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.

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.

Need marketplace to reward good design & doc reimbursement for social@jacthong @AtlasMD How to close gap between EMR & consumer tech? #hcsm

— borborygmi (@nickgenes) December5, 2011

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

G.E.-Microsoft Venture to Create ‘Windows’ for Health Care. #ehr #emrnyti.ms/u8ttTu

— Andrew Herman Heller (@andrewhheller) December8, 2011

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.

One of the really interesting things I noted while attending the NextGen user group meeting had to do with the move to SaaS based EHR and other SaaS based EHR software. I partially mentioned this in the write up I did at the conference, including a tweet where I talk about how Scott Decker really pushed the idea of NextGen making the move into the SaaS based software world.

I think there’s little doubt that NextGen sees the value of SaaS based software. I think they see the convenience to doctors of not having to manage a server. Most importantly, I think they see the value of not having the healthcare data stored in EHR in silos.

One thing that Scott Decker mentioned in his keynote was improving their coding rules engine based on the feedback and experience across all of their SaaS based EHR users. I found this really intriguing since it highlighted some of the challenges and limitations of the client server EHR model that’s so prevalent in healthcare.

After hearing these comments about NextGen’s move towards more and more SaaS based software, I wondered what users at the meeting thought about the move by NextGen to SaaS EHR. The nice part of a user group meeting is I had a chance to talk to a number of them.

One company I talked to said basically, “We have 30 Citrix servers in our NextGen EHR installation. That’s a huge investment we’ve made and I don’t see us changing that any time soon.” They’ve got an interesting point. There’s a lot of money invested in training, equipment, software, and general understanding of the current client server EHR installs that NextGen employs (or is it employed?) for its large EHR customers.

It’s quite a stark contrast to consider this entrenched client server user base that is unlikely to change even if NextGen’s direction is headed towards SaaS EHR software. To be completely honest, I’m not exactly sure how this “conflict” is going to play out.

Yesterday, I created a post on EMR & EHR called The Must Have EMR Feature – An iPad Interface. that post has driven quite a bit of discussion on Twitter and Google Plus. One comment from @2charlie hit me the most though:

2charlie – Charlie Gaddy
A decent web interface wouldn’t hurt either. RT @ehrandhit: The Must Have EMR Feature – An iPad Interface dlvr.it/tYkN7

Charlie’s twitter response highlights a number of interesting ideas. The first point that every SaaS EHR company will point out is that he said a web interface. We could go into the semantics of what is “the web”, but I have little doubt that Charlie meant a browser based interface when he said web. I’ll leave the rest of the discussion of “web” EMR interfaces for another post (plus, we’ve had that discussion many times on this site).

Instead, I want to focus on his use of the word “decent.” That adjective is interesting because no one would really argue that there aren’t plenty of web EMR interfaces out there. If you look at the EHR Scope EMR Comparison site, you’ll see a huge number of web based EMR companies listed. However, when you add the word “decent” to web EMR interface, I think we could have some really interesting discussion.

At least a couple times a week I get a doctor sending me an email or posting a comment on my website saying that “all of the EMR interfaces are terrible.” I don’t necessarily agree that “all” EMR interfaces are terrible, but a lot of them do fit the description quite well. I’m sure at this point all the EMR companies are thinking about their competitors and agreeing with me.

The iPad Opportunity for EMR Interfaces
As I thought on Charlie’s comment of a “decent web interface” as compared with an iPad EMR interface, I realized that the iPad provides a unique opportunity for EMR vendors with less than stellar web interfaces. While it would be great for EMR vendors to create stellar web interfaces or improve their current web interfaces, that’s much easier said than done. Many are working on older technologies. Others have so much company culture built into their interface that it’s hard to change. Many have large user bases that will freak out at the idea of a new web interface. Etc etc etc! The point being that the culture and history of many EMR interfaces make it hard to change.

In these cases, I see the iPad as a great opportunity to start fresh with your EMR interface. Many EHR vendors could use the iPad as a way to be able to create a new interface for their EMR with all the knowledge they’ve learned over the years baked in. Doctors expect the iPad interface to be different and unique.

