Large EMR Vendor Bias Towards EMR Stimulus

One thing I’m starting to notice is that it seems that ALL of the large EMR vendors are strong proponents of the EMR stimulus. All but a couple of the comments I’ve found from large EMR vendors laud praise upon the HITECH act. Listening to the information they’re putting out, you’d think that this was a fantastic stimulus package that will just be too good to pass up.

Now, I’m not saying that what these EMR vendors are saying is a lie (although some of the things they’ve said are). What I am saying is take a look at what motivation an EMR vendor has to do anything but prop up the EMR stimulus package. As far as I can see, there’s little benefit to their EMR business to talk poorly about the EMR stimulus. EMR vendors want people to think that the EMR stimulus is simple, effective and incredibly well done. If this were the case, many doctors should and would be all over it and EMR vendors would see increased sales. If EMR vendors were to describe it as complicated, ineffective and poorly defined, then that means fewer sales for those EMR vendors.

My point here isn’t to argue whether the EMR stimulus is good or not. It’s just to highlight that EMR vendors are (and probably should be) biased in their opinions of the EMR stimulus package.

Interestingly, a few smaller EMR vendors have made the opposite case. They’ve come out that the EMR stimulus is an atrocity, does little to improve doctors’ productivity and often hurts productivity.

The battle lines have been drawn. Just make sure you’re not a casualty of biased information.

EMR and HIPAA 2009

I knew that this year had been a really great year on EMR and HIPAA. However, I didn’t really realize how much we’d exploded until I started looking at the stats for the site. Thanks to the EMR stimulus (among other things), EMR and HIPAA saw an 800% increase in traffic in 2009 as compared to 2008. That amounts to the following stats for the year:
1.57+ million pageviews
900,00+ visits to EMR and HIPAA
Average Time on Site: 3 minutes and 17 seconds
Biggest Single Day: 8,679 pageviews

I’m most proud of how long people stay on the site to read what’s been written. However, I can’t really get my head around 1.5 million pageviews either. Isn’t technology amazing?

In 2009, I wrote 386 Articles on EMR and HIPAA. That’s a little over 1 post per day. I really didn’t think I posted that many. I guess they start to add up over time. However, even more exciting for me is that there have been over 2325 comments made on EMR and HIPAA. I love to see that much engagement and have loved so many of the conversations we’ve had. I’ve been educated and informed as much or more than I’ve helped you.

Google was by far my largest source of traffic with the following search terms being the most popular: EMR companies, EMR Stimulus, EMR vendors, “health it resource center” arra, ehr vendors. However, I’ve also seen a huge increase in traffic from my techguy and EHR and HIT twitter accounts. I’m amazed at how many people are discussing EMR on Twitter. It’s an amazing tool.

Of course, I also want to thank all of those companies that have sponsored EMR and HIPAA this year: Medscribbler, InterSystems,MxSecure, EMR Consultant, EHR Scope, Medical Voice Products, Plextra, MD-IT, Sfax, NextGen, My EMR Choice, EMR Jobs, andDigiDMS. Their sponsorship of EMR and HIPAA really does make a huge difference. It seems like it’s been mutually beneficial since almost all of the above advertisers have renewed their ad on EMR and HIPAA (and many of them multiple times). I have a feeling that 2010 will be an even bigger year for EMR advertising.

EMR and HIPAA has a lot of things in the works for 2010. I’ll follow up this post with a post talking about some of our plans for 2010. It’s going to be an exciting year.

EMR Interoperability and Working Together

I recently got the following email which highlights my point that the EHR stimulus money should have been focused on things like interoperability standards and not funding EMR adoption the way it is doing it. He also makes some interesting comparisons worth considering:

I see an uncoordinated money pot out there, attracting uncoordinated work on EMR. — about as effective technically as HDTV (since mid-80’s), W3C, the space station. Non-profit efforts seem to generally fail, or to work so slowly as to be irrelevant.

EMR standardization would likely benefit from an authoritative organization (similar to IEEE) that would work with existing systems as provided by Kaiser, Walmart, GE, etc. and grind out a solution acceptable to these and other major (and minor) players. Then a de facto standard would exist in a well-defined form, and other players would join the effort.

I may be wrong, but I don’t see this happening. Everyone seems to be drawing out the money and just going on their separate ways. People like me that try to help doctors into the electronic age thus have to develop their own protocols, as anything resembling a portable data standard simply doesn’t seem to exist.

Of course, whenever I think about and post something like this, I feel like it’s too late too change anything. The legislation is what it is and we have to make the most of it. It’s just really sad to consider what it could be.

I guess maybe the message to consider is that we can still start having EMR working together even if it’s not government funded.

