Turns out that my previous post about lack of EMR innovation at HIMSS was a little more controversial than I expected it to be. Plus, I’m not sure that I communicated the entire message about EMR innovation and the future of EMR software in healthcare (I’m blaming the late nights and lack of sleep).

I’m still suffering the HIMSS hangover and on this too small to type well netbook, but let me try and add some more context to the previous post.

One person emailed me about my “disappointment with EMR software.” I’d be careful to characterize it as disappointment with the EMR industry. I’m really optimistic about the future of EMR. I still think they’re a great value proposition and that EVERY (leave a few rural settings aside) doctor should and will have an EMR and technology in their office. I guess the disappointment is mostly that meaningful use has killed some of the innovation that could have made EMR even more exciting.

One thing seems to be clear. Every EMR vendor that I talked to has conformed with the meaningful use guidelines. So, inasmuch as you see the meaningful use guidelines as innovative, EMR vendors are certainly hitting those guidelines.

Janice commented on my other post that she was optimistic because meaningful use gets content stored electronically and that will unleash the real power of technology. One thing that can’t be argued is the increased interest and focus on EMR software. That I believe will have a great effect on EMR software and I’m optimistic that doctors and clinics will generally do what’s right and best in selecting and implementing EMR software. Plus, while a little harsh to mention, doctors that are on their second EMR implementation do much better and rarely get it wrong the second time.

One vendor described it well when they mentioned that their original business was a great and useful service, but it wasn’t the heart of any clinics business. Thus their move to EMR (although, there were other reasons also). Either way, the message they sent was clear: EMR will be the heart of every medical practice.

With that message in mind, I want EMR vendors to take this to heart and improve their applications in innovative ways for both patients, doctors and healthcare in general. I look forward to seeing those iPad-onian innovations in EHR software. Just like none of us expected or predicted the impact of the iPad. I don’t know where exactly a similar innovation will come in EMR. However, I look forward to it and believe we’ll see many many iPad-onian innovations in healthcare IT.

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

One of the most disappointing parts of HIMSS for me is that the really creative and disruptive innovations are missing from HIMSS. There are a few items I saw like the Shareable Ink technology, some of the Nuance NLP/voice recognition work, and a pretty cool biometric kiosk by Fujitsu (which I’ll blog about later). Sadly I wasn’t seeing the really creative innovation coming from the EMR companies (and I talked to a lot of them) at HIMSS. I think there’s two possible things at play in this regard.

First, meaningful use is probably largely to blame for much of the lack of innovation that I saw. As someone told me, the regulation of EHR software has damaged and deterred the innovation. I guess you could say I’ve seen some interesting and innovative ways to approach meaningful use, but being innovative in meeting a government regulation is not the innovation I want to see. I think it’s generally clear that EMR vendors have spent the last development cycle focused on EHR certification and meaningful use.

I asked one large EMR vendor about this idea and what innovations their EHR had available. I don’t think he was very comfortable with the assertion. In response, he described how at his EMR company, they had a team that was focused on EHR certification and the meaningful use requirements but that they also had a whole other group that was focused on customer’s needs and meeting those customer needs.

It’s incredibly interesting that so many EHR vendors responded to my innovation (or what differentiated them from other vendors) by playing the EMR usability or “Doctors like using our EMR” better card. That’s related to the above, we have a group that focuses on our customer’s needs.

Certainly focusing on customer requests and needs is vital. However, it seems fitting to mention the oft quoted, “If I asked my customers what they wanted, they’d have said a faster horse. – Henry Ford” Seems like HIMSS was just displaying the faster “horses” [EMR].

A second possibility is that maybe EMR software has become a commodity. Maybe the reason we don’t see that much innovation is because EMR software has now basically become a commodity. I certainly heard many EMR vendors suggest that EMR is basically a commodity service now and that many other factors will determine the success of the EMR company instead of the EMR software itself. I argue that once you reach a certain set of features, functions and successful installs that the software itself does become secondary to the success of most EMR companies. Does that mean EMR is a commodity?

The other angle that a few new EMR vendors are taking is that EMR is not a commodity. It’s just that all the current EMR software is junk. Most then like to compare EMR software to tablets. The Apple iPad came along and finally presented what amounts to an incredibly well thought out and designed tablet and is destroying the market. These new EMR vendors see their product as the innovative “iPad” of EMR software.

