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eClinicalWorks Faces Additional Fine For Violating Terms Of Fraud Settlement

Posted on August 10, 2018 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 mid-2017, the news broke that EHR vendor eClinicalWorks had agreed to pay $155 million to settle a whistleblower lawsuit brought by a former employee. The government had accused the company of doctoring its code to cover the fact that its platform couldn’t pass certification testing,

Following the agreement with the government, eCW was hit with two class-action lawsuits related to the certification fraud, one filed by a group of clinicians over funds lost due to the certification and another by patients who say that data display errors may have affected their care.

Unfortunately for eCW, its legal troubles aren’t over. The vendor is now on the hook for a fine it incurred for failing to comply with the Corporate Integrity Agreement it signed as part of its settlement deal. The $132,500 fine probably won’t have a massive impact on the company, but it’s a reminder of how much trouble the certification problem continues to cause.

In signing the CIA, which will be in place for five years, eCW agreed to a number of things, including that it would adhere to software standards and practices, identify and address patient safety and certification issues and meet obligations to existing and future customers. eCW also promised to report patient safety issues in a timely manner.

Apparently, it didn’t do so, and that triggered the penalty stipulated in the CIA. Among the terms buried in the hefty CIA document is that the vendor would be fined $2,500 for each day eCW failed to establish and implement patient safety issues as reportable events. Somehow, the vendor let this go for almost two months. Bummer.

Of course, eCW leaders must be reeling. This has to have been the most painful year in the company’s history, without a doubt. Customers are understandably quite angry with eCW, and some of them are suing. Patients are suing. Its reputation has taken a major hit.

The financial implications of the settlement are staggering too. Very few companies could cover a $155 million payout without a struggle, and even if a business liability insurer is covering the loss, the settlement can’t be good for its relationships with financial institutions. It’s a mess I’d wish on no one.

On the other hand, am I being too harsh when I suggest that under the circumstances, letting a reporting problem go for 53 days doesn’t speak well of eCW’s recovery? Yes, I’m sure that keeping up with CIA requirements has been pretty burdensome, but we’re talking about survival here.

I’m not going to hazard a guess as to whether eCW is on the skids or just struggling to recover from a massive blow to its fundament. But geez, folks. Let’s hope you get on top of these issues soon. Violating the terms of the CIA within year two of the five-year agreement doesn’t exactly inspire confidence.

Patient Satisfaction Drops After Ambulatory EHR Is Rolled Out

Posted on June 4, 2018 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, EHR implementations are supposed to not only make providers’ jobs easier but ultimately, improve patient satisfaction too. The idea is that EHRs will eventually add something beneficial to physician routines and ultimately improving care processes. Of course, there’s a lot of question as to whether EHRs can now or will ever do so, but researchers continue to look at different use cases.

For example, new research published in JAMIA has concluded that while they weren’t too thrilled by the ambulatory EHR they were using, a group of OB/GYN practices showed some enthusiasm once the outpatient EHR was attached to the one collecting data on their related inpatient perinatal unit.

The purpose of the study was to look at how the installation of the ambulatory EHR within the OB/GYN practices and subsequent connection to an inpatient perinatal EHR affected providers’ attitudes toward sharing of clinical information. It also looked at the impact all of this had on patient satisfaction.

To conduct the study, researchers collected data on both provider and patient satisfaction. They assessed provider satisfaction by conducting four surveys staged across the phased implementation of the EHR. To measure patient satisfaction, meanwhile, they drew on data from Press Ganey surveys managed by the healthcare network using the usual process.

Their ultimate goal was to determine how provider and patient perceptions changed as the EHR system enabled greater information flow between the OB/GYN practices in the hospital.

What the study found was that the outpatient OB/GYN providers were less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. On the other hand, they grew more satisfied with their access to information once the inpatient perinatal triage unit offered useful functions. Specifically, they were happier with their access to information from the inpatient system once its capabilities included the ability to send automatic data flows from triage back to the OB/GYN offices.

On the other hand, overall patient reactions to the project appeared to be negative. Patient satisfaction fell after the installation of the ambulatory EHR, and researchers could find no evidence that patient satisfaction rebounded after the information sharing process began between inpatient and outpatient settings.

In summary, the study concluded, if providers are dissatisfied with their EHR system, and those difficulties undercut patient care, the process could negatively impact patient satisfaction. The authors recommended that healthcare organizations take extra care to maintain good communication with patients during this process.

Coping With The Loss Of Your Ambulatory EMR

Posted on December 13, 2017 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.

Despite the struggles involved, most practices seem to have settled in with an EMR they can at least tolerate. Their workflows are, well, working, the practice management features seem to connect with the clinical ones and most clinicians are complaining about using it.

Yes, your practice may have had to go through a few systems before you found one everyone liked, wasn’t too expensive and had decent technical support to offer.  By this time, though you may have been a little scarred by the experience, hopefully practice leaders have gotten comfortable with the central role the EMR plays in the practice.

