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Thoughts on Practice Fusion Raising $70 Million

Today, Practice Fusion announced that they have just closed a $70 million round of funding. This series D round of funding brings Practice Fusion’s total funding to $134 million and a valuation estimated at $700 million. The round was led by Kleiner Perkins Caufield & Byers, OrbiMed Advisors, and Deerfield Management Company.

We’d heard that this round was close almost 2 months ago. I’m not sure what took them so long to finally close the round. I also found it interesting in this Forbes article about the funding round that “Practice Fusion leads vendors this year in acquiring Allscripts’ former customers.” I have a feeling Aprima might have something to say about that.

In that same article, Practice Fusion declined to disclose revenues, but Ryan Howard suggested that he expects Practice Fusion revenues to triple next year. Then, it was suggested in the article that payments from labs connected to Practice Fusion customers would make up a significant source of revenue. You might remember that Practice Fusion lost one revenue stream when Kareo decided to launch their own free EHR. Practice Fusion has since rolled out 3 new billing companies and so they could have made up that revenue.

The article also suggests that revenue is available from Pharma for mining the Practice Fusion data for insights. Then, they’ve always talked about the potential for pharma advertising in the Free EHR. I also had someone suggest to me recently that Practice Fusion could be making money off of selling leads to the various healthcare education companies out there. Considering the number of emails I get from these healthcare education companies, they definitely have money to spend on targeted leads.

The question I’ve asked for many years isn’t whether Practice Fusion has created value. No doubt their current user base and data set has value. The question that remains is whether they’ve created a company that merits a $700 million valuation and whether the $134 million investment will yield a quality return. Plus, can Practice Fusion build the company’s revenue while still maintaining physicians’ trust in Practice Fusion. They now have $70 million in funding to find out.

September 24, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Aprima EHR’s Offline Functionality

I’ve been writing for a number of years on the challenge that EMR downtime causes a clinic. In case you missed them, check out some of the following posts:
My EMR is DOWN!!!
Working Offline When Your EHR Isn’t Available
Cost of EHR Down Time
Reasons Your EHR Will Go Down
SaaS EHR Down Time vs. In House EHR Down Time

Not to mention Katherine Rourke’s recent post titled, “When The EMR Goes Down, Doctors Freak Out.” Obviously, downtime is a big problem as doctors become more reliant on their EHR software. Plus, as I state in some of the article, downtime is inevitable.

One of the most common comments I got on those posts was doctors asking why they couldn’t work in the EHR software even when it was down. My answer was usually that the EHR vendor could do that, but that it would require them to architect the EHR to be able to support offline use of the EHR and that wasn’t a simple task.

Turns out that Aprima has built this functionality into their EHR called Aprima Replication. Here’s their description of the replication feature:

Every installation of Aprima EHR includes the Replication functionality. This allows physicians to continue working within patient charts when they are not able to be connected to their server (whether it is hosted locally in their office or in the cloud). They have identical functionality as if they were fully connected with the ability to look up or enter data, perform everyday tasks such as messaging and tasking, create orders, review results, etc. Everything is stored locally on their hard drive in a secure and encrypted environment and automatically syncs information the next time they are online whether that be over a mobile wireless connection, wifi + VPN over a public network, back in their office over a wired or wifi network, at home, or wherever and however they are able to connect. Additionally, all of the synchronization is done behind the scenes allowing the provider to continue working live without having to wait for the replication to complete.

Aprima Replication goes beyond other mobile technologies because this does not require connectivity, and even more importantly it is not simply a copy of the server that is “read only,” or a partial export of charts that leaves the server side locked until the provider “checks the chart back in.” This is fully functional on the provider side while disconnected AND allows others to also continue to make updates and changes to the chart, patient scheduling, handle all the needs surrounding coordination of care, billing and collections, etc. This can also be used as a great “downtime” alternative to paper in the event of an internet outage for those using the cloud or a server failure when running it locally.

I asked a couple follow up questions to clarify exactly how the offline EMR functionality worked. Here are my questions and their answers (originally an email exchange):
The challenge I have is understanding how the patient records are available without an internet connection. You can’t be downloading every single patient record locally are you?

In our unique, patent pending Replication process, every provider has a profile unique to their needs and preferences. This includes a subset of patients based on their previous schedule, future schedule, open orders and tasks, a specific facility they may be servicing such as a nursing home, their messages, attachments, (they can set size limits to address minimal bandwidth environments such as wireless air cards) etc. Based on these parameters the appropriate patient charts are “replicated” to their tablet/laptop computer. This is an ongoing, real-time process while they are connected to the network that keeps the data current. Any time they disconnect, or even lose connectivity if there is an outage, they continue to have full chart access for reviewing, adding, and editing as if they were still connected. As soon as connectivity is restored the synchronization starts up again and continues until all of their work, plus all of the work done simultaneously on the server side, is merged back together.

