tag:blogger.com,1999:blog-43505262756521793352024-03-12T22:57:21.680-04:00Securing and Exchanging Health Information in ChattanoogaThis blog is dedicated to sharing my thoughts on the topics of health information exchange (HIE) and electronic health records (EHR). While I am focusing on Chattanooga and the surrounding areas, some posts will apply to the whole national scene.Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-4350526275652179335.post-82713062766373664892018-01-30T23:04:00.000-05:002018-01-30T23:04:01.235-05:00Finally!!! Apple has entered the EHR field <span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Apple has entered the EHR field. This is very good news for patients. <a href="http://www.zdnet.com/article/apple-can-win-electronic-medical-record-game-with-health-records-in-ios-heres-7-reasons-why/" target="_blank">Zdnet</a> has a very interesting article forecasting that Apple will have success. Here are the seven reasons why:</span><br />
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<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"The Apple Watch and iPhone is a conduit for micro-level data such as heart rate, activity and if in some cases medical conditions. Apple's HealthKit already gives the company a foothold in the healthcare market.</i></span></li>
</ul>
<ul>
<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>Apple is good with partnering. Just like Apple has with enterprise technology giants, the company has partnered with the leading players in the health record space. Apple is going for the aggregation approach and partnering to suck in data from participating medical institutions in one place.</i></span></li>
<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>The leading medical data players are on board with Health Records. Apple is starting with a dozen hospitals including Johns Hopkins Medicine and Penn Medicine and has connections into Epic Systems and Cerner. Epic and Cerner are the leading players in the medical record management space. Think of Epic as the SAP of hospital management software. The hospitals listed as Apple's launch partners run on Epic and Cerner for the most part.</i></span></li>
<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>Apple is going along with standards. Health Records is based on FHIR (Fast Healthcare Interoperability Resources), which is a standard for transferring electronic medical records.</i></span></li>
<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>The healthcare industry has already done a lot of the heavy lifting. The real work to move to electronic medical records has occurred over the last decade with a push from the government. All that IT integration primed the pump for a player like Apple to bring healthcare data to consumer devices.</i></span></li>
<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>Apple's enterprise footprint can be leveraged. When Apple is <a href="https://www.apple.com/healthcare/" style="cursor: pointer; text-decoration: none;" target="_blank">pitching its health record</a> and portal wares it appeals to IT executives directly.</i></span></li>
<li><span style="color: #444444; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>Privacy. Apple has played the privacy marketing well and differentiated itself from Google's cloud and data centric approach. In areas like artificial intelligence, Apple's approach is a handicap. In healthcare, that approach is an asset as Health Records will be encrypted and protected under a user's iPhone passcode."</i></span></li>
</ul>
Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-74749936659660149672015-04-12T18:40:00.004-04:002015-04-12T18:41:48.478-04:00Health Information Blocking - Congress report<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In my interactions with EHR companies over the years I have witnessed a reluctance to allow providers share "their own patients" information outside of that specific EHR ecosystem. </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Sometimes this was veiled and presented as a concern for patient security while other times it was quite blunt, scaring providers with the high costs of interfaces. </span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In a report presented this week by ONC, it was suggested that the Congress needs to intervene to prevent the intentional blocking of patient record sharing by health care providers and electronic record vendors. Here is a link to that report</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><a href="http://healthit.gov/sites/default/files/reports/info_blocking_040915.pdf">http://healthit.gov/sites/default/files/reports/info_blocking_040915.pdf</a></span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-30621458167002021402015-04-12T18:13:00.002-04:002016-08-01T14:58:18.325-04:00Your mother's maiden name<h1 class="title" style="-webkit-hyphens: manual; font-weight: normal; max-width: 100%;">
<span style="color: #414141; font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: small; line-height: 29px;"><span style="font-weight: normal;">Below is a very interesting article I found <a href="http://fusion.net/story/62076/mothers-maiden-name-security-question/" target="_blank">here</a> on the history and perils of choosing your mother's maiden name as a security question. </span> </span></span></h1>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif; font-size: small;">"Your mother’s maiden name has been a ‘security question’ since 1882</span></h1>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">It’s well-established that passwords are a flawed security system. Attackers can guess them, steal them from a database, or watch you type them in. But until we can get our smartphones to take our DNA to confirm our identities, we’re stuck with them.</span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">The processes that let you recover your password if you forget it, though, can be much worse than passwords themselves.</span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Companies that take security seriously will ask you to authenticate your identity with a “second factor,” such as a code they send to a device they know you own. Companies that <del style="max-width: 100%;">don’t care</del> are more casual about your privacy will ask you to answer “security questions” — which are typically questions that anyone could guess after a thorough stalking of your Facebook account: Oh, there’s a photo of you with your high school best friend. Oh, there’s a status update with your “porn star name,” combining your first pet’s name with the first street you lived on. (It’s possible the NSA invented that game.) And oh, there’s your mom commenting on everything you upload, and look, she’s divorced and using her maiden name. Pwned.</span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Disturbingly, security questions haven’t changed much over the last century. During a search for the inventor of the “<a href="http://en.wikipedia.org/wiki/One-time_pad" style="color: #416ed2; max-width: 100%; text-decoration: none;">one-time pad</a>” (the only theoretically unbreakable code system), Columbia computer science professor Steven Bellovin <a href="https://mice.cs.columbia.edu/getTechreport.php?techreportID=1460" style="color: #416ed2; max-width: 100%; text-decoration: none;">came across</a> a paper from 1882 in the Library of Congress about encrypting telegrams so they couldn’t be read in transit by snoops. He discovered that we were using “mother’s maiden name” as a security question over 130 years ago. From <a href="https://mice.cs.columbia.edu/getTechreport.php?techreportID=1460" style="color: #416ed2; max-width: 100%; text-decoration: none;">Bellovin’s 2011 paper</a> on crypto history, in which he writes, “Mother’s maiden name, that old standby ‘secret,’ was used that way at least as early as 1882:”</span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Frank Miller, the author of the 19th Century paper, “Telegraphic Code to Insure Privacy and Secrecy in the Transmission of Telegrams,” was a California banker. He was using telegrams for banking activity. “It would probably have been used when wiring money to someone,” said Bellovin by email. “The message would be from one bank to another, saying (via codewords): ‘Give $XXX to Joe Smith; he will authenticate himself by saying that his mother’s maiden name is Jones.'”</span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">I’d like to say maiden names are still around as an identity authenticator because it’s “stood the test of time,” but really it’s just because we are a bit lazy and uncreative when it comes to security. The question was never a great one but certainly worked better in the 1800s when women were less likely <a href="http://www.huffingtonpost.com/2013/04/14/changing-your-last-name_n_3073125.html" style="color: #416ed2; max-width: 100%; text-decoration: none;">to keep their maiden names</a> after getting married, and in a time when no one’s mother was on Facebook."</span></div>
Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-87467352830549508502014-09-02T10:45:00.000-04:002014-09-02T10:45:36.261-04:00Where is the health IT interoperability in 2014?<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The quick answer is: it is morphing (still !!). This article from <a href="http://www.lexology.com/library/detail.aspx?g=ae5b5243-616a-4665-b650-0ae6648cfa12" target="_blank">Lexology</a> does a good job of describing where we are at the moment.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: small;">Laser focus on health IT interoperability</span></h1>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The Health Information Technology for Economic and Clinical Health Act (HITECH Act) requires that the U.S. Department of Health and Human Services (HHS), in implementing the electronic medical records “meaningful use” incentive program, focus on the secure exchange of health information to improve individual and population health. Exchange requirements were fairly minimal, however, in the first stage of the program. Stage 2 began for early adopters this year, and concerns are being raised about the inability of program participants to meet exchange objectives, including:</span></div>
<ul style="background-color: #fbfbfb; color: #414141; line-height: 27px; max-width: 100%;">
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Exchanging information with other healthcare providers to support transitions in care.</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Sharing data with patients through portals and secure e-mail.</span></li>
</ul>
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<strong style="max-width: 100%;"><em style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lack of Interoperability Interferes with Sharing</span></em></strong></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lack of “interoperability” is commonly perceived to be the main obstacle to sharing data. From a technical standpoint, interoperability is “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.” (IEEE Standard Computer Dictionary, 1990) In the context of health IT, interoperability is more broadly understood to refer to the ability of disparate entities to access and share health information that can be easily utilized to inform decision-making by providers and patients and provide the foundation for improvements in individual and population health.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Pockets of interoperability exist today. The more robust interoperability needed to fully leverage the promise of health IT, however, has not yet been realized.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">At the August Health IT Policy Committee, the HHS presented a summary of survey research on health information exchange activity between physicians and hospitals, as well as between providers and patients. Prior to Stage 2 of meaningful use, exchange among providers – particularly exchange with external providers – remained fairly limited, although it had increased since 2008. Early Stage 2 data shows there still is only a limited exchange of data to support transitions in care, and a significant number of patients continue to report gaps in information-sharing.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The HHS summary reinforced key themes that emerged from “listening sessions” conducted by the Health IT Policy Committee’s Information Exchange workgroup and reported to the Policy Committee at its April 2014 meeting. Those sessions revealed that providers participating in the meaningful use program were undergoing significant challenges in meeting both of the Stage 2 exchange goals—supporting transitions in care and implementing data sharing with patients through secure portals and e-mail.</span></div>
