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EHR Vendor as ACO

Posted on December 18, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I was doing my interview with Dr. Jonathan Bertman and John Mooney about the Pri-Med acquisition of Amazing Charts, Jonathan Bertman made a really interesting comment that stuck with me. I asked him how he thought that Amazing Charts would do in this world of hospitals acquiring medical practices. He said that they were evaluated the environment, but then he suggested something that I’d never heard suggested before.

He said that he was considering the idea of whether Amazing Charts could act as an ACO for its members. You could tell that this was an idea that hadn’t been fleshed out completely. Although, I found it a concept that was really interesting to consider. Could an EHR vendor act as an ACO for the doctors that use their EHR?

The key question to me is really whether an EHR vendor has enough adoption of their EHR in a given area to be able to create an ACO. I imagine an EHR vendor like MEDENT that has only focused on selling their EHR in about 5 states could have enough geographically focused EHR adoption to be able to support the ACO model.

I’ve heard a number of small practice doctors call their colleagues to action when it comes to ACOs. Their call usually includes a reminder to the days of HMO’s when they claimed that doctors weren’t part of the conversation and that they can’t let the same thing happen with ACOs. Could an EHR vendor help to bring all these small practices to the ACO bargaining table? Seems like an interesting idea worth exploring to me.

What’s Behind the Pri-Med Acquisition of Amazing Charts EHR?

Posted on November 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those of you who missed the news, Pri-Med acquired Amazing Charts EHR for a currently undisclosed amount. This was a really interesting move in the EHR industry. Anne Zieger suggested that this and other indicators was a sign of EMR consolidation. Turns out there’s a lot more behind the Pri-Med acquisition of Amazing Charts than most people would see on the surface.

In a call I had with Amazing Charts founder and president Dr. Jonathan Bertman, as well as John Mooney, founder and CEO of Pri-Med, I learned a lot about why this acquisition makes sense and how they’re planning to capitalize on the investment.

CME Chart Level Review
One of the most interesting things I learned was that chart level review was the best way to see the gaps and needs that can be satisfied by CMEs. Considering Pri-Med is a major player in the CME space, you can see the value that having relationships with a bunch of doctors using an EHR can be for them. I didn’t dive into how Pri-Med plans to leverage the Amazing Charts EHR charts, but you can see the possibilities. Although, Amazing Charts is a mostly client-server based EHR, so Pri-Med won’t have any access to do chart level reviews without permission from the doctors using the EHR.

Protecting EHR Data
In fact, in my discussion I learned that Dr. Bertman and John Mooney both had no interest in using a physician’s EHR data to make money. That philosophy actually seemed to bring Pri-Med and Amazing Charts together to make this acquisition happen. Both believe that their company should make money providing the software and services a doctor needs as opposed to making money off the data in an EHR. This is nothing new since I’ve heard Dr. Bertman espouse this belief many times before, but does contrast with other EHR vendors in the market.

EHR Acquisition Options
I was also fascinated to hear about Dr. Bertman’s thoughts on Amazing Charts approach to acquisition. He said that he didn’t want Amazing Charts users to experience what other EHR users had experienced when their EHR was acquired by another EHR company. He didn’t want Amazing Charts to be one of many EHR software in a company’s portfolio. Inevitably, EHR software will get sunset to streamline the company and Dr. Bertman didn’t want that for his users.

What does the Acquisition Mean for Users?
Ont thing users of Amazing Charts can expect is efforts to create clinical training and information at the point of care. John Mooney mentioned their “5 Minute Clinical Consults” as a model of short education that could be integrated into the clinical documentation process. I’ll be interested to see how this evolves. Even 5 minutes seems too long for most doctors to stop their patient workflow. However, it is interesting to bring Pri-Med’s education knowledge, experience and library to the point of care in the Amazing Charts EHR.

I also was fascinated by John Mooney’s suggestion of Amazing Charts possibly integrating a Provider Self Assessment tool into Amazing Charts. Definitely makes sense to have the doctors self assess to get the best CME. While not a perfect match inside an EHR software, it doesn’t seem completely out of place in the EHR if it’s done right.

