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!

Is Healthcare Delivery Not ‘Sexy’ Enough for Investment?

Posted on September 1, 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.

On the latest #hcldr tweetchat, guest hosts Pam Ressler @pamressler and Pippa Shulman @drpippa posed an interesting question – why hasn’t the delivery of healthcare been an area of innovation? or put another way – is healthcare delivery not sexy enough to warrant investment?

Ressler and Shulman used the example of online retail giant Amazon. Among its many innovations, Amazon came up with a new way to deliver the retail experience. They found a way to deliver goods to people where and when they wanted it. Their approach to delivery was so good that it has since become the expected norm for anything purchased online.

Ressler and Shulman wanted to know why healthcare delivery wasn’t getting the attention it needed.

Shulman’s comment makes for an interesting thought exercise. Instead of just asking what it would be like if Disney ran your hospital. What if we asked what would happen if FedEx, Dominos or Amazon did. It would be fun to see uniformed “delivery agents” speed-walking through the hospital carrying meals and oxygen tanks.

Deanne Kasim @DKasim agreed with Shulman and Ressler:

Kasim’s “need it, want it” statement really struck a chord with the #hcldr community. It’s not just a case of delivering care in the way that patients want it (ie: Telehealth), we need to think about delivering it in when and where patients need it. Telehealth during regular business hours is helpful, but imagine how much more successful it would be if it were available after-hours when most people are home from work. The same with text messaging and email communication.

Kat McDavitt @katmcdavitt tweeted her frustration with this timing mismatch:

Dr. David Tom Cooke @DavidCookeMD went further and provided a great example of how appointment-booking could use an Amazon-upgrade.

Later in the chat, Dr. Cooke provided an compelling idea. Instead of trying to make healthcare delivery attractive for investment by making it “sexy” (which many believed would be very hard), why don’t we just present it as it is – a difficult and challenging problem.

I believe one of the best ways to spur investment is to have a bold pioneer show the world how successful they can be. Amazon showed the world how shopping online could be as-good-as (and now even better than) shopping in-person. FedEx showed us that next-day delivery could be done affordably and reliably. I believe it will take a healthcare pioneer to help blaze the trail for innovation in healthcare delivery.

For a time, Turntable Health in Las Vegas was one such pioneer. Zubin Damania MD, better known as @ZDoggMD, created a wholistic practice – one that made health a relationship rather than a transaction. They used technologies to engage patients in their care and they helped their patients with prevention as much as treatment.

James Legan MD, who practices in Montana, is another pioneer who projects his EHR so that patients can see what he is entering. He has also linked his EHR to a cloud-based customer-relationship-management (CRM) system so that his practice can be more efficient in the way they serve the community.

There are also practices like Access Healthcare in North Carolina and Izbicki Family Medicine in Pennsylvania that are demonstrating the benefits of direct primary care for both patients and physicians.

Hopefully there is a physician practice pioneer out there today that will become the beacon that will attract more investment in healthcare delivery. If you know of one, please email me or put their name in the comments section.

Various Medical Practice Model Types

Posted on May 3, 2017 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 EHR vendor (and many other services), Kareo, has put out a practice model guide which they call “Practice Models: The ABCs from ACOs to Concierge and Everything in Between.” With this guide they shared this picture that includes various practice models:

When I see an image like this I’m torn on if this is an extremely exciting time for physicians or if it’s a miserable time to be a physician. One thing is clear, times are a changing. The medical practice models of the past are going to be blown up by new models.

Take for example Telemedicine. Can you imagine any healthcare future where telemedicine is not part of that future? I can’t.

I’m still personally torn on concierge practices. I can see why they’re appealing to so many. I love the idea of unlimited primary care and getting insurance out of primary care. However, it’s not clear to me that this idea can scale across the entire healthcare system. Certainly the rich can do it no problem. Can the concierge model work for the middle and lower class? Many fans of concierge tell me it can. I’m still not so sure.

I know a lot of doctors that are part of ACOs. I don’t know very many that are excited by the work ACOs are doing. Most of them just feel like they need to be part of it to understand the future of medicine. They’re not joining ACOs because they think it’s something that shows a lot of promise for their patients.

