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EMR and HIPAA Summary of 2010

Posted on December 31, 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.

I found a really cool WordPress plugin which does a summary of the activity on a blog like EMR and HIPAA. 301 posts in 2010 isn’t too bad. The thing I like most about the stats is 1. the consistency and 2. the incredible number of comments people have contributed to the site. In the list of top commenters, I see some familiar names. I also love the list of posts with the most comments. Some really amazing discussions in those posts.

Thank you to each of you that participates in EMR and HIPAA. Have a Happy New Year!

In 2010 I wrote 301 posts.

The number of posts in each month:

January: 31 (10.3%)
February: 29 (9.63%)
March: 42 (13.95%)
April: 26 (8.64%)
May: 22 (7.31%)
June: 28 (9.3%)
July: 31 (10.3%)
August: 31 (10.3%)
September: 32 (10.63%)
October: 33 (10.96%)
November: 29 (9.63%)
December: 44 (14.62%)

The number of posts in each day of week:

Sunday: 23 (7.64%)
Monday: 69 (22.92%)
Tuesday: 66 (21.93%)
Wednesday: 73 (24.25%)
Thursday: 72 (23.92%)
Friday: 61 (20.27%)
Saturday: 14 (4.65%)

At what hours I publish new posts:

0: 7 (2.33%)
1: 2 (0.66%)
2: 1 (0.33%)
3: 1 (0.33%)
4: 2 (0.66%)
5: 3 (1%)
6: 3 (1%)
7: 19 (6.31%)
8: 98 (32.56%)
9: 79 (26.25%)
10: 34 (11.3%)
11: 24 (7.97%)
12: 14 (4.65%)
13: 6 (1.99%)
14: 12 (3.99%)
15: 7 (2.33%)
16: 11 (3.65%)
17: 1 (0.33%)
18: 1 (0.33%)
19: 7 (2.33%)
20: 6 (1.99%)
21: 11 (3.65%)
22: 18 (5.98%)
23: 11 (3.65%)

In 2010 the posts were commented 2009 times, from which 556 comments (27.68 percent) were written by registered users/authors.

TOP 10 commenters in 2010:

  • Don B: 82 comments
  • Michelle W: 60 comments
  • Anthony Subbiah: 46 comments
  • Brian: 41 comments
  • Bobby Gladd: 38 comments
  • David Swink: 28 comments
  • Nick Orlowski: 24 comments
  • D. Kellus Pruitt DDS: 20 comments
  • DonB: 18 comments
  • CEOmike: 16 comments

TOP 10 most commented posts in 2010:

The number of comments in each month:

January: 175 (8.71%)
February: 165 (8.21%)
March: 153 (7.62%)
April: 127 (6.32%)
May: 228 (11.35%)
June: 178 (8.86%)
July: 129 (6.42%)
August: 208 (10.35%)
September: 125 (6.22%)
October: 169 (8.41%)
November: 157 (7.81%)
December: 195 (9.71%)

On what days people comment:

Sunday: 101 (5.03%)
Monday: 412 (20.51%)
Tuesday: 385 (19.16%)
Wednesday: 322 (16.03%)
Thursday: 320 (15.93%)
Friday: 321 (15.98%)
Saturday: 148 (7.37%)

At what hours people comment:

0: 30 (1.49%)
1: 10 (0.5%)
2: 5 (0.25%)
3: 9 (0.45%)
4: 18 (0.9%)
5: 44 (2.19%)
6: 65 (3.24%)
7: 120 (5.97%)
8: 214 (10.65%)
9: 239 (11.9%)
10: 167 (8.31%)
11: 137 (6.82%)
12: 124 (6.17%)
13: 113 (5.62%)
14: 104 (5.18%)
15: 95 (4.73%)
16: 80 (3.98%)
17: 54 (2.69%)
18: 54 (2.69%)
19: 53 (2.64%)
20: 55 (2.74%)
21: 77 (3.83%)
22: 79 (3.93%)
23: 63 (3.14%)

SureScripts Becomes ONC-ATCB EHR Certification Body

Posted on December 30, 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.

