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.

Top 10 Open Source Medical Billing and Electronic Medical Records Applications

For those loyal readers of this blog, you’ll know that open source software and in particular open source EMR software has been a much discussed topic. I guess people love it when you talk about a free EMR. I must admit that I’m always intrigued by open source (free) software and open source EMR software is no different.

I recently came across a list of the top 100 Open Source Software Tools for Medical Professionals.

You know I’m a sucker for a list and I especially like EMR lists, so here’s their top 10 open source EMR software:
1. FreeMED
2. OpenEMR
3. OpenEMR Current
4. OpenEMR Virtual Appliance
5. FreeB
6. SmartCare
7. XChart
8. OpenMRS
9. Open Dental Software
10. ClearHealth

Quite an interesting list to choose from. Now if I could just get the data on number of installs for these applications. When I mean installs I mean doctors who actually use these open source EMR systems every day in their practice. Anyone want to let us know where we can find that data? Or any open source EMR packages want to fill us in on their progress?

I’ll update the post if I find anything or get that information in the comments.

Interesting. I wonder why none of these are CCHIT certified?

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.

REC Sharing or Lack Thereof

There was a pretty interesting thread posted to a LinkedIn group about the RECs. Here’s some comments that will make you think a little bit about the RECs and in particular the RECs working together (or not).

It is understandable that REC’s must adapt their programs to the communities they plan on serving….Healthcare is local. However, living in Florida, where there are 4 REC’s, I expect some things to be consistent…for example the implementation process should include the same pre-implementation workflow worksheet. Unfortunately, this may not happen.

We know that ONC is asking that the REC’s play nice and share best practices. However, as a consultant that is talking with 3 of the 4 REC’s about a role….one REC leader in Florida asked me…”Make no mistake, we are competing with the other RECs, so as a consultant, how will you keep our secrets from the other REC’s you are working with in the State? This was a valid question, which I will address in my agreements, however, it made me think. What are they competing for..additional funding that isn’t there yet? Reputation? Most innovative?

Well..I think its all of the above. I believe, the REC, that employs the right people, have the right vendor PARTNERS, and think outside the ONC box, will rise above the rest. However, best practices must be shared and that is where the ONC project lead/coordinators (in Florida its Kelly), must step up and do!

RECs competing is kind of a sad idea for me. Something doesn’t feel right about that. Now take a look at the compensation funding model for the RECs:

The REC’s do get 500k upfront for marketing the REC, initial staffing needs, etc. Then they get $ as they sign up the physcians, in my area its 5k for primary physicians with no EHR. I think they get 3k for primary physicians that have an EHR, but needs to get too MU. Primary Docs are the main targets though. In terms of competing for physicians….they do not. The REC’s are assigned Counties in their State. The only time they would compete is if a doctor has two offices in separate Counties.

With this followup clarification from another user:

In my state, it’s $1500 for sign up, $1500 upon implementation, $1500 for meaningful use. Perhaps the competitiveness referred to in your conversation with the REC in FL relates to future grant awards…

When you see the $ signs in the RECs eyes, now you’ll know why. I appreciate that the government wants to try and reward results. However, something tells me that this isn’t heading down the path the government intended.