Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

eCW (eClinicalWorks) Settles Whistleblower Lawsuit for $155 Million

Posted on May 31, 2017 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 many of my press panels and other discussions at the Healthcare IT Marketing and PR Conference, I’ve argued that there’s very little “Breaking News” when it comes to healthcare IT. Today is an example where this is not true. The news just broke that EHR vendor, eCW (eClinicalWorks), has settled a whistleblower lawsuit against them for $155 million.

The suit was filed by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement, by his law firm Phillips & Cohen LLP against eClinicalWorks. eClinicalWworks and three of its founders (Chief Executive Officer Girish Navani, Chief Medical Officer Rajesh Dharampuriya, M.D., and Chief Operating Officer Mahesh Navani) are jointly liable for the payment of $154.92 million. Separately, Developer Jagan Vaithilingam will pay $50,000, and Project Managers Bryan Sequeira, and Robert Lynes will each pay $15,000. As a whistleblower, Delaney stands to receive $30 million of the settlement.

Here’s the summary of the complaints against eCW from the Justice Department’s press release about the settlement:

In its complaint-in-intervention, the government contends that ECW falsely obtained that certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification. For example, in order to pass certification testing without meeting the certification criteria for standardized drug codes, the company modified its software by “hardcoding” only the drug codes required for testing. In other words, rather than programming the capability to retrieve any drug code from a complete database, ECW simply typed the 16 codes necessary for certification testing directly into its software. ECW’s software also did not accurately record user actions in an audit log and in certain situations did not reliably record diagnostic imaging orders or perform drug interaction checks. In addition, ECW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW’s software to the software of other vendors. As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software.

Most people are writing about how eCW didn’t fully integrate the RxNorm codes, but instead hard coded the 16 codes that the certification process used. That’s embarrassing so it’s not a surprise that so many people are sharing that part of the story. However, I think the bigger part of the violation is probably around the data portability requirements. I bet a lot of EHR vendors are sweating right now as they look at the way they implemented those requirements. Not to mention the EHR audit logs which are poor in many EHR. Plus, the scariest claim is eClinicalWork’s inability to reliably record diagnostic imagine orders or perform drug interaction checks. Those are patient safety issues and exist in many EHR software.

If you want to dig into the weeds like I did, then you can see the government complaint against eClinicalWorks that was filed May 12, 2017 and the final settlement agreement with eClinicalWorks. Even more insightful was looking at the original complaint from Delaney against eClinicalWorks. Comparing the original whistleblower complaint to the government complaint against eClinicalWorks is very interesting. You’ll see that the government didn’t grab on to everything that was originally filed by Delaney. I imagine that’s a standard legal practice to file as many areas as possible and see what the government decides to use. It seems like Phillips & Cohen have represented a number of whistleblowers so I’m sure they were expert at this.

Girish Navani, CEO and Co-Founder or eClinicalWorks, offered this statement about the settlement:

“Today’s settlement recognizes that we have addressed the issues raised, and have taken significant measures to promote compliance and transparency. We are pleased to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery.”

Looking at the bigger picture, I’m certain that every EHR vendor is going through their EHR certification process and looking at all the statements they’ve made to make sure they’re not going to be in a similar situation. Not to mention the anti-kick back laws that were mentioned in the settlement. I’m sure there are other EHR vendors that are in violation of both of these items just as much as eCW.

Former ONC National Coordinator, Farrzad Mostashari seems to agree with me. Farzad tweeted, “Wow!! I hope this changes the attitude of the EHR vendor space more broadly.” Then, he later tweeted, “Let me be plain-spoken. eClinicalWorks is not the only EHR vendor who flouted certification /misled customers
Other vendors better clean up.”

Farzad then nailed it when he tweeted “There are a LOT of doctor’s office staff looking at their EHR today and wondering if there’s $30M worth of false promises hidden there”

I do wonder if Farzad Mostashari feels a little guilty of the role he played in this process since he oversaw such a porous EHR certification process. I’ve been against EHR certification for a long time because I thought it provided so little value to providers. The fact that it can be gamed by 16 codes being hard coded is a perfect example of why EHR Certification is a waste. Although, one could argue that without EHR certification, this suit would have never happened and maybe eClinicalWorks could still be selling the same product today.

