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One Platform to Connect to All EHR Software

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I’ve talked for years with people who want to solve the problem of connecting their non-EHR software to all the EHR vendors out there. Entrepreneur after entrepeneur has asked me how they can connect their product to ALL the EHR vendors. It usually ends up being a question like, “Isn’t there just one company we could connect to that will connect us to all the EHR vendors out there?”

I’ve dreamed about this as well. In fact, I recently wrote a post on Hospital EMR and EHR titled “Meaningful Use Drove the Data Gathering” where I suggest things like “EHR data is a treasure trove of opportunity.” and “In the future, EHR vendors will be differentiated more on the marketplace of third party applications they support than on their own in house developed apps.”

The problem is that even if every EHR vendor were to open up their application to third party applications, a startup company doesn’t want to have to integrate with all 300+ EHR vendors out there. Instead, they’d much rather integrate with one company who can connect them to all the other EHR vendors.

While a simple solution to connect to every EHR isn’t available yet, In a recent chat with Thanh Tran, Founder of Zoeticx, he showed me the closest thing to this vision that I’ve seen.

This slide shows what Zoeticx has built so far and a little bit of their vision for the future. When I saw this slide, it looked very much like what I described above.
Zoeticx Data Platform

As the slide shows, it only connects to 4 EHR vendors (5 EHR software) right now. So, they still have a lot of work to do to make this model work across all 300+ EHR vendors. However, it displays a vision of what’s possible if a company like Zoeticx builds the right middleware to connect EHR software to third party software.

After talking with Thanh Tran, you could tell that he lived, breathed, and loved the middleware space. He understood what it took to build a great middleware. For example, Zoeticx has a number of applications that leverage the middleware that they’re building. Some might argue that this makes Zoeticx a product company and not a middleware company. However, those that say this don’t understand what it takes to make great middleware.

By Zoeticx having some applications which leverage their middleware, they accomplish a couple very important things. First, they are essentially “eating their own dog food” and get to see first hand the challenges of building an application that uses their middleware. This will improve the middleware product better than any other technique. Second, Zoeticx applications will serve as essentially a set of demo applications which can be used to demonstrate what’s possible. Without these essentially demo applications, it’s often hard for people to understand how an API like Zoeticx can be used.

Certainly it’s possible that the Zoeticx application business is so good that they don’t go after the middleware opportunity. However, knowing Thanh’s background makes me think that this is an unlikely possibility. He wants Zoeticx to be a middleware company.

Thanh Tran also said something really intriguing about the latest EHR that they connected to their universal patient clinical data model (Zoeticx Patient Clarity). He said that when they added the new EHR, they didn’t have to change the Zoeticx Patient Clarity side of the equation at all. I’ll be interested to see how this plays out as they connect to more and more EHR vendors.

In fact, I believe that’s the next key step for Zoeticx. They need to connect with the other EHR vendors. Although, my guess is that once they get enough momentum behind what they’re doing, then they can provide an API for EHR vendors and other software vendors to create a gateway to Zoeticx. Then, they’ll have something really powerful.

It’s still early for Zoeticx. We’ll see how they do at attracting third party applications to their platform. We’ll see how their gateways to EHR vendors go and how they’re able to scale up the number of EHR vendors they work with. However, their vision gave me some hope that we could have a simple model for entrepreneurs that want to connect their health IT software with multiple EHR software with one integration.

February 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

A Look Back on My 2012 Christmas Wish List

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Last year, I posted a healthcare IT Christmas Wish list. A year later, I thought it would be fun if I got what I wanted for Christmas last year or not (yes, it takes healthcare at least a year to grant wishes).

Here’s the list and my thoughts on how far we’ve come on each wish:

1. Open EHR Systems – We’re certainly not there yet, but I think there has been a sea change when it comes to opening up EHR software. I’m sure some could appropriately argue that we still have a long way to go, but let me give you some examples from Epic that give me cause for hope. First, this Epic Interoperability chart that Judy shared. Second, Kaiser joined the Epic network. Third, the Epic API.