I’m probably coming off a little more cynical than I am about these shifts. A number of these changes are really exciting to see happening. However, I’m also not blind to the challenges that many of these medical practice models face.

Needless to say, it’s an exciting and challenging time to be in medicine. The structure of how we pay for healthcare is being questioned and new models are being explored. This can be really exciting if you find yourself tracking the right wave. However, if you miss the wave, then you can be stuck out in the middle of the ocean wondering how you missed out.

Ditching Your EHR Just Isn’t Practical Regardless of Practice Model

Posted on May 12, 2016 I Written By

The following is a guest blog post by Tom Giannulli, MS, MD and CMO at Kareo.
Tom Giannulli - Kareo EHR
A recent piece by Anne Zieger on EMR & EHR opened up the discussion regarding whether or not direct primary care (DPC) physicians can or should ditch their electronic health record (EHR). And, this isn’t the first time the topic has surfaced. Other blogs have suggested that since EHRs are really just a means to gather documentation for insurance claims, DPC doctors don’t need them. Further, they offer other arguments against EHRs—like poor workflow and patient experience—however, the focus was really around insurance.

Yet, this is not a reason in and of itself for why DPC physicians should give up their EHRs. One role of an EHR is to improve documentation and coding to ensure physicians get paid. This is a good thing for DPC physicians, as well as traditional practices. The majority of DPC physicians use more than one payment model within their practice, meaning many also bill insurance for at least some patients.

A study conducted in 2015 showed that only 28% of physicians who used a DPC, concierge or other membership model in their practice had their entire patient panel on that model. The rest used it for some, but not all, patients. In fact, the largest group—37%—had 25% or less of their patients on a membership payment model. That said, insurance billing continues to be a challenge that those practices must navigate. An EHR can help them get paid correctly. It can also help them report for quality initiatives, like Meaningful Use and PQRS, prepare for the newly proposed MACRA ruling, and allow them to bill for chronic care management (CCM) services, while also improving patient experience and outcomes.

Independent practices understand that as we move forward in healthcare, a single payment model won’t do the trick. They need to be nimble and open to many options from fee-for-service to DPC to Virtual ACOs and other value-based reimbursement programs. The agile medical practices will be the ones that thrive in the long term. They are looking both at reimbursement models and industry changes, as well as increasing patient demands, such as increased connectivity, price transparency and improved patient access.

Using the EHR, Regardless of Practice Model

This is why even for those DPC practices that do go all in and don’t bill insurance, an EHR is essential. Many DPC practices offer largely primary care services with a focus on prevention and wellness. The right EHR can enable not only visit documentation but preventive care alerts and quick access to patient education. With a truly mobile EHR, physicians can engage patients face-to-face and share information in real time.

With the addition of integrated patient engagement features, such as telemedicine, self-care instructions and videos, tracking of wearable devices, and secure messaging through a portal, patients and their caregivers can stay in sync with their providers. This is an added level of convenience that DPC practices should support. Moreover, patient engagement components can be a critical part of managing wellness when studies show that most patients forget what their physician said after they leave the office. Keeping patients well means keeping the lines of communication open and a portal can play an important role.

Not only have patients expressed that they are more loyal to a physician who offers a portal (for the reasons stated above), but they have also said they like features like electronic prescribing. In fact, over 75% of patients have said they prefer an EHR to paper charts. Beyond the desire of patients, many states are beginning to mandate not just standard ePrescribing but also electronic prescribing for controlled substances. DPC physicians will not be exempt from rules like these.

There’s no other option but the EHR

It’s true that you can piece together just the technology features you want for your practice by combining several systems. However, the blog post referenced above seemed to suggest you could use an alternate system to an EHR. If you pick and choose features here and there, wouldn’t that mean more work entering data into a bunch of disparate systems? Or, logging into several different platforms translating to added time and less secure environments. One for ePrescribing, one for scheduling and reminders, one for the patient portal and maybe another one for patient collections?

