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One EMR Vendor’s Take on EHR Adoption and Government Intervention

Posted on March 23, 2010 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.

In response to my post on CCHIT’s comments on the EHR Certification criteria, I got an email from Ryan Ricks. Ryan works for XLEMR and shared the following perspective on EHR adoption (or lack thereof) and the effects of the EHR stimulus money on it.

I do not want to delve into politics, but I think this is a classic example of what happens when government intrudes upon the private sector. Rather than speeding up EHR adoption, this whole process has caused the market to grind to a standstill because physicians are waiting for all of the details to become final. I’m sure other small companies have been negatively affected by this, not just us.

It has been very difficult to convince physicians to buy. I think physicians as a group are more concerned with avoiding the risk of purchasing a non-compliant system – rather than motivated by the reward of the stimulus money. Furthermore, we have noticed a significant lack of trust in the government. Many physicians don’t believe the money will be available, or they are worried about the “strings” that are attached. In addition, several physicians expressed a great deal of concern over the interoperability requirement – they want to protect their patient’s privacy.

Sadly, what Ryan describes is basically what I’ve seen happening with EHR adoption as well.

Sailing Towards EMR – Treasure Island or Iceberg?

Posted on August 26, 2009 I Written By

The United States is moving steadily towards Electronic Medical Records (EMR). The HITECH Stimulus Act is like a hurricane-force wind, driving practices towards the electronic age. Many doctors have conflicting opinions about EMRs. Are they a treasure island, full of benefits like increased productivity and revenue, or is it a dangerous iceberg that could sink your practice?

This is going to be XLEMR week with Another interesting post from Ryan Ricks.

Interoperability, Meaningful Use and Certified EMRs

Posted on August 25, 2009 I Written By

I like reading the weekly newsletters from XLEMR. Ryan Ricks has a way of making complex issues simple. This is a part of his recent newsletter.

Meaningful use has four main functional requirements: computerized order entry, drug interaction checking, maintaining an updated problem list, and generation of transmissible prescriptions. A certified EMR system must provide these functions, and physicians must use them daily for all their patients. In addition, a certified EMR must be capable of sharing information and working with other systems.

The HIT Committee wisely chose existing data standards for their recommendations. Health Level 7 (HL7) is data standard based on the Extensible Markup Language (XML). HL7 was developed for earlier government programs, such as the Doctors Office Quality Information Technology (DOQIT) and Physicians Quality Reporting Initiative (PQRI).

For the full newsletter, go to:

What are your thoughts on the direction that the HIT committee is going?

Simple EMRs and the EMR Backlog

Posted on August 19, 2009 I Written By

The following is from XLEMR. In this Newsletter, Ryan Ricks argues that simple EMRs have many advantages over complex EMRs. They are simpler to learn and install. This may be important if you are going to get your first year HITECH Bonus (if you don’t get it in 2011, you lose it). In my opinion, it is very important that EMRs like this can be certified so Physicians have choice. As long as you can use them in a “meaningful” way, they should be certified. For my definition of “meaningful” see What is “Meaningful Use”, What EMRs should be “Certified” and Who should do the Certifying from July 27, 2009.

This is an excerpt from Mr. Ricks’ post.

Once preliminary certification begins in October, EHR demand should surge. Although the market is currently slow, many vendors have installation backlogs. Preliminary certification may cause those backlogs to increase. Physicians who are in the “wait and see” mode will need to make a decision quickly. Waiting could result in long delays that may jeopardize the ability to qualify for the first year of reimbursements. One alternative is to purchase a simple system. Simple systems take much less time to install, so backlogs are not a problem. Simple systems are also easier to learn, meaning you do not use as much valuable time for training instead of seeing patients. Finally, simple systems are easy to use, giving you more time to qualify for meaningful use. Be sure to ask any EHR vendor if they have any backlogs, and how long it takes to implement their system. Their answer will tell you if their system is simple.

Has anyone seen this backlog? How long do you have to wait?

