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EMR Permissions, EMR and mHealth, and EMR Adoption

Posted on December 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 think these are the types of issues that annoy EMR users the most. It’s something that could no doubt be easily solved, but finding the right person to solve it is often hard.


I think the answer to this is that it will make EMR more effective. I’ve already seen it start to happen with a number of EHR.


This isn’t surprising. Clinics with more doctors are able to share the cost of EMR.

CA EMR Adoption Up, But Other Health IT Use Is Behind

Posted on November 18, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While California providers are stepping up their use of EMRs, they’re still behind on some other measures of health IT adoption, according to a new report by the California HealthCare Foundation.

First, the positives. California physicians who use EMRs grew from 37 percent in 2008 to 59 percent in 2013. The report also concluded that 50 percent of California hospitals used EMRs in 2012, compared with 13 percent in 2007, and that 65 percent of community health centers used EMRs in 2011, compared with 3 percent in 2005.

All that being said, California providers are behind when it comes to Meaningful Use. While 58 percent of them said in 2012 that they planned to participate in Meaningful Use, only 30 percent of California providers with EMRs had a system that met all of the program’s 12 objectives, notes iHealthBeat.

What’s more, California hospitals’ use of clinical support systems fell from 77 percent in 2010 to 71 percent in 2012, a pretty low number given that the national average of 97 percent use of such tools. Also, the state ranks 49th in the country for e-prescribing rates.

The researchers also note that providers seem less interested in health IT than consumers. The 57 percent of state residents who had access to their EMRs  used them to view their health records, e-mail physicians and schedule care appointments, iHealthBeat reported.

All told, the report comes as something of a surprise, given that over time, California has traditionally been at the leading edge of many healthcare industry trends. And it suggests that many California providers are missing out on increasingly well-documented opportunities to improve productivity. So let’s hope that traditionally cutting-edge providers take the nudge provided by this report seriously.

EMR Market is Growing, But It’s Not What It Was

Posted on September 11, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The EMR market is likely to grow at more than 7 percent per year through 2016, according to a new report.

The estimate comes from London-based research and advisory firm TechNavio. The company wrote in its analysis, “Global Hospital-based EMR Market 2012-2016,” that “demand for advanced health monitoring systems” and for cloud-computing services were major contributors to demand.

On the other hand, according to the company, implementation costs could be a limiting factor.

The TechNavio figure is actually a compound annual growth rate of 7.46 percent. That means substantial opportunity for the many companies referenced in the report, including Cerner Corp., Epic Systems Corp., AmazingCharts Inc. and NextGen Healthcare, to name a few.

Another research firm, Kalorama Information, in April reported that the EMR market reached nearly $21 billion in 2012, up 15 percent from the year before, driven by hospital upgrades and government incentives.

About 44 percent of U.S. hospitals had at least a basic EHR in 2012, up from 12 percent in 2009, according to the Office of the National Coordinator for Health IT.

In the United States, at least, future growth might require more resources and creativity to achieve. You might remember the recent post “The Golden Era of EHR Adoption is Over,” by Healthcare Scene’s John Lynn, positing that the low-hanging fruit for EMR vendors, the market of early adopters and the “early majority,” is gone, leaving a pool of harder-to-convince customers.

But the TechNavio report is broader, considering not only the Americas but also Europe, the Middle East, Africa and Asia Pacific. That’s truly a mixed bag, as while health IT is at a preliminary stage in many developing markets, it’s highly advanced in countries such as Norway, Australia and the United Kingdom, where, according to the Commonwealth Fund, EMR adoption by primary-care physicians exceeds 90 percent.

When EMR initiatives get a firmer foothold in countries such as China, where cloud-based solutions could well prevail, growth rates for those areas might exceed — several times over — the overall figure predicted by TechNavio.

And in the United States, certain pockets, such as the rural hospital market, still present huge opportunity. Fewer than 35 percent of rural hospitals had at least a basic EMR in 2012, but the enthusiasm is clearly there, as that number was up from only 10 percent in 2010, according to the Robert Wood Johnson Foundation.

It looks like it’s still a great time to be an EMR vendor. But it’s not the same market that it was even a couple of years ago, and success in the new era might require looking at new markets and approaches.

The EMRs You Don’t Hear About

Posted on September 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.