I’ll be interested to see which EMR companies take this opportunity and make something of it. It’s the perfect chance for EMR companies to create a paradigm shift in their EMR software without having to admit publicly the mistakes they made in their first EMR interface. Unless you happen to be from an EHR company who built the perfect EMR interface from the start. Then, this need not apply.

Time to touch on a few popular topics that I found being discussed on Twitter. First, I’ll put the tweets and then a little but of my own commentary on these hot button issues in healthcare IT.

@GovHIT
Does a nationwide #EHR lower healthcare costs? Social media reactions | #GovHIT Blog http://ow.ly/64DL1

I always love when people talk about a nationwide EHR. I actually think that it’s a bad title by Government Healthcare IT, but that it’s a very good question. To me a nationwide EHR implies that there is one EHR for the entire nation. I think a number of other countries which are much smaller and less complex than the US have proven quite well that a nationwide government run EHR is a bad idea. I think the Government HIT article actually refers more to widespread adoption of EHR. To that, I’m obviously amenable and can’t wait for that day. Although, we still have a very long way to go.

@ekivemark – Mark Scrimshire
Should Health Care Move to the Cloud – Absolutely (but carefully)! #EHR #HIT 2.healthca.mp/oMMtNA

Might as well cover the cloud in healthcare issue if we’re talking about hot topics in healthcare. Little by little, I’m really seeing the shift to “the cloud” when it comes to EMR and EHR software. There are certainly still instances where the cloud based EHR doesn’t make sense. We also can’t start counting the days to the death of the client server based EHR software. In fact, non-cloud based EHR software is going to be around for a LONG LONG time to come. There’s far too many millions of dollars invested in these systems. However, I still do sense a shift from in house servers to cloud based EHR solutions.

I do appreciate the comment in the tweet about moving to the cloud…”Carefully!”

In my post about the common EHR implementation problem of EHR slowness, I mentioned that I’d follow up with a post on how you can avoid the EMR slowness issue altogether. It’s better to avoid than fix problems.

The best way to approach EHR performance issues is to make them part of your EHR selection process. EHR performance issues could and should be a deal breaker for you when you’re evaluating EHR companies. How then can you identify EHR software that might have these performance issues?

Red Flag #1 – EHR Demo Slowness – Bring a red pen to your demo and every time they say something like, “It’s not usually this slow?” or “It must be slow because it’s running on my laptop.” make a BIG RED mark on your paper (or tablet if you’re advanced like that). Even one red mark should be cause for concern and investigation.

Certainly there are situations where environmental issues can cause slowness to an EHR. So, you can’t completely rule them out completely for this, but this is their demo. This is there one time to shine. If they can’t get their EHR demo running at full speed, what makes you think an EHR production environment will be much better?

You can make an extra red mark if it’s a SaaS EHR that’s providing the demo. They might say it’s just “the internet connection.” Well, guess what? Soon, that’s going to be you using that EHR and often on similar internet connections.

Of course, the message to EHR vendors is to make sure your demo runs as fast as your production system.

Red Flag #2 – Site Visit Slowness – While the demo can tell you a lot about an EHR software, it can’t necessarily tell you the speed of the EHR software. Just because the EHR is fast during the EHR demo, doesn’t mean that same EHR software will be fast in a production environment. Add this to the multitude of reasons why a site visit to a current user of that EHR is so important.

Make sure to do that site visit at one comparable in size and users to your clinic. You don’t want to look at the EHR responsiveness of a solo practice if you’re going to be a 6 provider multi clinic setup. Size matters when it comes to EHR speed.

Once on site, you can get an idea of the speed and responsiveness of the EHR software in two ways. First, observe the users of the EHR in the clinic. See if they exhibit any of the systems listed in the first section of this post. Another observation is to see how quickly they’re clicking around the EHR. If you see a lot of clicks in a row with little waiting in between clicks, that’s a great thing. If you see them click, wait, click, wait, click, click , wait. Be afraid.

