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Docs, stop whining, start e-prescribing

The whining is getting old.

Per Surescripts, in 2012, the latest year for which statistics are available, about 69 percent of physicians nationwide used e-prescribing technology in one way or another, and 44 percent of all prescriptions written nationwide were routed electronically. (That report came out in early May 2013, so expect some new numbers soon.) Both are up substantially from the previous year, probably due in no small part to the Meaningful Use EHR incentive program, which does require a minimal level of e-prescribing.

But what about the holdouts? A recent article in the journal Perspectives in Health Information Management found that cost remains the No. 1 reason why physicians still haven’t ditched the paper prescription pad in favor of electronic prescribing.

“While e-prescribing offers many benefits, not all providers have been excited about implementing e-prescribing systems. A major barrier, reported by more than 80 percent of primary care physicians, has been lack of financial support. New technology requires training and information technology support for installation and upkeep. A practice must take these costs into account when deciding whether to implement an e-prescribing system and also when choosing a stand-alone system or one that is integrated into an EHR system. According to the Health Resources and Services Administration, in a 2007 study the total cost of implementing an e-prescribing system was found to be $42,332, with annual costs after implementation of about $14,725 per year, for a practice of 10 full-time equivalent psychiatrists,” the authors reported.

Yes, but the paper also says this: “E-prescribing improves the efficiency of the prescribing process. Though the actual entering of a new prescription takes about 20 seconds longer per patient than writing a prescription, this time is offset by the time saved because of the fact that less clarification is needed for electronic prescriptions. Prescribers spent more time on the computer, on average an extra 6 minutes per prescriber per day or an increase of 20 seconds per patient when seeing 20 patients per day. If implemented correctly, e-prescribing should cause little disruption in the workflow of ambulatory care settings.”

In other words, those resisting the switch are being penny-wise and pound-foolish.

Besides, e-prescribing systems don’t have to cost that much. In fact, they don’t have to cost anything. Allscripts offers a free, standalone e-prescribing system online, while PracticeFusion, DrChrono and Kareo have e-prescribing modules in their free EHRs. A startup named ScriptPad has an e-prescribing app for Apple iOS that’s free to prescribers; transaction fees get billed to pharmacies. I can’t vouch for the efficacy of any of this software, but cost doesn’t have to be an issue.

I think the real problem here is intransigence. Some doctors simply don’t want to get with the times, and the only losers are patients.

April 24, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

DrChrono and Sermo, what are you thinking?

Free, mobile ambulatory EHR developer DrChrono made a minor ripple of news this week, claiming to be the first vendor to release an EHR for the new Apple iOS 7. But that’s not why I’m writing this post. I’m calling out DrChrono co-founder and COO Daniel Kivatinos for this tweet:

I was quick to respond on Twitter.  

Indeed, the HITECH Act and Meaningful Use are about the Triple Aim of producing safer care, improving population health and lowering overall healthcare costs. The incentive money isn’t supposed to make physicians rich or even cover the cost of the typical EHR. (Yes, “free” EHRs have costs in terms of changing physician workflows and interfacing with practice management systems, and the advertising may cause patients to lose trust in their doctors, as John Lynn seems to have found with Practice Fusion.) Frankly, I don’t want to go to a doctor who views Meaningful Use as “cashing in.” That’s not “meaningful” in the spirit of the incentive program.

I’m making a big deal out of this because this is not the first time DrChrono has made misleading and hyperbolic statements. As I wrote a couple years ago, the company claimed its patient check-in app was “groundbreaking,” despite a lot of evidence to the contrary. The same post also had a video from DrChrono in which the vendor explained to physicians how they could qualify for Meaningful Use “tax breaks.” The incentive payments aren’t tax breaks. In fact, the money counts as taxable income.

The video is still up on YouTube, and it’s been viewed more than 57,000 times. That’s 57,000 times people have heard a patently false statement. DrChrono, stop misleading clients or you won’t have any clients left to mislead.

Also from the “what were they thinking?” department, physician social network Sermo marked the start of the NFL season this month with the launch of the “Pro Football Injury Challenge.” I know this because I received this e-mail:

Sermo injury challenge

Yes, I know I’m not a doctor. Sermo sent a follow-up a few days later saying that I received the invitation in error. But actual physicians still are competing against each other in kind of a fantasy football injury pool. Do you find this as tasteless as I do?


September 20, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: This time, I’m the interviewee

In a rare turn of events, I’m the one being asked the questions on a podcast by Sivad Business Solutions, which hosts regular audio discussions on a variety of business topics. I give kind of a high-level view of health IT and offer my very strong opinions on patient safety and healthcare reform. There’s an interesting discussion about EHRs being designed to maximize reimbursements rather than assure safety.

Interestingly, we recorded this via Skype. I like the audio quality, if not the nasal quality of my own voice, more than usual that day.

Hopefully the embedded audio works. If not, click here.

September 18, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Maybe there’s something to it

Now that everyone has had a turn trashing Practice Fusion for its apparent attempt to use Google‘s name to promote itself, I’m thinking that perhaps there is a future for an advertising-supported EMR.

