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Population Health Management (PHM) – The New Health IT Buzzword

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For some reason in healthcare IT we like to go through a series of buzzwords. They rotate through the years, but usually have a very similar meaning. The best example is EMR and EHR. You could nuance a difference between the two terms, but in practice they both are used interchangeably and we all know what it means.

With this in mind, I was intrigued by an excerpt from Cora Sharma’s post on Financial Analytics Bleeding into Population Health Management:

It appears that “population health management” (PHM) just has a better ring to it than “accountable care” or “HMO 2.0”. Increasingly, PHM is becoming an umbrella term for all of the operational and analytical HIT tools needed for the transition to value-based reimbursement (VBR), including EHR, HIE, Analytics, Care Management, revenue cycle management (RCM), Supply Chain, Cost Accounting, … .

On the other hand, HIT vendors continue to define PHM according to their core competencies: claims-based analytics vendors see PHM in terms of risk management; care management vendors are assuming that PHM is their next re-branded marketing term; clinical enterprise data warehouse (EDW) and business intelligence (BI) vendors argue that a single source of truth is needed for PHM; HIE and EHR vendors talk about PHM in the same breath as care coordination, leakage alerts and clinical quality measures (CQM); and so on.

Cora is right. Population Health Management does seem to be the latest buzzword and for some reason feels better to people than accountable care. I guess it makes sense. People don’t want to be held accountable for anything. However, they love to help a population be healthy.

Coming out of 30+ meetings with vendors at HIMSS this year I was asking myself a similar question. What’s the difference between an HIE, healthcare analytics, business intelligence, data warehouses (EDW) and even many of the financial RCM products? I see them all coming together into one platform. I guess it will be called population health management.

To Cora’s broader point in the post, there is a real coming together that’s happening between clinical and financial data in healthcare. All I can think is that it’s about time. The division of the data never really made sense to me. The data should be one and available to whatever system needs the data. ACOs are going to drive this to become a reality.

May 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Good Decisions, EMR Sales, and Patient Data Availability

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This is true if the actors are well intentioned. I’ve found that most in healthcare have the right intentions. Although, many don’t have the right data that could help them make better decisions.


I’m going to have to chew on the idea of EMR sales being non-linear. An interesting observation by Chandresh. I’m excited to hear Chandresh share more of his experience with EMR sales at the Health IT Marketing and PR conference.


I’m not sure if this was the exact intent of this tweet, but it reminded me of a discussion I had with some really chronic patients. To a person (and the parents since these were kids), they couldn’t give a rip about privacy. They were more than happy to give up any and all privacy if it would help them find a cure or treatment for their child. This reminds me that context is really important when it comes to privacy.

March 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Healthcare Pricing, Wiki Style EMR Editing, and Quantified Self Data – @nickdawson Edition

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It’s time again for my roundup of interesting EMR, EHR, and Healthcare IT tweets. Today’s tweets all come from Nick Dawson. I don’t know Nick really well, but see him online quite a bit. Plus, I did a Google Plus hangout with him after TEDMED. He’s a very interesting guy and these tweets illustrate some of his thinking.


I’ve been hearing more and more of these cases and many of them are not even international. I’m not sure if the shift is because of the growth in high deductible plans, but there’s definitely a shift happening as far as awareness of what healthcare really costs. I hope we see a sea change in this regard.

Also, don’t underestimate the medical tourism part of this. I think there are going to be regions of this country and around the world that are going to battle for medical procedures. Eventually we’ll know that certain regions of the country are known for certain medical specialties just the same way we know Texas has oil and Nebraska has corn.


Just the thought of this will make many doctors stomach’s churn, but I like the concept. It would definitely need to be refined so there was a well defined chain of who edited what and when. Not to mention some sort of method for knowing when something was modified and by who. A novel concept, but not one I think we’ll find anytime soon.


I love to read stuff like this. I wonder if Nick pays for the action that happens. This is what really has doctors scared. Nick saved a visit, but the doctor missed out on the revenue that visit would have generated. It’s also why we need to start reimbursing doctors for online visits.

