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Practice Acquisitions By Hospitals Causing Issues with EHR Adoption

Posted on October 28, 2011 I Written By

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

The readers of EMR and HIPAA have been incredible lately in sending in great commentary on the EMR industry. The following is one such commentary about the issues associated with the now widely seen trend of Hospitals acquiring practices. The person asked to remain anonymous and for the names of the specific EHR vendors to be removed. I agreed since I think the trend is more important than the specific companies.

One trend that I find extremely (and personally) troublesome is the migration from homegrown EMR’s to less functional Hospital based EMR’s – a migration that is occurring frequently now that most small practices are being purchased by Hospitals.

In our case, our small hospital administration decided unilaterally (without MD input) to implement a poorly designed EMR from it’s IT vendor. This has been a colossal failure, as none of the doctors were able to use the EMR. Hospitals are easily seduced by their IT vendors, and think that they can have only one software vendor. They think that all EMR’s are basically the same, either a Ford or a Chevy mentality. They don’t want the docs interfering with the decision process. They don’t have any idea of information and work flow in a doctor’s office. And now they are getting ARRA stimulus funds, and sometimes grant money from local endowments.

We doctors have asked that administration find us one practice that is successfully using the EMR they selected. I think they found 1 doctor 1,300 miles away who was able to make it tolerable. The hospital EMR is CHIT certified, so that doesn’t mean much. Hospital Software vendors have quickly tacked together some sloppy EMR’s in order to save their customer base, and have easily deceived administrators into buying these inferior products.

Our administration has pulled back from implementation, just having us use the scheduler, nursing putting in vitals/meds, and we just enter the ICD-9’s and charges. But another push to MU is coming soon. I have told admin that they must cut my daily schedule from 20 to 10 patients per day. I think that the ARRA stimulus funds and this whole Medicare push for EMR is having a negative effect so far, as least for me. I was using [EMR Vendor] (and still am unilaterally) to organize my data, and generate notes. It’s light years ahead of the EMR the software vendor selected.

I have heard my story repeated many times. The trend of Hospital owned practices may be inevitable, but it has severe negative consequences for EMR, in my opinion.

John’s Comments: While I don’t necessarily agree with the broad ranging comments about administrators not caring or listening to doctors, I’ve heard it far too many times to disagree completely. There’s little doubt from my experience that many hospitals don’t do a great job listening to doctors in selecting an EMR software. However, I’ve also seen many doctors who are terrible to work with when it comes to any discussion of an EMR. So, let’s not kid ourselves into thinking that the doctors are completely blameless either.

One important point that is made is that doctors like using EMR software that they select. As more and more hospitals acquire practices, this issue is going to come to a head. I won’t be surprised if it’s actually a major part of the reason that the cycle of independent doctors starts again.

Best Description of the CareCloud EHR Platform

Posted on August 31, 2011 I Written By

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

In a post on EMR and EHR about Social Media and EMRs, Andre Vovan, MD MBA from Mitochon Systems offered an interesting insight into the comparison between EMR and social media.

Social media and EMR are a natural fit. Think about what social media really enables. The ablity to stay connected, following different strings of info/story weaved by connected people. Say for instance you and your friends went to the Grand Canyon, one person took pictures while the other did the cooking, planning, and was responsible for entertainment during the trip. When they try to retell the story to their friends, each will be able to add different aspect of the story and with social network platforms such as facebook, this is possible.

Now take the story above, and insert 2 doctors and change the trip taken to be a patient going from a diagnosis to a surgery and afterwards trying to tell other physician providers on went on. If we design the EHR with this capability, then medicine will be improved.
A social media version of electronic medical records would have EMHR, HIE and PHR as one product not as separate.

I know that this was actually Andre’s initial vision for Mitochon Systems EHR. He wanted to create an EHR that could bring a healthcare community together in this way. I’m sure he’ll keep grinding away until he can achieve that vision. I haven’t looked at the Mitochon Systems EHR recently, so I can’t say how close they are to achieving that dream, but when I read Andre’s description I couldn’t help but remember the demo of the CareCloud EHR platform.

