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Good Luck With That HIE Tech Purchase

Posted on June 21, 2012 I Written By

Anne Zieger 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.

Want to buy HIE technology?  It’ll cost you. But more importantly, you’ll still be dealing with a bewildering array of choices, if a new report from KLAS has it right.

According to KLAS, which asked 95 providers about their HIE buying plans, there were a few clear leaders in the field.  Providers surveyed by KLAS reviewed 38 HIE vendor offerings.  Of those, five HIE vendors were considered in more than 10 percent of the providers’ buying plans, researchers found.

If there was a clear leader, it was Medicity, which was considered in 23 percent of HIE buying decisions, according to a report from Healthcare IT News.  Next was Axolotl, with 22 percent; RelayHealth, with 16  percent; ICA, with 11 percent, and Epic, also with 11 percent. (Note: Epic was only being considered seriously when providers want to tie together multiple Epic installations.)

Looked at another way — by vendors mentioned most frequently by providers — the leaders were Axolotl, Cerner, dbMotion (part owned by the University of Pittburgh Medical Center), Epic, GE, ICA, InterSystems, Medicity, Orion and RelayHealth.

If you want to really fit the HIE to your situation, consider the following criteria, the HIN story suggests:

  • Public HIEs – A public exchange may belong to official state agencies or may be semi-independent with direct and typically temporary government backing. Public HIEs demand solutions with strong potential scalability and need standards-based technology.
  • Cooperative HIEs – In this model, otherwise-competitive hospitals work together to form independent HIE organizations, generally with an open invitation to other hospitals, clinics and physician practices. These HIEs often struggle to establish long-term funding and look for vendor solutions that offer flexible and affordable cost alternatives while best adapting diverse EMR technologies.
  • Private HIEs – In some respects, private HIEs are designed to enhance relationships as well as exchange data. Often, a single hospital or IDN creates an HIE hoping to draw in community physicians while protecting or increasing revenues. Funding is less complicated and these HIEs are more likely to be satisfied with solutions that best work with their existing technology.

The truth is, though, that whatever model best fits your HIE purchase, narrowing things down to your short-list isn’t as easy as just picking from KLAS’s top contenders.  Even these leaders have a moderate to tenuous grip on the market, and may or may not have the solution that fits your model. (Note: I’m familiar with Axolotl and Orion, both of which have what may be some of the longest-deployed tech out there, but I can’t vouch that they’re exactly better than anyone else.)

If it were me, I’d look at lesser-known, strongly-backed folks focused directly on the problem. Then, I’d do a co-development program with them so both win.  Got other ideas to share readers?

Meaningful Use EHR Breakout by Percentage

Posted on June 20, 2012 I Written By

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

I’ve seen a bunch of different websites listing the top 10 EHR vendors based on physicians who attested to meaningful use using their EHR software. This list is certainly interesting and worthy of a discussion. However, I think it’s also important to put these numbers in some context. Remember that these numbers are just for the ambulatory EHR space. The Hospital EHR numbers are a different story which I’ll probably cover on Hospital EMR and EHR.

Here are the EHR incentive numbers by EHR vendor and also the percentage of meaningful use attestations they had (Thanks to Dr. Rowley for the numbers):

EHR Vendor MU Attestations Percentage
Epic 11075 23%
Allscripts 5743 12%
eCW 4057 8%
NextGen 2237 5%
GE 2002 4%
Athena 1733 4%
Greenway 1650 3%
Cerner 1375 3%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 2%
Sage 1140 2%
Other EHRs (272) 14358 29%

As Dr. Rowley points out in his post, Epic is the largest vendor on the list, but they don’t market or sale their product to independent clinics or even independent physician groups. Epic’s ambulatory EHR is found in owned or affiliated clinics who use the ambulatory piece of the EHR an Epic hospital buys. So, the above Epic number actually provides an insight into how many ambulatory practices are associated with Epic using hospitals.

