As most of you realize, HealthcareScene.com has grown tremendously over the last year. At the start of 2011 I think that there were 3 websites that were part of the Healthcare Scene network of EMR and Healthcare IT blogs. By HIMSS in March 2011, I’d grown the list of websites to 7. Today, I’m happy to say that there are 14 different websites and blogs that are part of the Healthcare Scene blog network.

As you can imagine, it is hard enough for one person to manage writing two blogs. It’s nearly impossible for one person to manage 14 websites. Luckily, I have a group of passionate writers that do a ton of amazing work across the network of EMR and HIT blogs. I imagine some of them don’t get nearly enough recognition for the great work they do. Each post says the name of the blogger at the top, but many people never take a look. This Christmas break I’ll see if I can finish a project I’ve wanted to do for a very long time and do a better job recognizing the various authors of each post better.

In the mean time, I decided that I’d mention each of my writers and recognize them for how great they are, cause they are indeed great. Now on to the writers (in no particular order):

Katherine Rourke – If you’re a reader of EMR and EHR (and you definitely should be), then you’ve no doubt have read some of Katherine Rourke’s posts on EMR and EHR. She’s done almost 100 posts on EMR and EHR and did a great job raising the level of content and readership of that site.

Lately she’s been spending most of her time writing for the relatively new Hospital EMR and EHR. She’s done a great job covering the Cerner and Epics of the hospital EMR world on that site. Also, if you’re more interested in some non health IT related healthcare blogging, you can find her writing at next Hospital.

Katherine is a passionate lover of healthcare and hospitals in particular (thus the move to the hospital site). She’s the only person I’ve ever met that gets excited to go to the hospital. Lucky for us, her passion throws through in her writing and she’s not one to mince words. She’s got a punchy style which I and many other readers really enjoy. As a trained journalist (unlike me), it has been great to work with her.

Side Note: Katherine Rourke is a penname. She wasn’t around when I was writing this so I could see if I could reveal her real name. I think she kind of likes the mystery and intrigue of being anonymous though.

Neil Versel – If you’ve been around the healthcare IT industry in any way at all, then I am certain you’ve read some of Neil Versel’s work. In the case of Healthcare Scene, Neil blogs on Meaningful Health IT News, but Neil has written for basically every major (and probably all of the minor) health IT publication that exists or has existed over the past 15 or so years. He’s one of the true professional health IT journalists.

On a more personal note, I stumbled upon Neil’s blog when I first started blogging. I remember reading Neil’s work in various publications and thinking to myself, “He’s a journalist. I’m not. What can I learn from what he does?” I know that much of my style and approach to writing came from the things I saw Neil do.

Dr. Michael West – I am always honored to have working physicians blogging on my network and Dr. West is one of the two doctors that participate in Healthcare Scene. Dr. West is an endocrinologist in private practice in Washington, DC and writes on the blog Happy EMR Doctor. Yeah, the name is a little cheesy, but it was the best we could find with all the domain squatters out there. Plus, he truly is a Happy EMR user.

Dr. West provides an interesting physician perspective since he implemented an EMR that was a complete failure. He replaced that EMR with a Free EMR solution. Plus, Dr. West chose to opt out of Medicare rather than to continue to experience all the Medicare cuts and penalties (particularly those related to meaningful use requirements). Obviously, all of these items make for some great content on his blog. I also love that he recently had his Practice Manager, Ken Harrington, hop on the blog and do a post about how EMR influences HR in a doctor’s office. I hope Ken writes for the blog more often.

Dr. Michael Koriwchak – The second doctor that writes of Healthcare Scene is Dr. Koriwchak. He’s an ENT out of Atlanta (there’s so much good health IT in Atlanta) that’s been working with health IT and EMR for a long time. You can read his blog at Wired EMR Practice. Lately he hasn’t had as much time to blog thanks to a number of other projects he’s working on including trips to Washington to talk about things like the HITECH act and ACOs. In fact, he just happened to be with Hermain Cain in DC for one of the famous Hermain Cain lines that was quoted over and over again on the news.