There are cloud-based EHRs today that can offer most, if not all, of this in a single platform. One platform means one patient database, one login, and one easy-to-access system for all employees. And for DPC practices with small staff, no duplicate data entry or tedious jumping from system to system. In addition, a single end-to-end system that can support all the needs of a practice also means the practice can be positioned for flexibility. For example, if a DPC practice decides to accept insurance again or try another payment model, you’ll have the solutions you need without making significant changes to your workflow.

EHRs may not be perfect, but they are improving in their ability to meet increasing consumer demands and changing government regulation. Moving forward, more progressive EHR platforms will continue to offer add-on partners or native capabilities to solve consumer-centric needs. As the types of practice models change and evolve, the need for a core EHR should remain a constant, while additional features will vary. Thus, the flexibility and configurability of the EHR platform is critical to enabling long term success.

Full Disclosure: Kareo is an advertiser on this site.

Do We Want a Relationship With Our Doctor?

Posted on June 22, 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.

As is often the case, this weekend I was browsing Twitter. Many of the people and hashtags I follow are healthcare and health IT related. Many of the tweets related to the need to change the healthcare system. You know the usual themes: We pay too much for healthcare. We deserve better quality healthcare. We need to change the current healthcare system to be focused on the patient. Etc etc etc.

This wave of tweets ended with one that said “It’s all about the relationships.” I actually think the tweet had more to do with how a company was run, but in the beautiful world of Twitter you get to mesh ideas from multiple disciplines in the same Twitter stream (assuming you follow a good mix of people). I took the tweet and asked the question, “Do We Want a Relationship With Our Doctor?

If you’d asked me a year ago, I would have said, no! Why would I want a relationship with my doctor? I don’t want any relationship with my doctor, because that means that I’m sick and need him to fix something that’s wrong with me. I hope to never see my doctor. Doctor = Bad. Don’t even get me started with hospitals. If Doctor = Bad then Hospital > Doctor.

I’m personally still battling through a change in mindset. It’s not an easy change. It’s really hard to change culture. We have a hard core culture in America of healthcare being sick care. We all want to be healthy, but none of us want to be sick. Going to the doctor admits that we are sick and we don’t want anything to do with that. If we have an actual relationship with our doctor, then we must be really sick.

From the other perspective, do doctors want relationships with their patients? I’ve met some really jaded doctors who probably don’t, but most of the doctors I’ve met would love an actual, deep relationship with their patients. However, they all are asking the question, “How?” They still have to pay the bills, pay off their debts, etc. I don’t know many doctors who have reconciled these practical needs with the desire to have a relationship with their patients.

The closest I’ve seen is the direct primary care and concierge models. It’s still not clear to me that these options will scale across healthcare. Plus, what’s the solution for specialists? Will ACOs and Value Based Reimbursement get us there. I hear a lot of talk in this regard which scares me. Lots of talk without a clear path to results really scares me in healthcare.

What do you think? Do you want a relationship with your doctor? Do doctors want a relationship with their patients? What’s the path to making this a practical reality? Are you already practicing medicine where you have a deep, meaningful relationship with your patient? We’d love to hear your experience.

Is the Concierge Model A Real Option for Providers?

Posted on February 25, 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.

This article last month in Crain’s New York Business talks about the pressures that primary care doctors are facing and how those financial pressures are getting many of them to try cash-only or concierge practices. Here’s an excerpt from the article:

To stave off the pressures prompting many physicians to sell their practices to hospital systems, Manhattan internist Peter Bruno has tried a number of creative solutions. They have ranged from forming a now-disbanded group practice with 60 colleagues to his ongoing strategy of working at a nursing home one day a week to supplement his income in his current solo practice.

With reimbursements dropping, Dr. Bruno made the bold move in July of converting his six-employee private practice on East 59th Street in Manhattan to a hybrid concierge model. In concierge care, patients pay an annual fee or retainer to get more immediate, customized care. Hybrid practices treat both concierge and traditional patients. He worked with SignatureMD, a Santa Monica, Calif.-based network that assists physicians in doing so.

I don’t think we need to cover the financial realities of being a solo physician here. You’re all to aware of the challenges. However, I’m interested to hear what you think about the potential for the concierge model of medicine for primary care doctors? Is that an option for most primary care doctors?

