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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.

Pervasive Healthcare Technologies Continuum

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.

In my random visit to Twitter today, the master of healthcare Twitter usage, Gregg Masters (@2healthguru), posted a picture that really struck a chord with me. It’s embedded below for those who want to see it. In the picture it shows a number of core functionality and technology that’s needed to get a person’s healthcare data into their hands to become truly empowered patients. You might also call this the Quantified Self Continuum, but I also like the Pervasive Healthcare Technologies Continuum.

Here are the steps it displays: Ubiquitous Sensing -> Wireless Connectivity -> Cloud Computing -> Social Networks -> Empowered Patients

I think the one we’re missing the most right now is ubiquitous sensing. We’ve just started down this path and still have a long way to go to make this a reality. I’m also not sure about social networks being the way that the information is distributed. At least not the social networks they list. I think they might be healthcare specific networks that connect and share the data, but are lifted up and made more prominent using the major social networks.

Ok, here’s the tweet and picture. What are your thoughts on it?

Meaningful Use Solidifies EHR as the Database of Healthcare

Posted on 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?

Paper vs EMR – Learning from Each Other

Posted on 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.

For those of you who read this site and don’t read EMR and HIPAA, you should go and read this post called Paper Has Healthcare Spoiled. While some might see it as an anthem for paper in healthcare, as I said in the comments of the post, it’s really an attempt to help EHR vendors see some of the advantages of paper and hopefully they’ll find ways to get those same benefits from EHR.

A Davis (who I believe is a doctor) also offered these insights in response to the post:

There’s no doubt that for one patient, in one office, paper is the absolute leader over EMRs in terms of ease of use. When considering multiple patients in multiple locations, the potential advantage of the EMR is easily seen.

The challenge is to transfer the benefits of paper to the EMR. That challenge has gone largely unmet, and it is the primary reason why uptake of EMRs among physicians has been so poor.

Medicine is a very personal undertaking. Physicians treat patients one at a time, and that’s how patients want it. That treatment is detailed, can be very personalized/customized, and documentation of that treatment varies to meet those individualized demands. EMRs, in their current state, are not user friendly to that type of documentation. While the government, insurers and hospitals are interested in aggregate data, physicians are not – at least not in the exam room, where their documentation occurs.

For an ever-shrinking number of physicians, typing is a problem. The problem is self-resolving over time.

For every physician, the “hunt and peck” mode of documentation is a problem. There are many variants – check boxes, radio boxes, drop down lists, “type ahead” automatic completion, etc – but there are hundreds, if not thousands, of locations in any EMR where the physician is required to choose among multiple options in a list. And there is no efficient way to do it. In a paper chart, the required entry simply flows from the tip of the pen. In an EMR, the physician’s attention must shift to the appropriate entry field, the mode of selection must be determined, the proper entry must be found and selected and, often, it must be confirmed, by clicking, by tabbing to the next field, etc. It takes a few seconds longer than simply writing the word and, when multiplied by the dozens or hundreds of times it must be done in a single patient encounter, the time lost becomes significant. Despite this limitation, it isn’t the method of data entry which is the primary problem.

The issue is how much data is required. Because hospitals and physicians are forced to accept fixed payments from the government and insurers, the natural evolution of EMRs as patient care tools has been altered. Rather than innovating to meet the needs of doctors and patients in the exam room, EMR vendors were forced to focus on the billing aspects of the EMR in order to justify their fees in a fixed-price economy. Therefore, EMRs are designed to elicit the information needed to justify the highest allowable payment rate from any given patient encounter. This is good for office and hospital economics, but is actually counterproductive to patient care.

For a given patient problem, the EMR doesn’t change the physician’s diagnosis and treatment decisions, but it does slow down the visit process by asking, typically, for more information than the physician needs for those decisions in order to get the required billing justification info needed to maximize the “billing code” for the patient encounter. This process is not only counterproductive to efficient care, but also increases the cost of medicine overall.

This problem is not inherent to the difference between paper and EMRs; rather, it is the result of the development of EMRs in a government-constrained environment. But it matters, because it is the basis of the very real fact that most physicians would prefer to use paper over an EMR. Until EMR vendors are able to innovate with the goal of improving the documentation needs of patients and their physicians, rather than government and insurers, paper will remain the medium of choice in the exam room.

As I’ve said for years, the biggest problem with legacy EHR software is that they’re big EHR billing engines.

Watch for more posts on EMR and HIPAA covering how healthcare is spoiled in other ways as well.

Craig Be Nimble: “Disruptive” Medicine or Inefficient Method?

Posted on March 16, 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.

I came across this very thought provoking post by Dave Chase on Kevin MD today, outlining “nimble medicine”. A little bit of googling revealed that a vastly better version of it, again by Dave Chase, ran on TechCrunch in late Jan. Yes, I’m that late to the party, and I will admit I’m feeling a little cheated by Kevin MD (really, how much trouble does it take for you to point out that a version of this article ran elsewhere?) But I digress.

