A Small EHR Vendor’s Emotional Open Letter to Users

flying cadeuciiOver the last few years, we have seen large EHR vendors purchase the moderate size EHR vendors, while moderate-size EHR vendors acquire smaller EHR vendors. We can expect to see a further decline in the number and diversity of EHRs as the IT mandates of Meaningful Use 2 and 3 are technically unachievable for all but the most well-endowed EHR vendors.

Along with the decreasing diversity of EHR options, an increasing number of physicians have lost the ability to choose the most important tool in their black-bag, their EHR, as many are now employed by large organizations which tell the physicians which EHR/HIT tools they are allowed to use.

If there was data that “Certified” EHRs, “Meaningful Use,” ICD10 and PQRS mandates had an impact on the cost or quality of healthcare which was commensurate with the IT costs and logistical disruptions, I would be the first to encourage physicians to use the new and proven technology. Unfortunately, we still do not know if “more” HIT is good for the healthcare system and society in general, or if it is only good for the IT industry.

Below is a letter I sent to the users of ComChart EMR, announcing that ComChart EMR, a product that I have been developing and refining since 1991, and selling since 2000, will no longer be available for sale.

I want to thank you for your years of support and encouragement. Some of you have been using ComChart EMR for more than 15 years. You have provided me with the encouragement, ideas and support which I needed to create the best EMR for the small medical practice. I am not bragging; ComChart EMR has literally had the highest  KLAS rating from 2006 – 2012. In the 2012 ranking, ComChart EMR again had the highest overall score (92.9) and the highest Product Quality Rating (8.4) in the Ambulatory 1-10 Provider category.

Unfortunately, my experience with the recent ComChart EMR upgrade has convinced me that I should stop selling ComChart EMR as more than half of the offices have had upgrade problems.

I believe the technology underlying ComChart EMR has gotten too complicated for smaller offices and the “upgrade” process is too slow for larger offices. In addition, I am not in complete control of the IT situation, I am reliant on Filemaker, Inc and the plugin makers and other HIT vendors and the faxing program companies as well as OS updates – all of these vendors create problems that I have to “solve” and which are beyond my ability to control.

I intend to continue using ComChart EMR in my office until I retire, or I am forced by external factors to give up ComChart EMR. I believe I have another decade in practice. I will continue to develop ComChart EMR for my practice and make these upgrades available to you should you choose to continue to use ComChart EMR. I will continue to support your practices as I have done to date.

If you decide you are not going to continue using ComChart EMR, I would recommend that you purchase a “read-only license”. That will allow you to continue to access your records, read your  records, print out the records, for as long as you need them. The read-only license comes with no technical support. Because of this, you need to be careful about changing operating systems on the computer that is running your read-only version of ComChart EMR.

As some of you know, I’ve blogged about health information technology in the past. Although I am a firm believer that health information technology helps me run a more efficient practice, there is a scarcity of data demonstrating that health information technology improves the quality of health or reduces the cost of healthcare at the societal level. Despite this lack of data, the Federal Government has felt it appropriate to apply financial penalties to physicians who do not use the health information technology software specified by the Federal Government and in the manner mandated by the Federal Government. To a large extend, this problem has occurred because the large EMR/EHR vendors now have undue influence over the Federal Government’s HIT initiative.

I have periodically blogged on the topic of evidence-based medicine as it applies to health information technology. Unfortunately, my comments have fallen on deaf ears.

Personally I am convinced that the solution to the healthcare cost and quality problem does not lie in the application of more/better health information technology. While the data would suggest that health information technology can have a marginal impact on the quality of care, and maybe even on the cost of care, it is not THE solution to a health care cost/quality problem. Politicians should stop listening to the IT geeks and the larger EMR vendors and begin to look at the published data about the efficacy of Certfied EMRs/EHR and Meaningful Use and start listening to the practicing physicians. Believing that more health information technology will solve the healthcare problem will only delay the process of finding a real solution to a very large problem.

I wish my users all the best, and I really appreciate the support you have given me over the years. If you have any questions, feel free to call me on my cell phone or email me, anytime, as you have done in the past.

Hayward Zwerling, M.D.

Hayward Zwerling, M.D. is President ComChart Medical Software

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4 replies »

  1. One key reason for failure of new EHR implementation is failure to bring over all historical medical records to the new system. EHR vendors should make it clear to hospitals that they do not convert over all data to new systems. Hospitals by now must be aware that they need to engage professional Data management companies who can help transition all the historical clinical and clinical data into the new EHR or archive them. When a nurse is forced to lookup two different systems to get a one year old lab report of a patient, I am sure they are not a happy customer! Check more for successful EHR implementation on

  2. I created ComChart EMR serially adding features that I needed in my practice. When my users suggested a feature, if it was something that had widespread applicability and utility, I added it. When meaningful use 1 came around, we did that, although it was a waste of resources and interfere with innovation. To this day, my interaction with my hospital’s EMR, Cerner, has been very disillusioning. When I suggest a new feature, usually something that’s already in ComChart and not in Cerner, the response is “yes we can do it,” but then it never happens or they have reasons why they cannot do it. Or they do it in a way that’s not physician friendly and when I suggest another design, the responses “that is how we do it”. It’s as if the health IT geeks think they really know how an EMR should be designed even though they never practiced medicine.

  3. Sorry to hear things have come to this.

    I understand you’re still very much caught up in this story and this is very personal for you. You’ve been doing this for a long time. But would like to hear a little bit more about ComChart and what you did differently. It sounds like you started by doing something many people don’t: you talked to your users.

    What did they tell you?

  4. On the one hand – it’s a sad story. On the other – there will be more of these “part-time” ISV’s (that baked a quick EHR) to go bust. There’s a lot more to an EHR than custom screens on top of an Access (or Filemaker) database.

    At last count, there were over 400 ISV’s with at least one “meaningful user.” That is simply not sustainable – unless they all standardize on a file/data exchange format. Of course once they do that – they have no business – so it begs the original question. What business were they in? They were selling a custom database to an industry that had money to burn – and couldn’t be bothered with programming.