The numbers tell an interesting story if you take Epic out of the mix:

EHR Vendor MU Attestations Percentage
Allscripts 5743 15%
eCW 4057 11%
NextGen 2237 6%
GE 2002 5%
Athena 1733 5%
Greenway 1650 4%
Cerner 1375 4%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 3%
Sage 1140 3%
Other EHRs (272) 14358 38%

Once you take out the hospital dominance in the ambulatory market, the EHR market share for any one EHR vendor is quite small. In fact, the other EHR vendor category has 38% of the EHR market. The long tail of EHR software is definitely at play right now.

Plus, we have to be really careful using meaningful use attestation as a proxy for the EHR market. I recently saw a figure that only 20% of the ambulatory EHR market had attested to meaningful use. That’s right, the above numbers only represent 20% of the ambulatory market.

If my math is correct, that still leaves almost 200,000 providers that aren’t represented in the above analysis of 50k providers. Imagine an EHR vendor comes along that’s so great that they quickly capture only 20% of the 200,000 uncounted providers (no small feat). That would give them about 40,000 providers and using the above numbers they would have 45% of the EHR market (including Epic).

Of course, the current EHR vendors will continue to sale EHR software and many will switch EHR software vendors during that time as well. Plus, no doubt many of those who haven’t attested to meaningful use already have an EHR, but aren’t represented in the numbers above. They just either don’t care about meaningful use and EHR incentive money or they’re still working to get to the point where they can attest to meaningful use. However, I still think the above numbers illustrate that there’s plenty of opportunity available for an upstart EHR company to get plenty of EHR market share.

It’s going to be an exciting next couple years as we watch all of this shake out. We’ll take a look back at this post in a few years to see how far we’ve come.

Meaningful Use Stage 2 Standards Video – Meaningful Use Monday

Posted on April 2, 2012 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.

Self proclaimed Standards Geek for GE Healthcare, Keith Boone, did a good presentation covering the meaningful use stage 2 standards along with briefly covering the meaningful use stage 1 standards and looking at the standards we might see beyond meaningful use stage 2. This meaningful use stage 2 standards presentation was done at the Crossing the Infrastructure and HITECH Meaningful Use Divide conference.

If you’re into healthcare standards, then you’ll enjoy this video. If you get confused or just don’t care about the various alphabet soup standards, then you won’t find this video that interesting or likely useful.

I think this video also illustrates a couple important points. First, healthcare standards are pretty complex. Second, a lot of thought and effort has been put towards these standards. Thanks to meaningful use and the EHR incentive money, EHR vendors don’t really have too much choice on whether to adopt these standards or not any more. Although, as Keith point out, these are just proposed standards. The meaningful use stage 2 feedback period is still open, so I encourage you to provide your comments during this period. ONC does listen to this feedback and do its best to incorporate it in the final rule.

As a side note, if you like EHR and Health IT videos, be sure to check out this EMR & EHR Video website. We just passed the 200th video posted on that site. Plus, I just did some math using our analytics programs and we’ve had about 432 hours of video watched on that site this year.

April Fools Day, Genomics EHR, EMR Blogs, and Hospital IT Consultants

Posted on April 1, 2012 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 most of you know, I’m usually all over April Fool’s Day on this site. I actually even had a great idea this year as well (some might remember my EMR Announcement last year), but with April Fool’s Day being on Sunday, I decided to pass this year. I’ll bring it back next year I’m sure.

As expected, Epic did another great job on their home page for April Fool’s Day. EpiCot partnership with Disney is pretty creative. Some might argue that the Epic campus is already EpiCot. Here’s a screenshot of it in case you missed it (click on the image twice to see it full size):

Mark Dente describes a genomic EHR as being quite far away. Certainly it’s not going to happen tomorrow, but I think it’s a little closer than he describes in this article. Although, much of the genomic research is still just beginning so we’ll see how quickly it can scale up and produce results. That will be the key.