Many of you might remember my previous (some might call scathing) post about the CareCloud EHR and an opposing view by David about the CareCloud EHR. That post and a recent trip to San Francisco made it possible for me to see the CareCloud EHR first hand.

I had a great time meeting with Albert Santalo and Mike Cuesta from CareCloud. That was good considering my previous devil’s advocate post about CareCloud. One thing is absolutely certain, Albert has a vision of what he wants CareCloud to be and he’s dead set on achieving that vision. I like that in a CEO and founder of a company.

When it comes to their EHR, I must admit that it kind of reminded me of a lot of other EHR out there. There were a few EMR subtleties that I noticed in the demo, but I can’t say I saw any real wow features that made it a must have EHR. Maybe a full demo and experience with the EHR would create a rainbow of EMR subtleties that would change my mind, but it was a relatively short demo.

Instead, the wow factor wasn’t in the EHR software, but was instead in the CareCloud platform that powers the EHR, PMS and CareCloud Community of users. The description above about an almost “social network of doctors” and the health stream of a patient seems like an apt description of what CareCloud has created. In fact, the social elements of the platform are integrated throughout all of the CareCloud software which makes for some really interesting possibilities.

The challenge that CareCloud has is that a social network or Care Platform if you prefer is only as good as the people and organizations that use that platform. If two doctors are seeing a patient, then both doctors need to be on the same platform to really see a lot of the benefits of a patient’s health stream.

I imagine this is part of the reason why CareCloud has to provide a solid PMS and EHR solution on top of the CareCloud platform. Doing so will seed the platform with users so that with each PMS/EHR sold the platform becomes that much more valuable.

It’s hard to predict the future. Maybe CareCloud won’t get outside of its Miami base and maybe they won’t reach their vision of a CareCloud platform (Maybe Andre and Mitochon Systems or some other HIT vendor will do it instead). However, I’m willing to predict that whether CareCloud wins the healthcare platform war or not, some company will create a healthcare platform like what CareCloud has started to create that will be too valuable not to participate.

Full Disclosure: Mitochon Systems is an advertiser on this site, but they didn’t know I was going to post Andre’s comment.

An Opposing View of Carecloud EHR

Posted on August 2, 2011 I Written By

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

Turns out David, who manages the Smart Phone Healthcare, EMR Videos, EMR Screenshots and EMR News websites, didn’t agree with some of the devil’s advocate positions I took in my Carecloud EHR post. He said that after reading Dr. Blackledge’s post, I missed a number of things. So, the following is his commentary on what I missed in my previous Carecloud post.

Pretty much every company out there has some good and bad about it.  There are a few that are completely useless, and a few that think they are perfect, but for the most part every company has some worthwhile traits and some things they need to work on.

Last week, John wrote about a new EHR, Carecloud that has been talked about for months, but finally was released last week.  He referenced a post that was written by Aaron Blackledge M.D. back in April about Carecloud.

John played somewhat of a devil’s advocate in analyzing the post and his views of CareCloud.  While I generally agree with his assessment that the post was, “…one where you can tell that the EMR employee has drunk the Kool-aid they’ve been fed by the company.”  I do think there were some very positive things that were addressed in the post. [Items in italics below are quotes from the original post or John’s post]

“What I like most about CareCloud is that when asked about a timeline for release they will only say that they won’t release it until they get it right…That is rare maturity for a company with huge numbers of customers and investors clamoring for a release date.”  While there is something to be said for the “release early and often” approach, I like to see a company that is willing to be patient in order to release a quality product rather than just make some money.

“Another thing I like is they are worried about not just becoming a very successful billing company,…I like a team to be actively looking at and worried about how their successes can derail the larger vision of what they want to accomplish.”  This goes hand in hand with the previous comment.  Companies that are willing to sacrifice long term goals for short term success are bound to fail in the long run.  For a company to truly succeed they must have clear, established goals and be willing to do the work necessary to achieve them.

“I would guess CareCloud’s calm steady course is because they just don’t feel that anyone else is on the same path they are on so why hurry when you have time to get your vision done right.”                         This is possible. Although, it’s also possible that they spent so much time waiting to release that it’s too late for them to capture the EHR market.  I for one believe it is never too late if you have the right product. There are plenty of great examples out there.  Consider how Facebook came in and stole the market away from MySpace, and how Google+ is trying to do the same thing now.  No matter how much people love a product they will always change if there is something better.

