EHR Vendor Says Good Bye to Meaningful Use

ComChart Medical Software, LLC president, Hayward K. Zwerling, MD, earlier this month posted a letter on The Health Care Blog saying that the ComChart EMR would no longer be meaningful use certified. Here’s a portion of the letter that describes the reasoning:

ComChart EMR will continued to be certified as a Complete EMR for Stage I Meaningful Use. Unfortunately, we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.

In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.

(I suspect this is also true, to some extent, for all EMR companies.)

While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.

In addition to a lack of understanding of what is important during the process of providing healthcare, it has also become apparent to me that the Federal and State health information technology agenda is now largely driven by the strongest HIT companies and health institutions; the individual physician is only an afterthought in the entire process.

This choice basically means that anyone interested in meaningful use and EHR incentive money won’t be doing so with ComChart EMR. The regulations say that even someone attesting to meaningful use stage 1 in 2014 has to use a 2014 certified EHR. ComChart won’t be able to meet that requirement.

I knew that this was going to happen with a number of EMR vendors, but ComChart really missed a huge opportunity with this announcement. The most damning part of the letter is when Dr. Zwerling says “we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.” I was aghast by this statement. So much so that I had a brief email exchange with Dr. Zwerling to see if he really meant what he said. Was it that they weren’t able to meet the requirements or that they chose not to meet them?

He responded, “Anything can be done, it is just a question of how much resources are going to be thrown at the problem and what is not going to get done return.”

It seems that Dr. Zwerling didn’t consult a PR or marketing person on how to make the most of this decision. Any of them would have told him that this decision could be a huge opportunity to differentiate the ComChart EHR from all the hundreds of certified carrot chasing EHR companies out there.

If Dr. Zwerling had asked me, I’d have told him that he should have said, “ComChart EHR has talked with our hundreds of physician end users about meaningful use and EHR certification and we’ve found that they don’t value any of the meaningful use criteria. Because of doctors desire to not be bogged down by meaningful use requirements, we’ve chosen to listen to our doctors and focus on what makes doctors lives easier. We’ll continue innovating our product to the needs of doctors, but we’ll be letting doctors drive that innovation versus some committee in Washington.”

I could keep going, but you get the idea. ComChart could have told every doctor out there that they were the ULTIMATE PHYSICIAN EHR that cares so much about the physicians who use their EHR that they’re shunning meaningful use because it’s detrimental to the way physicians should be practicing medicine. Making this case would not be hard and the message would resonate with the majority of physicians.

I’m not sure if this strategy would work or not. Government money that’s perceived as “free” is a hard opponent. However, government bureaucracy and headaches are an easy target that everyone understands and hates. In ComChart’s case, saying that they essentially aren’t capable of the complex meaningful use requirements is sending the wrong message. All doctors hear when they read this is that your EMR development team isn’t sophisticated or strong enough to keep up. What a missed opportunity and likely the nail in ComChart’s coffin!

Hopefully this is a warning message to any other EHR vendors who choose to go the route of shunning meaningful use and EHR certification. I’m not sure that shunning MU is a winning strategy for an EHR vendor, but being the physician advocate at least gives them a fighting chance.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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,, 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.


  • The cost of switching EHR’s isn’t cheap, both from a financial standpoint as well as workflow changes.

    If a practice has a relatively small Medicare panel, staying with a decertified EHR may be less painful than migrating to another vendor.

  • As a practicing physician who has used EMR since 2000 I applaud a vendor who will stand up against meaningful use. It has paralyzed innovation by forcing EMR’s to comply with regulations. Similar to the ObamaCare website most EMR’s seem DOS based in capability and user friendliness. If I were using NextGen to write this note it would take at least a dozen clicks and confirmation that I’m ‘really sure’ I want to proceed or ‘save’ vs’save and close’ before applying the period at the end of this sentence Yes. No. Yes. Click no no no…

  • former Nexus One user,
    You are correct. What I’m not sure about is how many are in the “small Medicare panel” group.

    Exactly. Why they didn’t capitalize on this and go after MU and it’s faults is beyond me. They could carry the banner of physicians against MU.

  • Dr. Z has gotten smart. “Pay no attention to the man behind the curtain.” Continue to make your EMR’s (and non-electronic records) better. Do what works: faster, easier and better. Not slower, more tedious, more reporting and more clicks. If MU suggests something that actually helps the MD and his patients, go for it. If MU means the MD must enter the day month and year of every mammogram for the computer to be happy… it’s not a good way to spend your day.