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<strong style="max-width: 100%;"><em style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">New Focus on a Solution</span></em></strong></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In the past, solving obstacles to exchange was seen as having at least two major dimensions:</span></div>
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<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Technical barriers (specifically, the inability of different electronic medical record (EMR) systems to be able to send, receive and “consume” relevant clinical information about a patient), and</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Lack of incentives to share information in fee-for-service payment models.</span></li>
</ul>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">With payment reform—including Accountable Care Organizations (ACOs), medical homes, and bundled and value-based payments—gaining a greater foothold in the industry, the demand from providers to share data with one another is growing. In addition, HHS now seems more focused on finding answers to the remaining technical and policy obstacles to exchange.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The latest effort to overcome challenges to interoperability began in March 2013, when the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) sent out a request for feedback from the public on “Advancing Interoperability and Health Information Exchange.” Several months later, the agencies jointly <a href="http://www.cms.gov/ehealth/downloads/Accelerating_HIE_Principles.pdf" style="color: #416ed2; max-width: 100%; text-decoration: none;" target="_blank">issued a report</a> summarizing the public’s comments and identifying a number of principles and strategies for accelerating HIE.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">On June 5, 2014, ONC, under new leadership, issued a “<a href="http://healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf" style="color: #416ed2; max-width: 100%; text-decoration: none;" target="_blank">10-Year Vision to Achieve an Interoperable Health IT Infrastructure</a>” that includes a short list of overarching guiding principles, broad goals and representative “use cases” that illustrate those goals to be met within three, six and 10 years. The agenda for achieving the vision, which is intended to engage all aspects of the federal government, focuses on five “building blocks”:</span></div>
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<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Core technical standards and functions</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Certification to support adoption and optimization of health IT products and services</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Privacy and security protections for health information</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Supportive business, clinical, cultural and regulatory environments</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Rules of engagement and governance</span></li>
</ol>
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<strong style="max-width: 100%;"><em style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">A National Interoperability Roadmap to Achieve the 10-Year Vision</span></em></strong></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">At the August 2014 meeting of the Health IT Policy Committee, Erica Galvez, the Interoperability Portfolio Manager for ONC, presented ONC’s efforts to develop a national interoperability roadmap to achieve its 10-year vision. The roadmap is expected to address three key questions:</span></div>
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<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">What are the critical technologies and policies (including governance) required to achieve the vision?</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Who needs to do what and by when (including government, technology developers and technology users)?</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">How will the roadmap be updated over time and at what frequency?</span></li>
</ul>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The roadmap is currently in development, informed by both an online community forum and the federal Health IT Policy and Standards Committees. The work is being augmented by research and analysis that both staff and consultants are actively performing.</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The initial draft is expected to be released in October, in time for a joint meeting of the Health IT Policy and Standards Committees scheduled for October 15. The draft will be subject to comment from the Committees and their working groups, as well as from the public. The final roadmap is expected to be released in March 2015.</span></div>
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<strong style="max-width: 100%;"><em style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Efforts Informing the Roadmap’s Development</span></em></strong></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">A number of developments could inform the roadmap’s development, including:</span></div>
<ul style="background-color: #fbfbfb; color: #414141; line-height: 27px; max-width: 100%;">
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In March 2014, the GAO issued a report criticizing HHS for its exchange strategy. The report urged the Department to develop specific actions to advance health information exchange and to set milestones with timeframes for the actions to gauge progress more accurately.</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In April 2014, the Agency for Healthcare Research and Quality released the JASON report prepared by Mitre Corporation, on “A Robust Health Data Infrastructure.” The report includes recommendations for developing a health information-sharing software infrastructure within the next 12 months, based on published application programming interfaces (APIs). Patients would control the sharing of their health data through expressed privacy preferences. The Health IT Policy and Standards Committees have established a joint workgroup to evaluate this report and provide feedback.</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In June 2014, an article published in JAMIA by the SMART (Substitutable Medical Applications and Reusable Technology) C-CDA Collaborative <a href="http://jamia.bmj.com/content/early/2014/06/26/amiajnl-2014-002883.full" style="color: #416ed2; max-width: 100%; text-decoration: none;" target="_blank">identified issues with interoperability for C-CDAs</a>, the standard for document exchange to support transitions of care for Stage 2 of meaningful use. The article suggested practical opportunities to improve C-CDA exchange capabilities in the coming years.</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The U.S. Senate included language in the draft HHS appropriations bill directing the federal Health IT Policy Committee to submit a report on the technical, operational and financial barriers to electronic health records interoperability.</span></li>
<li style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The private sector also is launching efforts to advance interoperability, including Healtheway’s Carequality initiative and the eHealth Initiative’s 2020 Roadmap.</span></li>
</ul>
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<strong style="max-width: 100%;"><em style="max-width: 100%;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Conclusion</span></em></strong></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The onset of Stage 2 has placed long-standing obstacles to exchange in sharper relief, and the recent spate of activity presents a critical opportunity for HHS to use its policy levers to build a firmer foundation for advancing interoperability. The success of this intensive effort, however, will depend as well on the willingness of the industry and other stakeholders to participate—and to embrace and support the changes that may be necessary to achieve interoperability.</span></div>
Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-15758075894949567232013-12-19T00:10:00.001-05:002013-12-19T00:10:05.949-05:00HealthVault - Psst, it's free!<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">If you are a patient desiring to keep track of your of health care electronically, Microsoft HealthVault is there to help. Once you sign up for free, HealthVault will give you a Direct Exchange address. You can give this address to your providers and, if they are Direct enabled, they will be able to send you results electronically to your HealthVault account. By the way, you can sign in to Microsoft HealthVault with your FaceBook account. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Here is an example of a letter HealthVault offers you to give to your doctor:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">----</span><br />
<span style="font-family: Courier New, Courier, monospace;">Microsoft HealthVault</span><br />
<span style="font-family: Courier New, Courier, monospace;">Patient Name: <b>Your Name</b></span><br />
<span style="font-family: Courier New, Courier, monospace;">Direct address: <b>yourname@direct.healthvault.com</b></span><br />
<span style="font-family: Courier New, Courier, monospace;"><br /></span>
<span style="font-family: Courier New, Courier, monospace;">Please send my medical information from your medical records system directly to my personal HealthVault record using the Direct address listed above.
I’m taking an active role in my health and wellness by keeping a personal health record in HealthVault. By sending my medical information directly to HealthVault, you can help me manage the information about my health care. Thank you.
</span><br />
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<span style="font-family: Courier New, Courier, monospace;">More information
If you are using an electronic health record (EHR) system that is certified for Meaningful Use Stage 2, then your software may be able to generate a CCDA and send it to me using the Direct protocol. (As you may know, Direct is a security-enhanced health messaging protocol designed to help protect health information when it is sent from one computer system to another). Your EHR software vendor should be able to provide instructions.</span><br />
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<span style="font-family: Courier New, Courier, monospace;">If you can’t yet send information via Direct, can you give electronic records another way, such as a disc? <i>(My plug: or suggest the provider contacts Infomedtrix for a provider Direct account)</i> HealthVault accepts structured information in CCDA, CCD, CCR, and BlueButton formats, as well as information in unstructured files as images, PDFs, and text.