Regardless of how much time he has to blog, if you look through his past posts you can see that he provides a lot of interesting thought and insight from a physician perspective to the challenge of implementing and using an EMR system. One of the best series of posts he did was his Lessons Learned from an EMR Upgrade Part 1, Part 2 and Part 3. Dr. Koriwchak is definitely ahead of the curve.

David Lynn – Many of you might not recognize David’s name, but his the quiet voice behind 4 of the Healthcare Scene blogs. He manages and does all the hard work on EMR & Health IT News, EMR & EHR Screenshots, and EHR & EHR Videos. In the short time those sites have been up, David’s turned them into a really great resource for those researching EMR and EHR software or for those in the industry just trying to stay up on the latest and greatest EMR info.

You will find David’s more creative work on Smart Phone Healthcare. That website is focused on mobile health and I’m always amazed at the content, devices, apps and other technology that David is able to find and post about on that site. I’m also happy to call David my brother (or maybe I should say little brother). For the longest time we’d wanted to work on some project together. The opportunity presented itself for him to participate in the network and he’s done an amazing job, which isn’t surprising since he’s one of the smartest people I know.

Lynn Scheps – I think most of you reading this are familiar with Lynn. Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft, but she’s also the power behind Meaningful Use Monday. I have had a ton of people tell me how valuable Meaningful Use Monday has been for them and all credit should go to Lynn for putting in the time to share the knowledge with all of us.

I think when I first suggested the idea of blogging about meaningful use to Lynn she was a little reticent. However, I think she’s come to enjoy the experience of putting the ideas down in writing and also the value of getting feedback and commentary from users. On a more personal note, Lynn is a genuinely kind person and pleasant to be around.

Priya Ramachandran – I was really lucky to be introduced to Priya and have her start writing on both EMR and EHR & EMR Thoughts. Priya provides a really fresh perspective on the industry. Plus, she’s a computer nerd like me which is always great for bonding us together.

One thing I love about Priya is that she always has her ear to the ground to hear the latest things that are happening in the EMR and Health IT world. In fact, I don’t know how many times I’ve had an idea for a post based on some current HIT happenings and then I get a post from Priya about that same subject.

Jennifer Dennard – The addition of Jennifer Dennard writing on EMR and EHR is relatively new, but I had known Jennifer for quite a while before she started writing. I can’t quite remember how I convinced Jennifer to write for my sites, but it was one of the best choices I’ve made.

One of the things I like most about Jennifer’s posts is her ability to share something personal and then connect it to an EMR or healthcare IT story. Plus, as I finish reading her posts I often think, “Wow, that took me somewhere unexpected and interesting.” I attribute this ability to her superior mind and creative writing style. I’m always excited to see what twist and turn she’ll take me on next. At the recent AHIMA conference I had a chance to connect with Jenn on a more personal level as well. Not only is she a great writer, but she’s an incredibly thoughtful and caring person that everyone should want to be around. I’m lucky I’ve had that chance.

As you can see, I’m lucky to work with such amazing people both professionally and personally. This Holiday Season I want to send out a big Thank You to them. If you want to send them a gift as well, I imagine one of the best things you can do is to read their posts and leave a comment on the ones you find interesting. There’s not much nicer as a blogger than someone taking the time to read what you do and engage in a discussion around that comment.

Happy Holidays!

A beautiful Thanksgiving is nearly over, but I’d be remiss if I didn’t at least drop a few sentences of gratitude for readers of EMR and HIPAA on Thanksgiving. I live a wonderful life. I have a fantastic wife that is a wonderful compliment to me. She’s had a lot more to put up with me traveling so much lately for HealthcareScene.com and she’s been a wonderful supporter of me. I have 3 wonderful kids that are incredibly fun and bring so much joy into my life.