  • While I applaud Dr. Z’s stance and his conviction (that in some ways may affect the financial outcomes as well) and also, as always find John’s comments humorous and insightful – I believe some of the MU II requirements are required to move towards interoperability and standardization. All the requirements pointed out by Dr. Z including Snowmed, Direct and so on, are requirements for the march towards standardization.

    Its agreed that the technical requirements are such that, a good number of resources have to be deployed to make the changes and go for the certification. Having gone through it ourselves, I fully agree with Dr. Z.

    At the end of the day, it may not make much of a difference to the Provider and if she/he is happy they will stick with the tried and tested EMR as opposed to chasing the balance of the MU $$$$ which might not be more than $15K range.

    Interesting topic that will garner much attention over the next 24 months.

    Happy New Year to all and John in particular, whose blogs over the last 5 years have educated many of us, spanning many topics of interest in Health IT.

  • John,

    Very insightful as always. It was interesting to note that rather than discuss the validity of Dr. Z’s decision, you focused on the execution. I think that was as smart thing because what is done is done. Your query – ‘Was it that they weren’t able to meet the requirements or that they chose not to meet them?’ was targeted and I saw an affirmative on both counts in his reply.

    Your suggestion was on the dot also – except that if there is truth to really involving his clients in the decision making it is extremely powerful but if he made that claim when his clients thought otherwise, it can backfire.

    Outcome of the company will depend on how loyal his clients are. If they believe in the product and the decision, it actually see the company growing and flourishing rather than dying. It must be managed and executed well.

  • I do agree with John, the delivery was not the best choice. Yes, MU is a tedious task that was implemented incorrectly. Hindsight is 20/20 and looking forward I do not see it getting any better. It is the Government running this incentive after all.

    My concern is, some folks have lost sight of the end goal. Patient outcomes. True, this transition is pain-full for all, however it will be for the better in the end.

    Imagine a day when a medical provider can see everything about a patient in one setting. Imagine when over ordering of redundant tests is no longer an issue. Imagine what it will be like when less patient are dying from incorrect medicines being prescribed. Something you may see in the future is an EMR that can query all other users anonymously about the best course of treatment without having to experiment, use a drug company suggestion or just learn by “practice”.

    Agreed, the incentive from CMS for a provider to use an EMR is less than exciting, but what about the patient?

    In the end (no pun intended) proper use of worthy EMR’s will prove to save lives and money.

  • Hmm.

    Sure this could have been handled differently, but obviously that is not their point. They were probably going for that fringe group of docs that wants to give the middle finger to “the man” and Doc Z’s tone fits that bill.

    They are tired of spinning their wheels with all the crazy regulations…but wait, this is for docs…right?

    This was bound to happen. Every Tom, Dick and Harry with some coding skilz decides they can do a better EHR.

    They dive in and gain some traction, only to realize this is a big time biz that requires big time cash.

    I’m not a conspiracy kind of guy, but I’m sure the lobbyists for the big players are just thrilled to add more and more requirements that will push the small players to the brink.

  • “these requirements are technically extremely difficult to implement”
    Difficult for who?
    On what platform?

    “the small EMR companies do not have the resources to do both”
    You do have the resources. Call us!

    HIT has always been a tough space to make a buck.
    You gotta love it and be committed. 🙂

  • I believe we will see more EMR vendors go the way of ComChart. However, if their client base stays loyal and they can market to practices that are not eligible for stimulus or face any sort of penalty, (example: pediatricians that see less than 20% Medicaid patients) it’s possible they can survive and perhaps even thrive.

    To further your point John B. The stimulus incentives created the environment for “every Tom, Dick and Harry” to get in the EMR biz. What many failed to realize is that they got into a pool with 500+ competitors and a market that is now shrinking. Many private groups are now owned by hospitals which means those docs are now using NextGen or Epic or whatever the hospital tells them to use.

    EMR sales are flat. Most new business is coming from replacing EMR and/or PM systems. These sales are harder to make and fewer and far between. So as you said John, small companies oftentimes do not have big time cash to sustain themselves through lean times and the cost of onerous regs.

  • Bill,

    Like beauty, “onerous” is in the eye of the beholder.
    If your team, platform, and existing system are not amenable to constant re-factoring, then you are in a difficult predicament in an already difficult industry.

    Many other issues including the Fremium systems and the REC system further distorted the marketplace.

    Who “woulda thunk” anyone would do a Fremium EMR???
    There is lower hanging fruit for the dot bomb disrupters.