Amazing Charts User Groups at Pri-Med Events
I also learned that they’ll be working to hold Amazing Charts user group meetings at the various Pri-Med events. This could be a great boon for Amazing Charts users. I know a lot of doctors and their staff won’t or can’t attend the national user group meetings that most EHR vendors hold. I’m not sure where the 6500 Amazing Charts users are found throughout the country, but if planned well it would be great to leverage the existing Pri-Med events for this and engage more of their EHR users close to home.

Post-Acquisition Logistics
They told me that Amazing Charts would maintain a separate entity in Rhode Island to continue developing and supporting the EHR software. Their marketing and sales would come out of Boston where Pri-Med is located. For Amazing Charts users, this sounds like it will be mostly business as usual from their perspective. In fact, it could mean Amazing Charts has more resources available to build our their EHR software. All in all, this seems like a smart move for Amazing Charts and their users.

Full Disclosure: Amazing Charts is an advertiser on this site, but you can be sure I’d cover every EHR acquisition I can find.

Major EMR Vendor Consolidation On The Verge

Posted on June 14, 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.

Note: This is a post by Katherine Rourke. Tomorrow watch for a post by John on EMR and EHR where he discusses some of his views on this discussion.

While it may not be immediately obvious, the EMR industry is at a major turning point in its history. Any day now, we’re going to see a bunch of mergers and acquisitions go off like a string of firecrackers, some of which may have a direct impact on your business.

Now, I don’t know how many EMR companies there are out there. In fact, I’m not sure anyone has a precise count. But can we agree that we’re looking at 1,000 or more, no?  And, heck, there’s probably thousands of companies pitching practice management + EMR,  medication management systems, clinical decision support, apps, mobile health plug-ins to EMRs and so on. Just visualize it all — you’ll get a headache but you’ll doubtless agree that we’re dealing with a raging flood of technology.

And most of it won’t stand alone forever. Every vendor likes to say that their product line has all the solutions, but even the most green sales rep doesn’t really believe that. Smart EMR tech firms and their natural allies are already beginning the mating dance, and quietly but inexorably, hooking up.

Since this isn’t the Wall Street Journal, I’m sure we don’t need to dig into deep financial discussion over this. And anyone who’s a regular reader of this site knows why software companies often buy rather than build the technologies they need to fill out their portfolio.

But I thought it was still worth noting that within, say, 18 months, the EMR world could look fairly different in the following ways:

* EMRs aimed at doctors are overabundant, to put it mildly. I predict that there will be a dozen or so well-publicized failures or buyouts in this space within the next year.

* Big vendors that pitch to both enterprises and medical practices will largely have to pick one,and it’s the enterprise side that will win. If you’re a doctor running a giant company’s EMR, stay in regular touch with your vendor and get their support promises in writing!

* There will be a flurry of mHealth activity, with EMRs that play nicely on tablets in center stage.  It’s possible the market will even support another IPO or two this year by EMR vendors if they’re offering a nifty mobile health aspect integrated with their core product.

* Doctors, in particular, risk finding that their product becomes abandonware this year as the market consolidates.  Have a Plan B available, and I mean a written plan developed by a consultant or tech-savvy senior member of your team.

So, what else do you think will happen as the market absorbs excess players and recombines relationships?

EMR Switching Encouraged by Meaningful Use

Posted on March 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For the past year or so I’ve been predicting that one of the top EMR and EHR related topics will be EMR switching. Yes, that’s right. A practice or doctor switching from one EMR to another EMR. At HIMSS it was suggested to me that meaningful use was a big driver in doctors switching EMR software.

I find the idea of meaningful use driving doctors to change EHR software quite interesting. It makes some sense when you consider that some of the EHR software that doctors currently use isn’t a certified EHR and/or will make it difficult for them to show meaningful use. More common is the HUGE number of physicians that have to upgrade their EHR software. This is a bit of a travesty to me. In any release of EHR software there’s always a mix of new features, security fixes and other optimization. Why a doctor wouldn’t want all of these things is hard for me to understand.