In the weirdest news I’ve seen in a while, SureScripts has become an ONC-ATCB. Here’s the details from Health Data Management:

In a Dec. 23 announcement, the Office for the National Coordinator for Health IT said that Arlington, Va.-based Surescripts can verify that e-prescribing, privacy and security modules meet the standards laid out in the meaningful use requirements. Surescripts is the sixth authorizer to be approved by ONCHIT, but it’s the only one with limited certification abilities—the five others have ONCHIT’s blessing to certify Complete EHRs and EHR modules.

Doesn’t this scream conflict of interest? They run a nationwide e-Prescribing network, and yet they can certify ePrescribing for ONC. I guess you could make the argument that they know ePrescribing well and so they are qualified to do it. Although, it is just weird and awkward to consider them as an ATCB. I wonder which ePrescribing companies will actually use them. Why did SureScripts even go to the effort to become an ATCB?

HIPAA Lawsuit – PHI by Un-encrypted Email

Posted on December 29, 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.

In kind of ironic timing, the news was recently reported of a patient talking to lawyers about a possible lawsuit against a doctor who sent her protected health information (PHI) to his home email in an un-encrypted format. The irony is that for the past week, my post on Email not being HIPAA secure has been having a really good discussion happening in the comments about these very issues (you should go read through the comments, they’re very interesting).

One interesting part of the above news story is that it didn’t even include the most common personal information used for identity theft. Certainly a person’s name and medical information should be kept private as well and could have consequences related to its release on the internet. However, it definitely doesn’t bring out the privacy critics like a breach of financial related info would bring.

While I personally hate lawsuits, a part of me kind of hopes that this or some other lawsuit happens related to email and PHI. Not because I like lawsuits or I want someone to be held responsible. Mostly because we could use some legal precedent to better enable those who want to use technology like email. Until the precedence is set (or a more specific law), I think that many people are just too afraid to use email for any sort of health care related communication.

In the comments I mentioned above, someone even commented about them wanting a doctor who would let them waive their right to privacy in the name of convenience. Basically, they would rather use email to communicate even PHI at the risk of someone seeing their health information so that they can use communication tools like email in their healthcare. I bet there are a lot more people who would opt in for this also. The problem is that the law is such that I don’t know many doctors who are willing to take the risk even if the patient gives them permission.

The best alternative right now is the patient portal where a patient receives an email saying something has been added or updated on the portal and invites them to login to the private secured portal to see the PHI or other health information. Not perfect and not that broadly adopted.

Lots of other issues related to email with doctors, but at least resolving the privacy and security ones would allow us to focus on those other issues.

Should Meaningful Use be Delayed?

Posted on December 28, 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.

I guess I should have assumed that people would start posing this question. Turns out Jeff Rowe at HITECH Watch (part of Healthcare IT News) has posted the question about delaying the HITECH incentives twice in a week.

I guess it’s a reasonable question to be asked, but my emphatic answer to the question is NO!

It took us plenty long enough to get to this point. The wait for the details of meaningful use and certified EHR was a long enough wait that absolutely slowed the adoption of EMR software. There are http://www.emrandhipaa.com/wiki/EMR_and_EHR_Matrix“>300-400 EHR companies just waiting for this EHR incentive program to get going. That’s a lot of companies to hold hostage while the government tries to “make meaningful use better.”

Plus, you can quite easily argue that more time won’t actually make meaningful use substantially better. In fact, it seems reasonable to argue that more time could actually make meaningful use much uglier and discouraging for those interested in implementing an EMR.

It is also worth mentioning that there’s kind of a built in year of waiting as is. You get paid the same amount of money whether you show meaningful use starting in 2011 or 2012. The amount is the same and the meaningful use requirements are the same.

Plus, meaningful use stage 1 is already pretty generic when it comes to the reasons Jeff offers for delaying in the above article. Meaningful Use stage 2 is where ONC and CMS should focus on adding in requirements that will help us get closer to the exchange of patient data. Trying to go in and mess with meaningful use stage 1 is a mistake. Not just because the hour is near, but also because it would provide little benefit.

