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The Ambulatory EHR Market with Raul Villar, Jr. CEO of AdvancedMD

Posted on September 5, 2018 I Written By

John Lynn is the Founder of the 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 and 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 ambulatory EHR market is near to my heart since that’s where I started when I entered this world of healthcare IT. My first job was implementing an EHR in a small ambulatory practice. As regular readers know, I’ve commented on how the independent small practice is in trouble. I’m not suggesting this is what I’d like to happen or what should happen, but there are certainly a lot of challenging pressures on small practices.

Along with these pressures, the ambulatory EHR market is extremely different today than it was 5-10 years ago. The $36 billion funded meaningful use era of EHR adoption was what I call the golden age of EHR. We could argue whether it was a golden calf or not, but from a market standpoint, the meaningful use money fueled adoption of the EHR.

Today’s ambulatory EHR market is very different. That’s why we were excited to sit down with Raul Villar, Jr. CEO of AdvancedMD to talk about his perspective on the ambulatory EHR market. We also talk with him about the evolution of AdvancedMD as it went from ownership by ADP to now being owned by Marlin Equity Partners and what those changes mean for their customers. Plus, we go over AdvancedMD’s acquisition of NueMD and what their strategy is behind the acquisition. Finally, we talk about EHR vendors as a platform and where he sees AdvancedMD taking their platform in the future.

If you’re interested in the ambulatory EHR market or in AdvancedMD, you’ll enjoy this interview with Raul Villar, Jr.

If you enjoyed this video interview, be sure to Subscribe to Healthcare Scene on YouTube and watch all of our healthcare IT interviews.

The Role of Practice Automation in Healthcare Communication

Posted on February 16, 2018 I Written By

The following is a guest blog post by Naveen Sarabu, Vice President of Product Management, AdvancedMD.

Practice automation was born out of the demand for quicker, more efficient manual processes. One of these manual processes is getting back to basics by using plain, old-fashioned communication – whether among members of a healthcare team, or between a physician and patient. Through automation we seek to deliver the right data to the right people exactly when they need it for the optimal provision of care. Likewise, we also seek to cut down on the manual processes that bog us down and add complexity. Many ambulatory practices struggle to find a solution that meets the complex demands of treating patients. Many admit that communication remains one of their greatest struggles – and miscommunication is one of the biggest frustrations for patients.

Doctors’ offices and hospital counterparts in the U.S. have shouldered $1.7 billion in malpractice costs due to poor communication—that’s 30 percent of all malpractice cases.

Automating manual processes of a physician practice enables the distribution of vital patient information in a fast, efficient, and accurate way. By leveraging an integrated physician-patient workflow system, physicians gain benefits of both accuracy and time in the sharing of clinical and billing information. This defines the next generation of the EHR: managing patient data among systems with authentic, automated data transfer and overall ease of use.

Task-based challenges

In a sense, many elements of communication, or information transfer points, are categorized as “tasks” by physicians. Obviously, every doctor in every office has his or her own way of organizing to-do’s. Rigid or cookie-cutter solutions can be more trouble than they’re worth for the busy ambulatory practice. The sheer volume of tasks and relentlessness of practice-specific workflow elements remain a huge burden to physicians and staff members. Without a straightforward means to categorize and execute frequently performed tasks such as prescriptions, refills, charge slips, notes, and orders, action items can fall through the cracks and leave room for errors.

Practices can address this by selecting flexible and customizable solutions that spell out all the moving parts of a practice and put them at the physician’s fingertips, much like an automated workflow analyst would. Visual tools like dashboards are helpful in presenting all tasks in a single snapshot, allowing physicians to manage to-do’s quickly and with ease to execute and communicate what must come next. Patient cards organized by specialty and workflow give physicians a snapshot of what’s really most important in a given moment. An integrated EHR dashboard not only helps physicians negotiate high-priority tasks of significant volume, it orients them to the vital patient information required for sound decision-making.

Impact of physician mobility on communication

A key asset of running a fully-automated ambulatory practice is the feasibility of team members accessing the same systems in real time, from any location. This has multiple benefits, including improved communication accuracy and workflow efficiencies.

“Many different user types [in my practice] from the nurse, to the office manager, to the biller, are all working with the same data on the same platform with real-time access. The seamless continuity is what I like about it,” said Larry J. Winikur, MD, pain management physician in Danville, Va.

