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What SaaS EHR Users Can Learn from the Megaupload Takedown

Posted on July 5, 2012 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s time to talk about a subject near and dear to my readers hearts: SaaS EHR. In this article, we’re going to take a serious look at some of the risks associated with the pure SaaS EHR model. I’m sure this will leave many concerned about SaaS EHR software. Before I get into that, I want to be clear that I can (and probably will) make a future post about client server EHR software that will likely leave you just as concerned.

The point isn’t that SaaS EHR or client server EHR is better than the other. I take a much more “switzerland” approach to the topic. I think both approaches to EHR have their risks, challenges, benefits and advantages. To me it’s much more important that users are educated on the risks of each so that they can address them properly.

With that in mind, I was recently reading one of my favorite venture capital bloggers, Brad Feld, who posted a guest post by Dave Jilk about what SaaS software vendors can learn from the Megaupload and its impact on the future of Multi Tenant Services. For those not familiar with the Megaupload situation, the Feds basically took down Megaupload and seized everything they had in response to copyright infringement violations. Wired has an interesting article about the case.

What then can we learn from the Megaupload case that applies to SaaS EHR companies. I think Dave Jilk describes the SaaS risks better than I could:

What this particular case illustrates is that a company that provides your online service is a single point of failure. In other words, simply offering multiple data centers, or replicating data in multiple locations, does not mitigate all the risks, because there are risks that affect entire companies. I have never believed that “availability zones” or other such intra-provider approaches completely mitigate risk, and the infamous Amazon Web Services outage of Spring 2011 demonstrated that quite clearly (i.e., cascading effects crossed their availability zones). The Megaupload situation is an example of a non-technical company-wide effect. Other non-technical company-wide effects might be illiquidity, acquisition by one of your competitors, or changes in strategy that do not include the service you use.

So again, while this is a striking and unfortunate illustration, the risk it poses is not fundamentally new. You need to have an offsite backup of your data and a way to use that backup. The situation where the failure to do this is most prevalent is in multi-tenant, shared-everything SaaS, such as and NetSuite. While these are honorable companies unlikely to be involved in federal data confiscations, they are still subject to all the other risks, including company-wide risks. With these services, off-site backups are awkward at best, and more importantly, there is no software available to which you could restore the backup and run it. In essence, you would have to engage in a data conversion project to move to a new provider, and this could take weeks or more. Can you afford to be without your CRM or ERP system for weeks? By the way, I think there are steps these companies could take to mitigate this risk for you, but they will only do it if they get enough pressure from customers. Alternatively, you could build (or an entrepreneurial company could provide) conversion routines that bring your data up and running in another provider or software system fairly quickly. This would have to be tested in advance.

As many of you know, I’ve been quite interested in this topic and risk for quite a while. I’m sympathetic to those doctors that want at least a copy of their data stored somewhere that they control. Yes, most SaaS EHR vendors have a good set of backup, disaster recovery and business continuity plans. However, as the above quote points out so well, that doesn’t deal with the “non-tecnical company-wide effects.”

I’ve long considered the idea of creating a set of standards that SaaS EHR vendors could adopt. Things like making a practice’s entire EHR data available in an easily downloadable XML format. That could be the starting point. I think it would also create a real competitive advantage to those EHR vendors that adopted these type of common sense, good customer service practices.

I’d even be happy to lead the EHR agnostic team that it would take to make this happen. Client Server EHR software vendors could be involved as well. Not to mention I’d be happy to provide a voice to the movement on my network of EMR websites. I think the key to success would be getting a couple EHR vendors to get on board with the idea and fully invested in seeing this happen. The challenge is that too many EHR vendors are blinded by the meaningful use lights.

Let’s just imagine for a minute that doctors that select an EHR didn’t have to worry about their data being safe. They knew that they could have their data available to them when they needed it where they needed it regardless of what happened to the vendor. I have that with my blog data. Although, instead of that making me wanting to change blogging platforms, it’s endeared me to WordPress even more.

I wonder if Todd Park could add this idea to his concept of EHR Data Liberacion.

My 2012 EMR and Health IT Wish List

Posted on January 3, 2012 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I said in my previous EMR and Health IT in 2012 post, I’m going to create some of my own lists for 2012. I decided to tackle the first one on the list: My 2012 EMR and Health IT Wish List. This was kind of fun to think about. I’m also sure that I’ll come up with other ideas once this is posted, so don’t be surprised if I add things to this list in a future post.

I should also note that I’m not sure any of these things are going to happen in 2012. In fact, I bet that many of them aren’t, but this list isn’t about what is going to happen. This list is about what I wish would happen.

EHR Companies Would Embrace Interoperability – It’s an incredible shame that in 2012 we still don’t have interoperable health records. EHR companies need to get off the stump and make this a reality. The technology is already there and has been there for a while. EHR companies need to start making this dead simple because it’s the right thing to do. Sometimes doing the right thing is more important than the bottom line. Plus, doing the right thing ends up often being the best long term strategy for your bottom line as well.

