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EMR Subtleties Are Hard to Quantify

Posted on August 23, 2011 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.

How would you respond if someone asks you, what makes a great EMR?

There are plenty of answers that come to mind. However, at a recent conference I attended, I was struck by a simple description a doctor made about a feature he liked in his EMR.

He described how a new patient portal they implemented would ask the patient a bunch of important questions. Then, the output to the doctor would display a list of those questions and responses. However, he loved how the so called “incorrect” answers were in a different color.

I’m sure many of you might be thinking, well isn’t that an obvious feature? Some of you might also be thinking, is John really trying to tell me that this feature is what makes that EMR great? The answer is Yes on both accounts. Although with one caveat.

First, it’s an obvious feature, but there are hundreds and possibly thousands of obvious features that EMR companies haven’t had the time or the foresight to put into their EHR package. Maybe they were working on a legacy EHR where such an obvious feature was difficult to implement, so they put it off. Maybe they were trying to get the software release out the door and so they didn’t take the time to add such an obvious feature. Maybe they just haven’t had “the time” to add it. The point being that there are many “obvious” features that never make it off the development list.

Second, these subtle features are what makes an EMR great. No, not one subtle feature. I’m talking about hundreds of subtle features that are done throughout the entire EMR system. The compilation of many subtle features creates a beautiful symphony of EMR greatness.

How then do you measure hundreds of small but great features in an EMR?

EMR Development, Where are the Doctors?

Posted on August 15, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at

John Lynn, over at recently wondered about Depth in an EMR Conference.  He recently attended the Health Tech Next Generation conference in San Francisco, where few doctors seemed to be present.  This is such a classic blunder in health IT: not checking with the end users to make sure what you are designing is on the right track.  To be honest, it’s what killed our first EMR experience and led us to fire the EMR vendor.  There was no clearly tangible evidence that a medical doctor was involved at all in programming the thing.  We felt like we were beta testing their system for them as they worked out “bugs” based on our suggestions.  Frankly, we should have requested three months worth of consulting fees in the end, but that’s a story for another time.

John also made the comment that he had never seen a true EMR conference focused on doctors, practice managers, and actual users of the EMR.  Hmm… I think Practice Fusion Connect 2010 did this to a large extent.  Lots of pics and videos from the event can be found here.  Better yet, I’ve already scheduled time to go the next one, Practice Fusion Connect 2011, which is being held in SF on 11.11.11.  It’s slated to be about  five times bigger this year according to my inside sources at the company, and they are expecting about 1,000 attendees.  When I was there in 2010, it seemed heavily focused on the end users, who seemed to make up a large portion of the audience.

John mentioned the important and puzzling question of “how do you get enough doctors together at an EMR conference?”  I’ll admit that one’s a tough nut to crack, since you are asking private practice docs to give up income to get to a conference during a weekday, on which most conferences like this are held.  If it’s held on a Saturday or over a weekend, that might help.  If the target audience is employed and salaried, then it’s not as much of a problem getting them there since they aren’t really losing any pay/income.  The problem with that is: employed docs generally don’t make buying and implementing decisions.  Those of us who do, typically are in small practices of our own.  An interesting conundrum to solve, but bring it on.  More conferences like this are definitely needed since American healthcare runs on private practice doctors, their managers, and their staff.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at










Build Or Buy, EMRs Cost A Bundle

Posted on March 7, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Ever wonder whether it would be smart to drop your vendors and grow your own EMR/HIT apps?  Here’s some food for thought.

Today, I ran across a very detailed analysis of the labor costs involved in developing EMR and HIT applications, straight from the blog of the always perceptive Shahid Shah.

Shah, a longtime health IT consultant and former CTO for two EMR companies, just posted a list of the various professionals you’ll need to develop such applications — and the high prices these professionals command:

  • Clinicians and healthcare professionals (HCP) like docs, nurses, etc. – perhaps as consultants
  • Senior project manager – about $150k per year
  • User interaction engineer (UX, usability) – about $120k per year
  • Web design engineers (UI, HTML, JavaScript) – about $60k to $100k per year
  • Web developers (UI, PHP, JavaScript, HTML) – about $80k to $120k per year
  • Mobile app developers (iOS, Android, etc.) — about $90k per year
  • Database modeler and information architect (SQL) — about $150k per year
  • Database administrator (SQL) –  about $120k per year
  • API engineer (REST / SOAP) – about $120k per year
  • Service code engineers (Java, Ruby, etc.) – about $150k per year
  • Security analyst and privacy engineer (HIPAA, HITECH, Sarbox, etc.) — perhaps as consultants, $175k per year
  • Cloud infrastructure admins (Amazon, Eucalyptus) – about $90k per year
  • Network infrastructure admin / engineer (TCP/IP, etc.) – about $120k per year
  • Data integration engineers (ESB / ETL / connectors) – about $90k per year
  • HL7 and healthcare data integration conformance engineers – about $90k per year
  • Technical documentation specialist – about $60k per year
  • Quality assurance directors (test strategy, test planning) — about $120k per year
  • Quality assurance engineers (test planning, manual execution) – about $80k per year
  • Quality assurance automation (automated execution) engineers – about $90k per year
  • Trainers (folks with healthcare office experience plus tech knowhow) — about $60k per year

As Shah notes, this is what U.S. specialists typically cost.  (Working with Indian developers can save you about 35 percent, he estimates.)  Still, either way we’re talking about a bundle on compensation alone.

Despite the expense, there are probably some large institutions which will choose to develop EMRs or related applications internally.

After all, if you have a deep enough IT bench, developing even high-end applications might be cheaper than paying for high-end packaged products.  And of course, there’s always something to be said for apps developed exactly to your own specs.

Ideally, your institution could build its own EMR/HIT apps, then license them to other institutions or co-develop them with partners who can sell them elsewhere. (For an example of how this might work, check out the $400 million partnership deal the University of Pittsburgh Medical Center did with IBM a few years ago.)

Still, Shah’s analysis is more than a little sobering, isn’t it?