Only problem is that I have yet to see any EMR company have an iPad-onian moment.

I could easily argue that the iPad was the most marketed IT device on the HIMSS exhibit floor. Yet, an Apple booth was absolutely no where to be seen.

I wonder what kind of EHR could be so innovative and disruptive that it would be the talk of HIMSS even if they didn’t exhibit?

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

I think the debate over a SaaS based EMR versus a Client Server EMR is never going to end. Maybe we should just have a peace treaty and decide that whoever has a SaaS EMR is going to love the SaaS model and the benefits and features of a hosted EMR solution. The client server EMR people are going to love their in house “doctor controlled” EMR software with its inherent features and benefits.

What inspired this post? A few old threads popped up on my stats page. First, is a SaaS EMR versus Client Server EMR poll I did back in June of 2009 about which type of EMR setup people prefer. Here’s the results (as of this posting):
Client Server EMR (Client Install) – 35 Votes
Client Server EMR (Web based) – 28 Votes
Hosted Web based EMR (SaaS/ASP) – 84 Votes
Huh? – 3 Votes
Doesn’t Really Matter – 7 votes

That’s good enough as a tie for me. Probably reflects the chasm we have in EHR and EMR companies. There’s plenty of each to go around.

The above poll also led me to this post about the myth that a SaaS EHR is required to show meaningful use. I forgot that some EMR companies (or likely their sales people) were spreading these crazy myths about meaningful use.

I’ve regularly talked about my belief that there isn’t just one major EMR market. Instead, I firmly believe that there are a number of EMR markets that are divided by clinic size, medical specialty, and possibly even location. In fact, there’s likely even other factors. There are just far too many EHR companies for this to not be the case.

I think this was also well illustrated in this blog post on Kevin MD about the “Perfect EMR Traits.” Here’s the perfect EMR trait #1:

Perfect EMR Trait #1: The ideal medical record would be tailored to the specific needs of a clinician, only exposing them to portions of the record which are relevant to their work.

Knowledge within healthcare is rapidly changing. Possibly more so than another other industry. Techniques which were considered state-of-the-art, can change in a matter of weeks. The electronic medical record has the potential to be the tool which disseminates those changes down to the clinician, through point-of-care decision support. EMR software should facilitate the clinician decision making, rather than requiring clinicians to keep track of the latest and greatest. This individualistic attitude creates discrepancies in care, which inherently leads to imprecise care.

While it is certainly technically feasible for an EMR vendor to be able to create software that satisfies Perfect EMR Trait #1, it’s just not practically feasible for an EMR vendor to satisfy every clinic size, medical specialty, and in many cases locale. This means that we’re going to see a wide variety of EMR software that satisfies the various EMR market needs.

With this as a preface, consolidation of EMR companies is going to become a very very real thing. However, I’d caution EMR companies that choose to just directly sunset an EMR software acquisition. In some cases, this is a reasonable solution based upon the EMR company’s existing EMR software. Plus, in many cases EMR vendors will be acquiring the EMR market share for their existing EMR software. I’m sure we’ll see more of this.

My recommendation for EMR vendors acquiring EMR software, is to be more selective in the types of EMR software that you acquire. It’s definitely worth considering the idea of sustaining the EMR software development of multiple EMR products. Is it really that hard to see a large EMR company that has an ED EMR software, a General Medicine EMR software, an OB/GYN EMR software, a Pediatric EMR software, etc etc etc.

An EMR vendor making a decision to act in this manner will require them to change how they look at EMR acquisitions. The EMR acquisition targets will dramatically change. Instead of looking for failing EMR companies where they can cheaply buy more EMR market share, EMR companies with this approach should be focusing on a quality EMR software that hasn’t yet achieved the EMR market share that they deserve.

The cool part about the strategy of maintaining multiple EMR software instead of the strategy of sunsetting one or the other is that you purchase a bunch of happy EMR users instead of alienating a whole mass of EMR users that’s software is no longer supported. Of course, this will require proper communication of your goals and objectives so that current EMR users see the benefit of the acquisition and aren’t left wondering what the acquisition means to them. I’m not just talking about standard PR spin. I mean real tangible communication and interaction which demonstrates your plans for the acquired EMR going forward.