Physician mobility is achieved through cloud-based technology and allows providers and staff members to communicate seamlessly from several practice locations: a home office, a patient’s home, the hospital or while traveling. It helps physicians respond to patient and staff messages quickly and stay on top of pressing work issues no matter where they are, preventing a backlog of tasks once they return onsite.

Surgical Specialists of Jackson (Miss.), treats more than 500 active patients, including those in rural areas. According to office manager Kristen Humphrey, having mobile capabilities as a result of complete practice automation has improved the quality of care the practice provides to patients. “When we have a physician seeing patients an hour away in a rural county, he takes the iPad and is able to log into the patients’ medical record and get any information he needs,” leveraging a seamless connectivity to the practice from our office in Jackson. “It makes life really easy,” Humphrey says.

Remote access also offers the feasibility of treating patients with video-based telemedicine, during hospital rounding, or home or hospice care. EHR mobile access is, without a doubt, a top priority for busy practices as they build out the future of their business.

The building blocks of patient engagement

As practices compete with other practices and larger health systems to secure and retain patients, these patients have developed a consumer-like healthcare mentality. Most patients want as much information about their condition as possible, so they can take a proactive role in their care. Patients want to engage with their physicians, by communicating openly and regularly about options and treatment decisions.

A fully-automated ambulatory practice utilizes patient engagement tools to secure satisfaction, retention, and referrals. Consider the ease with which patients can make appointments – online self-scheduling is a critical piece of functionality. Automated check-in tools such as an iPad kiosk are especially favorable to patients who can complete intake and consent forms electronically, eliminating the possibility of transcription errors that occur when data is transferred from paper to digital. A robust patient portal enables physicians to communicate with patients privately and efficiently; to share educational materials or share lab results.

Appointment reminders can also serve as simple communication tools that enhance not only the patient experience, but also the practice bottom line.

Dr. Winikur utilized a patient reminder system to help decrease costly no-show appointments in his busy schedule. The solution helped engage patients and reduced no-shows at his practice from about 12 percent to approximately two percent of appointments, which positively impacts his revenue.

The mobility benefits previously mentioned also allow physicians to demonstrate superior attention to patient needs. “I can pull up patient information no matter where I am in the world with internet access,” Winikur says. When patients receive a quick and effective response to inquiry, they perceive their doctor is in the office (even if he’s not!), which helps increase patient satisfaction.

Other important automated tools include post-visit surveys that enable patients to provide honest, timely feedback about the care they’ve received. These surveys can also trigger patients to post positive experiences to Google and social media outlets. In the event of a negative experience, patients can first communicate privately with the practice to resolve any potential problem or miscommunication.

The bottom line

In today’s competitive healthcare climate, patients have many options for their care. Practices that transition to cloud-based technology platforms with fully automated and customizable workflow elements show greater respect to the needs and time of their patients, increase revenues, and place greater value on their own needs and time. They also prove to be on the cutting edge of technology by streamlining processes and enhancing communication to deliver safer and more accurate care.

About Naveen Sarabu
Naveen Sarabu is Vice President of Product Management at AdvancedMD. Naveen has more than 15 years of experience developing innovative healthcare software solutions for the ambulatory, acute and accountable care organization (ACO) markets, including for Allscripts, Hill-Rom, and NTT DATA. Naveen received an MBA from University of North Carolina-Chapel Hill and an undergraduate degree from National Institute of Technology, Warangal, India.

Top 10 Blog Posts on EMR and EHR from 2017

Posted on January 4, 2018 I Written By

John Lynn is the Founder of the 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 and 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 we kick off 2018, I thought it would be fun to look back at the top 10 blog posts (based on views) in 2017 for EMR and EHR. It’s always great to see what people found interesting and which topics were of interest to readers. Plus, I’m always fascinated to see what old articles are still of interest to people. Not to mention, to look at what has changed since the article was written.

Facebook in Healthcare – What’s amazing about this blog post is that it’s from 2014. Looking back 3+ years later, I haven’t really seen Facebook become a big player in healthcare. Sure, there are plenty of patient groups on Facebook, but it’s not really a Facebook product. Facebook has done a number of things in healthcare over the years to get the word out about organ donation and things like that, but I currently don’t see them as a big player in healthcare the same way Amazon, Google, and Apple are looking at healthcare.