Minimum EMR Functionality DOES NOT Equal Usable EMR

Sometimes I feel like it’s my mission to combat the myths associated with EMR certification, selection and implementation. Ok, so maybe it’s mostly the EHR certification, but selection and implementation are closely tied to EMR certification. On that note…

An EMR certification that verifies “minimum EMR functionality” DOES NOT equal a usable EMR.

Yes, it’s a subtle difference, but an important one that far too many people ignore. Call it good marketing by the certification body. Call it a misunderstanding. Regardless, it’s scary how many people think that by testing for a “minimum EMR functionality” they are more likely to have a successful EMR implementation. The problem is, it doesn’t. If it did, then we’d have a lot more successful EMR implementations.

Sole Reliance on One EHR Certififying Body – CCHIT

There’s a whole lot of discussion going on (rightfully so) right now about CCHIT EHR certification and of course the term “certified EHR.” I don’t know if anyone else has noticed or not, but there seems to be a bit of a growing movement towards not having ONE EHR certifying body (presumably CCHIT).

A post over on John Chilmark’s blog highlights a really interesting point about having only one EHR certifying body. The point is that there’s little accountability if CCHIT is the only body that’s certifying EHR vendors. What reason would CCHIT really have to improve its certification if it’s the de facto standard for certification? CCHIT admitted that their CCHIT EHR certification wasn’t up to the ambitious goals of HITECH/ARRA. That doesn’t mean they can’t change (although I have my reasonable doubts). However, if they are set up as the sole EHR vendor certification body, then what reason would they have to change?

OK. Yes, you could make an argument that they would want to change for the common good of man. Yes, that means we would see some change on their behalf towards that goal. However, to really change the game in EHR, we need something that requires people to innovate and a sole EHR certification of any kind will have a rough time doing that.

What scares me is that I think that CCHIT is aware of its weaknesses and realizes that it wouldn’t be able to iterate it’s EHR certification to meet the ever changing technology. It seems like the market is ripe for some really smart person to do something to better certify EHR. I wonder what type of game changing certification that will be.

Kathleen Sebelius Sworn in as HHS Secretary – Impact on EHR

I’m sure that most of you in healthcare saw that Kathleen Sebelius was finally sworn in as the new HHS secretary. You can read the reuters report on the confirmation and swearing in of Kathleen Sebelius.

From the report, there’s no doubt that a lot of Kathleen Sebelius’s first job will be to work on this swine flu. No doubt a very important thing for her to keep an eye on and do what she can to protect us from having a major outbreak.

However, I must admit that I get the feeling that were going to hear very little from this new HHS secretary about EMR and EHR. I could be wrong, but I just don’t see her getting really involved in all the discussions of EHR implementation and the $18 billion of EHR stimulus money as part of the HITECH Act (ARRA).

Certainly she’ll be around for major announcements, but I get the strong impression that it’s actually David Blumenthal that’s going to be in the trenches doing the work of defining “certified EHR” and “meaningful use.”

Anyone know more about the situation that can help clarify what might happen, who will be responsible and whether Kathleen Sebelius will do much for EMR as HHS secretary?

EHR Adoption Will Be Slowed Significantly by HITECH

I recently posted what I think is a relatively reasonable timeline for EHR adoption. It’s very broad, but I think that most doctors could use it as a reasonable estimate of how long it will take to implement an EHR or EMR in their clinic.

Of course, the above EHR implementation timeline doesn’t start until a doctor or clinic makes the decision to actually implement an EHR in their clinic. Unfortunately, I’m afraid that HITECH is going to dramatically delay many doctor’s decision to implement an EHR.

The HITECH act just gave doctors who were on the fence about implementing an EMR will now have a bunch of great excuses why they should wait longer to implement an EMR:

• We need to know what certification criteria is chosen by HHS
• How will HHS define meaningful use? Will we even be able to show that?
• Will our preferred EHR be able to satisfy the HITECH act reporting requirements?
• Let’s wait to see what open source EHR HHS gives away

I’m sure there are other reasons. While I’d usually say that these were just excuses for people who don’t want to use an EHR, I actually think this is probably the best plan for those looking to implement an EHR. I don’t think I’d be signing any contracts with a vendor right now. Unless I didn’t care about getting the EHR stimulus (which might actually be a good line of thinking).

What shouldn’t be delayed is the evaluation of the various EHR on the market today. In fact, I highly suggest this evaluation takes place before HHS defines the above items. EHR stimulus money should not be a major factor in your EHR selection process, but instead should be an added side benefit or a tie breaker for 2 equally great EHR companies.

Certainly some will argue that some doctors will be motivated by the HITECH act to implement an EHR quickly in order to receive the EHR stimulus that begins in 2011. Doctors who can’t show meaningful EHR use by 2011 could possibly miss out on the medicaid and medicare bonuses. I just honestly don’t think that most doctors will care that much about it.