An EMR company with this method of EMR software acquisition, also needs a different set of skills. After sunsetting an acquired EMR, you need to have a strong set of integration and transition services to make the change to your EMR as smooth as possible. You also require a unique sales force that can sell the transition to your EMR over a transition to an altogether new EMR software. None of these services are needed if you continue to maintain the acquired EMR. Instead, your company must focus on other redundant services like marketing that could be leveraged across companies.

Of course, this isn’t an easy task to do well. Acquisitions rarely are an easy process. However, I think this is a lesson that was recently learned by Google as well. There’s value after an acquisition to keep autonomous business units. In fact, doing so opens up a whole new set of acquisition targets in a less competitive environment.

If I were a board member at an EMR company, this is the type of stuff I’d be considering. Certainly not every EMR vendor is 1. in a position to do these things and 2. has the culture to make it happen. However, I predict that the EMR company of the future will be a conglomerate of multiple specialty specific EMR software and not just a one size fits all atrocity.

A few months ago, the blogger over at Health Finch wrote blog post which analyzes 3 of the top health care IT companies and how they were started. It is very interesting to see the evolution of the large health care IT companies. Here’s the summary of the 3 companies Health Finch looked at:
Epic Systems – Started with Scheduling and Billing
Cerner – Started as a Laboratory Information System
McKesson – Started dong Rx Management

As a PS to the post, they point out Epocrates working on the same model with their Epocrates EMR. That is one of the most interesting things I’ve noted when attending the various EMR related conferences that I attend. There’s a whole variety of ways that EMR companies are approaching the market.

Another example of this trend is the Care360 EHR from Quest. Think about all the benefits that Quest has over many other providers. Sure, the most obvious one is that they have easy access to the lab data. You can be sure that an interface with Quest labs will be free (unlike most other EMR vendors). Although, certainly it also could be a challenge if you want your EMR to interface with another lab. That could be interesting.

However, Quest has a number of other advantages over a new EMR company. They have an entire sales force (which I think they prefer to call consultants) that already have existing relationships with thousands and thousands of doctors. Quest could literally only sell EMR software to their existing lab customer base and do fine. Of course, that’s probably not the best strategy, but that’s a powerful advantage over the other EMR companies.

There are a ton of other companies that we could talk about. Those entering ePrescribing first. Those transcription companies that are offering an EMR solution. I find it absolutely fascinating. So, if you know of others, I’d love to hear your EMR vendor’s story in the comments.

Suffice it to say that we’re in the middle of an all out war by EMR vendors. The good part is that it’s not likely to be a winner takes all affair, but there will be many many EMR vendors that will end up on the winning end.

I’ve tried every way imaginable to get away from having to fax things and as hard as I try, it’s just really hard to replicate the beauty of a simple fax to someone. We could talk about the reasons that faxes are so effective and successful (like everyone has a unique identifier…a phone number), but suffice it say that we’re going to be stuck using faxes for a long time to come. Of course, if you read this and you’re in healthcare then you know the love hate relationship with faxing and how faxing is an essential part of every clinic.

Previously, I’ve talked about the value of a fax server in a clinic that uses an EMR. Many EMR companies are even integrating some sort of fax service into their EMR offering. This is beautiful and any EMR company that doesn’t have this service should remedy it quickly. Doctors just get far too many faxes for it not to be integrated with an EMR.

Well, I was starting to get a fair number of requests to fax things and to get some faxes. I dreaded each request since I didn’t have a dedicated fax line and so I’d have to hook up and re-hook up my fax server all the time. Plus, it was pretty unprofessional for me to tell them to call me so I could hook up the fax. As many of you know, I’ve had SFax as an advertiser on this site for quite a while. So, I asked SFax if I could have free access to their faxing service in return for a post talking about their service. I figured their service had to be better than doing what I was doing. Turns out it was 100 times better than I could have even imagined.

Sfax Review
I’m not sure why, but I had the impression that Sfax would be some website where I just uploaded a file and then I could fax it out that way (which they do have). However, one of the coolest features of SFax was their Sfax Driver. It essentially creates a printer on your computer much like a fax server creates. When you print to it, the dialog for sending a secure fax comes up and you’re able to easily fax anything that you can print.

