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NoMoreClipboard and iMPak Join Forces as PHR Meets ACO and Patient Centered Medical Home

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I’ve long been fascinated by NoMoreClipboard ever since I learned at HIMSS a few years back that Jeff Donnell, President of NoMoreClipboard, was the creative genius behind the always entertaining Extormity EHR parody. So, I guess I should have expected Jeff to continue the trend of creativity in where he’d take PHR vendor NoMoreClipboard in the future.

While many are writing off the PHR after Google Health was shut down, NoMoreClipboard seems to be doubling down (a great reference before HIMSS Las Vegas) on PHR and extending it to capture two healthcare mega trends: patient centered medical homes (PCMH) and accountable care organizations (ACOs).

In an effort to learn more about this move I did the following interview with Jeff Donnell, President of NoMoreClipboard, and Sandra Elliott, Director of Consumer Technology and Service Development at Meridian Health, a not-for-profit health system in New Jersey that helped to create iMPak.

Tell me about what seems to be a shift of NoMoreClipboard from PHR to focus more on the patient centered medical home (PCMH) and facilitating ACOs.

Jeff: Our focus at NoMoreClipboard has always been on providing value to consumers and clinicians – looking for ways to connect patients with providers to facilitate meaningful information exchange, dialog and care coordination. This is not a shift away from PHR. Rather, we are elated that the concept of patient engagement is not only gaining traction, but taking off like a rocket. One of the reasons is the shift toward concepts like PCMH and ACO – where provider organizations have incentives to manage patient populations more carefully. Doing so at scale requires the use of technology to streamline communication, gather and analyze electronic data, and identify those patients who require more aggressive intervention. The PHR can be very valuable as the electronic management and communication tool for patients and their family members. We are adding provider-facing tools to help clinicians manage the patient populations who can benefit most from technology. And the collaboration with iMPak provides patients with easy-to-use, affordable and very powerful medical devices.

ACOs are quite nebulous at this point, so what ACO trends do you think are most promising?

Jeff: While no one is certain what form ACOs will ultimately take, the concept is generating not only interest, but activity. Hospitals, health systems, health plans and employers are making plans, piloting concepts and taking the steps necessary to form or become part of an ACO.

Sandra: The most profound change is the recognition that the care relationship with the patient now extends beyond the hospital doors upon discharge. There is no doubt that more incentives will continue to be placed on reducing readmissions and reducing the overall costs of care no matter what form ACOs will take in the future. The priority of better management of patients once they return home is and will continue to get significant attention.

This new partnership moves NoMoreClipboard into the patient centered medical home.  What do you see as the leading drivers of the medical home?

Jeff: As incentives shift, so must the orientation of the provider community. This is especially true for primary care providers who will assume greater responsibility for managing those with chronic conditions – providing them with a medical home where care plans are developed, deployed and carefully managed. As more hospitals and health systems acquire primary care practices, those practices become more than a source of hospital referrals – they serve as the front line in managing the care of patients who are discharged from the hospital to ensure quality and guideline adherence. This role is not only critical to improving outcomes and reducing cost, it also improves the real and perceived value of PCPs. Technology is no longer a barrier to enabling medical homes at reasonable costs.

You’ve focused on ease of use for patients.  Tell me some ways you’ve made this simple for users.

Jeff: One of the benefits of working with iMPak is their health system connection – Meridian Health in New Jersey is one of the owners. Meridian has experienced how difficult it can be to get certain patient populations to use electronic tools – be it a computer, a smartphone or an electronic medical device. Rather than throw in the towel on collecting electronic data from these patients, iMPak has developed simple devices that require little or no training and are ideal for those patients who say “I will never, ever use a computer.”

Sandra: iMPak health journals are used to collect subjective information using a push button journal – “smart” paper stock with an embedded chip that collects and stores patient responses to condition-specific questions. iMPak is also developing screening devices that are the size of a credit card and collect objective data with minimal patient effort. Both health journals and screening devices use touch and post technology so that when the device is placed on a Near Field Communications (NFC) reader, data is automatically downloaded safely and securely.

There are a lot of different medical home devices on the market.  What differentiates the iMPak product from the competition?

Sandra: The biggest differentiator is the form factor. These devices were designed with the technology-averse in mind. There are millions of people who simply will not use a computer, download an app or place an electronic home monitoring center on their kitchen counter. A significant percentage of these individuals have chronic conditions and can really benefit from sharing electronic data with a health coach or care manager. iMPak has cracked the code for these patients with devices that collect electronic data in a way that is simple, elegant and not at all intimidating.

