Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Survey Says Few Americans Want EMRs

Posted on August 31, 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.

I don’t know what to make of the following survey, which suggests that EMRs have a very long way to go before they’re accepted by the public.  Let’s lay out the numbers and see what you think.

According to new research from Xerox, only 26 percent of Americans would like to see their medical records digitized, despite otherwise having a love affair with all things digital.

Xerox, which hired Harris Interactive to do the study, did an online survey of 2,147 U.S. adults in May, asking them several questions related to their perceptions of EMRs. Forty percent said that digital medical records could deliver better and more efficient care, true, but 85 percent said they were concerned about the use of EMRs, Xerox reported.

Whatever is generating their resistance — and I’ll speculate on that in a minute — it’s not because they’ve never seen digital medicine. When asked how their providers recorded digital information during their last visit, 60 percent said data was entered into a tablet, laptop or in-room computer.

So, if Americans love online banking, Internet gaming and ordering from restaurants via the Web, why would medical records concern them so?

My guess is that the results we see here may be a result of the approach the researchers took.  If someone asked me: “Do you want something delicious and cool to eat during hot weather?” I’m pretty sure I’d say yes. On the other hand, if I was asked “Would you like to try this brand new ‘ice cream’ thing you’ve seen your neighbors eat?” I’m not as sure I’d be high on the idea.

If we’re going to forward the dialogue on EMRs with consumers, we’re going to have to help them understand why EMRs matter, and how they get the job done. Sure, the more esoteric stuff we discuss here might fly over their heads, but if you explained, for example, that EMRs can protect them from medical errors and and coordinate care better, they’ll get it.

Will Hospital Ownership of Small Practices Kill Ambulatory EHR Vendors?

Posted on August 30, 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.

There are a lot of interesting trends in the EHR and healthcare industry right now. One trend that everyone is seeing and talking about is the trend of hospitals buying up ambulatory practices. There are a number of reasons that we see this happening. Not the least of which is the move to Accountable Care Organizations. While I still think that this trend is cyclical, there’s some possibility that the small ambulatory practice might be in long term danger.

If the small ambulatory practice is in danger, what does that mean for EHR software vendors?

One of the first projects that hospital acquired practices experience is the move to the hospital owned EHR. In fact, I know of many cases where the move to the hospital EHR was part of the contract. I’m not sure all of the reasoning, but many hospital systems are moving their recently acquired practices onto EHR before they move their existing practices.

I have yet to see a hospital system use anything but a large EHR vendor. In many ways it makes sense. The hospital system is buying practices across dozens of specialties. Many of the smaller EHR vendors focus on a few different specialties and so they just aren’t an option for a big multi specialty environment.

Then, there’s the issues of scale and control. Can a smaller EHR vendor support such a large implementation? Can a smaller EHR vendor provide the hospital system the control they want of their EHR environment? The first one is an interesting challenge since I’ve seen some hospital owned ambulatory environments having scaling issues with some of the largest EHR vendors. The problem as I saw it from the outside was that the hospital system couldn’t get the attention of the right people at the large EHR vendor. This wouldn’t have been an issue at a small EHR vendor.

With that said, I do think that small EHR vendors will have a huge challenge getting into the large hospital owned clinical practices. Will enough small practices remain for ambulatory EHR vendors to survive? I enough will survive, but in the short term there could be some shrinking of that market.

Bringing up Your EMR in an Era of Meaningful Use

Posted on August 29, 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.

By now I assume most of you have read the recently released final rules for Stage 2 of Meaningful Use – or at least the plethora of synopses available online. (It wouldn’t hurt to read what Lynn Scheps wrote about meaningful use stage 2 over at EMRandHIPAA.com.)

Whatever level of knowledge you may possess about these rules and how near or far they deviate from those proposed, I think we can all agree that the EMR industry (developers and end-users) is suffering immense growing pains as vendors and physicians adjust to the Meaningful Use scheme. (I use that term in the British sense, by the way.)

Julie McGovern, CEO of Practice Wise, cleverly equated implementation of an EMR to being pregnant in a recent blog:

“In the beginning, you are tired and often feel like you have morning sickness. The first trimester is the hardest. In the second trimester, you start to get your legs under you, your energy starts to return, and you feel less beaten down by the EHR. By the third trimester, you start to see the light at the end of the tunnel, it’s starting to be second nature, the product is making more sense (hopefully), you’ve got good workflows and everyone is starting to forget how hard the first trimester was.”

I’ll go one step further and equate utilization (i.e. the regular use of an EMR after go-live) as relates to the various stages of Meaningful Use with bringing up that baby. I might even disagree with her – pregnancy is often the easy part (provided you’ve had no complications along the way, of course, be they IT, managerial, administrative, cultural or otherwise). You’ve got the PR-friendly ribbon-cuttings, parties and press releases that hospitals often initiate around their go-lives. Well-deserved events, to be sure. But then come the hard parts, when you and your colleagues integrate that new bundle of joy into your daily lives (i.e. workflows).