Does it just download some “active patient” list or the records for the patients on your schedule for some certain time period? It’s a really beautiful thing that you’re program can work without the internet. I assume all of the drug databases, etc are downloaded and available locally as well?

Yes, they are, including all drug interaction checking which remains fully functional while off line. Any orders for scripts, labs, diagnostics, or anything else, can be created offline and then processed when the computer is back in network range. So the script or order will be ‘staged’ and ready to go. It’s just like when you write an email when your offline, then when you get in range, the emails in your outbox just go.

The other question I have is how the records deal with multiple people modifying the record in a disconnected mode. What if the nurse accesses the record and documents something and then the doctor gets in and document something. Does the record get reconciled once it’s reconnected?

Yes indeed it does.

Are there every any issues that have to be reconciled manually?

There is a “collision” report. These “collisions” are rare but we do accommodate them very well. If a Replication “save” conflict occurs, a message will be sent to the user group that is defined to be notified. Replication conflict messages contain details of the conflict and the name of the associated patient if applicable.

The next time I see Aprima at a conference, I plan to check out this feature first hand. Reconciling a patient record that two people are editing can get pretty complex. I’d like to see how it handles it. Plus, I’d love to see how well it does at resyncing the data after being offline for a while. Not to mention how well it does at identifying the patient info it should have stored locally.

This is a really challenging feature to implement. I think it says something about Aprima that they took it on. If it works well, I know there are a lot of doctors that would love this feature in their EHR.

August 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Modernizing Medicine EHR Vendor Raises $14 Million

Modernizing Medicine®, the creator of the Electronic Medical Assistant® (EMA™), a cloud-based specialty-specific electronic medical record (EMR) system, announced today that it has received $14 million from Summit Partners, a global growth equity investor. -Source

I’ve been a big fan of Modernizing Medicine since I first came across them. Their approach to EHR is very smart and very different than many of the EHR software out there. They’re extremely focused on the specialties that work well with their visual method of documentation and that documentation method is something unique.

I’ll be interested to see if Modernizing Medicine plans to use this $14 million to expand beyond their current specialties or whether they plan to stay as a specialty specific EHR. I’m a big fan of specialty specific EHR software and so I hope that it’s the later. You have to compromise so many things when you expand an EHR to support so many different specialties. The number of doctors still not using Modernizing Medicine’s EMA EMR is still large enough for them to do very well.

August 20, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Code of Conduct – Siemens Healthcare

Here at EMR Thoughts we’re going to do our best to keep track of which EHR vendors and other healthcare IT companies choose to adopt the EHR Code of Conduct. Hopefully by doing so we can offer at least one small part in helping to hold EHR vendors accountable for the code.

Today, Siemens Healthcare Adopted the EHR Developer Code of Conduct. Siemens was a major part of the effort to create the EHR code of conduct, so this doesn’t come as a surprise. Unfortunately, the press release didn’t have any details or a link to a website or anything to show how they’ve actually implemented the EHR code of conduct.

If you’re someone who uses a Siemens Healthcare product, I’d love to see if you think that they’re following the EHR Code of Conduct or if they still have room to improve. Hopefully we can get more exposure for those EHR vendors that really implement the spirit of the EHR Code of Conduct and expose those who do so only with their lips.

June 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Consolidation and EHR Investment News

A couple big announcements came out this week that are continuing to shake up the EHR market. Most people consider this a really good thing when you look at the 300+ EHR companies in the market today. Most see this as unhealthy and a real issue for healthcare. No doubt it causes problems, not the least of which is the paradox of choice.

The first announcement was that Vitera Healthcare Solutions acquired SuccessEHS. Vitera is the new name for the SAGE EHR which they bought from Sage Software in 2011 for those tracking the EHR histories.

In the press release it says that the combined organizations serve “more than 10,500 medical organizations and over 415,000 medical professionals nationwide — including more than 85,000 physicians.” I was also interested to see Vitera’s emphasis on expanding their customer base in CHCs, Student Health Centers, HIV/AIDS Clinics, and FQHC.

I asked the company if there were any plans to sunset one of the competing EHR software platforms. They responded that they “plan to keep both EHR systems and keep developing both of them.” Of course, the acquisition was just announced, so that doesn’t mean in 3-6 months they may compare the EHR systems and make a different decision in the future.

The second announcement was CareCloud EHR raising $20 million. That brings CareCloud’s total funding to $44 million. Ever since I first met Albert Santalo, CEO of CareCloud, he said that he wasn’t looking for the early exit. Instead, he wanted to build CareCloud into a long term company. I expect this extra $20 million will let him and CareCloud really swing for the fences.

