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Power of the Cloud EHR – Hidden Technology

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Today’s post will be short. I’m hitting up the Black Hat conference in Las Vegas today and tomorrow. For those not familiar with Black Hat, it’s a hackers conference. It’s not quite as hardcore as Defcon when it comes to hacking, but they warn you about getting your devices hacked. I personally plan to play it safe and not bring my laptop and to turn my cell phone off. Anyway, hopefully I’ll do some future posts on security based on what I learn at the event. I always find deep value in going to a conference that doesn’t apply specifically to what I’m doing. Although, in the past they’ve had some medical device hacking sessions, but I digress.

The title of this post describes a concept I was recently considering. In fact, it was inspired by a comment on a previous post by Suzanne McEachron, that talked about a clinic needing to upgrade their in house EHR server from Windows Server 2003 to Windows Server 2008. Here’s the full comment:

Your statement, “While it’s sometimes disappointing to look at the old technology that powers healthcare,” must refer to an ambulatory vendor I am aware of, which installed its software onto a Windows Server 2003 just 3 years ago, and is now demanding the provider upgrade to Windows Server 2008. The provider wants to upgrade to Windows Server 2012, but the software company’s software won’t reliably work (yet) on that version. What is a poor country doctor to do?
He will be dumping his current vendor and finding a software company which uses the cloud instead of servers in his office.
Companies which continue to not keep up, will be left with few customers.

The last two lines are probably worthy of their own post. So, we’ll mostly set them aside for now. However, I was struck by Suzanne’s comment that they would be going with a cloud solution after this experience with an in house EHR vendor.

I’d never thought of this before I read this comment, but is one of the benefits of a cloud EHR that the user has no idea what type of back end technology you’re using to deliver the software? Sure, some of them will ask some questions during the EHR selection process, but I’ve never seen anyone ask a cloud EHR vendor how they’re doing at keeping their technology stack up to date. The reality for end users is that they don’t really care what technology is being used. They only care about the end result. Does it work? Yes. Is it fast enough? Yes. Then, since it’s in the cloud, who cares what technology is being used?

Of course, this may be exaggerating the situation a little, but not much. Certainly very few if any people are asking cloud providers how they’re doing at keeping their technology up to date. No doubt some do care about this and run into this problem even with cloud providers. My favorite example of this is when a cloud EHR provider requires a clinic to use an extremely outdated version of IE (internet explorer) to run the EHR. Yes, then they start to care a lot more.

Maybe it’s a mistake that practices don’t keep after their cloud provider more. However, the reality today is that the don’t. That makes it a huge advantage for cloud EHR providers. At least it does until they’re so outdated that they can’t hide it anymore. For example, when they can’t launch an iPad app because there’s no way for their old technology to work with it. Sounds like I need to create a new jokes series called, “Your EHR might be outdated if….” The problem is the jokes won’t be too funny if you’re suffering through it.

Side Note: So much for it being a short post.

August 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.

The EMRs You Don’t Hear About

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The best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.
September 4, 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.

Benefits and Struggles of EMRs, and More – Around Healthcare Scene

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Are tablets going to take the place of traditional laptops and desktops? Well, Dr. Michael West seems to think so. He talks about his new-found love for his iPad mini, and how it fulfills all his current needs. Have you traded your desktop in for a tablet yet? The new Microsoft Surface is making me kind of want to!

Having a PHR on your phone doesn’t have to be complicated. In fact, if your phone has a camera (what phone doesn’t nowadays?) you can create when quickly and easily. Here are five health-related snapshots you could keep on your phone to assist in a variety of situations.

If you have been following the Affordable Health Care Act, you’ll know that an optional Medicaid State Plan called Medicaid Health Homes was introduced. There are, of course, many questions that people have about this, including what kind of technology will be required for successful implementation. Lori Bernstein, president of GSI Health, addresses some questions and lays out the benefits that this new model has to offer in her guest post at EMR and EHR last week. what kind of technology will Medicaid Health Homes require to ensure successful implementation?

Paper to EMR is a necessary evil for for hospitals, therefore, it’s easy to justify the expense required to do so. But what about when you decide to switch EMRs. Is it justifiable? Not always. There is no ROI to switch from EMR and EMR, and it can be a big risk.

A current pilot program is currently underway to help identify high-risk pregnancies by using an EMR. This pilot program is being led by researchers and people from Johns Hopkins University’s Center for Population Health IT to find hints in a mother’s health history to help determine if her pregnancy is high-risk. It’s a slow-moving project, but may prove to be worth it if it helps get mothers the help they nee.d

June 9, 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.