Without This EMR Step, You Might Never Get It Right

Posted on August 29, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

It’s not hard to find physicians and nurses who say that far from improving health care, the EMRs they use are something to work around.

Billing problems, lost productivity and even diminished quality of care are common complaints, sometimes long after the implementation kinks should have been worked out. In some cases, doctors who bought into EMRs as a way to operate more effectively and efficiently have found themselves disappointed enough to look for hospital employment, try new practice models or even close their doors, as HealthcareScene.com founder John Lynn has written.

Often the problem lies deeper than the technology, according to a recent white paper from TechSolve, a Cincinnati-based consulting group. After all, an electronic overlay does little good when it serves only to automate bad processes.

TechSolve is promoting a process-mapping approach to EMR for hospitals through its Lean Healthcare Solutions unit. It’s part of a trend toward applying the efficiency techniques of Japanese manufacturers to EMRs and other aspects of health care.

Like Toyota and other pioneers of lean, health care providers should rely on line workers to help root out waste, according to TechSolve.

“While you may be inclined to dismiss negative comments as resistance to change, staff may be aware of design issues that the design team, PI facilitator, and vendor were not,” TechSolve consultants Sue Kozlowski and Alex Jones wrote.

They offered seven steps to ensure maximum benefit from an EMR, a few of which I’ll share. I suggest downloading the full paper for a complete view.

TechSolve recommends thinking about process improvement before getting started with an EMR. Of course, if it’s too late for that, the firm and others in the space are happy to step in later, as well.

Here’s what TechSolve advises:

  • Map your current processes. This can be done with help from your process improvement team or an outside group. In some cases, it’s best to assign a team to each service line.
  • Compare current and future states. Color-coding is one way to do this, highlighting visually for staff members how their work will change.
  • Prioritize issues that affect patient care and payment timing. An “issues list” can be created and then reviewed after “go live” to make sure problems have been corrected. Also, examine how well staff members are adhering to the new processes, asking questions such as, “Where are they using work-arounds, and where have they found new capabilities in the system?”
  • Process map again. This new snapshot is the baseline going forward. It can serve as a reference for staff members when they’re in doubt and as a training tool for new hires.

We’re all looking for technology that makes our lives easier right away. But when it comes to EMRs, there’s no true turnkey solution. Making a system pay off requires investments, particularly of time, well beyond the sticker price.

Under traditional reimbursement models, though, planning is not what brings in the revenue. It’s easy enough to see why hospital employment, with guarantees of a salary and IT assistance, is becoming a more and more attractive option for physicians who want to limit expenses and risk.

Hospitals, though, have no plan B. They’ll have to marry their IT to efficient processes or else.

EMRs and Patient Satisfaction

Posted on August 7, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

When it comes to keeping patients happy, EMRs matter, a new study suggests.

More patients are logging on to access their own records – and they tend to like it, according to data from research firms Aeffect and 88 Brand Partners. About 24 percent of patients have used EMRs for tasks such as checking test results, ordering medication refills and making appointments. And 78 percent of those patients reported being satisfied with their doctors, compared with 68 percent of those who hadn’t used EMRs.

“EMR users are telling us that they are more confident in the coordination of care they’re being provided, and think more highly of their doctors, simply because of the information technology in use,” Michael McGuire, director of strategy for Chicago-based 88 Brand Partners, said in a press release.

Patient satisfaction is fast becoming a top priority in health care as it determines a growing portion of providers’ reimbursement. So far, it’s mainly been an issue for hospitals. Their patient satisfaction survey results make up 30 percent of  their quality score in Medicare’s “value-based purchasing” program, part of the Affordable Care Act. In fiscal 2013, hospitals saw 1 percent of their Medicare reimbursement put at risk based on the overall score, which also considers performance on clinical measures. The figure will increase to 2 percent by fiscal 2017. Private insurers are also starting to link payments with quality scores.

The trend is now taking hold outpatient clinics, as well. About 2 percent of primary-care doctors’ compensation is tied to patient satisfaction measures, and the figure is likely to grow in coming years, according to a recent report from the Medical Group Management Association. Specialist physicians reported, on average, that 1 percent of their salary hinged on patient satisfaction.

Patients cited several reasons for preferring that their doctors use EMRs, according to the EMR Patient Impact Study from Aeffect and 88 Brand Partners. Among them were ease of access to information and the perceived clarity and thoroughness of communication that the records systems provide. And adoption rates could be set to go higher: 52 percent of survey respondents said they aren’t using an EMR yet, but would be interested in trying one. Only 18 percent said they had no interest.