You can find more information about HealthVault and how it supports Meaningful Use Stage 2 at www.healthvault.com/providers.</span><br />
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<br />Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-6664823124378469182013-11-10T15:35:00.001-05:002013-11-10T15:40:24.879-05:00Infomedtrix Achieves DirectTrust.org/EHNAC Accreditation<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i><br /></i></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>Direct Trusted Agent accreditation ensures adherence to data processing standards and compliance with security infrastructure, integrity and trusted identity requirements </i></span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Chattanooga, TN – Nov 5, 2013 – Infomedtrix LLC announced today it has achieved full accreditation with the Direct Trusted Agent Accreditation Program (DTAAP) for HISP, CA or RA from DirectTrust.org and the Electronic Healthcare Network Accreditation Commission (EHNAC). Direct Trusted Agent accreditation recognizes excellence in health data processing and transactions, and ensures compliance with industry-established standards, HIPAA regulations and the Direct Project.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Through the consultative review process, EHNAC evaluated Infomedtrix LLC in areas of privacy, security and confidentiality; technical performance; business practices and organizational resources as it relates to Directed exchange participants. In addition, EHNAC reviewed the organization’s process of managing and transferring protected health information and determined that the organization meets or exceeds all EHNAC criteria and industry standards. Through completion of the rigorous accreditation process, the organization demonstrates to its constituents, adherence to strict standards and participation in the comprehensive, objective evaluation of its business.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">“Endorsed by the Office of the National Coordinator for Health Information Technology (ONC), the Direct Trusted Agent Accreditation Program ensures that organizations like Infomedtrix LLC establish and uphold a superior level of trust for their stakeholders,” says Lee Barrett, executive director of EHNAC. “The need in the marketplace for guidance and accountability in health information exchange is undeniable, and we applaud Infomedtrix’ commitment to the highest standards in privacy, security and confidentiality.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">About DirectTrust.org</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">DirectTrust.org is a non-profit, competitively neutral, self-regulatory entity created by and for participants in the Direct community, including HISPs, CAs and RAs, doctors, patients, and vendors, and supports both provider-to-provider as well as patient-to-provider Direct exchange. The goal of DirectTrust.org is to develop, promote and, as necessary, help enforce the rules and best practices necessary to maintain security and trust within the Direct community, consistent with the HITECH Act and the governance rules for the NwHIN established by ONC.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">DirectTrust.org is committed to fostering widespread public confidence in the Direct exchange of health information. To learn more, visit www.directtrust.org.</span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">About EHNAC</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The Electronic Healthcare Network Accreditation Commission (EHNAC) is a voluntary, self-governing standards development organization (SDO) established to develop standard criteria and accredit organizations that electronically exchange healthcare data. These entities include electronic health networks, payers, financial services firms, health information exchanges, medical billers, outsourced services, e-prescribing solution providers and direct trusted agents. </span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">EHNAC was founded in 1993 and is a tax-exempt 501(c)(6) nonprofit organization. Guided by peer evaluation, the EHNAC accreditation process promotes quality service, innovation, cooperation and open competition in healthcare. To learn more, visit www.ehnac.org or contact info@ehnac.org. Connect with EHNAC on Twitter, YouTube, LinkedIn and Facebook.</span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-66297206582011733212013-09-29T19:03:00.002-04:002013-09-29T19:15:00.138-04:00When to automate manual tasks<div class="separator" style="clear: both; text-align: justify;">
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Today I was trying to automate some of the manual tasks involved in keeping our infrastructure running smoothly. Whenever I do this, it means writing programs, scripts, macros, etc, so I can speed things up. However, the automation process takes effort. </span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">So, when does automation save you time? </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This table I found </span><a href="http://imgs.xkcd.com/comics/is_it_worth_the_time.png" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;" target="_blank">here</a><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> offers a good indication:</span></div>
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<a href="http://4.bp.blogspot.com/-K2eLEKgAvuc/UkivD_uHZJI/AAAAAAAAADo/aPxRU1C-Yn4/s1600/is_it_worth_the_time.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="260" src="http://4.bp.blogspot.com/-K2eLEKgAvuc/UkivD_uHZJI/AAAAAAAAADo/aPxRU1C-Yn4/s320/is_it_worth_the_time.png" width="320" /></a></div>
<br />Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-47450379065173398482013-09-17T22:05:00.001-04:002013-09-23T20:47:55.568-04:00Our friends: Bob and Alice<span style="font-family: Arial, Helvetica, sans-serif;">Our BeDirect secure messaging sytem uses various encryption systems. Some of them are asymmetric and based on the Rivest-Shamir-Adleman algorithm also known as RSA. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Today I ran across this lecture on RSA and really enjoyed it. It is given in English by a German professor at Ruhr University in Bochum. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Bob & Alice? They are the characters employed in the majority of cryptography demonstrations. They come to the professor's rescue as well :-).</span><br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/guYNbJkiGUI" width="400"></iframe>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-90586452536187931702013-09-12T18:10:00.000-04:002013-09-16T22:03:39.994-04:00HIPAA Omnibus - Sep 23, 2013 On September 23 2013, HIPAA Omnibus becomes enforceable. The practices we have helped get ready for this deadline have found the requirements pretty straight forward. Here are the main areas addressed by the new rule:<br />
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- Revisions to the Notice of Privacy Practices<br />
- Revisions to the Business Associate Agreements<br />
- Prohibitions on sale of protected health information<br />
- The right to restrict disclosures to a health plan when services are paid for out-of-pocket<br />
- The new breach risk assessment provisions<br />
- Patients' ability to request a copy of their electronic medical record in electronic format<br />
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The Office for Civil Rights (OCR) has published a YouTube video summarizing the requirements for HIPAA Omnibus rule. <br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/mX-QL9PoePU" width="420"></iframe></div>
Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-51569724661993247792013-01-04T15:43:00.003-05:002013-01-27T12:56:09.667-05:00Participating in an HHS solicitation for NwHIN Direct HISP<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<span style="font-family: Arial, Helvetica, sans-serif;">In September 2012, <span style="background-color: white; line-height: 19px;">the Centers for Disease Control and Prevention (CDC) published solicitation </span><a href="https://www.fbo.gov/spg/HHS/CDCP/PGOA/2012-Q-49852/listing.html" target="_blank">2012-Q-49852</a>. <span style="background-color: white; line-height: 19px;"> This was a requirement for Health Information Service Provider (HISP) Services and implementation of the Nationwide Health Information Network (NwHIN) Direct Transport Protocol for the National Healthcare Safety Network (NHSN). </span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We decided to bid for the design of this HISP. The HISP we proposed was designed to allow CDC/NHSN to communicate with around 400 hospitals around the country using the Direct protocol. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">We worked hard putting the proposal together for this solicitation. We felt that the experience we had gathered running large messaging systems and deploying <a href="http://www.bedirect.co/" target="_blank">BeDirect</a>, a HISP based on NwHIN Direct specifications, would help in the successful implementation of HISP services for NHSN.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">There were more than 18 interested entities that applied for this HHS award.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Although we did not win the award, it was encouraging to know that the highest score was 98 and ours was 91 … or as the CDC contract coordinator put it , we were "the 3rd highest" in the nation. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">This experience was very positive and it allowed us to sharpen our design for our current <a href="http://www.bedirect.co/" target="_blank">HISP</a>. </span></div>
Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-35781992752765595802013-01-04T14:52:00.000-05:002013-01-04T15:01:18.277-05:00Year 2012 in review<br />
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This is how 2012 went for us:</div>
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- Finished a large EHR implementation at a cardiology practice. We chose eClinicalWorks and went live with the clinical and billing part in August. We deployed several interfaces: a hospital interface with Parkridge Hospital, and equipment interfaces with CardiacScience devices.<br />
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- Helped six providers attest for using their EHR meaningfully (<a href="http://www.cms.gov/apps/ehr/">http://www.cms.gov/apps/ehr/</a>)</div>
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- Launched - BeDirect (<a href="http://www.bedirect.co/">www.bedirect.co</a>)- the first NwHIN Direct HISP in Chattanooga and for that matter in the South East Tennessee. </div>
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- Participated in several Direct Connect-a-thons (<a href="http://wiki.directproject.org/Dec+2012+Connect-A-Thon">http://wiki.directproject.org/Dec+2012+Connect-A-Thon</a>)</div>
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2012 was a very busy year with very little time to write :-).</div>
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-Doru</div>
Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-62154651422037012242012-01-16T21:09:00.005-05:002012-01-19T08:40:38.120-05:00Meaningful Use Attestation - EHR used by 22962 providers<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">This week CMS <a href="http://explore.data.gov/d/8pfj-qf8a">released</a> the list of providers (anonymized) who attested for meaningful use in 2011. The data comes from 22,962 providers and is a gold mine. I have played with the dataset for a bit trying to see who has a the greatest electronic medical records market share. </span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">I admit, the stats may be misleading when it comes to the big EHR systems used by hospitals. For instance, one install of Meditech can be used by hundreds of providers in a hospital setting and it would count here as one. So, use your judgement when looking at the table below. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Here are the results:</span><br />
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<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; width: 356px;"><colgroup><col style="mso-width-alt: 2688; mso-width-source: userset; width: 63pt;" width="63"></col> <col style="mso-width-alt: 11050; mso-width-source: userset; width: 259pt;" width="259"></col> <col style="mso-width-alt: 1450; mso-width-source: userset; width: 34pt;" width="34"></col> </colgroup><tbody>
<tr height="14" style="height: 14.0pt;"> <td class="xl64" height="14" style="height: 14.0pt; width: 63pt;" width="63"><b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Rank</span></b></td> <td class="xl63" style="width: 259pt;" width="259"><b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Unique EHR</span></b></td> <td class="xl63" style="width: 34pt;" width="34"><b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Providers </span></b></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Epic Systems Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6330</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">eClinicalWorks LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1847</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Allscripts</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1502</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">athenahealth, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1158</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Community Computer Service, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">999</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">GE Healthcare</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">921</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">NextGen Healthcare</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">899</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">8</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">e-MDs, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">770</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Greenway Medical Technologies, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">712</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Cerner Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">567</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">11</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Sage</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">565</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">12</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">BioMedix Vascular Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">397</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">13</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">HCA Information & Technology Services, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">264</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">14</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MEDITECH</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">256</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">15</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">AmazingCharts.com, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">252</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">16</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Eyefinity/OfficeMate</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">239</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">17</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">meridianEMR, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">210</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">18</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">McKesson</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">206</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">19</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Sammy Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">199</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">20</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">SOAPware, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">179</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">21</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Health