Start doing what’s right and making your EHR interoperable!

Meaningful Use Would Go Away – I’m actually certain that this one won’t be happening in 2012, but I wish it would. I guess there’s a small chance that it could go away if Republicans take control of Washington and start slashing everything Obama related. However, I have a feeling that even then meaningful use will find its way back into Washington. There’s too much invested in it.

My reasoning for wanting meaningful use gone is clear. It provides a perverse incentive to providers and often incentivizes them to choose an EHR software that doesn’t work well for their practice. As I’ve mentioned in some recent posts, far too many clinics are so focused on meaningful use and EHR incentive money that they’re ignoring the real and tangible business cases for implementing an EHR in their clinic. I think this is a bad thing for healthcare and EHR software in general. The short term bump in EHR adoption won’t be worth the cost of EHR implementations focused on the wrong criteria.

I also really hate how meaningful use has hijacked the software development cycle of pretty much every EHR vendor out there. This is a real travesty since rather than developing for user/customer requirements EHR vendors are developing for a criteria. Talk about a perfect method for destroying innovation. This is a real travesty in my opinion.

Of course, I’m a realist and realize that meaningful use isn’t going away. We have to make the most with what we’re given and live with the realities that exist. However, in this New Year Wish list, I wish that meaningful use would be a past memory.

New Healthcare Model that Provides Care, Not Reimbursement – I’m sure many of you might be thinking that I’m calling for ACO’s in this wish list item. We’ll see how ACO’s evolve, but my gut tells me that the ACO model still won’t make the fundamental change that I wish would happen in healthcare. There’s far too much focus on reimbursement the way our healthcare is structured today. I’m not arguing that doctors and other healthcare professionals not get paid what they deserve. I’m just wishing that there was more focus on care for patients and less worry on maximizing the reimbursement.

How does this have to do with health IT and EHR? I’ve long argued that the biggest bane to EHR systems is the onerous reimbursement requirements. I can’t imagine how much healthcare could benefit from fabulous EHR systems if the energy spent on maximizing reimbursement were spent on improving patient care.

Diabetes Prevention App – I’ll admit that this is a little personal. I come from a long line of diabetes in the genes and I love sweets far too much. I’m pretty much destine to be a diabetic. I think that mHealth apps can have amazing power if done correctly. My wish is for someone to create a Diabetes app that will help me overcome the seeming destiny I have in this regard. The key will probably be illustrating in a profound way the impact of the choices I’m making.

Of course, you could insert hundreds of other chronic illnesses into this wish list too. I’d love to see mobile health work to solve those as well.

A True Patient Identifier – I realize that America is a large place, but we’re also a really creative country that can figure out creative solutions to problems. The lack of a true patient identifier is a challenge and a problem in healthcare. I’d love to see this problem finally resolved. I think every EHR company would rejoice at this as well.

Real EMR Differentiation – My heart absolutely goes out to doctors, practice managers and others who have the unenviable job of trying to sift through the 300+ EMR companies. I’d love for some EMR companies to really do something so innovative to differentiate themselves from the rest of the pack.

No doubt part of this problem is what I stated above about meaningful use. Hard to create innovation and differentiation in EHR when you have to develop for a government list of requirements.

EHR Data Liberation – I’ve wanted EHR data Liberation for a long time, but I think in 2012 this is one thing on the list that could become a reality. It’s a bit of a long shot, but I think there’s potential for this to happen.

My gut tells me that if we can find a way to liberate the data that’s stored in EHR software, then we’d see a dramatic increase in adoption of EHR. One of the major concerns doctors have with selecting an EHR is that once they select an EHR they know they’re locked in with that EHR for the long run. If a doctor knew that they could switch EHR software if they made a bad choice, then they’d be much more likely to pull the trigger on EHR adoption.

We need a wave of EHR vendors that aren’t afraid of liberating their EHR data, because they:
1. Know that their EHR software is so good users won’t leave
2. Know that if someone wants to leave their EHR software it’s better that they find one that’s good for them than the few extra dollars the EHR company will make off an unhappy user.

How’s that for a wish list? I think achieving these things would do an amazing amount of good in healthcare and EHR. Of course, I won’t be holding my breathe on any of them happening any time soon. That doesn’t mean I won’t keep holding out hope.

Common EHR Implementation Issue – EMR Upgrade Problems

Posted on September 29, 2011 I Written By

John Lynn is the Founder of the 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 and 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’m really excited that this Common EHR implementation issues series has been so popular. If you missed it, you can see the previous posts in the series: Unexpected EHR Expenses, EHR Performance Issues, a little follow up to avoiding the EHR performance issues altogether, and inadequate EHR templates.

This weeks common EHR implementation issue is: EMR Upgrade Problems

I’d like to categorize this EHR implementation issue into two areas. One is upgrading to an EHR from an old legacy EHR and/or PMS. The second is upgrading your existing EHR that’s just outdated. I’ll take them in reverse order.