“Even the office space at CareCloud is beautiful and reflects this attention to aesthetic and experience of the individual, in this case the employee experience.”  While John is right that a company who spends too much on aesthetics ends up having to pass that cost onto the consumer, there is something to be said for taking care of your employees.  In the military they often offer bonuses for staying in longer than your original commitment.  It has been shown that most of the people who accept those bonuses would have stayed in the military anyway.  On the other hand, many companies have shown that improving the quality of life for their employees encourages them to stay.  The reality is that a crappy job, even with a bonus is still a crappy job.  On the other hand a great job, in a great environment, attracts the best employees and keeps them there the longest.

I will end where John started: “My recommendation is if you are about to give up and lay down some hard earned cash on an EMR that is just good enough I would urge you to wait a few more months and compare CareCloud’s first iteration with other emerging platforms now gaining a foothold in the marketplace.”  This sums up Dr. Blackledge’s post quite well.  Luckily, for those that may be interested you don’t have to wait a few months anymore.  Carecloud has been released and can be viewed at their website whenever you want.

There is no doubt that there are already companies firmly planted in the EHR market, and that there are plenty of others trying to do the same.  Some of them will fail, and others will succeed, that is the reality of business.  One thing is for sure though, EHRs will continue to be implemented across the country, and for those that are willing to put forth the effort to develop a quality product, there is plenty of success to be had.

New EHR Company Ready to Launch – Carecloud

Posted on July 26, 2011 I Written By

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

Aaron Blackledge M.D., founder of Care Practice clinic in San Francisco, sent me a link to a post he did back in April about a new EMR company called Carecloud. The irony of this is that Carecloud had just reached out to me for information about advertising their EMR on my sites since they are getting ready to launch their product. Their impending launch was why Aaron decided to share his post with me.

I think Dr. Blackledge’s post about Carecloud is summarized in his final paragraph:

My recommendation is if you are about to give up and lay down some hard earned cash on an EMR that is just good enough I would urge you to wait a few more months and compare CareCloud’s first iteration with other emerging platforms now gaining a foothold in the marketplace.

Since Carecloud is about to launch, you won’t have to wait a few months to check it out, but if you read the rest of the post, you see that Dr. Blackledge is high on Carecloud and its potential.

The hard thing for me is that I’ve seen this same EMR high from people over and over. You know the EMR employee (particularly the EMR sales people) “high.” (Although, Dr. Blackledge is not a Carecloud sales person and calls himself a “wayward disgruntled platform evangelist waiting for the future to arrive.”) The one where you can tell that the EMR employee has drunk the Kool-aid they’ve been fed by the company. They’ve likely not looked at many other competing systems and only know the stuff they’ve read in their email from the company highlighting how they’re better than everyone else in the industry.

This “high” is especially potent before a product is actually released. Why? Because it’s easy to get excited about an ideal and see the potential of the ideal. What’s much harder is when the customers start using your product and telling you what’s wrong and trust me that customers will find something wrong. No product is ever perfect.

This pre-product launch “high” is not unique to the EMR industry. It’s found throughout the tech industry (and likely many others). Funny thing is that Dr. Blackledge probably knows this pre-launch hype better than most doctors since he practices medicine in in the internet startup mecca: silicon valley. Ironically he traveled to an EMR company in Miami to find his EMR “high.”

Funny thing is that as I read Dr. Blackledge’s post on Carecloud, a number of comments he made popped out to me as potential red flags. Here are a few:

“First off, they have a really impressive group of people with ambitious plans for building something robust and elegant.”
How many big ambitious plans by companies have fallen apart? Many! I’m not saying that companies shouldn’t think big. I am saying that a group of impressive people with ambitious plans often leads to a momentous flop. At least the startup company numbers seem to spell this out.

“What I like most about CareCloud is that when asked about a timeline for release they will only say that they won’t release it until they get it right. They simply don’t know when it will be ready.”
Some might say that this sounds like a company that’s too afraid to release a product. That the company won’t ever find out what’s right until they launch the product and get customer feedback on what needs to be improved. I guess they don’t follow the release early and often approach to software development.