Check out the article in the tweet to learn more about Caradigm, GE’s healthcare partnership with Microsoft. It’s definitely all about the data.


Never heard of any EMR blogs. Have you?


Really? I wonder how well these consulting companies will do post-EHR incentive money. This will be interesting to see play out.

DrFirst Shifts to EHR Platform Company

Posted on February 8, 2012 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.

If you haven’t yet seen this video that DrFirst created for HIMSS 2012 and the HIMSS Healthcare Hero, then you need to watch it now. It’s a really beautiful video: http://bit.ly/AnNvzU

After seeing such a well made video, I definitely wondered what was up DrFirst’s sleeve at HIMSS 2012. So, I reached out and today I had the chance to talk with Cam Deemer President of DrFirst about the transition that’s happening at DrFirst.

I think that most of us have known DrFirst as an ePrescribing company. Since about 2004 they have been extremely focused on the ePrescribing area and that shows in the fact that DrFirst is the “ePrescribing Inside” 230 EHR companies. That’s a really impressive number and includes a client list with such names as GE and Greenway.

DrFirst is ready to make a shift which they’ll be talking about at HIMSS in Las Vegas. What I think makes DrFirst’s ePrescribing platform really interesting is that they can provide it using the DrFirst interface or an EHR vendor can customize it to their liking using a series of API calls. It takes a unique company and a unique set of skills to be able to do this effectively. Now imagine they provide these same functions and features across a whole array of EHR related products and services. By doing so, DrFirst becomes a really interesting EHR Platform.

You can find DrFirst at HIMSS to get the entire list of the products and services that they’ll be offering to EHR software vendors beyond just ePrescribing. However, I was really intrigued when they talked about their EHR platform providing compliance programs, patient education, and even co-pay discounts which help with medication compliance. I wouldn’t say that any of these things on their own are all that interesting. They are however things that a small EHR vendor wouldn’t have the time or the resources to be able to execute properly. For those EHR vendors who use the DrFirst interface, they can be turned on with the flip of an online switch.

Now just imagine a whole suite of other EHR services that DrFirst could provide EHR vendors as well. It becomes a really interesting value proposition. Plus, DrFirst also has a number of interesting solutions in the hospital market that also leverages this platform. Things like medication history for hospitals and a lab platform.

At the end of the day, EHR vendors are going to decide if this is a value added service or not. Many larger EHR vendors are going to develop a number of these features themselves and that should be expected. I just see it as a really healthy thing to have these type of EHR platform services available. Many EHR vendors have been so swamped with meaningful use and EHR certification, it’s great that a third party integration could continue to add real value to an EHR software.

The real challenge for DrFirst is going to be around how well they integrate these new EHR service offerings into the various EHR software vendors. If the integration is clean and adds value, they’re going to do very well. If it’s kludgy (a software term for messy) and doesn’t integrate well, then we won’t see much adoption. I think their current 230 EHR integrations are one sign that it will go smooth, but we’ll see.

My next question to consider is how DrFirst could extend their platform next. I can think of a number of mobile health companies that could benefit from the right connection to prescription data or to doctors. I’ll be pressing them at HIMSS to find out what’s next. I hope you will too and come back and share what you find out.

On a side note, I just got the list of things DrFirst is doing at their HIMSS 12 booth. It’s extensive and will be a can’t miss booth. Watch for the details in my upcoming HIMSS 12 exhibitor post.

Full Disclosure: DrFirst is an advertiser on EMRandHIPAA.com.

GE Centricity Advance Ceasing Operations

Posted on January 26, 2012 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.

Yesterday I had the opportunity to talk with the people from GE who briefed me that GE is in the process of shutting down their GE Centricity Advance product line. This was pretty big news to me since I remember just last year at HIMSS meeting with GE and hearing that for the small practice (I believe 1-10 docs) GE Centricity Advance was where they were putting all their effort. You could see the energy they had behind it. In fact, their iPad EHR app was built on top of the GE Centricity Advance solution (which is now being moved to their other EHR product lines).

