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Watch for EMR Company Consolidation but Not EMR Software Consolidation

Posted on December 21, 2010 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 regularly talked about my belief that there isn’t just one major EMR market. Instead, I firmly believe that there are a number of EMR markets that are divided by clinic size, medical specialty, and possibly even location. In fact, there’s likely even other factors. There are just far too many EHR companies for this to not be the case.

I think this was also well illustrated in this blog post on Kevin MD about the “Perfect EMR Traits.” Here’s the perfect EMR trait #1:

Perfect EMR Trait #1: The ideal medical record would be tailored to the specific needs of a clinician, only exposing them to portions of the record which are relevant to their work.

Knowledge within healthcare is rapidly changing. Possibly more so than another other industry. Techniques which were considered state-of-the-art, can change in a matter of weeks. The electronic medical record has the potential to be the tool which disseminates those changes down to the clinician, through point-of-care decision support. EMR software should facilitate the clinician decision making, rather than requiring clinicians to keep track of the latest and greatest. This individualistic attitude creates discrepancies in care, which inherently leads to imprecise care.

While it is certainly technically feasible for an EMR vendor to be able to create software that satisfies Perfect EMR Trait #1, it’s just not practically feasible for an EMR vendor to satisfy every clinic size, medical specialty, and in many cases locale. This means that we’re going to see a wide variety of EMR software that satisfies the various EMR market needs.

With this as a preface, consolidation of EMR companies is going to become a very very real thing. However, I’d caution EMR companies that choose to just directly sunset an EMR software acquisition. In some cases, this is a reasonable solution based upon the EMR company’s existing EMR software. Plus, in many cases EMR vendors will be acquiring the EMR market share for their existing EMR software. I’m sure we’ll see more of this.

My recommendation for EMR vendors acquiring EMR software, is to be more selective in the types of EMR software that you acquire. It’s definitely worth considering the idea of sustaining the EMR software development of multiple EMR products. Is it really that hard to see a large EMR company that has an ED EMR software, a General Medicine EMR software, an OB/GYN EMR software, a Pediatric EMR software, etc etc etc.

An EMR vendor making a decision to act in this manner will require them to change how they look at EMR acquisitions. The EMR acquisition targets will dramatically change. Instead of looking for failing EMR companies where they can cheaply buy more EMR market share, EMR companies with this approach should be focusing on a quality EMR software that hasn’t yet achieved the EMR market share that they deserve.

The cool part about the strategy of maintaining multiple EMR software instead of the strategy of sunsetting one or the other is that you purchase a bunch of happy EMR users instead of alienating a whole mass of EMR users that’s software is no longer supported. Of course, this will require proper communication of your goals and objectives so that current EMR users see the benefit of the acquisition and aren’t left wondering what the acquisition means to them. I’m not just talking about standard PR spin. I mean real tangible communication and interaction which demonstrates your plans for the acquired EMR going forward.

An EMR company with this method of EMR software acquisition, also needs a different set of skills. After sunsetting an acquired EMR, you need to have a strong set of integration and transition services to make the change to your EMR as smooth as possible. You also require a unique sales force that can sell the transition to your EMR over a transition to an altogether new EMR software. None of these services are needed if you continue to maintain the acquired EMR. Instead, your company must focus on other redundant services like marketing that could be leveraged across companies.

Of course, this isn’t an easy task to do well. Acquisitions rarely are an easy process. However, I think this is a lesson that was recently learned by Google as well. There’s value after an acquisition to keep autonomous business units. In fact, doing so opens up a whole new set of acquisition targets in a less competitive environment.

If I were a board member at an EMR company, this is the type of stuff I’d be considering. Certainly not every EMR vendor is 1. in a position to do these things and 2. has the culture to make it happen. However, I predict that the EMR company of the future will be a conglomerate of multiple specialty specific EMR software and not just a one size fits all atrocity.

Different Methods to Become a Top EMR Company

Posted on December 20, 2010 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.

