Finally!!! Apple has entered the EHR field

Apple has entered the EHR field.  This is very good news for patients.  Zdnet has a very interesting article forecasting that Apple will have success.  Here are the seven reasons why:

• "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.

• 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.
• 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.
• 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.
• 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.
• Apple's enterprise footprint can be leveraged. When Apple is pitching its health record and portal wares it appeals to IT executives directly.
• 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."

Health Information Blocking - Congress report

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.   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.    

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

http://healthit.gov/sites/default/files/reports/info_blocking_040915.pdf

Your mother's maiden name

Below is a very interesting article I found here on the history and perils of choosing your mother's maiden name as a security question.  

"Your mother’s maiden name has been a ‘security question’ since 1882

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.

The processes that let you recover your password if you forget it, though, can be much worse than passwords themselves.

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 don’t care 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.

Disturbingly, security questions haven’t changed much over the last century. During a search for the inventor of the “one-time pad” (the only theoretically unbreakable code system), Columbia computer science professor Steven Bellovin came across 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 Bellovin’s 2011 paper 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:”

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.'”

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 to keep their maiden names after getting married, and in a time when no one’s mother was on Facebook."

Where is the health IT interoperability in 2014?

The quick answer is:  it is morphing (still !!).  This article from Lexology does a good job of describing where we are at the moment.

Laser focus on health IT interoperability

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:

• Exchanging information with other healthcare providers to support transitions in care.
• Sharing data with patients through portals and secure e-mail.

Lack of Interoperability Interferes with Sharing

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.

Pockets of interoperability exist today. The more robust interoperability needed to fully leverage the promise of health IT, however, has not yet been realized.

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.

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.

New Focus on a Solution

In the past, solving obstacles to exchange was seen as having at least two major dimensions:

• 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
• Lack of incentives to share information in fee-for-service payment models.

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.

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 issued a report summarizing the public’s comments and identifying a number of principles and strategies for accelerating HIE.

On June 5, 2014, ONC, under new leadership, issued a “10-Year Vision to Achieve an Interoperable Health IT Infrastructure” 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”:

1. Core technical standards and functions
2. Certification to support adoption and optimization of health IT products and services
3. Privacy and security protections for health information
4. Supportive business, clinical, cultural and regulatory environments
5. Rules of engagement and governance

A National Interoperability Roadmap to Achieve the 10-Year Vision

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:

• What are the critical technologies and policies (including governance) required to achieve the vision?
• Who needs to do what and by when (including government, technology developers and technology users)?
• How will the roadmap be updated over time and at what frequency?

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.

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.

Efforts Informing the Roadmap’s Development

A number of developments could inform the roadmap’s development, including:

• 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.
• 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.
• In June 2014, an article published in JAMIA by the SMART (Substitutable Medical Applications and Reusable Technology) C-CDA Collaborative identified issues with interoperability for C-CDAs, 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.
• 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.
• The private sector also is launching efforts to advance interoperability, including Healtheway’s Carequality initiative and the eHealth Initiative’s 2020 Roadmap.

Conclusion

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.

HealthVault - Psst, it's free!

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. 

Here is an example of a letter HealthVault offers you to give to your doctor:

----
Microsoft HealthVault
Patient Name: Your Name
Direct address: yourname@direct.healthvault.com

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. 

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.

If you can’t yet send information via Direct, can you give electronic records another way, such as a disc? (My plug: or suggest the provider contacts Infomedtrix for a provider Direct account) 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.

Infomedtrix Achieves DirectTrust.org/EHNAC Accreditation

Direct Trusted Agent accreditation ensures adherence to data processing standards and compliance with security infrastructure, integrity and trusted identity requirements 

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.

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.

“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.

About DirectTrust.org
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.

DirectTrust.org is committed to fostering widespread public confidence in the Direct exchange of health information. To learn more, visit www.directtrust.org.

About EHNAC
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. 
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.

When to automate manual tasks

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.  

So, when does automation save you time?  This table I found here  offers a good indication:

Our friends: Bob and Alice

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. 