What the EMR Industry Can Learn From Facebook – Amazing that another article about Facebook was in the Top 10 and this one from 2012 was written by Priya Ramchandran. Her vision of a world where a patients health record was just automatically pushed down to a server every time we have a health encounter has been far from realized. The challenge of the comparison for me is that Facebook has a reason to push all that data together. In healthcare, there are reasons why organizations don’t want to push the data out to the patient. Until we change those reasons, we won’t see this vision despite hundreds of companies efforts to try and accomplish it. Yes, even Apple is working on solving this problem now and I think they’ll fail.

Epic Launches FHIR-Based App Platform – Epic’s launch of the Epic App Orchard platform was big news in 2017. I’ll admit that I’m still a bit skeptical about Epic App Orchard. Many herald it as Epic opening up their EHR to developers. I personally am skeptical and fear that it’s really just making public the connections they were already creating and is more PR than anything. Epic App Orchard isn’t a truly open API that would allow innovators and entrepreneurs to build on top of the Epic EHR. Plus, I fear that Epic App Orchard is just a new revenue stream for Epic. Those are my fears that I’ll be exploring as I talk to people in 2018 about it.

Publicly Traded Health IT Companies – I wouldn’t have thought of this blog post as one that would have garnered a lot of attention. Maybe that means we should do more work covering the publicly traded healthcare IT companies on this blog. They seem to be increasingly dominating the landscape.

Artificial Intelligence in Healthcare: Medical Ethics and the Machine Revolution – One of the great additions to EMR and EHR this year was Janae Sharp and this blog post was an excellent example of her work. Understanding the impact of AI in healthcare is going to be an extremely important topic over the next decade. I’m glad she kicked off the conversation since it’s a challenging one. I still keep thinking about the question she asked, “Can a machine learn empathy?” Chew on that one for a while.

EHR Innovation & Regulation: Friends or Foes? – I’m really glad that this post by Stephen Dart from AdvancedMD did so well. I think most doctors don’t appreciate the challenging situation EHR vendors are in when it comes to balancing compliance and innovation. I believe it’s the core of what’s wrong with most EHR software out there and contributes to a lot of physician burnout.

Is Cerner Edging Up On Epic? – This post was from 2016, but the question is still a good one. The reality is that both Cerner and Epic are doing amazingly well. I don’t see anything on the horizon that’s going to change it. Both of them are behemoths that are doing incredibly well. I don’t really see either of them cutting into the progress of the other either. What do you think?

Is Your Health Data Unstructured? – Enabling an AI Powered Healthcare Future – I still love the insight shared in this article. Technology doesn’t solve your problems. Technology amplifies your current state. If you’re doing a good job, technology will accelerate the good. If you’re doing poorly on something, technology will accelerate and amplify the bad.

#HIMSS17 Mix Tape – This is just a fun post leading into HIMSS that Colin has done every year with us for a lot of years. The exciting part is that when Colin posted this he was still working at a Healthcare IT vendor. We’re lucky to now have him formally as part of the Healthcare Scene team. I’m quite sure Colin will be doing a #HIMSS18 Mix Tape shortly. So, if you have suggestions, reach out to him on Twitter.

12 Reasons Why EMRs Improve Patient Care – How amazing that this post from 2011 is still doing so well. I imagine it’s because so many people are trying to understand the value of the EHR. Especially as it related to improving patient care. This post really deserves a future dedicated blog post to look at the 12 ways EMR improve patient care and how many of them have been realized. I’ll put it on my to-do list for 2018.

There you have it. The top 10 blog posts on EMR and EHR for 2017. It’s always fun to look back and see what’s changed and what’s stayed the same. Thanks to each of you for reading and supporting the work we do here. Now on to an awesome 2018!

Patient Generated Data, Workflow and Usability Coming Into Focus for EHR Vendors

Posted on October 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

At the recent Medical Group Management Association annual conference (MGMA17), I made a point of visiting as many of the EHR vendors in the exhibit hall as I could so that I could ask them two questions:

  1. What are you working on right now, given that there is a bit of a lull between ONC requirements?
  2. How do EHRs and EHR vendors need to evolve over the next 5 years?

Below are some of the best responses I received.