IT Services Group</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">174</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">22</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ChartLogic, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">164</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">23</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedInformatix, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">147</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">24</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Compulink</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">144</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">25</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">CPSI (Computer Programs and Systems), Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">142</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">26</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Altos Solutions, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">141</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">27</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">STI Computer Services, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">134</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">28</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Intuitive Medical Software</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">125</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">29</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">AllMeds, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">113</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">30</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Practice Fusion</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">113</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">31</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Ingenix</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">107</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">32</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medflow</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">102</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">33</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Aprima Medical Software, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">95</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">34</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedPlus, A Quest Diagnostics Company</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">94</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">35</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">gMed, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">88</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">36</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Meditab Software, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">88</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">37</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">DrFirst</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">82</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">38</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">WellCentive</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">81</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">39</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">SuccessEHS</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">78</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">40</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">GEMMS, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">77</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">41</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Prime Clinical Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">77</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">42</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">SuiteMed</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">69</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">43</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Pulse Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">67</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">44</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Clarkson Eyecare</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">65</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">45</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">gloStream, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">59</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">46</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">NexTech Systems Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">58</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">47</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Healthland, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">54</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">48</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Siemens Medical Solutions USA Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">54</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">49</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Waiting Room Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">48</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">50</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">HealthFusion</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">42</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">51</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">T-System Technologies, Ltd.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">42</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">52</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">BizMatics Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">40</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">53</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Office Ally</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">39</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">54</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">digiChart, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">38</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">55</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">M3 Healthcare Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">38</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">56</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ACOM Health</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">37</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">57</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Iatric Systems, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">32</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">58</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Sevocity a division of Conceptual MindWorks, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">30</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">59</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MacPractice, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">29</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">60</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">NCG Medical Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">29</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">61</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Healthcare Management Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">28</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">62</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MTBC (Medical Transcription Billing Corporation)</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">28</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">63</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MCS - Medical Communication Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">26</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">64</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Trinity Health, Trinity Information Services</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">26</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">65</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Advanced Data Systems Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">24</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">66</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">iSALUS Healthcare</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">24</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">67</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MDLAND</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">24</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">68</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">UltraMed Software</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">24</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">69</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Digital Medical Solutions Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">23</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">70</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedLink International, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">23</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">71</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EMedicalNotes, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">21</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">72</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ManagementPlus</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">21</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">73</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ADP AdvancedMD</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">20</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">74</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">American Medical Software</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">20</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">75</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">GeniusDoc, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">20</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">76</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MPN Software Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">20</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">77</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Addison Health Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">19</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">78</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ClearPractice</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">19</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">79</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Encite, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">18</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">80</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Trellix Engineering Corp.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">18</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">81</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medical Informatics Engineering</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">17</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">82</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Prognosis Health Information Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">17</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">83</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">CodoniX</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">15</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">84</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Intivia, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">15</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">85</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Health Innovation Technologies, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">14</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">86</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">iMedicWare, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">14</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">87</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Midwest Software, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">14</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">88</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Penn Medical Informatics Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">14</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">89</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Phoenix Ortho, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">14</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">90</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Crowell Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">13</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">91</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Health Care Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">13</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">92</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PlatinumMD</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">13</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">93</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Businet, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">12</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">94</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ExitCare, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">12</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">95</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Indian Health Service</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">12</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">96</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">IOS Health Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">12</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">97</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Insight Software, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">11</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">98</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">OCERIS, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">11</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">99</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Sequel Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">11</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">100</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Clinix MIS LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">101</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">E-Z