medicaid incentives, and some of those haven’t even launched incentive programs yet.  Not good news, to say the least.

According to a new post on CMS’s official blog, CMS has handed out Medicare and Medicaid incentives to more than 59,000 eligible professionals and 2,000 hospitals. It also noted that the Medicaid program alone had made more than $1.8 billion in MU incentive payments between January 2011 and the end of last month.

That’s not a bad start, but the slow pace of some Medicaid MU programs is a drag on meeting CMS’s overall goal, which is to have 100,000 providers get MU payments this year.

True, some states are clearly doing their level best: Ohio, which wants to reach 40 percent of eligible providers, Washington, whose goal is 7,000 EPs and hospitals, California, which is trying to get 10,000 providers set up for Medicaid incentives by June; and New York, which hopes to get 6,000 providers get incentive payments in 2012. And 43 states in total have launched a Medicaid incentive program and begun registering applicants, the article reports.

But then there’s the naughty states, which include Hawaii, Idaho, Minnesota, Nebraska, Nevada, New Hampshire, and Virginia — which haven’t launched their Medicaid incentive programs at all. As of December, however, CMS expects (demands?) that all states be making Medicaid incentive payments by June, according to a CMS official quoted in the story.

In the grand scheme of things, I’m pretty confident that Medicare, not Medicaid incentives, are going to drive the train here.  That being said, it is worth asking whether the states’ lagging efforts will create serious problems for the MU program. As I see it, it could go either way, but regardless, it’s not a good sign.

Who do Doctors trust in EHR Selection?

Posted on March 29, 2012 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.

Anne Zieger has a really interesting post about Hospital Recommended EHR software over on Hospital EMR and EHR. In it she talks about how most doctors don’t take the hospital recommended EHR software. This will come as little surprise to doctors and likely to hospital systems as well. Doctors and hospitals have always had a mixed bag relationship. There’s this odd co-dependence that usually makes the relationship awkward.

When it comes to EHR adoption, physicians love the idea of getting IT and implementation support from the hospital. They also love the group buying power. Although, they also are concerned that they’ll just be a small fish in the big hospital waters and not get the support that they think they deserve (and maybe they do). Although, the most important reason doctors don’t want to get the hospital recommended EHR is they don’t want to create that “permanent” tie to the hospital. Of course, this is one major reason why hospitals want doctors to take their recommended EHR.

If we can say that doctors don’t trust hospitals recommended EHR software, then who do they trust?

That answer is easy: other doctors.

There’s something really powerful about the trust connection that doctors have between themselves. I’m sure there’s a number of factors that contribute to why they trust doctors more. It probably goes back to the bond that going through medical school creates. Reminds me of when my brother described how boot camp in the Marines created a unique bond between Marines. Doctors seem to experience a similar bond around medical school. Even if they’ve never met before, they can connect sharing “war stories” from their medical school and residency experience.

In many cases, their physician colleagues are a great reference pool for them when it comes to EHR selection. This is particularly true if their colleagues are in the same specialty and have a similar practice size. Although, once doctors start talking to colleagues from different specialties or different size institutions then they often run into trouble. The EHR that works for a 100 office multi-specialty clinic likely won’t be the right one for a solo practice.

IT Service Companies
I also believe many practices have a great trust in their IT service provider. You can see this trend in how many IT service company employees comment and subscribe to this site. Plus, many of them offer some sort of specialized EHR service to doctors. In fact, many are VARs for EHR vendors.

Internet EHR Info
Turns out that most doctors are very independent thinkers. So, many of them want to do the EHR selection on their own. This leads them to the internet to search and narrow down the list of EHR companies. I expect the internet resources for EHR are probably now the most influential part of a physician’s EHR selection process. Can you imagine a physician selecting an EHR without online research? I can’t.

Who else do you see influencing the EHR selection process?

Social Media Resources for Healthcare IT Job Seekers

Posted on March 28, 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.

In my attempts to prepare for a panel discussion during last week’s TAG Health-sponsored HIT Job Fair, I corresponded with a number of you, dear readers, on how you and your colleagues have or are currently using social media in your job hunt. Thanks to everyone who shared their experiences, tips and tricks with me. I was able to relay some of it to the eager job seekers in the audience – many of whom were only vaguely aware of the potential social media can play in helping candidates: manage their personal brand and digital footprint; educate themselves on a particular niche as they transition from one industry into another; and of course, find job openings.

McKesson and Children's Healthcare of Atlanta were just a few of the employers at TAG Health's recent job fair.

The following is a list of resources that I didn’t have time to share during the job fair. Many of them come directly from the fingertips of EMRandEHR.com readers.

