Yesterday I had the opportunity to talk with the people from GE who briefed me that GE is in the process of shutting down their GE Centricity Advance product line. This was pretty big news to me since I remember just last year at HIMSS meeting with GE and hearing that for the small practice (I believe 1-10 docs) GE Centricity Advance was where they were putting all their effort. You could see the energy they had behind it. In fact, their iPad EHR app was built on top of the GE Centricity Advance solution (which is now being moved to their other EHR product lines).

You might remember that the GE Centricity Advance solution was actually created out of the purchase of MedPlexus in March 2010. At the time, MedPlexus had 100 employees out of California with the development team out of India. At the time of purchase it seemed GE’s acquisition would provide a SaaS based EHR option to the independent physician market. Plus, MedPlexus (which became GE Centricity Advance) also provided an integrated Practice Management System with the EHR.

The GE Centricity Advance website is already forwarding to the Centricity Practice Solution website and a letter was sent out to all Centricity Advance customers informing them that the product line was ceasing operation. I’ve asked for a copy of that letter and if I get it, I’ll add it to this post (or if you’re a customer that received it and doesn’t mind sharing we’d welcome it).

I was told that GE is offering Centricty Advance users a free transfer to their Centricity Practice Solution EHR software. From what they told me it seems this will include data migration, training on the new system and a license for Centricity Practice Solution. Of course, Centricity Advance was paid on a subscription model so they’ll have to continue paying the monthly fee. As with most data migrations, I don’t think we’ll know how good GE is at migrating the data from GE Centricity Advance to Centricity Practice Solution until they start to do them.

Since both Centricity Advance and Centricity Practice Solution have ONC-ATCB complete EHR certification, there shouldn’t be any problems for those that transfer to Centricity Practice Solution when it comes to EHR stimulus money. Those not wanting to move to the Centricity Practice Solution will have this as part of their decision on what to do once Centricity Advance is no longer supported. I expect there will be many in this situation since while Centricity Practice Solution is available through GE’s partners as a “SaaS” offering, I think many will want to find a true from the ground up web based SaaS EHR offering.

I asked how many providers would be effected by the end of the Centricity Advance product line, but it’s GE’s policy to not comment on those numbers.

Where does this leave GE Centricity EMR software?
GE Healthcare IT still does a couple billion dollars of business and still has three EMR software offerings:
*Centricity Practice Solution – The replacement for Centricity Advance and will be GE’s EMR offering for the 1-100 provider practices.
*Centricity EMR – Still ambulatory EMR, but for the 100+ provider practices.
*Centricity Enterprise – Acute care EMR

I’m sure that many will wonder how good the Centricity Practice Solution will do in the small practice arena. Will this basically mean that GE is no longer a player in the small 1-10 provider practices? It’s hard to say for sure, but I’ll be interested to see how the Centricity Practice Solution EHR does in this market. There must have been a reason they purchased what became Centricity Advance instead of going with Centricity Practice Solution in the first place.

On the other hand, I could see people making the argument that this is a sound strategy by GE since movements like accountable care organizations (ACO’s) and related initiatives are putting the small practice in jeopardy. We know that many hospital systems are purchasing up group practices as they prepare to become an ACO among other reasons. While we still have many small group practices, it’s worth considering how many of them will survive the changing landscape. If not many survive, then this strategy by GE could end well for them. Although, I personally believe that practice consolidation is cyclical and so I’m not ready to announce the death of small group practices yet.

Another trend that might make this a good decision on GE’s part is what I call the Smart EHR. Our current phase of EHR adoption is basically converting paper to electronic. Once doctors start requiring EHR software to do things far more advanced (see Artificial Intelligence and Genomics EHR), it will require a new kind of EHR. Maybe Centricity Advance wasn’t prepared to make this shift. We’ll see if GE’s other EHR software is ready for it.

Many have argued that EHR consolidation is inevitable. I guess I shouldn’t be surprised that part of that EHR consolidation is happening within the same EHR company. I’m sure there are more on the way as we see which EHR companies survive the meaningful use winter and come out on the other side and which EHR companies close up shop.