I guess part of the problem with staying updated to the latest EHR software has to do with the client server model that many EHR software companies use. Upgraded client server software isn’t always easy or fun. There’s some things you can do to streamline it, but it takes time. When the upgrade doesn’t offer a new feature that a doctor wants to get his hands on, it’s hard to justify the costs associated with the upgrade. I’m talking about time costs to upgrade, not software costs to upgrade. Unfortunately, most doctors don’t think too much about the security implications of not updating their EHR software.

Meaningful use has definitely gotten a lot of doctors to upgrade or replace their EHR software. This seems like something that should have happened naturally, but I believe it’s a good outcome of meaningful use.

Going back to switching EMR software, I’ve heard from a number of EMR vendors that some of their best EMR sales are to those that already have an EMR. I know I’ve done a much better job buying my second cell phone than I did my first. I knew what I really wanted when I bought my second one. The same seems to apply to doctors buying their second EMR.

Don’t get me wrong. I’m not advocating that doctors switch EHR in order to get a better one necessarily. It would be a really terrible thing if the way to get a quality EHR was to implement one first and then switch EHR. However, as time goes on there are going to be a HUGE variety of reasons to switch EHR software. Meaningful use might be driving EMR switching today, but there are going to be other factors driving doctors to change EMR in the future. Not the least of which could be a large number of doctors who focused too much on meaningful use and EHR incentive money and not nearly enough on the way the EHR selected will impact their practice. The other likely cause will be EHR consolidation and EHR software companies going out of business.

The real problem with all this EHR switching will be the lack of standards and flexibility around pulling the data out of the old EHR. I still have in mind some ways to hopefully help with this problem, but it’s a monumental task.

Independent Thinking of Doctors Limits EHR Vendor Consolidation

Posted on July 13, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m not sure all the details of why this is the case (but I’m sure some will tell me why in the comments), but doctors are some of the most independent thinkers that I know. I’m not saying whether this is a good or a bad thing. It’s just an observation based on thousands of interactions with doctors from all specialties. This independence is shown in a plethora of areas from charting to treating to diagnosing to the business of medicine.

Turns out, this independence is part of why I’ve heard doctors say hundreds of times that they basically want their own EHR and not a mainstream one. Doctors want an EHR that fits their unique practice style. Thus they have an expectation that whatever EHR they choose should understand that each doctor is different and naturally adapt to each unique doctors need. Ok, that’s a pretty broad generalization and no one would ever vocalize it that way, but it’s an undercurrent that I’ve seen time and time again.

I believe this is an important characteristic of the EHR market that must be considered. If you don’t accept the broad theory of doctor independence in practice style and approach, then most of you will appreciate that doctors from various specialties have unique needs. The easy to understand examples are Pediatricians and OB/GYNs. Everyone can quite readily see that tracking child growth and pregnancy require different charting and documentation requirements. I believe each specialty could describe similar requirements that are unique to that specialty.

This doctor and specialty independence is why I’ve long argued against what everyone loves to call mass EHR vendor consolidation. Certainly we can all agree that we have too many EHR vendors right now. However, I’ve read many many people argue that there’s only going to be 3-5 EHR vendors left standing after the mass EHR consolidation (or EHR vendor failure). I just don’t believe that’s the case. If we get down to 100 EHR companies, I’ll be impressed.

There are two things that might partially affect my EHR consolidation prediction.

First, I won’t be surprised if some really smart company comes along and scoops up each of the best of breed EHR companies for various specialties. However, instead of sunsetting the acquired EHR software, they continue to offer that same EHR software to a specific specialty. Then, they do this over and over again across all the specialties. So, the larger company would own a pediactric EHR, an OB/GYN EHR, a Family Practice EHR, a Cardiology EHR, a Orthopedic EHR, an Oncology EHR, etc. You get the idea. Instead of getting benefits from software development consolidation, they get the benefits in other areas of their business. It would be really fun to run a company like this.

The other healthcare trends that could have a serious impact on this is the ACO movement and hospitals buying up clinics. I’m still not sure how those two trends are going to play out. However, this type of consolidation of healthcare entities could impact whether a specialty specific EHR is a viable option. Clinics that are bought by a hospital or become part of an ACO lose some of their independence. At least their independence in selecting an EHR software.

Are there things I’m missing? Any other trends that are happening that will change the EHR consolidation landscape?