It’s fun to use Epic as a proxy for openness because they’ve been so closed for so long. Judy Faulkner was after all the one that suggested that open EHR was an issue for patients. I’d love to see EHR more open, but I’m excited by the possibilities of open EHR. I believe this will have to happen and vendors who fight against it will be left behind.

2. Remove Healthcare’s Perverse Incentives – Sadly, I’ve seen almost no change to this yet. One area where I think this could be starting to change is around price transparency. There’s been a strong push to make healthcare pricing more transparent. As more and more patients have high deductible plans (like me), we start to shop around a lot more and be more interested in price. When we’re footing the bill, that price translates to our cost. This will cause companies to change how they do business.

3. Beautiful EHR User Interfaces – I’ve seen very little change in this regard. Sure, a few have rolled out an iPad interface, but I think they’ve missed out on the iPad Opportunity. Although, I recently saw the Modernizing Medicine iPad interface again in person. It’s so fundamentally different than every other EHR interface I’ve seen. While it demonstrates well the opportunity, it’s so fundamentally different that I’m not sure any existing EHR vendors can replicate it. I ask myself if we’ve spent billions of dollars on EHR user interfaces that can’t be what they should become.

4. More Empowered and Trusted Patients – I’m sure we’ll be battling this one for a long time to come. Although, the empowered patient is happening. Health information is available to everyone at the click of the mouse or a swipe of the finger. This shift is going to happen. There is nothing anyone can do to stop it. It’s more a question of whether people will embrace it or “kick against the pricks.”

Overall I’d say that we’re generally trending towards my wish list, but as is usually the case there is plenty more to do. I’d love to hear your thoughts on the above items.

December 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

4 Reasons U.S. EMR Firms Won’t Try China

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If you have something to sell, chances are you’ve thought about selling it in China.

With a population of 1.35 billion, it’s become an attractive market for U.S. companies pushing everything from athletic shoes to light trucks to Tide. Given the natural limits of their home market, you’d assume that American EMR firms would eventually size up China’s nascent health IT scene.

And it’s likely they have. In a report a few years ago, 100 percent of vendors surveyed told the consulting firm Accenture that they saw global markets as an opportunity in the long term.

But health IT doesn’t export quite as easily as Pringles and KFC. I’ve seen China’s healthcare system up close several times, and if you ask me, making headway in the world’s most populous nation will be beyond difficult.

China, which is in the midst of its own health care reform, could certainly be tempting for companies such as Epic, McKesson and Cerner. As Benjamin Shobert wrote for Forbes, the country in 2009 extended basic health coverage to 97 percent of its citizens. It also promised to build 31,000 hospitals, upgrade 5,000 existing ones and train 150,000 new primary-care doctors.

McKinsey & Co. last year said health care spending in China would grow to $1 trillion in 2020 from $375 million in 2011.

Meanwhile, U.S. EMR companies are going to need new markets to conquer. Estimates of how much growth potential is left are many and varied. But no matter how you look at it, at some point every American healthcare organization of any size will have an EMR. Millennium Research Group last month predicted declining EMR-industry revenue from this year on because of “market saturation.”

Of course, plenty of IT firms, including Oracle and IBM, have a major presence in China. But the China market won’t happen in a significant way for U.S. health IT companies any time soon, and here’s why:

  • China’s healthcare is different. The private physician’s office that Americans are used to is more or less nonexistent. You go to a hospital-based clinic and see the doctor who’s available. Patient privacy hasn’t taken hold, so there could be other clinic-goers and family members milling about near — or in — your exam room. Chinese traditional medicine is practiced alongside the “Western” variety. Even with insurance, you typically pay up front and get reimbursed later. A U.S.-centric EMR would not map neatly onto China’s workflows. There’s an overview of China’s system here. I’ve written about a Chinese dental clinic here.
  • No one understands China’s health IT. OK, I’m sure some people do, and I hope they comment. But it’s a challenge. The health information firm KLAS Enterprises isn’t even attempting to cover China. A KLAS executive vice president, Jared Peterson, told Modern Healthcare, “The Chinese market, that’s a big mystery.” Meanwhile, Accenture omitted China from its 2010 report “Overview of International EMR/EHR Markets” because of “conflicting opinions of overall EMR maturity.”
  • The language barrier will be formidable. Epic CEO Judith Faulkner told Modern Healthcare how her company had adapted its system for another language. “We’ve only done it once, for Dutch,” she said in January 2012. “It’s a lot of mapping. It’s a task, but it hasn’t been that bad of a task.” But Dutch is not Chinese, and Chinese doesn’t use the Roman alphabet. I’m betting that when you throw Chinese characters into the mix, the conversion will be “that bad of a task” and then some.
  • Cloud-based systems could raise security issues. Some experts expect cloud-based services to play a significant role as health IT spreads to developing countries. But according to a U.S.-China Economic and Security Review Commission report, “Regulations requiring foreign firms to enter into joint cooperative arrangements with Chinese companies in order to offer cloud computing services may jeopardize the foreign firms’ information security arrangements.”