Update: I asked GE for some more clarification on when GE Centricity Advance would be sunset and which data they’ll be migrating as part of the data migration process. Here are their answers:
Sunset Period: We have announced that we will cease operations of Centricity Advance on June 30, 2012. The data will be available in read-only mode until December 31, 2012.

Data Migration: We are working with our partners and customers to figure out the best way to migrate data. We have told customers that we will migrate the following data:
a. Patient Demographics, Patient Insurance data, Fee Schedules, Appointments
b. Patient Summary
c. Patient chart
We will migrate all clinical data. We are working with our partners to determine which financial information should be automatically migrated.

In a post done in 2009 that’s still getting comments, Diane G. offered some interesting commentary that I think is fair warning for those purchasing an EHR (names removed since it could apply to a lot of EHR vendors):

We use Software A for our EMR, but Company A provided the equipment and installation quote for Software A and I can tell you, you’ll want to look at EVERY line they bill to your company. We have been billed for equipment that we never received and interfacing that was never launched. I have spent hours explaining to them what services they have billed us but didn’t provide. I am extremely grateful that we did not purchase their EMR and/or Practice Management product!!

Definitely a good warning for all purchases, but applies to EMR software as well. A number of EHR software companies have really simplified the way they bill and so this is less of a problem with those EHR vendors. However, many EHR vendors still try to pilfer doctors for the extras which can often add up to more than the core product. It’s ugly and unfortunate since it leaves a bad taste in doctors mouths.

Along these same lines is making sure your EHR contract is sound. There’s a whole section on EHR contracts in my EHR Selection e-Book that is worth looking at if you’re going through the EHR process.

As I said in my previous EMR and Health IT in 2012 post, I’m going to create some of my own lists for 2012. I decided to tackle the first one on the list: My 2012 EMR and Health IT Wish List. This was kind of fun to think about. I’m also sure that I’ll come up with other ideas once this is posted, so don’t be surprised if I add things to this list in a future post.

I should also note that I’m not sure any of these things are going to happen in 2012. In fact, I bet that many of them aren’t, but this list isn’t about what is going to happen. This list is about what I wish would happen.

EHR Companies Would Embrace Interoperability – It’s an incredible shame that in 2012 we still don’t have interoperable health records. EHR companies need to get off the stump and make this a reality. The technology is already there and has been there for a while. EHR companies need to start making this dead simple because it’s the right thing to do. Sometimes doing the right thing is more important than the bottom line. Plus, doing the right thing ends up often being the best long term strategy for your bottom line as well.

Start doing what’s right and making your EHR interoperable!

Meaningful Use Would Go Away – I’m actually certain that this one won’t be happening in 2012, but I wish it would. I guess there’s a small chance that it could go away if Republicans take control of Washington and start slashing everything Obama related. However, I have a feeling that even then meaningful use will find its way back into Washington. There’s too much invested in it.

My reasoning for wanting meaningful use gone is clear. It provides a perverse incentive to providers and often incentivizes them to choose an EHR software that doesn’t work well for their practice. As I’ve mentioned in some recent posts, far too many clinics are so focused on meaningful use and EHR incentive money that they’re ignoring the real and tangible business cases for implementing an EHR in their clinic. I think this is a bad thing for healthcare and EHR software in general. The short term bump in EHR adoption won’t be worth the cost of EHR implementations focused on the wrong criteria.

I also really hate how meaningful use has hijacked the software development cycle of pretty much every EHR vendor out there. This is a real travesty since rather than developing for user/customer requirements EHR vendors are developing for a criteria. Talk about a perfect method for destroying innovation. This is a real travesty in my opinion.

Of course, I’m a realist and realize that meaningful use isn’t going away. We have to make the most with what we’re given and live with the realities that exist. However, in this New Year Wish list, I wish that meaningful use would be a past memory.

New Healthcare Model that Provides Care, Not Reimbursement – I’m sure many of you might be thinking that I’m calling for ACO’s in this wish list item. We’ll see how ACO’s evolve, but my gut tells me that the ACO model still won’t make the fundamental change that I wish would happen in healthcare. There’s far too much focus on reimbursement the way our healthcare is structured today. I’m not arguing that doctors and other healthcare professionals not get paid what they deserve. I’m just wishing that there was more focus on care for patients and less worry on maximizing the reimbursement.