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. 

Bob & Alice? They are the characters employed in the majority of cryptography demonstrations. They come to the professor's rescue as well :-).

 

HIPAA 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:

- Revisions to the Notice of Privacy Practices
- Revisions to the Business Associate Agreements
- Prohibitions on sale of protected health information
- The right to restrict disclosures to a health plan when services are paid for out-of-pocket
- The new breach risk assessment provisions
- Patients' ability to request a copy of their electronic medical record in electronic format


The Office for Civil Rights (OCR) has published a YouTube video summarizing the requirements for HIPAA Omnibus rule.

Participating in an HHS solicitation for NwHIN Direct HISP

In September 2012,  the Centers for Disease Control and Prevention (CDC) published solicitation 2012-Q-49852.   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).   

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.

We worked hard putting the proposal together for this solicitation.   We felt that the experience we had gathered running large messaging systems and deploying BeDirect, a HISP based on NwHIN Direct specifications, would help in the successful implementation of HISP services for NHSN.

There were more than 18 interested entities that applied for this HHS award.

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. 

This experience was very positive and it allowed us to sharpen our design for our current HISP.  

Year 2012 in review

This is how 2012 went for us:

- 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.

- Helped six providers attest for using their EHR meaningfully (http://www.cms.gov/apps/ehr/)

- Launched -  BeDirect (www.bedirect.co)-  the first NwHIN Direct HISP in Chattanooga and for that matter in the South East Tennessee.  

- Participated in several Direct Connect-a-thons (http://wiki.directproject.org/Dec+2012+Connect-A-Thon)

2012 was a very busy year with very little time to write :-).

-Doru

Meaningful Use Attestation - EHR used by 22962 providers

This week CMS released 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.  
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. Here are the results:

Rank	Unique EHR	Providers
1	Epic Systems Corporation	6330
2	eClinicalWorks LLC	1847
3	Allscripts	1502
4	athenahealth, Inc	1158
5	Community Computer Service, Inc.	999
6	GE Healthcare	921
7	NextGen Healthcare	899
8	e-MDs, Inc.	770
9	Greenway Medical Technologies, Inc.	712
10	Cerner Corporation	567
11	Sage	565
12	BioMedix Vascular Solutions	397
13	HCA Information & Technology Services, Inc.	264
14	MEDITECH	256
15	AmazingCharts.com, Inc.	252
16	Eyefinity/OfficeMate	239
17	meridianEMR, Inc.	210
18	McKesson	206
19	Sammy Systems	199
20	SOAPware, Inc.	179
21	Health IT Services Group	174
22	ChartLogic, Inc.	164
23	MedInformatix, Inc	147
24	Compulink	144
25	CPSI (Computer Programs and Systems), Inc.	142
26	Altos Solutions, Inc.	141
27	STI Computer Services, Inc.	134
28	Intuitive Medical Software	125
29	AllMeds, Inc.	113
30	Practice Fusion	113
31	Ingenix	107
32	Medflow	102
33	Aprima Medical Software, Inc	95
34	MedPlus, A Quest Diagnostics Company	94
35	gMed, Inc.	88
36	Meditab Software, Inc.	88
37	DrFirst	82
38	WellCentive	81
39	SuccessEHS	78
40	GEMMS, Inc.	77
41	Prime Clinical Systems, Inc.	77
42	SuiteMed	69
43	Pulse Systems	67
44	Clarkson Eyecare	65
45	gloStream, Inc.	59
46	NexTech Systems Inc.	58
47	Healthland, Inc.	54
48	Siemens Medical Solutions USA Inc	54
49	Waiting Room Solutions	48
50	HealthFusion	42
51	T-System Technologies, Ltd.	42
52	BizMatics Inc	40
53	Office Ally	39
54	digiChart, Inc.	38
55	M3 Healthcare Solutions	38
56	ACOM Health	37
57	Iatric Systems, Inc	32
58	Sevocity a division of Conceptual MindWorks, Inc	30
59	MacPractice, Inc.	29
60	NCG Medical Systems, Inc.	29
61	Healthcare Management Systems, Inc.	28
62	MTBC (Medical Transcription Billing Corporation)	28
63	MCS - Medical Communication Systems, Inc.	26
64	Trinity Health, Trinity Information Services	26
65	Advanced Data Systems Corporation	24
66	iSALUS Healthcare	24
67	MDLAND	24
68	UltraMed Software	24
69	Digital Medical Solutions Inc.	23
70	MedLink International, Inc	23
71	EMedicalNotes, LLC	21
72	ManagementPlus	21
73	ADP AdvancedMD	20
74	American Medical Software	20
75	GeniusDoc, Inc.	20
76	MPN Software Systems, Inc.	20
77	Addison Health Systems, Inc.	19
78	ClearPractice	19
79	Encite, Inc.	18
80	Trellix Engineering Corp.	18
81	Medical Informatics Engineering	17
82	Prognosis Health Information Systems	17
83	CodoniX	15
84	Intivia, Inc.	15
85	Health Innovation Technologies, Inc.	14
86	iMedicWare, Inc	14
87	Midwest Software, LLC	14
88	Penn Medical Informatics Systems, Inc.	14
89	Phoenix Ortho, LLC	14
90	Crowell Systems	13
91	Health Care Systems, Inc.	13
92	PlatinumMD	13
93	Businet, LLC	12
94	ExitCare, LLC	12
95	Indian Health Service	12
96	IOS Health Systems	12
97	Insight Software, LLC	11
98	OCERIS, Inc.	11
99	Sequel Systems, Inc.	11
100	Clinix MIS LLC	10
101	E-Z BIS, Inc.	10
102	MicroFour, Inc.	10
103	PBO	10
104	StreamlineMD, LLC	10
105	TriMed Technologies Corp	10
106	Darena Solutions LLC	9
107	dbMotion	9
108	MagView	9
109	Mighty Oak Technology, Inc.	9
110	Nuesoft Technologies, Inc.	9
111	SynaMed, LLC	9
112	Ulrich Medical Concepts	9
113	VIP Medicine, LLC	9
114	Criterions LLC	8
115	MED3000, Inc	8
116	Midas+ / ACS a Xerox Company	8
117	ABEL Medical Software Inc.	7
118	Crystal Practice Management	7
119	Henry Schein Medical Systems	7
120	Integrated Systems Management, Inc.	7
121	MEDHOST	7
122	Medical Office Online, Inc.	7
123	Noteworthy Medical Systems, Inc.	7
124	Orion Health	7
125	QRS Inc.	7
126	AllegianceMD Software, Inc.	6
127	DoctorsPartner, LLC.	6
128	eCareSoft Inc.	6
129	First Insight Corp	6
130	Health Systems Technology, Inc.	6
131	ifa united i-tech Inc.	6
132	Jefferson Technical Services, LLC	6