* Social Networking for Career Success – great book – no matter what industry you’re in – by Miriam Salpeter of Keppie Careers. You can follow her on Twitter and learn more at her website, KeppieCareers.com, which also includes a guide to Google+ in the books section.

* NWHIT.org – a website devoted to Health IT Workforce Development in the Northwestern States, part of the Community College Consortia to Educate Health IT Professionals Program. It includes some great advice blogs by Health IT Talent Specialist Yvette Herrera-Greer, as well as a session from Matthew Youngquist of Career Horizons on using LinkedIn as an effective tool for job seekers in the Health IT sector. You can also join the organization’s group on LinkedIn – just search for NW Healthcare IT Workforce.

* the @HIMSSJobMine Twitter account is a great national resource, as is the @TAG_Health account if you’re in Georgia.

* Twitter hashtags you may want to consider paying attention to include #HealthIT, #Jobs, or the name of the company, technology or position you’re interested in, such as #CIO, #Allscripts, #Epic, #EHR, etc.

* Pinterest – yep, you read that right. I’d say it’s a little too early to tell whether it will be a valuable resource for folks in healthcare IT, but the recent Forbes article I came across on the subject is worth a look, especially if you’re already a fan of the new social media sight. (Side Note: You can Find Healthcare Scene and EHR Screenshots on Pinterest also)

* CareerEnlightenment.com – a website devoted to helping people use social media to get jobs. Blogger Joshua Waldman is also the author of Job Searching with Social Media for Dummies.

Have additional resources and tips to add? Please share yours in the comments below.

How Can I Spend Less Time in a Patient Encounter?

Posted on March 27, 2012 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.

I was reading on LinkedIn the other day, and someone suggested that in far too many ways we’re restricting our view to the following question:

How can I spend less time in a patient encounter?

While this certainly applies to our use of technology in healthcare it goes well beyond just EHR. Although, one challenge with technology like EHR is you get exactly out of it what you design it to do. If the focus of your EHR is just about minimizing the patient encounter, then that’s what you’ll get. If the focus of your EHR is to maximize reimbursement, then that’s what you’ll get. If the focus of your EHR is to meet government requirements, that’s what you’ll get.

Instead, of you focus an EHR on providing amazing patient care, that’s what you’ll get.

Many like to blame the EHR vendors for not producing EHR software that improves patient care. While I think they hold some responsibility, they are mostly just trying to satisfy the demand of their customers.

Healthcare deserves better and we need to find ways to incentivize doctors to want an EHR because it improves patient care. Otherwise, we’ll keep getting great billing engines which minimize the patient encounter at the expense of great health care.

Docs Gone Wild

Posted on March 26, 2012 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.

Update: Be sure to read A Davis’ comments on this post as well where he provides some more perspective and understanding on the magnitude of the issue.

And in a bit of a break from our usual EMR and EHR content, we have a couple of stories that caught my eye on Fierce Healthcare.

The first story is about a talk on provider disruptive behavior presented at the American College of Healthcare Executives (with the somewhat hilarious acronym ACHE) Annual Congress in Chicago. The kind of behavior that includes ponytail-flipping, pestering patients and colleagues for dates and not taking no for an answer, threatening to use AK47 etc. Rolling your eyes because you’ve never encountered these doctors from hell? Me too. To a person, the doctors I’ve encountered here in the US have been professional, courteous and polite.

But how common is this kind of stuff?

The Fierce article doesn’t say, but the not-so-subtly titled “Physicians behave badly online” provides some statistics on doctor behavior online.

The litany of complaints against doctors is as long online. The most common complaint is that doctors ask patients out on dates. According to the article, 48 participating state medical boards had at least one case of online misconduct, and the accusations leveled include:

Inappropriate online communication with patients (69 percent), such as sexual misconduct

Inappropriate medical practice (69 percent), such as prescribing medication without establishing a clinical relationship with the patient

Misrepresenting medical credentials online (60 percent)

The penalties for these online faux pas included reprimands, loss of licence, community service, fines etc.

Taken in totality, doctor behavior both on and off-line has some cause for concern. The same behavior in the real world translates to disruptive behavior online. I would also argue that it’s not just the same behaviors, but also the same set of doctors who misbehave. If you meet a jerk in the real world, chances are it’s the same person that might pursue you on a dating site.

The statistics as reported on Fierce Healthcare are a little fuzzy though. OK, so 69% of the 48 states had at least one reported online misconduct case, but how many doctors were involved? What percentage of doctors displayed inappropriate behavior? Were there repeat offenders, or multiple cases against the same misbehaving doctor? I don’t know. The JAMA abstract is woefully short on any meaningful details.