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.

EHR Interoperability and the Transcontinental Railroad

Posted on April 7, 2009 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 recently read a nice article comparing EHR interoperability to the Transcontinental Railroad. They hit the key point when they said, “Just as standardizing the railroad gauge created a uniform distance between tracks so that track the came from the East and West would fit together, health care IT standards will create a seamless and interoperable IT infrastructure that will benefit the entire nation.”

I find the comparison incredibly intriguing and thought provoking.

The only problem I have with the comparison is that the transcontinental railroad was merging essentially 2 standards (east and west) and standardizing the gauge was the only standard needed. In health care IT we have far more stakeholders in the game and far more standards that need to be established (allergies, labs, RX, diagnosis, just to start).

This doesn’t diminish the value of the comparison since it’s often valuable to see a complicated challenge in a simplified way. I’m just saying that creating a standard in HIT is going to be much more difficult.

Reasons Health Care IT Can’t Spend $20 Billion

Posted on January 31, 2009 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 think it’s reasonable to consider some of the reasons why health care IT won’t be able or willing to have $20 billion of government money invested in health care IT.

Not Enough Healthcare IT Professionals – It’s been widely suggested that the number of health care IT professionals might not be sufficient to support this type of invesment in health care IT.  I hope my fellow IT professionals from every field can easily make the transition to health care IT.  Certainly many will without a problem.  However, the question remains if enough will be able to do so.

Other Reasons Not to Adopt EMR – I’m certain that a study on why doctors haven’t implemented an EMR yet would not show money as the main factor preventing adoption of EMR.  There are many other reasons a doctor chooses not to implement EMR and money isn’t going to resolve those concerns.

CCHIT Requirement – Of course, this assumes that the government chooses to make CCHIT a requirement for receiving funds.  Doing so will limit the choices a doctor has in selecting an EMR.  I think it’s very likely that many doctors will forgoe government funding in order to use a non CCHIT EMR.  This could be especially true for specialists who would rather select a non CCHIT certified EMR that focuses on their specialties needs.

Paperwork Required – The government won’t just be going around handing people checks.  We’ll have to wait and see how much paperwork and reporting will be required to obtain these government funds, but many doctors will shun the paperwork and beuracracy associated with receiving the government funds.

EMR Vendor Selection Process – With over 400 EMR companies to choose from, it will take doctors some time to decide which EMR they like best.  Even if you narrow the list of EMR companies to CCHIT certified companies, you’re still looking at a lengthy evaluation process.  Most doctors want to practice medicine not learn about software.  So, evaluating EMR software often gets pushed down on their list of things to do.

We’ve all seen or heard it said that it’s harder to spend $20 billion than you would think.  This couldn’t be more true when it comes to investment in health care IT and electronic medical records.  Let me know in the comments if there were any other reasons I might have missed on why the spending in health care IT might not occur.

Do We Know What Obama’s Health Plan Is?

Posted on January 22, 2009 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 been writing quite a bit lately about Obama’s investment in EMR and healthcare IT. I find the topic completely fascinating and so I expect I’ll be writing a lot more about Obama and EMR/EHR. Hopefully I can not just talk about it, but add something to the conversation.

Related to all of this is a headline I recently read from The American Spectator that said “Obamacare Could Kill You.” While the headline is meant to attract attention, the first paragraph in the article made a lot of sense. Here’s a small portion of it:

It is probable, therefore, that many people who believe they voted merely for what the Obama-Biden campaign site calls “affordable and accessible” health care will be unpleasantly surprised by the “reform” they are about to get.

It is pretty amazing that Obama could put forth such an ideal with so little detail work on how he was going to make healthcare affordable and accessible. If like the article implies that Tom Daschle is looking at adding in more government bureaucracy to healthcare, then our healthcare system is in real trouble. It reminds me a lot of another headline I read that basically said “To see Government run health care, then Just Take a Look at Medicare.” Can you imagine?