Steve Dart, Senior Director of Product Management at AdvancedMD believes that both EHRs and EHR companies need to fundamentally change their paradigms in order to thrive over the next five years. “EHRs should facilitate the job that needs to get done rather than serve as a documentation repository,” says Dart. “What is that job? Helping patients live healthier lives while at the same helping physicians be happier at work. We really missed the boat during the Meaningful Use (MU) gold rush. We neither helped patients be healthier nor did we make physician lives easier. In fact, as an industry we generally made things more difficult for doctors.”

AdvancedMD is charting a new path forward, instead of just fixing their user interface (UI), they are rethinking their entire approach to their EHR. The company is taking full advantage of the lull in MU requirements by using the time to bring together designers, UI experts, physicians and office managers to design a brand new EHR. Dubbed the “connect the dots” strategy, AdvancedMD is centering their next generation on clinical and administrative workflows.

“When you think about it, healthcare is really just a journey of sequential workflows,” Dart explains. “A patient starts by experiencing symptoms, then moves to research physicians online, schedules an appointment, comes in for their visit, goes to get lab tests done, comes back to discuss the results and fills a prescription. What EHR companies have done is create whole bunch of point solutions for each one of these situations. What we haven’t done well is connect these all together with technology. We siloed everything. Instead what we need to realize is that each situation is actually a complex workflow and we journey from one workflow to another as patients. What we need now, and what AdvancedMD believes, is that we should build technology that enables these workflows – make them easier and more seamless for patients and physicians. Data collection, for example, should happen on devices that both doctors and patients already use and in a way that doesn’t detract from the visit.”

To illustrate that AdvancedMD is doing more than just giving their theory lip-service, Dart showed an early design prototype of an EHR interface that provides a longitudinal view of a practice. Instead of clicking down into one patient to order labs or renew prescriptions and then clicking down into the next patient to do the same, the new interface groups all lab orders together and all the prescriptions together. One click and the physician can see all that they need to do and clicks once to push the orders ahead. The new interface is highly intuitive and functional.

Juan Molina, VP of Strategy and Business Development at CareCloud also believes that EHRs need to radically change. “EHRs need to allow doctors and their staff to do their jobs better,” says Molina. “We have to stop asking doctors to be data entry clerks and documentation specialists. They need to go back to being 100% focused on the patient and providing care. As an industry we have focused too much on checking the box. We need to move beyond that through better use of technology – especially modern cloud-based architectures.”

Mollna is most excited about the potential of real-time analytics and Artificial Intelligence (AI) at the point of care. He feels that the promise of precision medicine and true personalized care will only be possible if “massive amounts of health data is crunched and context from that data delivered to the doctor at the time when they are seeing a patient.” CareCloud is using the freedom from compliance requirements to work on new partnerships for deep analytics, AI and patient experience (read about their partnership with First Data here).

It is refreshing to hear EHR companies talk about collaboration. Over the past several years it was frustrating to see vendors attempt to build everything themselves only to end up with inferior solutions to what was readily available in other industries from other vendors. Partnership and collaboration are a welcome shift in EHR strategy.

athenahealth is actively pursuing partnerships as part of their More Disruption Please (MDP) program. “We are constantly expanding and improving our cloud-based platform to align with our vision,” says Stephanie Zaremba, Director of Government and Regulatory Affairs at athenahealth. “We want to see a healthcare industry free from administrative burden, enabled to care for diverse and disparate populations, and one that ultimately lets doctors be doctors. We believe that the current paradigm of federal regulations hinders, rather than helps, our industry from making this vision a reality. The innovation we so desperately need can’t flourish in the confines of check-the-box requirements that do not grow and evolve with technological advances. But even if we’re stuck with the regulatory status quo, in the next five years, we hope that vendors will continue to embrace their collective potential, shifting from competitors to collaborators in an effort to create a more provider-friendly, patient-facing, and connective tech landscape that captures the full continuum of care.”

The announcement of the partnership between Pulse Systems and InteliChart at MGMA17 is a prime example of this newfound collaborative spirit. For years Pulse offered a perfectly serviceable patient portal, yet they recognized that they would never pour as much time and effort into that area of their solution versus a company like InteliChart.

“We are pursuing an open-EHR strategy,” explains Chris Walls, President & CEO of Pulse Systems. “Although we provide a comprehensive solution, we recognize that clients may not want every component from our stack. They may want to keep a best-of-breed solution that they already have in place. Rather than force our clients to change, we are working to ensure we can integrate and play nice with others.”