I also wasn’t sure exactly how they’d handle the fax number. Much to my surprise, they assigned me a unique toll free (877) phone number to receive all my faxes. Most doctors office faxes are local, but for me it’s pretty nice to have a toll free number that people can use for my fax number. Obviously, in a clinic you could just forward your existing number to the toll free number and actively promote your new number for a time period. Then, after an appropriate period you can phase out the old number and save the cost of the extra line or re-purpose the line for something else.

It was kind of funny, because the Sfax support people had been reaching out to me to be sure I got the customer service that I needed to be able to use their product. I found their Sfax printer and online product so simple to use that I just emailed them back and said I didn’t need their help. Basically I’d be wasting my time talking to them because their secure faxing was so easy to use.

I will mention that I was pointed to some videos and tutorials that stepped through the process as well. I actually watched one or two of the videos and kind of laughed because the process was so simple it almost felt like the video wasn’t needed. Although, I’m sure some people will enjoy the hand holding.

The receiving a fax was a great user experience too. I got an email notifying me that the fax had arrived. Plus, the online portal gave me access to the entire history of faxes that I’d sent and received. Pretty sweet.

My only real complaints about the product was that at first some of the terminology was confusing. Sfax driver doesn’t intuitively tell me that it’s going to set up a local printer on my computer that I can use to fax out. I also wish they had a quick way to send a fax to a new phone number. Maybe there is and I just missed it, but it seemed like you needed the phone number in your “Contacts” list in order to send the fax out. Sure, a contacts list is a great feature since you often send something to the same place. However, there’s always those one off faxes where you don’t want that phone number in your contact list. You just want it for that fax.

I won’t cover all the other standard benefits of electronic faxing (ie. no printing, no scanning, no creating cover letters, etc etc etc). Suffice it to say that Sfax had those benefits as well. They also had a bunch of features like Starred Faxes, Forwarding Faxes, and Draft Faxes. I’m not exactly sure how I’d use a Starred Fax (It’s like the Starred feature in Gmail if you’ve used that), but forwarding a fax is a great idea and I’ve used Draft Fax a few times when I needed to go and get more info before sending the fax.

I also love that their online portal can be accessed from any computer I’m using. So, I can access all my faxes in one place and can even send a fax from any computer in the world. Pretty sweet.

EMR Faxing Integration
I wouldn’t be EMR and HIPAA if I didn’t talk about the possible integration of the Sfax secure faxing technology with an EMR. Sfax offers three ways to fax: Sfax Driver (Desktop), Sfax Online (Web) & Sfax API (Integrations). Of course, the API integration piece is the most interesting when it comes to EMR.

Sfax actually has provided a white label fax solution for 7 different EMR vendors and 6 other healthcare solution providers with 8-10 other healthcare software company integrations in the works. So, you might even be using Sfax and not even know it. I can’t say which companies for obvious reasons, but I can see this type of EMR integration working really well. They even mentioned some clever integrations with adding/reading barcodes and automating handling.

Here’s their comments on their faxing API:
We have great API documentation, sample code, test harness (and test account) and have had integrators faxing out from their app in 2 hours! Our delivery rates are industry leading along with error reporting through API. When the integration is done right, the document exchange(fax) part is just beautifully fitted into the natural workflow.

If I was an EMR vendor and didn’t have an integrated faxing service yet, I’d be on the phone to Sfax to talk about leveraging their API so I could worry about other EMR features.

Digital Signatures
Sfax offers a built in set of features for digital signatures. I had a lot of questions about digital signatures and adoption of digital signatures in healthcare and so I’ve asked Sfax to do a future guest post on the topic. So, watch for that.

Fax Security
All of the Sfax online faxing portal uses https 128 bit encryption. Yes, that’s the level of encryption that’s used by the best SaaS based EMR software and all the other e-Commerce sites you might use online. Turns out my first fax was filled with my social security number and other personal info. So, this level of encryption was absolutely necessary for me. Plus, is a requirement for HIPAA if you plan on faxing any PHI.

Secure Fax Pricing
You can check out all the Sfax details including plans and pricing on their web page. They just launched a $24/year plan for people like me that do a pretty low volume of faxing. Then, they have monthly plans from $15/month to $199/month depending on the number of fax pages per month, toll free numbers, API access needs, importing contacts, tailored cover pages, etc. You can also sign up for a 14 day free trial to test it out yourself.