I do find this quote from the US Attorney’s Office for the District of Vermont press release a little over the top (which I think is common on these things):

“Electronic health records have the potential to improve the care provided to Medicare and Medicaid beneficiaries, but only if the information is accurate and accessible,” said Special Agent in Charge Phillip Coyne of HHS-OIG. “Those who engage in fraud that undermines the goals of EHR or puts patients at risk can expect a thorough investigation and strong remedial measures such as those in the novel and innovative Corporate Integrity Agreement in this case.”

Another topic I haven’t seen anyone else cover is the impact that this settlement will have on eCW’s customers that used eCW to attest to meaningful use. Technically it shows that eCW wasn’t appropriately certified, so that means that they weren’t using a certified EHR and therefore shouldn’t have been eligible for meaningful use incentives. I asked one friend about this and he suggested that CMS had previously said that it would not hold eligible providers and eligible hospitals responsible for EHRs that calculated the meaningful use measures the wrong way. So, we’ll probably see this same approach with eCW users that got EHR incentive money on what we now know was not appropriately certified.

I was also intrigued by the Corporate Integrity Agreement (CIA) that eClinicalWorks entered into with HHS-OIG. There are a lot of details and oversight that eCW will get from OIG, but it also required eClinicalWorks to “allow customers to obtain updated versions of their software free of charge and to give customers the option to have ECW transfer their data to another EHR software provider without penalties or service charges. [emphasis added]”

Free updates is pretty clear and ironic since not wanting to update all their clients is one possible hypothesis for why they didn’t really push the proper upgrades. Hopefully all eCW users will do it now or they might be facing their own violations for using outdated software that has known clinical issues. However, the kicker in the CIA detail above is that eClinicalWorks has to give customers the option to have eClinicalWorks transfer their data to another EHR without penalty or service charges. I wonder how many will take them up on this requirement and what the details will be. I still wish this was required of all EHR vendors, but that’s a story for another day.

How many EHR vendor marketing groups are putting together their eClinicalWorks Rescue Plan to take in the downtrodden eCW users? I’m not sure these will be as successful as other EHR switching marketing efforts like those we see when an EHR is being shut down.

I’m sorry to say that I think this is likely only the beginning of such lawsuits. In fact, it’s probably already woken up a lot of potential whistle blowers. Hopefully it’s woken up a lot of EHR vendors as well.

Insightful Tweets from Farzad Mostashari’s Session at #MGMA15

Posted on October 13, 2015 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.

Today, Farzad Mostashari took the stage at the MGMA Annual Conference. As a man that I respect and someone that has deep connections and insights into what’s happening in Washington and how that plays out in actual practice (thanks to his ACO company), I was interested in the insights he’d share.

Here’s a quick Twitter roundup of some of the insights he shared:

Farzad Mostashari’s Aledade Raises $30 Million on the Back of the Switch to Value Based Care

Posted on June 15, 2015 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.

On Aledade’s 1 year anniversary, they just announced that they’ve raised a $30 million Series B round of funding from new investor ARCH Venture Partners and return investor Venrock. That brings their total funding to $35 million. For those not familiar with Aledade, it was Founded by Farzad Mostashari and Mat Kendall soon after Farzad left ONC. They work with independent, primary care physicians who want to participate in ACOs and value based reimbursement programs.

Farzad’s blog post announcing the funding says that by end of the year Aledade will have 100 physician practices managing 75,000 Medicare Patients. With such small numbers, this should illustrate what a huge opportunity value based reimbursement will be for many companies that get it right.

Aledade has an interesting business model. They take about $500/provider as a membership fee and then they split the value based reimbursement commission with the provider. 60% of the reimbursement goes to the provider and 40% goes to Aledade. I’ll be interested to see how well this commission structure holds up. While certainly not an Apple to Apples comparison, doctors are use to paying 5-10% commission to billing companies. Will they be ok with paying 40% to what will feel like a billing company to many? Is this an opportunity for medical billing companies?

