Monthly Archives: October 2014

Right Answer, Wrong Question- New CIO EHR Survey

New Survey- “CIOs Say Usability, Search-Related Problems Prevalent Among EHRs”

iHealthBeat reports on new Frost and Sullivan survey focused on CIO EHR perspectives. I believe we need to refocus today’s EHR dialogue on the many benefits EHR provides- this vision seems to be missing. We are playing catch-up to many countries who have embraced EHRs. Survey highlights and summary of my comments posted on iHealthBeat . I see many parallels between the e-commerce revolution in the 1990’s and today’s EHR debate. Copy of my unedited comments below.


Right Answer, Wrong Question…

Asking CIOs how they feel about EHR’s, you would expect comments that today’s EHRs are challenging, slow, and have operational problems. That is the right answer, but in my view the wrong question. While the information gained provides insights into perceptions, the more important question to address is from the CIO perspective, what do they see as the most immediate EHR applications they need to change and/or enhance their current operations, including meeting ACA guidelines and improving their cost/performance benchmarks. What I am suggesting is let’s move the discussion to focus on specific process enhancements that EHRs will drive. My thinking is driven by what we saw in the e-commerce market evolution.

E-commerce, new electronic services that displaced paper, was a driver of the Internet revolution in the late 1990’s. Many saw the vision that cost/performance benefits, not paper or admin cost reduction was the real driver here, but we faced formidable challenges, e.g., lack of standards, privacy, multiple technology platforms, training issues, complexity compared to ‘simple’ paper forms, and others.

From my perspective, sure sounds like exactly what we are facing with today’s migration to EHR. So looking back, what did we learn and what does experience tell us about today’s EHR “revolution.” I see three key directions based on my experience.

First, e-commerce winners understood that changing process, not solely displacing paper, was the key benefit. For example, using electronic purchase orders rather than paper saved paper and admin costs and were more efficient, but they also enabled analytics to optimize supply chains and improve profitability- that could not be done with paper. This was a key point driving e-commerce revolution which myself and others reinforced, i.e., “implementing e-commerce systems will cost more, but you will achieve cost and operational efficiencies and improve your competitive position.” This was not accepted by all at the time. Key point here- today’s EHR’s may cost more but they don’t just automate paper-based record keeping- they really open the door to create new processes and dramatically reshape healthcare. That is the message we should be reinforcing backed up with solid cost- effective applications.

Secondly, new e-commerce applications emerged and many new ventures were spawned contributing to e-commerce market growth. And these were entrepreneurial ventures, targeting sectors and all value chain functions to improve operations, e.g., supply chain management, distribution channel optimization, marketing analytics, and so on. Market growth at the time was fueled by venture capital and creative entrepreneurs, not the major firms. In today’s EHR environment, expect to see many new ventures accelerate in areas of remote telemonitoring, predictive analytics, and others- healthcare is a significant target, long overdue for major cost performance step up, and EHR is the accelerator to make it happen. VCs in my view are still behind the curve here but I believe approaching a critical mass here.


Finally, e-commerce was a global business and, at the time, many new technologies and e-commerce structures emerged overseas. Today, recognize that many countries have EHR adoption rates greater than 90 percent, and we are playing catch-up with EHR adoption at less than 70 percent and CIO resistance based on the survey . In these overseas markets today, EHR is embraced and driving new applications, analytics, and solutions which I expect will play a role as the US market for enhanced EHR achieves what I believe will be exponential growth in the next decade.

Paul B. Silverman writes about entrepreneurship, healthcare, and strategy management. He serves as Managing Partner of the Gemini Business Group, LLC, a consultancy firm, and Adjunct Professor in the R.H. Smith School of Business at the University of Maryland. Contact:; blog; follow @globalbizmentor

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WSJ Article: “VCs Should Back Gadgets for the Sick, Not the Healthy, Doctors Say”

WSJ Article/Comments “VCs Should Back Gadgets for the Sick, Not the Healthy, Doctors Say”

Article in WSJ Venture Capital Dispatch notes that medical professionals believe the investment community is missing the opportunity to develop healthcare solutions for seniors and patients with chronic conditions. Today’s focus is on ‘gadgets’ targeting primarily healthy patients as noted in the WSJ article. I agree with the key points- we are seeing several exciting new healthcare/analytics markets emerge and they are moving quickly- these will attract VC funding-.

Due to space, I posted summary comments on the WSJ site and shared some ideas on opportunities – link to WSJ article and comments:

Full copy of my comments:


Agree- suggest we focus less on the gadgets and more on developing the technologies and solutions to address real needs- senior care, chronic care, prenatal, preventative medicine.  

We are missing the mark but healthcare is now positioned for major capital infusion by investors that understand the market and recognize that analytics, software, and solutions, not hardware or gadgets, will drive and scale the market. I am pleased to share comments on some new directions/numbers here.

New Clinical Decision Support Systems (CDSS) and Clinical and Business Intelligence (C&BI) systems using analytics to achieve performance improvements such as reducing misdiagnosis errors (accounts for about 10 to 30 percent of medical errors) and improving operational efficiency (estimated at $17-29 billion annually due to patient misdiagnosis). These are spawning exciting new related analytics/software ventures to reshape healthcare and streamline clinical analysis.

Look at the upside here- in 2011, a HIMSS study reported only 30 percent of US hospitals had a clinical data warehousing/mining solution. And among these users, only 35 percent of these users employed any analytic tools for predictive modeling, and less than 1 out of 5 of these users even use their transactional systems to capture data. We are in the early growth phase of the exponential growth market for ventures developing creative healthcare applications using ‘big data’ and analytics tools.

The remote healthcare monitoring market is also in its infancy, but positioned for dramatic growth. One driver is EHR adoption now being driven by ACA’s Meaningful Use rules. Integrating EHRs with remote monitoring and analytics, we create exciting new business sectors which, for example, link to medications for compliance, drug efficacy, adverse effect tracking and so on- very exciting area which I have been directly involved with.

Also consider the need, as an example, for prenatal care and chronic conditions treatment in rural areas with 25 percent of population but only 10 percent of physicians- you realize very quickly the benefits offered by emerging enhanced remote healthcare telemonitoring applications. Note these go well beyond the “gadget” market (such as a wristwatch tracking vital signs). I shared comments on EHR directions/recommendations in a prior WSJ posting (“Can Data From Your Fitbit Transform Medicine?:” WSJ Technology, June 23, 2014)

EHR adoption provides the foundation to support remote telemonitoring and other analytics-based applications. A 2012 Commonwealth Fund study showed EHR adoption rates over 90 percent in Australia, the Netherlands, New Zealand, Norway and the U.K., compared to about 69 percent in the U.S. No surprise these countries have healthcare systems that lead the U.S. based on analysis of patient outcomes and cost performance.

New EHR-related applications, analytics, enhanced system ventures represent high growth, and EHR adoption is now accelerating in the US driven by both Meaningful Use and the need to improve cost/performance- these forces will be key healthcare market growth drivers.

Summarizing, there will no doubt be a need for ‘gadgets’ but suggest we keep our focus on the real issues and opportunities such as the above, which represent high sustainable growth creating value for smart investors

Paul B. Silverman


Paul B. Silverman writes about entrepreneurship, healthcare, and strategy management. He than 35 years senior corporate management, global management consulting and entrepreneurial experience and serves as Managing Partner of the Gemini Business Group, LLC, a consultancy firm. He also serves as Adjunct Professor in the R.H. Smith School of Business at the University of Maryland. Contact:; blog; follow @globalbizmentor


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