Those who would have been proactive in implementing an EHR because of this already have an EHR and are just licking their chops at the idea that they might get some extra money from government for little additional work. I don’t see many of those who haven’t implemented an EHR being that motivated by a few thousand possible government dollars.

Reasons Health Care IT Can’t Spend $20 Billion

I think it’s reasonable to consider some of the reasons why health care IT won’t be able or willing to have $20 billion of government money invested in health care IT.

Not Enough Healthcare IT Professionals – It’s been widely suggested that the number of health care IT professionals might not be sufficient to support this type of invesment in health care IT. I hope my fellow IT professionals from every field can easily make the transition to health care IT. Certainly many will without a problem. However, the question remains if enough will be able to do so.

Other Reasons Not to Adopt EMR – I’m certain that a study on why doctors haven’t implemented an EMR yet would not show money as the main factor preventing adoption of EMR. There are many other reasons a doctor chooses not to implement EMR and money isn’t going to resolve those concerns.

CCHIT Requirement – Of course, this assumes that the government chooses to make CCHIT a requirement for receiving funds. Doing so will limit the choices a doctor has in selecting an EMR. I think it’s very likely that many doctors will forgoe government funding in order to use a non CCHIT EMR. This could be especially true for specialists who would rather select a non CCHIT certified EMR that focuses on their specialties needs.

Paperwork Required – The government won’t just be going around handing people checks. We’ll have to wait and see how much paperwork and reporting will be required to obtain these government funds, but many doctors will shun the paperwork and beuracracy associated with receiving the government funds.

EMR Vendor Selection Process – With over 400 EMR companies to choose from, it will take doctors some time to decide which EMR they like best. Even if you narrow the list of EMR companies to CCHIT certified companies, you’re still looking at a lengthy evaluation process. Most doctors want to practice medicine not learn about software. So, evaluating EMR software often gets pushed down on their list of things to do.

We’ve all seen or heard it said that it’s harder to spend $20 billion than you would think. This couldn’t be more true when it comes to investment in health care IT and electronic medical records. Let me know in the comments if there were any other reasons I might have missed on why the spending in health care IT might not occur.

Generic Electronic Medical Record Description

I get a bunch of email from all sorts of electronic medical record vendors telling me about their software and their company. I don’t mind when people contact me with something innovative and interesting. The problem is that most company press releases are all the same. They all tout the more or less the same feature set of every other emr company out there. I’ll put an example press release I got below so you can see what I mean.

At the end of the day, reading press releases like the one below I wonder if 1. companies understand what it gets bloggers and media to use their press release and 2. emr companies have really stopped innovating the way they should.

On the first point, if you want me to write about you or your company then you better tell me something cool and different. Sure, add in the list of standard features at the bottom, but sell me on a feature that makes you better than every other EMR company out there. Otherwise, I’m just going to ignore you as one of the other on the long list of EMR vendors. You’ll notice I didn’t even put a link to the company whose press release is found below, because there’s nothing interesting or unique enough about the company in that press release that makes me want to send people to their website.

As far as the second point, it’s been a while since I’ve seen some truly creative and innovative thinking from an EMR company. I’m talking about things like Medtuity’s granular method of data entry or Brendon’s beloved eMedRec which is a really interesting hybrid of a scanning/document work flow with some of the EMR features layered on top. I’m sure there are more cool things being done with EMR, but it gets lost in everyone needing the standard boring features.

So, keep the emails coming, but make them interesting so I don’t just go straight for the delete button.

WITH MTBC, THE LOCAL DOCTOR�S OFFICE FINALLY JOINS THE PRESENT � AND FUTURE � OF HEALTHCARE IT

New integrated IT system provides patient scheduling, touch-screen check-in, integrated records and billing with mobile access, real-time adjudication of insurance claims and more