You might remember that the GE Centricity Advance solution was actually created out of the purchase of MedPlexus in March 2010. At the time, MedPlexus had 100 employees out of California with the development team out of India. At the time of purchase it seemed GE’s acquisition would provide a SaaS based EHR option to the independent physician market. Plus, MedPlexus (which became GE Centricity Advance) also provided an integrated Practice Management System with the EHR.

The GE Centricity Advance website is already forwarding to the Centricity Practice Solution website and a letter was sent out to all Centricity Advance customers informing them that the product line was ceasing operation. I’ve asked for a copy of that letter and if I get it, I’ll add it to this post (or if you’re a customer that received it and doesn’t mind sharing we’d welcome it).

I was told that GE is offering Centricty Advance users a free transfer to their Centricity Practice Solution EHR software. From what they told me it seems this will include data migration, training on the new system and a license for Centricity Practice Solution. Of course, Centricity Advance was paid on a subscription model so they’ll have to continue paying the monthly fee. As with most data migrations, I don’t think we’ll know how good GE is at migrating the data from GE Centricity Advance to Centricity Practice Solution until they start to do them.

Since both Centricity Advance and Centricity Practice Solution have ONC-ATCB complete EHR certification, there shouldn’t be any problems for those that transfer to Centricity Practice Solution when it comes to EHR stimulus money. Those not wanting to move to the Centricity Practice Solution will have this as part of their decision on what to do once Centricity Advance is no longer supported. I expect there will be many in this situation since while Centricity Practice Solution is available through GE’s partners as a “SaaS” offering, I think many will want to find a true from the ground up web based SaaS EHR offering.

I asked how many providers would be effected by the end of the Centricity Advance product line, but it’s GE’s policy to not comment on those numbers.

Where does this leave GE Centricity EMR software?
GE Healthcare IT still does a couple billion dollars of business and still has three EMR software offerings:
*Centricity Practice Solution – The replacement for Centricity Advance and will be GE’s EMR offering for the 1-100 provider practices.
*Centricity EMR – Still ambulatory EMR, but for the 100+ provider practices.
*Centricity Enterprise – Acute care EMR

I’m sure that many will wonder how good the Centricity Practice Solution will do in the small practice arena. Will this basically mean that GE is no longer a player in the small 1-10 provider practices? It’s hard to say for sure, but I’ll be interested to see how the Centricity Practice Solution EHR does in this market. There must have been a reason they purchased what became Centricity Advance instead of going with Centricity Practice Solution in the first place.

On the other hand, I could see people making the argument that this is a sound strategy by GE since movements like accountable care organizations (ACO’s) and related initiatives are putting the small practice in jeopardy. We know that many hospital systems are purchasing up group practices as they prepare to become an ACO among other reasons. While we still have many small group practices, it’s worth considering how many of them will survive the changing landscape. If not many survive, then this strategy by GE could end well for them. Although, I personally believe that practice consolidation is cyclical and so I’m not ready to announce the death of small group practices yet.

Another trend that might make this a good decision on GE’s part is what I call the Smart EHR. Our current phase of EHR adoption is basically converting paper to electronic. Once doctors start requiring EHR software to do things far more advanced (see Artificial Intelligence and Genomics EHR), it will require a new kind of EHR. Maybe Centricity Advance wasn’t prepared to make this shift. We’ll see if GE’s other EHR software is ready for it.

Many have argued that EHR consolidation is inevitable. I guess I shouldn’t be surprised that part of that EHR consolidation is happening within the same EHR company. I’m sure there are more on the way as we see which EHR companies survive the meaningful use winter and come out on the other side and which EHR companies close up shop.