Does the online world just make this worse? Do we see more of this happening and since it’s so easy to connect with patients online? Does it also make the doctor more accountable for their actions since something done online can be more easily tracked and reported?

EMR the 4 Letter Word

Posted on March 23, 2012 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.

Adam Sharp, MD, Founder of par80 and SERMO, has come out swinging on his relatively new blog for his new company par80. One of his first blog posts talked about why EMR is a four letter word for most doctors. The thing is he’s right in many ways.

The first thing he does is debunk the 50% EHR adoption number that’s gone around and been propagated by the ONC and others:

The 50% adoption rates seen in the first link reflect the presence of ANY type of an EMR-like technology. While it is a great headline for sure, the second link shows that this is an overly broad declaration. When we look at “fully functional systems,” meaning they are being used for a full work-flow solution, we get numbers in the low teens instead. (When you subtract out unique situations such as Kaiser, the VA, and a few large independent doctor networks, I suspect the actual number is much lower.)

I personally put EHR adoption at about 25%, but now we’re quibbling over small percentages. Either way, it’s quite low. Adam describes the real challenge that EHR vendors face and how they can remove the 4 letter word connotation of EMR:

Widespread adoption of an EMR (or multiple compatible EMRs) that is intuitive and easy to use, that empowers the end user and patients, and that actually helps to make the healthcare system more efficient would be a good thing for doctors, patients, and the industry. However, unless we recognize what the ultimate goals are and better involve the people most critical to their effective use (physicians), I believe Jonathan’s prediction will be true and cash-for-clunkers applied to the healthcare sector will turn out about as successful as that other government program…TARP.

I think this trend is changing for many EHR vendors that really are trying to focus on the physician, but sadly have this huge distraction called meaningful use. Plus, we are having more doctors write about their good experience with EHR. The more doctors that can say that their desk is clean, their life is better, and they have more time, the more we’re going to see EHR adoption really increase.

Unfortunately, there’s still far too many poorly implemented, poorly selected and poorly accepted EHR implementations out there. This is a tough problem to solve particularly in this government incentivized environment. I think I read recently in a passing tweet something about HIMSS soliciting for more EHR success stories. I don’t think a manufactured list of EHR success stories is going to do the trick. Although, it’s true that EHR failure stories spread faster than EHR success stories.

What do you think will shift the tide of EHR adoption? Is the EHR incentive money going to be enough to change it? We’ve certainly seen some increase in EHR adoption from the EHR stimulus, but will it be enough and in the right direction?

EMR & EHR Advertising

Posted on March 22, 2012 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.

It’s getting close to a year since I last wrote a post about the companies who support the work we do here at EMR and EHR. Since it has been so long, I thought I’d just list all of the companies that have ads on EMR and EHR and say a few thoughts about each company. I also dug back into my archives and figured out how long they’ve been advertising with me. It’s amazing to see some advertisers going all the way back to 2009.

Practice Fusion – Advertiser since 4/2010 – I had to really dig into my email to see when Practice Fusion first started advertising on EMR and EHR. A name change made it even harder, but I found the original email when Kellie first emailed about Practice Fusion advertising. I imagine most people know about Practice Fusion’s Free EHR. I should ask them how many people have signed up for their EHR from ads on my sites. Considering it’s free, I bet it’s a large number of sign ups. It’s really quite amazing how far Practice Fusion has come in the past few years and I think they’re really just getting started. I love having front row seats to the Free EHR model at work.

Ambir – Advertiser since 1/2010 – I’ve been a fan of Ambir ever since I my clinic had to drop a few thousand dollars on non-Ambir scanners for their office. Sure, for a few thousand dollars the clinic got some great scanners that worked well, but if I’d known about Ambir at the time we could have saved a lot of money. I’m planning to do a full write up of their Ambir ADF scanner. It’s a really sweet product at a much better price point than the other industrial strength scanners out there.

SOAPWare – Advertiser since 7/2010 – Not only has SOAPWare been a long time supporter of EMR and EHR, but they’re also regular readers of my sites and some of the nicest people you’ll meet in this world. I think it’s the southern roots of the company along with their founder, Randall Oates, MD, that guides who they are as a company. If you ever get the chance to sit down and talk with Randall Oates, I can assure you that you won’t be disappointed. He’s been doing EHR software since before it was called EHR software. I think that’s reflected in SOAPWare’s approach to EHR development.