A host of other factors, such as level of attention and ease of making appointments, also factored into patient satisfaction, according to the survey of 1,000 consumers. But for doctors who have implemented EMRs, getting their patients to log on might be a simple way to create a more loyal following. In many cases, according to the survey, EMR-using patients had adopted the technology after being encouraged by a physician.

EMR Market Topped $20B Last Year

Posted on May 2, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As we all know, last year was a huge year for EMR adoption. How big?  Well, according to new data from research firm Kalorama Information, the EMR market hit $20 billion in 2012, driven by health IT upgrades and the desire for Meaningful Use incentive payments.

According to Kalorama, the EMR market was $20.7 billion last year, up 15 percent from the $17.9 billion it reached in 2011.  These numbers include revenue for EMR systems, CPOE systems and directly-related services such as installation, training, servicing and consulting.

Kalorama expects near year to be big as well, as providers implement EMR systems in an effort to avoid government penalties for sticking to paper charts.

More than $12.3 billion in Meaningful Use incentive payments had been doled out to 219,000 eligible hospitals and healthcare professionals as of March 1, 2013, with the incentives largely driving physician adoption of EMRs.

A recent CMS study reported that over 70 percent of physicians have used EMR systems, a huge jump from the 26 percent which had used these systems in 2006.  Hospital EMR installlations, meanwhile,  have been maturing, with 77 percent having reached Stage 3 or higher, compared  with 71 percent in 2011.

Going forward, Kalorama predicts that EMR adoption will continue to increase, that hospital adoption will be more rapid than physician adoption and that hospitals currently at adoption Stage 3 will continue to increase their engagement with their systems. The research firm also predicts that current EMR owners will be upgrading their systems.

Meanwhile, researchers say, the threat of penalties for failing to use EMRs meaningfully will force both doctors and hospitals to make upgrades over the next year or so.

While Kalorama doesn’t mention this, the next year or two is also likely to be marked by “the big switch,” with doctors in particular changing out systems that haven’t proven effective to date.  The likelihood that doctors will be buying new systems is likely to lead to a gangbuster year for ambulatory HIT vendors.

The False Economies of EMR

Posted on January 2, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

In my recent look around the EMR twittersphere on EMR & EHR, I briefly commented on the challenges of choosing the wrong EMR and EMR Switching. Dan Haley from athenaHealth asked for some deeper clarification of my comment, “I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.”

Here was my response:

I think there are a whole list of things in the HITECH act which encourage and promote the use of outdated technologies. I’m sure this is something you agree with and know all about as well.

My core argument has been, sure we’re seeing an increase in EHR adoption. However, what if the EHR incentive money is incentivizing doctors to adopt the wrong EHR. By wrong EHR I mean one that they don’t like, that can’t adapt to changing technology, that can’t support the future Smart EMR requirements that are bound to come, that kill a physician’s workflow, that cause a doctor to not want to be a doctor, etc.

I think we may be headed this direction and the number of doctors switching EHR software is a decent example of why this is the case. I’m sure that some would argue that meaningful use is driving people to switch EHR software and that the switch we’re seeing happening is from EHR software that isn’t highly functional to EHR software that is highly functional.

While this argument is true in some cases, there are just as many cases which illustrate that the EHR switching was because their first MU EHR was such a terrible experience that they had to switch EHR. Plus, we’re just at the start of this. Many are painfully grinding through the day to day with an EHR they hate. Wait until that explodes.

Even worse is those clinics that are switching EHR for the sake of EHR incentive money and go from an EHR they enjoy to one they hate. Add in the many doctors who are stuck using an EHR that was selected by some large company who didn’t worry too much about the physician needs and we’re in for a crazy next couple years.

Hopefully this gives you a better idea where my comment was coming from. Needless to say, I’m not sure that HITECH has been a benefit to doctors. The short term numbers might look good, but it might have just created some painful underlying difficulties going forward.

With all of this said, there are some beautiful EHRs out there that make doctors lives better. I’m pro-EHR when it’s done right. I just don’t see meaningful use and EHR incentive promoting the right EHR adoption methods.

This provided some interesting background for a conversation I had recently with a doctor. He told me, “It seems like there are a number of false economies driving EMR adoption.