The article linked above had an interesting poll related to this. However, it requires registration and so there had only been one response. Hopefully this poll will get a little bit better response:

Meaningful Use Monday – Meaningful Use Resources

Posted on December 27, 2010 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

I’m excited to announce the beginning of Meaningful Use Monday on EMR and HIPAA. I first came up with the idea when Lynn Scheps from SRSsoft commented on one of my previous meaningful use posts. Lynn provided such valuable information, I asked her if she’d be interested in becoming a regular guest blogger on EMR and HIPAA. As they say, the rest is history. Each Monday, Lynn (and sometimes myself) will be covering some topic related to the EMR Stimulus money and meaningful use. We hope you enjoy Meaningful Use Monday.
-John

With the impending start of the EHR incentive program on January 1, the results of a recent Health Data Management poll are troublesome. 72% of respondents feel that the meaningful use guidance provided by the government to-date has been either “inadequate and confusing” or “of little use,” with only 8% categorizing it as good.

It is critical to understand the requirements accurately because the regulations provide “no recourse” for providers whose attempt to demonstrate meaningful use is deemed unsuccessful. So where does a provider go for definitive information and answers to their questions?

  • The most reliable source to-date has been the CMS website and its FAQ page, but as I learned when I submitted a question, the term “FAQ” is meant quite literally: An automated response informed me that only “frequently-asked” questions are answered! So, if your question is not a common one, this source will not provide the information you seek.
  • Vendors and medical societies have offered numerous webinars and educational meetings since the legislation was passed in February 2009, but be aware that presenters have varied in their interpretations of some of the requirements.
  • Regional Extension Centers exist to assist providers, but their focus is limited to hospitals and primary care physicians, and they charge for their services. UPDATE: As has been mentioned in the comments, not all RECs charge for their services.
  • Knowledgeable consultants will be very busy and may also be costly.
  • The most promising source:  CMS has just established the EHR Information Center: 1-888-734-6433. If it operates as well as the ePrescribing and PQRI Quality/Net Help Desk, it will be a great source of information. As of the writing of this post (12/23), however, that number is answered with a recording that refers callers back to the CMS website. Hopefully, the Information Center will be live by the start of 2011.

Lynn Scheps is Vice President, Government Affairs at EMR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Which EMR Conferences Do You Attend?

Posted on 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.

This week I finally got my flight and hotel all lined up for my trip to HIMSS. Thanks to Practice Fusion for sponsoring that part of my trip to HIMSS. It’s greatly appreciated. I think Orlando is going to be a great destination for HIMSS and the energy and excitement is going to be something else thanks to the EMR stimulus money. It should be a pretty exciting event with far too many people, sessions and vendors to take in.

I’m still considering throwing together a New Media Meetup at HIMSS like I did last year. It was a lot of fun and worked out well since we just partnered with MEDecision to pull it off. If you’re interested in helping put something like that together or attending an event like that, let me know and I’ll be sure to let you know the details. I personally really like these sorts of intimate meetings with interesting people who understand New Media like blogs, twitter, Facebook, etc.

What other conferences do people attend? I’ve been to a number of different EMR events this last year. The Mobile Health Expo was a fun event and should get better as it grows. I really enjoyed mixing it up with all the doctors at AAFP (even if I did get kicked out of a session since I wasn’t a doctor).

I’d wanted to go to MGMA this year, but couldn’t quite swing it. The good thing is that the 2011 MGMA Annual Conference is in Las Vegas (my backyard) and so I can easily attend while still enjoying my own bed. HIMSS 2012 is also going to be in Las Vegas which is very convenient for me. Obviously, you can see I have a bit of a bias to EMR or healthcare IT related conferences in Las Vegas. It’s just so much nicer and luckily a fair amount of them come to Las Vegas.

I heard there’s going to be a healthcare portion of SXSW in Austin. That’s a conference I’ve always wanted to go to. Health 2.0 could also be interesting, but I find it much more consumer health app focused than EMR and doctor focused.

Are there any other EMR related conferences that I should keep my eye on?

Merry Christmas!

Posted on December 24, 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.

Merry Christmas!

I just finished our family tradition of a Christmas Eve mini dinner. My wife executed it to perfection. It was absolutely fantastic. We somehow got the kids in bed despite their excitement over the visit from Santa Clause. Shortly, I’ll go and eat the cookies and drink the milk the kids left out for Santa (man I love being Santa). I’ll leave the reindeer’s carrots for my wife.

This Christmas shopping season has been interesting for me. I see and hear so many people talk about the stress of shopping for Christmas. So many people want to “get it over” and get all worked up doing the Christmas shopping. Personally, I decided to forget all of those people who try to give the impression that Christmas shopping is a terrible experience and just enjoy it. Turns out, I love the experience of Christmas shopping.

