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Cloud-Based EHRs With Analytics Options Popular With Larger Physician Groups

Posted on April 20, 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.

Ever wonder what large medical practices want from the EHRs these days? According to one study, the answer is “cloud-based systems with all the bells and whistles.”

Black Book Research just completed a six-month client satisfaction poll questioning members of large practices about their EHR preferences. The survey collected data from roughly 19,000 EHR users.

According to the survey, 30% of practices with more than 11 clinicians expect to replace their current EHR by 2021, primarily because they want a more customizable system. It’s not clear whether they are sure yet which vendors offer the best customization options, though it’s likely we’ll hear more about this soon enough.

Among groups planning an EHR replacement, what appealed to them most (with 93% ranking it as their preferred option) was cloud-based mobile solutions offering an array of analytical options. They’re looking for on-demand data and actionable insights into financial performance, compliance tracking and tools to manage contractual quality goals. Other popular features included telehealth/virtual support (87%) and speech recognition solutions for hands-free data entry (82%).

Among those practices that weren’t prepared for an EHR replacement, it seems that some are waiting to see how internal changes within Practice Fusion and eClinicalWorks play out. That’s not surprising given that both vendors boasted an over 93% customer loyalty level for Q1 2018.

The picture for practices with less than six or fewer physicians is considerably different, which shouldn’t surprise anybody given their lack of capital and staff time.  In many cases, these smaller practices haven’t optimized the EHRs they have in place, with many failing to use secure messaging, decision support and electronic data sharing or leverage tools that increase patient engagement.

Large practices and smaller ones do have a few things in common. Ninety-three percent of all sized medical and surgical practices using an installed, functional EHR system are using three basic EHR tools either frequently or always, specifically data repositories, order entry and results review.

On the other hand, few small to midsize groups use advanced features such as electronic messaging, clinical decision support, data sharing, patient engagement tools or interoperability support. Again, this is a world apart from the higher-end IT options the larger practices crave.

For the time being, the smaller practices may be able to hold their own. That being said, other surveys by Black Book suggest that the less-digitalized practices won’t be able to stay that way for long, at least if they want to keep the practice thriving.

A related 2018 Black Book survey of healthcare consumers concluded that 91% of patients under 50 prefer to work with digitally-based practices, especially practices that offer conductivity with other providers and modern portals giving them easy access to the health data via both phones and other devices.

Practice Fusion Drops Free Software Model

Posted on February 26, 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.

More than a decade ago, an upstart company grabbed the health IT world’s attention when it rolled out a free advertising-based EMR. The company, Practice Fusion, wasn’t the only venture offering free EMR access. But its brash attitude and unapologetic defense of its business model won the industry’s grudging acceptance, and its occasional bouts of hyper-aggressive sales tactics actually made its story more interesting.

Now, in the wake of its $100 million agreement to sell out to Allscripts, the end of an era has arrived. The company has announced that it’s now switching to a paid subscription model, priced at $100 per physician per month, according to CNBC.

Prior to his 2015 ouster from the company, founder and then-CEO Ryan Howard had continued to insist that Practice Fusion software would always be free. Apparently, over the long run, this didn’t work out. (No need to shed any tears for Howard, by the way. He’s comfortably ensconced in a new venture called iBeat. The company is building a cellular smartwatch that monitors heart rhythms and calls emergency responders in a crisis.)

Most observers see the $100 million sale to Allscripts as a bad deal for Practice Fusion which, as my colleague John Lynn notes, had raised more than $157 million over its lifespan.

It seems fair to say that if the free EMR model was still working, Allscripts wouldn’t have been able to pick up Practice Fusion so cheaply.Its increasingly tarnished reputation can’t have helped either. The company has always pushed the envelope with its aggressive marketing strategies, but in recent years it pretty much burst the envelope open.

Two years ago, Practice Fusion got slapped by the FTC for engaging in deceptive consumer marketing practices. Its problems began in 2012 when it began to send out email messages to patients of providers who used its EMR. According to the agency, Practice Fusion never told consumers that the doctors didn’t send the email messages, nor informed them that their responses to the emails would be made public. It’s hard to tell whether this played a role in the firm’s seeming decline, but it certainly didn’t help.