EMR-Switching Physicians Demand Mobile EMR Apps

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We already know that many physicians are considering dumping their current EMR, with up to one fifth telling research firm Black Book Rankings that they were considering a switch in 2013. Now,  Black Book says that it’s found a focus for the switch:  that physicians are looking for new EMRs to offer integrated mobile applications as front ends.

Seldom do you see as unanimous a decision as doctors seem to have made in this case. One hundred percent of practices responding to Black Book’s follow-up poll on EMR systems told the researchers that they expect vendors to allow access to patient data wherever physicians are providing or reviewing care, according to the firm’s managing partner Doug Brown.

Not surprisingly, vendors are responding to the upsurge in demand, which has certainly been building for a while. As part of the current survey, 122 vendors told Black Book that they plan to launch fully-functional mobile access and/or iPad-native versions of their EMR products by the end of this year, while another 135 say they have mobile apps on their near-term product roadmap.

Demand for core patient care functionality in mobile EMRs outpaces physicians’ interest in other types of mobile functionality by a considerable margin.

According to Black Book researchers, 8 percent of office-based physicians use a mobile device for electronic prescribing, accessing records, ordering tests or viewing result.  But 83 percent said they would jump on mobile EMR functions to update patient charts, check labs and order medications if their currrent EMR made them available.

When asked what  mobile EMR feature problems need to be addressed, current users of both virtualized and native iPad applications saw the same flaws as being the most important. Ninety-five percent of both groups said that the small screen of a smartphone was the biggest mobile EMR feature problem. Eighty-eight percent said difficulties with easy of movement within the chart was an issue, 83 percent said they wanted a simplified version of the EMR on their mobile screen and 71 percent wanted to see screens optimized for touch use.

For more info on EMR Switching check out this whitepaper called Making the Switch: Replacing Your EHR for More Money and More Control.

June 3, 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.

EMR Selection Time, Mobile EMR, and Difficult EMR Selection

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A prudent investment is an understatement. The very best use of your time in an EMR implementation is in the selection process. Although, I’ve also seen some clinics go too far and run into the issue called “paradox of choice.”


Mobile EMR has always been a wonderful idea, but how many are really using their EMR on a mobile device. Let’s also not confuse mobile EMR with remote EMR. Certainly many doctors are using the same EMR from multiple clinics. That’s common and beautiful. However, far fewer are using their EMR on a mobile device. The most common response I get from doctors about a mobile EMR is “I can access my EMR on a mobile device, but the experience is terrible.” I expect this will dramatically change over the next 3-5 years, but won’t likely be the full EMR. Instead, I think it will be a really focused set of EMR functions on the mobile device. I’m not sure anyone has nailed that experience yet. Although, a lot of EMR vendors are working on it.


Everyone that’s read this site for a while knows how much I love analogies. Both of these are pretty spot on. The root canal is necessary and can relieve a lot of long term pain, but it’s no fun going through the process. Buying a car is hard because there are so many choices and so many details that it’s hard to know what really differentiates the complex item you want to buy.

May 19, 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.

The Rise Of mHealth And EHR Use, And The World Of Telehealth – Around Healthcare Scene

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mHealth is on the rise, and it looks like usage of smart phones among physicians is following that same trend. A recent study shows that usage rose about nine percent in 2012, which shows that it is becoming more accepted in the medical world. It will be interesting to see if it increases even more this year (I have a feeling it might.)

Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

Even though 90 percent of doctors are using an EMR at one point or another, only about 55 percent have actually adopted an EHR into their practice. It can be nerve-racking trying to find the perfect EHR. If you are finding yourself at that crossroad, be sure to read these five tips from ADP AdvancedMD on how to have a successful EHR implementation.

Still, some of you may be hesitant to implement an EHR. You may ask, is it worth it? Does it takeaway from healthcare? There is debate from both sides, each with compelling arguments. John believes that technology is overall positive in any industry, and discusses his thoughts, and some of the challenges that faces the industry.

Telehealth and medicine is so huge, it can be hard to digest. Neil Versel recently attended the American Telemedicine Association’s annual conference in Austin, Texas, and saw just how huge this market was. Be sure to check out this video he created from his experience, and to perhaps get a better idea about the many types of telehealth. Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

With summer quickly approaching, it’s more important than ever to stay hydrated. But if you need a little reminder, be sure to look into the Jomi Band.  It gives you warnings when you might be on the brink of dehydration, and makes it easy to keep track of how much water you’ve consumed in a day’s time.