SOMERSET, N.J. � Sept. 9, 2008 � Unable for years to match the cost-cutting IT advances of deep-pocketed insurance companies and hospitals, private physician practices are now embracing a level playing field with innovator MTBC.
This playing field extends throughout the patient-physician-insurer continuum, from the Internet to the paperless doctor�s office, creating enormous efficiency for all involved parties�even the pharmacy and medical laboratory. Through MTBC�s integrated system, patients schedule appointments online, receive automated reminders by phone, and check in at the doctor�s office at a touch-screen kiosk.
�Technology becomes far more dynamic as it enhances the patient-physician relationship,� said David Rosenblum, president of MTBC. �Our newest services reduce the time the patient spends in the doctor�s office and increase the care the physician can provide.�
Patients whose physicians use MTBC can schedule appointments privately with their doctors on a secure web site, while viewing available blocks of time. The reason for the appointment and medical symptoms may be entered, along with current insurance information. The patient will receive automated reminder calls prior to the appointment, minimizing no-shows�a bane of most doctors� offices.
At the doctor�s office, the kiosk scans a patient�s insurance information with a swipe of a card and then conducts a brief survey of medical questions. This information is integrated into MTBC�s EMR software for easy access by doctor and staff.
During and after the appointment, doctor and staff enter notes, diagnoses, and prescriptions into MTBC�s EMR software. Prescriptions are transmitted by electronic fax to any pharmacy�handwritten prescriptions are obsolete. Lab reports are also electronic, accessible securely by the doctor on the web.
Insurance claim data, such as procedure and diagnosis coding, is entered and transferred securely via automated synchronization on a daily basis to MTBC�s web-based billing platform, with its real-time financial reporting and array of practice management tools. MTBC�s dedicated teams in billing, practice and patient support complement the cutting-edge service package.
After the patient examination, MTBC will determine exactly how much of the visit is covered, and how much the patient needs to pay out of pocket, thanks to Real-time Adjudication (RTA), a new service spearheaded by certain insurance companies.
MTBC�s system means no more waiting in a doctor�s office for hours due to poor scheduling practices. It means having the physician know what the problems are the moment the appointment begins. It means no more uncertainty or confusion over insurance payments, avoiding the unpleasantness of an unexpected bill that arrives weeks later.
And for the physician, MTBC creates a streamlined scheduling and billing system that allows substantially more time to be spent on the patient�s needs and questions.
�These advances demonstrate that we�re a nimble technology company that acts quickly on the issues reshaping the entire healthcare industry,� said Mr. Rosenblum. �We are always committed to maximizing and accelerating our clients� collections.�
MTBC�s system integrates several advances in healthcare IT�previously available only at hospitals or insurance companies� to revolutionize private practices:
� Doctors migrate to MTBC�s free EMR (electronic medical records) software and slash records-related administration.
� MTBC provides access to real-time adjudication (RTA) of insurance claims for patients with UnitedHealthcare insurance, greatly accelerating related payment.
� MTBC recently launched the PDA version of its billing platform so that clients can access their practice�s financial reporting, claims data, and scheduler through an iPhone, Blackberry and Windows Mobile device.
� MTBC is now rolling out physician web sites that allow patients to schedule appointments online.
� MTBC conducts automated phone reminders to patients.
� MTBC is integrating a detailed survey program that patients can access online when an appointment is made. This survey gives a physician a better sense of the patient�s symptoms before the appointment even begins. And unlike other companies that have started to offer patient survey services, MTBC does not sell patient information to third parties � everything is kept confidential between doctor and patient.
� MTBC is testing patient kiosks that read a patient�s insurance card, take his or her picture, and conduct brief medical surveys. This will dramatically reduce waiting times and bottlenecks in physician offices.
�We�ve always been committed to bringing state-of-the-art technology to private practice physicians and practice administrators,� said Mr. Rosenblum. �Our business model makes all these innovations easy to use, integrated, and remarkably affordable.�

When EMR Software Became Free…Or Does It Cost

I’ve been meaning to write about a new Free EMR for a while. One of my most blogged and searched about topics is free EMR. I guess everyone loves to get something free. Why should free EMR be any different?

The problem with free EMR is that while it may be free from a financial perspective there are always other costs associated with free EMR. Here’s an example of a parts of an email I recently got about a new Free EMR. The company is called Practice Fusion and the following is excerpts from the email I received:

Today we have a press release going out (below) about Practice Fusion releasing a suite of physician applications, including Practice Management, Scheduling, Secure Email and Patient Management that are free and web-based. These are effectively ‘Google Apps’ for doctors – everything a practice needs to run their office, manage and schedule their patients, communicate with other members of the office – all web-based and at no cost.

I really liked the marketing angle that this company is taking. I personally am a devoted google apps user and I absolutely love what google apps is doing for me. Google apps is a completely free application that gives my businesses (EMR and HIPAA included) a whole bunch of business services with my very own branding. Most important of which are Email and Google documents. In return for using this free service, Google puts ads around the various services. A small price to pay for me to receive free email.

Turns out, Practice Fusion is offering a free EMR using the same model as Google Apps. My email described Practice Fusion’s free EMR revenue model as follows:

We generate revenue by embedding advertising, including pharmaceutical products, into our physician tools. We also incur revenue through the sale of anonymized patient data to research groups, pharmaceuticals, and health plans.

Basically, their planning on selling ads around people’s patient information. People are still freaking out about Gmail and Google apps placing targeted ads around their email. Why? Because in order to target the ads properly, that means Google has to search all of your “private” emails. Does this mean that Practice Fusion is going to be searching through all of your patient data?