Update: I asked GE for some more clarification on when GE Centricity Advance would be sunset and which data they’ll be migrating as part of the data migration process. Here are their answers:
Sunset Period: We have announced that we will cease operations of Centricity Advance on June 30, 2012. The data will be available in read-only mode until December 31, 2012.

Data Migration: We are working with our partners and customers to figure out the best way to migrate data. We have told customers that we will migrate the following data:
a. Patient Demographics, Patient Insurance data, Fee Schedules, Appointments
b. Patient Summary
c. Patient chart
We will migrate all clinical data. We are working with our partners to determine which financial information should be automatically migrated.

The New Healthcare Team: GE & Microsoft

Posted on December 13, 2011 I Written By

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

Editor’s Note: The following is a guest post by Jeremy Bikman. You can read more about the GE and Microsoft Venture on EMR and EHR.


Guest Post: Jeremy Bikman is Chairman at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

Healthcare is being held hostage and it doesn’t even know it.

It is held hostage by burdensome regulations, by archaic practices, and (oddly enough) by technology itself. In this age of Facebook, Twitter, and LinkedIn, an age where anybody with internet access can connect to somebody else on the other side of the globe and share personal information and other data with the click of a mouse, it is impossible that you could visit a hospital in the next town over and they would be able to procure your personal health information as easily or as quickly.

Healthcare, globally and locally, is utterly huge and mind-blowingly complex, and thus absolutely needs the very best innovation of everybody involved. Yet, healthcare technology companies almost universally deliver products which are built on closed-minded concepts. They lock down their platforms, creating real barriers to interoperability, patient data exchange, and actual innovation. This is the present reality within, and across, practically every hospital on earth. The recently announced joint venture between GE and Microsoft offers hope of an alternate reality, one where hospitals can bring together data streams from all over the enterprise, while utilizing new innovations and technology as they see fit, including different best-of-breed sources.

Giving Hospitals a New Choice
There are huge flaws in how technology is delivered in healthcare today, flaws which impact quality of care within a hospital and across the entire industry irrespective of country or region. While the rest of the tech world is moving towards open platforms and collaborative delivery models, healthcare seems to be stuck in the dark ages of single-source solutions which compel all-or-nothing investments to the tune of millions and millions of dollars. Too often those investments fail. But, the more important question is why must hospitals be forced into all-or-nothing decisions in the first place? Why must they choose between integration and functionality, between a single platform, however mediocre, and a best-of-breed mix? We believe those are questions of the antiquated past and that brave new innovation can deliver a new avenue for hospitals who refuse to be painted into a corner. Hospitals shouldn’t have to choose between apples and oranges. They want, and should be able to get, both.

The Basics of the Joint Venture
Selected product lines from both companies’ health groups will be part of the new company. These products were chosen for their specific focus on “empowering connected patient-centric care.”

GE is contributing an interoperable clinical data model and decision support system via Qualibria. GE’s eHealth is an HIE solution in use at a large number of sites in North America. Microsoft is bringing Amalga to the table, which is a data aggregation platform which facilitates interoperability and a host of other advanced capabilities. Vergence and expreSSO come through Microsoft’s acquisition of Sentillion and provide strong context management and single sign-on solutions. The strategy appears to be one of leveraging Microsoft’s platform technology (Amalga) to underpin GE’s clinical depth (Qualibria, eHealth). Additionally, this model will allow hospitals and vendors to integrate best-of-breed 3rd party products into the ecosystem as they see fit. This mix of products and capabilities will enable a true best-of-breed environment emerge while still having the core elements of integration as well. This ecosystem will be powered by the partnership’s own applications and those built by ISVs. No other major vendor offers this unique model and set of abilities, although Allscripts is the one traditional EMR vendor that is building a strategy of accepting of 3rd party solutions.