It’s worth mentioning that three years ago, China was mentioned as Cerner announced plans to develop global markets. It wanted to get into emerging regions before its U.S.-based competitors did.

There’s not much sign of life now in any China-related plans the company might have had, though. According to a message from Chad Haynes, managing director for Cerner Asia, on the firm’s website: “We look forward to improving the health of communities in ASEAN, China, and beyond.”

In the case of China, that could be a while.

October 23, 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.

These 5 Innovative Companies Are Cause for Health IT Hope

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When the topic is health IT, it’s easy to get caught up in discussing the major EMR players.

And because of Meaningful Use, there’s a tendency for everyone to do the same things — even if they go about it in different ways. Whether you’re a giant like Epic, an upstart like Kareo or a specialty firm like the gastroenterology-focused gMed, you’re likely making sure, for example, that your customers will be able to exchange structured care summaries with other providers and with patients.

But there’s still plenty of innovation in health IT, much of it with little or no connection to MU2 or other federal requirements. Startups all over the country are trying to improve lives through more efficient collection and use of data.

Here’s a sampling of startups and specific innovations:

  • HealthLandscape. This Cincinnati-based firm markets a mapping application that lets you input data from a variety of sources. The idea is to better understand health information by visualizing it. The company is a subsidiary of the nonprofit Health Foundation of Greater Cincinnati, which worked with the American Association of Family Physicians and the Robert Graham Center to develop the platform.
  • SwiftPayMD. This iPhone and iPad app from Atlanta-based Iconic Data allows physicians to note diagnostic and billing codes by voice right after seeing a patient. I have to admit, when I stopped to think about it, I was surprised that doctors couldn’t already do this. The major selling point: It helps practices to get paid as much as two weeks sooner.
  • Vivify Health. Based in Plano, Texas, this startup has created a cloud-based platform for monitoring and testing patients remotely. Its system works with just about any consumer mobile device to provide customized care plans, coaching, educational videos and interactive video conferencing. In a press release, Vivify Health said it’s helping hospitals, home health agencies, payers and others to reduce readmissions, manage chronic diseases and improve care transitions. It received funding this year from Ascension Health Ventures and Heritage Group.
  • Drchrono. This Mountain View, Calif.-based company bills its flagship product as “the original mobile EHR built for the iPad.” It was part of the Y Combinator, a Mountain View-based seed accelerator, in 2011. Drchrono in 2012 raised $2.8 million in funding led by venture capitalist Yuri Milner.
  • Doc Halo. This firm, based in Cincinnati, makes possible HIPAA-secure texting. (If this list seems slightly Cincinnati-centric, it’s because I worked in the city for eight years and know the market better than I know others.) Many doctors use regular text messaging to discuss patient information, but they shouldn’t. Doc Halo’s mobile app system uses several levels of encryption.

These are just a few projects that I thought were cool. Based on what they’re doing, there’s plenty to be hopeful about in health IT. There are, of course, many other firms equally worthy of mention. And there are now accelerator programs all over the country specifically for health IT startups.

I often get the feeling that the federal government’s involvement is taking the joy out of health IT. That’s not the case, but amid the push to meet MU2 requirements, you might have to look a little harder to find it.

And with these startups, here it is.

Disclosure: gMed and DrChrono are both advertisers on this site.