Given my propensity for letting things pile up, I just read the Feb. 15 commentary by Michael Millenson in HHN Most Wired OnLine. Millenson, who’s been covering health IT a lot longer than I have, suggests with tongue only slightly in cheek that the profit motive will lead to all kinds of corporate sponsorships of healthcare technologies and even facilities.

What’s cool about this article is that it was published a full month before the Practice Fusion story broke. Could it be that advertising really is the future of medicine?

And speaking of advertising, I’m going to use this space to promote myself once again. Don’t forget to check newsstands next week for the April 23 issue of Red Herring for my look at personal health records. Naturally, I’ll post a link to the online version when it’s available.

April 12, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Going multimedia

Watch the hit counter at the bottom of the right-hand column. Watch it carefully as it approaches and hopefully passes 20,000 since I began tracking traffic in September 2004. Thank you for your continued readership.

And now for a reality check. The HIStalk blog had 186,445 hits in March alone. While I count visits more than hits (a.k.a. total page views) still I can only aspire to provide a fraction of the entertainment value as Mr. HIStalk—or for that matter, a fraction of the entertainment value of those fun-loving hipsters at the Agency for Healthcare Research and Quality, who have gone all YouTube on us.

Yes, AHRQ and the Ad Council have teamed up to produce the following public-service announcement aimed at encouraging patients to seek information from their healthcare providers as part of a campaign called “Questions are the Answer.”

This is the 30-second version. A 60-second spot is at

AHRQ also is working on a pilot with PBS related to patient safety. The first episode will focus on health IT, according to Jon White, M.D., health IT portfolio manager of AHRQ’s Center for Primary Care, Prevention, and Clinical Partnerships. I’ll try to track down some more details.

Meanwhile, on the publishing front, Atul Gawande, M.D., seems to be doing something useful with his $500,000 “genius grant.” The follow-up to his 2002 best-seller “Complications: A Surgeon’s Notes on an Imperfect Science,” hits bookstores April 10. Read the introduction to “Better: A Surgeon’s Notes on Performance” here.

And finally—stealing a phrase from FierceHealthIT since editor Anne Zieger asked me to link to them—said publication has come out with its list of 10 Top Health IT Innovators for 2007. Anne would like readers to chime in on the selections.

Of course, lots of people have already chimed in on No. 2, namely Practice Fusion, and the CEO of No. 5 athenahealth already has opined in the form of a podcast on this very blog.

Viva la shameless self-promotion!

April 3, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

The whole truth?

Health IT vendor Practice Fusion grabbed headlines a couple of weeks ago with the news, first reported March 16 in the San Francisco Chronicle, that it would offer a free EMR to physician practices, thanks to a “deal” with Google.

Publications nationwide jumped on this story, which some interpreted as Google’s long-anticipated entry into the world of healthcare. As of this morning, Practice Fusion’s own Web site lists no less than 17 instances of media coverage the company has received since then, including my story in Digital HealthCare & Productivity last week.

Thanks to the publication schedule, my story didn’t appear until March 20, which gave me time to put in a call to Google and get spokesman Brandon McCormick to say, “This shouldn’t be interpreted as a product move on Google’s part.”

Further, an e-mailed official statement from Google read as following: “Practice Fusion has recently joined Google’s AdSense program to place ads on their Web pages. AdSense helps hundreds of thousands of publishers effectively monetize online content in just about every vertical category that exists on the Web. Practice Fusion’s participation in our AdSense program is not exclusive and should not be read as an indication of any product plans by Google.”


That makes it sound like Practice Fusion’s invocation of the G word was little more than a publicity stunt. I guess it worked, since so many publications—the Wall Street Journal included—took the bait.

The news also lit up the blogosphere.

Fred Trotter’s post called the news “snake oil” and “bunk”—and that was just in his headline.

A new blog called e-CareManagement took issue with the business model and raised the obvious privacy concerns about an ad-supported EMR. That blog’s writer, Vince Kuraitis, e-mailed me twice last week.

The first message questoned both Practice Fusion’s ethics and the wisdom of publicizing the supposed business connection to Google. The second message, sent exactly nine minutes later, said the following:

…one more thing that doesn’t fit…

Google AdSense revenue is peanuts, see, e.g.,

certainly not enough to sustain an EHR.

On the other hand, you would think that PF would have negotiated a special
click thru rate with AdSense knowing that doctor eyeballs poised on an EHR
at the point of care would be worth a lot more that an average eyeball.

….which would suggest that indeed there is a special deal with Google

…but which Google now denies ????

This thing stinks.

I don’t know if anything stinks or not, but I can vouch for the ad revenue being peanuts. Google doesn’t cut a check unless you have at least $100 in your account. I’ve had AdSense ads on this site since July 2005, and I haven’t seen a dime yet. But I never expected to make a profit from blogging.

On the other hand, Practice Fusion finally updated its blog on Tuesday, the first post since March 6. Perhaps the phones were ringing off the hook there for the past three weeks?

Stay tuned to this story and to my blog. I have at least two more posts in me, and hopefully I’ll have them up in the next day or two.

March 29, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.