Tackling the Big Problems

No one is saying that this joint venture is guaranteed to be a resounding success. However, we applaud the visionary model and risks this new team is taking. It looks like they want to address all the big hairy obstacles that every provider organization, region, and nation is facing. Big data? Absolutely. Enterprise analytics and business intelligence? Yes. Clinical decision support? For sure. Population management? You bet. Nobody else in the industry has shown they can tackle these issues even though every hospital is clamoring for this type of model. So why not this joint venture between GE and Microsoft? We say good luck, and more power to them.

The principals of KATALUS Advisors have worked with hundreds of healthcare organizations, vendors, and other consulting firms across the globe. The opinions expressed here are our own and are not intended to promote any specific vendor and do not reflect those of any other organization or individual.

Software User Interface Redesign

Posted on December 8, 2011 I Written By

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

Today I opened up a web browser and eventually made it to Twitter to see what was going on. I was greeted by the not so friendly Twitter site redesign. If you’re on the Twitter page at all, you won’t miss it. To be honest, it felt like going to a foreign land. I use a number of tools for Twitter, but my favorite is just going to the Twitter website to consume and send my @techguy tweets. Although, maybe I should say it WAS my favorite place.

Yes, change is always hard, but isn’t that kind of the point? Was there any announcement about the change before it happened? Nope! Did they give users a chance to try the new interface before they made a wholesale swap to the new interface? Nope. Google’s actually done this really well recently with things like Gmail. They’ve made the new interface available, but you can always click back to the old interface if you don’t like. That way they can solicit feedback and improve the new interface while still not alienating those that love the old interface.

In my example on Twitter, I quickly was able to identify the thing that annoys me most. When I click on someone’s Twitter name it gives me a pop up box for that person. Before it use to have that appear on the side. It’s a small subtle change, but makes a huge difference since on the side I can continue consuming tweets, but in a pop up box I have to remove it before I continue on.

I could go on about the new Twitter, but the point is that software vendors have to be careful when they change the user interface. Maybe this new Twitter interface will even grow on me. I didn’t like the last time they changed the Twitter interface either, but once I found some of the secret features I came around for the most part. Maybe I’ll come around on this too, but it would have been nice if I knew it was coming.

What does this have to do with EMR?

The connection seems quite clear to me. EMR and EHR companies have to be really careful and considerate when they change their EHR interface. Give users options to be able to try it and to adapt to it over time. With a sort of limited opt in release of a new EMR interface to an active user base, you’ll likely get a lot of pointed feedback for the new EMR interface. Certainly you’ll get the useless “I hate the new look” emails without any value. However, you’ll also get the pointed emails that provide constructive ideas on things you probably didn’t realize were important in the old EMR interface.

Most SaaS EHR companies are constantly considering this since they’re rolling out changes to their software all the time. Client server based EHR software also takes it into account, but this can be shown and taught as each client is upgraded.

The main point is to be thoughtful of and upgrade to your EHR user interface. Get feedback and whenever possible let them opt in and out of the new interface so you don’t alienate your users.

While I may not be totally enamored by the new Twitter interface, I do always love new features in software. For example, as part of the new Twitter interface there’s a feature that lets you embed tweets. Here’s a few EMR related tweets to see how it works.


And then some big news from GE and Microsoft that just came out:

Hmmm…still looks like they have some work to complete on their embedded tweets (UPDATE: The preview looked different from when it’s posted. It’s not too bad in the actual post). Sounds like many doctors talking about EHR features that get rolled out.

Meaningful Use Attestation Issues for EHR Companies

Posted on October 26, 2011 I Written By

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

Many of you have probably read about the problems that GE Centricity EHR software had with a few of the meaningful use guidelines. If you haven’t read about it, go and check out that link to read Priya Ramachandran’s post about what happened. Plus, you can read a GE representative’s additional comments and clarifications. I actually had the chance to talk with GE in person at MGMA about these issues. While there’s no doubt that GE is taking heat for these problems (and they should), I personally believe it just highlights a bunch of possible problems with meaningful use attestation and raises a lot of unanswered questions.

