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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 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.

Should EHR Vendors Integrate Google Search Into Their Software?

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One thing I love about Twitter is the on the ground insight you can get into healthcare. Here’s a tweet example of this:

When I read the tweet, I was fascinated by the shift that Eric Topol observed by his residents. I’m sure many doctors out there are cringing at the idea that Google instead of some “trusted” source of information is where new doctors are turning for health information.

I think this view is a little short sighted and ignores the sophisticated ways that people are using Google. I find myself doing this more and more as well as I search out information on the internet. When I’m searching, I don’t always select the top Google result. Instead, I regularly find myself checking the website for that result to see if that website is what I would consider a trusted source. I’m sure that many residents do the same thing as well.

Certainly this shift is not without its pitfalls. Some likely don’t look to see if the Google result is a trusted source. Even what may look like a trusted source might not be trusted. However, I believe this is the minority of people searching (in particular residents).

One other change that’s happening is that many people are triangulating the results from their search. Instead of blindly looking at a result from Google, when you’re making a decision like a doctor is making you’ll often take a look at multiple sources and compare how the results and information compares. Instead of treating Epocrates like the Bible, they’re looking at Epocrates and Medscape and Google and triangulating all that information into what is the best course of action or the best information. This is a very good shift and many in the latest generation just do this naturally.

Since this is largely an EHR site, it makes me wonder if more EHR vendors should be integrating Google searches into their EHR. It wouldn’t have to be blatantly Google. I think the web browser is likely the right implementation to consider. If you highlight a word in the Google Chrome web browser and then right click, it will do a Google search on the highlighted word. Seems like it wouldn’t be too hard to do the same within an EHR.

While the tweet might indicate that companies like Epocrates and Medscape our in trouble (see my post about Taking Down the Epocrates Monopoly), there’s no reason that these health information companies can’t capitalize on Google search results as well. They’ll just have to learn how to get their information listed in Google as opposed to stuck in an app.

September 18, 2012 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.

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 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.

Kaiser’s Mobile Health Approach

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As I mentioned in my previous post about laptops and iPads in healthcare, I had the chance to meet with Kaiser at the Health 2.0 conference in Boston. I had a chat with Brian Gardner, head of the Mobile Center of Excellence at Kaiser Permanente and learned a bunch of interesting things about how Kaiser looks at mobile healthcare.

The first most interesting thing to note was that Kaiser currently does not support any sort of BYOD (Bring Your Own Device) at this time. Although, they said that they’ve certainly heard the requests from their doctors to find a way for the doctor to use their own mobile device. Since this means that all the mobile devices in use at Kaiser are issued by them, I was also a little surprised to find that the majority of their users are currently still using Blackberry devices.

Brian did say that the iPhone is now an approved Kaiser device. It will be interesting to check in with Brian and Kaiser a year from now to see how many Blackberry devices have been replaced with iPhones. I’m pretty sure we know exactly what’s going to happen, but I’ll have to follow up to find out. What is worth noting though is the time delay for an enterprise organization like Kaiser to be able to replace their initial investment in Blackberry devices with something like an iPhone or Android device. While I’m sure that many of those doctors have their own personal iPhones, that doesn’t mean they can use it for work.

I also asked Brian about the various ways that he sees the Kaiser physicians using their mobile devices. His first response was that a large part of them were using it as an email device. This would make some sense in the context of most of their devices being Blackberry phones which were designed for email.

He did say that Kaiser had done some video pilots on their mobile devices. I’ll be interested to hear the results of these pilot tests. It’s only a matter of time before we can do a video chat session with a doctor from our mobile device and what better place to start this than at Kaiser?

Of course, the other most popular type of mobile apps used at Kaiser were related to education apps. I wonder how many Epocrates downloads are used by Kaiser doctors every day. I imagine it gets a whole lot of use.

What I found even more intriguing was the way that Kaiser used to discover and implement apps. Brian described that many of their best apps have come from students or doctors who had an idea for an app. They then take that idea and make it a reality with that student or doctor working on the app. It sounded like many of these students or doctors saw a need and created an app. Then, after seeing its success Kaiser would spread it through the rest of the organization.

This final point illustrates so well how powerful mobile health can be now that the costs to developing a mobile health innovation is so low. Once you lower the cost of innovation the way mobile health has done, you open up the doors to a whole group of entrepreneurs to create amazing value.

July 10, 2012 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 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 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.

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 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.

Mobile vs Computer and the Patient Interaction

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“It’s Friday, Friday! Gotta get down on Friday. Fun, fun, fun, fun. Looking forward to the weekend.” – Friday Music Video by Rebecca Black Dang those viral videos, but I have to admit that I’m grateful that today is Friday and I have a weekend to catch up on things. I’m sure that many of you can relate to this feeling.

As we head to the weekend, I’ll leave you with a little something to think about and discuss in the comments. Someone at HIMSS pointed this out to me and I thought it was worth sharing. Think about the patient interaction in the exam room. For some reason, doctors don’t and haven’t had any problem pulling out their mobile phone (or previously their PDA) in order to pull up Epocrates (or some other similar app) while in the room with the patient. It was perfectly natural for them to pull it up to look up a certain drug or other information.

Why are doctors comfortable with a smart phone between them and a patient, but a computer is not? Is there a relationship between this and why the iPad is so popular with doctors?

March 25, 2011 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.

Different Methods to Become a Top EMR Company

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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.

December 20, 2010 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.

iPad EMR

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EMR and EHR has been getting a ton of traffic related to my posts on the iPad EMR. It’s a really interesting discussion that I think people that love technology and EMR will enjoy. I have no doubt that the interface that the iPad is helping to promote and develop is going to have a major impact on healthcare. Not that everyone will have an iPad in healthcare, but that the technology behind it will be copied and we’ll see lots of interesting documentation methods for EMR software.

Dr. Larry Nathanson, MD from BIDMC seems to disagree with me in his writeup about his experience using the iPad in an Emergency Room. However, what I found most interesting about his writeup is his comments about the challenges of the iPad.

The first was how well it will hold up in a clinical environment. The iPad doesn’t seem to be the most rugged device and clinics like to abuse devices (from my experience). The second was the challenge that plagues all tablets: difficulty entering strong passwords. between the numbers, symbols and mixed case, it’s harder to enter these passwords on a device like the iPad. Is biometrics the solution to that?

What do you all think about the iPad and EMR? Will we see an iPad only EMR develop into a real power player in the industry?

April 8, 2010 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.