Eventually the EMR will develop its own personality, form bonds with its users, bring joy to many for the clinical outcomes it improves, and hopefully not cause too many tears of frustration along the way. Hopefully it will gossip with its peers at other hospitals, and even aspire to interoperate in the same circles as its distant cousin – health information exchange. You can bet that it will end up costing more money than you had anticipated – upgrades, add-ons, etc.

The years will go by – 2014 and 2016 will be here before you know it. Hopefully, the EMR that caused so much joy when it was first brought into this world shiny, new and virus-free will still bring a smile to the face of its users, and better care to the patients whose information it so closely guards.

Having Already Failed Once, DoD Snubs Open Source For Second EMR Try

Posted on August 28, 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.

In theory, the VA now has everything it needs to standardize and upgrade the open source VistA EMR, especially after forming the Open Source Electronic Health Record Agent (OSEHRA) organization.  But when it comes to bringing that expertise to the DoD’s EMR projects, it seems OSEHRA alone can’t do the trick.  Sadly, it’s no surprise to find this out, as the DoD has an abysmal track record on this subject.

OSEHRA, an independent non-profit open source group, was launched about a year ago. The group is working away at improving compatibility between versions of VistA at the 152 VA medical centers.  According to an InformationWeek piece, there’s now about 120 different versions of VistA ticking away within the VA system.  OSEHRA hopes to create a common core — a “minimum baseline standard”  for 20 VistA modules — which will make it easier for the medical centers to deploy enterprise-wide apps.

The DoD, meanwhile, is hacking away at a joint system with the VA, called iEHR, which is due for initial testing in 2014.  A few months ago, DoD told Congress that while open source technology will be part of iEHR, the agency will also include commercial and custom applications, using a service-oriented architecture.

What that means, in practical terms, is that OSEHRA will be cooling its heels waiting for DoD contractor Harris Corp. to build an Enterprise Service Bus and open source APIs to allow for open source development on the project.

Now, that wouldn’t raise my suspicions so much if DoD hadn’t proven to be a collosal failure at developing an EMR.  Did anyone else here catch the major slap GAO delivered to DoD a couple of years ago, noting that its 13-year, $2 billion AHLTA application was a near-complete fizzle?  If anyone at DoD had humility, or if their bosses were held accountable for AHLTA’s staggering losses, nobody would let them drive the technical choices on this project.

Am I the only one who sees a recipe for billions more in DoD losses here?

Increasing Revenue Through Clinical Connectivity

Posted on August 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.

As most of you know, I’ve been working hard to create more content related to revenue in healthcare. My interest in this has grown even more since I had the chance to attend the ANI 2012 conference in Las Vegas where I got the chance to talk to people like Rishi Saurabh from GE Healthcare. It’s amazing how many people (myself included) don’t think that revenue cycle management is sexy since there are so many opportunities in healthcare.

One example of missed healthcare revenue management opportunities has to do with connecting clinical content with the financial data. From my experience, it’s quite rare to see a healthcare institution that does a great job of connecting these two pieces of data. The clinical data is in a silo of its own and it’s only looked at by the clinical people. The financial data is in its own financial data silo and only ever looked at by the financial people.

These silos are a problem and present a really big opportunity for healthcare organizations to increase the revenue of their organization. Although, doing so in an organization is not always easy. It takes great leadership to bridge the two content silos. Plus, you need someone who’s effective at understanding both the clinical and financial point of view. So, it’s not hard to understand why this doesn’t happen more often.

I think the most basic example of what I’m talking about can be seen in the annual checkup. I was talking with a colleague the other day when I told him that I couldn’t remember the last time that I’d been to my doctor. In fact, I honestly don’t even know my doctor’s name (which might beg the question of whether he’s really MY doctor). Why hasn’t my doctor sent me a reminder about the need to do an annual physical exam? Why don’t I have a regular connection with my doctor that helps me to take better care of my health?

I think at least part of the answer to this is that the clinical is not tied to the financial. If the clinical were tied to the financial, then the doctor could provide a care plan for me and my specific health needs. Then, the financial could ensure that I’m following that care plan. Imagine the revenue implications of me visiting the doctor regularly as part of a well defined care plan.

I’m sure that many of you out there are likely skeptical about whether patient reminders will actually change behavior. Certainly in many cases, these reminders will be discarded or ignored. However, a certain percentage of those reminders will be followed. This will mean your patients get better care and your clinic increases their revenue. Plus, maybe we need to take a deeper look at the care plans that we offer patients. If large percentages are ignoring the suggestions, then maybe we need to rethink the plan or how we’re communicating that plan to the patient.

