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Some Inside Baseball for the EHR World

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I thought I’d take this moment to take a quick look at what many might consider inside baseball when it comes to the EHR world. Although, I’ve been intrigued by a couple announcements that were made recently.

The first announcement is Kareo buying the Epocrates EHR which came just in time for HIMSS. You might remember that I covered the Epocrates EHR on a number of occasions. I first saw the Epocrates EHR at HIMSS in 2010, and subsequently wrote about Epocrates “killing” their EHR immediately after launch. When that happened, I think we all wondered what would happen with the Epocrates EHR code base. You don’t just throw a meaningful use certified EHR to the curb do you?

We now know the answer to that question is no. Kareo saw fit to acquire the Epocrates EHR software and Dr. Tom Giannulli, formerly of Epocrates, is now the Kareo CMIO. I can imagine that Dr. Giannulli wanted to stay with his baby (the Epocrates EHR). I’m also quite intrigued that Kareo is offering the EHR for free (at least for now?). The funny thing is that I had written that the Epocrates EHR should be free. I guess I was sort of right, but I definitely didn’t think that the Epocrates EHR would become free since Kareo makes their money from the Practice Management and billing side of the house. We’ll see how that strategy works for Kareo. In some ways it’s taking a page out of the AthenaHealth playbook.

What might be simply an odd coincidence of timing (or not), Practice Fusion just sent out a letter (shown below) to its users from Practice Fusion Founder and CEO, Ryan Howard. In it he acknowledges Practice Fusion’s past challenges with billing, and he outlines their strategy on making the Practice Fusion billing situation better.

Does this relate to Kareo? Maybe, maybe not. What I do know is that many Practice Fusion users are on Kareo as well since it was Practice Fusion’s only major Practice Management software partner when Practice Fusion started. It seemed like a great match since Practice Fusion only had EHR, and Kareo only had Practice Management. Kareo now has an EHR, and Practice Fusion is working on billing and practice management. I guess we should have seen this coming.

Here’s the full email I got from Practice Fusion (Full Disclosure: They said Dr. Lynn, but I’m not a doctor.):

Hi Dr. Lynn,

The Practice Fusion team takes pride and appreciates your role in making us the fastest growing EHR community in the US.

We also recognize that billing has not been our strongest suit. Improved superbills and an updated payer list have been highly requested by our user community.

That’s why, by the end of March, we’re going to deliver you major new enhancements to your billing experience:

• A comprehensive, streamlined superbill, directly integrated with your workflow
• Flexible reports for billing users
• The ability to export billing data to most major billing systems
• New billing software and service partners with more economical pricing

This means you can stick with the exact billing workflow and system you use today in your practice. We’re building the ability to integrate directly by allowing you to export data to your billing system via HL7. If you prefer superbills, you’ll soon have a drastically improved superbill to work with. And if you’re looking for a new billing system altogether, we’ll also have new, low-cost partners coming soon.

We’re excited to be making your EHR faster, more flexible and easier-to-use. Lastly, our commitment to you has not changed since the day you signed on—Practice Fusion will deliver all this for free. Stay tuned for our billing revamp at the end of March!

Best,
Ryan Howard
Founder and CEO
Practice Fusion
ceo@practicefusion.com

February 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

What Will Take Down the Epocrates Monopoly?

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The most popular mobile health app for medical professionals is far and away Epocrates. I haven’t seen the latest numbers on Epocrates physician install base, but they have what I consider a pretty solid monopoly when it comes to drug information on a mobile device. Almost every doctors has Epocrates, uses it, and can’t imagine life without the information Epocrates provides.

Consider Epocrates dominance in this area, it made me start to wonder what changes could occur that could cause Epocrates to fall from its pedestal. Here are just a few thoughts on what could diminish Epocrates powerful market presence.

Drug Information Integrated with the EHR – If I were Epocrates, this would be my biggest concern. If I’m a doctor seeing a patient, I’m certain to have my EHR close by. If I can find the information Epocrates right in my EHR, then why would I open up another device to find the same information which is just a click away? The answer is that you wouldn’t. The good news for Epocrates is that it will take a while for EHR vendors to integrate this info. EHR companies are a bit distracted by something called meaningful use right now.

No iPad App – Yes, you can use the regular iPhone optimized Epocrates app on the iPad, but how is it possible that Epocrates has missed out on not creating an iPad optimized version? Considering physicians deep love of the iPad this is crazy to consider. Imagine the possibilities with so much more screen real estate as well. What a missed opportunity for Epocrates.

Lack of Epocrates Focus – The best example of Epocrates lack of focus was the Epocrates EHR. They first announced the Epocrates EHR at HIMSS 2010. Almost 2 years later and right after the official launch of their EHR, they shutdown the Epocrates EHR. Distractions like creating an EHR is an example of how Epocrates lack of focus could lead to issues in their core business.