I think meaningful use and EHR incentive money driving EHR adoption is a false economy. This doctor described to me how many of his colleagues weren’t using the EHR that they wanted, but instead were using an EHR that they “had” to use. What are some of the forced requirements for EHR that create these false economies besides meaningful use and EHR incentive money?

Another False EMR economy is around HIE connections. Many doctors can’t select the EHR they want to use and fits their workflows best because their local HIE may or may not choose to support a connection with that EHR. So, the doctor opts for an EHR that does connect with the local HIE even though it wasn’t their EHR choice.

Hospital Connections is another false economy. Similar to an HIE, many doctors will opt for what they consider to be a less than desirable EHR because it’s the one that works with their local hospitals.

I’m not trying to pretend that doctors should be the end all be all in EHR selection. A physician can think one EHR is the best and not realize until after using it that another EHR would have been better. Sometimes you think you have a great EHR until you actually use another one and realize what you’re missing. However, the easiest recipe for disaster with EHR is for a doctor to hate using an EHR. As I mention above, it will not end well and will drive the future EMR switching that I’ve predicted.

Yes, Healthcare IT Adoption Is Expensive AND Painful!

Posted on December 4, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

<Mandi’s Rant>

Few topics infuriate me as much as the notion that national standards-based implementation and adoption of healthcare IT should be cheap and easy. Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

We’re talking about an industry that takes an average of 17 YEARS to put significant medical discoveries into routine patient care practice. (Numerous sources confirm this: The Healthcare Singularity and the Age of Semantic Medicine Translating Research into Public Health Action, etc.)

17 years is an entire generation of doctors. Doogie Howser could have been born, graduated med school, and begun to practice medicince by the time any insights from his birth were applied to practice. Suffice it to say, “fast” is not a way that healthcare is used to doing a “thing”.

Let’s contrast that with the information technology industry’s acceptance of iterative development releases and planned obsolescence for enterprise AND consumer assets. The big boys (Oracle, IBM, etc.) generally cease support of older products between 7-10 years after their introduction. Your company’s AS/400 server hardware may be 15 years old, but the O/S is the latest release, and all the data on the legacy server is preserved with the latest in backup packages over a wire-speed network connection. How long have you had your laptop? How frequently have you updated your Facebook app this year?

If someone tried to sell you a 17 year-old 480DX PC with a 9600 baud modem, 5″ floppy disk, 64MB RAM, running Windows 3.11 using the argument that, although much newer, faster, cheaper, more effective technology is available it is not yet PROVEN, would you buy it?

So, healthcare – an industry which moves at the speed of 17 years of Doogie Howser medical student maturity, and technology – an industry reinvented with the introduction of the iPhone in June of 2007, are at a crossroads for how to accomplish this “thing”: developing, implementing, and widely adopting national standards-based healthcare IT within mandated timelines that fall well within the next 10 years.

It must be done “fast”, relative to the usual pace of healthcare change.

And it must be done “well”, because it is OUR health at stake.

Suffice it to say, it will not be “cheap”. And my momma always told me that nothing worth doing is easy.

We have to stop whining about how costly and hard it is to turn this ship, and start working with the ONC on how to make healthcare IT better, faster, and ultimately more meaningful to all stakeholders involved in its use.

</Mandi’s Rant>

EMR Documentation Pitfalls, EMR Adoption Numbers, and from the Hospital EMR

Posted on November 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.


This article is one of the most thoughtful pieces I’ve read about the challenges and benefits of EMR versus paper charts. It hits the nail on the head of the opportunities that are available with EMR, but also the stark realities of what’s happening with EMR implementations as well. Go read it and I think you’ll agree.


I’m always suspicious of EMR adoption rates that are put out there. This one puts EMR adoption at 69%. What I think is more significant is the change in EMR adoption rate from their previous survey in 2009 where EMR adoption was at 46%. A 23% increase in EMR adoption is definitely a trend, but we didn’t need a survey to tell us that shift was happening.


You should probably just go read all of Dr. Killpatient on Twitter. Yes, I’m sure many of you will cringe at what’s tweeted. I did in some cases too, but it is a really transparent look into one ER doc’s views. I wonder what his nurses would think of the tweet above. It’s also interesting what’s documented in the EMR. I wonder what Dr. Killpatients note looked like. Probably not as specific as the tweet.