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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.

New Opportunities to Avoid ePrescribing Penalty for 2013 – Meaningful Use Monday

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According to the 2013 Medicare Final Rule released last week, there are new ways to avoid future payment adjustments under the MIPPA ePrescribing rule for those who have not already taken the necessary steps to avoid them: 1) The exemption request period has been reopened and 2) meaningful use will satisfy the ePrescribing requirements according to specific timetables.

1) CMS is offering a second chance to physicians who missed the June 30 deadline for requesting an exemption to the 2013 ePrescribing penalty (1.5%) under the original 4 categories. Between November 1, 2012 and January 31, 2013, physicians can go to the Quality Reporting Communication Support Page and request an exemption based on one of the following justifications:

  • Inability to electronically prescribe due to local, State, or Federal law or regulation (i.e., prescribe predominantly controlled substances)
  • Prescribed fewer than 100 prescriptions between January 1 and June 30, 2012
  • Insufficient high speed internet access (i.e., rural area)
  • Insufficient available pharmacies that accept electronic prescribing.

2) In the interest of harmonizing the various government programs that contain ePrescribing components, CMS now will provide two additional ways to avoid the 2013 MIPPA penalties:

  • Achieve meaningful use during 2013
  • Demonstrate intent to participate in the EHR Incentive Program and adopt Certified EHR Technology by January 31, 2013

This information will be retrieved by CMS from the information in its EHR Incentive Program’s Registration and Attestation System, rather than by having providers request an exemption as in #1 above.

November 5, 2012 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.

Final Rule for Stage 2 Brings Some Changes to Stage 1 – Meaningful Use Monday

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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. Check out Lynn’s previous Meaningful Use Monday posts.

Although Stage 2 requirements don’t become effective until 2014, the Final Rule for Stage 2 contains some changes that apply—or can apply—to providers before then, and some that will apply to all physicians in 2014, even those still in Stage 1. These changes fall into 3 categories in terms of timing:  those that are effective in 2013, those that can be adopted in 2013 at the physician’s discretion, and those that are implemented in 2014.

Effective 2013:

  • Conducting a test of the EHR’s capability to exchange clinical information (Stage 1 Core Measure 14) will be dropped from the requirements. It will be replaced in Stage 2 by measures that require actual and ongoing exchange of information.
  • A new exclusion for the ePrescribing requirement is being added for physicians who have no pharmacy within 10 miles that accepts electronic prescriptions.

At Physician’s Discretion in 2013 (and required in 2014):

  • The Vital Signs measure will be restructured to separate the reporting of height and weight from the reporting of blood pressure. This is good news for those specialists who consider some, but not all 3 of the vital signs, relevant to their practice. Along with this change in the measure are revised minimum ages: blood pressure reporting will be required for patients age 3 and over instead of age 2, and height (or length) and weight will be required for all patients, even those under 2.
  • An alternate calculation for CPOE will help physicians—again, likely specialists—who do not prescribe frequently enough to meet the Stage 1 (30%) threshold. The denominator will be limited to “medication orders created by the EP during the EHR reporting period,” instead of “unique patients with at least one medication in their medication list.”

Effective 2014:

  • Currently, in Stage 1, if a provider attests to an exclusion for any menu measures, these measures can be counted towards the menu requirement. In Stage 2, this will no longer be true—excluded measures will not satisfy the menu requirement if there are other measures on which the provider could report instead. This will also apply to providers who are still reporting under Stage 1 in 2014—a change which those providers will likely perceive as inequitable since it did not apply to the earlier attesters. Those physicians who qualify for multiple exclusions—specialists, once again—will find that the menu set is really no longer a menu, as they will be left with few, if any, choices. 

So, while physicians do not have to focus on Stage 2 just yet, they should consider whether they might benefit from the 2013 changes described above.

September 10, 2012 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.

MU Stage 2, ICD-10 Delay, Epic-Related Safety Errors, and Mobile EMRs – Around HealthCare Scene

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EMR Thoughts

Meaningful Use Stage 2 Final Rule Published

The long awaited MU Stage 2 final rule was published last week by CMS. No one will be required to follow the requirements until 2014, when the program is set to begin. The Stage 2 final rule is 672 pages long. The press release concerning MU Stage 2 mentions interesting facts, such as 3,300 hospitals have participated thus far.

ICD-10 Delay Finalized with New Unique Plan Identifier

In an announcement that was kind of lost in the midst of the meaningful use stage 2 final rule, the ICD-10 delay is official. As someone said on Twitter, you now have two years to get ready for ICD-10. You better get started now. The announcement of a Health Plan Identifier (HPID) is also very big news.