Pulse arrived at this open approach by listening closely to clients and prospects. What they found was an under-current of a best-of-breed approach. Physician offices wanted to use different tools and applications from different vendors but the lack of integration and internal IT resources forced them to go with a single monolithic solution instead.

Through this listening exercise, Pulse also realized that it was more than an EHR vendor to its clients. Many of their clients are smaller practices which do not have ready access to technical support. Rather than deflect their client’s calls for help with mundane things like anti-virus updates, internet connection issues and printer failures, they leaned into it. They created a dedicated IT Field Support team that handles calls for routine IT issues and will even fly out to help a client if needed.

By proactively helping their clients in this manner, Pulse has found that they reduce EHR issues down the road and they engender tremendous loyalty. When you think about it Pulse is essentially applying a Population Health approach to their own clients – offering preventative maintenance to avoid more costly support calls in the future.

Most impressive is how Greenway Health is using this lull in compliance requirements. “Now that we are freed from working on ONC compliance work, we are putting focus on customer requested enhancements” says Mark Janiszewski, EVP of Product Managmeent & Corporate Development at Greenway. “Much to the delight of our customers, we can now apply resources to the enhancements that they have asked for, but that were lower in priority compared to what was needed to comply with regulations and the Meaningful Use program.”

Greenway is also using their “found time” to take a serious look at EHR usability. They recognize that there is tension between physicians and EHR makers caused by the endless clicking and confusing user interfaces. Greenway is hoping to relieve that tension by collaborating with clients to improve their system. According to Janiszewski, the company has planned a series of customer visits where a team of designers and engineers can observe how people interact with their system over a 2-3 day period.

The team has already identified several areas of improvement after observing how admin staff were copying down ID numbers from one screen onto post-it notes in order to key it in on a different screen to bypass a lengthy click-path. The team is hard at work to ensure data is transferred across the system more seamlessly.

Over the next five years, Janiszewski believes that EHR companies will have to embrace the concept of multiple care settings and multiple data sources: “EHRs will need to have a higher degree of interoperability as patients move between care settings – from acute care to rehab to home care or from acute care to elder care. EHRs will also need to solve for Patient Generated Data. We are all wearing fitness trackers and using apps to track our health. This data needs to be incorporated in a meaningful way into the EHR. “

The responses from MGMA17 demonstrates that companies are well aware of the negative feelings healthcare providers have towards EHRs. What is very encouraging is that fixing the user interface is only one of many different solutions being pursued by EHR companies. Rather than myopically focusing on the shiny object in front of them, companies like Greenway, Pulse, athenahealth, CareCloud and AdvancedMD are taking a step back and looking at healthcare with a broader perspective in order to identify opportunities for improvement. It will be interesting to circle back with them a year from now to see what progress has been made.

EHR Innovation & Regulation: Friends or Foes?

Posted on August 16, 2017 I Written By

The following is a guest blog post by Stephen Dart, Sr. Director of Product Management at AdvancedMD.

Healthcare insiders often point out how far behind the industry is in taking advantage of technology when compared to industries like retail or finance.

Technology providers get their share of blame for not designing it with a user in mind, a common argument heard in relation to the Electronic Health Record (EHR) ill-fitting place in the physician’s workflow. What is not talked about much is the role regulations play in shaping the technology and its use in healthcare.

Designing for compliance

Regulations are present in every industry and serve an important function of protecting individuals’ privacy and rights. Healthcare is highly regulated compared to many other industries due to the sensitive nature of Protected Health Information.  There is a good deal of additional regulations regarding programs such as MACRA, dedicated to monitoring provider performance and reporting it back to the government for reimbursement. As such, technology for providers must be designed to capture and report such data.

For vendors like AdvancedMD, one of the challenges is not in designing software to address the regulations, but rather in designing it under the ever-evolving guidelines and shifting deadlines. At times, well-meaning standards also fail to function as intended because they are not enforced end-to-end.

As an example, Meaningful Use Stage 2 required the EHR to meet a standard for interfacing with state immunization registries. For certification, technology providers had to produce a standard-format file and transmit it to the state immunization registry. However, every state had its own set of requirements and most states would not accept the format designated as the certification requirement but instead have their own additional or different requirements.

Consider lab results as another example. The EHR has to meet the engineering standard for using a LOINC code when receiving lab results to enable the physician to report metrics for regulatory attestation. Unfortunately, labs are not held to the same standard, and if the lab does not send results using the LOINC code, the physician cannot get credit when reporting or has to manually add a code for it to be considered for meeting the performance metric.