There are certainly plenty of other medical examples where a follow up doctor visit would make sense and improve the health of your patients. In fact, you could get really sophisticated with how you reach out to your patient population.

I believe the key to success of this type of program is to integrate the clinical data with the financial data. It creates tremendous power and amazing opportunities.

EMR Security, Afghanistan EMR, and Regina Holliday EMR Video

Posted on August 26, 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.

Time once again for our roundup of interesting tweets from around the EMR twittersphere. We really go around the world with one of these tweets. Hopefully you find them useful and interesting.

I don’t think most of you know that I’m also working on a redesign of my websites. It’s still got a little ways to go, but I think it’s coming together nicely. It’s going to add some features I’ve wanted for a while and make the design look a lot better. I’ve had the current design for more than 6 years, so it was time. One of the best features of the new website is Twitter embeds. I can’t wait!

Without further ado, a few EMR and health IT tweets with some of my own commentary:


I always love when people talk about the huge EMR security risk. When you look at the breach list and the healthcare data security issues, EMR barely shows up. There are so many other security issues with medical practices that are much more vulnerable. Not that we should give EMR security a pass, but EMR security is likely one of the most secure things in a medical office. So, this is good advice.


I always love to hear how the military uses EMR. They use EMR in some of the most challenging places imaginable. I think we can learn a lot from their experiences.


I think this is a really interesting contest by ONC. I’m looking forward to see more of the videos that are created. My fear is that most of the videos will be EHR companies that push their power EMR users to make something. We’ll see how it turns out.

We Know What’s Right, but It’s Hard

Posted on August 24, 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 perusing various blogs, I came across Matthew Gibson, MD’s blog and this really compelling article titled, “It’s So Easy, and Yet…” Here’s one especially poignant section:

What I see day in and day out is complications of simple, easy to manage problems like diabetes, high blood pressure, asthma, etc. These are things that we KNOW how to treat. We know how to prevent complications. And yet, I just had a man last week who required half of his foot to be amputated as a complication of untreated diabetes. I had a woman this week who came in seeing snakes on people’s clothing, because her blood pressure was so high it was affecting her mind. Last month, I saw a man who had large amounts of yeast growing in his mouth and groin because his blood sugar (and thus urinary sugar) was so high.

This morning, I’m caring for a truly pleasant gentleman with COPD (bad chronic lung disease usually caused by smoking). He hasn’t smoked in the last 15 years, but he smoked quite heavily before that. Even though he’s been doing things all right as far as his lungs are concerned for the last 15 years, he has to live with the consequences of his actions prior to that. For the last several days, I’ve seen him decompensate and gasp for air, feeling like he’s drowning, because he can’t get the air to move through his lungs like he should. How did this kind old man get to this point?

At the core of his comments is the idea of how do we motivate ourselves to do something we know we should be doing. This is a really hard question to answer and something we probably will never solve completely. However, I think there’s plenty of room to improve even if we never become perfect at it.

Over on Smart Phone Healthcare we’ve spent a lot of time reviewing various mobile health applications. I’d say that the large majority of mHealth applications are about trying to help solve this problem. Plus, I think the mobile device connected with good data about ourselves is one method that will help us be healthier.

Related to this idea, is what I’ve called treating healthy patients. This is a concept that won’t leave me since I think it will be a fundamental part of the future of healthcare. I believe we’re on the brink of a series of devices and technology that will help us monitor our bodies in such a way that we can identify sickness within us before we feel sick. This information won’t make everyone change their behaviors, but it will help many.

We’re in the very early stages of monitoring our bodies and connecting all that data with action. However, it’s exciting to see that now many of these things are possible thanks to powerful computing and a new generation of devices.

Retail Clinics Buddy Up with HIT and MU Lessons from a 3 Year Old

Posted on August 23, 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.

It seems I can’t read a blog, tweet or even old-fashioned newspaper these days without coming across some headline having to do with retail health clinics buddying up to healthcare IT. Announcements from two companies come to mind.

The first involves SoloHealth – developer of health and wellness kiosks. It received FDA approval for its product earlier this summer, and followed that development up with news of financial investment from benefits company WellPoint. It also has announced plans for a national rollout of its kiosks sometime this fall. Assuming its website is up to date, there are SoloHealth Stations across the country at retailers like Walmart, Safeway, Publix, Sam’s Club and Schnucks. CVS appears to be its only traditional retail clinic customer at the moment.

The second involves Greenway Medical – well-known developer of electronic health records for a variety of healthcare organizations, including Walgreen’s Take Care Clinics. It currently has placed its PrimeSuite EHR in more than 700 Take Care pharmacies, and just this week announced plans to implement a custom EHR – WellHealth – to coordinate other types of care in Walgreen’s locations. I’m assuming the two EHRs will play nice with other from an interoperability standpoint. Implementation of all WellHealth systems is expected to be finalized by the end of next summer.