The second way is to ask the EHR users. The problem with doing this is that only one response has value. If they say the EHR is slow, then you’ve gleaned some important information that’s worth checking on. If they say the EHR is fast, then you don’t necessarily know. The problem is that you don’t know what the user considers fast. What’s their frame of reference for saying it’s fast? Do they know what fast is? Have they just been using the EHR software so long that they’ve hit a rhythm that makes it feel faster than it really is? It’s a good sign if they say that it’s fast, but take it with a grain of salt.

Red Flag #3 – Use A Demo EHR System Yourself – Most EHR vendors will provide you a way to demo the product yourself. This isn’t a fool proof method to test EHR slowness, but it’s another decent test of the EHR’s responsiveness. Try it out using your internet connection and your computer hardware. Nothing like first hand experience documenting some patient visits to learn about the speed of an EHR.

EHR Speed Suggestion – Don’t Skimp on Hardware
Far too often I see a clinic skimp on the hardware requirements and regret it later. In fact, they often end up spending the money twice since they have to buy new hardware since they skimped in the beginning.

Of course, this suggestion can be taken too far as well. The computer and laptop manufacturers will try to sell you the whole kitchen and you might only need the stove and refrigerator. To put it in more practical terms, you’re going to want plenty of RAM, but do you really need the webcam, Blu-ray player, and special 100 in 1 media device?

Just because an EHR vendor says their EHR software can work on a certain hardware configuration doesn’t mean it should be used on that hardware configuration. In the middle there’s a spot between can and overkill that’s called optimal. Find that hardware configuration and you’ll be a much happier EHR user.

Conclusion
Don’t accept an EHR that’s slow. Make sure that the EHR performs at a satisfactory level. I know of nothing that frustrates a clinic more than a slow EHR.

We’re back again with our ongoing series on Common EMR Implementation Issues. Seems like readers really liked my first entry in the series about Unexpected EHR Expenses. To be quite honest, I was really happy with how that post turned out myself. It’s one of the most comprehensive and useful posts I’ve written in the 5.5+ years I’ve been writing about EMR and EHR. Hopefully we can continue that trend.

Today’s Common EMR Implementation Problem: EHR Performance Issues

I have to admit that this is a really tough problem to crack. However, it’s also incredibly common. The symptoms for this problem usually are described as, “THIS EHR IS SOOOOOO SLOW!” (This is appropriate use of ALL CAPS since they are often yelling this.) Followed by a *huff* and an angry doctor or nurse leaving their computer in a fit of rage. Other symptoms might include drumming fingers on the desk while staring blankly at the screen, lots of mouse clicks that get progressively longer and more emphatic, or the sitting back in your chair staring at the screen hoping that something will happen.

Once you’ve identified that there’s a problem with EHR slowness, then begins the fun and exciting (that was written in the sarcasm font) journey to identify the real issue. The biggest challenge with identifying the slowness is that there are a multitude of places that could be the bottleneck that’s causing your slowness. Some of which you can fix, and others you have to rely on your EHR vendor to fix.

To assist you in the ugly process of improving EHR performance issues, here’s a list of possible reasons you could have a slow EHR.

EHR Slowness You’re Responsible For
Slow Computers and/or Laptops – I’ve heard of a few EHR vendors offering free iPad’s with their EHR, but for the most part, you’re responsible for buying the computers and laptops for your EHR implementation. See my “EHR Speed Suggestion – Don’t Skimp on Hardware” below for more info on buying the right hardware. Needless to say, I’ve seen many slow computers be replaced and the EHR went a lot faster.

Slow Local Internet – Your local internet (or LAN as it’s often referred) could be the cause of your EHR slowness. I could have split this point into a half dozen possible issues. Some of them might include: Bad network card, bad cabling, bad switch, bad router, bad routing configuration, bad DNS configuration, overwhelmed network, etc etc.

Of course, in most cases you’ll probably have to call your IT service provider to solve these issues. They should be able to easily test most of the above issues and prove that it works for other internet applications and so it must be some other issue causing your EHR slowness.