Then, you decide it makes sense to sell your practice to the local health system. It could be because it’s an irresistible deal financially, or you feel you can’t survive without their help and partnership, or any number of additional reasons. Everything looks good, but then you take a hit: your new “partner” wants to dump the EMR you worked so hard to find and customize. They want you to work on the same enterprise system they do.

Now, from a hospital’s perspective that may make sense. Here’s how one consulting firm lays things out:

“[When acquiring a medical practice] one critical issue is how to transition the workflow of these physicians and their staff from the practice-owned ambulatory EMR to the centralized hospital-owned EMR to ensure the efficient and safe delivery of care to patients,” it tells its hospital customers. In other words, it’s a question of when and how, not IF the hospital should require acquired practices to make the switch.

The thing is, while the hospital may have a comparatively large staff dedicated to integrating and managing the data pulled in from your ambulatory EMR, the reverse is probably not true. Unless your practice is particularly large, it probably only includes 5 to 10 doctors. In such practices, having even a single data expert on staff would be unusual. (Not to mention that hiring one part-time or as a consultant wouldn’t be cheap.)

In other words, for a while you may be fishing for your patients’ data as you transition to the larger team to which you will belong. Also, until the hospital health system completes integrating the data from your practice into its enterprise system, you may or may not have access to quality metrics important to running a practice these days, and the effect on your billing practices could turn out to be a disaster too.

At this point, I’m supposed to stop and tell you that all this can be handled efficiently if you take one step or the other. Unfortunately, I’m not sure there is any great happy ending to suggest at this point. If you have to give up your own ambulatory EMR, it’s probably going to be painful.

However, it doesn’t hurt to be prepared. There probably are some strategies, perhaps unique to your practice, that can blunt the impact of some of these problems if you’re prepared. That said, the move to a new EMR is always painful, even if the change ends up being a good one.

News Flash: Physicians Still Very Dissatisfied With EMRs

Posted on October 18, 2016 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.

Anyone who reads this blog knows that many physicians still aren’t convinced that the big industry-wide EMR rollout was a good idea. But nonetheless, I was still surprised to learn — as you might be as well — that in the aggregate, physicians thoroughly dislike pretty much all of the ambulatory EMRs commonly used in medical practices today.

This conclusion, along with several other interesting factoids, comes from a new report from healthcare research firm peer60. The report is based on a survey from the firm conducted in August of this year, reaching out to 1,053 doctors in various specialties.

Generally speaking, the peer60 study found that EMR market for acute care facilities is consolidating quickly, and that Epic continues to add market share in the ambulatory EMR market (Although, it’s possible that’s also survey bias).  In fact, 50% of respondents reported using an Epic system, followed by 21% Cerner, 9% Allscripts and 4% the military EMR VistA.  Not surprisingly, respondents reporting Epic use accounted for 55% of hospitals with 751+ beds, but less predictably, a full 59% of hospitals of up to 300 beds were Epic shops as well. (For an alternate look at acute care EMR market share, check out the stats on systems with the highest number of certified users.)

When it came to which EMR the physician used in their own practice, however, the market looks a lot tighter. While 18% of respondents said they used Epic, 7% reported using Allscripts, 6% eClinicalWorks, 5% Cerner, 4% athenahealth, e-MDs and NextGen, 3% Greenway and Practice Fusion and 2% GE Healthcare. Clearly, have remained open to a far greater set of choices than hospitals. And that competition is likely to remain robust, as few practices seem to be willing to change to competitor systems — in fact, only 9% said they were interested in switching at present.

To me, where the report got particularly interesting was when peer60 offered data on the “net promoter scores” for some of the top vendors. The net promoter score method it uses is simple: it subtracts the percent of physicians who wouldn’t recommend an EMR from the percent who would recommend that EMR to get a number from 100 to -100. And obviously, if lots of physicians reported that they wouldn’t recommend a product the NPS fell into the negative.

While the report declines to name which NPS is associated with which vendor, it’s clear that virtually none have anything to write home about here. All but one of the NPS ratings were below zero, and one was rated at a nasty -73. The best NPS among the ambulatory care vendors was a 5, which as I read it suggests that either physicians feel they can tolerate it or simply believe the rest of the crop of competitors are even worse.

Clearly, something is out of order across the entire ambulatory EMR industry if a study like this — which drew on a fairly large number of respondents cutting across most hospital sizes and specialties — suggests that doctors are so unhappy with what they have. According to the report, the biggest physician frustrations are poor EMR usability and a lack of desired functionality, so what are we waiting for? Let’s get this right! The EMR revolution will never bear fruit if so many doctors are so frustrated with the tools they have.

Providers In Underserved Areas Lagging On EMR Implementation

Posted on July 11, 2013 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.

Providers in large metros are less likely to have implemented EMRs than those in smaller metro areas and rural areas, according to a study written up by Healthcare Informatics.