Many people say that they hate the crowds. I love the bustle of people every where. Some people hate the cheesy Christmas music. I think the music makes for a great atmosphere. Some people hate that they don’t have enough money. I love the opportunity to teach my children that it’s not about the money. Plus, it’s fun to be creative within a budget. Some people hate “having” to take around treats to their friends and neighbors. I love the chance to go and see people that I love and care about.

Needless to say it’s been a magical Christmas season for me!

I can’t help but wonder if there’s not an analogy here for those implementing an EMR. Basically, if you want excuses not to implement or enjoy an EMR, you’ll find it. If you look for ways to implement an EMR and enjoy its benefits, you’ll find those too. I’m not suggesting you rush into anything, but you can choose to enjoy the EMR selection and implementation process and it will make a huge difference.

I realize that many of the readers of this site don’t celebrate Christmas, but I’ve never been offended when someone told me Happy Hanukkah and I don’t celebrate it. So, I hope that people can join me in the spirit of giving and caring that’s associated with Christmas.

Email is Not HIPAA Secure

Posted on December 23, 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.

An interesting discussion happened in the comments about HIPAA secure fax services in regards to the security of email. Being a tech person who formerly managed a few different corporate email systems, sometimes I forget that many people don’t understand some of the details about the security (or lack of security) that’s provided by email.

The short story is: Email is NOT HIPAA Secure (at least in 99% of cases)

There is a way to encrypt email sent between 2 email systems, but so far a standard and mechanism for encryption between all the vast number of email providers has not been established. I won’t go into the details of why this is the case (cost of encryption, standards for encryption, etc), but suffice it to say that almost none of the email systems send encrypted email that would satisfy the HIPAA requirements.

In fact, most times when an EMR, PHR or other patient portal wants to send a secure email/message to someone they send an email which contains a link to an encrypted website that has a unique login. The reason they do this is because there’s no recognized and adopted standard for encryption of email. However, presenting Protected Health Information (PHI) through an encrypted webpage where someone has a unique login is HIPAA compliant and doesn’t require the receiving email system to understand the encryption. It’s a pain, but it’s the reality of privacy of health information right now.

One of the major reasons that many people think that email is secured is that a number of email providers (Gmail being the most famous for this) turned on encryption for all of their users. The misunderstanding is that this encryption is just for users logging in to check, read and send their email. It does not encrypt the email as it it sent from Gmail to the destination email system. Aleks, from Sfax described it similar to a postcard. It’s open where anyone listening can see what’s in the email with no traces left behind.

The only security email partially offers in this manner is the volume of emails that are sent. There’s such a huge volume of useless emails that there’s some security by obscurity benefits. Although, that security doesn’t meet well with the HIPAA requirements. Plus, remember that one thing that computers are great at doing is crunching large amounts of data.

One minor exception that I might make is that if you’re sending email in an internal email system, then it’s possible to set up email encryption. This is possible because you control the email system for the sender and the receiver and so there are ways to do this. However, I know very few people that have actually set this arrangement up. Probably because if they are on your internal email system they usually have access to your EMR and all the PHI can remain in the EMR instead of your email system.

Now many have said that you shouldn’t use the free email providers like Gmail. After reading this it should be clear. You shouldn’t use ANY email provider for sending PHI. So, whether you use Gmail or some other free email provider it shouldn’t matter since I’m sure you won’t be sending any PHI through email any more.

Of course, I’d recommend you use the free Google Apps version of Gmail since DrSmith@yourpractice.com is so much more professional than DrSmith985373@gmail.com. Although, that’s kind of a topic for a different discussion.

Guest CPA Post: Year End Tax Considerations for EMR Equipment and Software Purchases

Posted on December 22, 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.

