Curt Rosinski offered some really good advice on a previous meaningful use post for those doctors who are evaluating EHR software and the customization features that they offer:

The thing all potential consumers should keep in mind when buying an EHR, EMR or any medical management software is this; the more out-of-the-box the product is, the less customization the product is capable of. Customization in this case being meaningful customization, not screen color or placement of toolbar.

I’m not sure I agree completely that the more out-of-the box the product is, the less customization will be available. This could be the case, but EHR vendors can make it so you can customize everything in the EHR while still preserving a great out-of-the-box EHR experience.

However, the second comment was even more interesting to me. I’m always amazed how some people evaluating an EHR get so annoyed by the color of a window or get so enamored by the size of the font. I’m not saying that the color of the window and size of the font aren’t important. They can be really important in improving the usability of the software. However, if those things are so important to the usability of the system, then they shouldn’t likely make those things part of the customization preference package.

The idea of meaningful EHR customizations is a good one. Look for the EHR that does a great job balancing the out-of-the box EHR implementation experience while still making lots of customizations possible, because you can be sure that 6 months into your EMR implementation you’ll be ready to look at ways to really maximize the use of your EHR.

While attending the EHR Summit by HBMA, I got the chance to learn more about the AZ REC and HIE. Here are some tweets about the things they said that worth noting with my own comments:

Arizona REC

AZ REC had trouble getting vendors to take their free EHR interns. #EHRSummit11

This was pretty interesting since they said that doctors were more than willing to take on their student interns, but vendors were reticent to take them on. I do love the education program that the AZ REC put together. Internships like this are valuable.

Biggest complaint the HIT students had was access to actual EHR software. AZ REC created a EHR software lab to solve it. #EHRSummit11

This is a really common complaint by the RECs. In fact, I just helped a REC get access to some EHR software to solve this problem. It’s amazing to me that more EHR vendors aren’t happy to provide their software for these education programs.

AZ REC has a list serv of 2500 doctors and a list for vendors. See: http://www.arizonarec.org/? #EHRSummit11

I found it interesting that they had a doctor list and a vendor list. Makes sense.

AZ REC looking at optimizing health IT for ACO’s to be sustainable. I think this will be a common strategy. #EHRSummit11

The idea of REC sustainability is an important one. I think many are looking towards the ACO requirements as one pathway to sustainability. Of course, how stable are ACO’s? One thing seems certain, the relationships the RECs create with doctors could be leveraged for good if done right.

Arizona HIE

The case for the benefits of good information from something like a HIE is easy. The problem is making it actually happen. #EHRSummit11

This was my gut response when the AZ HIE was talking about the benefits of having the information an HIE provides. I don’t think I’ve heard anyone say that exchanging information would be a bad thing and produce worse clinical outcomes. Sure, they want to ensure privacy of the data when it’s done, but the benefits of having the best information are completely apparent.

HINAz (AZ HIE) didn’t depend on grants to create the HIE. They focused on the benefits of the HIE to users. #EHRSummit11

This seems like something that’s a bit unique to AZ. Most HIE’s are so focused on the grant funding. In this sense, I think that this might give the AZ HIE a chance to be successful. Plus, I loved that they did actual research into which users benefited from the HIE.

AZ HIE, Hospitals pay 50% of costs, Plans pay 50% of costs. Physicians pay nominal fee to participate (cause nominal benefit). #EHRSummit11

This is where the real fun begins. The hospitals and plans are paying for the HIE since the AZ HIE found that they’re the ones that would benefit from it. They found that doctors received nominal benefits from using the HIE and so they shouldn’t be charged to use it. Of course, the other beneficiaries not mentioned here is the benefit to the patients. I’m sure hospitals and plans will pass the cost on to patients, so I guess that works out in the end.

Today and tomorrow I’ve got the opportunity to attend the EHR Summit that’s being held by the Healthcare Billing and Management Association (HBMA) in Phoenix (officially Scottsdale). I first heard of this conference about a year ago and loved the idea. In fact, this conference was kind of what I’ve dreamed of creating in an EHR conference. The idea is to have actual practical advice on how to select and implement EHR software.