Being completely honest, I personally don’t have much to hide and so Practice Fusion could have a hey day looking through my health information. However, I’m not sure most patients will share my same view. My guess is that most patients would feel very uncomfortable going to a doctor that is using a service like this. I think they’ll feel like their doctor was selling their information to save a buck. It might be one thing if the patient saved some money too, but that’s not going to happen.

Certainly a doctor using this free emr didn’t have to tell their patients that it was paid for by advertising and getting their information sold. However, could you imagine the backlash that would occur if they didn’t tell their patients and then someone found out. I’m honestly not sure how many doctors would want to take that risk. Sounds like the perfect 11 o’clock (it’s later in Vegas) news story to me. Lead Story: “Doctor Sells Patients Data to Save Money.”

Maybe I’m wrong and people won’t care about this or those that do care won’t find out. If that happens, then it’s hard for a doctor to argue with free. I personally haven’t looked at the feature set to know how it compares to other EMR vendors. However, there’s no arguing some of the benefits described in the email I received:

Practice Fusion offers a unique product to small and medium sized physician practices, which was developed using Adobe® Flex® 3 software for creating Rich Internet Applications (RIAs). Practice Fusion’s solutions are web-based, require no upfront costs, no extra hardware, no large software applications to install and rollout, and no backend databases, which are required by traditional vendors such as Misys and NextGen. Where enterprise solutions may take weeks or even months to implement, Practice Fusion’s services utilizes its exclusive ‘Live in Five’ process to enable physician practices to be deployed and up and running within minutes.

Web Based – Awesome! Certainly the future of almost every software application.
No Upfront Costs – Nothing to lose, but also no motivation to avoid EMR implementation failure either.
No Extra Hardware – Very nice for the doctors. Not so much for the IT support people.
No Large Software Applications to Install and Rollout - I hate managing client applications. This is a big plus.
No Backend databases – This isn’t really true since they certainly have a back end database, but the point being you don’t have to manage the backend database. A nice benefit for most doctors.

Now a word about Practice Fusion’s “exclusive ‘Live in Five’ process.” I’m certain that it is true that they can create an instance of their EMR in 5 minutes. However, don’t be misled to think that you can spend 5 minutes and have a fully functioning and fully configured EMR. It’s just not reasonable to think. It’s a nice marketing angle, but it’s just impossible.

Think about this for a second. Assuming a very small practice of 5 staff. It’s going to take you somewhere around 5 minutes just to gather the information and create the user accounts for your 5 staff members. Now add in the myriad of other configurations you’ll certainly have to do and you start to realize that your EMR won’t be setup and ready to go in 5 minutes. In fact, my experience is that the EMR configuration process is an ongoing process that never ends. Practice Fusion’s free EMR could certainly argue that setting it up is faster than setting up other traditional EMR softare, but don’t be fooled by the “Live in Five” marketing.

One final thought before I end this. Let’s go back to my current Google Apps experience. What do I do if Google changes their mind and shuts down their service? There’s not really much you can do. Google’s giving you a free service which they can terminate at any time. Luckily a number of creative IT users have found ways for people to backup their email stored on Google servers.

I finally found a link to this topic buried on the Practice Fusion website. Most of that page talks about how their more reliable than an in house system. Interesting that they didn’t address what happens when your internet goes down and you’re left up a creek without a paddle, but that’s a topic for a different post.

The thing that isn’t addressed by Practice Fusion is what happens if Practice Fusion disappears. Sure, it would be nice to think that Practice Fusion will be around forever and it’s great for them to have that confidence, but it’s just not realistic. What if Practice Fusion sells to another company? What if Practice Fusion goes under? What if the free EMR model doesn’t work and Practice Fusion decides to start charging?

It does alleviate some fear that at the bottom of the linked page Practice Fusion says “It’s your data – always.” However, we’re not talking about a bunch of linear data like email. We’re not talking about something in a standard format that can easily be exported between one software to another. We’re talking about Practice Management, Scheduling, Secure Email, Electronic Medical Record and Patient Management. How do you expect them to provide you a “copy” of this data? Would be an interesting experience to try and see what they provide and how responsive they are to the request.

I’m not trying to be overly critical of Practice Fusion. Maybe they have a great product that’s worth every penny. Wait, of course it’s worth every penny since it’s free. Sorry I couldn’t resist. My point here is that doctors should be careful when evaluating free EMR software. There are certainly benefits to a free hosted EMR solution. Just don’t be blown away by the free tag and make sure you know the challenges of free.