To exemplify nimble medicine, Chase talks about a few interesting cases:
– Dr. Craig Koniver, who has closed his B&M clinic, and now runs a mobile clinic visiting patients at their homes or workplaces
– Medlion, a Silicon Valley company, completely bypasses the insurance brokered model of primary care and uses the Direct Primary Care model instead
– Companies like 2nd.md have made it easier for patients to get a second opinion.

Ladies and gentlemen, here’s medicine, as it perhaps should be practiced in this age of 4GS. Of the many cases that Chase discusses, the one that is most iffy for me is the mobile clinic one. Don’t get me wrong – I’m as much a sucker for a David-Vs-Goliath story, and if Dr. Koniver’s story were on Hallmark tonight, I’d be reaching for the tissues right about now.

However. The idea sounds awesome in theory. In practice, I’m not sure the model is sustainable. In fact there might be plenty of inefficiencies built into it.

Let’s say Dr. X sees about 8-10 patients a day. This is well below the 20 minute per patient average that most PCPs see their patients for.

Patient 1 lives in the North east quadrant of the city, Patient 2 work in the heart of downtown, and Patient 3 is in a city suburb, and so on.

One way to see all his patients is to go on a strictly First-Come-First-Serve basis, based on whatever his medical assistant has scheduled. This is not a feasible alternative at all. What if Patient 1 is 20 miles W from patient 2 and Patient 3 is far, far East of Patient 1. Horribly inefficient, which is exactly why algorithms such as the Travelling Salesman were invented in order to optimize travel paths.

The other alternative for the good doc is to apply the Travelling Salesman algorithm to his situation and base his visits to patients on geography. He might schedule his patients in such a way that he first sees all his patients that live in the Northeast quadrant and so on. Except now, the most pressing patients might need to wait till Dr. X actually services the patient’s part of the city.

Dr. X can of course optimize his travel path based on location as well as patient priority/needs, which is enough to give any grown person a raging migraine. And it doesn’t even get to the bottom of Dr. X’s biggest headaches, which is that
a) he spends an inordinate amount of time in traffic in
b) a gas guzzling vehicle that houses his medical equipment.

Waste of time, money and maybe even lives (imagine a patient dying while Dr. X is negotiating rush-hour traffic in DC)

So how can Dr. X compensate for this? By charging his patients for his time and attention. Or cutting down his clientele to a tiny sliver of a neighborhood. And yet, it makes for a wonderful story on “disruptive” medicine.

5010 Enforcement Delayed by CMS

Posted on March 15, 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.

The Twitterverse is alive with people tweeting about the news that Modern Healthcare broke about CMS deciding to delay enforcement of 5010 until June 2012. Here’s a quote from the article:

The CMS will not begin enforcing the mandated move to Version 5010 transaction standards for an additional three months, until after June 30.

In some ways this is just delaying the inevitable and giving payers a reason to delay their 5010 implementation even more. However, there were likely so many practices that wouldn’t get paid under 5010 and many payers who would be paying using the non-compliant 4010 that this was probably a smart move to delay. For those not that familiar with some of the issues, here’s a good post about how practices should deal with the move from 4010 to 5010. The post highlights the challenge to a practice when some payers are on 5010 and others aren’t yet ready for it.

I’d been hearing a lot of rumblings about the challenges of 5010, so this isn’t that big of a surprise. Although, you can be sure that CMS didn’t want to delay 5010. Particularly since CMS had recently delayed ICD-10 implementation as well. Although, I think fewer people will complain about this 5010 delay compared with those still arguing against the ICD-10 delay.

Epocrates EMR Killed Immediately After Launch

Posted on 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.

Back in 2010, Epocrates had its EMR ducks in a row. The company, known best for a very popular smartphone-based drug interaction database for physicians, announced plans to release a mobile SaaS EMR.  While Epocrates was jumping into a market more crowded than a barrel full of monkeys, one could see where leaders might see an EMR as an extension of the relationship it already had with physicians.

Now, Epocrates leaders have said “oops” and announced that they were killing the product,  telling investors and the public that building the darned thing was distracting it from its core business.  It does seem that the company was struggling with the EMR rollout process:  it didn’t roll out its first-phase product until August 2011 and didn’t get its Meaningful Use certification until February of this year. But this is the first time I’ve seen a company kill a product at this stage of development, particularly in such a high-profile manner.

It must have been more than a bit embarrassing to make the announcement during HIMSS12 when, of course, companies traditionally kick off products they’re planning to sell vigorously. As Epocrates was making plans to dump or sell their EMR, the company’s CMIO, Tom Giannulli, MD, was pitching the company’s new iPad EMR to editors.

As Epocrates itself pointed out, there aren’t too many dedicated iPad EMR offerings out there. So in theory, this should not have been a waste of the company’s time.  On the other hand, with the iPad still a new frontier for EMRs, we still don’t know whether it will ultimately work as a platform of choice for physicians.  As we’ve previously discussed on this blog, the iPad seems to be a pretty good medium for reading data but a very awkward one for entering data. Whether that’s a fatal flaw remains to be seen.

Truthfully, this looks like a failure of execution from start to finish, rather than a product that couldn’t possibly work. But these are tough times. Even the best execution may not work; and if so, Epocrates was probably wise to fold its cards before further damage was done.