Naturally, there is cost incurred to design compliance features for vendors. At AdvancedMD, it has a significant impact on our research and development (R&D) budget. It also influences the other two R&D categories that have a direct impact on the end-user experience – keeping the technology on the cutting edge and innovation.

Integrating compliance into workflow

If regulations require physicians to report more data, vendors have a choice of designing compliance features to either ask the physician to input that information manually or to capture it automatically for reporting.

At AdvancedMD, a lot of effort goes into automating the regulatory requirements and integrating the necessary data collection naturally into providers’ existing workflow. If software identifies that the physician has just written an electronic prescription, there is no reason to ask him or her to go into a separate system and attest manually to having done so. This regulatory tracker can be natively built into the platform.

All roads lead to innovation

There is a lot of pressure on everyone in healthcare today and the industry is undergoing constant changes. Patients expect more as they pay more under high-deductible plans.  They increasingly rely on wearables to tell them how well they sleep and how many steps they need to take as part of a larger trend of taking command of their own health. Doctors and patients alike will benefit from this data being integrated into patient records.  If this patient-captured data can be merged into the patient chart, machine learning and analytics algorithms can in some cases predict what an independent practice needs to do next. This next step could be to streamline administrative processes for outreach messaging and improve care through electronic follow-up, leading to increased profitability and better care. Importantly, the EHR, practice management and all other technologies designed for providers need to liberate them to focus on patient care, not distract from it.

All these advanced features are the next frontier in healthcare and require vendors to dedicate a lot more effort and budget to innovation. While healthcare technology can’t be expected to catch up with an Apple or Facebook overnight with regard to user experience, there is much that can be done to close the gap. The industry as a whole will get there much faster when regulations and technology align to advance that goal.

Incremental regulatory steps in areas where standards can be controlled and enforced cradle-to-the-grave will benefit all parties. Vendors can plan their engineering budgets in advance and design fully functional compliance features. The industry will benefit from designing with the user in mind, furthering the role regulations play in shaping technology and its use in healthcare. Ultimately, regulations should allow providers to focus on care and to engage more meaningfully with their patients, thus optimizing the EHR’s role in the physician’s workflow.

e-MDs Acquires McKesson’s Portfolio of Ambulatory EHR Software

Posted on March 10, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post will likely be a little bit of inside baseball for many, but I think it’s a really important subject to cover since it’s going to impact so many practices and so many doctors. The news just came out that e-MDs was acquiring the suite of ambulatory EHR software owned by McKesson. For those keeping track at home, these are 6 of the assets acquired from McKesson: McKesson Practice Choice™, Medisoft®, Medisoft® Clinical, Lytec®, Lytec® MD, and Practice Partner®.

This shouldn’t be a surprise from a McKesson perspective. At HIMSS I heard multiple stories of people talking with McKesson staff who didn’t even know the names of their EHR software. Sad, but true. The only question for McKesson is will Paragon get sold off next?

For those that aren’t familiar with the history of e-MDs, it was purchased by Marlin Equity Partners back in March 2015 and merged with Marlin’s MDeverywhere company. Marlin then went on to acquire AdvancedMD from ADP in August of 2015 as they started to stock pile ambulatory EHR vendors. With the acquisition of the McKesson assets, Marlin now owns a large number of ambulatory EHR vendors.

This shouldn’t really be a surprise to anyone. We all knew that 300 EHR vendors wasn’t sustainable long term and we know that the EHR market has matured now that the false market meaningful use created is over. Some consolidation was bound to happen and it’s no surprise that a private equity firm is rolling up these companies as they seek to find the benefits of scale. The press release notes that the combined company’s products and services are being used by nearly 55,000 providers nationwide after this latest acquisition. That’s quite a presence in the ambulatory space.

The unfortunate downside of this type of EHR roll up is that not all of these EHR software can survive under one roof. Some of them have got to go. The only question is which one(s) will survive. Unlike EHR vendor founders, private equity companies are disconnected from the original product and so it doesn’t hurt as much for them to shut down a weaker product line as they consolidate users on to what they consider the best software. I’d be shocked if we didn’t see this happen with a number of EHR software that are now under e-MD’s (and Marlin’s) roof.

I also won’t be surprised if Marlin and e-MDs continue with more acquisitions. There are still a few hundred other ambulatory EHR vendors out there.