2010 Year End Tax Considerations for EMR Equipment & Software Purchases

Good Timing Can Help Practice Bottom-Lines Sooner Than Later

As many of us are in the throws of holiday preparation and party participation (say that 3 times with some eggnog ), attention still needs to be paid by medical practice owners and administrators to 2010 year end business purchases. Reason being ?  Something called Section 179 depreciation. The IRS avails small businesses a great opportunity to maximize their purchasing power, especially with the increase to a maximum annual deduction of $500,000 for equipment and software purchased and placed in service in 2010 – 2012. The Small Business Jobs & Credit Act of 2010 increased the annual Section 179 depreciation deduction from $250,000 to $500,000. Because EMR systems are all about equipment and software for business purposes, EMR implementation does qualify quite nicely for the Sec 179 depreciation deduction, and related tax savings.  Timed right, practices can take advantage of tax savings for 2010 that may come close or exceed the amount of payments they actually make on the equipment or software in 2010.

EMR computer equipment, software and peripherals need to be “placed in service” by 12/31/10 in order to qualify for the Section 179 deduction for the 2010 tax year.

What people need to be reminded of at this busy time of year is that they can still qualify for deducting the full cost of office, medical and computer equipment / software they purchase, so long as it is “placed in service ” by the end of the tax year they are trying to take the deduction for (in this case 2010). Even if a practice is in the  earlier portion of the EMR implementation phase, it can still purchase computer equipment and peripherals (scanners, printers, faxes, etc) that they will need for their EMR system and get a deduction via Sec 179 depreciation for the full cost of the equipment in  2010. To gain the tax advantage sooner than later (2010 vs: 2011) practices just need to plug the equipment in and start utilization by 12/31/10 to constitute “placed in service”. Items purchased before 12/31/10 but left in the boxes sitting in the closet or trunk do not qualify for the Sec 179 deduction for 2010; a deduction would be able to be taken when set up and utilized in 2011.

I mention the computer equipment and peripherals as minimal time is typically needed to plug in a computer, printer, or fax machine, synchronize it and legitemately constitute  “placed in service” before 12/31/10,  and legitemately qualify for the Sec 179 deduction for the 2010 tax year.  EMR software on the other hand requires more set-up and modification in order to be considered “placed in service” by the practice for IRS purposes. It would be a more challenging explanation to an IRS auditor that EMR  sofware purchased on 12/28/10 was set up and in use by 12/31/10. Anyone who has read John Lynn’s e-book Selecting The Right EMR knows that 3-4 days for EMR software set-up is not quite the norm.

For software to qualify for Sec 179 depreciation when put into service it must be “Off-the-Shelf” software; meaning that it isn’t custom designed and is available to the general public. If the core software is standardized,  a  small amount of customization is acceptable, as is done with EMR systems.  As an aside, the customization factor generally holds websites ineligible for Section 179 depreciation.

Practices can qualify for the Section 179 depreciation deduction in 2010 even if the equipment and software is financed and no payments are made in 2010

A practice has multiple payment and financing choices when it comes to acquiring the equipment and software for an EMR system, and thereby achieve some sizeable tax savings through the  Sec 179 deduction. Business credit card, bank financing and equipment leasing are all viable options.  A practice could actually purchase computer equipment and peripherals (as mentioned above) via credit card, line of credit or bank/lender term financing and qualify for the Sec 179 deduction of the full equipment purchase price in 2010, even without having made any payment toward the items purchased in 2010 – a nice cash flow management approach.

The thing to keep in mind when leasing the equipment and software is that in order to qualify for the Sec 179 deduction the lease needs to be a capital lease and not an operating lease. Capital leases are typically either a ” $1 Buyout Lease” or a “10% Purchase Upon Termination Lease”.  In either case the practice will own the equipment and/or software at the end of the lease term.  With an operating lease the practice is not considered to own the equipment/software at the end of the term, and thereby can only write off the lease payments as they are paid out each year (typcially over a 3-5 year term), rather than the full cost of the equipment and software in the year of purchase as can be done with a capital lease and Sec 179 depreciation.

The obvious advantage to leasing or financing equipment and then taking the Section 179 deduction is the fact that the full amount of the equipment can be deducted without paying the full amount for the equipment in the same year. The amount saved in taxes can actually exceed the payments, making Section 179 a very bottom-line friendly deduction. Compared to stimulus funds achieved by scaling Meaningful Use hurdles, tax savings through Section 179 depreciation is like money on the table – you just need to know about it and grab it.  Something to keep in mind as 2011 New Years resolutions are being formulated.    ______________________________________________________________________________________

Leslie A. Thomas, CPA is a Supervisor offering 20+ years of tax and healthcare advisory experience in the Healthcare Business Services segment at Nisivoccia LLP, a multidimensional CPA firm with offices in Mt. Arlington and Newton, NJ.  The firm offers traditional tax, accounting and audit services, and maintains practice specialties in sectors including health care, technology, municipal government, education, nonprofit and financial services.  Contact her at lthomas@nisivoccia.com or (973)-328-1825

Watch for EMR Company Consolidation but Not EMR Software Consolidation

Posted on December 21, 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.