Mitochon – Advertiser since 12/2010 – Founded by Dr. Andre Vovan, Mitochon has a vision around connecting doctors through a Free EHR, Free PM, and Free HIE. In many ways, when I first met Andre Vovan and Mitochon back in 2010 he was already talking about what we now call ACOs. Offering the whole suite of health IT services (EHR, PM, and HIE) for Free is a really interesting way to be able to achieve an ACO and for that matter connected healthcare.

Amazing Charts – Advertiser since 5/2011 – One thing that sets Amazing Charts apart from other EHR software is that it was founded and first created by a physician, Dr. Jonathan Bertman. At HIMSS I had a meeting with Dr. Bertman and at one point he described how Amazing Charts didn’t mind leaving money on the table. I found it a really interesting way to describe their corporate approach to not try and nickel and dime the doctor at every corner. I think this approach is something that doctors really appreciate when their selecting and purchasing an EHR.

Elsevier – Advertiser since 9/2011 – I’m sure many of you have seen the name Elsevier all over healthcare. They are a company with a large footprint in healthcare across a variety of parts. In the case of EMR and EHR, Elsevier is advertising their Gold Standard Drug Database. For those who don’t realize it, EHR vendors don’t create their own drug database (with very few exceptions). Instead, EHR vendors rely on databases like Elsevier’s Gold Standard Drug Database. Turns out this is a much better model. Most EHR vendors would do a terrible job trying to create a drug database themselves.

Medical Mastermind – Advertiser since 1/2012 – Originally started as a practice management system, Medical Mastermind has been working in healthcare since 1984. They take a very hands on approach to supporting their customers and while they’re known for their practice management software, they’ve also added EMR and ePrescribing as well.

Cerner – Advertiser since 9/2011 – Do I really need to go into who Cerner is? Their one of the industry heavy weights in the EHR world. One thing I’ve personally found interesting in my interactions with Cerner was the type of forward looking features they’re discussing. They seem to have taken a really broad look at what EHR will be like 20 or 30 years from now. They’re asking questions like, How are we going to deal with a 50 year patient record? This is probably deserving of its own post, but I was intrigued by their look at EHR software and being able to do things now that will make life better for doctors in the future.

HITR – Advertiser since 1/2012 – HITR is an interesting Healthcare IT community built around research. Brought to us by Porter Research and Billian’s HealthDATA, it’s a really smart idea to bring together those that can provide and want the research data into one place. Those that participate can get financial and quality performance comparison data on peer facilities and a benchmarking tool that can help providers. They can also rank vendor products and see how other providers have ranked those products.

Greenway – Advertiser since 3/2012 – Coming off their successful public offering, Greenway (GWAY) is well positioned to be a big player in the EHR market. Doesn’t hurt that thehave 40,000 healthcare providers in 30 specialties using their products and services. I’m also intrigued by Greenway’s new Marketplace. We’ll see how many leverage Greenway’s API technology on top of PrimeSuite.

Online Tech – Advertiser since 3/2012 – As I recently posted on EMR and HIPAA, Online Tech is a hosting company that takes security and privacy seriously. If you’re looking for a host that can meet the HIPAA guidelines you should take a look at Online Tech. Talk to them and then to other hosting companies and I bet you’ll see a big difference in how they approach the HIPAA requirements.

SequelMed – Advertiser since 11/2009 – I think the Sequelmed home page describes them well: trusted by over 15,000 physicians and over 1,000 practices. I think Sequelmed is one of the many EHR companies out there that’s generally gone along quietly about their business. They aren’t big and flashy, but they keep adding more and more doctors and servicing those doctors they already have on board.

NoMoreClipboard – Advertiser since 2/2012 – I recently called the NoMoreClipboard and iMPak product offering the “most creative technology” I found at HIMSS 2012. I plan to do a full post on the technology at some point as well. Although, I love the approach that NoMoreClipboard and iMPak have taken to be able to get the data to improve healthcare while realizing that many don’t want to have to deal with all the tech details. This is a hard concept for many of us that live and breathe tech to understand and appreciate, but many people want tech solutions that more easily fit into their life flow.

There you have it. I really appreciate each of these companies support. I hope to continue working with these companies many years into the future as we continue covering the crazy world of EHR and healthcare IT.

Are EMRs the Answer to Small-Practice Challenges?

Posted on March 21, 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.

During my recent visit to my daughter’s pediatrician, I was pleasantly surprised to see a computer up and humming along in a corner of the exam room. The last time we had been in, some six months before, that same piece of equipment sat shrink-wrapped (as it had been for a few months even before that), waiting for an eager clinician to tear open its plastic casing and put its digital capabilities to good use.

