Pushback to My WSJ Comments “Electronic Medical Records: A Huge, Expensive Burden…”

Pushback to My WSJ Comments “Electronic Medical Records: A Huge, Expensive Burden…”

In response to WSJ article citing EMR problems, last week I posted comments taking position that a full featured EMR system is a “powerful building block improving our healthcare system. The U.S. lags Australia, Netherlands, New Zealand, Norway and the U.K-all have EMR adoption rates above 90 percent… ”

As expected, I have received some pushback to my support for today’s EMR and the outlook/vision I see here. Check out the pushback comments and my reply at WSJ

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Comments on WSJ Post- “EMRs: A Huge, Expensive Burden”

Electronic Medical Records (EMRs) provide the foundation to improve healthcare quality and improve cost performance. And standardized EMRs open the door to telehealth and new analytics to improve clinical decision support systems and save lives. But the transition from paper records, as we learned in the e-commerce revolution, will take time and create disruption. I posted comments on a WSJ post to share my view on the benefits we can expect to see. WSJ post and my edited comments at

Copy of my complete comments as follows:

We need a standardized, full- featured EMR system- this is powerful building block to improve today’s healthcare system. The U.S. lags Australia, the Netherlands, New Zealand, Norway and the U.K., all of which have EMR adoption rates above 90 percent. No surprise these countries have healthcare systems that lead the U.S. based on all patient outcomes/cost performance metrics. Coupled with the ACA’s new core quality measure reporting (‘eCQM’s), we are taking the right steps. But EMR also enables predictive analytics which I see as the Holy Grail here. What lies ahead- new clinical decision support systems improving outcomes; new tools to minimize adverse drug events; improving patient selection for new drug trials; improving surgical outcomes examining chronic issues; and many more. The Social Progress Index report, created by Harvard Business School’s Professor Michael E. Porter’s team, ranked 132 countries using 50 indicators. In the Health and Wellness category the United States ranks poorly at 70th, behind Mali (69th), and Nepal (68th), but, small consolation, ahead of Kuwait (71st). Keep that in mind the next time you hear a pundit say “…our healthcare system works just fine and we don’t need to change it.” These studies are based on metrics/data analysis, not hype or talking points. There will be some disruption, but a standardized EMR system will benefit both the entire healthcare community and the public.

Paul B. Silverman


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Posted Comments -Ex-Apple CEO Invests in Telemedicine

Health telemonitoring market is moving quickly with many major players including Xerox, Medtronics, others.  Posted comments on Fierce Medical Devices article: Ex-Apple CEO investment in remote health monitoring market. Link to article and comments at

Here is copy of my posted comments:

MDI, Xerox’s Healthspot investment are moving us in the right direction-using internet and telemonitoring technology to improve healthcare and create value. As example, look at one area – 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 these emerging healthcare telemonitoring applications. But we can and should be doing more here. Several observations:

— We need standardized EHRs and adoption now being driven by ACA’s Meaningful Use rules. Integrating EHRs with remote monitoring and analytics, we create exciting new opportunities linking to medications for compliance, drug efficacy, adverse effect tracking, and so on. EHR adoption is over 90% in many countries and we are about 60%- we can do better here. EHRs provide the transactional data to support “big data” analytic solutions.

–No doubt telemonitoring and kiosks will improve healthcare and hopefully achieve the $6B projected healthcare savings. All players should emphasize analytics, how analytics will be used to support clinical care decisions, how patient data to personalize healthcare, develop improved treatment modalities and so on. These analytical tools exist, can make a difference, and help address the 30% of all medical errors due to misdiagnosis. Very high leverage and upside here but I do not hear these discussed- they should be

–New ACA regulations/penalties imposed to reduce readmissions are forcing institutions to establish new processes to address after discharge patient tracking- while the emphasis of these “kiosk centric” ventures has been mostly walk-in users, I see several major hospital related markets such as readmission reduction and others which I believe will be significant.

–Pharma clinical trials demand working with 1,000’s of patients and closely tracking their meds during the Phase I/II trials. Networks of remote kiosks provide an excellent vehicle to support new drug clinical trials more efficiently than done today

No question exciting times and strong growth ahead in the remote telemonitoring and medical monitoring device market – lets do what is needed here to use these new offerings to create value and improve our healthcare system

Paul B. Silverman

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Comments – NPR: Surprise Medical Bills: ER Is In Network, But Doctor Isn’t

Posted comments today on NPR story about ER billing problems using ER services in Texas. Ironic, as noted in my comments,  Texas is one of the states that has pushed back most strongly on ACA efforts to improve our healthcare system. So if you do have an emergency while traveling in Texas, on the way to the ER in the ambulance, I suggest make sure you check that you are covered for both hospital and doctor costs. Looks like “every doctor  for himself” there- what a way to run a healthcare system. We can fix this and I believe with modifications ACA is the vehicle to accomplish this objective.

You can read my comments and the NPR article at

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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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Posted Comments on Fierce EMR: Should more be done to make docs happier with EHRs?

The ACA’s efforts to ensure ‘mesningful use’ of EHRs are creating backlash from practitioners and other healthcare players. Costs, operational issues, security, are among the problems often cited- these were reviewed in a May 29th article on FierceEMR (“Should more be done to make docs happier with EHR’s?”).

I posted comments emphasizing EHRs are a positive driver tor the healthcare sector, and shared a vision on what predictive analytics solutions are coming to improve healthcare quality and lower costs. EHR’s provide the foundation to help make this happen.

Here is an excerpt from my comments …

No question the EHR transition is creating challenges and physicians are on the front line here.But EHRs do provide the foundation to dramatically reshape today’s healthcare system and this is not an
overstatement. Take a step back here and look at the facts and what lies ahead

First our healthcare system is broken-most of us know the numbers, e.g., healthcare costs at 18 percent of GDP, etc. And we also see multiple studies showing the quality of U.S. healthcare lags behind most nations. I just reviewed the Social Progress Index report, created by a team led by Harvard Business School’s Professor Michael E. Porter- the report ranked 132 countries using 50 indicators. In the Health and Wellness category the United States ranks poorly at 70th, behind Mali (69th), and Nepal (68th), but, small consolation, ahead of Kuwait (71st).
Keep that in mind the next time you hear a pundit say “…our healthcare system works just fine and we don’t need to change it.” These studies are based on metrics and data analysis, not hype or talking points.

The ACA through the three stage meaningful use process is driving EHR adoption. The Commonwealth Fund surveyed doctors in 10 countries in 2012 and… READ MORE AT


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