In all fairness, Howard and his team deserve a great deal of credit for breaking ground in HIT. Offering doctors an alternative to the hugely expensive, doctor-hostile EMRs available to medical practices at the time was a big accomplishment and provided a lifeline for many medical practices. Unlike many of its old-school competitors, Practice Fusion was physician-centric and affordable, and that was no small feat either. But over time, its big idea didn’t prove out. Practice Fusion has been forced to admit that there’s no (even ad-based) lunch.

Let’s see what Allscripts does with Practice Fusion’s assets and whether it invests in its latest addition to the corporate family. My guess is that Allscripts will let its latest toy languish and eventually die, but you never know. Maybe Practice Fusion will be reborn.

Allscripts to Pay $100 Million Cash to Acquire Practice Fusion

Posted on January 8, 2018 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.

Today, Allscripts announced that it would pay $100 million cash to acquire EHR vendor, Practice Fusion. I wouldn’t quite say this is a fire sale, but in Silicon Valley it’s pretty close when you consider that according to CrunchBase Practice Fusion had raised over $157 million. These seem to be the kind of transactions that Allscripts likes to do. I’ve heard it said that Allscripts is the place where EHR software goes to die. That’s a corrupt way of describing what I think has been their strategy.

The press release said that Practice Fusion supports 30,000 ambulatory practices and 5 million patients. I wouldn’t be surprised if the practices number is inflated since it’s a free EHR and a lot of ambulatory practices signed up to check it out, but don’t actually use the software. I’m at least 2-3 of those practices and haven’t touched my accounts in years. The July 2017 meaningful use attestation data listed 8,440 providers using Practice Fusion software. So, Practice Fusion still has a good size user base, but it’s probably closer to 12-15k practices in my opinion.

As I’ve looked at the ambulatory EHR market, I’ve often been describing EHR vendors as distribution channels as opposed to EHR software vendors. If you go around any exhibit hall, EHR vendors aren’t really selling EHR software much anymore. In most cases, EHR vendors are catering to their existing user base and then using them as a distribution channel for other products and services. With this in mind, Allscripts acquisition of Practice Fusion expands their distribution channel. That’s a valuable thing.

One other piece of this transaction which I believe many won’t understand is Practice Fusion’s relationships with life science organizations. Those relationships are how Practice Fusion was funding their free EHR. I’ve heard mixed reviews on those relationships, but no doubt Allscripts is hoping those relationships can generate more revenue for their company when they add Allscript’s large userbase.

Fierce Healthcare also found in the SEC filing for this acquisition an interesting note about Practice Fusion receiving a request from the US Attorney’s office:

The SEC filing also noted that Practice Fusion received a request from the U.S. Attorney’s Office for the District of Vermont in March 2017 requesting information and documents as part of a civil investigation into the company’s EHR certification. Allscripts stated that although Practice Fusion has complied in “a cooperative, thorough and timely manner,” any legal proceedings, damages or settlements could “adversely impact” future operating results.

No doubt these requests are an extension of the $155 million eCW Whistleblower lawsuit. I expect most major EHR vendors have had some sort of inquiry after the eCW lawsuit. Hopefully, the team at Allscripts vetted the inquiries well especially given Practice Fusion’s past history of pushing the envelope. Considering Practice Fusion’s FTC Charges and Settlement, I’d think that they’d have been careful about their EHR certification, but it’s hard to take the Silicon Valley mentality out of your culture.

The other obvious tie into this story is Allscript’s previous acquisition of McKesson’s HIT software business. I’ll admit that it’s hard for me to keep up with all the EHR software that exists under Allscripts umbrella, but with the addition of Practice Fusion, Allscripts certainly has an EHR software for healthcare organizations of every shape and size. Plus, I expect they run their EHR businesses at break even while they make most of their money off of other lines of business they can sell to their EHR customers. It’s not just Allscripts that’s seen how much money can be made doing revenue cycle management and providing other services to their EHR users.

I will be interested to see what Allscripts chooses to do with Practice Fusion long term. Will they eventually sunset the Practice Fusion EHR and encourage users to migrate to one of their other EHR? Will they start charging Practice Fusion EHR users for the EHR? You can imagine the outrage that would come if they did start charging, but EHR switching isn’t a simple process. So, I’d imagine that many practices would just start paying and it would take months and years for them to finally switch EHR vendors and many would probably just decide to stay with “the devil they know.” That would be a big gamble on the part of Allscripts, so it will be interesting to see if they make it. Then again, maybe they have enough revenue from being a distribution channel to Practice Fusion users that they’ll be able to continue the free EHR model. Time will tell.