The other major difference is the time and cost required to develop and deploy these solutions. Unlike complex medical devices that usually take years and millions of dollars to develop, iMPak journals and screening tools can be customized rapidly and affordably.

These differentiators are attracting the attention of organizations interested in partnering with us to develop and deploy purpose-built solutions for a wide variety of use cases ranging from chronic disease management to improving medication therapy.

What are the top 3 benefits someone will glean from using iMPak with NoMoreClipboard?

Sandra: Patients who either lack access to information technology or avoid its use now have an easy, anywhere way to share health information with family members and clinicians who are providing them with care.

Jeff: Family members helping take care of loved ones can now access a complete health picture through a PHR – from the latest in subjective and objective data reported by the patient to a comprehensive health record.

Clinicians, health coaches and other care advocates now have a solution designed to manage patient populations that tend to be difficult to manage – those with serious conditions who are technology averse or lack technology access. Clinical staff can now collect electronic data from these patients, and are provided with up-to-date reporting and alerts that identify those patients who require intervention much earlier.

What’s the biggest barrier to adoption of medical devices in the home?

Jeff: That depends on the home and the people using them. We are focused on homes where the adoption of high-tech, complex medical devices is extremely unlikely for any number of reasons. That does not mean these patients are not candidates for using medical devices. It does mean the devices must be carefully selected to fit the technical capabilities of the target population.

Sandra: Many devices in the home are overwhelming for the great majority of people so they were not being used. iMPak Health has designed its devices in an easy-to-use, intuitive form to overcome some of these intimidation factors

In what ways is a doctor involved in this medical home model?

Sandra: iMPak and NoMoreClipboard are collaborating to provide end-to-end solutions that connect physicians, patients and family members – giving each individual in the care equation a valuable tool to communicate and share information.

The iMPak devices are designed to help patients collect and share electronic health information in a user-friendly form factor. Captured data is then available to patients and their family members via NoMoreClipboard.

Jeff: This same data is also directed to a clinical portal that a doctor, case manager or other care advocate can use to manage a patient population. Collected data populates the portal, giving clinicians a dashboard view of patient status. Data is compared against a rules engine, and alerts identify at-risk patients who require more aggressive intervention.

The doctor seems to be an incredibly important part of medical home models.  What has been doctor’s reaction to this product?  How do you plan to get more doctors to accept this new and evolving model of care?

Jeff: Most physicians we talk to support the use of patient-facing technology, but they are quick to point out how many of their patients are not tech-savvy – senior citizens, rural patients, safety net patients, etc. When we put an iMPak device in the hands of these doctors, their reaction is amazing to watch – you can almost see the light bulbs go on.

As physicians learn that we can provide a complete solution that includes an easy-to-use clinical portal with a rules engine, reporting capability and visible identification of those patients who require additional intervention, we expect interest in this new model of care will grow.

Is it essential that the patient have their medical record in NoMoreClipboard?  What value is gleaned from the data the device provides together with the medical record?

Jeff: The iMPak device data alone is incredibly valuable – subjective and objective data collected from a patient as they experience symptoms or engage in therapy. Adding medications, allergies, conditions, medical history and family history to that data paints a more comprehensive picture. If a clinician can easily see in a combined view what medication form and strength a patient is taking along with the patient’s reported response to that medication, it is that much easier to make rapid and informed clinical decisions.

Do you plan to integrate more devices with NoMoreClipboard?  Will they all be from iMPak or will you work with other medical device manufacturers?

Sandra: NoMoreClipboard and iMPak are working on a complete line of devices, with an initial focus on pulmonary and cardiovascular conditions, as well as health and wellness applications. We are also talking with a number of potential partners about developing purpose-built solutions to support specific use cases. iMPak and NoMoreClipboard also have flexibility to work with other organizations as it makes sense. If a NoMoreClipboard client wants us to integrate with other devices, we can certainly do so. If a hospital system wants to integrate iMPak data with existing healthcare IT applications, they have that freedom.

Currently this product seems focused on the senior population. Do you see this or other related products eventually reaching the wider population?

Sandra: While seniors are a natural fit, any patient population on the wrong side of the digital divide is an ideal candidate for iMPak solutions. This includes underserved populations in urban or rural areas without regular access to technology. These devices are affordable, they are portable, and they are easy to use. We believe these devices can help overcome disparities in care.