Here’s a sample of some of the topics that will be covered:

• EHR: Where are we Today?
• Vendor Selection
• Medical Legal Considerations
• An Insider’s Perspective
• Training for Meaningful Use
• REC & HIE Update
• Market Needs Your Help with EHR
• Workflow & Process Management
• EHR Implementation Planning
• EHR Implementation Support
• EHR Adoption & Ongoing Support
• EHR Optimization, Meaningful Use & Use in Health Reform

That’s quite a bit different agenda than all the other EMR and healthcare IT related conferences that I’ve seen. I also love that the conference has some built in time for users to get some EHR demos. In fact, it’s almost like they’ve created a track of EHR demos as part of the conference. I do wish they’d had a session on EMR demos on the first day to better help attendees make the most of their EHR demos. Things like how to ask the right questions (ie. Don’t ask Yes/No questions)

I’ll be doing a number of posts talking about the messages shared at the EHR Summit on this site, EMR and EHR, and EMR Thoughts over the next couple of days.

If you don’t want to wait for the blog posts, I’ll be doing a fair amount of tweeting from the event on my @ehrandhit account.

I imagine that many of you have seen some people talking about HITR around the web. It’s a website backed by the people at Porter Research and Billian’s HealthData. I know that I first saw it a few months ago and wasn’t quite sure I understood what they were trying to do. I couldn’t tell if they were trying to be Sermo, a private healthcare IT social network, or something new. The lack of clear vision for me meant I set it to the side.

While attending AHIMA this year I had the chance to spend quite a bit of time with a number of different people from Billian’s HealthData and Porter Research. We had a great time talking about all sorts of things, but they of course told me that I should look more at their new HITR product. I told them I’d take a look not knowing what to really expect.

A week or so ago, Jennifer Dennard set up a demo of HITR for me. While still a nascent product, I was intrigued how they used their knowledge and experience in healthcare research and embedded it so fully in the product. I guess I could have and should have assumed as much, but I was reasonably impressed with the idea of having a hub for healthcare IT research. I know how much I and other IT people love our data.

One interesting thing about HITR is the give to get model that they’ve set up. Basically they’ve arranged it so you give your feedback on your products to get access to other information and research from your peers. I imagine they’ll be adjusting this model over time, but it kind of reminds me of the open source model where everyone contributes a little bit and everyone benefits from the other people’s efforts.

The real challenge that HITR faces is just making sure they get enough people involved and participating to make the information they collect valuable. Plus, they have to get enough people and the right people on board. I’m not sure how scientific the results will be considering it’s a basically self selected example. I can’t remember if they include qualitative results along with the quantitative, but that could be really helpful even if the results aren’t scientifically correct on the quantitative side.

One other concept that they said they were exploring with HITR is the idea of getting connected with referral sites for a healthcare IT product that you’re considering. I REALLY love this idea. In my e-Book on EMR selection I recommend finding some referral sites and visiting them to get a feel for that EHR software in practice and to talk with a doctor who actually uses that EHR software day in and day out. The problem is that if you ask the EMR company for some referral sites they’ll give you a bias list. I suggest in the book to ask for their entire client list. However, I think using HITR could be another interesting way to find a referral site outside of the EMR vendors’ pre-groomed list.

I asked Jennifer Dennard to send me a list of some of the other benefits of using HITR. This should also give you a decent feel for what they’re working on with HITR.

I’d list the benefits for everyone as:

• Ability to connect with peers
• Blogs
• Groups
• Discussions
• Job boards

Benefits to providers that take surveys would include:

• Ability to gauge how your employees evaluate the systems you’ve put in place at your facilities
• Ability to see how those same systems are rated by your colleagues at peer institutions
• Ability to start a more in-depth dialogue with HITR connections about HIT systems you may be considering for your facility, and their experiences with those same systems
• Ability to influence future HIT product development

Benefits to vendors include:

• Ability to view how their systems are evaluated by their customers
• Ability to correspond with providers for product management/development purposes
• In the near future, vendors will be able to sponsor surveys through HITR to deploy to their chosen audiences – customers, prospects, etc.