How does this have to do with health IT and EHR? I’ve long argued that the biggest bane to EHR systems is the onerous reimbursement requirements. I can’t imagine how much healthcare could benefit from fabulous EHR systems if the energy spent on maximizing reimbursement were spent on improving patient care.

Diabetes Prevention App – I’ll admit that this is a little personal. I come from a long line of diabetes in the genes and I love sweets far too much. I’m pretty much destine to be a diabetic. I think that mHealth apps can have amazing power if done correctly. My wish is for someone to create a Diabetes app that will help me overcome the seeming destiny I have in this regard. The key will probably be illustrating in a profound way the impact of the choices I’m making.

Of course, you could insert hundreds of other chronic illnesses into this wish list too. I’d love to see mobile health work to solve those as well.

A True Patient Identifier – I realize that America is a large place, but we’re also a really creative country that can figure out creative solutions to problems. The lack of a true patient identifier is a challenge and a problem in healthcare. I’d love to see this problem finally resolved. I think every EHR company would rejoice at this as well.

Real EMR Differentiation – My heart absolutely goes out to doctors, practice managers and others who have the unenviable job of trying to sift through the 300+ EMR companies. I’d love for some EMR companies to really do something so innovative to differentiate themselves from the rest of the pack.

No doubt part of this problem is what I stated above about meaningful use. Hard to create innovation and differentiation in EHR when you have to develop for a government list of requirements.

EHR Data Liberation – I’ve wanted EHR data Liberation for a long time, but I think in 2012 this is one thing on the list that could become a reality. It’s a bit of a long shot, but I think there’s potential for this to happen.

My gut tells me that if we can find a way to liberate the data that’s stored in EHR software, then we’d see a dramatic increase in adoption of EHR. One of the major concerns doctors have with selecting an EHR is that once they select an EHR they know they’re locked in with that EHR for the long run. If a doctor knew that they could switch EHR software if they made a bad choice, then they’d be much more likely to pull the trigger on EHR adoption.

We need a wave of EHR vendors that aren’t afraid of liberating their EHR data, because they:
1. Know that their EHR software is so good users won’t leave
2. Know that if someone wants to leave their EHR software it’s better that they find one that’s good for them than the few extra dollars the EHR company will make off an unhappy user.

How’s that for a wish list? I think achieving these things would do an amazing amount of good in healthcare and EHR. Of course, I won’t be holding my breathe on any of them happening any time soon. That doesn’t mean I won’t keep holding out hope.

Yesterday, I created a post on EMR & EHR called The Must Have EMR Feature – An iPad Interface. that post has driven quite a bit of discussion on Twitter and Google Plus. One comment from @2charlie hit me the most though:

2charlie – Charlie Gaddy
A decent web interface wouldn’t hurt either. RT @ehrandhit: The Must Have EMR Feature – An iPad Interface dlvr.it/tYkN7

Charlie’s twitter response highlights a number of interesting ideas. The first point that every SaaS EHR company will point out is that he said a web interface. We could go into the semantics of what is “the web”, but I have little doubt that Charlie meant a browser based interface when he said web. I’ll leave the rest of the discussion of “web” EMR interfaces for another post (plus, we’ve had that discussion many times on this site).

Instead, I want to focus on his use of the word “decent.” That adjective is interesting because no one would really argue that there aren’t plenty of web EMR interfaces out there. If you look at the EHR Scope EMR Comparison site, you’ll see a huge number of web based EMR companies listed. However, when you add the word “decent” to web EMR interface, I think we could have some really interesting discussion.

At least a couple times a week I get a doctor sending me an email or posting a comment on my website saying that “all of the EMR interfaces are terrible.” I don’t necessarily agree that “all” EMR interfaces are terrible, but a lot of them do fit the description quite well. I’m sure at this point all the EMR companies are thinking about their competitors and agreeing with me.