BIS, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">102</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MicroFour, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">103</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PBO</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">104</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">StreamlineMD, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">105</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">TriMed Technologies Corp</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">10</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">106</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Darena Solutions LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">107</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">dbMotion</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">108</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MagView</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">109</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Mighty Oak Technology, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">110</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Nuesoft Technologies, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">111</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">SynaMed, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">112</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Ulrich Medical Concepts</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">113</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">VIP Medicine, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">9</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">114</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Criterions LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">8</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">115</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MED3000, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">8</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">116</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Midas+ / ACS a Xerox Company</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">8</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">117</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ABEL Medical Software Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">118</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Crystal Practice Management</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">119</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Henry Schein Medical Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">120</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Integrated Systems Management, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">121</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MEDHOST</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">122</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medical Office Online, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">123</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Noteworthy Medical Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">124</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Orion Health</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">125</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">QRS Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">7</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">126</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">AllegianceMD Software, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">127</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">DoctorsPartner, LLC.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">128</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">eCareSoft Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">129</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">First Insight Corp</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">130</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Health Systems Technology, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">131</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ifa united i-tech Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">132</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Jefferson Technical Services, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">133</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MediSYS</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">134</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Spring Medical Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">6</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">135</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Altapoint Data Systems, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">136</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">DrChrono.com Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">137</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">empowersystems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">138</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Forte Holdings</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">139</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Health Management Associates</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">140</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ICANotes, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">141</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medcom Information Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">142</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Networking Technology dba RxNT</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">143</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PatientNOW</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">144</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ProMed Clinical Systems, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">145</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Acurus Solutions Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">146</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Aurora Health Care, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">147</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Comtron Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">148</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">CureMD Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">149</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EyeMD EMR Healthcare Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">150</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EZnotes, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">151</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Glenwood Systems LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">152</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Infor-Med Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">153</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedcomSoft</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">154</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medsphere Systems Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">155</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Net Health Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">156</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">RazorInsights</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">157</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">TechSoft, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">158</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Valant Medical Solutions, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">159</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">XLEMR</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">160</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Covisint</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">161</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Data Strategies, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">162</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Diversified Ophthalmics, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">163</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Doctor Office Management, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">164</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Emdeon Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">165</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Future Health</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">166</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">H-DOX</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">167</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">HHT International, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">168</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Integrated Health Care Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">169</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Integrated Practice Solutions, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">170</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">IO Practiceware, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">171</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedSym, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">172</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedXLnce, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">173</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Netsmart Technologies</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">174</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Outcome Sciences, Inc. (Outcome)</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">175</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Partners Healthcare System</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">176</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Rheumatology and Dermatology Associates PC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">177</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Soren Technology</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">178</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">TRANSMED NETWORK INC.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">179</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">UNI/CARE Systems, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">180</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Acrendo Software, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">181</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">DigiDMS</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">182</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">eCast Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">183</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EMRlogic Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">184</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Falcon, LLC.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">185</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Health Administration Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">186</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">HealthPort</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">187</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Institute for Health Metrics</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">188</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Keiser Computers, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">189</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">KeyMedical Software, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">190</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MDoffice, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">191</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MedConnect, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">192</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medical Voice Products, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">193</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medtech, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">194</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">nextEMR, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">195</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Origin Healthcare Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">196</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">San Diego Hospitalist Physician Corp</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">197</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Sunquest Information Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">198</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Systemedx Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">199</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">TheraManager LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">200</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Thomson Reuters (Healthcare) Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">201</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">UnisonCare Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">202</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">VipaHealth Solutions, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">203</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Williams Group</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">204</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Zenith Technology Solutions, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">205</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3M Health Information Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">206</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Abraxas Medical Solutions, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">207</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Advanced Medical Information Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">208</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Alma Information Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">209</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">AppMed, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">210</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Axolotl Corp</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">211</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Benchmark Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">212</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Beth Israel Deaconess Medical Center</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">213</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Bogardus Medical Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">214</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Boston Medical Center</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">215</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Colonial Valley Software, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">216</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ComChart Medical Software, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">217</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Cyclops Vision Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">218</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Design