I had been dreading this particular appointment – our first with the one pediatrician left at the practice. Our usual doctor had left a few month earlier for parts unknown, so I wasn’t sure who – or what – to expect. The advice nurse who made my last minute “work-in” appointment was kind enough to make sure I understood that due to the second doctor’s departure, we would likely wait an extremely long time.

Our wait, which ended up being no longer than usual, gave me time to do a bit of snooping around the new computer. No keys or mouse were touched, but I did notice that NextGen was the practice’s EMR of choice. Yes, the nurse did have her back turned to us as she asked me questions about the reason for our visit and entered responses into the EMR. When I asked her if she liked the new system, she gave a rather noncommittal response in close approximation to “some days I do, some days I don’t.”

I’m guessing she may have bigger issues to deal with, such as assisting the patients of a double-, sometimes triple-booked pediatrician. The single-doc situation made me wonder how much training the practice’s staff had time for before and during go-live. I could certainly believe that follow-up training will take a backseat until a second pediatrician is brought into the fold and everyone gets back to a somewhat normal workload.

So how do small practices in similar situations do it? How do they find time for EMR training when overscheduled? Do vendors often step in and help with extra resources? How long do practices go before hiring additional staff? (That’s an off-topic question, I know, but one I’d still like an answer to.) I’d like to think that in the long run, the new EMR would of course help make everyone more efficient, and us patient parents more satisfied. Let me know what you find out in the comments below.

Meaningful Use Solidifies EHR as the Database of Healthcare

Posted on March 20, 2012 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.

Earlier this month I wrote a post describing EHR as the Database of Healthcare. I believe this is a powerful and important thing to understand. It also led to some good conversation in the comments. As an entrepreneur I’m always interested to see the trends in the industry to hopefully better understand what is going to happen in the future. I think that this is one of those trends.

Just to make the case clearer, consider the effects of meaningful use on EHR software. Meaningful use stage 1 and EHR certification has already hijacked at least one EHR development cycle and you can be sure that meaningful use stage 2 and stage 3 will be hijacking another couple EHR development cycles. You heard me right. In order to meet the EHR certification and meaningful use requirements, most EHR vendors have to put a whole development team focused just on meeting those government requirements.

Meaningful use has codified EHRs into a box.

Instead of allowing EHR software to create innovative solutions it requires standards be met for storing and accessing info. Sure it also adds in security and tries to work towards interoperability, but those aren’t innovations that doctors want to see.

I expect many of the best healthcare innovators will build on top of the EHR base, not try and build the base again.

Specialist EMRs: Pros and Cons

Posted on March 19, 2012 I Written By

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

Right now, the bulk of well-known vendors are fighting for hospital and multispecialty/primary care group business.

But specialist EMRs are a thriving market, too, and one analysts like myself don’t cover often enough. To get an idea of how many specialist EMRs are out there, check out this list of EMR specialties my colleague John Lynn compiled. Though it’s from 2009, it should give you an idea of what we’re dealing with here.

Is it really necessary for specialty physicians to buy an EMR dedicated to their profession?  One specialty vendor offers a thoughtful argument as to why their approach is better:

 Clinical content is required to sufficiently document exam findings, diagnoses, and medical plans. To be truly effective, an EMR must possess a comprehensive library of information that alleviates the need for physicians to document from scratch. Otherwise, both the workflow efficiencies and the documentation improvements touted by EMR vendors suffer.

But, according to [Peter] Waegemann, “most medical specialty societies simply are not ready to ‘come up with the data’ around which vendors can design specialized systems.” Therefore, most generalized EMR vendors put the responsibility for developing clinical content on the shoulders of their customers. But, therein lies the problem.

Writing a comprehensive, usable library can take up to 400 hours of a physician’s time – time that is already in very short supply and very expensive. The sheer amount of time required for such a task oftentimes delays implementations, frustrates users, and is one of the top reason behind EMR failures. Some vendors rely on third party resources to sell libraries to specialty customers, but doing so oftentimes raises the overall cost and complexity of the solution to unacceptable levels.

On the other hand, I can think of at least a few reasons why a specialty EMR might not be the best choice for a practice:

* Interoperability:  If your practice joins a health information exchange (and let’s face it, that day is coming for most physicians) will your specialty EMR be able to link up comfortably with mainstream systems?

* Connections with hospital systems:  Another interoperability issue. If the hospital where you do most of your business is an Epic shop, and you’re using, say, the

* Workflows that don’t fit with major systems:  It’s all well and good to be really comfortable with your specialty EMR, but how will that work when you’re forced to “switch gears” and use mainstream systems in settings outside your practice.

So folks, which side do you come down on in this discussion?