This seems like the first step in addressing the patient centered medical home and facilitating ACOs.  Where do you see this going in the next couple years?

Jeff: As we talk to patients with chronic conditions, what keeps them up at night is the difficulty of gathering, organizing and managing all their health information, and making sure that all their doctors have the latest information and are talking with one another about what it means and how to proceed. When we talk to physicians, they describe the challenge of managing transitions in care, gaining access to all the information they know is out there somewhere, and working with patients, families and fellow clinicians to develop a coordinated plan of action.

It is pretty clear that incentives will migrate from fee-for-service to paying for a focus on wellness, prevention, and more thoughtful management of chronic conditions. While the care models (and their labels) that support this will evolve, we believe there will be increased effort to connect patients, family members and clinical teams. Electronic tools will play an important role in fostering dialog, facilitating care coordination and keeping everyone up-to-date based on their role in the care continuum. Significant value can be realized by developing “care networking” tools that combine the power of healthcare IT and social networking on an integrated platform.

John’s Note: NoMoreClipboard, in collaboration with iMPak Health, will launch and demo this new comprehensive solution for achieving a successful medical home or accountable care organization at HIMSS Booth #7902.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

February 14, 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.

HIE, ACOs Are the ‘Fast-Moving Train’ of Health Reform

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Healthcare and health IT are plagued by conundrums. Providers long have been the ones asked to make hefty investments in EMRs and other IT systems to help remove costs from the healthcare system, but payers and plan sponsors tend to enjoy most of the financial benefits. Clinicians wish their organizations would share data with others, but those in the executive suite have been reluctant to cooperate with competitors for fear of losing revenue. And, let’s face it, medical errors can be profitable if a routine procedure turns into an expensive inpatient admission.

Portions of the American Recovery and Reinvestment Act and the Patient Protection and Affordable Care Act are intended to address these problems by providing financial incentives for “meaningful use” of EMRs (including health information exchange) and by encouraging the creation of Accountable Care Organizations

I’m just back from the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla., where I moderated panels on how health IT underpins ACOs and how business intelligence can create a framework for health information exchange.

The panelists did great job of articulating some of these conundrums and strategies to overcome them, but none better than Kevin Maher, director of clinical innovations for Horizon Healthcare Innovations, a new affiliate of Horizon Blue Cross Blue Shield of New Jersey tasked with testing new care models, and Victor Freeman, M.D., quality director in the Health Resources and Services Administration‘s Office of Health IT and Quality.

The patient-centered medical home is a great idea for managing care, promoting prevention and, ultimately reducing costs. “We view the base of the ACO as the patient-centered medical home,” Maher said. But what exactly does an ACO look like? “An ACO is like a unicorn,” Maher said. “We can all describe it, but we’ve never seen one.”

He noted that Horizon has started paying some physicians a care coordination fee to manage populations that potentially could add $60,000 or more to a doctor’s annual income. But there are plenty of factors outside a physicians’ control.

“Potentially the No. 1 focal point of a patient-centered medical home or an ACO is patient behavior,” Maher said. A doctor can’t force a patient to exercise more, quit smoking or get a mammogram or PSA test. There’s pay-for-performance for doctors, but what about paying for patient performance?

In January 2012, Horizon will launch a pilot to offer incentives to members who get recommended tests and choose providers that meet the health plan’s quality standards. That’s right, the Blues plan in New Jersey will pay people to go to the doctor and to make informed choices about which doctors they see. (“Everyone says she’s a great doctor” won’t cut it as an informed choice anymore.)

Freeman called the Horizon experiment “P4P that makes sense.”

Let’s just hope the technology can support making the right choices. “People in government get more involved in quality measurement, not necessarily quality,” Freeman said. Incentive programs these days still tend to be more pay-for-reporting than pay-for-quality, and the technology hasn’t fully matured in that area.

“EMRs were designed for billing, not quality reporting,” noted Freeman, who has a background in public and population health. Information often isn’t stored in discrete form, such as with images generated by specialists flagged as being abnormal, so even with HIE, it’s hard for primary care physicians to identify patients who might be candidates for early interventions before they actually exhibit symptoms of a disease.

“My biggest interest in HIE is how clinicians communicate with each other,” Freeman said.