I have no doubt that physicians and hospitals are going to need a great mix of technology and healthcare knowledge to be successful in this new world of value based reimbursement. Aledade is on the cutting edge of this trend. Time will tell if they’re too early or right on time for the change.

In a recent article in the Palm Beach Post, they said the following about Aledade:

Thanks to Aledade’s focus on data analytics and physician reminders, Mostashari’s doctors became five times more likely to give recommended preventative care to their older patients, such as annual wellness visits and vaccinations against pneumonia.

This sounds great on face. It’s great that primary care physicians are interested in the wellness of their patients. I also think it’s great that we have a method for incentivizing these kinds of actions. However, my fear with this trend is that we’ll push out guidelines for “wellness care” without knowing if those guidelines actually improve someone’s health.

One lesson Mostashari should have learned well from meaningful use is that if you regulate something too early, you might freeze something in regulation that adds a lot of burden without actually improving healthcare. I’m glad they’re on the cutting edge of this trend. Let’s just be thoughtful that we don’t give our doctors more hoops to jump through that don’t actually provide value. That’s the massive challenge we face with the shift to value based reimbursement and we’re just getting started.

Aledade and company are explorers of a new land. I think we’ve only found the Bahamas. Most of us believe the Americas are still out there to be discovered, but we haven’t found it yet. So, let’s be careful drawing the final maps.

EMR vs Tumblr, EMR Issues, and Improving Care

Posted on October 20, 2013 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.

As we do almost every weekend (every other week on EMR and EHR), we like to take a look at some interesting tweets that we find related to EMR and health IT. We have a bunch of spicy tweets this week that I think each start an important conversation.


My first gut reaction was to laugh. It’s nice that someone is using Tumblr as their therapy for EMR issues. Although, my second reaction is to be a little frustrated that an EMR would be so poorly designed that you could close your EMR in the middle of a report and it wouldn’t be saved. Of course, this isn’t surprising to me since I’ve seen hundreds of EMR, but it is still sad that it’s the state of EMR software today. Imagine if Word was still that way today.


I think this is an important discussion. I think there are workarounds that help this situation. We’ve written about many of them over the years. However, it definitely takes some good design to make the patient the center of the work you do as a doctor and not the EMR.


I love the irony of Farzad’s statement. The real challenge with this idea is that humans can adjust and learn over time much better than computers. At least in the short term. We’ll see how that plays out in the long term as the volume of information that needs to be processed can’t be handled by the human brain.

Will The Government Shutdown Lead to the Meaningful Use Stage 2 Delay?

Posted on October 10, 2013 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.

It seems like every healthcare organization that exists has called for a delay to meaningful use stage 2. I’ve predicted before that I think that meaningful use stage 2 will have some sort of delay. I feel even more confident in that prediction thanks to the government shutdown.

With so many people not working at ONC, I think there’s a practical question of whether they can really be ready for MU stage 2. However, maybe even more powerful is that the government shutdown now gives ONC an excuse for why the delay should happen. They can blame the delay on the government shutdown and not on something else. Let’s call it the straw that broke the camel’s back.

Although, Farzad Mostashari at CHIME 2013 disagreed. Here’s the tweet I sent during his keynote presentation:

It was nice of Farzad to retweet it as well. I think he really believes this statement. I was sad he didn’t reply or retweet my other tweet:

If I were a betting man (which I’m not despite living in Vegas), I’d bet on a MU stage 2 delay. However, Farzad did place that seed of doubt in my prediction. Farzad made a good case for why some parts of meaningful use stage 2 we can’t wait on anymore. However, with him no longer as leader we’ll see if they can hold the course with no delays.

Build Your Own EHR, EMR Patient Satisfaction, and Social Media in EMR

Posted on August 18, 2013 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.