Summary
I honestly wasn’t sure how well Sfax had done at taking the headache out of faxing. Turns out, now I don’t blink an eye when someone asks me if they can fax me something or if I can fax them something. It’s as easy as sending an email now. I just fax away.

Needless to say it’s a lot cheaper and easier to use Sfax than a $10+ per month extra phone line, a $50+ fax machine. Not to mention the paper, tonor and desk space the fax machine requires.

A reader of EMR and HIPAA recently emailed me about the title of this post. The way they saw it, the software renewals fees for an existing EMR user amounted to EMR vendor extortion. This person felt like providers had little options when it came to the renewal fees that EMR vendors would charge them.

The fact of the matter is that it’s not actually extortion (from what I’ve seen), but it certainly can feel that way if you’re a provider that’s getting charge a train load of money to renew or update your license with your EMR vendor. Unfortunately, once you’re in that position you really don’t have many options. Plus, your options are always very specific to the contract you signed with the EMR vendor.

Instead of focusing on those who are stuck with little options, I think it’s more valuable to try and help those that are just signing and negotiating their contracts with an EHR vendor. This is such a crucial part of the EMR implementation process. Here are a couple paragraphs of the three pages on contract negotiation from my EMR selection e-Book:

Once you have made a final decision on an EMR vendor, it is time to start negotiating the contract with the vendor. It is interesting that doctors are use to negotiating contracts for purchases of large medical devices, but for some reason do not often negotiate the details of their EMR contract. The amount of negotiation room you have in a contract will depend on a number of factors. Generally the larger the EMR vendor the less negotiation room you have with the contract. Interestingly, the larger your organization the more negotiating power you will have as well. That is not to say that large EMR vendors and small doctors do not negotiate the contract. They are just less likely to negotiate or there is less room to negotiate.

There is always some room to negotiate with your EMR vendor. The vendor’s first proposal or contract is always their first offer. You should never take it since price and contract details can always be negotiated.
…
Many doctors find themselves handing their contract over to their lawyer to handle the negotiation. You will want a lawyer to look over it for final review. However, very few attorneys know much about negotiating tech software contracts. Lawyers usually bill by the hour and you do not want to be paying your lawyer by the hour to negotiate commas and periods that will have little meaning or value to your practice.

The contract negotiation with the EHR vendor is the key time when you make sure it’s very clearly stated the types of fees that you’ll have to renew the software. This should all be clearly stated in the contract and if it is not, then get it changed. As it says above, don’t leave it to an inexperienced lawyer who knows little about EMR software and the types of fees they’ll charge to understand these details. Experience is valuable at this stage of the process.

Another part of the contract should be the details of how you could get the data out of your EMR should you decide to ever move to a new EMR. Access to the database schema and clearly defined data ownership are two key parts of the contract that will be needed should you choose to move to a new EMR. There’s real value in an EMR vendor knowing that you can easily move to another EMR. For some reason, those EMR vendors don’t seem to charge the outrageous unexpected renewal fees.

Many EMR companies might baulk at the idea of providing a method for providers to switch EMR companies. That might be telling you something. Yes, I definitely come from the philosophy of “If you make it easy for people to leave, they’re more likely to stay with you.” Chew on that concept for a little while.

Either way, providers need to make sure they’re protected against the unknown future. That protection comes during the EMR selection process and contract negotiation phase.

I’m still mulling over my post on EMR and EHR about EMR market share. Add in my mulling over my post about creating an EMR pricing comparison website and my mind is kind of overwhelmed with ways to try and get providers better information.

One of my hobbies is learning about internet startup companies. In fact, I’m starting one of my own. In my reading about internet startup companies I found this really provocative post by Eric Ries about entrepreneur speakers lying on stage. Here’s the money quote for me:

This is the same issue we see with vanity metrics: companies are giving the appearance of sharing information while actually engaging in spin or outright deception.

I call this the vanity ratio: the amount of apparently interesting information given divided by the amount of useful information contained therein. The higher the vanity ratio, the more effective the PR. Unfortunately – also – the more misleading the story is as a help to others.

Of course, since I’d just recently written the post I linked above about EMR market share, I quickly drew the line to EMR vanity metrics. Or as Eric Ries might say it, EMR vendors lying about their market share.