Public Company – Yes, Epocrates is now a public company (EPOC:NASDAQ). Will being a public company cause issues with Epocrates? The founder is already gone and working at Doximity. We’ll see how Epocrates does with the challenges of being a publicly traded company.

Don’t misunderstand me. Epocrates is still well positioned in the medical space. However, I think there are opportunities for entrepreneurial companies to cut into Epocrates current monopoly.

One thing I do wonder is why Epocrates hasn’t come out with some killer APIs for their drug information. Epocrates has all of the info, and EHR companies would love to have that info integrates into their EHR. Seems like the perfect marriage. I expect the answer is that Epocrates doesn’t have the expertise to execute on the API front.

August 22, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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 Ring Around the EHR and Health IT Twittersphere

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One challenge that many bloggers face is creating good titles for all of their posts. I usually don’t have too much problem creating one. Although, I have to admit that when I do my weekend Twitter round ups, I often do have a problem coming up with a title. I don’t like them all to be essentially the same. Maybe I’ll just do the top two stories in the title in the future and then say and more… I mostly mention that because of the creative title above.

Ok, enough discussion of blog titles. Let’s get to the meat of the tweets that I found. A number of these are really substantial pieces of news. So, take a look and enjoy.


I’m sure many might be wondering why this is in an EMR and health IT roundup. The EMR mentioned in the tweet is not electronic medical record. However, if you love tech, you’ll be amazed at that post. It’s such a great illustration of how what Amazon is doing with EC2 and their other “cloud” services is going to continue lowering the costs for so many internet services.

I like to think about it this way. How many servers are running at maximum capacity all the time? The answer is none of them. In fact, many of them often use some small percentage of what that server could process. So, that means there’s a lot of wasted processing power on servers. I think services like Amazon EC2 create such an interesting model since they have so many fewer wasted resources.


Yes, this is a survey by CDW healthcare, but that’s a pretty strong number regardless of who is doing the survey.


I’ve become more and more annoyed by the way our current payment system causes so many perverse incentives. It really makes me want to find ways to change the system.


It could be the most overlooked. Although, the question we should be asking is why is it overlooked? I think the answer is that it’s not an easy thing to understand during the selection process.


Nice job by Neil of covering Epocrates selling their EHR software. This is BIG news. Sure we could argue that Epocrates didn’t have the DNA in their company to build and sell EHR. However, this should be a cautionary tale for other EHR vendors trying to enter the market. Of course, entrepreneurs will ignore this caution and enter anyway. That’s why I love entrepreneurship.


This story was passed around on Twitter all week this last week. It probably deserves more than a tweet at the end of a Twitter round up. This is a great story about an iPad EMR saving a life, but it’s also a great story about patient information being available in emergent situations. I’ve met a number of companies that are working on this problem (including My Crisis Records who advertises on one of my sites). I think over the next 5 years we’re going to see a really dramatic change in how an emergency responder addresses a medical situation. I look forward to that day. I believe information is power and I think we can do a lot better getting them the information that will make them more powerful.

March 11, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Epocrates EHR Should be Free

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I came across this article on Lab Soft News (he does great work) that talked about some Ethical Questions that related to Epocrates recently launched EHR software and their existing pharmaceutical relationships. Here’s one section from the post:

Very distressing to me, however, is the clear link of the company [Epocrates], and its software, to the pharmaceutical industry. … I have also reluctantly come to the conclusion that even apparently trivial advertising connections to Big Pharma can lead to mischief. I had previously thought that inconspicuous advertisements in EMRs by drug companies might be tolerated if the companies were to bear the costs of these systems. I now believe that allowing these companies even a tangential relationship to physician-office electronic medical records is too risky.

I’ll leave the highly discussed topic of pharmaceutical influence for another post and the comments section. However, when I read this I couldn’t help but wonder why Epocrates isn’t offering a Free EHR.

If you think about most Free EHR models, one of the core revenue paths is through advertising. Let’s not kid ourselves here. When they talk advertising, they’re talking about pharmacy ads. Sure, they might sell some other ads, but the majority of the big dollars for EMR advertising is from pharmaceutical companies.

With this understanding, doesn’t that mean that Epocrates relationships with these pharmaceutical companies would be perfectly positioned to execute on the Free EHR model?

I just checked the Epocrates EHR pricing page and it has the pricing as a $359 monthly subscription per seat. It’s also interesting that they’ve chosen to integrate with Nuesoft’s PMS which will cost $200/month per seat. They also require the purchase of the Epocrates EHR Quick Start Package. Not sure the cost on that. Sounds a bit pricey to me, but that’s a topic for another post.

I keep asking myself as I’m writing this post, Epocrates is perfectly positioned to execute the Free EHR Pharma advertising model and yet for some reason they’ve chosen not to do it. Remember, Epocrates has been executing the free software for Pharma advertising for a long time. Why did they choose not to do the same model with their EHR? Do they know something we don’t know?

I don’t know the answer to these questions, but I’m sure to ask them next time I see them. Maybe they’ll be at AHIMA or MGMA.

September 14, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.