It looks like Dr. Rob Lamberts is crazy. It’s nice of Farzad to support him. I think Dr. Lamberts response to Farzad was enlightening as well: “Thanks. More endurance than luck, though.” He’s right. None of the individual components of an EHR are technically very hard, but the number of components you have to build is HUGE.


This is a perception thing for sure. We are trained that technology improves whatever it touches. So, when a patient sees a doctor with an EMR, they believe it will mean better quality care. Reminds me of the “Got EMR?” campaign I talked with people about 7 or 8 years ago.


I question the value of having a patient’s social profile in your EMR. However, I think the concept of looking at your EMR as a CRM for patients could become a very important concept over the next 5 years. I think it will take more than just putting in a patient’s social profile though.

ONC Cartoon with Homage to Farzad

Posted on August 9, 2013 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.

Today, someone who calls themselves HIT Sprite sent me a cartoon that looks at ONC dealing with the recently announced departure of Farzad Mostashari. You might not get the cartoon if you don’t know Farzad and ONC well, but for those who live, eat, breathe and sleep health IT, I think you’ll enjoy it.

ONC Cartoon 1
ONC Cartoon 2
ONC Cartoon 3

While not completely accurate, Farzad’s quirks have grown almost as large as his efforts to change healthcare. Will Farzad be better remembered for his bowtie or his work to move healthcare IT forward?

Can Healthcare “Step on a Scale” Today?

Posted on August 1, 2013 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.

At the Healthcare Forum, Dr. Farzad Mostashari posited an important question: Can healthcare step on a scale today?  Embedded in this question is the idea that healthcare should have a simple way to measure the quality of care it provides.  Dr. Mostashari suggested that most practices today can’t step on the proverbial scale.  However, the technology is now available for us to measure and track how well we are doing at providing care.

The problem with stepping on the scale is that the feedback it provides can often be difficult to accept.  Our normal first response to stepping on the scale is to exclaim, “this scale must be broken.”  Dr. Mostashari suggested that “There isn’t a healthcare provider in the world who doesn’t think they’re doing better than they are.”  This isn’t a condemnation of the healthcare providers, but a simple reality of our own self evaluations.  The way to solve this reality distortion is to provide trusted data which illustrates the realities of the situation.

This proverbial “scale” isn’t some high level concept, but is part of a major shift that’s happening in healthcare measurement and payment.  Dr. Mostashari said that “Reimbursement will be tied to how well we manage a population.  People will have to answer, ‘How am I doing?'”  This shift in payment models is happening quickly and healthcare IT will be the tool that measures our progress in key healthcare quality measures.  We must have the courage to step on the scale and face the reality of our baseline metrics.  We must set goals and take action to improve our performance.

The unique promise of technology is that it can make things better.  One of the core beliefs of Dr. Mostashari and his predecessor, Dr. Blumenthal, is the equation:  man + computer > man

Dr. Mostashari offered some high level ways that technology can help to improve healthcare.  He said, “What we need isn’t necessarily big data in the sky.  We need small data in every interaction we have.  We need to learn from the healthcare interactions and learn from what we’re doing.”  What a drastically different view of health data than what we often see in the market today.  We are collecting a lot of data, but are we using that data in ways that will improve care?  This is the promise of technology in healthcare.

Another way technology could be used to improve healthcare was described as learning as we deliver care.  Think about putting together an A/B trial for emails or letters sent to patients who need to return back to the office.  We can take these care experiences and learn from them.  Our hospital CEOs know what our length of stay is to multiple decimal points, but does our CEO really know what population health management will do for our workflows?

Healthcare is no longer an individual sport.   Healthcare is now a team sport that will require interoperability of healthcare data.  The purpose of clinical notes are no longer short notes for myself or long notes for the CMS auditors, but are data to be used to improve care.

Healthcare improvement needs to happen across the spectrum.  This includes improvement at the community, practice and personal level.  The shared values of health IT are that healthcare can be better, data is the key to making it better, and an optimism that the future will be better than today.  As Dr. Mostashari concluded, “We can use information and tomorrow will be better, faster, and cheaper than today.”