August 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR Market Share

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Editor’s Note: This is the first post on EMR and HIPAA by James Ritchie. James is a longtime journalist including the past eight years as a staff writer with the Cincinnati Business Courier.

Practice Fusion announced in June that it led the EMR industry in market-share gains.

Citing SK&A reports, the San Francisco-based firm boasted that it controlled 5.8 percent of the market as of May, up from 3.8 percent in July 2012. Beyond Practice Fusion, only Epic, AthenaHealth and Cerner showed gains.

In this data, which represents physician offices only, Allscripts was the market leader, with a 10.6 percent share. Not far behind were eClinicalWorks, with a 10.5 percent share, and Epic, with 10.3 percent. (The report that Practice Fusion links to is actually dated January 2013.)

But there’s more than one way to look at the EMR share picture.

Epic was the clear winner in a report by the Austin, Texas-based consultancy Software Advice on meaningful use attestations. Epic, based in Verona, Wis., accounted for 20.3 percent of attestations for a complete EHR in an ambulatory setting.

The firm’s competitors were nowhere close as of the March 2013 report. Allscripts was the system of choice for 11.6 percent of attestations by eligible professionals, and eClinicalWorks accounted for 8 percent. Next on the list were NextGen Healthcare, GE Healthcare and, with 2.7 percent share, Practice Fusion.

Software Advice claimed that the figures, based on Centers for Medicare and Medicaid Services data, might be the best around. They at least provide a standard in a market where vendors “use varied criteria to calculate their customer base,” according to the company.

Companies “might count number of users (which could include everyone from physicians to administrative staff), number of medical providers (which could include everyone from physicians to midwives) or number of practices,” Software Advice noted on its website.

Practice Fusion, founded in 2005, claimed in its press release to have doubled both its monthly active user base of medical professionals and its patient population between 2012 and 2013. The company claims to reach “a community of 150,000 medical professionals serving 65 million patients.”

The prospects for the free model that Practice Fusion uses are still up in the air. Doctors might question whether they want ads, unobtrusive as they are at the bottom of the screen, to compete for their attention when they’re entering patient data. Data, by the way, might prove to be the real revenue generator for Practice Fusion. In June the firm launched Insight, an analytics product offering a population-level view of diagnoses, prescribing patterns and other information. It’s a model worth watching. If Facebook and google can build businesses on data, maybe Practice Fusion can, too.

The SK&A figures show just how fragmented the outpatient EMR/EHR market is. The top 10 vendors accounted for only 64.8 percent of attestations, leaving about 35 percent of the market to the “other” category. By Software Advice’s count, 560 firms logged at least one meaningful use attestation.

Eager to steal share are firms like Irvine, Calif.-based Kareo Inc. It launched its own free, cloud-based EHR in February based on technology acquired from San Mateo, Calif.-based Epocrates Inc. The firm reported in June that 4,000 providers had signed on, with a third of them moving from another EHR.

Of course, ambulatory adoption is only part of the EMR story.

Epic is No. 1 among the nearly 3,000 hospitals that have received federal incentives for using complete electronic records systems, according to Modern Healthcare. The company holds a 19.6 percent share, followed by Computer Programs and Systems Inc. with 15.5 percent, Meditech with 14.1 percent and Cerner with 11 percent. The late-May report was based on numbers from CMS and the Office of the National Coordinator for Health Information Technology.

The inpatient market is far less fragmented than the outpatient space. The top 10 companies control 92 percent of share, according to the report.

No matter how you count share, the EMR space will continue to be hypercompetitive because of the dollars at stake. The market amounted to $20.7 billion in 2012, up 15 percent from 2011, according to the research firm Kalorama Information.

July 18, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EHRMagic, EHR Certification, and the Great EHR Switch — #HITsm Chat Highlights

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Topic One: What lessons can be learned from the ONC’s decision to revoke #EHR Incentive Program certification of EHRMagic? #HealthIT

Topic Two: Does this action make EHR certification more meaningful or does it reduce confidence in certified products?

Topic Three: Who suffers the most from the ONC’s decision? The vendor or the physicians who purchased the product?