If you have a chance to sign up for HITR, I’d love to hear your thoughts and experience. Like I said, it’s a new site, but has some interesting possibilities if they execute it right.

What else could be written about meaningful use that hasn’t already been said? Really. I’ve been thinking this over since I think we’ve been writing about the EHR incentive money and meaningful use for almost two years now.

I still remember the first time I read about the government planning to give out incentive money for those who adopt an EMR. Some thought that they’d just give out the money to doctors who adopt an EHR kind of like they did for those who purchased a home. I guess the government assumes that when you purchase a home you’re going to use it, but when you purchase an EHR that’s not always the case. So, meaningful use was born.

One of my biggest problems with meaningful use has always been its conflict with certified EHR. I’ll never understand why the government wants to certify EHR software (ie. more expense) when they could have just built the requirements of meaningful use so that the only way for a user to meet the requirements is by using an EHR software that performed the functions required. I guess I can partially see some security checks that could be done in an EHR certification that wouldn’t show in meaningful use, but does anyone really think that EHR software is much more secure thanks to EHR certification?

Of course, much of this is water under a bridge. We have meaningful use and certified EHR and there’s no going back now.

At this point, I wonder how many doctors are still undecided on meaningful use and EHR software. Considering all the discussion and chatter, I feel like most doctors have made the decision on the subject. They’re either going to use an EHR or not. I guess there might b e a few doctors that want to use an EHR, but are waiting for the right one. Certainly there are many doctors that know that EHR is the future, but they just haven’t committed the time to evaluating the various EHR software and deciding which one is best for their office.

My gut feeling tells me that the EHR incentive money wasn’t enough for many of them to finally get down to the business of selecting and implementing an EHR. I imagine many of them are waiting and hoping for a clear EHR market leader to emerge. I’m sorry to inform them that I don’t think that’s going to happen for another 2-3 years at least. Plus, I still think we might have market leaders in each medical specialty.

I’ve heard some argue that it’s the future meaningful use stages that have people scared to implement an EHR. Basically, they believe that meaningful use stage 1 is reasonable, but they think that meaningful use stage 2 & 3 will be much harder and not worth the effort. Kind of reminds me of the arguments that businesses have made about the uncertainty of economic policy causing them not to “move” on more investments. I think many doctors are uncertain about the EHR stimulus money, future stages of meaningful use, and how private insurance companies may react in the future. This uncertainty does cause issues for their ability to plan.

One thing I think the EHR industry could do to provide more comfort to doctors is to provide doctors that adopt your EHR a pathway to leave your EHR if you don’t meet their expectations. Why vendors try to lock someone into their EHR that hates it is beyond me. Ok, I get the short term gain and why you hate losing customers. However, by locking them into a product they don’t like you’re creating an eternal enemy to your product and believe me when I say that doctors talk. Plus, if you have doctors that want to leave because your product doesn’t meet their expectations, then you have a bigger issue on your hands. Sure one or two that have work flows that don’t match your product, fine. A mass exodus from your product because you chose to make it easy for them to leave means you should probably fold up shop anyway or fix the reasons why they want to leave.

Unfortunately, the large EHR vendors won’t really care at all. They’re all about lock in whether you like it or not. I hope doctors start to kick against this and support EHR vendors that provide pathways out of their product. I’d still be happy to support a movement to “liberate” EHR data. Any EHR vendors want to join?

This brings us back to meaningful use. It’s too bad the meaningful use didn’t require practical elements that would make a lot of sense for government to institute. For example…
-Require EHR vendors to create an easy export of all patient data
-Require EHR vendors to communicate with other EHR vendors
-Require EHR vendors to send public health data (they’ve kind of done this)

I’m sure there are more, but that’s a good start.

Now the most interesting thing is going to be how this first wave of meaningful use doctors react to the EHR software they’ve chosen. Unfortunately, I’ve really only seen meaningful use doctors who’ve had an EHR software well before the term meaningful use was coined. If you are a doctor who recently implemented an EHR post meaningful use, I’d love to hear from you so we can tell your story.