Upgrade of Existing Outdated EHR
In this world of your web browser and operating system auto updating at regular intervals it’s sometimes hard to remember that not all software does that. In fact, it turns out that most software doesn’t auto update (often for good reason). Of course, this problem doesn’t apply to a SaaS based EHR software since those updates are applied whether you like it or not. The nice part is that the SaaS EHR updates appear to the user to just happen automatically with little to no intervention on their part. Of course, we’ll save what happens when a SaaS EHR update causes you problems for another post. In the client server world of EHR (or hybrid EHR as some like to call themselves when they’re web based on an in house server) you will have to deal with updating your EHR.

I think with rare exception, it’s a huge mistake to not keep your EHR software up to date (goes for most other software as well). I’m not suggesting that even client server software should auto update. Considering the deployment and upgrade model of most EHR software, it’s almost essential to review the new feature list before doing an update to ensure that the update won’t cause you unnecessary heartache. Understanding the changes that will happen with the EHR Upgrade will let you warn your users about it so that they don’t come running into your office after the upgrade wondering why their favorite feature was changed.

What’s the problem with not upgrading? Many might just think that they don’t need to update their EHR software since they don’t want/need the extra features that are part of the upgrade. This is a bad strategy for a couple reasons. First, there are often security fixes that are part of the EHR upgrade that you’ll be missing out on if you don’t upgrade. Second, a bunch of relatively minor updates is much better on a clinic than one massive one that requires a ton of change. Third, when a future update comes that has a feature you do want, it’s not always pretty to go through multiple upgrades at the same time. Fourth, try calling the EHR support when you’re on an old version. Most of the time they’re going to say you need to upgrade for them to appropriately support you.

One other suggestion on EMR Upgrades now that I’ve supported the idea of upgrading. Just because I suggest you upgrade to the latest version of your EHR, doesn’t mean you have to be the beta tester for the company. Do the upgrade early in the process, but not necessarily so early that you’re going to be the bug tester for the company.

Upgrading an EHR from a Legacy EHR or PMS
This situation happens most often when either a clinic decides to switch from their old hasn’t been updated legacy PMS (which might include some basic EHR features) or when a clinic decides to move off their existing EHR to a new one.

Upgrading from a legacy PMS could easily be a whole series of blog posts. Suffice it to say that the biggest challenge with the upgrade from the old legacy PMS system is often getting the data out of it. Some legacy PMS systems don’t provide that data willing. In fact, many will even charge you to get access to it. They’ve basically lost you as a customers, so they’re trying to maximize whatever revenue they can get. It’s not pretty.

Even if you can get access to the data, there’s often a lot of data manipulation that will have to occur. A common problem that’s related to this is whether you even want to get the data out of the old PMS. Far too often, the data in the old legacy system has so much junk in it, that it’s worth considering the option of starting from scratch. It’s not pretty to upload inconsistent and ugly data from a legacy system into your nice, new EHR software.

Switching from one EHR software to another is becoming more and more common. In 2-3 years I believe we’re going to see an amazing influx of EHR software switches. It will be the topic du jour. We’re already starting to see it in a number of situations: an EHR that isn’t certified, an EHR that the doctor hates, an EHR that’s gone under, an EHR that’s sold to another company, etc.

The biggest problem right now with switching EHR software is that there’s no standard for the data to be exported and imported into a new EHR company. Some of you might remember my post asking EHR vendors to consider the value of EHR data liberation. In it I describe why not only is it the right ethical thing to do, but it also can make a lot of business sense to do so. Sadly, I’ve only really seen one EHR software that has embraced the concept of really liberating the data in their EHR.

I’d love to support a movement from EHR vendors that embrace the concept of EMR data liberation. I imagine most are too afraid of giving their users an easy option to leave their EHR. It’s too bad EHR vendors are so focused on protecting their business instead of focusing everything they do on the customer experience, but I digress.

Considering the above described state of EHR data export, you can see why moving to an EHR is such an issue. It’s worth mentioning this topic before you even select an EHR. Before purchasing the EHR, ask the question, What if this EHR is terrible and I want to switch? This is water under a bridge if you’re already in a compromising position under contract with an EHR you don’t like.

Unfortunately, I don’t really have very many great suggestions for those in this position. Just some words of comfort. First, switching EHR software can actually be easier than implementing an EHR in the first place. You already have the computers and IT infrastructure. Plus, for some reason second EHR implementations have a much higher success and satisfaction rate from what I’ve seen. Second, while it’s a bitter bullet to bite, everyone that I know that’s done it wishes they’d done it earlier. Although, don’t rush into another EHR just because. Take your time to select an EHR properly if you’re going to switch, but don’t be afraid to switch based on what economists call sunk costs. Third, this is one case where it’s often good to hire someone who’s done these type of EHR switching before. They can be a big help.

Value to EMR Vendors of EMR Data Liberation

Posted on February 8, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.