Simple and Effective EMRs will Solve So Many Problems

Posted on August 6, 2009 I Written By

I just read Ryan Rick’s guest post on Phoenix, Arizona EHR Uninstalls and I remembered a New York City Health Department’s project called Primary Care Information Project (PCIP) headed by Dr. Farzad Mostashari. I see big problems for Dr. Mostashari’s project. I predict many uninstalls and ultimately a low successful implementation rate. They have good intentions but are making classic mistakes which will ultimately prove to be their undoing. I hope what they are doing will work (because I am a big fan of EMRs), but let me outline a couple of critical weaknesses in their plan and then we will see how things work out for them over time. I think all “top down” EMR implementation organizations will take note of this experiment.

I think Dr. Mostashari has bought into the notion that implementation has to be daunting and hard. “Our experience here is that it’s just hard,“ Dr. Mostarshari said. He thinks like Dr. Middleton, “A crucial bridge to success, according to experts, will be how local organizations help doctors in small offices adopt and use electronic records. The new legislation calls for creation of “regional health IT extension centers”. In a letter to the White House and Congress last month, Dr. Blackford Middleton, chairman of the Center for Information Technology Leadership, a research arm of Partners Healthcare in Boston, and 50 other experts emphasized the importance of these centers and pointed to the Primary Care Information Project in New York City as a model.” — Steve Lohr, How to Make Electronic Medical Records a Reality, New York Times, March 1, 2009.

Implementation is daunting and hard if you pick systems which are NOT simple, NOT easy to install, NOT easy to learn, and NOT easy to use. PCIP in New York City is using eClinicalWorks which has a good reputation, but I am NOT sure it is simple, easy to install, easy to learn and easy to use. If eClinicalWorks had all the “simple and easy” characteristics, then I don’t see why the implementation would be so difficult and daunting.

Dr. Mostarshari is also moving very aggressively and fast. Not a good idea in my opinion! He is rolling things out to the whole system before seeing what works and what does not work. “The city Health Department’s Primary Care Information Project (PCIP) has already converted over 1,300 physicians and 226 medical practices to EHRs”. Record Recovery, Center for an Urban Future, page 5, June 2009. I think the project is only a couple years old.

Ryan Ricks, of XLEMR, makes a series of suggestions in his post which I believe are extremely important. “It seems that Arizona physicians are scrambing to remove unusable systems due to poor selection or botched implementations.”. “Physicians need to be careful and not rush into a decision they may regret.”. “Physicians should focus on their needs … and select the simplest system that fulfills their requirements”. “Simple systems are easy to install, easy to learn, and easy to use.” “Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded”. “They should take their time to find a simple, user friendly system that meets their needs.” — Ryan Ricks, XLEMR Update Newsletter, July 2009, Mr. Ricks makes some excellent points. Water flows downhill very nicely, but it takes a lot of energy to pump it to the top of the mountain!

It is my feeling that implementations would be less daunting and more successful if the EMR systems were less complex, easier to install, easier to use and easier to learn. Doctors are smart people who can learn to do stuff without handholding and constant supervision and oversight. The fact that the New York City PCIP Project needs all this hard work and all this effort and all this money makes me suspect that they have made major mistake in choosing an EMR system that is too complex, too hard to learn and too hard to use. Their second mistake is moving very rapidly to roll it out to the whole system before removing the bugs (the bug may be eClinicalWorks).

This top down approach is doomed to fail. Doctors must be able to choose the systems which works for them. If you have to ram it down our throats, it will be regurgitated at some point when we just get fed up. This happened in Pheonix Arizona, is going to happen in New York City and, if we are not careful, may happen in the whole country if things are not managed in a smarter manner. This is also a warning to Hospital Systems which are working in a similar “top down” manner to provide EMRs to their employed physicians and their private physicians (via the 85% rebate model). We don’t need Regional Health IT Extension Centers and we don’t need large organizations forcing us to use THEIR preferred EMR. We need to be using EMRs which are easy to install, easy to use and easy to learn! We need to identify those EMRs and promote them aggressively.