By the way, I hope that Practice Fusion will respond to my various assertions and comments with a response in the comments. They seem like they’re pretty tech savvy. Just the fact that they have a Practice Fusion Blog is enough for me to give them some props (even if they did use typepad and not wordpress). You can expect some future blog posts linking to their blog.

Time to Thank Our EMR and HIPAA Advertisers

I never thought when I started this blog that it would do so well. I mostly just started it as a labor of love. It still is a labor of love, but I was really happy when a number of advertisers were interested in advertising on EMR and HIPAA.

Thanks to Medical Software Associates and emrexperts for advertising on EMR and HIPAA. I really appreciate your financial support of this blog and my wife appreciates it even more.

If there are any other advertisers interested in advertising on EMR and HIPAA, please leave a comment on this post or email john [at] emrandhipaa {.} com Visitors to this site stay an average of 4 minutes and 40 seconds and visitors are almost exclusively interested in EMR and health care related topics. A very nice targeted market for EMR vendors, EHR vendors or I would think it would work really well for pharmaceutical companies too.

EMR and EHR Software and Dragon Naturally Speaking

n a recent comment, Tom Hamilton from KnowBrainer software sent some interesting insights about using Dragon Naturally Speaking. His observation about more and more physicians using Dragon Naturally Speaking with their EMR or EHR is very true. I expect this trend to continue for quite a while. I don’t know how many times doctors have asked me for this ability. Unfortunately, it is like any software program and takes some getting use to, but those that do get use to it seem to really love it.

Here’s what Tom sent me. I hope it’s valuable for those looking at voice recognition with their EMR or EHR. I always welcome guest posters who want to post information like this to my blog. If you’re an expert at something related to EMR, EHR, or other Healthcare IT related topics, then let me know if you’re interested in being a guest blogger.

EMR Software and Dragon NaturallySpeaking are being utilized together in more practices and by more physicians every year. In light of that fact I would like to offer this information to the curious.

1. If you’re using Vista you should have 3-4 GB of RAM. For an XP platform you will require 2 GB of RAM. The software will run on less but won’t be very as effective.

NOTE: If you’re looking at buying a new computer to use with DNS I would consider looking at ASUS computers. Regardless of what system you by, you want a Core2 Duo 2 GHz or better CPU speed, 2 GB of RAM an XP platform (3 GB on Vista), 2 – 4 MB of L2 cache, a SATA hard drive of at least 100 GB although you may be able get 160 for about the same price. Your soundcard will be important so go with a mid to high end Soundblaster.

2. Unless you’re using a Soundblaster card don’t depend on the integrated soundcard in your computer as it is probably poorly shielded. Get yourself an external soundcard (USB Pod) and use a USB port on the back of your computer as opposed to the front.

3. Here is a copy of the manual we wrote for version 9. It’s designed as version 9.5 upgrade manual but if you are a new user to DNS you can download a full copy manual at KnowBrainer.com. KnowBrainer Manual

4. Here is a copy of the KnowBrainer Quick Tips which is PDF help file for day to day troubleshooting that is updated all the time from questions answered on our forum.

5. Here is a copy of our DNS 9 Review. I think you’ll find it pretty thorough.

6. For research feel free to use the KnowBrainer Speech Recognition Forum as it is by far the largest and most active of its kind.

7. I know there are quite a few users of NaturallySpeaking version 9 who don’t know about the Free upgrade to 9.5. Then there are some that do but don’t have time to find a path to it and worry about difficulty installing it. You should always use the most updated software especially when it’s free. Version 9.5 consolidates the code between version 9 and 9.1 and contains a few minor tweaks. The main purpose for the upgrade is for Vista compatibility. Here is your path and instructions – DNS 9.5 Update Guide

KnowBrainer, Inc. Support Staff – Tom Hamilton
Now Providing FREE (1st 5 min.) Tech Support 615-884-4558
A Nuance Gold Certified Endorsed Vendor
ALWAYS Ask If Your Speech Recognition Vendor Is Nuance Certified

Thanks Tom for the information. I think I’m going to have to “borrow” the dragon naturally speaking software one of my users cast aside and try it for myself.

Google Health Beta Page is Up

UPDATE: Google Health Beta is now LIVE!

Today I saw an article on TechCrunch that talked about how Google Blogscoped found a Google Health login page (UPDATE: The Google Health Beta Landing Page has been taken down) for the hopefully soon to be released Google Health. Of course, there isn’t really anything all that special about the login page. It looks just like almost all the other Google login pages. However, the Google Health page did include the following information:

With Google Health, you can:

* Build online health profiles that belong to you
* Download medical records from doctors and pharmacies
* Get personalized health guidance and relevant news
* Find qualified doctors and connect to time-saving services
* Share selected information with family or caregivers

Too bad none of the other links work, but it does give some interesting information about what Google Health will be like. The part that is most concerning to me is downloading medical records from doctors and pharmacies. How are they going to do that? The answer is that they aren’t really going to do it. There are going to be a handful of the thousands and thousands of doctors and pharmacies that will be able to work with Google Health.