I’m really excited that this Common EHR implementation issues series has been so popular. If you missed it, you can see the previous posts in the series: Unexpected EHR Expenses, EHR Performance Issues, a little follow up to avoiding the EHR performance issues altogether, and inadequate EHR templates.

This weeks common EHR implementation issue is: EMR Upgrade Problems

I’d like to categorize this EHR implementation issue into two areas. One is upgrading to an EHR from an old legacy EHR and/or PMS. The second is upgrading your existing EHR that’s just outdated. I’ll take them in reverse order.

Upgrade of Existing Outdated EHR
In this world of your web browser and operating system auto updating at regular intervals it’s sometimes hard to remember that not all software does that. In fact, it turns out that most software doesn’t auto update (often for good reason). Of course, this problem doesn’t apply to a SaaS based EHR software since those updates are applied whether you like it or not. The nice part is that the SaaS EHR updates appear to the user to just happen automatically with little to no intervention on their part. Of course, we’ll save what happens when a SaaS EHR update causes you problems for another post. In the client server world of EHR (or hybrid EHR as some like to call themselves when they’re web based on an in house server) you will have to deal with updating your EHR.

I think with rare exception, it’s a huge mistake to not keep your EHR software up to date (goes for most other software as well). I’m not suggesting that even client server software should auto update. Considering the deployment and upgrade model of most EHR software, it’s almost essential to review the new feature list before doing an update to ensure that the update won’t cause you unnecessary heartache. Understanding the changes that will happen with the EHR Upgrade will let you warn your users about it so that they don’t come running into your office after the upgrade wondering why their favorite feature was changed.

What’s the problem with not upgrading? Many might just think that they don’t need to update their EHR software since they don’t want/need the extra features that are part of the upgrade. This is a bad strategy for a couple reasons. First, there are often security fixes that are part of the EHR upgrade that you’ll be missing out on if you don’t upgrade. Second, a bunch of relatively minor updates is much better on a clinic than one massive one that requires a ton of change. Third, when a future update comes that has a feature you do want, it’s not always pretty to go through multiple upgrades at the same time. Fourth, try calling the EHR support when you’re on an old version. Most of the time they’re going to say you need to upgrade for them to appropriately support you.

One other suggestion on EMR Upgrades now that I’ve supported the idea of upgrading. Just because I suggest you upgrade to the latest version of your EHR, doesn’t mean you have to be the beta tester for the company. Do the upgrade early in the process, but not necessarily so early that you’re going to be the bug tester for the company.

Upgrading an EHR from a Legacy EHR or PMS
This situation happens most often when either a clinic decides to switch from their old hasn’t been updated legacy PMS (which might include some basic EHR features) or when a clinic decides to move off their existing EHR to a new one.

Upgrading from a legacy PMS could easily be a whole series of blog posts. Suffice it to say that the biggest challenge with the upgrade from the old legacy PMS system is often getting the data out of it. Some legacy PMS systems don’t provide that data willing. In fact, many will even charge you to get access to it. They’ve basically lost you as a customers, so they’re trying to maximize whatever revenue they can get. It’s not pretty.

Even if you can get access to the data, there’s often a lot of data manipulation that will have to occur. A common problem that’s related to this is whether you even want to get the data out of the old PMS. Far too often, the data in the old legacy system has so much junk in it, that it’s worth considering the option of starting from scratch. It’s not pretty to upload inconsistent and ugly data from a legacy system into your nice, new EHR software.

Switching from one EHR software to another is becoming more and more common. In 2-3 years I believe we’re going to see an amazing influx of EHR software switches. It will be the topic du jour. We’re already starting to see it in a number of situations: an EHR that isn’t certified, an EHR that the doctor hates, an EHR that’s gone under, an EHR that’s sold to another company, etc.

The biggest problem right now with switching EHR software is that there’s no standard for the data to be exported and imported into a new EHR company. Some of you might remember my post asking EHR vendors to consider the value of EHR data liberation. In it I describe why not only is it the right ethical thing to do, but it also can make a lot of business sense to do so. Sadly, I’ve only really seen one EHR software that has embraced the concept of really liberating the data in their EHR.