EMR and EHR

Nurses Raise Alarm Over Epic-Related Safety Errors

With any EMR, there is an adjustment period. However, there was an error recently at a prison clinic in California that could have been deadly that was related to the implementing of an Epic installation. Nurses have raised many concerns about the system, and have likely not been adequately trained. Is the issue with Epic because of the system, or because of inadequate training?

We Know What’s Right, but It’s Hard
Being healthy and overcoming illnesses takes works. And obviously, most of us know that if we don’t put in that effort, there will be negative consequences. Unfortunately, many people don’t put in that effort. Luckily, with the advent of being able to monitor health from home with smart phone apps and other gadgets, it is easier to do what we know is right. Is mHealth applications the answer to the question of how do we motivate ourselves to do what we know we should?

Happy EMR Doctor

Can We Talk? Challenges of SaaS Type EMR User Interfaces

SaaS EMR User Interfaces have a variety of challenges. The latest issue is ensuring that all the individual software work together in a way that doesn’t interrupt a practice’s workflow. This week, Dr. Michael West talks about how, when one component gets updated, it often causes others to work less efficiently. His office recently experienced this, and described the frustrating experience.

Smart Phone Health Care

Detecting Parkinson’s with a Phone Call

About 5 percent of adults over the age of 80 has Parkinson’s Disease. A new technology is being developed that supposedly can detect Parkinson’s Disease. And not only can it detect it, but with 98.6 percent overall accuracy. This raises the question, what can a smart phone not do? This is just the beginning of disease detection and treatment with smart phones. What’s next?

Five Health Communities Every Patient Should Use

It’s easier than ever to have a health problem. Okay, not really, but it’s easier to find support. There are many great communities online dedicated to helping patient’s find information about just about every health topic out there. Some offer free advice from medical professionals, and others implement social media. Here are five of the best communities everyone should join.

Hospital EMR and EHR

Survey: Virtually All Docs Want Mobile EMRs

9 out of 10 doctors want to be able to access their EMR on a mobile device, according to a recent study. It makes sense, since so many doctors are using iPads and smart phones nowadays. Luckily for these doctors, companies like Vitera and eClinicalWorks are working on mobile solutions for this. Hopefully these solutions will include things like reviewing and updating patient charts, and ordering prescriptions, which ranked among the top functions doctors are hoping a mobile EMR would include.

August 26, 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.

Global eHealth Olympics, LifeArmor, and Meaningful Use Stage 3 Draft: Around HealthCare Scene

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Time to take a quick look at some of the interesting posts happening on the other Healthcare Scene blogs. I think you’ll enjoy many of the posts.

EMR and EHR

Would Meaningful Use Go Away Under a Romney Presidency

With the November presidential election quickly approaching, there are many questions floating around. With Mitt Romney’s desire to repeal ObamaCare, some are wondering if he will try and stop HITECH as well. And if so, what is the fate of Meaningful Use.

Global eHealth Olympics

While the 2012 Olympics in London have been on the minds of many across the world for the past two weeks, Blair Butterfield suggested another sort of Olympics — one comparing the health care of different countries. He asks the question, “What if we compared our healthcare system to those of Europe, Asia and the Middle East in terms of areas like integration, communication and population health? How would the U.S. fare?” This post contains ideas for the different “events” that might occur in an eHealth Olympics, as well as suggestions for the top contenders for each category.

Meaningful Health IT News

Colbert Lampoons Proteus Digital Pill

The Proteus digital pill has gotten a lot of attention since it was announced. Included in that attention was a bit about it on the Colbert Report. It’s a spoof, of course, but somewhat entertaining. As Neil Versel says, “At least Colbert’s version featured a wireless tablet computer.

Smart Phone Health Care

LifeArmor Created for Military Families for Coping with Stress

A mobile app created by the Department of Defense aims to help military families cope with different issues. It addresses 17 topics, including depression and post-traumatic stress. The app takes content from the D0D website, AfterDeployment, and has videos and assessments. The app is free.

Several Pharmacies Offer Online Services for Patients

In-store pharmacies have started offering online services to make re-filling and transferring prescriptions easier than ever. Target and Walgreens are among those stores, and there are positives and negatives to using these services. Have you switched to online management of prescriptions?

Hospital EMR and EHR

Population Health Management is No Fad

Is population health management a fad, or is it here to stay? Anne references a recent column by Information Week by Paul Cerrato, where he states that it is. However, while she agrees that Cerrato’s column was “well-argued,” she disagrees with the suggestion.

