Likewise, says Allscripts’ Tullman, “today we’re building the operating system for the future of healthcare. This country can’t afford its healthcare system anymore, so something’s got to change. We can no longer buy our way out of the problem.” – Source: Information Week

The above comments sparks all sorts of interesting thoughts and questions for me. The first is “What is the Operating System of healthcare IT?” Obviously, we’re quite sure Tullman hopes that it’s the suite of Allscripts products. Although, how ironic is it that one company can have 5-10 (I lost count) different EMR software. I’ve never known an operating system to have 5-10 completely different software. Seems like something needs to change there. Unless you want to say that various segments of healthcare IT are going to have different operating systems.

I do feel like EHR software is the operating system of healthcare IT. It’s going to be the basis upon which many other software packages are built on.

I imagine the above statement is probably why Tullman made the comment and the comparison. Allscripts has an ambitious project (although I haven’t seen many results yet) to create a kind of app eco system for healthcare IT apps. There are other vendors that do the same. For example, I know that SRSsoft has open API’s that allow developers to extend their apps. I love this movement in the EMR world. My biggest challenge is identifying the application developers that are interested and willing to leverage these APIs. That part of the app ecosystem seems to be missing to me.

My next thought is that similar to how we didn’t realize how beneficial an application like Excel would be until we had the operating system that facilitated its creation. Who is going to create an Excel like app that can run on the EMR operating system and provide benefits to claims processing, clinical decision support, diagnosis help, insurance billing, etc etc etc. Certainly it’s possible that the O/S (EMR) developers will make a lot of these applications, but I won’t be surprised if the EMR is just the platform that allows other smart people to innovate on a particular subject.

In my time writing about EMR, one thing has been very clear. You can’t be all things to all people. An EMR vendor that embraces, supports and creates a strong healthcare IT application developer community would cause me to take notice above the noise.

I finally had a few moments to watch the Matthew Holt interview of Glen Tullman, Allscripts CEO at HIMSS. Allscripts is no doubt a large player in the EHR industry (like it or not). This is especially true after Allscripts acquisition of Misys. So, Glen Tullman will have a large effect on the EHR industry so it’s worth listening to hear what he has to say. I’ll include a few quick comments of my own below the video.

Overall a pretty low key video. There were a few things that are worth commenting on.

The first thing that hit me was that Glen Tullman thought that the controversy over CCHIT was that CCHIT certified over 300 EHR vendors. Glen makes the argument that government wants a smaller footprint of EHR vendors and that 300 was too many. I guess I can kind of see why government might not want to certify 300 EHR providers since doctors just don’t have time to look through that many. However, it was the first I’d heard of that CCHIT controversy.

What does make a lot of sense is why the CEO of one of the largest EHR vendors would want the certified EHR vendor list to be a really small list that includes them. So, it would make sense for him to lobby the government to keep the list small.

I’m glad that Matthew Holt brought up at least another reason that CCHIT as the EHR certification is a problem. How about you just start with the controversy that CCHIT certification doesn’t provide benefit to doctors. Solve that one and we can find a way to deal with any other CCHIT controversies.

Of course, at the end Glen Tullman also said “CCHIT has done it [EHR certification] very effectively.” Effectively? Seriously? Can he provide me some data on how effective it is? It might be effective for his organization’s interests. So, maybe that’s what he meant.

Glen Tullman did make a great comment about SAAS EHR versus client server EHR. He basically said that most users don’t know the technology behind SAAS EHR and client server EHR. Glen suggested that most users just know the financing model of the two EHR options. A very fine point. I’d just add that they know the financing part AND the IT support part of the equation (ie. SAAS EHR means you [the EHR vendor] do the IT. Great!) Glen does seem to understand how to sell an EHR product to his customers.

There you go, there’s my quick comments. What can I say? I type fast.

I recently found an interesting post about AllScripts market share after the acquisition of Misys last year.

Based on recent research, Allscripts is estimated to own about 21% of market share for the practice management system space. Further, of the 18% or so of medical providers who have adopted electronic health records, Allscripts has around 17% of that market.

17% of the EHR market is pretty huge. Congratulations AllScripts. I previously posted a really cool viral EHR video by AllScripts. I really like things like this that AllScripts is doing. It’s nice that a technology company is using technology to encourage EHR adoption.

I have been a little soured towards AllScripts after I posted about AllScripts CEO being a HIT advisor to Obama. I just can’t comprehend how an EHR vendor can think that’s not a conflict of interest. I don’t know how Obama can’t understand what that looks like from the outside looking in.