The iPad Opportunity for EMR Interfaces
As I thought on Charlie’s comment of a “decent web interface” as compared with an iPad EMR interface, I realized that the iPad provides a unique opportunity for EMR vendors with less than stellar web interfaces. While it would be great for EMR vendors to create stellar web interfaces or improve their current web interfaces, that’s much easier said than done. Many are working on older technologies. Others have so much company culture built into their interface that it’s hard to change. Many have large user bases that will freak out at the idea of a new web interface. Etc etc etc! The point being that the culture and history of many EMR interfaces make it hard to change.

In these cases, I see the iPad as a great opportunity to start fresh with your EMR interface. Many EHR vendors could use the iPad as a way to be able to create a new interface for their EMR with all the knowledge they’ve learned over the years baked in. Doctors expect the iPad interface to be different and unique.

I’ll be interested to see which EMR companies take this opportunity and make something of it. It’s the perfect chance for EMR companies to create a paradigm shift in their EMR software without having to admit publicly the mistakes they made in their first EMR interface. Unless you happen to be from an EHR company who built the perfect EMR interface from the start. Then, this need not apply.

As I’ve been able to talk to more and more EMR companies I’ve been trying to figure out a way to differentiate the various EHR software. In fact, when I meet with EHR software companies I suggest that instead of them showing me a full demo of their EHR software, I ask them to show me the feature(s) that set their EHR apart from the other 300+ EHR companies out there. I must admit that it’s always interesting to see what they show me. Sometimes because what they show me isn’t that interesting or different. Many of my EMR company specific posts come from these experiences.

Today at MGMA as I went from one EHR company to another I started to get an idea for what might be the future differentiation between EHR companies. I’m calling it: “Smart EMR.”

You can be sure that I’ll be writing about my thoughts on Smart EMR software many more times in the future. However, the basic idea is that far too many EHR software are just basic translations from paper to electronic. Sure, some of them do a pretty good job of capturing the data in granular data elements (something not possible on paper), but that’s far from my idea of what a future Smart EMR software will need to accomplish.

I’m sure that many of those that are reading this post immediately started to think about the idea of clinical decision support. Certainly clinical decision support will be one important element of a Smart EMR, but I think that’s barely even the beginning of how a Smart EMR will need to work in the future. However, clinical decision support as it’s been described to date focuses far too much on how a clinician’s discretely entered data elements can support the care they provide. That’s far too narrow of a view of how an EMR will improve the patient-doctor interaction.

Without going into all the detail, EHR software is going to have to learn to accept and process a number of interesting and external data sources. One example could be all the data that a patient has in the PHR. Another could be patient data that was collected using personal various medical devices like a blood pressure cuff, an EKG, and blood glucose meters. Not to mention more consumer centric data devices and apps such as RunKeeper, Fitbit, sleep tracking, mood tracking, etc etc etc.

Another example of an external source could be access to some community health data repository. Why shouldn’t community trends in healthcare be part of the patient care process? None of this is far reaching since we’re collecting this data today and it will become more and more mainstream over time. Something we can’t do today, but likely will in the future is things like genomics. Imagine how personalized healthcare will change when an EHR will need to know and be able to process your genome in order to provide proper care.

I don’t claim to know all the sources, but I think that gives you a flavor of what a Smart EMR will have to process in the future. I’ll be interested to see which EHR software companies see this change and are able to execute on it. Many of the current innovations in EHR have been pretty academic. The Smart EMR I describe above will be much more complicated and require some specific skills and resources to do it right.

Many of you might remember my recent post about EMR Performance Issues (ie. EMR Slowness). Turns out, the post had a pretty big impact on some readers of the site. In fact, it sounds like it was partially therapeutic for some to realize that they’re not alone.

I asked permission to share one of the responses with you so you could get some more first hand perspective on the issue of EMR slowness. I share it in the hopes that others can be aware and avoid it. Plus, I hope the EHR vendors that read this will take it to heart and be fanatically focused on EMR speed and customer support.

I’ve removed the name of the writer and the names of the vendors. Plus, realize that it was written originally in an email communication and not necessarily to be published.

OMG…you hit the nail on the head with this post. Our EMR is so slow. It often takes minutes between pages. My clinical and front office staffs so frustrated. We have had nothing but finger pointing going on ever since.