Slow ISP (external internet connection) – If you’re using an in house EHR server, you won’t have to worry about this as much (except for interfaces, or EHR updates). If you’re using a SaaS EHR, then this could be a major bottleneck. Good thing is that it’s easy to test your ISP speed. If you’re speed is great to other sites, but not your EHR then you can move on to another issue. If you’re speed is bad for all sites on the internet, you need to see if your ISP can make some changes to provide the speed you’ve purchases from them. Otherwise, you might just need a bigger ISP connection than you have and you’ll be able to get your EHR running much faster.

Also, be sure you don’t have employees using up all your bandwidth downloading illegal (or legal) music or videos. That can eat up your bandwidth really quickly. There’s a reason Netflix uses up 20% of bandwidth on the internet. Movie downloads/watching might be using up your internet connection as well.

Memory on Server – I see this issue most often when a clinic tries to re-provision an old server for their new EHR or when they don’t follow the suggested specs of their EHR vendor. It can also happen when you start your EHR with 1 doctor and then grow your practice to 5 doctors. More users usually requires more memory on the server. There are good tools on servers for analyzing how much memory is being used so you’ll know if this is the problem or not.

Hard Disk Space on Server – This definitely shouldn’t happen in a fresh EHR install, but often can happen over time. Servers don’t like to run out of hard disk space and can do all sorts of crazy and unexpected things if they do. Other things that cause a hard disk to run out space might be backups or large log files. I’ve also seen where the IT administrator takes a 500 GB hard drive and divides it into multiple partitions. One partition for the O/S and one partition for the data. Often they misjudge how much to give to one partition versus the other. So, the one partition runs out of space while the other one has TONS of space left.

Good planning and regular maintenance will avoid these issues.

CPU on Server – I believe this is pretty rare these days since memory is usually the bottleneck instead of CPU. However, if the EHR software isn’t written correctly, this could be an issue. Particularly on older boxes.

Complex Workstation Setup – Your IT service provider might have told you all the great benefits of a thin client setup or some sort of virtualized desktop software solution. When done right, these solutions can work fantastic and save you a LOT of money. When done wrong, they can cause you all sorts of slowness and heartache.

EHR Slowness Your EHR Vendor Must Fix
Slow Server Configuration – There are lots of ways to tweak a server to go faster with less resources. Unfortunately, most of these tweaks are likely going to have to come from your EHR vendor. In a larger hospital implementation, you might be able to work with your EHR vendor to implement some of these tweaks. In a small clinic, you’re basically at the mercy of your EHR vendor to configure the server to run fast.

Slow Server (SaaS EHR) – Yes, SaaS EHR vendor servers can go slow too. The good thing is that your EHR vendor likely has monitoring tools that are watching for any slowness so they can proactively fix it. The problem is that then you’re at their mercy to fix the slowness. Needless to say, an EHR vendor’s server support staff rarely feel the end user pain of EHR slowness. At least the pain isn’t nearly as poignant.

Of course, a chorus of calls from EHR users to the EHR support line will help them understand better and fix the slowness. One call about your in house server doesn’t resonate quite as loud.

Slow or Overwhelmed Data Center Connection – Data Center internet connections are generally quite robust and built with a lot of redundancy. However, since data centers usually host many many different systems, they can also get overwhelmed. Sometimes through spikes of traffic, but more often through other nefarious attacks on the systems in the data center. Often, it’s not even your EHR software that’s causing the issue, but it might suffer the consequence. Not very common, but possible.

A little more common could be an EHR vendor that’s growing so rapidly that they can’t keep up with the demand for their EHR software. Other times the EHR vendor just did a poor job planning to expand their EHR data center services.

Poor EHR Code – Not all code is created equal. Some programmers are good at creating code that will execute quickly, but most are not. Fixing speed issues aren’t trivial. Particularly if you have a large code base that’s been created over a long period of time.

Poor EHR Design – The design of an EHR software often determines how fast it work. Designing for speed from the beginning is crucial. Otherwise, a poorly structured EHR can almost never be made fast.