October 1, 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.

Intermountain Chooses Cerner, International EMR, and Patient Focused EMR

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This was really big news this week. I’m not sure it’s quite a turning point for EMR. I think we’re still early in the war, but this was a big battle for Cerner to win. We’ll see what GE decides to do after losing this deal. Will GE leave this business behind or buy another vendor?


I think we don’t look nearly enough at the international EMR experience. We could learn a lot in the US from what’s happening nationally. Plus, for many EHR vendors the international opportunity is a big one that most don’t even consider.


I’ve been preaching this for so long I can’t remember. I know there are EHR vendors that focus as much as they can on the patient, but compliance and reimbursement still means you have to make compromises. That’s not an indictment of those companies, but a reality of the situation.

September 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Epic API, EMR Market Saturation, and Faith in Clinical Decision Support

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Vince asks a good question. I wrote a little bit previously about the Epic User Group Meeting where they announced the Epic API. I definitely think there’s still a lot of missed opportunity for the announced Epic API, but hopefully what they’ve released is successful so it encourages them to open up their API much more.


I’ve been writing a lot lately about the changing EMR marketplace (see Golen Age of EHR Over). This prediction offers a new insight I hadn’t covered. The market could decrease because many of the larger purchases are already done. So, that could slow the EHR spending.


I wish I could find this talk. I’m really interested in how properly implemented clinical decision support can save lives. That’s what this should be about anyway, no?

September 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EpicUGM Insights, Announcements (Epic API), and Pictures

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This week has been the annual user group for Epic EHR users, otherwise known as Epic UGM. @VinceKuraitis aptly noted that the Epic user conference had 15k attendees and yet it only produced 188 tweets the first day of the conference. I’m not sure if this is a reflection of Epic users view of social media or Epic users fear of sharing what’s happening. The limited tweets aside, there were still a number of interesting tweets and pictures coming out of the event. Plus, some interesting quotes from the Madison paper I think you’ll enjoy.


Look at the crowds for registration. I wonder when Epic will outgrow Madison and need to move the event to Las Vegas. We’d certainly welcome them here. Although the local paper said that the event is the second biggest tourism engine in the area (World Dairy Expo beats it out).


Deep Space was the theme of the conference and also is the name of the enormous 11,400 seat underground auditorium on Epic’s campus. More pictures of the auditorium below. It’s also worth noting that Judy did the keynote dressed as a Na’vi from the movie “Avatar.”

Now for some tweets with pictures of the auditorium:


Soon the Epic conference will pass HIMSS on attendance. Not likely, but it is interesting that there were only 297 healthcare organizations. I wonder how many people organizations like Kaiser brought to the event.


This is a really interesting tweet. First, it’s interesting that Judy is talking about meaningful use stage 4. Does this mean there will be an MU stage 4? Second, what happened to MU stage 2? I’m pretty sure most aren’t worried much beyond MU stage 2 right now.


This likely deserves a blog post of its own. Although, this comment is really interesting in the context of Epic. Does this mark a fundamental shift in the products that Epic develops?

What I think will be the biggest announcement coming out of Epic UGM 2013 is the new Epic API. While it definitely falls short of what most of us would love to see Epic do with an API, at least it’s a start. The focus of the API seems to all be around getting all of the various health and wellness app data into the EHR. Here’s a good description of who they want to use the Epic API:

Are you a manufacturer of a consumer-facing monitoring device? We have an API for that.

Have you developed a health or wellness-related tracking app or portal? Clinicians need that information.

We’ve designed open.epic to make it gosh-darn simple to integrate the data you collect into your patients’ medical records. Interested?

I believe this will be a great opportunity for many developers. We’ll see how it plays out long term. I’m a little surprised that the Epic API doesn’t include interoperability which Epic is doing more and more. I guess they see it as a separate initiative.

The local newspaper covered the Epic UGM event as well and offered a few other insights into what was said at the conference:

“We’ve just gone over the 51 percent mark. You take care of a little over half of the patients in this country,” Faulkner said. Worldwide, nearly 2.4 percent of the population is covered by electronic health records created by Epic.