What Does e-MDs and AdvancedMD Under the Same Private Equity Mean?

Posted on August 11, 2015 I Written By

John Lynn is the Founder of the 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 and 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 healthcare IT world has seen a lot of movement and investment lately. Kareo raised $55 million recently. Modernizing Medicine acquired gMed last month. Accolade secured $22.5 million in funding. medCPU closed $8 million in financing. BoardVitals raised $1.1 million to build the Wikipedia of Medicine. Premier acquired CECity. Plus, that doesn’t even mention the $1 billion acquisition of Merge healthcare by IBM. I’m sure that there are many more that people can share in the comments.

There’s a lot of investment going into healthcare IT. No doubt there’s a huge opportunity for health IT companies. However, I’ve been most interested in what’s happening with the EHR companies involved in these deals. For example, one recent transaction that I didn’t mention above was Marlin Equity Partners acquiring AdvancedMD from ADP. The ADP acquisition of AdvancedMD never seemed to work. The idea of doctors offices being small businesses and ADP offered a bunch of small business services kind of made sense, but most doctors offices treat their EHR purchase very different than other tech investments for their office. The EHR purchase is its own beast. So, it’s not surprising that ADP would divest itself of an EHR software company.

What’s more interesting about the deal is that Marlin Equity Partners had already acquired EHR vendor e-MDs in March of 2015 and merged it with MDEverywhere. Now Marlin Equity Partners has e-MDs and AdvancedMD under their umbrella. I asked them what their plans were now that they had two EHR vendors (competitors) in their portfolio. They declined to comment until the acquisition of AdvancedMD closed.

Something has to give. I can’t imagine Marlin Equity Partners continuing with two software companies. Hard to say whether e-MDs will win or AdvancedMD, but I expect we’ll see one of them being sunset in the next year or two. They’ll offerer a way to convert from one to the other, but switching EHR software is never fun. It’s even less fun when it’s being forced upon you by the vendor.

The crazy thing is that I think we’re just getting started with this kind of activity. 300 EHR vendors is not sustainable long term. I don’t think we’ll get to 5 EHR vendors like most suggest, but we could narrow it down to 100 and still have plenty of options. That’s a lot of doctors being left high and dry when their EHR gets consolidated.

A Thoughtful Approach to EHR Implementation – 5 Tips

Posted on May 9, 2013 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While many in the EHR industry have started moving beyond EHR implementation, it’s worth realizing that only 55% of physicians have adopted an electronic health record (EHR). Yes, that means that 45% of physicians are still working on selecting and adopting an EHR. Ok, it’s probably more like 40% of doctors are looking to implement an EHR. The other 5% will stick with their paper.

Plus, along with the 45% of doctors who don’t use EHR, there are a whole slew of existing EHR users that are selecting and implementing an EHR as well. For example, 2 days ago I was at my son’s cub scout event where an opthamologist friend of mine cornered me and asked me about how he should go about selecting an EHR for his practice. He had just decided to go out on his own and open his own opthamology practice. What a perfect time to select and implement an EHR.

With this in mind, today I came across this whitepaper by ADP AdvancedMD called A Thoughtful Approach to EHR Implementation. They provide a number of stats, charts, and graphs using data from the CDC about EHR satisfaction and EHR use. The most intriguing number to me was the number of physicians that reported accessing the patient chart remotely using their EHR. That’s an EHR benefit that I don’t see talked about very often.

The whitepaper also offered these 5 tips for a successful EHR Implementation:

  1. Stay committed to your goal, but flexible in your approach
  2. Don’t short-change your training opportunities
  3. Don’t underestimate the impact to your workflow
  4. To pilot or not to pilot
  5. Optimizing the EHR

A lot more could be said about each point and they cover each point in detail in the full whitepaper, but the first and third ones really stand out to me. EHR is a commitment, but requires some flexibility. The best way to have a failed EHR implementation is to not be committed or to be inflexible. Your workflow will be impacted, but if you take a thoughtful approach to your EHR implementation it can be impacted for good.

EMR and EHR Whitepapers

Posted on April 23, 2013 I Written By

John Lynn is the Founder of the 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 and 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 a while I’ve been considering how the Healthcare Scene network of blogs can provide an EMR, EHR and healthcare IT whitepaper service. Over the many years I’ve been blogging about EMR and EHR, I’ve seen a lot of really valuable whitepapers created by the various EHR vendors. The time required to create a whitepaper is lengthy and for someone looking for an in depth look at a subject, a whitepaper is a nice option.