Those are some initial thoughts on the acquisition of Practice Fusion by Allscripts. I should also note that the acquisition isn’t complete. It still has to go through the standard ant-trust evaluation process, but I don’t expect that to be an issue. What do you think of this acquisition? Is this a good move by Allscripts? What does this mean for Practice Fusion users?

Health IT End of Year Loose Ends

Posted on December 13, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

In that random scrap heap I refer to as my memory, I’ve compiled several items not worthy of a full post, but that keep nagging me for a mention. Here are the ones that’ve surfaced:

Patient Matching. Ideally, your doc should be able to pull your records from another system like pulling cash from an ATM. The hang up is doing patient matching, which is record sharing’s last mile problem. Patients don’t have a unique identifier, which means to make sure your records are really yours your doctor’s practice has to use several cumbersome workarounds.

The 21st Century Cures Act calls for GAO to study ONC’s approach to patient matching and determine if there’s a need for a standard set of data elements, etc. With luck, GAO will cut to the chase and address the need for a national patient ID.

fEMR. In 2014, I noted Team fEMR, which developed an open source EHR for medical teams working on short term – often crises — projects. I’m pleased to report the project and its leaders Sarah Diane Draugelis and Kevin Zurek are going strong and recently got a grant from the Pollination Project. Bravo.

What’s What. I live in DC, read the Washington Post daily etc., but if I want to know what’s up with HIT in Congress, etc., my first source is Politico’s Morning EHealth. Recommended.

Practice Fusion. Five years ago, I wrote a post that was my note to PF about why I couldn’t be one of their consultants anymore. Since then the post has garnered almost 30,000 hits and just keeps going. As pleased as I am at its longevity, I think it’s only fair to say that it’s pretty long in the tooth, so read it with that in mind.

Ancestry Health. A year ago September, I wrote about Ancestry.com’s beta site Ancestry Health. It lets families document your parents, grandparents, etc., and your medical histories, which can be quite helpful. It also promised to use your family’s depersonalized data for medical research. As an example, I set up King Agamemnon family’s tree. The site is still in beta, which I assume means it’s not going anywhere. Too bad. It’s a thoughtful and useful idea. I also do enjoy getting their occasional “Dear Agamemnon” emails.

Jibo. I’d love to see an AI personal assistant for PCPs, etc., to bring up related information during exams, capture new data, make appointments and prepare scripts. One AI solution that looked promising was Jibo. The bad news is that it keeps missing its beta ship date. However, investors are closing in on $100 million. Stay tuned.

 

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.

Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 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.

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

Practice Fusion Settles FTC Charges Over “Deceptive” Consumer Marketing

Posted on June 20, 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.

In what may be a first for the EMR industry, ambulatory EMR vendor Practice Fusion has settled Federal Trade Commission charges that it misled consumers as part of a campaign to gather reviews for its doctors.

Under the terms of the settlement, Practice Fusion agreed to refrain from making deceptive statements about the privacy and confidentiality of the information it collects from consumers. It also promised that if it planned to make any consumer information publicly available, it would offer a clear and conspicuous notice of its plans before it went ahead, and get affirmative consent from those consumers before using their information.

Prior to getting entangled in these issues, Practice Fusion had launched Patient Fusion, a portal allowing patients whose providers used its EMR to download their health information, transmit that information to another provider or send and receive messages from their providers.

The problem targeted by the FTC began in 2012, when Practice Fusion was preparing to expand Patient Fusion to include a public directory allowing enrollees to search for doctors, read reviews and request appointments. To support the rollout, the company began sending emails to patients of providers who used Practice Fusion’s EMR, asking patients to review their provider. In theory, this was probably a clever move, as the reviews would have given Practice Fusion-using practices greater social credibility.

The problem was, however, that the request was marketed deceptively, the FTC found. Rather than admitting that this was an EMR marketing effort, Practice Fusion’s email messages appeared to come from patients’ doctors. And the patients were never informed that the information would be made public. And worse, a pre-checked “Keep this review anonymous” only withheld the patient’s name, leaving information in the text box visible.