133	MediSYS	6
134	Spring Medical Systems, Inc.	6
135	Altapoint Data Systems, LLC	5
136	DrChrono.com Inc.	5
137	empowersystems	5
138	Forte Holdings	5
139	Health Management Associates	5
140	ICANotes, LLC	5
141	Medcom Information Systems, Inc.	5
142	Networking Technology dba RxNT	5
143	PatientNOW	5
144	ProMed Clinical Systems, LLC	5
145	Acurus Solutions Inc.	4
146	Aurora Health Care, Inc.	4
147	Comtron Inc.	4
148	CureMD Corporation	4
149	EyeMD EMR Healthcare Systems, Inc.	4
150	EZnotes, Inc.	4
151	Glenwood Systems LLC	4
152	Infor-Med Corporation	4
153	MedcomSoft	4
154	Medsphere Systems Corporation	4
155	Net Health Systems, Inc.	4
156	RazorInsights	4
157	TechSoft, Inc.	4
158	Valant Medical Solutions, Inc.	4
159	XLEMR	4
160	Covisint	3
161	Data Strategies, Inc.	3
162	Diversified Ophthalmics, Inc.	3
163	Doctor Office Management, Inc.	3
164	Emdeon Inc.	3
165	Future Health	3
166	H-DOX	3
167	HHT International, Inc.	3
168	Integrated Health Care Solutions	3
169	Integrated Practice Solutions, Inc.	3
170	IO Practiceware, Inc.	3
171	MedSym, Inc.	3
172	MedXLnce, Inc.	3
173	Netsmart Technologies	3
174	Outcome Sciences, Inc. (Outcome)	3
175	Partners Healthcare System	3
176	Rheumatology and Dermatology Associates PC	3
177	Soren Technology	3
178	TRANSMED NETWORK INC.	3
179	UNI/CARE Systems, Inc	3
180	Acrendo Software, Inc.	2
181	DigiDMS	2
182	eCast Corporation	2
183	EMRlogic Systems	2
184	Falcon, LLC.	2
185	Health Administration Systems, Inc.	2
186	HealthPort	2
187	Institute for Health Metrics	2
188	Keiser Computers, Inc.	2
189	KeyMedical Software, Inc.	2
190	MDoffice, Inc.	2
191	MedConnect, Inc.	2
192	Medical Voice Products, Inc.	2
193	Medtech, Inc.	2
194	nextEMR, LLC	2
195	Origin Healthcare Solutions	2
196	San Diego Hospitalist Physician Corp	2
197	Sunquest Information Systems, Inc.	2
198	Systemedx Inc.	2
199	TheraManager LLC	2
200	Thomson Reuters (Healthcare) Inc.	2
201	UnisonCare Corporation	2
202	VipaHealth Solutions, LLC	2
203	Williams Group	2
204	Zenith Technology Solutions, LLC	2
205	3M Health Information Systems	1
206	Abraxas Medical Solutions, Inc	1
207	Advanced Medical Information Solutions	1
208	Alma Information Systems, Inc.	1
209	AppMed, Inc.	1
210	Axolotl Corp	1
211	Benchmark Systems	1
212	Beth Israel Deaconess Medical Center	1
213	Bogardus Medical Systems, Inc.	1
214	Boston Medical Center	1
215	Colonial Valley Software, Inc.	1
216	ComChart Medical Software, LLC	1
217	Cyclops Vision Corporation	1
218	Design Clinicals, Inc.	1
219	Doc-tor.com, LLC	1
220	DocuTAP	1
221	eHealth Made EASY, LLC	1
222	EHR Doctors, Inc.	1
223	EHR Solutions Group, LLC	1
224	Elekta - IMPAC Medical Systems, Inc.	1
225	EPOWERdoc, Inc.	1
226	Exemplo Medical LLC	1
227	Infomedika, Inc.	1
228	InstantDx, LLC	1
229	LeonardoMD, Inc.	1
230	LOGICARE® Corporation	1
231	LSS Data Systems	1
232	Medaxis Corporation	1
233	Medrium Inc.	1
234	Microsoft Corporation	1
235	Mitochon Systems, Inc.	1
236	Mountain Computer Systems	1
237	MxSecure, Inc.	1
238	Northwestern University	1
239	ODOS Industries, Inc.	1
240	OEMR	1
241	Orchard Software	1
242	Pacific Medical Communications, Inc.	1
243	Patagonia Health	1
244	PatientKeeper	1
245	PCC Physician's Computer Company - Pediatric Software	1
246	PeriGen	1
247	Phyaura, LLC	1
248	Practice Velocity, LLC.	1
249	PracticeSuite, Inc.	1
250	QuikEyes, Inc.	1
251	Raintree Systems, Inc	1
252	RWHC QI Program	1
253	SMARTMD Corporation	1
254	Softworx Solutions	1
255	TransMedic	1
256	UAMS	1
257	Varian Medical Systems	1
258	VersaForm Systems Corp.	1
259	VersaSuite	1
260	Vision Infonet Inc	1
261	Visionary HealthWare, LLC	1
262	WEBeDoctor, Inc.	1
263	Wellsoft Corporation	1
264	WorldVistA	1