With that in mind I recently launched a new EMR, EHR and Healthcare IT whitepaper portal. We’re just getting started with the healthcare whitepaper portal, but we’ll be growing the content that’s available there over time. We’ll also be including a nice sidebar widget for those interested in the latest whitepapers we have to offer and we’ll embed a list of whitepapers in the email subscription as well.

We already have a number of great whitepapers available. For example, athenahealth created this whitepaper on Making the Switch: Replacing Your EHR for More Money and More Control. We’ve often talked about EMR switching becoming a very popular and important topic. This whitepaper helps a practice considering the EMR switch to go through an analysis of why to switch EMR or not.

Another whitepaper by NextGen is called The tips and tools to help you on the path to MU (Meaningful Use) and beyond. Considering less than 50% of providers have attested to meaningful use, this could be useful to many. It contains a lot of great resource links and some tips on how to approach meaningful use. If you’re looking at meaningful use stage 2, check out this one from AdvancedMD called Achieving Stage 2 Meaningful Use in Private Practice.

Those are just a few examples. You can find many more of them on this EMR and EHR whitepaper library page. I look forward to adding a lot more interesting whitepapers in the future. Hopefully you’ll find the content valuable.

ImagineMD EHR Closes Doors and Amazing Charts Acquired

Posted on November 19, 2012 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A lot of activity lately in the EHR world and I think this is just the beginning. ImagineMD posted an “Important Notice” (quoted at the bottom of this post) on their website that said that they’re no longer providing ImagineMD services. The interesting thing is that a respected EHR consultant that I know absolutely loved the Imagine MD EHR. This guy had worked with hundreds of EHR software, so he knew the difference. Sadly, as often happens in business it’s not enough to have a great product. You also have to be able to market that product well. Looks like ImagineMD went out with their heads held high and didn’t leave their doctors high and dry. That’s always good since even an assisted transition is hard.

In other unrelated news, today it was also announced that Amazing Charts was acquired by Pri-Med. This is an interesting acquisition since Amazing Charts has a nice EHR footprint and Pri-Med wasn’t previously in the EHR space. Although, it does seem that Pri-Med’s physician connection could be really beneficial to Amazing Charts. I’m going to try and do an interview with Amazing Charts and Pri-Med which I’ll post on EMR and HIPAA or EMR and EHR.

ImagineMD is part of the EHR consolidation that everyone said is coming. We just can’t sustain 300+ EHR vendors. However, the Amazing Charts acquisition isn’t part of EHR consolidation. It’s similar to the ADP Acquisition of AdvancedMD where Neil Versel aptly pointed out wasn’t the expected EHR consolidation. Add these changes to large EHR vendors shutting down EHR software like MyWay and GE Centricity Advance and were slowly winnowing down the number of EHR vendors out there.

ImagineMD Client Notice:

Dear Clients of Imagine MD:

This notice is to inform you that as of September 30, 2012 (the “Effective Date”), we will no longer be providing Imagine MD Services as defined in the End User License Agreement – Terms of Use as set forth on our website at (the “Services”). The Services may or may not include, without limitation, electronic prescribing “eRx”, meaningful use attestation services, and other related services. After the Effective Date, you will no longer have access to any of our Services and we will terminate all access codes that we have provided to you.

Following termination of Services we will return to you, or, upon your written instruction, transfer to another party, all patient records, including personal information you have provided to us or we have created and maintained on your behalf. Such information will be provided in an encrypted format. You will be contacted in the near future regarding this transfer of information. The files will include information through the period ending September 30, 2012, or the date as of which you request such data, whichever occurs first. Thirty days after the information is transferred, we will destroy all patient records and we will not retain a copy of the information. Additionally, we will provide you with a log of all relevant disclosures, if any, of protected health information that you may need to fulfill your obligations under the Health Insurance Portability and Accountability Act of 1996 with regard to the provisions and accounting of such disclosures.

We are terminating all of our services as we are in the process of exiting the business. All of us at Imagine MD thank you for using our services.

If you have any questions, please contact us by email at or call us at (877) 394-7774.

eHealth Made EASY, LLC (a/k/a Imagine MD™)

Full Disclosure: Amazing Charts is an advertiser on this site.