But is the technology ready to help them do so? “HIE now reminds me of what EMRs were five years ago,” said another panelist, Bruce Metz, Ph.D., newly hired senior VP and CIO at the Lahey Clinic in Massachusetts. It’s viewed as an IT project that’s not necessarily linked to a business or clinical strategy. “You can’t force the technology to mature that fast,” he added.

And so the ride continues on what Metz called “a fast-moving train.” Have we even had time to see if the right people are on board?

May 12, 2011 I Written By

CCHIT Town Halls and CCHIT Comments on New Jersey Bill

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For those that participated in the CCHIT town hall meetings at HIMSS, it seemed like the writing was on the wall that CCHIT needed to offer some more town hall meetings. There was certainly a lot more to discuss. CCHIT just announced 2 more web “conferences” where the public will have a chance to comment on CCHIT.

The first conference, “New Paths to Certification: Dialog with the Open Source Community,” will take place on June 16 at 1 p.m. EDT and focus on technology. It will address outlying concerns on certification of solutions that are licensed under open source models. Leavitt and Dennis Willson, the commission’s technology director, will be the moderators.

The second conference, “New Paths to Certification,” will take place on June 17 at 11 a.m. EDT and be more geared toward a generalized audience, with dicussion focused on new CCHIT programs.

I think it’s good that they’re having another open source EHR session. I’m just not sure why they would have it before the general session. That means that the open source discussion is going to not be as focused since many people will want to discuss the general issues with CCHIT certification during the open source session.

I’ve made my views on open source and CCHIT certification pretty clear. So, it will be interesting to hear what CCHIT could change to avoid some of the problems I’ve suggested. There’s just not the right motivations for open source EMR to certify. I’ll publish more details on these meetings as they become available.

In a different CCHIT issue, CCHIT has made a comment on the New Jersey bill I’ve written about previously. Here’s the part of their comment that really matters:

First, I do not believe this is an appropriate use of health IT certification. Our goal, stated in almost every presentation I’ve given, and to which I’ve adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. Bridges to Excellence provides a role model for integrating health IT into outcome-based, pay for performance incentives. Successfully executed, ARRA might too. But the New Jersey bill is nowhere near that. Making software purchases illegal, like dangerous substances? Let’s “just say no” to that idea.

Second, neither I personally, nor CCHIT as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings.

Kudos to Mark Leavitt and CCHIT for making these comments. Underscores my previous feelings that Mike Leavitt and CCHIT really sincere in his desire to help. It’s just that they’re going about it the wrong way.

June 10, 2009 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.

One EMR Vendor’s Comments on New Jersey CCHIT Bill

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Hopefully my readers aren’t tired of this NJ CCHIT bill. This will probably be my last post on the subject. Any future comments I’ll just update on my original post about the bill or my post on the Financial ties to NJ Bill Outlawying Non CCHIT EHR. I just had an EMR vendor who is based in New Jersey send me an email with the message they sent to Herb Conaway and their request to meet with Herb. I encourage other people to send in their feelings to Herb Conaway on this bill and I’d be happy to publish other people’s messages on this site if you’re interested.

Here’s the email sent from the New Jersey EHR vendor:

Dear Assemblyman Herb Conaway Jr.

I would like to request a small 15 minutes meeting with you on the ASSEMBLY BILL NO.3934 wherein you have suggested to impose the use of Certified EHR from January 1st, 2011.

As part of the bill, New section suggested is “No person or entity, either directly or indirectly, shall sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by the CCHIT.

As used in this section, “health information technology product” means a system, program, application , or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative and financial health information.
Everything is fine with this bill, it is a good initiative except the FINANCIAL PART, CCHIT doesn’t certify any product based on FINANCIAL PARAMETERS, CCHIT strictly certified EHR or EMR based on clinical parameters. That is the reason why half of the CCHIT certified products don’t have PRACTICE MANAGEMENT OR BILLING PROGRAM BUILT INTO THE SYSTEM,

We , Digital Medical Billing Inc (registered under Department of Banking and Finance) are a small billing company using PRACTICE MANAGEMENT program “DigiDMS” to do billing for 32 providers’ offices, in future we shall continue to use the same program, why we would be forced to switch to CCHIT certified product when CCHIT themselves don’t have any criteria for Financial Data Handling as part of certification. On one side President OBAMA is trying to create more jobs, and wrong bill like this can eliminate 50 jobs which our company is offering.

We would like to meet you to discuss this in person with details of CCHIT certified products which don’t have BILLING SYSTEM built into their product.