So patients, who thought they were communicating privately with their physicians, shared a great deal of private and personal health information. Many entered their full name or phone number in a text box provided as part of the survey. Others shared intimate health information, including on consumer who asked for dosing information for “my Xanax prescription,” and another who asked for help with a suicidally depressed child.

The highly sensitive nature of some patient comments didn’t get much attention until a year later, when EMR and HIPAA broke the story and then Forbes published a follow up article on the subject. After the articles appeared, Practice Fusion put automated procedures in place to block the publication of reviews in which consumers entered personal information.

In the future, Practice Fusion is barred from misrepresenting the extent to which it uses, maintains and protects the privacy or confidentiality of data it collects. Also, it may not publicly display the reviews it collected from consumers during the time period covered by the complaint.

There’s many lessons to be gleaned from this case, but the most obvious seems to be that misleading communications that impact patients are a complete no-no. According to an FTC blog item on the case, they also include that health IT companies should never bury key facts in a dense privacy policy, and that disclosures should use the same eye-catching methods they use for marketing, such as striking graphics, bold colors, big print and prominent placement.

Practice Fusion Founder Launches Wearables Startup

Posted on May 31, 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.

Free EMR vendor Practice Fusion has always been something of a newsmaker. Since its launch in 2005, the company has drawn both praise and controversy for its revenue-generation approach, which has included the analysis and sale of de-identified patient data and advertising to physicians.

But it’d be hard to question Practice Fusion’s success, particularly given that it found its legs during a hyper-competitive period of EMR vendor growth capped by the Meaningful Use incentive program. Over the company’s lifespan, it has grown to serve over 110 million patients, and reportedly supported more than 70 million patient visits over 2015. It also attracted over $150 million in venture and private equity funding. Will it provide a great return for investors, time will tell, but they’ve definitely left their mark on the EHR industry.

At the helm of Practice Fusion until last year was CEO and Founder Ryan Howard. Howard – whom I’ve interviewed now and again over the years — certainly doesn’t lack for confidence or creative thinking. So I was intrigued to learn that Howard has stuck his toe into the wearables market. Clearly, Howard has not wasted time since August 2015, when he was booted out as Practice Fusion CEO. And if he believes a wearables startup can make money in this rapidly-maturing niche, I’m inclined to give it a look.

Howard’s new startup, dubbed iBeat, is creating a watch which constantly monitors and analyzes users’ heart activity. The device, which transmits its data to a cloud platform, can alert emergency medical services and, using an onboard GPS, provide the wearer’s location when a user has a heart attack or their heart slows down below a certain level. Unlike competitor AliveCor, whose electrocardiogram device can detect heart rhythm abnormalities such as atrial fibrillation, it has no immediate plans to get FDA approval for its technology.

iBeat expects to sell the device for less than $200, though if users want the emergency alert service they’ll have to pay an as-yet unnamed extra monthly fee. That puts it smack in the middle of the pack with competitors like the Apple Watch. However, the startup’s focus on cardiac events is fairly unusual. Another unusual aspect to the launch is that Howard is targeting the 50- to 70-year-old Baby Boomer market. (Imagine a more-focused version of the LifeAlert “I’ve fallen and I can’t get up” service, which focuses on the 75-plus market, Howard told MobiHealthNews.)

My take on all of this is that there may very well be something here. As I wrote about previously, my own heart rhythm is being monitored by a set of devices created by Medtronic, a set-up which probably cost a few thousand dollars in addition to the surgical costs of implanting the monitoring device. While Medtronic’s technology is doubtless FDA approved, for not-so-serious cases such as my own a $200+ plus smart watch might be just the ticket.

On the other hand, I doubt that uncertified devices such as the iBeat watch will attract much support from providers, as they simply don’t trust the data. So consumers are really going to have to drive sales. And without a massive consumer marketing budget, it will be difficult to gain traction in a niche contested by Apple, Microsoft, Fitbit and many, many other competitors. Not to mention all the competitors in the “I’ve fallen and I can’t get up” category as well.

Regardless of whether iBeat survives, though, I think its strategy is smart. My guess is that more-specialized wearables (think, I don’t know, iSugar for diabetics?) have a bright future.

Dumb Question 101: What’s Workflow Doing in an EHR?

Posted on March 29, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

This was going to be a five year relook at Practice Fusion. Back then, I’d written a critical review saying I wouldn’t be a PF consultant. Going over PF now, I found it greatly changed. For example, I criticized it not having a shared task list. Now, it does. Starting to trace other functions, a question suddenly hit me. Why did I think an EHR should have a shared task list or any other workflow function for that matter?