Also, I literally just got an email from another EHR vendor that’s in the process of being acquired. I can’t say who the company is until it’s official, but it seems that EHR consolidation is happening. Either that or the companies are taking on funding to try and last for the long term.

June 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Certification Revoked for EHRMagic

Yesterday HHS released news that they’d revoked the EHR certification of the EHRMagic-Ambulatory and EHRMagic-Inpatient EHR software. Looks like InoGard originally certified the EHR and they and ONC received information that had them retest the EHR software and it failed the certification re-test.

I think we all want government to hold bad actors accountable. So, it’s good to weed out EHR companies that aren’t doing what they should. However, they better also be careful. Imagine being a doctor of an EHR vendor whose EHR certification gets revoked. Does that mean that they have to give back the EHR incentive money the received? Those doctors trusted in InfoGard’s ability to certify an EHR vendor and InfoGard failed at that job. Should a doctor be punished for InfoGard’s failing? Now apply this to a hospital that uses a certified EHR and loses that EHR certification. That’s a multi-million dollar impact.

I guess EHRMagic better take down the info on their website that says they can get physicians $44,000 in EHR incentive money. Looking at their website, it makes me wonder who chose to use their EHR in the first place. That would be interesting to know.

Here’s the full press release from HHS on the EHR revocation:

Two electronic health records, previously certified as products to be used as part of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, have had their certifications revoked. Farzad Mostashari, M.D., the national coordinator for health information technology, announced today that the products do not meet standards and providers cannot use these products to meet the requirements of the Medicare and Medicaid EHR Incentive programs.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both developed by EHRMagic Inc. of Santa Fe Springs, Calif., no longer meet the EHR certification requirements. The EHRs must be certified by a certification body (ACB) authorized by the Office of the National Coordinator for Health IT (ONC) before regaining certification.

Both ONC and an ONC ACB, InfoGard Laboratories Inc. (InfoGard), received notifications that the EHRMagic products did not meet the required functionality and the products should not have passed certification. InfoGard analyzed the additional information from the notification and contacted EHRMagic, launching the ONC authorized certification body required surveillance activities. InfoGard concluded that it was necessary for the EHR products to be retested for select requirements. EHRMagic, Inc. participated in retesting and failed.

“We and our certification bodies take complaints and our follow-up seriously. By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” said Dr. Mostashari. “Because EHRMagic was unable to show that their EHR products met ONC’s certification requirements, their EHRs will no longer be certified under the ONC HIT Certification Program.”

Information about ONC’s certification process for EHR technologies is available at http://www.healthit.gov/providers-professionals/certification-process-ehr-technologies.

April 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Extormity Touts Customer Dissatisfaction, EHR Switching Statistics

I guess I really should post this Extormity press release to my EMR, EHR and Health IT News site (where you’ll find all the various press releases that are coming our before, during, and after HIMSS), but this is so much more than news. For those not familiar with Extormity, it’s kind of “The Onion” of Healthcare IT. A fictitious company that highlights many of the absurdities in the healthcare IT and EHR world. Although, the irony is how well they mix the reality with the absurdities.

Without further ado, the latest Extormity News which just hit my email inbox:

Electronic health record vendor Extormity today announced that nearly 75 percent of its existing customer base reports being dissatisfied, extremely dissatisfied or contemplating suicide based on the decision to implement the Extormity EHR solution. Further, Extormity expects nearly 40 percent of its clients to de-install their solution in 2013 and switch to another vendor.

Citing a recent study which indicated that nearly 20 percent of EHR users could be switching out their first choice EHR this year, Extormity CEO Brantley Whittington stated “We are ecstatic that unhappiness levels among our clients clearly outpaces the industry average.”

“Even as analysts are expressing concern with these statistics, these findings have generated incredible buzz about Extormity – resulting in a disproportionate share of media attention,” added Whittington. “Better yet, the focus on dissatisfaction levels has obscured questionable financial dealings, several catastrophic medical errors linked to flawed clinical decision support algorithms, and more breaches than you can shake a stick at.”

While the projected de-conversion rate could be considered alarming, Extormity officials remain bullish on the company’s future. “While much of our installed base is fleeing the good ship Extormity, we are winning new clients at a record pace as providers head for the exits with other vendors who also made expensive empty promises,” added Whittington. “When one considers early termination penalties, exorbitant costs for data conversion and the steep hourly rates we charge clients who are transitioning away from our EHR, we expect record profits which will fund the construction of our new corporate headquarters.”