Vishal
Manager
Digital Medical Billing Inc
www.dmbi.com

Full Disclosure: Digital Medical Billing is an advertiser of DigiDMS on this site.

June 9, 2009 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.

Financial Ties to NJ Bill to Make Non CCHIT EHR Use Illegal

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I previously wrote about a NJ bill to make non CCHIT EHR use illegal. I got an email from one of my readers that I should take a look at the financial ties to this NJ bill to see how that might have influenced its creation.

Turns out that Al Borg was already a few steps ahead of me and did the following research:

Some data on all of this:

About the main sponsor of the bill-

Ok, so once you discount for some of Al’s bravado it’s interesting to see the back history of the sponsor of this bill. Even if you don’t want to make the claim that he doesn’t have financial reasons for creating this bill, you can at least see where he drank the kool-aid.

Al also missed some other sources of campaign contribution for Herb Conaway and the co-sponsor of the bill Chivukula Upendra. I also found this page on the JN legislature site where I think we’ll be able to track the votes for this bill. Looks like it made it through committee (which it looks like Herb Conaway chairs) with a unanimous vote by Herb Conaway Jr., Connie Wagner, Mary Pat Angelini, Anthony Chiappone, Jerry Green, Linda R. Greenstein, Sandra Love, Nancy F. Munoz, Vincent J. Polistina, Joan M. Quigley, and Linda Stender. That’s a lot of people who probably aren’t getting good information on the EHR industry and CCHIT’s effectiveness.

On that note, someone mentioned in the comments of my first post that I should contact the representative from NJ and take a more proactive approach in responding to such a horrible bill. I’m not sure a representative from NJ really cares about what someone from NV might say, but I also think that it’s worth taking a stand on such a bill so that this bill doesn’t cause other states to consider similar bills. So, here’s the page where you can send a message to Herb Conaway, Jr and Upendra J. Chivukula. Should be interesting to see if they reply to a whole bunch of emails on the issue.

What’s even crazier to me is that Herb Conaway is a physician. I guess he hasn’t been practicing with an EHR lately.

June 8, 2009 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.

NJ Bill to Make Non CCHIT EHR Use Illegal

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Graham over at EMRUpdate found a really crazy bill being proposed in New Jersey that would make the use of non CCHIT certified EHR illegal.

Here’s the sections of the bill that seems to capture the crux of what’s being proposed:

“· On or after January 1, 2011, no person or entity is permitted to sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by CCHIT. A person or entity that violates this provision is liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the “Penalty Enforcement Law of 1999,” P.L.1999, c.274 (C.2A:58-10 et seq.).

· The bill defines “health information technology product” to mean a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information.”

” 5. (New section) a. The Director of the Division of Consumer Affairs in the Department of Law and Public Safety, in consultation with the Office for e-HIT in the Department of Banking and Insurance and the Commissioner of Health and Senior Services, shall require that, on or after a date to be determined by the Office for e-HIT and in accordance with requirements established by that office pursuant to and in furtherance of the purposes of subparagraph (a) of paragraph (1) of subsection b. of section 8 of P.L.2007, c.330 (C.17:1D-1), each health care professional who is licensed or otherwise authorized, pursuant to Title 45 or Title 52 of the Revised Statutes, to practice a health care profession that is regulated by a professional and occupational licensing board within the division or by the director, shall purchase, rent, lease, or otherwise acquire for use in that person’s professional practice only those health information technology products that have been certified by the Certification Commission for Healthcare Information Technology.”

I’m really kind of speechless. If you read this blog regularly, you know that’s pretty rare. As Graham points out, why would they want to pre-empt whatever rules ONCHIT puts in place for EHR? I also wonder how they plan on enforcing this act. Plus, what is this senator really thinking? I think that each of these bills should require a full disclosure as to the impacts both good and bad and the reasoning behind even proposing such an idea. Reminds me a lot of the senator who called for an open source EMR, but this is much crazier.

Seriously, what’s the basis for this senator wanting to have it illegal for someone to use any EHR other than a CCHIT certified EHR? I’ve asked many times for some sort of study (independent hopefully) that shows that CCHIT certified EHR have a higher implementation success rate, or improve patient care, or save doctors time or any other benefit over the non CCHIT certified EHR out there. So far no one has produced such a finding. I’d suggest we haven’t found that study since the results of said study would find the opposite.

All I can say is that I’m glad that I don’t live in New Jersey and for their sake I hope this bill fails miserably.

June 6, 2009 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.