The Current EHR “Reality”

In response to my post on EMR and EHR about specialty specific EHR, we started a nice discussion about the need for specialty specific EHR vendors and all EHR vendors to create the capability to integrate with third party vendors who can extend the functionality of the EHR. This is not a new subject for Healthcare Scene, but it is an important one.

After talking about the dream framework of a middleware provider that connected third parties with every EHR, one of the readers offered their perspectives on the current EHR “reality”:

1) EHR vendors believe they are making great progress with their evolution.
2) EHR vendors believe that the next release is going to make everything right.
3) EHR vendors don’t believe that anyone can deliver a better solution then they can.
4) EHR vendors want to restrict access to “their” data. There’s money in that thar data.

He then offered a quote from this article: “we are stuck in a perpetual midpoint” along with these insights:

Procrastination is the best defense the EHR vendors can use to protect their turf.

That is where we will stay.

Unless there is some type of congressional action we will all keep wondering why interoperability keeps stalling and UCD is failing.

Those are some stinging words. The sting is stronger because I’ve seen so many cases of what he describes. I’ve seen glimpses of change on the horizon, but they are just glimpses. We’re really talking about an entire change in culture when it comes to EHRs.

I asked him this question, “Can the current crop of EHR build an app store model that would enable this vision? Is it an opportunity for a new vendor?

About the author

John Lynn

John Lynn

John Lynn is the Founder of, 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.


  • In my opinion, as long as EHRs are designed to be provider centric, rather than patient centric, we will still have silos of documentation: Docs won’t look at PT notes; nurses won’t look at case mgr notes; counselors won’t read physician notes; dietician won’t read nurses notes, etc etc. We need an EHR that has progression of care notes – a single chronological document that provides evidence of interventions and the patients response to them.

  • Why not think of a care COORDINATION system? Care mgt could imply that each provider is responsible for managing their portion of the patients overall treatment progress. A CCS implies that in addition to managing the patients’ care, the proposed care must coordinate with the care other members of the healthcare team are providing. So a primary care physician may prescribe a medication but it will not be processed until the CCS confirms that it does not conflict with any other med or patient’s healthcare status. Similarly, the urologist may order an intervention but the CCS will be able to drill into the record to confirm that the intervention wasn’t ordered previously or if it was, then the result will be made available immediately to the provider. Unless the patients condition changes, the CCS would not permit a repeat. Dream on, right?

  • S Daniels,
    I like that we coordinate care. However, I think there are competitive pressures that make the word coordinated a bad word for many organizations. Coordinated for many healthcare organizations means that they’re working with their enemy (in a competitive sense) and so they won’t want to do it. That’s why I like Management better. Management means that they’re taking a proactive approach to the care as opposed to the passive approach they take today.

  • Those words do sting… Specialty EHR companies are in an interesting position. In contrast to the comment that EHR vendors want to “restrict access to our data”, we actually want to receive more data from, and share more data with, other sources. We want the same “dream framework” that allows seamless connection to third parties because it makes the data more useful to patients and providers alike.

    However, there are real world challenges getting in the way of an “App Store model”. Resource allocation is one and regulation is the other. Increasing regulation on HOW to interoperate has proven to be a fool’s errand. You don’t need to look any further than CCDA to see this. In October of 2014, the AMA stated this standard had “wild variation in technology versioning”, and questioned its ability to foster interoperability, yet it is the standard going forward. As for resource allocation, as a Product Manager, I want to do many innovative things around interoperability. However, I am always having to trade these things off for the next regulatory hurdle that is created by ONC and CMS, which for the most part, specialty providers abhor and find useless. Looking at the 137 proposed certification requirements for MU3, I again see all innovation in 2016 slipping through the fingers of all specialty EHR companies. That stings.

  • L Parada,
    It’s true that some of the specialty specific EHR would love to change the paradigm. It’s the larger ones that don’t want to play usually.

    Your last comment is scary. I’m going to create a post on highlighting it. MU3 could definitely zap innovation in the EHR space even more than previous stages.

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