Exposing the Jabba the Hutt EHRs and Finding the Han Solo EHRs

I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.

After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).

The conversation started with this email that Richard sent me:

I understand your reluctance to name names in your article, BUT… this is exactly what is needed.

I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.

With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.

Richard

Here was my response:

Hi Richard,
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.

As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.

Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.

So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.

As a side note, I do have a wiki page: http://emrandhipaa.com/wiki/Main_Page and it even has an EMR and EHR Matrix of companies. Although I closed registrations since spammers were getting into it.

Richard then provided this response:

It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.

I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.

Then I offered this response which shows I’ve been on Wikipedia far too much:

I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.

Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.

I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.

Then Richard commented:

I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.

I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.

I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.

Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.

In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.

I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)

I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.

Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.

If nothing else, we can reach Richard’s goal of “broadening the discussion”

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

14 Comments

  • Amazing interaction and I like Richard’s conclusion.

    Its a broad discussion and rightly, as John pointed out, there is a cost associated with a broad scale evaluation and/or tests related to all EHRs out there.

    KLAS does some of it and it is a model; but its also a model paid for by the vendors. The users will have to embrace and somehow find a way to pay for such services. Not sure if that model will work in this space.

    I have been interacting with John for some time and he is very pragmatic in his approach; knows what he can and he can’t do; I am sure if it can be done, he will find a way to do it.

  • The part about naming EMR’s resonated with me in this post John. I realize that you don’t want to burn too many bridges as you’re getting your EMR/EHR/HIPAA journalism empire started but I don’t think you’ll be able to avoid naming names much longer. I’m looking forward to EMR and HIPAA product reviews, previews, and editorials.

  • Thanks for your confidence Anthony. I agree I’m quite pragmatic. I stick with things I can do.

    Andrew, I sometimes name names. The problem with broadly naming names on a post like the “You might be a Jabba the Hutt EHR if…” is that what might be true for one specialist or one area of practice isn’t true for another one. If I was a blog that wrote about pediatric cardiology EMR, it would be much easier to name names.

  • I too have always had a vision of creating a site that reviews EHR vendors for the small and medium medical practices (for core & specialty medicine). I recently worked with a regional extension center (REC) helping family medicine (core) practices select and implement EHR and meet Meaningful Use criteria (now doing this same work for specialties as a consultant). I was exposed to several EHR vendors while helping the staff and providers of these practices work in their systems. I watched many of them struggle with day to day issues and try to resolve them. Some of the challenges were normal; practice’s learning curve, vendors are stretched, etc. Some of the issues though were due to poor customer service on the part of the vendor or a bad fit (EHR to the practice specialty). These could have been avoided if they had more relevant information before they made the plunge.

    The playing field has been leveled somewhat as a result of the ONC certification criteria. And when you ‘look under the hood’, EHRs each have to do the basic fundamental tasks, but not one of them could be deemed as ‘one size fits all’. Each system has its benefits and its drawbacks. For various reasons, it is a challenge to get timely, meaningful information that is applicable to the needs of each practice or specialty. So, I agree wholeheartedly with the need for some kind of neutral review schematic. And, I also think it is doable…

    I gained an interesting perspective advocating for the medical practices and taking the stance of vendor neutrality. Using this leverage I was able to get enough detailed information to do a meaningful ‘apples to apples’ comparison, right down to the nuts and the bolts of each system’s capabilities and pricing. There has got to be a way to do grassroots vendor neutrality review by the people who actually use the systems and those who advocate for them.

    I can’t help but think about the website Yelp.com. Yelp is an online urban city guide that helps people find cool places to eat, shop, drink, relax and play, based on the informed opinions of a vibrant and active community of locals in the know. If they can do it, why can’t we?

  • The challenges in EMR ranking are:
    -There are too many of them,
    -They are complex which would be burdensome to review each one
    -Some EHRs are better for some specialties
    -Some people don’t want to annoy the EHR vendors.

    I’ve dealt with almost a dozen different EHRs. They are all different, yet the same.

    I never recommend an EHR – BUT – I have written a guide to helping choose an EHR.

    My goal is to help a provider narrow down their choices to 3 to 5 EHRs.

    Then they need to visit actual users – NOT the vendor HQ – for a demo.

    I specifically avoid mentioning EHR vendor names in good or bad write ups I make…partially because I don’t want to piss them off and partially because I don’t see that as my place.

    I do hold EHR choosing strategy sessions via teleconference and as mentioned above, have a guide to help select.

    As John mentioned, a wiki won’t work, a forum probably won’t work – the vendors have deep pockets and can hire folks to write rosy reviews and game the system.

  • I have a feeling such a Yelp-like tool would be full of irritated customers wanting to vent. You might also get glowing reviews of EMRs that just happen to work for a specific practice. It’s a tough nut to crack. Good luck!

  • I’ve never been a big fan of nut cracking;-)

    Everyone can see the benefit of good information. The information is just so hard to come by and often needs to be personalized to the individual provider. That’s what makes it such a challenge. Plus, that doesn’t even take into account the business model for it.

  • And don’t forget another big hurdle: gag orders. Many doctors are legally prohibited from sharing their negative experiences with a bad vendor thanks to fine print in the EMR contract.

  • I would love to have a site where I can make comments on what ought to be available in an EMR and is not. I have investigated 12-15 EMRs and I don’t like any of them. I’m currently using a low-cost EMR that is no better or worse than any of the ones I’ve checked out. But I’m using it in conjunction with a homemade Word-based system since none of the EMRs I’ve seen will do what I want. I would love to help create an EMR by docs for docs!

  • Dr. Oneal,
    I happen to have a few EMR websites and we always love sharing physician viewpoints on EMR. I’ll drop you an email to see if you wanted to post some thoughts or do a series of posts. You never know who could read what you write and want to work with you.

  • Blake,
    That is interesting. Although, even that can be easily gamed. I’ll avoid sharing how so I don’t give people ideas, but it’s pretty easy.

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