It’s a given that an EHR is supposed to record and retrieve a patient’s medical data. Indeed, if you search for the definition of an EHR, you’ll find just that. For example, Wikipedia defines it this way:

An electronic health record (EHR), or electronic medical record (EMR), refers to the systematized collection of patient and population electronically-stored health information in a digital format.[1] These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.[2]

Other definitions, such as HIMSS are similar, but add another critical element, workflow:

The EHR automates and streamlines the clinician’s workflow.

Is this a good or even desirable thing? Now, before Chuck Webster shoots out my porch lights, that doesn’t mean I’m anti workflow. However, I do ask what are workflow features doing in an EHR?

In EHRs early days, vendors realized they couldn’t drop one in a practice like a fax machine. EHRs were disruptive and not always in a good way. They often didn’t play well with practice management systems or the hodgepodge of forms, charts and lists they were replacing.

As a result, vendors started doing the workflow archeology and devising new ones as part of their installs. Over time, EHRs vendors started touting how they could reform not just replace an old system.

Hospitals were a little different. Most had IT staff that could shoehorn a new system into their environment. However, as troubled hospital EHR rollouts attest, they rarely anticipated the changes that EHRs would bring about.

Adding workflow functions to an EHR may have caused what my late brother called a “far away” result. That is, the farther away you were from something, the better it looked. With EHR workflow tools, the closer you get to their use, the more problems you may find.

EHRs are designed for end users. Adding workflow tools to these assumes that the users understand workflow dynamics and can use them accordingly. Sometimes this works well, but just as often the functions may not be as versatile as the situation warrants. Just ask the resident who can’t find the option they really need.

I think the answer to EHR workflow functions is this. They can be nice to have, like a car’s backup camera. However, having one doesn’t make you a good driver. Having workflow functions shouldn’t fool you into thinking that’s all workflow requires.

The only way to determine what’s needed is by doing a thorough, requirements analysis, working closely with users and developing the necessary workflow systems.

A better approach would be a workflow system that embeds its features in an EHR. That way, the EHR could fit more seamlessly its environment, rather than the other way around.

Practice Fusion Cuts 25% of Staff

Posted on February 4, 2016 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.

Following on our post a few weeks ago about the potential Practice Fusion IPO, news just came out that EHR vendor, Practice Fusion, has now cut its staff by 25%. The Techcrunch report says that the cuts were across the board and affected roughly 74 people. Many are suggesting that the two reports are related since cutting staff is a great way to improve your profit numbers before an anticipated IPO.

While I think the IPO could be in mind, I think there are likely some other trends at play too. While Techcrunch notes that it’s a down market for many IT companies, I think it’s fair to say that many EHR vendors have felt the pinch of late. I wrote a year or so ago that the golden era of government incentivized EHR sales was over and we’re entering a much different market. So, it shouldn’t be a surprise that an EHR vendor might go through some cuts as the false market created by meaningful use disappears. I won’t be surprised to see more layoffs from other EHR vendors. Especially ambulatory EHR vendors like Practice Fusion.

No doubt another factor at play is that Tom Langan replaced Ryan Howard as CEO back in August. It’s very common for a new CEO to go through a round of layoffs after taking over a business. Doing so is hard for the previous CEO who’s so connected to the staff. Not that layoffs are ever easy, but it’s much easier for a new CEO to layoff people in order to make the organization more efficient. That’s particularly true when the previous CEO was the original CEO and Founder of the company.

The cynical observer could also argue that Practice Fusion needed to do these layoffs in order to slow their burn rate since they aren’t in a position to raise more capital. You’d think the $150 million they already raised would give them plenty of run way. However, you’d be surprised how quickly that disappears with that many staff on payroll (Not to mention rents in San Francisco). I personally don’t think this is a case of Practice Fusion cutting staff because they can’t go and raise money. However, it could be Practice Fusion cutting its burn rate so that they have some flexibility on when they go public without having to raise more money.

All of this said, 74 people lost their jobs at an EHR vendor. That’s never fun for anyone involved. At least they’ll likely have plenty of job opportunities in silicon valley. Unless that bubble pops like some are suggesting. It will be interesting to see how many now former Practice Fusion employees search for another job in health care IT.