Lately I’ve been talking with a lot of people and they invariably ask me what I do. My simple answer is: I’m a blogger. Many times I comment how I never thought I’d be a blogger when I grew up. In fact, if you’d asked me a year and a half ago when I quit my day job if I’d be a full time blogger I probably would have laughed. I’m certainly the beneficiary of a little bit of luck, some great timing, and a decent amount of hard work. Although, I’ve had so much fun doing most of it that it’s often hard for me to call it work.

All in all, I have so much to be grateful for. I’m particularly grateful for all those who read EMR and HIPAA and my other sites and the advertisers who support my site as well. No doubt, none of this would be possible with out great readers. Thanks for reading. Thanks for commenting. Thanks for participating. Thanks to all the advertisers that have supported this site. As I’ve discussed recently with a number of advertisers, my goal is to provide really great value so we have long term relationships with our advertisers. For the most part, we’ve been able to do just that. So, Thank You!

Today’s been an interesting day to say the least. It’s amazing the mixture of emotions that have come to me as the 10th anniversary of September 11th passes. It’s this interesting mix of pride for America and its resiliency, sorrow for the loss of life and still not completely understanding how people could do what they did.

However, the thing that struck me most today was that my son really didn’t know anything about September 11th. He’s only 7 years old and so we’d never really talked to him about the details of what happened and quite frankly he’s still too young to really understand the meaning of that terrible day.

My wife and other two kids were out of town this weekend and so my 7 year old and I sat together and watched a few of the 9/11 specials that were going on. It provided a new perspective to me to try and share with my son why someone would fly a plane into a building like that. Needless to say, he’s got a lot more to learn and understand about the situation. However, it was educational for me to think through the questions he asked. I definitely didn’t have all the answers, but it helped me to appreciate the sacrifice the emergency response staff made on that day.

At one point in the fire fighter special we were watching my son had slowly gone and gotten all the fire engines we had in the house (I didn’t realize we had so many). In one scene they’re driving to ground zero where they see fire engines trashed and cars, ambulances and fire engines on top of each other. My son started to do the same with his toy fire engines. I tried to help him understand how “the good guys,” the fire fighters were doing everything they could to save people’s lives.

Each year as he grows, I’m sure he’ll learn more and more about the importance of 9/11. In some ways, I guess it’s a good thing that he doesn’t have to be harrowed by sad memories of that day.

I read somewhere that the theme for the 9/11 10 year anniversary is “I will volunteer.” I love the idea, but wish they’d have called it, “I do volunteer.” The idea of volunteering and helping others shouldn’t be like a New Years Resolution which we fail to keep. Helping others should be apart of who we are. I hope that this is indeed the legacy of 9/11. That’s what I plan on teaching my son.

For those of you that were expecting a meaningful use monday post, I’m sorry. Don’t worry though, Lynn will be back with another Meaningful Use Monday post next week. It is Labor Day after all. Although, I saw a great tweet or Facebook status that said, “Why in America do we take the day off on Labor day?” I love plays on words. They also asked why we put a tree in our house for Christmas and not Arbor day.

I must admit that Labor day has become pretty inconsequential for me. Football has already started. My son’s been in school for a week already. Blogging for myself, it’s not like I really get a day off. Plus, we don’t live close to family, so there aren’t even any big family parties.

With that said, I am glad to have the summer behind us. Maybe that’s a function of living in Las Vegas. I’m beginning to understand why retired people come to Vegas in winter and head to cooler areas for summer. Maybe one day I’ll achieve that dream. Although, I also must admit that there’s something comforting about getting back into the routine of school and other activities. Maybe this is a function of younger kids being home all summer.

I must admit that this Labor Day my thoughts have been with many of those who are without jobs. It’s a crazy economic and political environment that we’re in now. I’m afraid we’re looking at a slow recovery and so we’re going to be in the current situation for a while to come.