I hope that Google Health does the right thing and integrates with something like CCR since it is already beginning to be established in many Electronic Medical Record software programs. That would be a huge boon to CCR, but it would also open up an entire set of doctors that could support upload to Google Health. This could definitely be a nice differentiator from Microsoft Health Vault which can’t do this either (unless it’s been added since I looked).

If Google Health decides to create their own standard for a clinic to be able to upload to Google Health they are crazy. Doctors have almost no motivation to support Google’s standard for uploading medical records. I’m not sure many EMR companies will support it either. I can see a few of them do it as a PR move, but I’d be very surprised if many of them bit on this. Doctors don’t buy EMR software because their patients can get their record out easier. It just doesn’t make business sense for EMRs or doctors to really do any sort of uploading like this to Google Health.

Of course the good thing for this all is that having another big player like Google interested in helping the healthcare system with someHealth 2.0 solutions is great by me.

You can see my previous coverage of Google Health and also the Google Health Co-op.

Update: Here’s a screen shot of what Google Health could look like.

Update 2: What CEO of Google Eric Schmidt said about Google Health at HIMSS08.

Free EMR by Medicare?

I’ve been working with John Deutsch of EMR Experts, Inc. and I invited him to be a guest blogger on my blog. Here’s an article John sent me about the Free Vista EMR offered by the government. While I think the news about Vista being free came out about 2.5 years ago, the information about adopting it is still VERY relevant. Probably because the EMR adoption level is so low.

Enjoy John’s take on the government’s “Free EMR.”

Is anything ever free these days? Maybe so.

Instigated by the incredibly slow adoption of Electronic Medical Records (EMR) by doctors across the nation, Medicare is announcing it will begin offering doctors free electronic medical record software solutions.

Both upfront and ongoing costs have been critical factors in the lagging EMR adoption rate. Medicare hopes that by providing doctors with a free or very low-cost system, doctors will readily adopt EMR putting healthcare providers in America on a common system, thereby, providing Medicare and the general public with obvious, health, reporting and billing benefits.

The proposed system is VistA, (Veterans Health Information Systems and Technology Architecture) the widely popular system built by the Veterans Administration.

The adoption of VistA has resulted in the VA achieving a pharmacy prescription accuracy rate of 99.997%. Due to the implementation of VistA, the VA also outperforms most public sector hospitals on a variety of criteria.
The VistA system is public domain software, available through the Freedom of Information Act directly from the VA website or through a network of distributors.

Installed in over 1300 inpatient and outpatient facilities, the system is well-established and quite successful by EMR standards.

But can a system designed for a large organization like the VA also work for a solo practitioner family practice office?

A doctor in a New York Time article writes:

“It is one thing to use a system that someone else installed and someone else maintains. It is another to get a set of disks in the mail and do it yourself.”

Those who have tried to install VistA on their own would agree.

“Giving out a version of VistA is a great idea,” said Dr. David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians, a group that has been working on the project. “But at the beginning, there was a lot of wishful thinking. They said, ‘We’ll just release it.’ I said, ‘Where’s the fairy dust?’ ”

The problems with the healthcare sector and its slow adoption of electronic medical records are much deeper than some would like to admit, and viable solutions have been hard to come by.

The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows.

Building a one-size-fits-all system has failed in the past and will likely continue to fail. The fact that over 300 different vendors currently develop and market EMR software attests to the need for customization.

The need for pre- and post-sale customization is a reality in every practice since every practice operates differently. Even practicing physicians within the exact same specialty do things differently and run their practices differently.

A key challenge for systems with large installation bases is often that the system becomes rigid simply due to the vendor trying to please too many different practices. Customization gets repeatedly delayed or shelved altogether.

Another concern is that when medical records are stored on servers that Medicare can access and control as they please practices may be hesitant to use the system regardless of the benefits to the practices and their patients.

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

Even if Medicare did make it 100% free, a free EMR is not free if it fails. The costs involved with a failed implementation can far outweigh the costs of purchasing an EMR at market price due to productivity losses, and hardware and implementation costs.

Maybe Medicare could focus more of their resources in the development and promotion of better standards for integrating already proven EMR systems and integrating EMR systems with electronic personal health records, managed by the patient

Why not offer patients a free electronic health record which can easily interface to all the major EMR vendors in the market? Wouldn’t a record they control, that can communicate with all their health providers, and be accessed by any other provider in the event of an emergency be more beneficial?