#HITsm T4: ”2013 is the year of the great #EHR switch.” With data migration and implementation hassles, is this truly a possibility?

May 4, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Telehealth, BYOD Gain Momentum In 2013

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I’ll be honest — I’m always a bit skeptical when I read on health IT trends appearing in a general-interest corporate IT magazine.  Ours is such a tricky business that the nuances often escape my brethren in the journalistic field, unless of course they specialize in the health IT business. But in this case, an eWeek piece has delivered some useful information, and even caught me off guard a bit.

The piece contends that BYOD issues and the use of telehealth are likely to shape the year in health IT:

BYOD:  Bring-your-own-device problems aren’t unique to healthcare by any means, but they’re certainly become a particularly high-profile issue in healthcare.

In the piece, eWeek quotes Dennis Schmuland, chief health strategy  officer for U.S. Health and Life Sciences at Microsoft, who argues that BYOD costs, including privacy, security and licensing for virtualization of software are so high that BYOD may actually be costing organizations big money. Good (and interesting) point.

Certainly, healthcare organizations can’t afford to let that keep happening in 2013, and this year, solutions are likely to emerge, Schmuland told the magazine.

Telehealth:  While they’re in their early stages right now, telehealth services such as American Well’s Online Care are likely to get a stronger footing this year, the eWeek article suggests.

Lynne Dunbrack, program director of connected health IT strategies at IDC Health Insights, notes that consumers are getting used to having videoconferencing at their fingertips, given the extent to which webcams are now embedded in laptops and video chat on mobile phones.

Now that they’re accustomed to videoconferencing, they’ll soon want to use this capability for telehealth visits with doctors, eWeek reports:

Sending a blood pressure reading and seeing a doctor online could be more convenient than taking off from work, Dunbrack noted.

“If you can just go in and have these quick visits, people would be more apt to make these appointments and keep them, and organizations will start to experiment with these services,” said Dunbrack.

In all candor, I think both Schmuland and Dunbrack are a bit ahead of the market. I doubt that we’ll see a huge expansion of telehealth this year, though there may be some additional uptake. And as for BYOD, I’m not expecting to see any comprehensive solution that providers can affordably adopt this year; after all, trends are still shifting and there’s tons of moving parts to consider. But I do think we will see some progress in both areas.  All told, the two have offered some useful fodder for thinking about 2013.

January 4, 2013 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.

Wireless Healthcare IT, Risk Analysis, and Ever-changing Technology: Around Healthcare Scene

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EMR and EHR

Why 2013 Will Be A Good Year For EMRS

EMRs don’t always have the best reputation, particularly concerning their ease for implementation. However, there are some things that are looking up in 2013 for the industry. Ann Zieger discusses these, and includes ideas such as vendors being able to offer mobile options, as well as consolidation leading to a more stable vendor market.

Wireless Healthcare IT Could Hold the Key to Preventable Readmissions

CardioMEMS developed a heart-failure monitoring system, the first of its kind. The company understands the need from back-end data and has a lot of potential for the future. Technology like this may be the key to preventing hospital  readmissions.

Hospital EMR

Hospitals Stepping Up Security Risk Analysis, While Practices Lag

EMRs pose a large risk for criminal hackers to come in. However, according to a HIMSS survey, around 90 percent of hospitals are now conducting annual risk analysis. Unfortunately, practices only came in at about 65 percent. An even more surprising fact was that 22 percent of survey responders reported having a security breach next year. While there have been a lot of strides made toward stepping up security risk analysis, there is still a ways to go.

Meaningful Health IT News

Technology Changes Faster Than You Think

In 2005, smart phones weren’t mainstream in the health industry. This post also includes other interesting facts about mHealth only seven years ago, and it goes to show just how fast technology is changing. It raises the question, where will we be seven years from now? An interesting infographic from 2005 is also shown in this post as well.

Smart Phone Healthcare

The Patient’s Guide Reveals How iPhone Dominates Mobile Health Research

A recent study done by the Patient’s Guide researched the use of medical devices. During this study, they discovered how the iPhone is by far the most popular device being used. This post includes an infographic from The Patient’s Guide that displays other findings from the study.