My one consolation is that there are now 10 writers on the HealthcareScene.com blog network. That’s pretty good considering a year and a half ago when I quit my day job it was just me. I hope I can continue to grow the network and provide even more people income writing about EMR and Health IT. I’m lucky to be associated with such amazing writers. If you don’t know what I mean, go check out some of the other HealthcareScene.com blogs.

Now, time for a little family time. I hear making a fort with my kids is on the agenda today. I love being a kid again.

Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)

Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.

This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.

On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.

On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.

That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.

While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.

I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.

I’m pretty sure that most of you didn’t notice that I was completely off the grid this last week. I was high up in the mountains at a high adventure scout camp enjoying the beauty of God’s creations while shooting guns, mountain biking, saling, hiking and many other amazing adventures. It’s actually a great thing for me to do it. It is great fun to work with fine young men and see them have these amazing experiences, but it’s also a great way for me to recharge. Hopefully you didn’t notice my absence since I scheduled the posts to appear as usual throughout the week.

This week I’m actually “on vacation” as well.  I’m in Rochester, NY where my wife is from. Although I’m never far from work. I’ll be spending some time posting as usual. Plus, I’m hoping to have lunch with a reader of this site while I’m here.  I’d love to meet other readers from Rochester if you’re free sometime too.

Not to mention, I met someone today that is a PA in DC and we talked for a little while about EMR. It’s always interesting to get new perspectives. Plus, I’m always amazed at how little these clinical people really know about the details of the stimulus. I guess that’s what happens when you eat, sleep, and drink it every day. This PA from DC also made me excited to go to DC sometime soon. So, if you know of a must attend healthcare IT conference happening in DC, let me know. I’ve never been and I now have a number of reasons to go out there. Plus, I’ve been itching to go to a conference. Of course, I’d love to meet any DC readers as well.

More tomorrow from the beautiful upstate NY. I’m not use to all this green.

I hope that everyone is enjoying this wonderful Fourth of July. I know I’ve had a great day so far and we’re gearing up to head to KFC and enjoy some fireworks with friends. Should be a great evening if the kids don’t get too cranky along the way.

It has been a great day for me to remember how lucky I am to live in this wonderful country. There are plenty of things that are messed up in this country, but over all the freedoms we enjoy and benefits of living in America far outweigh the down sides.

As I typed in the title of this post, I wondered what other things do I wish had their freedom when it came to the EMR world.

First thing that came to mind was data independence. How beautiful would it be if our healthcare data was independent. I’m sure the ePatients out there would love to have access to their patient data. I think they’ve made some great progress in this regard, but our systems still need to get to the point that healthcare data independence is an even bigger reality.

I also couldn’t think about the doctors that are held hostage by unscrupulous EHR vendors who are taking them for whatever money they can while they hold a doctor’s data hostage. You know what I’m talking about if you’ve ever wanted to leave one EMR vendor to go to another. There are some EHR vendors who do a great job of this, but most of them are terrible. Yes, most of them are large companies who are more worried about numbers than they are customers. Thus, the results aren’t pretty. Of course, the great companies out there realize the benefits of making the data available to users. Not to mention the trust that’s built with a customer when they know they could leave any time they want. That kind of customer first focus will carry through to all of the other features of the software. We need more data independence from EHR vendors.

I recently wrote a post on EMR and EHR about Technology Flourishing without the Chains of Insurance. I’m not sure if complete independence from the insurance companies is the right approach, but we need to allow more doctors to be free to be doctors. They need to have more independence from the insurance company requirements and more concerned about the health of patients. I’m not sure how we get there from here, but I applaud those many doctors who do this in the face of perverse financial incentives.

I’m sure there are many more. Let me know your thoughts about independence day and I hope you enjoy the holiday.

This is a great video that does a great job showing how big the world is, how fast technology is growing and a number of amazing perspectives about what’s going on in the world. I’d seen this video a while back, but Wes Kemp just emailed it to me again and it was great to be reminded of the amazing world we’re living in. I hope you’ll enjoy it as well:

I’m not sure how many of you have followed the announcement of the Google 1+ button. If you haven’t seen them yet, you’ll start seeing them sprinkled all over the internet soon. I just added them to a couple of my sites including EMR and HIPAA. You can see it next to the Facebook button on the right side of each post. Feel free to click it if you’re reading a post that you like. It’s a simple action which can tell me a lot about whether people like the post or not.