About Extormity

Extormity is an electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize and prohibitively expensive healthcare IT solutions. Our flagship product, the Extormity EMR Software Suite, was recently voted “Most Complex” by readers of a leading healthcare industry publication. Learn more at www.extormity.com

February 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The EMR Complexities

Carl Bergman offered an interesting comment on this post about “When the EMR Is the Problem.” In his comment he creates a list of ways that an EMR company can cause a problem for the end user:

  • Requirements
  • Research
  • User involvement
  • References
  • Hardware
  • Software
  • Usability
  • Customization
  • Configurations
  • Implementation
  • Testing
  • Training and
  • Support

I found this to be a really intriguing list since it highlights many of the complexities associated with creating and implementing EMR into a medical office. There are a lot of points of failure and each has to be addressed to have a beautifully seamless EMR implementation experience.

With so many points of failure, is it any wonder that we have so many “failed” EMR implementations?

It’s a special EMR company that can handle all of this list well (not to mention doing so at scale).

January 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

AthenaHealth (NASDAQ: ATHN) Acquires Epocrates (Nasdaq: EPOC)

It was just announced that AthenaHealth plans to acquire Epocrates. This is a big move by AthenaHealth and a really smart one. Here are the details of the agreement for AthenaHealth to acquire Epocrates from the press release:

The board of directors of each of athenahealth and Epocrates has agreed to a price of $11.75 per share, in cash, for an aggregate purchase price of approximately $293 million. The purchase price represents a 22 percent premium over the closing price per share of Epocrates on NASDAQ on Friday, January 4, 2013. This is an all-cash offer for all outstanding shares of Epocrates’ common stock, and athenahealth intends to finance this acquisition using available cash and funds available from its existing credit facility. The closing of the transaction is subject to the approval of Epocrates shareholders and other customary closing conditions and is currently expected to occur early in the second quarter of 2013. Epocrates shareholders representing approximately 17.5% of the outstanding common stock have agreed to vote their shares in favor of the transaction.

Of course, there are still a number of regulatory hurdles that must be overcome to make the transaction final, but this looks like it’s going to happen. Considering Epocrates stock price was so low after their initial IPO, this isn’t really a surprise. Plus, once Epocrates shut down their EHR business it presented a great opportunity for another EHR vendor to come in and capitalize on Epocrates relationships with the doctors. In fact, Jonathan Bush describes the value of the Epocrates brand really well:

“I have been an admirer of Epocrates since it first emerged and have watched the company grow consistently, one app download at a time, as it has cemented itself into the consciousness of America’s physicians. No other company has been able to replicate the brand awareness, familiarity, and trust that Epocrates has across the clinical mobile user base. We are confident that we can provide Epocrates with the stewardship and resources it needs to grow and develop within health care, and that Epocrates’ capabilities are going to mesh exceptionally well with athenahealth’s cloud-based physician and patient services.”

I’ll be interested to see how AthenaHealth chooses to integrate the Epocrates knowledge base within its EHR and how they use the Epocrates relationship to sale their EHR to doctors. Will the Jonathan Bush cloud mantra take hold in the Epocrates culture? I’ll be interested to watch that transition.

January 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Glen Tullman Steps Down as CEO of Allscripts (NASDAQ:MDRX)

The news is just coming out that Glen Tullman has stepped down as CEO of Allscripts (NASDAQ:MDRX) along with Allscripts President Lee Shapiro.

Paul M. Black has been selected by the Allscripts board as the new President and CEO. Mr. Black was COO at Cerner for 12 years before he retired from Cerner in 2007. He has served on the Board of The Truman Medical Centers for 12 years, most recently as Chairman, and as a director of Haemonetics Corporation (NYSE:HAE). Plus, Mr. Black is currently sitting on the board of Allscripts.

It’s an understatement to say that it’s been an incredibly tumultuous year for Allscripts. Allscripts chose to discontinue their Allscripts MyWay EHR, Allscripts sued NYC after losing an EHR deal, and then Allscripts started looking for a private equity buyer.

This latest round of firings was predicted by Anne Zieger when she wrote about the previous Allscripts Management Shakeup and the investors desire to fire Glen Tullman a while ago.

I imagine the board was waiting to see if any of the strategic alternatives (ie. Private Equity buyouts) could save Glen’s job, but Allscripts also announced that “the Board has formally concluded its evaluation of strategic alternatives.”

Usually there’s a lot of shakeup after a change like this, but Allscripts EHR users have already been through a lot. It will be interesting to see what Mr. Black does with Allscripts going forward.

Here’s the details of the Conference Call that will be held tomorrow about the changes:

Conference Call

Allscripts will conduct a conference call tomorrow, Thursday, December 20, 2012, at 8:30 AM Eastern Time to discuss today’s announcement. Investors can access the conference via the Internet at http://investor.allscripts.com. Participants also may access the conference call by dialing (877) 303-0543 (toll free in the US) or (973) 935-8787 (international) and requesting Conference ID #83012880.

A replay of the call will be available two hours after the conclusion of the call, for a period of four weeks, at http://www.allscripts.com or by calling (855) 859-2056 or (404) 537-3406 – Conference ID #83012880.

December 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.