The study, which appeared in Health Services Research, set out to determine whether EMR adoption was lower in traditionally underserved areas. To look at this issue, in 2011 researchers gathered data from 261,973 ambulatory healthcare sites with 716,160 providers, covering 50 states and the District of Columbia. Provider sites ranged from one-physician practices to large multi-physician groups, Healthcare Informatics reports.

Researchers found that areas with high concentrations of minority and low income populations, as well as those in large metropolitan areas were more likely to be in the lowest quartile of EMR adoption nationally, as compared with rural areas. The study also found that 43 percent of providers working in ambulatory healthcare sites had EMRs with e-prescribing capabilities, Healthcare Informatics reports.

Clearly, if researchers were expecting to find a lack of EMR adoption in these metro practices, they hit the nail on the head. I’d like to know, however, why things fell out this way.

Are metro practices lacking the resources to adopt EMRs in a more pronounced way than rural practices? Is there some phenomenon in the works in which underserved populations aren’t expecting EMRs, and therefore aren’t pressuring providers to implement them?

It’s worth noting that according to HIMSS data for Q1 2013, about 50 percent of ambulatory providers were still paper-based, and that nearly half of remaining practices were still stuck at Level 3 of adoption (CDR, access to results from outside facilities) or lower.

I’d argue that the gap between practices with mature implementations and those who are barely crawling is of equal importance and worth a study of its own. In the meantime, it is worth considering what can be done — beyond Meaningful Use incentives, clearly, or the gap wouldn’t exist — to be sure that EMR uptake doesn’t hit a snag with metro providers.

Where Are Usability Standards For EMRs?

Posted on December 7, 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.

The other day, I was talking with a physician about ambulatory EMRs.  “None of them are any good,” said the doctor, who’s studied EMRs for several years but never invested in one. “I can’t find a single one that I can use.”

Are any of you surprised to hear him say that? I’m certainly not.  Perhaps he’s exaggerating a bit when he says that absolutely none are usable at all, but it’s hard to argue that doctors cope with a counter intuitive mess far too often.  And of course, enterprise EMRs get if anything lower usability ratings from practicing doctors.

All of which brings me around to the notion of EMR usability standards, or rather, the lack of such same. While those in the industry talk often about usability, there’s no real consensus standard for measuring how usable a particular EMR is, despite noble efforts by NIST and impassioned advocacy by usability gurus in the field.

Certainly, private research organizations take usability into account when they survey clinicians on which EMRs they prefer. So clunky EMRs with lousy UIs do pay some kind of price when they’re rated by the clinical user. But that’s a far cry from having a standard in place by which medical practices and hospitals can objectively consider how usable their preferred EMR is going to be.

So, why don’t we have usability standards already in place?  The market still hasn’t punished vendors whose EMRs are a pain to use, so vendors keep on turning our products built around IT rather than clinical needs. The doctor I spoke with may have opted out of the EMR market, but most providers aren’t going to do that, Meaningful Use incentives being just one reason why. (It’s a “handwriting is on the wall” thing.)

It’s a shame CMS isn’t pushing vendors to produce Meaningfully Use-ABLE EMRs. That might do the trick.

Hospital Preparation for Meaningful Use

Posted on November 18, 2010 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.

HIMSS Analytics recently sent out some interesting results from a survey the did of hospital’s preparation for meaningful use. Here’s the results:

*Nearly one quarter (22 percent) of participating hospitals have the capability to achieve 10 or more of the required core measures in the meaningful use Stage 1 requirements.

*Some 34 percent of respondents have the capability to achieve between five and nine of the core measures for meaningful use.

*Just over 40 percent (40.47 percent) of the market indicated they have the capability to meet five or more of the menu items for meaningful use.


Click on the images to see the larger images.

As lone data points it’s hard to judge if hospitals are making progress or not. I’ve heard many people say that hospitals are going full bore towards meaningful use and that ambulatory practices are slower to adopt EMR and meaningful use. I’m not sure this is totally true. Plus, the lead time needed to implement in an ambulatory setting is so much shorter than in a hospital. Even a hospital that owns ambulatory practices.

I’m told that HIMSS Analytics will be doing this same survey every couple months. I’ll see about publishing the results as I get them so we can compare the change.

EMR US Adoption Rates

Posted on November 21, 2009 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.

People are always interested in learning what the adoption rates for EMR software are in the US. Chilmark recently posted about a Harvard School of Public Health study that was presented at the PHAT conference. This study focused on EMR adoption rates and the reasons that doctors and practice managers have chosen not to adopt an EMR, yet. Here’s a summary of the findings:

Hospital EMR

  • 90% of Hospitals have no functional comprehensive EHR
  • Mostly large hospitals and teaching hospitals do
  • Top Barriers to EMR Adoption: Inadequate capital (73%), maintenance costs (44%) and physician resistance (36%)

Ambulatory EMR

  • 83% do not have a functional EHR
  • 17% stated they have purchased an EHR, but not implemented
  • 26% plan to purchase an EMR in the next 2 years
  • Top Barriers to EMR Adoption: lack of capital (67%), finding a system that meets their needs (54%) and uncertainty of ROI (51%)