I’m sure we’ll be hearing Epic users quote this 51% number a lot more.

Epic, with $1.5 billion in 2012 revenue and 6,800 employees, will keep growing as its customers grow, Faulkner said, adding that clients are loyal. “To us, it’s a lifetime relationship,” she said.

I think Judy might be right for many Epic customers. The lock in to Epic for many of these large organizations is strong.

I guess the 15,300 attendee number is interesting when you think that 6,800 of them could be employees. Although, no doubt it is a really important and interesting event in the healthcare IT world. Judy seems to be softening on media coverage of Epic. It seems like Judy and Epic have decided to start becoming a larger part of the conversation. I wonder if a blogger could attend the event next year.

September 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day

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The Epic EMR at Northern California’s Sutter Health crashed earlier this week, leaving the system inaccessible for an entire day, reports Healthcare IT News. The system, which cost Sutter nearly $1 billion, went offline at approximately 8AM, locking out doctors, nurses and staff from accessing vital information such as medical lists and patient histories.

The crash followed a few days after planned downtime of eight hours which was scheduled to take place due to implement an upgrade.  During that period nurses could still read med orders and patient histories but had to record new data on paper and re-enter it later into the system, Healthcare IT News notes.

During the unplanned outage this week, the Epic system was offline at several Sutter locations, including Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Hospital, Sutter Delta, Sutter Tracy, Sutter Modesto along with several affiliated clinics, the magazine said.

The outage drew the ire of the California Nurses Association, which called this incident “especially worrisome.” But the CNA notes that the crash is hardly the first time there’s been a concern over the Epic rollout. Nurses at Sutter have been complaining for months about alleged safety problems with the Epic system, notes the Sacramento Business Journal.

According to the CNA, more than 100 nurses had previously filed complaints at Alta Bates Summit, arguing that the Epic system was hard to use, and that computer-related delays had adversely affected the ability of nurses to monitor patients properly.

Sutter nurses’ complaints included the following:

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.
• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

Sutter officials, for their part, are not having any of it. Hospital spokeswomen Carolyn Kemp called the allegations that Epic was causing problems “shameful,” and argued that the accusations are arising because the hospital system is involved in a labor dispute with the CNA.

Meanwhile, Sutter execs are turning up the heat on nurses whom they feel aren’t using the EMR properly. According to Healthcare IT News, leaders have been scolding nurses whom they believe have not been entering all billable services into the EMR, which resulted in a loss of $6,000 in a single week, according to a July memo obtained by HIN.

Sutter’s spokesperson, Bill Gleeson, offered this official response:

Sutter Health undertook a long-planned, routine upgrade of its electronic health record over the weekend. There’s a certain amount of scheduled downtime associated with these upgrades, and the process was successfully completed. On Monday morning, we experienced an issue with the software that manages user access to the EHR. This caused intermittent access challenges in some locations. Our team applied a software patch Monday night to resolve the issue and restore access. Our caregivers and office staff have established and comprehensive processes that they follow when the EHR is offline. They followed these procedures. Patient records were always secure and intact. Prior to Monday’s temporary access issue, our uptime percentage was an impressive 99.4 percent with these systems that operate 24/7. We appreciate the hard work of our caregivers and support staff to follow our routine back-up processes, and we regret any inconvenience this may have caused patients. California Nurse Union continues to oppose the use of information technology in health care but we and other health care provider organizations demonstrate daily that it can be used to improve patient care, convenience and access. While it’s unfortunate the union exploited and misrepresented this situation, it comes as no surprise given the fact that we are in a protracted labor dispute with CNA.

August 30, 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.

Interesting EMR Interface Prototype

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I love when doctors and medical students talk about their first encounter with EHR software. In this case, I came across a medical student who ran into Epic in the hospital and writes about it in this post. Here’s his initial response to it:

I took the training module for it and the moment it loaded, I was bewildered. My monitor had turned into a wormhole and was suddenly displaying software built in the 1990s. I stared for 30 minutes at what was basically a wall of text, trying to find my way around small buttons and clogged sub-screens. I hadn’t even learned how to use Epic yet and I was already frustrated. Perhaps it’s because Epic was a platform built upon billing practices that made it so confusing. Either way, I was done before I had even begun.