My first premise is this, “If a large EHR vendor that’s intimately involved in the meaningful use rule creation process can mess up some of the meaningful use guidelines, how many other EHR vendors are going to do the same?”

This is a serious issue. Imagine you’re using an EHR software that runs into this problem. How quickly will that EHR vendor respond? Will they even know that they have an issue with meaningful use attestation before it’s too late? At least GE caught it early and can now address the issue for all of their doctors that are affected and get their EHR stimulus money. Even if they don’t get it resolved this year (which wouldn’t be a good outcome), then they do have next year which pays the same amount of money.

I’m not sure the same outcome will occur for some doctor who instead of proactively realizing a meaningful use attestation mistake gets “caught” with some mistake in some sort of meaningful use attestation audit. I guess we’ll see how those play out, but I imagine it won’t be as pleasant for MU attestation issues to be caught in an audit.

Plus, I think there’s very little doubt that there are other EHR companies which haven’t implemented the meaningful use attestation requirements quite right. I’m sure it’s just a matter of time before we hear of more issues. In fact, I have a feeling that EHR vendors that are reading this post are ready to forward it to their meaningful use expert/development staff to evaluate if they’re at risk for such a problem. The answer is that many EHR vendors likely are at risk. I imagine part of the risk is due to laziness in implementing the meaningful use guidelines (I guess they haven’t been reading our Meaningful Use Monday series), but the other part is that it’s not like meaningful use is that simple. It’s not quite the tax code, but it’s not always that straightforward.

This incident does bring up a whole new set of questions for CMS to answer. For example, what happens if a doctor attests to meaningful use and then realizes that for some reason (their fault, their EHR vendor’s fault or some other situation) they actually didn’t meet the meaningful use guidelines as required? Do they need to show another 90 days of meaningful use? Do they need to return their EHR stimulus check? Will CMS take the money back out of future payments? Can a physician go back and fix any mistakes that were made (this will likely depend on what went wrong)?

I’ll be keeping an eye on this discussion and we’ll do our best to post what GE and others learn from CMS when it comes to mistakes in meaningful use attestation. I have a feeling this could get a little messy. Based on my own experience with CMS in the past, I have a feeling they’re going to be as lenient as they possibly can be. However, they’re still going to have to follow whatever legal guidelines they’ve been given.

One other question that still makes me wonder is why didn’t the CCHIT EHR certification catch this mistake too? This would obviously require a pretty good dive into the EHR certification guidelines and the implementation of these guidelines. To me it highlights how little value the EHR certification process adds to the EHR market.

I have a feeling that this post has people like Dr. West enjoying their Meaningful Use Freedom even more.

HIMSS11 EMR Company and EMR Market Wrap Up

Posted on February 25, 2011 I Written By

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

It’s going to take a couple weeks to really process all that I saw and heard at HIMSS 2011. In fact, there’s no doubt that much of the content I publish over the next month or two will be things I learned from the people I learned from at HIMSS or influenced by what I saw and heard. However, after a good night’s sleep in my own bed I’m really happy with my experience at HIMSS. The energy and passion for healthcare IT that was found at HIMSS was really powerful and wonderful to be apart of.

I think those people out there that are asking if we’re in a healthcare IT bubble right now are on the mark. There’s very little doubt in my mind that we’re in a healthcare IT bubble. It’s a feature of $36+ billion in EHR incentive money being given out by the government. I can’t remember the size of the EMR market numbers off the top of my head, but $36 billion in money coming into what is a relatively small market is going to change things dramatically. So, it makes sense that this type of infusion of money would create a bubble of sorts.

One person in their comments that we’re in a healthcare IT bubble asked if the bubble would pop before HIMSS 12 in Las Vegas. I believe we have at least one or two more years before the healthcare IT bubble pops. In fact, if you thought that HIMSS 11 in Orlando was big, I predict that HIMSS 2012 in Las Vegas will be even bigger. The EHR incentive money will have started flowing and the trench battles will be in full swing as the 300+ EMR vendors battle each other for customers.