After all, isn’t the patient’s best interest the goal of healthcare in the 21st century?

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For more information about EMR Experts, Inc. and their Medical Software solutions, please visit www.emrexperts.com

EMR Market Share

I regularly am asked what the market share of the various EMR companies is. Unfortunately, I think this is an impossible question to answer even if people would love to know the top EMR vendors. EMR vendors just don’t publish the number of EMR implementations they have for strategic purposes (usually). Plus, those that do publish numbers aren’t usually very truthful in the number they give out.

For example, they might say something like they have 500 offices using their EMR. Then, you’ll find out that they’ve actually only sold 20 offices and one of those has 250 actual offices. Then, you’ll find out that the they have 250 offices and plan to implement the EMR in all of those offices, but they’ve only done it in 2 pilot offices right now.

Another example, EMR vendors love to say that they have XXXXXX thousands of doctors using their system. Of course, what they don’t tell you is how many of those thousands of doctors used it once and left it. How many of those doctors only log in to write prescriptions. How many of those doctors only use 10% of the features of the EMR (hardly can be considered using an EMR). We really want to know how many doctors have that EMR, log into it every day and do almost every part of their work in the EMR. Even that’s a hard number to calculate. Should we count them if they print off their scripts or do they have to ePrescribe?

That’s why it’s really brave of Software Advice to try and estimate the EMR market share. No doubt the market share listed is off. I think the most significant number that’s off is likely the list of “Other EMR vendors.” There are 300+ EMR vendors and more being launched every day. I’m pretty sure that this other EMR vendor category actually dwarfs all of the EMR vendors that are on the list.

Florida Board Member Recommends Statewide Warning on EMR Errors

Here’s an interesting story from Florida:

A Florida Board of Medicine member wants the board to issue a statewide warning about EMRs, following an incident in which an OB-GYN missed an abnormal Pap smear and blamed the EMR. The OB-GYN punished the EMR by replacing it, while the Board of Medicine punished the OB-GYN with a $20,000 fine, a risk management review, and 100 hours of community service. The board member, a dermatologist, said “”I think the Department of Health needs to put out a warning to physicians that they need to look at their programs’ default settings. This year we have seen as many if not more medical records violations from electronic medical records as we saw from hand-written records violations.”

I’m not sure what benefit the Department of Health issuing a warning would do. I know I’ve never personally seen a warning from the health department (outside of the major news ones). One thing is clear to everyone involved with EMR or not. EMR isn’t the secret potion with no issues. Doctors are still accountable for the care.

Benefits of EMR Software to Consumers

One of my readers emailed me about a presentation he was looking at doing about EMR software and consumers. I was really intrigued by the idea of presenting on the benefits of an EMR to the consumer (Translation: Patients). I’d spent quite a bit of time thinking about the benefits of an EMR to doctors, but I hadn’t put as much thought and effort into the benefits of an EMR to patients.

Here’s our initial brainstorm on the benefits of an EMR to patients. Feel free to add to the list in the comments:
-Online Appt Scheduling
-Online Prescription Refills
-Online Patient Information
-Online Forms (possibly pulled in from a PHR)
-e-Visits (this is a controversial one)
-Secure communication with doctor
-Recall/Reminders Electronically
-Patient participation in health record (ie. diet journals)
-Better point of care
-Clinical decision support
-Better access to your health records
-Less errors
-Lower cost
-Better collaboration and communication between primary care and specialty Drs

No doubt some of these benefits should have a ? mark by them. Although, I like the idea of looking at the EMR from the patient perspective. I do after all think that consumers might be the key to “forcing” broad EMR adoption.

EMR Permissions

It’s always interesting to talk with someone about the permissions they should set in their EMR. Pretty much every EMR that has any footprint has a broad set of permissions available to restrict the access of your end users. It can often be a pretty significant task to set all of these permissions. Thankfully, it’s a project that you do once and then don’t have to go again (except for maybe some minor changes). Also, many EMR vendors have good templates for giving you a starting point for permissions.

What usually happens is that users end up with ALL sorts of restrictions on user accounts. I can’t say this is such a bad thing. Users should only have access to the information and features they need for the job. However, in the application of this rule, people almost always go overboard. Shortly after an implementation, the permissions are eventually opened up.

Since this is bound to happen, it’s important to make this part of the EMR implementation plan. Don’t make your nursing staff beg you for access to something. Give them a way to ask for access without making them feel like they are doing something they shouldn’t. Instead, encourage them to ask you for access to things that would make their life easier. That doesn’t mean that you’ll always give access, but from what I’ve seen, most people don’t want more access than what they need.

Remember that the rule is that people should only have access to the information that they need. If they’re asking for access to certain information to make their (and often your) life easier, then they probably do need it and should have access.