Clinicals, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">219</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Doc-tor.com, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">220</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">DocuTAP</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">221</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">eHealth Made EASY, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">222</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EHR Doctors, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">223</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EHR Solutions Group, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">224</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Elekta - IMPAC Medical Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">225</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">EPOWERdoc, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">226</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Exemplo Medical LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">227</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Infomedika, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">228</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">InstantDx, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">229</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">LeonardoMD, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">230</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">LOGICARE® Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">231</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">LSS Data Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">232</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medaxis Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">233</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Medrium Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">234</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Microsoft Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">235</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Mitochon Systems, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">236</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Mountain Computer Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">237</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">MxSecure, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">238</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Northwestern University</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">239</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ODOS Industries, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">240</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">OEMR</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">241</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Orchard Software</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">242</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Pacific Medical Communications, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">243</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Patagonia Health</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">244</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PatientKeeper</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">245</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PCC Physician's Computer Company - Pediatric Software</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">246</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PeriGen</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">247</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Phyaura, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">248</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Practice Velocity, LLC.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">249</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">PracticeSuite, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">250</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">QuikEyes, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">251</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Raintree Systems, Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">252</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">RWHC QI Program</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">253</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">SMARTMD Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">254</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Softworx Solutions</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">255</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">TransMedic</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">256</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">UAMS</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">257</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Varian Medical Systems</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">258</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">VersaForm Systems Corp.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">259</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">VersaSuite</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">260</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Vision Infonet Inc</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">261</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Visionary HealthWare, LLC</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">262</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">WEBeDoctor, Inc.</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">263</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Wellsoft Corporation</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
<tr height="14" style="height: 14.0pt;"> <td class="xl65" height="14" style="height: 14.0pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">264</span></td> <td><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">WorldVistA</span></td> <td align="right"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1</span></td> </tr>
</tbody></table>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-65865119994065007562012-01-01T18:20:00.003-05:002012-01-01T18:32:08.632-05:00My experience with the Clinician Practitioner Consultant HIT Pro Exam<div style="font: 13.0px Verdana; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Back in 2009 the HITECH Act was passed seeking to improve American health care delivery and patient care through an investment in health information technology. Most of the people I talk to think of this legislation in terms of "meaningful use" incentives. A few people actually know that this act made provisions for other programs such as HIEs, "beacon communities", "SHARP programs", Community College and University based training and competency exams. The competency exams (<a href="http://healthit.hhs.gov/portal/server.pt?open=512&objID=1809&parentname=CommunityPage&parentid=16&mode=2&in_hi_userid=11673&cached=true" target="_blank"><span style="font: normal normal normal 12px/normal Helvetica;">link here</span></a>) test several EHR implementation areas such as project management, clinical and technical health IT skills. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">The Clinician/Practitioner Consultant qualification exam caught my attention and in August 2011 I registered for the competency exam at www.pearsonvue.com/hitpro/ . The exam was so new that there was no material that I could purchase in order to study. Looking at healthit.hhs.gov I determined that the areas tested were divided in the following domains:</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">- Fundamentals of health workflow process analysis and redesign</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">- Quality improvement</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">- Working with HIT systems</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">- Health Information Management Systems</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">- Planning, Management, and Leadership for Health IT</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">In the end I had to rely on the clinical and technical knowledge I had accumulated over the years. The 3 hour exam was intense and </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">I was ecstatic to receive the news that I had passed it. In November 2011 I received my Clinician/Practitioner Consultant certificate, which I am proudly attaching here:</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-PLiVn9rSSdE/TwDp-cHUknI/AAAAAAAAACU/jFtibo_jbsU/s1600/Clinician+Practitioner+Consultant.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="320" src="http://2.bp.blogspot.com/-PLiVn9rSSdE/TwDp-cHUknI/AAAAAAAAACU/jFtibo_jbsU/s320/Clinician+Practitioner+Consultant.png" width="246" /></span></a></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Mission accomplished!</span></div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com2tag:blogger.com,1999:blog-4350526275652179335.post-45030153275824366172011-12-28T18:07:00.003-05:002011-12-28T18:12:18.968-05:00Chattanooga HIE - by Middle Tennessee eHealth Connect<div style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 12.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Here is profile of the MTeHC - the HIE that is going to help Chattanooga exchange health information. </span></div><div style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 12.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">The<b> </b>Middle Tennessee eHealth Connect (www.midtnehealth.com) is a not-for profit regional health information exchange organization whose mission is to improve the effectiveness and efficiency of health care delivered to every member of the community without regard to payer by connecting health care providers throughout Middle Tennessee.</span></div><div style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 12.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">MTeHC uses Informatics Corporation of America (ICA) which was technology developed by Vanderbilt Medical Center for the broader health care market, and now delivers a comprehensive HIE solution to hospitals, IDNs, communities and states. </span></div><div style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 18.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Participating entities in the Nashville area:</span></div><ul style="list-style-type: disc;"><li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Saint Thomas Health Services</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Vanderbilt University Medical Center</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Metropolitan Hospital Authority (Nashville General Hospital)</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">HCA TriStar Division</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Tennessee Hospital Association</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Meharry-Vanderbilt Alliance</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Metropolitan Government of Nashville and Davidson County</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">State of Tennessee</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Nashville Academy of Medicine</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Tennessee Health Care Campaign</span></li>
<li style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Safety Net Consortium of Middle Tennessee</span></li>
</ul><div style="color: #333233; font: 12.0px Arial; margin: 0.0px 0.0px 12.0px 0.0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;"></span><br />
<div style="color: #333233; font: normal normal normal 12px/normal Arial; margin-bottom: 18px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Participating entities in the Chattanooga area:</span></div></div><ul style="color: black; list-style-type: disc;"><li style="color: #333233; font: normal normal normal 12px/normal Arial; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Erlanger Hospital</span></li>
<li style="color: #333233; font: normal normal normal 12px/normal Arial; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Memorial Hospital</span></li>
<li style="color: #333233; font: normal normal normal 12px/normal Arial; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: inherit; font-size: small;">Parkridge Hospital - a part of the HCA TriStar Division</span></li>
</ul></div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-80274139457246309362011-12-28T18:03:00.001-05:002011-12-28T18:12:50.169-05:00Health Information Exchange in Chattanooga … the latest developments<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">In my February post I described Chattanooga health community's attempt to get a Health Information Exchange started. When we got together the main charge (established by the leadership group) was to determine if Chattanooga should form its own exchange or become a "community" within an already established HIE. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">The three workgroups (technical, clinical and security & privacy) debated over several months, looked at the issues from their respective points of view, and came up with the verdict: join the MTeHC (Middle Tennessee eHealth Connect) out of Nashville. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">The decision was not easy but it had to do with the speed of implementation and the cost of running our own HIE. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">At end of November the workgroups were "reactivated" and we started planning for the nitty gritty of hospital data exchange. The initial aim of the health exchange is reduce the rate of readmissions for Erlanger, Memorial and Parkridge Hospitals. Data sharing tests are projected to start somewhere in the April-June 2012 timeframe. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">While we are waiting for the data sharing agreements and the technical architecture for sharing of data to be built, the clinical workgroup would like to have "security messaging" functional as soon as possible. This will allow clinicians to share data among each other using something like a secure webmail system. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br />
</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small;">In my next post I will post MTeHC's profile. </span></div><div><br />
</div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-28305586171632082372011-02-23T22:40:00.007-05:002011-02-23T22:50:43.623-05:00Southeast Regional Exchange!<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><div>Yay! On February 4-th we had our first meeting to discuss the HIE for our region. </div><div>These were the institutions attending the first meeting:</div><div><br />
</div><div>Erlanger</div><div>IVHIN - Knoxville</div><div>Memorial</div><div>MidSouth eHealth Alliance - Memphis</div><div>Office of e-Health - State of TN</div><div>Parkridge</div><div>Southern Adventist University</div><div>Tennessee Hospital Association</div><div>TriStar</div><div><br />
</div><div>The name adopted (for now) was Southeast Regional Exchange. </div><div>We split in several workgroups (clinical, leadership, privacy & security and technical) and each adopted their own charter. The charge for everyone is to determine whether we should form our own HIE or join an existing one. This decision will be taken by the middle of April.</div><div><br />
</div><div>The technical workgroup, of which I am a part of, has the mission of coming up with the technical requirements for an HIE in our region and judge whether two of the existing Tennessee HIE can serve our needs. The work has already started. </div><div><br />