Obama Wants Full EHR by 2014

Posted on January 14, 2009 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.

Obama has held very strong on his commitment of $10 billion a year for 5 years in health care. Obama’s set the audacious goal of full digital health records by 2014. The question is if it’s even possible to invest that much money in health care IT in such a short period and will we be able to reach the goal of full EHR by 2014.

A recent CNN Money article pointed out some important problems with investing so much in health care IT. The biggest of these is finding enough qualified IT professionals that can navigate the complex health care IT systems. There really is a lack of qualified health care IT professionals. Some jobs I’ve seen listed for EMR professionals have gone unfilled for months just because they couldn’t find qualified candidates.

Many reports are also suggesting hundreds of thousands of jobs will be created by this investment in health care IT. This of course would be true if you had enough people to fill those jobs. It’s hard enough for an IT professional to move into health care IT. It will take a lot more training for a blue collar worker to try and implement an electronic medical record.

Certainly it’s not impossible for someone to learn from scratch. I know, because I did it myself. However, it is literally like learning to talk a different language. It takes a lot of work and training and a unique person who can balance the IT needs, the health care requirements, with the business requirements.

I also think that it’s sad to say that $50 billion might be enough to achieve the goal of interoperable EHR by 2014. A look at a small Massachusetts Example gives a good measure of what it will actually cost:

Massachusetts has developed a plan to fully computerize records at its 14,000 physicians’ offices by 2012 and its 63 hospitals by 2014. After a pilot program, the state legislature estimates it will cost about $340 million to build the statewide computer system, with a cost of about $2 million per hospital.

“[Obama’s] timeframe is very ambitious, but there is a need to be able to track data on patients and talk across providers and health care systems,” said Dr. JudyAnn Bigby, Secretary of Health and Human Services for Massachusetts. “The program will allow for greater patient safety.”

Despite being less than what might be needed, it certainly would give it a good start that could build into the future.

I’m still planning on writing a few words about whether I think the investment is worthwhile or not. However, I think it’s important to have as much of an understanding as possible at the goals Obama has proposed for investment in IT for health care.

Health Care IT Spending to Grow in 2009

Posted on January 13, 2009 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.

Sitting here amidst this deep recession (some might say edging on depression) I think most people would be surprised to hear the report I read today that health care IT spending was expected to grow in 2009. Here’s an excerpt from the article and a link to the original study:

IT spending will grow for several reasons, including plans by the incoming Obama Administration to fund health IT; consumer demands to control healthcare costs; providers’ desire to use IT to improve efficiency and increase margins; and payers turning to IT to help manage their costs and better track whether providers are meeting wellness goals.

HII predicts that in particular, healthcare organizations will invest in business intelligence software, whose uptake will grow rapidly through 2011 as a means of improving health outcomes. HII also predicts that new products will emerge for use in remote patient monitoring. Still another trend anticipated by HII is that IT outsourcing will to grow

The craziest part of this is that it’s the second such report that health care IT spending will be growing despite the widespread slowdown of investment in IT. Here’s the first such report and an excerpt:

While global IT spending is expected to contract through next year, the healthcare IT sector should grow, according to new data from research firm Datamonitor. IT budgets should shrink in 2009, partially because of the down economy, but also due to increasingly cautious budget moves by IT administrators over the past few years.

Let’s hope that spending increases if Obama does invest $50 billion in health care IT. Plus, it’s hard to decrease the level of investment in health care IT. We’ve needed more cash in health care IT for quite a while.

Obama’s Investment in EMR, EHR and Health Care IT

Posted on January 12, 2009 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 been hearing a lot about Obama’s plans to invest in health care as part of his economic recovery plan. Here’s a few snippets of things I’ve read. Once I have a few free minutes, I’ll try to take a few minutes to provide my thoughts on Obama’s plans to invest in health care IT and EHR/EMR software.