December 16, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Health IT Hazards, Selecting the Right EHR, and Withings Wireless Scale – Around Healthcare Scene

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Hospital EMR and EHR

Health IT Stands Out In Health Technology Hazards List

The Top 10 Health Technology Hazards list was recently released by ECRI. And this year, two of the hazards that made the list are health IT related – patient/data mismatches in EHRs and other HIT systems, and, interoperability failures with medical devices and health IT systems. Anne Zeiger predicts that more HIT issues will top this list in the future.

Patients Accessing Online Medical Records Use More Services

A new study revealed something interesting — patients who use online access to medical records are likely to use more clinical services than those who do not. The Journal of the American Medical Association drew this conclusion after studying members of Kaiser. Kaiser has had a patient portal in place since 2006, which made it an ideal candidate for this study.

EMR and EHR

10 Tips for Selecting the Right EHR

In the market for a new EHR? Or perhaps just implementing one? This post highlights 10 tips on selecting the right EHR for your practice, as presented by Insight Data Group. Some of the suggestions include making sure the EHR is easy to use and customized, and use the government’s money to pay for your EHR.

Meaningful Healthcare IT News

Social and Mobile Continue to Converge in Healthcare

An interesting infographic is shown and discussed in this post. It is called “How Health Consumers Engage Online,” and reveals some interesting facts about the digital and health world. According to it, more people in the United States own a smart phone than a tooth brush, and 23 percent of people use social media to follow the health experiences of a friend. This definitely presents some fascinating data that is worth reading.

Smart Phone Health Care

New Withings Wireless Internet Scale Hits the Market

A new scale was recently released, and it does more than just tell a person how much they weigh. It tracks numerous variables, including BMI, and can be synced to various mHealth apps. There is also an app that goes along with the scale as well. It is a bit pricey at over $100, but it definitely “tips the scales” when it comes to scales.

Smart Phone Enabled Thermometer Approved By FDA

The “Raiing” is the newest in smart phone technology. It’s a high-tech, yet easy-to-use, thermometer, designed for iOS devices. It is placed under the armpit, and can actually track a person’s temperature over time. If a temperature reaches a certain number, an alarm will go off on the connected smart phone. This can help give parent’s peace of mind, as a sick child sleeps.

December 2, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EHR Incentive Inflates EHR Pricing

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In a recent conversation I had, the question of EHR pricing came up. It was suggested in the conversation that EHR incentive money was inflating EHR pricing.

I wish that I had harder data on the price of EHR software. Unfortunately, there’s no really good source of EHR pricing across all the 600+ EHR comanies. At one point I considered the idea of creating such a resource, but the challenge of getting that type of information is ominous and might be impossible since many EHR vendors keep that information very close to the chest.

Since we don’t have the quantitative data that we’d love to have in this situation, instead let me offer some observational data on EMR pricing.

In my first couple years blogging about EMR software (I started EMR blogging 6+ years ago), I was able to witness a dramatic shift in the price of EHR software. The norm 6+ years ago was for an EMR for a small clinical practice to cost somewhere in the $30,000 range. For a larger group practice they were easily paying $100,000-200,000 for their EHR software. In almost every case this was a huge up front lump sum payment for the EHR software. Although, many of them conveniently offered financing for your purchase. These EHR were almost always an in house EMR software that needed a lot of up front costs for things like a server.

In those early years, we started to see a wave of mostly SaaS EHR software enter the market at a much lower price point. In most cases they were offering their EHR software for a small monthly fee (usually around $350-500/doctor). Of course at this same time a number of Free EHR software entered the market as well. Both of these entrances forced the price of EMR software to decrease dramatically. Sure, a few EMR software vendors pillaged a practice for an ourtrageous price, but for the most part the price of EMR software came down. Plus, the movement to the monthly charge pricing model for EMR software took hold. In most cases, EMR software vendors would offer a one time fee EMR pricing model along side a monthly per doctor EMR pricing model.