Related to this is EHR software built on old technology. To use a car analogy, you can only make a pinto go so fast without gutting the engine. Too many EHR vendors are built on engines that can only go so fast. They can keep squeezing a bit more speed out of the engine, but eventually you have no other speed benefits because of the legacy technology limitations.

I’m sure there are other possible bottlenecks. Let me know of any I missed in the comments and I’ll add them to the list.

EHR Performance Finger Pointing
Another big problem with the complex list above is that it often leads to a bunch of finger pointing. Yes, sometimes it will feel like you’re back in Kindergarten again. Your EHR vendor will point the finger at your IT setup. Your IT service provider will point the finger at the EHR vendor. Then, the EHR vendor will point the finger at the hardware vendor. You’ll never be able to talk to a person at the hardware vendor and so you’ll have to use other tricks to prove it’s not them.

Needless to say the finger pointing can get really tiring really quick. Not to mention it can be very expensive as you spend money proving to your EHR vendor that it really is their problem and not your setup.

I’ll follow up this post with another on how to avoid EHR Performance Issues during the EHR selection process. I’ll link to that post once it’s up.

Side Note: This post was much longer than expected. I guess I did have a lot to say about this issue.

What happened in the M&A arena had interesting ramifications, but what didn’t happen might be equally significant: The overcrowded electronic health records market didn’t consolidate.

Well over 200 EHR vendors are fighting for meaningful use business. How crowded is the field? As of mid-April, the federal government lists 393 Complete or Modular certified ambulatory EHR products, along with 182 certified inpatient Complete or Modular products.

There were several good reasons for the non-event, but consolidation’s got to come soon, says Rob Tholemeier, senior research analyst at Crosstree Capital Partners, a Tampa-based corporate financial advisory firm. “There has never in the history of software been 200-plus companies selling similar functionality,” he notes. “Less than a dozen-maybe a dozen at most-will survive.” -Source

I always find these reports on the EHR market fascinating. I’ve done some analyst work for a few companies that are looking at the EhR market. I should probably do more since it’s pretty fun to be able to provide investors a view at what I see happening in the EMR and EHR market.

I agree with the above statement that it’s been a little bit surprising that we haven’t seen more consolidation in the EHR market. I think we can all agree that there are far too many EHR vendors out there right now. I’m all about competition, but this many competitors makes it really hard for the clinician to choose an EHR. Certainly this is going to change.

The above linked article suggests that most of the EHR consolidation would be through attrition instead of acquisition. I don’t totally agree with this theory. There will be a nice mix of both. Although, I believe that acquisition of EHR vendors will actually be more common than EMR vendors shutting down the business.

Plus, while we will see some consolidation, I totally disagree with the above quoted articles assertion that the EHR market will consolidate down to “a dozen at most” EHR vendors. I’ll be surprised if we get down to 100 different EHR vendors. The SaaS EHR vendor business model just doesn’t need that many doctors using their system to work. Unlike many other industries, I think that there’s a whole set of very conservative EHR vendors who can run their business very well with a small subset of providers.

Of course these EHR vendors are always looking to grow, but I see many of these companies ready for the long EHR grind. They’ve been very conservative in their approaches and can last a very long time with their current EHR user base. Many aren’t even trained in the thinking of how to exit the business. They’re entrenched and ready for a long battle. So, while we’ll see some consolidation of the EHR industry, don’t believe these analysts that are predicting a massive consolidation to a handful of companies.

While some might consider the following commentary an ad for Quest Diagnostic’s Care360 EHR, it’s not. I don’t even have them as an advertiser. Plus, you could easily submit a number of other companies name in the place of Quest. However, the following were some thoughts I had after talking with the people behind Care360 EHR at Quest.

First, let me clarify some name issues so we’re all on the same page. Quest Diagnostics is the company. It’s publicly traded on the NYSE with the ticker DGX. Most of you will know about Quest since they’re one of the leading lab companies in the US. MedPlus is the subsidiary within Quest that covers the healthcare IT portion of the company including their EMR software. Care360 is the name of their SaaS EHR software which they sell. Although, Care360 is also used to provide lab results amongst other functions as well.