I can’t help but point out that both of these companies are based in Atlanta, and I know for a fact that their team members congregate at similar networking events, so I wonder if we’ll see some synergy between them in the near future.

In any case, if predictions of retail clinic growth prove to be true – a recent Rand Report notes that use of retail health clinics quadrupled between 2007 and 2009, and will continue to grow – it seems likely that we’ll see HIT companies popping up in clinics across the country.

On a completely unrelated note, my daughters and I joined the rest of my company’s team members at the annual Lekotek Run 4 Kids last weekend. We had a great time and enjoyed helping out a great cause. I was a bit apprehensive that my youngest would enjoy it. Before the race began, she came up to me with number in hand and asked, “Is it okay if I lose?” Happily, she declared herself a winner after crossing the finish line and receiving a medal along with her sister and all the other kids.

I wonder if this is a sentiment physicians in smaller practices sometimes have as they consider implementing an EHR in the hopes of receiving Meaningful Use incentive money. Do some just want to throw in the towel and “lose?” Do some not want to even start the race? I’m always looking for additional Meaningful Use wisdom from the under-6 set, so please enlighten me in the comments below.

ONC Plans Mobile Device Security Guidance For Smaller Practices

Posted on August 22, 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.

In an effort to help them avoid joining the long list of mobile device-based security failures, ONC has set plans to release guidance for small- and mid-sized providers on securing mobile devices. The agency, which has projects underway studying how mobile devices are used by smaller providers, expects to release its conclusions in the spring, reports HealtcareInfoSecurity.com.

If you read medical business trades, it’s hard to miss that slip-ups with mobile devices and mobile data sources (such as flash drives) have been a major source of security breaches.  In fact, it seems that 54 percent of the 464 HIPAA breaches affecting 500 or more individuals reported to HHS between September 2009 and July 2012 involved the loss or theft of unencryped mobile devices.

To see how smaller medical practices are doing in this area, ONC is conducting an effort dubbed the Endpoint Security Project, for which it has built a health IT implementation typical of mid-sized and small doctor practices, including tablets, laptops, smartphones, storage devices and desktops. When the project is done, ONC plans to release configuration settings which should help these smaller practices protect their mobile device data.

This is all well and good. After all, smallish practices seldom have an IT staffer to advise them on such things, and a simple set of best practices can go a long way.

Still, what strikes me is that time and again, it’s the larger providers whose data breaches are making the news.  That’s no surprise — big providers and hospitals simply have more data endpoints to control — but given this, ONC might make slapping larger organizations into shape more of a priority.

Of course, it’s also true that we don’t want small providers being the “weakest link” in HIEs, or compromising even a comparatively small amount of patient data in their practices. But if ONC’s assuming that big practices and hospitals can take care of themselves, they’re ignoring a truckload of evidence that it ain’t so.

Creating The Intelligence-Based EMR

Posted on August 21, 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.

Given today’s trends, I’m betting most of us would agree that EMRs need to evolve from transaction-based to intelligence based systems. They need to do better leveraging “big data,” make context-based care recommendations and support smart processes.  John likes to call them “Smart EMR,” but what would such an EMR look like?

In a recent issue of Hospitals & Health Networks, Dr. John Glaser, Ph.D.,  lays out a long– but useful– explanation as to why EMRs are stiffly focused on transactions such as documenting a visit or writing a prescription. (Very short summary: That’s just where they are coming from historically.)  Then he offers a take on the “intelligence-based EMR” and what it will take to get there.

Glaser, CEO of the Health Services Business for Siemens Healthcare, was formerly VP and CIO for Partners HealthCare, so he’s got both the vendor and the care provider view, which I think proves very useful for this discussion.

In his article, he argues that the next-gen EMR needs to offer the following:

  • foundational sets of templates, guidelines and order sets that reflect the best evidence or established best practice;
  • a process-management infrastructure that supports basic transaction checking such as drug-drug interactions, as well as asynchronous alerting like panic lab reporting and process monitoring and guidance;
  • team-based care support such as shared work lists, as well as tools for patient engagement and health information exchange;
  • novel decision aids like predictive models that can tell us if a particular patient is likely to be readmitted because he or she is fragile or has a substandard social situation at home that may negatively impact healing;
  • context-aware order sets and documentation templates that guide the physician and help infer what types of orders should be placed and what types of documentation should be done
  • intelligent displays of data, intelligent correction and identification of data, and extraction of structure by going through free text and pulling out quality measures or problems that were not previously in a patient’s problem list, for example.

The question is, are these functions science fiction (i.e. many years away from being standard) or just an evolutionary leap from today’s systems?  What are you seeing out there?