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EHR Vendor as ACO

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When I was doing my interview with Dr. Jonathan Bertman and John Mooney about the Pri-Med acquisition of Amazing Charts, Jonathan Bertman made a really interesting comment that stuck with me. I asked him how he thought that Amazing Charts would do in this world of hospitals acquiring medical practices. He said that they were evaluated the environment, but then he suggested something that I’d never heard suggested before.

He said that he was considering the idea of whether Amazing Charts could act as an ACO for its members. You could tell that this was an idea that hadn’t been fleshed out completely. Although, I found it a concept that was really interesting to consider. Could an EHR vendor act as an ACO for the doctors that use their EHR?

The key question to me is really whether an EHR vendor has enough adoption of their EHR in a given area to be able to create an ACO. I imagine an EHR vendor like MEDENT that has only focused on selling their EHR in about 5 states could have enough geographically focused EHR adoption to be able to support the ACO model.

I’ve heard a number of small practice doctors call their colleagues to action when it comes to ACOs. Their call usually includes a reminder to the days of HMO’s when they claimed that doctors weren’t part of the conversation and that they can’t let the same thing happen with ACOs. Could an EHR vendor help to bring all these small practices to the ACO bargaining table? Seems like an interesting idea worth exploring to me.

December 18, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Will Windows 8 Kill Physician iPad EHR Requirement?

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Yesterday at the Digital Health Conference I had the chance to catch up with George Cuthbert from Medent. He’d emailed me a few months back about the potential benefit of Windows 8 in the EHR world and the deep integration of Win 8 that they’d been working on to leverage the unique abilities of Windows 8 for their EHR users.

I admit that since I’ve become more of a health IT blogger and less of a techguy, I haven’t kept close track of all that was happening with Windows 8. I knew that it was designed to incorporate touch as a major focal point of the new Operating System and I knew that it was Microsoft’s attempt to integrate the best of touch together with the advantages of data input using a keyboard and mouse.

Based on the short demo that George did for me of Win 8 and the Medent EHR, it has some real promise. In fact, as the title suggests, I think that if an EHR vendor does it right this could solve the issues that so many EHR vendors have of trying to create an iPad EHR application.

This may sound a little outlandish and certainly many doctors have a special love affair with Apple products. However, I think that most doctors don’t care if it’s an iPad or Windows 8. They just want the iPad like touch interface which allows them to smoothly consume data from their EHR. The Fujitsu model that George showed me has the potential to do just that. In fact, it was quite beautiful how seamlessly you could go from the tablet to a laptop workstation and back.

The biggest challenge that most EHR software will have with this idea is that their EHR isn’t built for touch. Just because Windows 8 makes touch possible doesn’t mean that it will be a good experience to use that way. That’s true for iPad as well and is the major reason why Citrix access to your EHR on your iPad isn’t a great solution. Touch requires a very different interface. George and Medent realize this and you could see the thought and effort they’ve been putting in to transform their interface into a touch optimized experience.

Obviously, I think we’ll still see plenty of iPad in healthcare and iPad EHR. However, I have a feeling that many in healthcare will be just as happy with the Windows 8 touch implementation.

October 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use EHR Breakout by Percentage

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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.

June 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

AI (Artificial Intelligence) in EMR Software

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Today I had an interesting conversation with MEDENT. It’s an EHR company that’s in only 8 states. I could actually write a whole post on just their approach to EMR software and the EMR market in general. They take a pretty unique approach to the market. They’ve exercised some restraint in their approach that I haven’t seen from many other EHR vendors. I’ll be interested to see how that plays out for them.

Their market approach aside, I was really intrigued by their approach to dealing with ICD-10. They actually described their approach to ICD-10 similar to how Google handled search. There’s all this information out there (or you could say all these new codes) and so they wanted to build a simple interface that would be able to easily and naturally filter the information (or codes in this case). A unique way of looking at the challenge of so many new ICD-10 codes.

However, that was just the base use case, but didn’t include what I consider applying AI (Artificial Intelligence) to really improve a user interface. The simple example they gave had to do with collecting data from their users about which things they typed and which codes they actually selected. This real time feedback is then added to the algorithm to improve how quickly you can get to the code you’re actually trying to find.

One interesting thing about incorporating this feedback from actual user experiences is that you could even create a customized personal experience in the EMR. In fact, that’s basically what Google has done with search with their search personalization (ie. when you’re logged in it knows your search history and details so it can personalize the search results for you). Although, when you start personalizing, you still have to make sure that the out of box experience is good. Plus, in healthcare you could do some great personalization around specialties as well that could be really beneficial.

I’d heard something similar from NextGen at the user group meeting applied to coding. The idea of tracking user behavior and incorporating those behaviors into the intelligence of the EMR is a fascinating subject to me. I just wonder how many other places in an EMR these same principles can apply.

I see these types of movements as part of the larger move to “Smart EMR Software.”

December 2, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.