Over the past couple years I think we generally saw a leveling off of EMR pricing. However, I have seen one major thing happen with EMR pricing since the EHR stimulus money was introduced. The new bar for EMR pricing was set at $44k over 5 years. You can be certain that every EHR vendor has looked at their EHR pricing and compared it to the $44k over 5 years.

While I can’t say I’ve seen long time EHR vendors increase the price of their EHR to match the $44k of EHR incentive money, what I have seen is new EHR vendors pricing their EHR software accordingly. Instead of pricing their EHR according to market pricing, they’re generally inflating their EHR price to match the EHR incentive money. I believe this has driven the overall cost of EHR software up thanks to the EHR incentive money. Plus, it has held the EHR pricing of some EHR vendors higher than it would have been if the EHR incentive money weren’t there.

One other thing worth considering is the long term effect on EHR pricing because of the EHR incentive money. EHR incentive is creating an artificial pricing bubble, but eventually the incentive money will run out and I expect a number of EHR vendors to drop their price when that happens. However, what might have an even longer term impact on EHR pricing is the increased number of EHR vendors thanks to the EHR incentive money. Standard economics says more EHR competition leads to lower EHR prices.

What have you seen related to EMR pricing? I’d love to hear your thoughts and experience.

July 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use EHR Breakout by Percentage

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I’ve seen a bunch of different websites listing the top 10 EHR vendors based on physicians who attested to meaningful use using their EHR software. This list is certainly interesting and worthy of a discussion. However, I think it’s also important to put these numbers in some context. Remember that these numbers are just for the ambulatory EHR space. The Hospital EHR numbers are a different story which I’ll probably cover on Hospital EMR and EHR.

Here are the EHR incentive numbers by EHR vendor and also the percentage of meaningful use attestations they had (Thanks to Dr. Rowley for the numbers):

EHR Vendor MU Attestations Percentage
Epic 11075 23%
Allscripts 5743 12%
eCW 4057 8%
NextGen 2237 5%
GE 2002 4%
Athena 1733 4%
Greenway 1650 3%
Cerner 1375 3%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 2%
Sage 1140 2%
Other EHRs (272) 14358 29%

As Dr. Rowley points out in his post, Epic is the largest vendor on the list, but they don’t market or sale their product to independent clinics or even independent physician groups. Epic’s ambulatory EHR is found in owned or affiliated clinics who use the ambulatory piece of the EHR an Epic hospital buys. So, the above Epic number actually provides an insight into how many ambulatory practices are associated with Epic using hospitals.

The numbers tell an interesting story if you take Epic out of the mix:

EHR Vendor MU Attestations Percentage
Allscripts 5743 15%
eCW 4057 11%
NextGen 2237 6%
GE 2002 5%
Athena 1733 5%
Greenway 1650 4%
Cerner 1375 4%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 3%
Sage 1140 3%
Other EHRs (272) 14358 38%

Once you take out the hospital dominance in the ambulatory market, the EHR market share for any one EHR vendor is quite small. In fact, the other EHR vendor category has 38% of the EHR market. The long tail of EHR software is definitely at play right now.

Plus, we have to be really careful using meaningful use attestation as a proxy for the EHR market. I recently saw a figure that only 20% of the ambulatory EHR market had attested to meaningful use. That’s right, the above numbers only represent 20% of the ambulatory market.

If my math is correct, that still leaves almost 200,000 providers that aren’t represented in the above analysis of 50k providers. Imagine an EHR vendor comes along that’s so great that they quickly capture only 20% of the 200,000 uncounted providers (no small feat). That would give them about 40,000 providers and using the above numbers they would have 45% of the EHR market (including Epic).

Of course, the current EHR vendors will continue to sale EHR software and many will switch EHR software vendors during that time as well. Plus, no doubt many of those who haven’t attested to meaningful use already have an EHR, but aren’t represented in the numbers above. They just either don’t care about meaningful use and EHR incentive money or they’re still working to get to the point where they can attest to meaningful use. However, I still think the above numbers illustrate that there’s plenty of opportunity available for an upstart EHR company to get plenty of EHR market share.

It’s going to be an exciting next couple years as we watch all of this shake out. We’ll take a look back at this post in a few years to see how far we’ve come.

June 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.