EMR software was obviously my focus at the conference and despite my comments about the lack of innovation by EMR vendors and the future of EMR, I think there are a ton of really interesting EMR approaches that in aggregate are going to impact the EMR world in really dramatic ways. Here’s some examples:

  • Azzly described a meeting of EHR vendors they attended with ONC. The question was asked which EHR vendors in the room started development after the HITECH act was announced. Azzly was the only one to raise their hand. I’m sure there’s other EHR vendors in that same boat, but it will be interesting to see an Azzly EHR that was built post incentive go up against the legacy EHR software.
  • ClearPractice was the first native iPad EMR (called Nimble) that I’d seen and there’s no doubt they’ve made a big play in that space. Will that combined with the backing of John Doerr and their internet driven sales change EMR as we know it?
  • Will larger companies like Greenway and Sage continue to gain market share as they go after the EMR market while maintaining their customer experience? Or will they head the way of the Misys of the world and be bought up by other EMR vendors?
  • What about NaviNet‘s entrance into the EMR world? Can they leverage their existing connections with so many providers to be a major player in not just interoperability but in EMR as well?
  • Even the big behemoth of a company, GE surprised me when I visited with them. There was a polish and a professionalism that I loved about my visit with GE and GE’s Centricity Advance people. I think there’s a fair comparison with Microsoft. Something about the nature of the US loves the underdog and hates the big name player. Yet, the big company just keeps executing their vision and many doctors are going to happily buy and use their products.
  • What about Ingenix‘s multiple EMR offering strategy? Will it just be confusing to clinicians or will they effectively differentiate their various offerings while providing a backbone for interoperability as well? Is the future large EMR vendor one that aggregates a bunch of niche specific EMR companies?
  • What impact will the transcription based EMR vendors have on the market? I wrote about the change from transcription company to EMR vendor earlier this week. Watch for the names MD-IT, FutureNet, Intivia, and MxSecure.
  • Many people probably don’t recognize the name MedPlus. However, everyone knows the company behind the MedPlus Care360 EMR: Quest Diagnostics. There’s something powerful about being able to turn on an EMR in a medical practice with basically the flip of an electronic switch. That’s what MedPlus can do since Care360 is already being used in so many clinics that use Quest for their lab work. Add in their existing lab sales staff that already have relationships with large numbers of clinics and they’re going to be a very interesting player in the EMR space.
  • Free EMR is a really compelling marketing tool. There’s a reason that Practice Fusion and Mitochon Systems free EMR offerings get so much press and so many doctors evaluating their EMR offerings. While many might disagree with their model or even believe that it will fail, these companies have and will have an interesting impact on the EMR landscape.
  • MicroMD offers an interesting approach. First, because of their existing LONG term practice management clients. Second, because of the interesting integration with the supply side of their company. Not to mention, the executives that I met with were some of the most realistic people and well thought out people I met at HIMSS.
  • Props to EMR company MIE that could use a fake EMR company (Extormity) to launch themselves into the EMR discussion while also helping to open up the discussion as well.  If I were a doctor, I’d want to demo their EMR just so I could see if I could find any Extormity features in their EMR.  Although, maybe that’s just the blogger in me.

I could keep going on, but that gives you a bit of flavor of some interesting EMR vendors and their market approaches. Plus, this is just 16 of the 300+ EMR companies that are working in this space. Each one with their own interesting story.

The most exciting thing for an EMR nerd like myself is that we’re really only at the beginning. Wait until we get beyond 15-25% adoption and reach 50% adoption. Then, the fun really begins.

Full Disclosure: Practice Fusion, MD-IT, MxSecure, and Mitochon Systems are all advertisers on this site. EMRandHIPAA.com’s HIMSS11 coverage was also sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.