Part of the issue is the interface between our practice management system VENDOR A and our EMR VENDOR B It takes a minimum of 3-4 minutes for data entered into VENDOR A to roll into VENDOR B. My front office staff has taken to entering the data twice, once in each program in order to get our patients registered timely. When you see 80-100 patients in a day, a few minutes makes all the difference.

Additionally, certain criteria does not roll over, namely email addresses. This makes it impossible for us to send out patient visit summaries thus we are unable to meet meaningful use for that criteria. Referring physician is another part that does not roll over.

The most frustrating part is that no one will take any responsibility for the issue much less work on fixing it. These two vendors spend all day playing the blame game. Fortunately for our practice, we have a wonderful IT company that we work with. Our IT specialist has spend countless hours trying to mediate between these two vendors. Most times he just fixes what he can but we are paying for his services in addition to the tech support agreement with VENDOR A and VENDOR B.

A perfect example happened this week when the EMR went down in one of our exam rooms.. First we spend at least 10-20 minutes on hold waiting for a VENDOR B tech to pick up the call. In this particular case, they worked remotely for at least 4 hours on this one computer only to tell us they could not fix it.

I called my IT guy and he fixed it within 10 minutes. My staff spends countless hours on the phone most days trying to keep the system up and running. We are in the process of replacing all our PCs and I recently upgraded our Internet to a 10×10 fiber service however we still are not seeing any difference in speed.

It is at least comforting to know we are not alone. I plan to hang up your post for all my staff to see. It may not make our system work faster but hopefully it will give them some comfort knowing they are not alone.

Thanks for all the great information.

A little while back I asked my wife what she would do with all my blogs if I was hit by the proverbial “bus.” Her answer made me laugh. She said, she’d log into my blogs and post that I had passed away and that if readers of the site would like to support my wife and kids they could do so using the PayPal button below. I guess it’s a good thing I taught my wife how to blog. I hope she never has to post that PayPal button.

However, I’ve always loved the question of “what are you going to do if they get hit by a bus?” The “they” can be replaced by all sorts of things. Each organization will have a different set of “they’s”. Remember that the buses can come in all sorts of ways: re-location, new job, injury, illness, change of lifestyle, etc etc etc.

For example, if I’m a clinic and I have one doctor that is our EHR master, I might ask the question of what our clinic will do if that EHR master is no longer around.

How do you solve the problem of individual knowledge? I’ve seen it best approached in two ways: dual training or documentation. Personally I prefer the later to the former. Unless it’s a task that multiple people can perform regularly. The problem with dual training is that you train someone on how to do it, but if they don’t get to do it for a long time to come then they’re very likely to forget. That’s why documentation is better than dual training in most instances. Plus, once you have the documentation, you can use it to perform the dual training. It’s a great way to test how good your documentation really is.

These same questions apply to the EHR vendors that read this blog. How would your EHR software do if a key person in your organization was “hit by a bus?” We could also look at it from an EHR selection perspective. How would your EHR support be impacted if your EHR vendor lost their main EHR support person? What if the lead developer of the EHR left the company? This is sometimes hard information to obtain, but these were questions I knew the answer to with the EHR I supported for over 5 years. These are things worth considering.

How cool would it be for an EHR vendor to do a blog post about how they’d answer the question of how they’ve prepared their organization for the “hit by a bus” problem? I’d respect that EHR vendor: warts and all.

I’m pretty sure that many readers of this site haven’t found my new EMR related website called EMR and EHR Thoughts and so you might have missed the post I did about Greenway Medical filing to go public. This is obviously big news for Greenway, but I also think it’s a sign of things to come. I believe that Greenway is likely the first of many EHR companies that we’ll see go public over the next year or so.

I’m sure that many of you haven’t followed the trends of tech company IPO’s and I’m far from an expert on this. However, the IPO window which was generally closed for tech companies now seems to be open after a number of successful public offerings from tech companies. I’m not sure why it took me so long to realize this, but I believe that we’re going to see a number of IPO’s from the larger privately held EHR companies during this period as well (Don’t be surprised if even Epic can’t resist).