Today I got on the AllScripts conference call to hear AllScripts take on HITECH. I won’t post all my thoughts on the experience (too many to list here), but myself (@techguy) and John Moore (also check out John’s blog) were both twittering during the call and the following are some of the tweets we made as we listened to the Allscripts CEO address HITECH and CCHIT:

@techguy tweeted: AllScripts: [HITECH] Huge win for EHR industry…I agree that the EHR vendors are going to profit greatly from this $18 billion

@john_chilmark tweeted: Tullman now giving High Praise to CCHIT – logical, in his interests, not necessarily the mkt. CCHIT cert doesn’t equate to data liquidity

@techguy tweeted: @john_chilmark You like how he said that CCHIT would probably be the certification criteria. Of course AllScripts wants that to happen.

@john_chilmark tweeted: AllScripts now stating that CCHIT cert will help winnowing out the mkt – Yes, leaving mostly legacy stuff behind

@techguy tweeted: Man, the AllScripts discussion on CCHIT is just killing me. Full of misinformation about CCHIT EHR certification benefits.

@john_chilmark tweeted: @techguy CCHIT/AllScripts conv driving me nuts as well, loads of mis-information

@john_chilmark tweeted: AllScripts: Nutty, not like docs won’t use tech if there is a true value in adoption- to date, EMR vendors have not demonstrated such value

@john_chilmark tweeted: AllScripts claims that $$$ is now available is disingenuous. True, prob need to make decision soon to demonstrate meaningful use of EMR

@john_chilmark tweeted: With so many questions left unanswered, eg, what is certified, what is meaningful, will wise docs sit back and wait to see? Could stall mkt

In a recent Wall Street Journal article on electronic medical records, they talk about Allscripts’ CEO’s take on the governments planned $20 billion investment in EMR.  Here’s a portion of the article:

Glen Tullman, chief executive of the health IT outfit Allscripts-Misys Healthcare and an advisor to the Obama campaign on health information technology issues, argues that that any legislation should first help doctors buy and install electronic medical records, then give them financial incentives to actually use them in a way that could reduce waste and improve care. “That one-two punch would dramatically change the adoption rate for physicians,” he said in an interview with the Health Blog.

I’ve talked about Obama EMR many times before on this blog and over the next 6 months I expect I’ll talk about it a lot more.  This could be the most significant change in health care IT that we’ve ever seen.

However, it should scare all of us that Obama’s health information technology advisor is the CEO of Allscripts-Misys Healthcare any EMR vendor.  I know Obama’s from Chicago, but could this be a more blatant conflict of interest?  Why not call in the tobacco companies to see if they think that smoking will help improve the condition of America.  I’m pretty sure I know there answer.  Why would an EMR company be any different?

Even more interesting is this quote from the same Wall Street Journal article on EMR:

He[Glen Tullman] points to the success of a similar incentive program, courtesy of Medicare, to get more doctors to use electronic prescriptions — Allscripts’ other big business besides electronic health records. 

I just wanted to thank Glen Tullman for pointing out that not only does he have a huge conflict of interest in regards to EMR adoption, but he’s also had success influencing other Medicare legislation for which he would be even more biased (Allscripts being the most widely used e-prescribing software).  This sure doesn’t sound like the CHANGE that Obama’s been talking about.  Sounds like business as usual to me.

I can understand why Obama would want to talk to some of the main EMR vendors out there.  It would be interesting and insightful to hear their biased point of view.  However, I’m talking about a discussion with these EMR vendors.  I’m not talking about having them as an advisor to Obama.  Are there really no unbiased consultants that can inform Obama on the challenges of EMR implementation?  There has to be something better.

I just think that Obama and the US governemnt don’t have anyone telling him the true realities associated with EMR implementations.  Nothing proves this more than the idea that the government will probably use CCHIT certified EMR as a criteria for who will get some of the $20 billion allocated to healthcare in the economic stimulus package.

The crazy part is I feel like I shouldn’t blame Obama for these decisions.  I hope and think that he’s trying to make the best decisions he possibly can with the limited information he’s receiving on the subject.  Does anyone have Obama’s blackberry number?  I’d like to send him a short message with my thoughts on his proposed investment in EMR.

Thinking along those lines, I think I might send a tweet to John Culberson, Congressman from Texas.  Talk about someone who’s really trying to listen to the people and have an open dialog about subjects.  I’ll let you know how that goes and if he even cares about electronic medical records.