  • Anthony,
    An EHR vendor shunning meaningful use doesn’t mean they have to shun everything about it. I’d be surprised if an EHR (MU or not) won’t want to do CDA for example. The key is to be able to pick and choose the elements based on what the doctors/users want and not the govt.

    Happy New Year to you as well! It’s been a great 8 years. I’m glad you missed the first 3 when I was learning what I was doing.

    Certainly I was hypothetical that he talked to his customers. If he hadn’t, he should have done so before making the decision. I assumed he did and that they were supportive. Time will indeed tell when renewals come.

    I like outcomes too. I just am not sure that we’ve gotten the outcomes we deserve for $17 billion and counting. Either way, the bed is made and EHR has been accelerated. Now we make the most of it. It’s just a question of whether doctors see MU as that pathway. I think many will love an alternative to it.

    John Brewer,
    I’ve been surprised how little influence many of these large organizations have over the standards. I think their influence has grown a lot since ARRA was passed, but it wasn’t before ARRA.

  • @ AXEO Med – everything you are saying is true…if the original system/code was well written and organized.
    For the most part what I see is the interface getting more convoluted as the vendor attempts to pile on the latest MU requirements without regard for the process making any sense.

    @John – IF the big vendors had little influence over the standards, then things got screwed up on their own – which isn’t a surprise…but I’d be surprised if the lobbyists did nothing. Very surprised. Whether before or after ARRA, I’m sure their goal is to squeeze out the small players.

  • John Brewer,

    ComChart (as an example) may have simply lost control of their developers and development process. What can be done and what makes economic sense are likely two very different things.

    The cross-currents for small/mid-size HIT vendors are many and varied. They are pressed from the top by the large, “nobody got fired buying IBM”, incumbents. And pressed from the bottom by the Fremiums.

    Let’s talk sometime.


  • John Brewer,
    The big vendors had influence over CCHIT and the government took heavily from CCHIT. So, I guess there was some tangential influence. Although, I was surprised how little connection CCHIT had to ONC. It was odd to me.

  • John Lynn,

    I ran the numbers for our practice of 2 PCP’s with a 30% Medicare panel, and I would say that the decertification hit would by slightly (as opposed to moderately or severely) painful. YMMV.

  • Let’s see the numbers. I did a post a while back for a general medicine using AAFP’s average Medicare numbers and it was only a few thousand dollars of payment adjustments as I recall. I can’t find the post offhand.

  • The typical internal med doc should be seeing total annual payments in the $500k-$600k range. At 40% Medicare, that puts the range between $200k-$240K in Medicare. A 1% reduction means $2,000-$2,400. Not bad, but if in fact the penalty climbs to 5%, that jumps to $10,000-$12.000. That becomes much more painful!

  • Axeo Med-I would completely agree with that statement. One of the reasons I believe that many docs are not happy with their EHR is simply because of the customer service (or lack thereof) they receive.

    It is going to be interesting to see just how much drop-off in participation occurs from Stage 1 to Stage 2 MU. I believe it will be at least in the 50% range.

  • Bill,
    I’m always interested to see how the customer service evolves as the customer becomes a long time customer and as the EHR vendor starts to scale. Both usually lead to poor customer service outcomes.

    50% is a bold prediction. I think you might be close.

  • JohnL,
    No doubt about it.

    I believe I read from Evan Steele’s blog that there has already been a drop-off of 17% just from the 90 day attestation to completing the full year of attestation for stage 1 MU. So to get to 50%, it only has to drop another 33%.

    Here’s another reason I believe there will be dramatic drop off in participation for Stage 2 is this. I counted the actual number of companies that are Stage 2 MU certified (ambulatory-complete EHR) from the CHPL website. There are only 36 as of last week! There are many more products of course, but I found the number of companies to be staggeringly low. In your blog “Will your EHR vendor be around in 5 years”, Angela Carter stated “According to the Centers for Medicare and Medicaid Services (CMS), there are over 900 EHR vendors currently on the market, many of whom offer more than one product.” If those numbers are correct, it just becomes simple math.

    And finally, practice administrators and doctors will be dealing with ICD-10, PQRS, Obamacare and a host of other regulations in 2014-15. Something is going to give…and I think that will be MU 2.

  • Bill,
    It’s still early for 2014 Certification. Most of them will still get there and you only need 90 days of attestation data, so the EHR vendors aren’t rushed. I think 4 months from now the number of 2014 certified EHR will be much much higher.

  • John,
    True, it is early still. Perhaps with MU 2 being extended and MU 3 delayed at least for a year, it may allow vendors to “catch up”. For sure, the next 18 months will be interesting.

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