May 12, 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.

Will an EMR’s Quality Metrics Differentiate it from Other EMRs?

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In the emerging consumer-centered, value-driven U.S. healthcare marketplace, the EHR vendors that survive and thrive will need to differentiate their brand by successfully competing on the value (quality/price) their product actually delivers to its end users.

-Bob Coi, MD

This is a fascinating look at EMRs and future differentiation in the EHR market. There’s little doubt we could use some EMR differentiation with so many EMR companies still out there. I’m just not sure that the quality of care that an EMR provides is going to be why a doctor selects one EMR over another EMR.

Every doctor I know wants to provide great care to their patients. Every patient I know wants to go to the doctor who provides them the best care. The problem is that most doctors don’t see a direct correlation between EMR use and the quality of care given. Patients don’t either, and the other challenge is that patients have no way to measure the quality of care they’re given anyway. The closest we come to knowing if the doctor provided quality care is that as a patient I know I’m sick and then I get better. I guess if I got better, then the doctor must have provided me quality care.

With this said, I think there’s the possibility that an EMR discovers a way to clearly show that something they do improves the care of the patient. The incremental document management and simple alert notifications that we see from EMR’s today won’t show that clear improvement in care.

No, we have to think much bigger to clearly show that the care provided was better because of the EMR and that the improved care wouldn’t have been possible without the EMR. An example of this would be integrating genomic data into the care provided. What if genomic data influenced which drugs you prescribed so that the drug was perfectly tailored to the patient? This is a great example where it would literally improve the care you provide a patient and it would be impossible without the technology to do the analysis. Assuming this technology was integrated with the EMR, it would be impossible for doctors not to use the EMR.

This is just one example. I’m sure creative entrepreneurs will come up with many more. Showing that EMR improves quality of care is a really high barrier. Plus, changing physicians perceptions on EMR is going to be really hard even if an EMR system does indeed improve the quality of care. Some company will do it and then Dr. Coi will be right that an EMR’s quality metrics will differentiate it from other EMR companies.

April 11, 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.

New EHR Selector Website

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As long as I’ve been blogging, I’ve been quite interested in the various EHR selection tools that are available out there. For a while, it seems like there was a new EHR selection tool coming out every week. The frenzy of EHR selection tools has mostly stopped and only a few major ones remain. One of those is EHR consultant (Full Disclosure: Has been an advertiser on EMR and HIPAA for many years) which has been doing this as long as anyone and has one of the most comprehensive EHR databases out there. The other that has lasted all this time is EHR Selector. Then, to round out the various EHR selection websites, there are the websites out there like Medical Software Advice and even the AAFP offers a tool to help in EHR selection (only available for AAFP members).

As I suggest in my e-Book on EMR selection, I think you should take advantage of multiple EHR selection tools. I call it triangulating the data since none of them are comprehensive with the EHR world changing so quickly. So, you take all of the data and triangulate down to the best EHR possible.

Many might wonder why I’m talking about EHR selection anyway. Well, if you’re being generous, we’re somewhere around 50% EHR adoption. That’s still a lot of doctors who haven’t adopted EHR. Add to that the number of clinics that are looking to switch EHR software, and there’s still a big need for great EHR selection tools.

The reason I started this look at EHR selection websites is because EHR Selector has rolled out an Open Beta with new features. The best feature they’ve rolled out is that EHR selector is now free for everyone to use. I was pretty harsh on EHR selector in the past for charging doctors to use their service. That business model just didn’t make sense to me. Ironically, Carl Bergman (one of the people behind EHR Selector), has since become a regular reader of this site and we regularly exchange emails about the EHR world. So, I’m glad that he converted the service to a free service for everyone to use.

I tried out the new release of EHR selector and I have some mixed reviews. It is a beta release so that’s partially to be expected. I was a bit overwhelmed by the number of fields I had to complete to get into the tool. I imagine that could be streamlined some to make it a better experience for the user. Although, I expect the data is part of the reason the service can be made free. Plus, the more data you offer, the better customized experience the EHR selection tool can offer you.

What I do love about EHR Selector is that it’s always had a deep set of data available. I wonder if this will backfire for some users thanks to the paradox of choice. Although, as a data lover I really love all the data. Plus, they could help solve this issue with how they choose to display the various EHR and their data with a beautiful UI. I don’t think the UI is to that point yet, but having the data is the first step in that process.