Meaningful Use Stage 3 Draft On The Way

Although the MU Stage 2 final draft hasn’t been released yet, the draft regulations for stage 3 are apparently going to be released in August. Healthcare Informatics suggested a list of recommendations that are likely to be in stage 3, such as tracking individual care goals, and track tracks/steps and responsible party.

August 12, 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.

Reverse Innovation, Health IT Adoption, and Mobile Health – #HITsm Chat Highlights

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Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: ‘Reverse innovation’ is effective for community health organizations. Can health IT facilitate a return to basics for the overall system?

 

 

 

 

Topic Two: Why have allied health professionals adopted health IT faster, overall, than physicians? Can these practices be transferred to patients?

 

 

 

 

 

 

Topic Three: What are some uses of mobile health that you feel aren’t receiving enough care or attention?

 

 

 

Topic Four: Free for all. What Health IT topic has interested you most this week? Why?

 

 

 

August 4, 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.

EMRs Can Spark Creativity

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Today I’ve been letting a few curious little theories germinate in my head. So I thought I might try out an idea on you good folks.  For those who have read my previous rants about breaking a doctor’s workflow, this may seem rather contrary, but hey, we can always duke it out later.

Yesterday, I went to see a specialist who’s a member of a decent sized practice (about a dozen docs, give or take).  The office is completely paper-based, efficiently and elegantly if my patient’s eye view is any indication.  The practice is something of a zoo — super-high volume — but I seldom if ever feel rushed or impatient.  In other words, we’re talking what looks like a pretty well-run shop from the pre-EMR era.

When I saw my doctor, we puzzled together a bit over a medical issue I’m facing, one which could be drug-induced or could be organic.  We spent some time talking about standard solutions and how to manage them and then, boom, my specialist had an inspiration.  We agreed that I should taper off one medication and begin the other shortly.

Luckily for me, my doctor was engaged and seemed interested in digging into the problem.  But in other cases, realistically, I might have gotten a physician that stuck blindly to the obvious and didn’t dig up what might be a slightly unconventional solution.

Here’s where I contradict myself to some degree.  In past essays, I’ve written on how inelegant and undesirable it can be to break physicians’ workflow for the sake of squeezing an EMR into place. I’ve argued that EMRs should be designed for physicians and not for administrators. And so on.

This encounter, however, convinced me that when EMRs break passive, standard workflows, it could be a spur to creativity in some cases.  In the right situation, if the doctor I saw was distracted or bored, the EMR could throw second line solutions at him or her just when they were ready to e-prescribe and sign off on the visit. (Yeah, a “do you want to leave this chart now?” prompt with a med recommendation might be annoying, but it could be productive!)

Of course, no system can force a physician to engage if they simply don’t want to do so, or don’t have time to think. But if the system is designed right, maybe the changes EMRs engender can lead to fresh ideas, better grasp of details or just a reminder on a bad day.  At least I hope so. What do you think?

June 15, 2012 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.

DrFirst Shifts to EHR Platform Company

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If you haven’t yet seen this video that DrFirst created for HIMSS 2012 and the HIMSS Healthcare Hero, then you need to watch it now. It’s a really beautiful video: http://bit.ly/AnNvzU

After seeing such a well made video, I definitely wondered what was up DrFirst’s sleeve at HIMSS 2012. So, I reached out and today I had the chance to talk with Cam Deemer President of DrFirst about the transition that’s happening at DrFirst.

I think that most of us have known DrFirst as an ePrescribing company. Since about 2004 they have been extremely focused on the ePrescribing area and that shows in the fact that DrFirst is the “ePrescribing Inside” 230 EHR companies. That’s a really impressive number and includes a client list with such names as GE and Greenway.

DrFirst is ready to make a shift which they’ll be talking about at HIMSS in Las Vegas. What I think makes DrFirst’s ePrescribing platform really interesting is that they can provide it using the DrFirst interface or an EHR vendor can customize it to their liking using a series of API calls. It takes a unique company and a unique set of skills to be able to do this effectively. Now imagine they provide these same functions and features across a whole array of EHR related products and services. By doing so, DrFirst becomes a really interesting EHR Platform.

You can find DrFirst at HIMSS to get the entire list of the products and services that they’ll be offering to EHR software vendors beyond just ePrescribing. However, I was really intrigued when they talked about their EHR platform providing compliance programs, patient education, and even co-pay discounts which help with medication compliance. I wouldn’t say that any of these things on their own are all that interesting. They are however things that a small EHR vendor wouldn’t have the time or the resources to be able to execute properly. For those EHR vendors who use the DrFirst interface, they can be turned on with the flip of an online switch.