Now why am I talking about Care360 and Quest? I find it completely fascinating that a company like Quest is part of the EHR landscape. Certainly we have plenty of large and even many publicly traded companies that already provide an EHR, but I see some potential differences between Quest and many of these companies.

One of the biggest fears that doctors have when selecting an EHR company is that they’re afraid of how long that company will be around. Even in the cases of very large companies, there’s still the fear that the large EHR company might get bought out or merged into another company and the EHR software will be left on life support (see Misys being bought by Allscripts for an example). This is a reasonable fear that should be considered during the EMR selection process.

I believe that Quest and Care360 EHR has a distinct advantage in this regard. Quest is not likely to go out of business or even sell off their EHR software to another company. In fact, their Care360 EHR is so tightly coupled with the rest of Quest’s lab services, I’m not sure it would even be possible for Quest to sell off their EHR software if they wanted to do it.

That’s not to say that something couldn’t happen to Care360 that would make Quest change their direction. They could essentially “sell” their users to another EHR vendor through some sort of referral process or they could just choose to shutdown that division of the company because it wasn’t profitable. However, you can be quite sure that they’ll be interested in the transition process. At least if you’re a Quest lab customer. They’re not going to want to lose lab customers because they decided to stop doing EHR.

This is only one factor related to selection of an EMR (see my free EMR selection e-Book for more). There should be some discussion related to how tied you are to Quest if you use their EHR. For example, I can’t remember if Care360 has an interface with LabCorp or not. You might even ask yourself if a Lab company can make great EHR software. They also don’t have a practice management system, but said they’d consider creating one in the future.

It’s like most things in life. There’s pros and cons to everything. You could certainly argue some of the other benefits of going with Quest and Care360 EHR. For example, Quest’s been doing the SaaS based model with their Care360 lab results for a while on a very large scale. They have some expertise in that regard which they can carry over into their EHR product.

Now the question I’m interested in finding out is, what is Labcorp’s approach to EHR?

My last post on EMR companies holding practice data for ransom was very popular and had some very interesting discussion in the comments. Honestly, every EMR vendor should be considering the impact of the choice to not liberate the data in the EMR.

No, I’m not talking about being loose with the data. HIPAA will come back to bite you if you do that. Plus, no doctor will want to use your system. What I’m talking about is making the data in the EMR available to the doctor. In fact, if your a doctor or practice manager reading this post, you should make this a requirement of the EMR vendor you select. If you already have an EMR vendor, you should work to have them incorporate this feature in their EMR ASAP.

Lest you think that I’m just being pro doctor and not considering the EMR vendor, let me provide you some business reasons why an EMR vendor would want to create a plan to make the data in their EMR available to their doctor in a liberated format.

As one EMR vendor put it:

Bottom line, its a good business practice to provide the data in an accessible manner to the client when and if he/she wishes to move on to another EHR.

Let me add the following:

If you don’t hold the EMR data ransom then you will have a better image in the community.

1. If someone wants to leave and you make it hard, word will travel that you held them ransom and others will be afraid to choose you because they know they’ll be locked in. We all know how tight the medical community is.

2. If you free the data, users will trust you more cause they know they can leave at any time. Plus, they see you’re doing what’s best for the customer. This narrow minded focus on the customer’s needs will certainly carry over into other areas of your application and lead to happy customers who can leave, but won’t have any reason to leave.

3. SaaS EHR vendors in particular should offer this service. One of doctors biggest complaints about SaaS EHR is their fear that their EMR data isn’t stored in their office. What easier way to allay this fear than to provide them a regular copy of their data?

Do NOT underestimate the power of your image with the customer. It leads to happy long term customers, but also leads to future customers. I saw a recent study (which I can’t find right now), but it was amazing to see the amount of influence that other colleagues EMR recommendations made on a doctor’s EMR selection decision. Providing doctors their EMR data which may lose you a few customers along the way, but it will retain and find more customers than you lose.