I really don’t know any way to solve this problem since Eric is right that the vanity ratio applies. The higher the vanity ratio, the more effective the PR. I guess the key is to educate providers about the skewed numbers that EMR vendors like to provide. These posts are my effort.

In a number of my recent posts and conversations the idea that providers need a way to filter through the plethora of EHR vendors that exist out there (Between 300-600 EHR vendors) has become a really compelling theme.

I think some of the challenges with filtering EHR vendors include:

1. Getting truthful information about an EHR vendor. This is especially true when it comes to pricing. There’s just a lot of bad information out there. On top of that, there’s a lot of partial information that doesn’t tell the full story of how much an EHR costs.

2. Having a way to compare the pricing of various EHR vendors. Let’s be honest, price is ALWAYS a part of the EMR selection process. However, it’s definitely a challenge for providers to try and compare prices across EHR vendors. Comparing the cost of a SaaS EHR versus a Client Server EHR takes some analysis.

I’m considering the idea of creating a website or section of one of my existing websites that’s devoted to getting truthful and complete EHR pricing information. I’m not exactly sure the right approach to do this in a successful way that’s accurate and scalable.

One direction is to go to the EHR vendors themselves and get the pricing info. Over time I think that EHR vendors would start coming to me to be listed on the price list. The key would have to be asking the EHR vendors the right questions so that we got ALL the pricing information and not just part.

The other way is to talk to doctors who’ve recently implemented a specific EHR vendor and get the pricing details that they actually incurred implemented that EHR software. This would obviously be some very interesting data. The question here is whether doctors would be willing to collect and provide that data. Plus, would there be phony “doctors” deployed by the EHR vendors to skew things?

A few other challenges with this idea. The first challenge is that EHR vendors will often change prices. Keeping up with the EHR price changes would be a challenge. The second challenge is that many EHR vendors pricing is a negotiated price. Obviously, if I’m buying software for 100 doctor practice I have more leverage to negotiate price. Maybe the key for this second challenge is to just focus on the 1-5 doc practice EMR pricing. They have much less leverage in negotiating price anyway. Plus, wouldn’t it be interesting to see which EHR vendors have drastically different pricing?

What do you think of this idea? Does it have merit? What things would I have to do to ensure that the data was interesting and useful? Would having something related to EHR pricing be better than what we have now (very little)?

What data elements would be useful to have from an EHR vendor when you’re evaluating pricing? What’s on your list of pricing questions?

Would you as a doctor or EHR vendor be interested in sharing your pricing info?

If I decide to take this on, my goal would be to provide truthful information that was valuable to providers in their filtering of EHR vendors. To make it worth my time, I’d likely put ads on the site. In fact, both things are basically what I do here on EMR and HIPAA.

I knew that my previous post about the cost to update an EMR would bring out the people who like to back the SaaS EMR model versus those who like to back the Client Server EMR. As I’ve said before, it’s one of the most heated debates you can have in the EMR space.

I realized in the comments of that post why it’s such a heated topic. It’s because once an EMR software chooses to go down one path or the other, it’s nearly impossible to be able to switch paths. Why? Cause if you do choose to switch you basically have to just code a new application all over. Basically, the switching costs are enormous. So, only a few software companies (let alone EMR software companies) ever change from one to the other.

Considering the high switching costs, that basically means that an EMR vendor that is SaaS based has a strong vested interest in the benefits and upside of the SaaS model of software development. The same is true for Client Server EMR software and client server EMR companies looking at the benefits and upside of the client server model of software development.

This entrenching around a software development methodology (for which they can’t change) is what makes discussing each model so interesting. Each party dutifully makes the most of whichever software development methodology they’ve been given.

Of course, from the clinical perspective it’s sometimes hard to cut through all this discussion and get good information on the real pros and cons of each model.

In that vein, I’m looking for a couple EMR and HIPAA readers that would be interested in making the case for one or the other. All you’d need to do is create a guest blog post on the pros and cons of your preferred method. If needed, you’d also be welcome to do a response post to the other method’s post as well.

If this interests you, leave a comment or let me know on my Contact Us page. I think this could be really interesting.

On a different note, it looks like I’m going to be attending the AAFP conference in Denver next week. Is anyone else planning to be there? Anything I should know about the conference to get the most out of it?