</div><div>This is definitely an exciting beginning for a faster coordination of care in the Chattanooga region.</div><div><br />
</div></span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-74681511213585448802011-02-23T21:28:00.001-05:002011-02-23T21:58:03.011-05:00The architecture of Tennessee's state HIE<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">Things are starting to move along with the building of the Tennessee HIE. As part of my engagement with HIP-TN (Tennessee HIE) I continue to participate in the meetings of the Technical Workgroup. I have displayed a few diagrams showing the general architecture of the processes of querying for patients, documents and retrieval of documents.</div><div><br />
<div style="text-align: center;"><span class="Apple-style-span" style="font-family: Helvetica; font-size: large;"><span class="Apple-style-span" style="font-size: 17px;"><span class="Apple-style-span" style="font-size: 11.8056px;">Tennessee HIE architecture</span></span></span></div></div><div class="separator" style="clear: both; text-align: center;"></div><div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-3eXC4HF5_8g/TWXG_Ed0bdI/AAAAAAAAACA/y_Up4bslc2E/s1600/hip-tn-architecture.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="219" src="http://4.bp.blogspot.com/-3eXC4HF5_8g/TWXG_Ed0bdI/AAAAAAAAACA/y_Up4bslc2E/s320/hip-tn-architecture.png" width="320" /></a></div><span class="Apple-style-span" style="font-family: Helvetica; font-size: 11.8056px;"><br />
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<div style="text-align: center;"><span class="Apple-style-span" style="font-family: Helvetica; font-size: 11.8056px;">Patient Discovery</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-IflaRRqkfZU/TWXHIlTJukI/AAAAAAAAACE/D_7Dag7D3gA/s1600/patient-discovery.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="246" src="http://4.bp.blogspot.com/-IflaRRqkfZU/TWXHIlTJukI/AAAAAAAAACE/D_7Dag7D3gA/s320/patient-discovery.png" width="320" /></a></div><br />
<div style="text-align: center;"><span class="Apple-style-span" style="font-family: Helvetica; font-size: 11.8056px;">Query for Documents</span></div></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-Cf3ILRr-Avg/TWXHgfCzUUI/AAAAAAAAACI/Yjk8GMp-vGY/s1600/query-for-documents.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="251" src="http://3.bp.blogspot.com/-Cf3ILRr-Avg/TWXHgfCzUUI/AAAAAAAAACI/Yjk8GMp-vGY/s320/query-for-documents.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><span class="Apple-style-span" style="font-family: Helvetica; font-size: 11.8056px;">Document Retrieval</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-IHVm9jZ-d2o/TWXH2M8AKLI/AAAAAAAAACM/qrYS7OrNt4Q/s1600/document-retrieval.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="251" src="http://3.bp.blogspot.com/-IHVm9jZ-d2o/TWXH2M8AKLI/AAAAAAAAACM/qrYS7OrNt4Q/s320/document-retrieval.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
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</div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-65207043772029635862010-10-12T13:46:00.000-04:002010-10-12T13:46:34.548-04:00Tennessee statewide HIE vendor chosen!<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">I am back to blogging after a hiatus of a few months. So, what has been going on? </span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">During this time I have participated in the HIP-TN Technical Workgroup writing the technical requirements for the state-wide HIE RFP (see http://www.hiptn.org/hip-tn-rfp/) and evaluating the various HIE solution vendors.</span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">We evaluated thirteen vendors based on their experience and response to our RFP (clinical, financial, technical).</span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">A number of the respondents were eliminated in the first round because they could not meet the "mandatory requirements. In the second round we split in little groups each evaluating a specific vendor. The vendors that emerged out of the this round participated in a "face-to-face" meeting in Nashville, where we all descended upon the "Tennessee Health Association" headquarters. </span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Even after that we had two vendors that were very closely scored. After further evaluation of their offering one vendor come out victorious: Axolotl. You can view the press release <a href="http://www.hiptn.org/hip-tn-press-releases/10%2007%202010%20HIP%20TN%20-%20Axolotl%20Press%20Release.pdf">here</a>.</span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">I feel the vendors were evaluated in a fair manner with input from various workgroups which represented a wide range of organizations from the Tennessee healthcare spectrum. </span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">So who were the software vendors that participated? Sorry, I cannot tell you. The general consensus was that we would not divulge the names of those who responded to the RFP in order to avoid negative publicity for those companies.</span></span><br />
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The HIP-TN Technical Workgroup will continue to meet and provide feedback in the process of state wide HIE implementation. Stay tuned!</span></span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-12142344989338299162010-03-29T23:34:00.006-04:002010-03-29T23:41:15.762-04:00NHIN Direct - introduction<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">At HIMSS 2010 Dr. Blumenthal launched the new ONC's initiative - NHIN Direct. This created quite of bit of confusion ... myself included. Why now? What is new? What's wrong with existing NHIN? Why are HIEs still needed? Is this a "skinny NHIN"? </span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Wes Reshel outlines the differences very well in his </span><a href="http://blogs.gartner.com/wes_rishel/"><span class="Apple-style-span" style="font-size: small;">blog</span></a><span class="Apple-style-span" style="font-size: small;">. I have included the article below for convenience:</span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Helvetica; font-size: 18px; font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><a href="http://blogs.gartner.com/wes_rishel/2010/03/14/nhin-direct-v-hies-competitors-or-collaborators/" rel="bookmark" style="border-bottom-style: none; border-color: initial; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; border-width: initial; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;" title="Permanent Link to NHIN Direct v. HIEs: Competitors or Collaborators"><span class="Apple-style-span" style="color: black;">NHIN Direct v. HIEs: Competitors or Collaborators</span></a></span></span></span></span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: Helvetica; font-size: 18px; font-weight: bold;"><span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><a href="http://blogs.gartner.com/wes_rishel/2010/03/14/nhin-direct-v-hies-competitors-or-collaborators/" rel="bookmark" style="border-bottom-style: none; border-color: initial; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; border-width: initial; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;" title="Permanent Link to NHIN Direct v. HIEs: Competitors or Collaborators"></a><span class="Apple-style-span" style="font-family: Helvetica; font-size: 12px; font-weight: normal;">"Recently a person organizing a state’s HIE effort reported a hospital CIO saying, “<b>why do I need your complex HIE when can have NHIN Direct?</b>”</span></span></span></span></span></span></span><br />
<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">This question gets to the heart of the confusion that some states or stated designated entities are experiencing with the introduction of NHIN Direct into the mix. I wrote this fellow back, outlining the relative value propositions of HIEs and NHIN Direct. It is clear that <b>the two notions are complimentary</b> even if there is still <b>some need to work out the rough edges</b>. Here is what I wrote.</div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">The hospital that is evaluating its need to participate in a state HIE needs to answer the following questions.</div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">How long will the hospital and community physicians be satisfied with the following assumptions that will probably be baked into NHIN Direct:</div><ul style="list-style-type: disc;"><li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will be sending information but not offering clinicians the opportunity to look up a patient and retrieve their information.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will be sending the information to a practice without sending the practice’s patient ID number</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will send out structured lab information from our lab using standard LOINC codes</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will independently determine whether it is appropriate to send each transmission to a specific provider.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will send all information with only a very general usage agreement in place.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will accept inbound information without our patient ID so each such input will have to be matched by the receiver.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">We will accept information without assurance as to whether coded information is standard.</li>
</ul><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">Most of the hospital CIOs that I talk to say, “I’d be happy to live with those restrictions in order to get started reaching out to physicians in my community sooner. I know that practices that I send info to would be willing to live with them as well.”</div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;"><b>This is a fair trade-off. However, it provides clear limits in supporting care transitions in that the sender has to know to whom the patient is transitioning – or the receiver has to make a special request for information that must be manually approved by the sender.</b></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">Furthermore, it is unlikely that community physicians will remain satisfied with this approach if an HIE is available that supports both the hospital and the practice or if HIEs are linked in a way to provide the connection.</div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">The value that HIEs typically add include</div><ul style="list-style-type: disc;"><li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">Maintaining a common patient index</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">Providing the trust mechanism, software interfaces. access control and consent mechanism that enables lookup up information</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">Developing a common trust agreement that all parties can accept.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">An interface to consumer advocates that will assert their role protecting the interests of the patients.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">A common software channel and active support to enable multiple data sources (e.g., labs and hospitals) to send results to multiple recipients and provide both senders and receivers a single point of contact for troubleshooting.</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">Mapping imprecise recipients data (e.g., taking a physician name as the recipient of the lab result and determining whether to deliver the result by fax, on-line lookup or structured transmission to the EMR).</li>
<li style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">Aggregating data at a community or state level for measuring quality, epidemiology, and other programs.</li>
</ul><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;"><b>The only thing that an HIE has to do to compete with NHIN Direct-based communications is exist.</b></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;">How, then should an HIE deal with the fact that by the time it comes to an operational state a great deal of communication may be going on under NHIN Direct? Easy: <b>join it instead of fighting it.</b> Be prepared to bring practices that are already using NHIN Direct into the fold without having to immediately change what they do. Add immediate value by forwarding patient results and notes with the practice’s patient ID. Provide shims for labs that cannot get to standard approaches. Allow them to begin to look up patients (using new interfaces) as soon as their EHR is ready. Allow them to use a portal to look up patients and have the results sent to them through NHIN Direct.</div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 12.0px 0.0px;"><b>To really seize the initiative the HIE should become a provider of NHIN Direct services to physicians that don’t yet have an EHR</b> or have an EHR that is not yet capable of dealing with NHIN direct. Operators of such a portal are in an ideal state to gradually introduce services that add value as soon as they can make the software and business agreement arrangements."</div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-84011582125589451482010-03-29T23:18:00.001-04:002010-03-29T23:21:03.140-04:00HIMSS 2010<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">HIMSS was huge this year. It took me close to 3 hours to walk the two main exhibit floors ... without stopping. </span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">I spent a significant time at the Interoperability Showcase Booth. I also got to meet (face to face) an NHIN team mate from Kaiser Permanente ... after having spent almost a year together in weekly telephone conferences. He was demonstrating the NHIN connection between Kaiser and Veteran Administration. </span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Here is a picture of a gentlemen that gave the orientation tour at the Interop Showcase:</span></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_a0yKWowNqSI/S7FrB0LfvKI/AAAAAAAAABI/KLALZ4XmuGY/s1600/photo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-size: small;"><img border="0" height="300" src="http://2.bp.blogspot.com/_a0yKWowNqSI/S7FrB0LfvKI/AAAAAAAAABI/KLALZ4XmuGY/s400/photo.jpg" width="400" /></span></a></div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Here is a picture of the Showcase booth itself with lots of companies demonstrating how they could "play nicely" on the health IT playground:</span></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_a0yKWowNqSI/S7FrqhZCjzI/AAAAAAAAABQ/MZZLhHJQpD4/s1600/photo1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-size: small;"><img border="0" height="300" src="http://4.bp.blogspot.com/_a0yKWowNqSI/S7FrqhZCjzI/AAAAAAAAABQ/MZZLhHJQpD4/s400/photo1.jpg" width="400" /></span></a></div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Here is another picture capturing the vendors participating in the showcase:</span></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_a0yKWowNqSI/S7Fsn6UmxRI/AAAAAAAAABY/I58a3f1TzZk/s1600/photo2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-size: small;"><img border="0" height="300" src="http://1.bp.blogspot.com/_a0yKWowNqSI/S7Fsn6UmxRI/AAAAAAAAABY/I58a3f1TzZk/s400/photo2.jpg" width="400" /></span></a></div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"><br />