Now just imagine a whole suite of other EHR services that DrFirst could provide EHR vendors as well. It becomes a really interesting value proposition. Plus, DrFirst also has a number of interesting solutions in the hospital market that also leverages this platform. Things like medication history for hospitals and a lab platform.

At the end of the day, EHR vendors are going to decide if this is a value added service or not. Many larger EHR vendors are going to develop a number of these features themselves and that should be expected. I just see it as a really healthy thing to have these type of EHR platform services available. Many EHR vendors have been so swamped with meaningful use and EHR certification, it’s great that a third party integration could continue to add real value to an EHR software.

The real challenge for DrFirst is going to be around how well they integrate these new EHR service offerings into the various EHR software vendors. If the integration is clean and adds value, they’re going to do very well. If it’s kludgy (a software term for messy) and doesn’t integrate well, then we won’t see much adoption. I think their current 230 EHR integrations are one sign that it will go smooth, but we’ll see.

My next question to consider is how DrFirst could extend their platform next. I can think of a number of mobile health companies that could benefit from the right connection to prescription data or to doctors. I’ll be pressing them at HIMSS to find out what’s next. I hope you will too and come back and share what you find out.

On a side note, I just got the list of things DrFirst is doing at their HIMSS 12 booth. It’s extensive and will be a can’t miss booth. Watch for the details in my upcoming HIMSS 12 exhibitor post.

Full Disclosure: DrFirst is an advertiser on EMRandHIPAA.com.

February 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

MU Stage 2 Delayed: Should You Rush to Attest? – Meaningful Use Monday

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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. Check out Lynn’s previous Meaningful Use Monday posts.

HHS recently announced the postponement of Stage 2 Meaningful Use to 2014. The only providers who are in a position to act on this “opportunity” are those who have not yet, but still could, attest to meaningful use in 2011—but, a word of caution before you rush to attest in 2011. 

The HHS announcement “encourages any providers who have been waiting until 2012 to attest to Stage 1 meaningful use now. ….Those providers who first attest in 2011 can get three payment years for meeting the Stage 1 expectations, while those first attesting in 2012 can only get two payment years under Stage 1 criteria.” 

True. However, you must carefully weigh the benefit, (earning the $8,000 third incentive payment under the rules of Stage 1 instead of those of Stage 2), against the cost, (the permanent loss of your 2011 Medicare ePrescribing bonus money). Remember, you cannot receive incentive payments under both programs during the same year, so you maximize your total reimbursement by collecting the 1% ePrescribing bonus this year and waiting just 3 months to begin earning the $44,000 in EHR incentives over the next 5 years. There is no universally right or wrong strategy—just do the math and analyze the trade-off before making a decision.

December 12, 2011 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.

Riskiness of Pharma Ads in EHR

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I’ve been having a number of really interesting conversations with people about Pharma ads appearing in EHR and other clinical software. Most people’s gut reaction is that they don’t want their doctor seeing a pharma ad while he’s ePrescribing. However, most people also agree that there’s too much Pharma money for it not to happen.

In an article at Lab Soft News a few months back, they discuss the challenge and issues surrounding Pharma ads in an EHR:

Very distressing to me, however, is the clear link of the company, and its software, to the pharmaceutical industry. I have blogged on numerous occasions about some of the ethical and legal lapses of some of these companies (see, for example: On the Corrosive Influence of Big Pharma on Academic PhysiciansMerck Creates Phony Peer-Reviewed Medical Journal to Dupe PhysiciansDetails Emerge About Ghost-Written Medical Articles for Wyeth). I have also reluctantly come to the conclusion that even apparently trivial advertising connections to Big Pharma can lead to mischief. I had previously thought that inconspicuous advertisements in EMRs by drug companies might be tolerated if the companies were to bear the costs of these systems. I now believe that allowing these companies even a tangential relationship to physician-office electronic medical records is too risky.

Certainly there are some really great points made. Absolutely there’s a risk that a doctor could be influenced by a pharma ad in an EHR. Will it make them provide a lower quality care because of the ad? I’m not sure it would. Could the care cost more because of the pharma ad? Possibly so. Do we not trust our doctors to do what’s best for us regardless of the other outside influences?

Back to the initial premise, many are concerned with Pharma ads, but they’re bound to happen anyway. So, I ask you the question, is there any way to have Pharma ads without compromising the integrity of the visit? Is there a way to minimize the influence of Pharma while still allowing them a way to talk with the doctor?

No doubt this discussion is going to come up again and again. With Pharma unable to even give a doctor a pen we’re going to see new creative ways for Pharma to be seen by doctors. Advertising Pharma products to patients won’t be enough.

November 23, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.