The great part is that he wasn’t just complaining about the experience. He decided to create a prototype of what he thought an EMR interface could look like. Here’s his video prototype:

Obviously, it’s lacking a lot of detail, but I love his fresh take on how you could navigate the information in the EHR. We need more people who aren’t clouded with current EHR design to offer design suggestions like this.

August 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EMR Market Share

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Editor’s Note: This is the first post on EMR and HIPAA by James Ritchie. James is a longtime journalist including the past eight years as a staff writer with the Cincinnati Business Courier.

Practice Fusion announced in June that it led the EMR industry in market-share gains.

Citing SK&A reports, the San Francisco-based firm boasted that it controlled 5.8 percent of the market as of May, up from 3.8 percent in July 2012. Beyond Practice Fusion, only Epic, AthenaHealth and Cerner showed gains.

In this data, which represents physician offices only, Allscripts was the market leader, with a 10.6 percent share. Not far behind were eClinicalWorks, with a 10.5 percent share, and Epic, with 10.3 percent. (The report that Practice Fusion links to is actually dated January 2013.)

But there’s more than one way to look at the EMR share picture.

Epic was the clear winner in a report by the Austin, Texas-based consultancy Software Advice on meaningful use attestations. Epic, based in Verona, Wis., accounted for 20.3 percent of attestations for a complete EHR in an ambulatory setting.

The firm’s competitors were nowhere close as of the March 2013 report. Allscripts was the system of choice for 11.6 percent of attestations by eligible professionals, and eClinicalWorks accounted for 8 percent. Next on the list were NextGen Healthcare, GE Healthcare and, with 2.7 percent share, Practice Fusion.

Software Advice claimed that the figures, based on Centers for Medicare and Medicaid Services data, might be the best around. They at least provide a standard in a market where vendors “use varied criteria to calculate their customer base,” according to the company.

Companies “might count number of users (which could include everyone from physicians to administrative staff), number of medical providers (which could include everyone from physicians to midwives) or number of practices,” Software Advice noted on its website.

Practice Fusion, founded in 2005, claimed in its press release to have doubled both its monthly active user base of medical professionals and its patient population between 2012 and 2013. The company claims to reach “a community of 150,000 medical professionals serving 65 million patients.”

The prospects for the free model that Practice Fusion uses are still up in the air. Doctors might question whether they want ads, unobtrusive as they are at the bottom of the screen, to compete for their attention when they’re entering patient data. Data, by the way, might prove to be the real revenue generator for Practice Fusion. In June the firm launched Insight, an analytics product offering a population-level view of diagnoses, prescribing patterns and other information. It’s a model worth watching. If Facebook and google can build businesses on data, maybe Practice Fusion can, too.

The SK&A figures show just how fragmented the outpatient EMR/EHR market is. The top 10 vendors accounted for only 64.8 percent of attestations, leaving about 35 percent of the market to the “other” category. By Software Advice’s count, 560 firms logged at least one meaningful use attestation.

Eager to steal share are firms like Irvine, Calif.-based Kareo Inc. It launched its own free, cloud-based EHR in February based on technology acquired from San Mateo, Calif.-based Epocrates Inc. The firm reported in June that 4,000 providers had signed on, with a third of them moving from another EHR.

Of course, ambulatory adoption is only part of the EMR story.

Epic is No. 1 among the nearly 3,000 hospitals that have received federal incentives for using complete electronic records systems, according to Modern Healthcare. The company holds a 19.6 percent share, followed by Computer Programs and Systems Inc. with 15.5 percent, Meditech with 14.1 percent and Cerner with 11 percent. The late-May report was based on numbers from CMS and the Office of the National Coordinator for Health Information Technology.

The inpatient market is far less fragmented than the outpatient space. The top 10 companies control 92 percent of share, according to the report.

No matter how you count share, the EMR space will continue to be hypercompetitive because of the dollars at stake. The market amounted to $20.7 billion in 2012, up 15 percent from 2011, according to the research firm Kalorama Information.

July 18, 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.