</span></span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-52490648847315539832010-02-18T11:34:00.002-05:002010-02-18T13:39:13.588-05:00Top Electronic Health Records (EHR) software<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">There is ehr software and then there is EHR software. When asked which company is the best my answer is ... you guessed: "it depends". Here are some factors to keep in mind:</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- size of the practice</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- specialization</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- certification (CCHIT for now)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- features</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- quality of support</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- number of sites</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- location of data (local or cloud)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">- sales rep likeability factor ( ... oops, scratch this one :-))</span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">It is rather hard to compare EHR packages. Klas is an organization that attempts to do that. Here is their 2009 top 20 best of Klas awards for EHR. Please use this information as a starting point. As I mentioned there are other factors to keep in mind. </span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2009 Top 20 Best in KLAS Awards: Professional Services Awards</span></span><br />
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<b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Over 100 Physicians</span></span></b><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">1. Epic EpicCare Ambulatory EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2. NextGen EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">3. Allscripts Enterprise EHR</span></span><br />
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<b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">26-100 Physicians</span></span></b><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">1. eClinicalWorks EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2. NextGen EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">3. Allscripts Enterprise EHR</span></span><br />
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<b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">6-25 Physicians</span></span></b><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">1. Greenway Medical PrimeSuite Chart</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2. e-MDs Chart</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">3. Optimed CHARTCARE EMR (CLINICARE)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">4. Sage Intergy EHR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">5. eClinicalWorks EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">6. NextGen EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">7. McKesson Practice Partner EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">8. Allscripts Professional EHR</span></span><br />
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<b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2-5 Physicians</span></span></b><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">1. Greenway Medical PrimeSuite Chart</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2. Amazing Charts EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">3. Allscripts Professional EHR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">4. e-MDs Chart</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">5. eClinicalWorks EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">6. McKesson Practice Partner EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">7. Aprima AprimaEHR (iMedica)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">8. NextGen EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">9. Sage Intergy EHR</span></span><br />
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<b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">1 Physician</span></span></b><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">1. e-MDs Chart</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">2. eClinicalWorks EMR</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">3. Aprima AprimaEHR (iMedica)</span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">* Rankings were calculated in December 2009</span></span><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Here is a quick description of KLAS is and how they come up with this classification.</span></span><br />
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<i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Who is KLAS Enterprises?</span></span></i><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">KLAS Enterprises helps healthcare providers make informed technology decisions by offering accurate, honest, and impartial vendor performance information. KLAS independently monitors vendor performance through the active participation of thousands of healthcare organizations. KLAS uses a stringent methodology to ensure all data and ratings are accurate, honest and impartial. Research results are offered to healthcare providers through, a free directory of vendor and product information, free online access to vendor ratings for participating providers and in-depth published reports.</span></span><br />
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<i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">What is the purpose of KLAS research? </span></span></i><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Their mission is to improve healthcare technology delivery by honestly, accurately, and impartially measuring vendor performance.</span></span><br />
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<i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Where does the data come from? </span></span></i><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">KLAS speaks with hospital and clinic executives, administrators, physicians, nurses, and other directors and managers with business responsibilities regarding the experiences they are having with their vendors and products. Routinely, KLAS speaks with approximately 5,000 hospitals and nearly 3,000 ambulatory organizations annually in order to gather direct client feedback on vendor performance.</span></span><br />
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<i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">How does KLAS obtain and verify data? </span></span></i><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Evaluations are received online from the KLASresearch.com website, via fax, by email, or directly from one-on-one interviews with professionals from provider organizations. Each research participant responds to a standard set of questions. These answers, once they are aggregated and averaged, determine a vendor’s overall score and rank as reflected in KLAS reports and online databases. All completed evaluations are followed up with a confidential interview by a KLAS research analyst. Each phone call includes a candid conversation regarding the experience with the participant’s vendor(s). Appropriate comments from that conversation are included anonymously in the research. KLAS confirms the role and responsibility of the participant and assesses any conflict of interest. If an evaluation cannot be confirmed or corroborated as valid, it is discarded. Where the providers participate at the invitation of the vendor, KLAS more heavily scrutinizes the data for evidences of bias. The results are posted to the KLAS Database and subsequent.</span></span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-39563008579847168152010-02-14T16:42:00.004-05:002010-02-15T13:06:02.678-05:00Chattanooga within the national context<span class="Apple-style-span" style="font-family: 'Lucida Grande';"><span class="Apple-style-span" style="font-size: small;"><br />
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<span class="Apple-style-span" style="font-family: 'Lucida Grande';"><span class="Apple-style-span" style="font-size: small;">Let's travel together :-). It is 2012 and the health information exchange (HIE) in Chattanooga is operational. Deep in the belly of the HIE there are documents capturing the episodes of care of various people in TN, AL or GA. John D., is among the patients with such documents. He lives in Chattanooga but regularly goes out of town for business trips. In this particular trip to Denver, CO he feels lousy and necessitates a trip to the emergency room. How does the ER doctor get the access to the health records John has in Chattanooga? The answer is Nationwide Health Information Network (NHIN). The ER doctor contacts Denver's HIE, which in turn contacts Chattanooga's HIE and retrieves John's electronic health record. All at the wire speed, all through NHIN.</span></span><br />
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</span> </span></div><div><span class="Apple-style-span" style="font-family: 'Lucida Grande';"><span class="Apple-style-span" style="font-size: small;">On the map below, Chattanooga and Denver HIE are green hexagons. There are some other entities also represented on the map: Google Health (PHR), hospitals, labs, pharmacies, federal agencies, etc.</span></span></div><div><span class="Apple-style-span" style="font-family: 'Lucida Grande';"><span class="Apple-style-span" style="font-size: small;"><br />
</span> </span></div><div><span class="Apple-style-span" style="font-family: 'Lucida Grande';"><span class="Apple-style-span" style="font-size: small;">This is how the health information is going to flow in US. I have been involved with NHIN team since the beginning of 2009 and I can testify that this vision (started in 2004 by president Bush's administration) is moving forward.</span></span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"><br />
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<div><div></div><div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_a0yKWowNqSI/S3huysCyKqI/AAAAAAAAABA/1FLW0QF4lDw/s1600-h/nhin-map.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-size: small;"><img border="0" height="300" src="http://3.bp.blogspot.com/_a0yKWowNqSI/S3huysCyKqI/AAAAAAAAABA/1FLW0QF4lDw/s400/nhin-map.png" width="400" /></span></a></div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div></div></div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-26440508221970611592010-02-10T21:47:00.012-05:002010-02-14T16:18:12.976-05:00"Standards" for an HIE<span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: medium;"></span></span><br />
<span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: medium;"></span></span><br />
<span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: medium;"><div><span class="Apple-style-span" style="font-size: small;">When talking about sharing clinical data, we technical people have the tendency to point to the lack of standards and headaches associated with the secure transmission of such sensitive information. The good news is that over the years IHE (see below) has been faithfully working at creating frameworks for sharing medical data.</span></div><div><span class="Apple-style-span" style="font-size: small;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: small;">Last year, while at Connect 2009 in Washington DC, I had a chance to meet Karen Witting - the co-chair of IHE's IT Infrastructure technical committee. Karen, a senior software engineer with IBM, has done a lot of work for IHE and NHIN since 2006 and together with other very dedicated people has been working tirelessly at providing standards for sharing medical info.</span></div><div><span class="Apple-style-span" style="font-size: small;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: small;">Why is this relevant? Because no HIE should buy software from a vendor that does not implement the IHE frameworks. By the way, these are not "standards" but rather a theoretical abstraction of the interaction between various health entities. They are definitely the starting point.</span></div><div><span class="Apple-style-span" style="font-size: small;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="font-size: small;">Here is a short description of what IHE does:</span></div><div><span class="Apple-style-span" style="font-size: small;"><br />
</span></div></span></span><span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-size: small;">"</span></span></span><span class="Apple-style-span" style="color: #232020;"><span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: small;">Integrating the Healthcare Enterprise (IHE) is an organization whose aim is to improve how electronic patient information is shared among healthcare systems and, by doing so, to make</span></span><span class="Apple-style-span" style="color: black;"><span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: small;"> </span></span></span><span class="Apple-style-span" style="font-family: arial;"><span class="Apple-style-span" style="font-size: small;">sure that current and accurate data is readily available to both patients and healthcare professionals. IHE has developed technical frameworks that define how to process healthcare events, how data is shared, how security is handled, how audit records are generated, and how components interact with one another. The frameworks are made up of integration profiles that provide specifications of how each type of event is processed and how the audit message should be generated for each type of event. The profiles also define standards for security, communication, and time synchronization. These profiles are designed to ensure that data is transmitted securely and accurately among systems, and that data handling is coordinated according to communication and security standards. Having this common framework gives the various participants in a healthcare system a common base for integrating disperse systems."</span></span></span>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0tag:blogger.com,1999:blog-4350526275652179335.post-45381652619953321042010-02-10T18:44:00.009-05:002010-02-14T16:16:04.879-05:00Counties served by Chattanooga's medical institutions<div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Chattanooga serves the medical needs of a population spread across several states. I have attached the map with the patients coming from the adjacent counties in TN, GA and AL. </span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Wouldn't be great if:</span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">- the clinical information would be shared in a seamless and secure way among all the providers in this area? </span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">- the patients would be able to obtain their medical records in a few minutes even when they visit relatives in California? </span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">- the quality of care would be increased as a result of the faster exchange of medical information?</span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">In the next few months, drawing from the experience gained while working with various national HIEs, I will share my thoughts on how I think we can make this happen. Stay tuned.</span></div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_a0yKWowNqSI/S3NEwnDzYLI/AAAAAAAAAAw/uCMldA_Ecec/s1600-h/patients.003.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="http://3.bp.blogspot.com/_a0yKWowNqSI/S3NEwnDzYLI/AAAAAAAAAAw/uCMldA_Ecec/s400/patients.003.png" width="400" /></a></div>Doru Mihaescuhttp://www.blogger.com/profile/10917242541120849648noreply@blogger.com0