Of course, I’ve been using social media indicators like this for a while. For example, I’ve known the number of people who tweeted out my various posts on Twitter. I often can see how many times an article gets published on Facebook. I always love to get feedback like this that tells me that someone liked the article I created. However, often tweeting a link or sharing a link on Facebook is more than someone wants to do. The Google 1+ is an even simpler and more anonymous way of telling a blogger or other website that you like what they’ve created. I’m interested to see how many people are willing to take the simple step of clicking the Google plus 1 button when they like a post.

However, beyond the benefit to a blogger of knowing which content its readers like, Google is no doubt going to use this information as well to create more targeted search results (and likely ads as well). Some people bristle at the idea that Google would have this information. However, I don’t have any problem with it. In fact, I like that Google will be able to provide me a better service. For example, if I search for EMR on Google, they should know I want to know about electronic medical record sites and not the EMR paintball one. I think data like the plus 1 could help Google to improve that experience for me. That’s a good thing.

I’ve been really interested in these social media indicators and the influence that someone can have online. For example, just because someone has a lot of followers, does that make them an authority? What if you find some health information online? How do you know the quality of that information? What if you’re searching for EMR software? How do you evaluate the quality of the information that’s being provided? What about any biases that information might have? Can social indicators help you to improve your understanding of the quality of the information?

I’m not sure the answers to many of these questions, but I do think there’s power in a crowd of people expressing their opinions on a subject. Even something as simple as clicking on a Google plus one benefit. Will it cure Cancer? No. However, it can still have a profound impact on the way we discover information and how we help others understand the quality of that information.

I very rarely republish items on EMR and HIPAA. However, every once in a while something is so good that I think it’s worth sharing so that more people can read. The following is one such case. I loved reading Dr. Rowley’s perspective on the Japan disaster and potential radiation health risks. The article was originally published on the EHR Bloggers site. As Dr. Rowley, our thoughts are with those in Japan who are suffering amidst this terrible disaster. Hopefully the following thoughts will clarify a confusing situation.

The horrific events we have seen unfold in Japan as the result of the recent earthquake and tsunami, and subsequent instability of a large nuclear facility in the disaster zone with (at least) partial melt-down of the uranium fuel, raises questions of health risks from radiation exposure.

Granted that the West Coast of the U.S. is some 7000 miles away, and disbursement of any radiation leaked into the air in Japan, carried by the jet stream eastward, would expose people here only trivially. Even close to the reactor, as nicely illustrated by a New York Times graphichere, the amount of ambient radioactivity is less than the average annual dosage experienced from all sources by Americans in a year, though spikes in exposure can be higher. The potential for a full meltdown with much larger escape of radiation still exists, with differences of opinion as to the probability of this.

The more likely health issues related to radiation exposure from this catastrophe is from people who were nearby, and leaving the highest-risk areas (see BBC article here). Because of crippled infrastructure and shortages of food in many grocery stores in a widespread area, people have been not only leaving the area, but also leaving the country. And those exiting the country may end up in the U.S., seeking medical attention.

What should practitioners do? Are there any precedents to a situation like this?

Historical experience from 35 years ago
I am reminded of an experience in the mid 1970s, when I was a medical student at UCSF. I was part of an organizing effort that included UCSF and several local community organizations, which helped with outreach to local hibakusha – survivors of the Hiroshima and Nagasaki atomic bombs, now living in the U.S. The atomic explosions (one was uranium-based, like what is now used in nuclear power plants at much lower levels; and one was plutonium-based) killed over 200,000 people and injured 150,000 more. Many of these survivors remained in Japan, but some 30,000 of them were American-born and many returned to the U.S. (see an in-depth article that appeared in People in 1990 here). They were often Japanese-Americans visiting Japan when the war broke out, were trapped there unable to return during the war, survived the Hiroshima and Nagasaki atomic bombs, and afterwards came home. During the 1970 outreach campaign I was involved with, there were about 400 hibakusha living in the Bay Area.