I’ve regularly talked about my belief that there isn’t just one major EMR market. Instead, I firmly believe that there are a number of EMR markets that are divided by clinic size, medical specialty, and possibly even location. In fact, there’s likely even other factors. There are just far too many EHR companies for this to not be the case.

I think this was also well illustrated in this blog post on Kevin MD about the “Perfect EMR Traits.” Here’s the perfect EMR trait #1:

Perfect EMR Trait #1: The ideal medical record would be tailored to the specific needs of a clinician, only exposing them to portions of the record which are relevant to their work.

Knowledge within healthcare is rapidly changing. Possibly more so than another other industry. Techniques which were considered state-of-the-art, can change in a matter of weeks. The electronic medical record has the potential to be the tool which disseminates those changes down to the clinician, through point-of-care decision support. EMR software should facilitate the clinician decision making, rather than requiring clinicians to keep track of the latest and greatest. This individualistic attitude creates discrepancies in care, which inherently leads to imprecise care.

While it is certainly technically feasible for an EMR vendor to be able to create software that satisfies Perfect EMR Trait #1, it’s just not practically feasible for an EMR vendor to satisfy every clinic size, medical specialty, and in many cases locale. This means that we’re going to see a wide variety of EMR software that satisfies the various EMR market needs.

With this as a preface, consolidation of EMR companies is going to become a very very real thing. However, I’d caution EMR companies that choose to just directly sunset an EMR software acquisition. In some cases, this is a reasonable solution based upon the EMR company’s existing EMR software. Plus, in many cases EMR vendors will be acquiring the EMR market share for their existing EMR software. I’m sure we’ll see more of this.

My recommendation for EMR vendors acquiring EMR software, is to be more selective in the types of EMR software that you acquire. It’s definitely worth considering the idea of sustaining the EMR software development of multiple EMR products. Is it really that hard to see a large EMR company that has an ED EMR software, a General Medicine EMR software, an OB/GYN EMR software, a Pediatric EMR software, etc etc etc.

An EMR vendor making a decision to act in this manner will require them to change how they look at EMR acquisitions. The EMR acquisition targets will dramatically change. Instead of looking for failing EMR companies where they can cheaply buy more EMR market share, EMR companies with this approach should be focusing on a quality EMR software that hasn’t yet achieved the EMR market share that they deserve.

The cool part about the strategy of maintaining multiple EMR software instead of the strategy of sunsetting one or the other is that you purchase a bunch of happy EMR users instead of alienating a whole mass of EMR users that’s software is no longer supported. Of course, this will require proper communication of your goals and objectives so that current EMR users see the benefit of the acquisition and aren’t left wondering what the acquisition means to them. I’m not just talking about standard PR spin. I mean real tangible communication and interaction which demonstrates your plans for the acquired EMR going forward.

An EMR company with this method of EMR software acquisition, also needs a different set of skills. After sunsetting an acquired EMR, you need to have a strong set of integration and transition services to make the change to your EMR as smooth as possible. You also require a unique sales force that can sell the transition to your EMR over a transition to an altogether new EMR software. None of these services are needed if you continue to maintain the acquired EMR. Instead, your company must focus on other redundant services like marketing that could be leveraged across companies.

Of course, this isn’t an easy task to do well. Acquisitions rarely are an easy process. However, I think this is a lesson that was recently learned by Google as well. There’s value after an acquisition to keep autonomous business units. In fact, doing so opens up a whole new set of acquisition targets in a less competitive environment.

If I were a board member at an EMR company, this is the type of stuff I’d be considering. Certainly not every EMR vendor is 1. in a position to do these things and 2. has the culture to make it happen. However, I predict that the EMR company of the future will be a conglomerate of multiple specialty specific EMR software and not just a one size fits all atrocity.