I’d love to support a movement from EHR vendors that embrace the concept of EMR data liberation. I imagine most are too afraid of giving their users an easy option to leave their EHR. It’s too bad EHR vendors are so focused on protecting their business instead of focusing everything they do on the customer experience, but I digress.

Considering the above described state of EHR data export, you can see why moving to an EHR is such an issue. It’s worth mentioning this topic before you even select an EHR. Before purchasing the EHR, ask the question, What if this EHR is terrible and I want to switch? This is water under a bridge if you’re already in a compromising position under contract with an EHR you don’t like.

Unfortunately, I don’t really have very many great suggestions for those in this position. Just some words of comfort. First, switching EHR software can actually be easier than implementing an EHR in the first place. You already have the computers and IT infrastructure. Plus, for some reason second EHR implementations have a much higher success and satisfaction rate from what I’ve seen. Second, while it’s a bitter bullet to bite, everyone that I know that’s done it wishes they’d done it earlier. Although, don’t rush into another EHR just because. Take your time to select an EHR properly if you’re going to switch, but don’t be afraid to switch based on what economists call sunk costs. Third, this is one case where it’s often good to hire someone who’s done these type of EHR switching before. They can be a big help.

I’ve been really intrigued lately by the changing media landscape. Things like Blogs and Twitter are providing opportunities for basically anyone to be able to share a message with the world. Certainly, many of the blogs don’t get read and a tweet on Twitter falls off people’s radar very quickly. However, some of the better or more interesting ones rise to the top and provide an interesting and sometimes dissenting voice to the conversation. Personally, I think this type of open discussion around topics is valuable and beneficial as long as people maintain a certain level of respect and decency.

My question to you then, is what would you say to a Healthcare IT audience?

As I considered on this difficult question myself, I decided the message that I would want to deliver: You can resist all you want, but the future of healthcare will require IT.

Pretty much every day, someone comes on this site to talk about the benefits and challenges associated with EMR and EHR in their office. As I’ve listened to the various challenges that people have posted, I’m sympathetic to them. However, almost all of those I’ve heard boil down to poor EMR selection or poor EMR implementation.

To me, the EMR selection is the absolute most important part of the EMR implementation process. Far too many doctors and clinics don’t take the time and effort that’s required to really go through a proper EMR selection process. I’m very sympathetic to them for a lot of reasons (ie. It’s not their job or interest, there are 300 EHR vendors, there aren’t great resources for differentiating EHR, there are a lot of perverse incentives, etc). However, it’s worth the cost to do it right. Otherwise, you should wait until you can do it right.

However, I believe that EMR is still only one small part of how healthcare IT is going to impact healthcare. Just last night I was at a local event and someone who use to work in the casino industry has been working for the past year or so on an app that helps improve doctor to doctor communication. Fascinating stuff.

Personally, I see us just at the very begging of a revolution in healthcare IT. IT is going to start invading every part of healthcare and will pretty much be impossible to avoid.

Certainly there will be some (possibly many) who continue to resist the adoption of technology in their clinic. However, I’m seeing more of a shift by patients and doctors that are interested in finding more ways to integrate technology into their healthcare. Most of the doctors aren’t sure what to do next, but they’re looking.

I can certainly understand and appreciate those that say that the current EMR and healthcare IT offerings aren’t up to snuff. The fact is that many of them aren’t. However, that doesn’t change my belief that IT is still going to change how healthcare is provided. It just may mean that healthcare will be changed by an IT offering that most of us don’t know about today.

My greatest wish would be that we could close the case on whether healthcare IT is important and/or it can change healthcare. Instead, let’s put our energy into finding the ways that it can change healthcare IT for good. All of us focused on using healthcare IT and EMR for good in healthcare would produce some amazing results.