I ask this because I’ve seen concierge medicine work in the rich areas (the above case is Manhattan for example), but I have yet to see it really work in poorer areas. If we’re shifting to concierge medicine, what does that mean for the poorer areas of the country?

Here in Las Vegas, they have an interesting hybrid model that they’re trying where concierge medicine is part of the insurance plan. In fact, it could be part of the insurance plan your employer provides. I just signed up for the plan, so we’ll see how it goes.

I’m also watching how the EHR market is adapting to this trend as well. Over on EMR and HIPAA I wrote an article titled “An EHR Focused On Customer Requests, Not MU” which talks about what an EHR would look like that was just focused on patient care and how Amazing Charts was offering that product.

Just today SRSsoft announced their new SRS Essentials product that’s a non-MU EHR as well. Although, they offer an interesting wrinkle that allows their SRS Essentials customers to move up to an meaningful use certified EHR should they decide they later want to take part in meaningful use (or whatever that program eventually becomes).

Of course, SRSsoft focuses mostly on the specialty market and not general medicine. Although, maybe this physician focused EHR product will be of interest to the emerging concierge and direct primary care doctors as well.

What do you think of these new models of medicine? What’s their place in the healthcare world? Where are they going in the future? Will their technology needs be different than other doctors?

Remote Patient Monitoring and Small Practices

Posted on February 18, 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.

We’ve started to see the proliferation of wireless health devices that can track a wide variety of health data and more of these devices are becoming common place in the home. Here’s a great tweet that contains an image of some of the popular devices:

While many of these devices are being purchased by the patients and used in the home, there are a number of other programs where healthcare organizations (usually hospitals) are purchasing the devices for the patients who then use the device at home. These programs are designed for hospitals to remotely monitor a patient and identify potential health issues early in order to avoid a hospital readmission.

For those who work in hospitals, you know how important (financially and otherwise) it is for hospitals to reduce their readmissions. While this is great for hospitals, how does this apply to small practices and general and family practice doctors in particular. There’s no extra payment for a small practice doctor to help reduce the readmission of their patient to the hospital. At least I haven’t seen a hospital pay a doctor for their help in this service yet.

What then would motivate a small practice doctor to leverage these types of remote patient monitoring tools?

Sadly, I don’t think there is much motivation for the standard small practice office to use them. It’s easy to see where a concierge doctor might be interested in these technologies. As a concierge doctor or direct primary care doctor, it’s in their best interest to keep their patient population as healthy as possible. As this form of care becomes more popular, I think these types of technology will become incredibly important to their business model.

The other trend in play is the shift to value based reimbursement and ACOs. Will these types of remote patient monitoring technologies become important in this new reimbursement world? I think the jury is still out on this one, but you could see how they could work together.

I’ve recently had a number of doctors hammering me on Twitter and in the comments of blog posts about how technology is not the solution to the problems and that technology is just getting in the way of the personal face to face connection that doctors have been able to make in the office visit of the past. Their concern is real and those implementing the technology need to take this into account. The technology can get in the way if it’s implemented poorly.

However, these people who smack the technology down are usually speaking from a very narrow perspective. EHR and other technology can and does disrupt many office visits. We all know the common refrain that the doctor was looking at the computer not at me. This is a challenge that can be addressed.

While the above is true, how impersonal is a rushed 10-15 minute office visit with a doctor? How impersonal is it for the doctor to prescribe a medication to you and never know if you actually filed it? How impersonal is it for a doctor to prescribed a treatment and never follow up with you to know if the treatment worked? How impersonal is it for the doctor to never talk or interact with you and your health unless you proactively go to that doctor because you’re sick?

Technology is going to be the way that we bridge that gap and these remote patient monitoring technologies are one piece of that puzzle. I believe these technologies and others make healthcare so much more personal than it is today. It changes a short office visit to treat a chief complaint into actually caring for the patient.

This is what most doctors I know would rather be doing anyway. They don’t want to churn patients anymore than the patient wants to be churned, but that’s how they get paid. Hopefully the tide is changing and we’ll see more and more focus on paying providers for using technology that provides this type of personal care.