Nuclear survivors were often afraid to make their history known, partly due to social stigma, and partly dueto fear of losing health insurance coverage for radiation-related illnesses – an increased risk of thyroid disease and thyroid cancer was seen in this population (long-term effect), with increased risks of multiple other cancers seen (medium-term effects), and blood and immune system suppression (acute effect).

Besides the actual health risks, there was also fear and discrimination – a stigma of being “exposed” – with the unfounded belief that those exposed to radiation were themselves radioactive, and would expose others to ill effects of this imagined “radioactivity.” It took education to overcome these mistaken beliefs.

Post-war, Japan had enacted specific government-funded programs for hibakusha, and periodically assessed their health and treated their illnesses. This included sending teams from Hiroshima that would travel to the U.S. to reach out to survivors here – this was the program I was involved in. UCSF hosted the Hiroshima team, and a variety of community groups helped reach out to hibakusha, and bring them to “Hiroshima clinic day” in San Francisco.

Modern-day lessons
In the context of history, the scale of radiation exposure, and how to take care of people significantly exposed, is nowhere near what has been seen in the past. However, the issues of exposure to radioactivity from a compromised nuclear power plant should not be minimized – the risks are real, particularly for those living nearby.

Hawaii and the West Coast of the U.S. may experience some measurable increase in background radiation levels, not unlike a solar flare, or flying in an airplane at 30,000 feet. Our instruments for detecting such radiation are very sensitive. This is not likely to be the source of impact on the health care system.

More likely, practitioners may face the issue of taking care of someone who was near the disaster zone in Japan, who has now left and is in the U.S., and is concerned about radiation exposure. There is (unfortunately) much experience in dealing with such issues at orders-of-magnitude higher levels of exposure.

Based on the hibakusha experience, monitoring of blood counts (CBCs), thyroid functions and a comprehensive metabolic panel (which includes liver function tests) are about all that is indicated. For practitioners looking to code for such encounters, the ICD9-CM codes E926.8 (exposure to other specified radiation) or E926.9 (exposure to unspecified radiation) can be used.

The larger issue is reassurance and adding the calming effect of reason on a situation of fear and rumor. Unless one ingests a radioactive substance that remains in the body, being exposed to external radiation does not render one “radioactive” and there is no risk of “contaminating” others. The levels of radiation seen, even right at the nuclear power plant during times of reactor explosions, have remained less than that experienced by someone undergoing a full-body CT scan (compare the levels in the New York Times graph here).

The impact of modern health IT
Another difference in the world since the 1970s (now-vs.-then) has been the emergence of health information technology (HIT), including web-based Electronic Health Records (EHR) systems. This kind of technology is capable of capturing clinical encounter data from practices in all settings, and identifying issues among those with radiation exposure. Reporting these findings – whether to the CDC or to Japanese health authorities – can be done more systematically, and much more quickly than was ever dreamed possible in the 1970s.

In addition, the source of the health information can be much more grass-roots. Modern web-based EHR systems are used by local ambulatory clinicians in their private practices, and not necessarily affiliated with an institution. The need for travelling teams, university-to-university, is not as much of a requirement as it was in the 1970s, given modern HIT.

Our hearts go out to those who have suffered tremendous loss and upheaval in Japan. Assisting with the rebuilding of a devastated infrastructure is something everyone who can should do. The health effects seen outside the immediate area, however, should be put into their proper perspective – those leaving the disaster area will need our help. But the risk to U.S. populations – even those on the West Coast (7000 miles downwind) – is not where our attention should be.

Robert Rowley MD
Chief Medical Officer
Practice Fusion EMR