I can’t remember exactly where I saw someone talk about the “WIIFM” (What’s in it for Me) principle, but it really is an important principle that when understood can have an amazing impact for good. This post isn’t about whether you should live a life asking WIIFM. I’ll leave that question to people much smarter than me. Instead, I want to look at how applying the WIIFM principle to others can help those working on a successful EHR implementation.

In most cases I’m talking about, the WIIFM should be changed to “What’s in it for Them?” Understanding the answer to this question can help you as an EMR consultant, an EMR vendor or even a practice manager or doctor that’s trying to work through an EMR implementation.

One of the first things I cover in my e-Book on EMR selection (It’s free, check it out) is the idea of getting buy in from those that will be affected by the EHR implementation (that’s usually everyone). One of the best ways to get EHR buy in from people is to understand the WIIFM. It’s not fool proof, but it’s one good strategy for getting people on the same bus, going the same direction.

Let me tell you that there’s always a way to find a WIIFM in an EHR implementation. This list of EMR and EHR benefits is a great place to start. However, many of those benefits can be extrapolated in ways that will show what’s in it for every person in the clinic.

Let’s say for example, that your goal for implementing an EHR is to increase clinic revenue by freeing up chart storage space so you have an extra exam room for another provider. You can then talk about what that new revenue can be used for to improve the clinic. Maybe it could include bonus checks or other incentives. These become tangible things that staff can use to better understand WIIFM in an EHR implementation.

I’m sure many of the nay sayers out there are thinking, but an EHR doesn’t provide those benefits. That’s why it’s so important that you define which benefits your clinic is striving to achieve before you select or implement an EHR. The list of benefits you use to show WIIFM ends up being your goals for your EHR implementation. They can be used to define your EHR selection process. They can be included in the EHR contract so you have some assurance or protection if the EHR vendor can’t deliver on their sales promises. Not to mention, after the EHR implementation you have a way to measure if it was a success or not based upon those goals.

Test the WIIFM principle. Not from an arrogant Me Me Me approach. Instead, step into the other people’s shoes and ask WIIFM. This approach can really help improve any EHR Implementation if applied correctly.

I know I’ve written about ERP and EMR before, but the more I think about the EMR selection and implementation process, the more I see the same issues that are experienced with an ERP implementation.

The one issue that is a bit different about EMR versus ERP is that there are only a small handful of ERP vendors to choose from. However, we have 300-600 to choose from in the EMR world. That’s an important and challenging difference.

However, the similarities to ERP are many. One of the most striking is how the EMR like the ERP is something that’s going to be used and have an effect on the entire organization. As such, the need to manage the participation of multiple stakeholders is so key.

The key to a successful ERP implementation is to have a great project leader.  Someone who is great at working with various departments. They are great listeners who hear and understand each departments needs. Then, they have to be great at making the case for each depaartment’s needs.

The same is true for EMR. You need an EMR implementation champion who is great at listening to all areas of the clinic: nurses, doctors, front desk, billing, medical records, etc. Sometimes this can be done well by a physician lead, but is more likely to be a practice manager, IT support (if they have project management skills), or an outside consultant. 

It’s easy to underestimate the challenge of “herding sheep.” Done right, it can work very well. Done wrong and your clinic is likely going to have the opportunity to try again after the failed EMR implementation.

There are other comparisons worth considering, but this one was striking me today. I’ll be interested to hear stories and experiences from those who have implemented an EMR. Did you have a strong leader to help pacify the different stakeholders in your clinic? 

I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.

After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).

The conversation started with this email that Richard sent me:

I understand your reluctance to name names in your article, BUT… this is exactly what is needed.

I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.

With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.

Richard

Here was my response:

Hi Richard,
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.

As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.

Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.

So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.

As a side note, I do have a wiki page: http://emrandhipaa.com/wiki/Main_Page and it even has an EMR and EHR Matrix of companies. Although I closed registrations since spammers were getting into it.

Richard then provided this response:

It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.

I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.

Then I offered this response which shows I’ve been on Wikipedia far too much:

I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.

Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.

I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.

Then Richard commented:

I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.

I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.

I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.

Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.

In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.

I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)

I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.

Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.

If nothing else, we can reach Richard’s goal of “broadening the discussion”