My favorite feature of EHR Selector is the Compare EHR feature. I love seeing the features of multiple EHR’s compared side by side. This is where all the EHR data points becomes really valuable as well. One thing I do wish is there was more than just a check mark for each EHR data point. I’d love to have some qualitative description or images of each data point so you could really compare the EHR features that matter most to you.

One of the other shortcomings of EHR Selector is they haven’t yet gotten the data for all 300+ EHR vendors. No doubt that’s a daunting task and you have to start somewhere. I expect they’ll work to resolve this over time. Plus, they need the support of the EHR vendors to be able to get the data as well (not always an easy task).

Certainly EHR Selector isn’t perfect yet, but with its new Free feature it’s worth taking a look at if you’re in the market for an EHR. It’s another nice data point in the EHR selection process.

March 21, 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.

One-Fifth Of Physician Practices Might Switch EMRs

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Here’s yet more evidence that this is the year of the “big switch” in EMRs, at least among physicians. A new survey by Black Book Market Research has concluded that about 23 percent of practices with currently implemented EMRs are unhappy enough with their current system to consider switching to a different vendor.

According to a piece in Medical Economics, doctors’ concerns include a lack of interoperability, excessively complicated connectivity and networking and problems with mobile device integration.

The survey, which reached out to 17,000 doctors, found that internal medicine docs had the highest rates of satisfaction (89 percent), followed  by family practice (85 percent), general practice (82 percent) and pediatrics.

The unhappiest specialists were nephrologists (88 percent), followed closely by urologists (85 percent) and ophthalmologists (80 percent).

So if a practice is going to switch vendors, what are they looking for? The Medical Economics piece listed five “must-have” features doctors voted for in the Black Book survey:

* vendor viability

* data integration and network sharing

* adoption of mobile devices

* health information exchange support and connectivity

* perfected interfaces with lab, pharmacy, radiology, medical billing partners, and others

Unfortunately, they won’t find it easy to find all of these features in a single EMR.  Of course, you faithful editor isn’t the be-all and end-all when it comes to EMR products (who could be?) but it seems to me that if even pricier enterprise products seldom offer all of these options, it’s decidedly unlikely that ambulatory products will. (OK, vendor viability is a judgment call, but in a world where so many practices don’t like their EMR, it’s hard to imagine that vendors are at their strongest.)

Folks, the truth is that it looks like we’re coming to a market crash of some kind. Physicians aren’t getting what they need from EMRs, but vendors aren’t keeping up, especially in the realm of specialty EMRs.

As if that wasn’t enough, the threat of fines looms for practices that don’t get their Meaningful Use act together, something they may have trouble doing if they’re in the midst of EMR shopping, installation and adoption.

Time is getting tight, and customers aren’t happy. Ambulatory vendors, what’s your next move?

February 26, 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.

EHR and Mobile Health News Around the Country

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It may come as a surprise to some, but according to a study by eClinicalWorks, the majority of physicians like EMR-connected apps, and mHealth apps in general. 2,291 healthcare professionals were surveyed, and 649 were physicians. Over 90 percent of physicians feel it’s valuable to have their EMR connected to an app. The study also revealed other interesting things concerning physicians and medical apps.

And EHR vendors may want to consider this when developing and updating their EHR. From the Black Book Rankings, here is a list of top EHR vendors among hospitals. I bet some of these ones definitely have.

On a similar topic, there was a recent study about physican EMR use in the United States. Apparently, they are behind other countries. While usage has definitely increased recently, with 69 percent of doctors using some type of EMR in 2012, it’s still well-below the rates in the Netherlands, Norway, New Zealand, the U.K, Australia, and Sweden, all that have EMR usage rates above 88 percent.

For anyone that is interested, there is quite a bit of legislation on telemedicine this year across the United States. This chart shows all that’s going on in three different categories — legislated mandate for private coverage, legislated medicaid coverage (primarily interactive video,) and other proposed bills affecting medicaid coverage.

There’s always a lot going on in the mHealth world. Have you heard of FilmArray? It’s a device that was developed by a company in Utah. So what does it do? Well, it can detect 20 respiratory diseases in less than an hour. This will definitely make it easier for people to get their illnesses diagnosed quickly. In other news, HealthTap has released a new program called TipTaps. The program sends tips, created by health professionals, and personalized for a person’s lifestyle.

February 24, 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.