“Another thing I like is they are worried about not just becoming a very successful billing company, but they want to achieve much more by building something that really resonates with users and transforms the space.”
I applaud this ambition since I’ve been preaching that current EMR software are often just expensive billing machines for a long time. If they solve that problem I’ll be quite happy. Let’s just hope they didn’t forget the billing part though. Sadly, it’s still very important.

“I would guess CareCloud’s calm steady course is because they just don’t feel that anyone else is on the same path they are on so why hurry when you have time to get your vision done right.”
This is possible. Although, it’s also possible that they spent so much time waiting to release that it’s too late for them to capture the EHR market.

“If you hear an EMR company offer you 20 hours of free training with your purchase you can stop right there because any software that needs 20 hours of free onsite training forgot about the user long ago during the building and won’t be doing much in 5 years.”
Of course, in this comment it’s assumed that Carecloud’s focus on a great UI will limit the number of hours needed for EMR training. I love the irony of this being said right after he describes it as a “very complex and difficult to develop product.” I guess you could say it’s making a complex process simple is what’s so difficult. No doubt I agree that many EHR vendors over charge for their EHR training services. Problem with Carecloud is that we don’t know if they’ll charge, how much they’ll charge, and how many hours of training is needed since they haven’t launched.

“Even the office space at CareCloud is beautiful and reflects this attention to aesthetic and experience of the individual, in this case the employee experience.”
That’s one way to look at it. Another is that they overspent on office space and you’re going to pay for that overspending when you buy the software.

Ok, I won’t go through and nit pick the whole post. I think you get the basic idea. Dr. Blackledge describes Carecloud as the best thing since sliced bread. In this post, I’ve played devil’s advocate and described how maybe it’s an over funded, slow to release software company that’s trying to bite off more than it can chew. The reality is that Carecloud is probably somewhere in the middle of those two extremes.

The fact of the matter is that I really don’t have any clue if Carecloud is a good EMR system or not. They haven’t even launched their product, so I’m not sure that anyone knows. However, after creating this post, I have to admit that I’m excited to see it in action in a real doctor’s office. Plus, I think the founder, Albert Santalo, and Dr. Blackledge are going to be at a healthcare IT conference I’m hoping to go to in SF in a couple weeks. I’m looking forward to learning more and talking with them in person.

If nothing else, I love the audacity that it takes for someone to launch an EHR company now. I’ll be interested to see if their product is compelling enough to be “heard above all the EMR noise.”

EMR Ethical Dilemma

Posted on April 12, 2010 I Written By

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

I was really intrigued by this well done article by Dr. Richard Hom about the Ethical Dilemma of the EMR. In it he describes the difference between the EMR technology world that will “sell anything at any cost” against the medical community values of things like the Hippocratic Oath.

He ends the post with these stinging paragraphs:

But medical angst persists. Because the EMR vendor is pursuing a “top down” sell, they bypass the medical leadership and pitch the C-level administrative staff. The medical input is usually an afterthought and the medical angst continues.

Countering the medical angst and overcoming the perception of “business ethics” being ugly will not be easy. If there be a truth in medicine, it is the gaining and loss of trust. Trust is not a trivial matter that can be bandied about just for a sale. To belie the image of the untrustworthy EMR vendor, both vendors and medical professional must make this their primary goal and objective even before the first sales pitch is given. The reward is either an EMR project that is successful after two years or an unsuccessful project that lasted ten years. The shipwrecks of EMR failed projects are a testament to that result should we forget this difference in world perceptions.

I agree that trust is really the key to a successful long term relationship with a doctor’s office. The sad part is that far too many EMR vendors aren’t interested in the long term relationship. They’re making the quick sale and then looking for the next sale. I really believe that a number of EMR companies are going to quickly scale to a level of sales where they can’t support the growth and then sale off to another competitor.

However, more important might be those EMR vendors who go in for the quick sale and then leave the clinics hanging during the EMR implementation process. You all know stories of what I’m talking about. I suggest that it’s only going to get worse not better.