Check out the full Healthcare Forum presentation by Dr. Farzad Mostashari embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

Farzad Mostashari Tweets #HDPalooza

Posted on June 4, 2013 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.

Health data geeks from across the US have descended on Washington DC this week for what’s called Health Datapalooza. It’s a sort of Mecca for healthcare data sharing where health data geeks virtually hold hands and sing koombaya as they circle around blue buttons and hard drives full of granular health data. As someone who believes that health data liberacion is the right direction for healthcare, this is a great event and this year it seems to have really hit its stride.

One of the biggest advocates of using healthcare data for good is ONC’s own Farzad Mostashari. Never someone afraid to tweet or Retweet health data related topics, Farzad’s twitter account has been incredibly active during Health Datapalooza. So, I thought I’d use it to illustrate some of the messages Farzad found important enough to share from the event. Plus, I’ll throw in my commentary after each tweet as appropriate. (Note: when the tweet is from someone else it’s because Farzad retweeted it.)


If you want to stop reading here you could, because it’s the core of Farzad’s message. Although, if you want to go into depth on the topic, keep reading. At least Farzad has made clear that he’s going to use whatever methods he has available to make patients’ health data available.


I’ve said this a few times recently as well. I have an extreme belief in the creativity and drive of entrepreneurs. We just need more of them to be able to do their work in healthcare.


Amen! The challenge is getting this message to consumers. If you tell them that their data will be kept private, but will be shared where appropriate to provide better care, every patient wants this to happen. In fact, most already assume this is what’s happening.


Healthcare problems are still a HUGE challenge. We don’t need any more barriers than we already have to overcome.


I wish the $36 billion in EHR incentive money would have been spent on standardization. We’d have had better results. I’m still not sure how we’re going to get to future payment models. Govt could play a role in it.


Speaking of changing payment models. Seems like government doesn’t know how to get their either. A fundamental delivery system transformation could be translated as impossible.


The ladies will love Farzad in his bowtie. I love people who aren’t afraid of trying what seems impossible. Who in health IT is doing that today? I guess looking at the last tweet CMS and ONC are trying.


I’m not sure if we should be proud or sad at the 8% number. Granted, it’s a lot of people that have to learn about it. Although, since many don’t care about their health data, 8% is pretty good.


I’ll be interested to see this number post-meaningful use stage 2. Doctors will be really encouraging their patients to get their health data so they can meet MU stage 2.


This isn’t actually from Health Datapalooza, but Farzad did just retweet it. I haven’t dug into Obama’s plan to deal with patent trolls, but I’m really glad more of a spotlight is being put on this challenging problem. In the case of software, I’m really against patents because as the tweet says they do stifle innovation. It’s ironic because they’re suppose to encourage innovation, but it’s just not the reality of how they’re being used.

Meaningful Use and Sequestration

Posted on March 7, 2013 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’m a little surprised that I didn’t hear more discussion of sequestration and it’s possible impact on meaningful use and other EHR and healthcare IT related programs. Maybe I was just in the wrong circles for this discussion, but I didn’t hear about sequestration until the final day of HIMSS.

I think the effects of sequestration on meaningful use, EHR and other Health IT aren’t exactly known right now. Although some hints at the potential effects of sequestration were given at HIMSS 2013.

Jessica Kahn sent out the following tweet about the topic:

Of course, it’s hard to read into exactly how the EHR incentive payments could be effected by sequestration. I can’t imagine the cuts will allow them to pay a lower incentive amount since that’s been legislated. I could see it slowing payments down. I guess we’ll have to see what Jessica means by her tweet.

Farzad Mostashari also commented on the effect to ONC of sequestration in this PhysBizTech article Q&A:
Q: By how much will sequestration reduce your budget and what has to give?

A: It’s 5 percent: A $3 million cut for an office whose budget has been $60 million since the day it was founded by President George W. Bush. This is going to hurt. We are not furloughing people, which is the bulk of the budget. So our contracts are going to take a big hit.

What do you think will be the impact on EHR and healthcare IT because of sequestration?