Many people in silicon valley are suggesting that we’re in a startup internet bubble that in some ways is similar to the initial dot com (or bomb if you prefer) bubble. When you look at startup company valuations, I believe this is definitely the case. In some similar ways, we are also in an EHR bubble. However, I don’t believe this EHR bubble is going to pop for a couple years.

The obvious reason we’re in an EHR bubble is the EHR stimulus money. That’s going to continue to hold the EHR bubble up for at least another 2-3 years. Then, the real fun (or sadness depending on your position) is going to start to set in. However, until then HIMSS, MGMA and other EHR related conferences are going to have some really great parties.

We’ll see what the post EHR bubble looks like, but I can see a number of EHR companies enjoying the benefits of an IPO during the current bubble.

It seems like EMR innovation has been a strong theme on EMR and HIPAA ever since I wrote about the lack of EHR innovation at HIMSS. I of course clarified my original post with this post on the future of EMR and EMR innovation and then wrote about the challenge that doctors have to differentiate EHR software amidst all the noise. I also think it’s worth noting that EMR software can be a tremendous innovation for a practice that is using paper charts. I just don’t see an EMR software that is the must go to EMR system. There’s no “iPad” of EMR software (yet?).

After careful consideration of these ideas, I can’t help but wonder if an EMR that provides innovation in healthcare is the innovation that will have an “iPad-onian” moment. Basically the EMR facilitates a dramatic change in the way healthcare is delivered. This isn’t some feature or function that the EHR company can announce at HIMSS. EMR features and functions will never be heard above the noise. EHR vendors are already saying they can do everything, whether they can or not. Instead I’m talking about a real change to the way healthcare is provided and that’s facilitated by an EMR software.

For example, is there a doctor brave enough to have an all iPad/iPhone medical practice? Their EMR software would all be in the cloud and would facilitate online visits with patients or in house patients with visits where the EMR software was easily accessible using wireless technologies. They wouldn’t even have an office. They would do half of their visits from the comfort of their homes and half at people’s houses. Would that cause people to talk? I think so. Would the business model for the practice need to be different? I think so. Would an EMR and related technology be essential to make this happen? Yes. Could an EMR company be built to facilitate this type of a medical practice? Sounds like an interesting franchise model to me.

I’m not sure if this is a good idea or not. Plus, there are certainly people a lot smarter, more informed and innovative than me that could make this type of idea even better. However, it’s becoming quite clear that building just one more feature and function isn’t going to differentiate you from the rest of the EMR companies. That’s why I won’t be surprised if the real “innovative” EMR company will likely be a startup company. They’ll likely not know very much about how healthcare is “suppose” to work. They’ll also likely be told that their model is impossible and just won’t work. Instead they’ll just focus on using technology to connect the doctors and patients in some non-traditional manner. To me, that’s the type of companies that healthcare really needs.

There’s some really good comments happening on my previous post about EMR companies with an “In” with doctors. Check it out and join in with your thoughts. One of the comments reminded me of another interesting issue with all of these EMR vendors trying to vie for your attention. How does an EMR system rise above all the noise? Or if you prefer the doctor perspective, how can a doctor notice the really innovative and useful EMR companies amidst all the noise?

This is a serious problem and sadly I don’t know a very good answer. I talked with one company who was considering going into the EMR field and they said, “We know we can create a great product that works better than those that are present. Although, if we do, will anyone even notice.”

It’s a fine question that reminds me of my post about EMR software possibly being a commodity. Maybe it’s not a commodity, but the noise of 300+ EMR companies and meaningful use relegates it to a commodity because no one can tell the difference with all the noise. Bad singers sound a lot better in a noisy restaurant.

Basically, is there anything that an EMR system could say they deliver that would rise above the noise? In fact, this is essentially the question that I posted to the new Healthcare Scene LinkedIn group (You should join). I get a lot of pitches all the time running this site, and I’m not sure I’ve seen any EMR company have an iPad-onian (my new word for how the iPad revived the tablet industry) moment.

The biggest problem with this is that EMR vendors are saying everything under the sun. Including things that the EMR system can’t deliver.