Add in the EMR stimulus money and the natural increase in initial (at least) EMR adoption that will occur and even many well intentioned EMR companies are going to be caught in the trap of trying to support all these EMR installs. Lack of support from the EMR vendor is going to lead to even more EMR failures.

Naturally, all of these increased EMR implementation failures will taint the EMR industry even more and slow EMR adoption worse than ever.

Not to be all doom and gloom. I’m just highlighting one possibility. What’s the solution?

1. EMR vendors don’t over sale (this will be nearly impossible and takes a special vendor to not do this).
2. Doctors, do more research about the EMR vendor you select. I call it an EMR vendor background check.

EMR is the future, but the question is how long until that future is the present.

Great Time to Be Experienced in the EMR Industry

Posted on October 25, 2009 I Written By

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

I was reading through this blog post describing the staffing challenges that face the healthcare IT and EMR industry in the coming years. I’ve read and written quite a bit about the looming crisis in filling qualified healthcare IT and EMR jobs. However, the above blog post does a nice job of looking at it from a number of different angles. Not the least of which is the challenge of retaining staff as demand for those qualified staff members increases.

I’d love to hear more about what companies are doing to retain the good, qualified and experienced healthcare IT people in their organization.

While we’re at it, let’s hear what EMR vendors are doing to prepare for the EMR implementation/training backlog which is likely to happen. In this regard, you might read the response by SOAPware’s president to my interview question about this subject as well. I’d love to hear about other unique training and implementation models that EMR vendors are employing.

EMR Hype, Hope and Hyperbole

Posted on August 24, 2009 I Written By

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

I’ve been exchanging emails with someone in the EMR industry who described us as going through some interesting times of hype, hope and hyperbole.

Then, they went on to say:

“I have installed (successfully and not so successfully) EMR’s and clinical systems from most vendors since the mid 90’s and found almost all vaporware looking for their next sale, but not too worried about their last.”

Thankfully, I know a couple EMR vendors that aren’t just “vaporware looking for the next sale.” Sadly, far too many of them are.

Promising EHR Prospects with Short List of EHR Sales

Posted on April 11, 2009 I Written By

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

I recently got the following message from a colleague who was attending HIMSS:

I overheard a couple of sales managers discussing how they have seldom had longer lists of promising prospects and shorter lists of contracts they expect to close this month.

This all goes back to my previous assertion that the HITECH Act and ARRA are actually slowing the number of EHR implementations. I expect this trend to continue throughout the rest of this year.

I’d say my nice bump in traffic also shows a similar trend. The HITECH Act and ARRA so far doesn’t seem to have increased adoption, but it certainly has increased interest in EHR. We’ll see if the increased interest in EHR ends up eventually increasing EHR adoption. Interest and education on the subject is the first step and a very good thing for the EHR industry.

EMR and EHR Industry Ready to Contract

Posted on February 6, 2009 I Written By

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

Considering the tremendous amount of political talk about EMR and EHR systems, you’d think that the number of EMR companies would continue to grow (see my EMR list of over 400 companies).  It makes sense that entrepreneurs would chase after the $$’s that they see being invested in EMR, EHR and health care IT.  However, I personally believe that the number of EMR companies will decrease in the next year rather than increase.

The number one reason that EMR companies will descrease over the next year is that we’re going to see an amazing number of EMR companies failing.  The current economic climate is not the best time to be an EMR company.  Those EMR companies who require sales of EMR software to survive are going to have major troubles surviving.  Many EMR companies gain most of their revenue through the upfront initial cost of the EMR.  It will be interesting to see how many EMR companies have enough financial reserve to survive the current economic crisis.  Within 6 months I expect to see a plethora of EMR companies shutting down their business.

I think we can also expect a number of EMR companies to consolidate.  Sometimes this will happen because of the previous point.  Other times it will just be a natural part of the growth of the industry.  Either way, we can expect to see a major consolidation in the industry.

Understanding what’s going to happen is really important for those using and selecting an EMR.  Expect support times to really slow down if a merger or acquisition occurs to the EMR software you’re using.  Also, if your EMR software company shuts down, how will that impact you?  Might be a good time to talk with your EMR company and try your best to measure their future viability as a company.