First, take a look at an excerpt of Obama’s technology agenda from his website change.gov:

Lower Health Care Costs by Investing in Electronic Information Technology Systems: Use health information technology to lower the cost of health care. Invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.

I originally saw the above listed as “Obama to invest $50 Billion in Electronic Health Records” and it’s interesting to see the same thing quoted just a little bit different at the Health Informatics Blog. $50 billion is a lot of EHR software.

Next, the Washington Post wrote that Obama and Daschle is looking for feedback on the health care system:

“In order for us to reform our health care system, we must first begin reforming how government communicates with the American people,” Obama said in a statement yesterday. “These Health Care Community Discussions are a great way for the American people to have a direct say in our health reform efforts.”

As part of this, you can go and share your thoughts on health care in the US with Obama and his health care team on Change.gov. It will be interesting to see what happens with the information posted to that site. I’m not sure exactly how we’ll know if what we’re saying is heard or not. However, the idea that ti might be heard is great to think about.

Discharge Summaries by Email from an EMR

Posted on March 21, 2008 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.

Think about how wonderful the ability to send a discharge summary by email to a patient straight from your EMR. I think it’s pretty easy to see the tremendous benefits of this type of communication. Send the patient information to one place they probably visit every day and where they can read and process the information away from the hustle and bustle of the clinic. Certainly many doctors have been doing this with little pamphlets or handout sheets with clinical information. Unfortunately, too many of these sheets never get read. Certainly that same thing could happen with an email, but at least the next generation of patients are going to want this information in their email box.

Of course, the problem with sending this information in an email is that email is not secure. Email encryption hasn’t taken hold fast enough to make it encrypted. Is a user’s email box really a secure location where they want their health information? I personally don’t have a problem with it, but I would expect that many people wouldn’t want their health information in their email any more than their regular mailbox. Either way, without the encryption it wouldn’t be difficult for someone to sniff out what’s being sent in an Email containing for example a patient’s discharge. It would be going across the internet in basically plain text.

This situation actually happened in Austrailia a little while back in an article I read called “Unsecured email sparks dispute.” I know I wouldn’t be happy if a clinic just decided to send these unsecured emails. Not so much because I was personally worried about my information being lost. I personally have nothing to hide (yet anyway). However, I would feel uncomfortable patronizing an organization that would deal so flippantly with my information.

I’m sure that someone will chime in that this is the whole purpose of a Patient Portal or EHR interface that allows people a secure method to receive and send protected health information. This is all well and good, but from what I’ve seen this usually requires the doctor’s EMR company to support this type of interaction. Plus, even more serious of an issue is that you’re giving your patients one more login and password that they’ll need to remember. Certainly not a deal breaker, but one more inconvenience for our users and the staff that have to support our users when they forget their password. Unfortunately, I think that this is the future of secured messaging, but I can always hope that there’s something better that we’re just missing.

We should also realize that this isn’t going to get any easier. In fact, I think we can reasonably say that this is going to get harder and harder. Don’t be surprised if soon some patient would like their health information somehow incorporated into some site like Facebook. It’s really only a matter of time until some developer creates a health interface into Facebook.

It might not make sense to most people, but the next generation of patients are going to grow up living and breathing their online life in some sort of social network (Facebook is just one example of these). They are very comfortable with transparency and will be interested in being able to track and compare health information with other people. Not to mention interact in a social network with other people who have similar conditions. It seems like this isn’t a question of if, but when this type of interaction will happen.

Even if you think that health information on a social network like Facebook is far fetched, we are already seeing health information propagating to the web in Microsoft’s HealthVault and Google Health. Is this going to be ok? Will it become as synonymous as online banking has become to the banking world? It’s not that far of a stretch to think that Google Health could easily be tied into Google’s OpenSocial platform which would allow a patient’s health information to do all sorts of cool things.

The convergence of Health Care and IT is going to be really interesting. It’s taken health care a while to get going with IT, but I think almost everyone agrees that IT could do amazing things to better the health care a person receives.