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.

Thank You EMR and HIPAA Sponsors

As EMR and HIPAA passes our 3 year anniversary, I thought I’d take a moment to thank the sponsors of this blog. Their sponsorship makes this website possible. This is especially true at Christmas time. So, thanks to both EMR Choice and EMR Experts for your sponsorship and advertising on EMR and HIPAA. Our relationship with EMR Experts goes back almost 2 years and so hopefully they’ve found our relationship as beneficial as I have found it. EMR Choice is a new sponsor that’s really trying to do some good things in the EMR market.

It’s hard to believe that it’s been over 3 years since I started this blog. I first started out just wanting to document my experience with EMR. I still do that to a large extent, but it’s grown to a lot of other things including some of the various EMR related technologies like the ever popular Dragon Naturally Speaking medical. Regardless of the topic, I still am passionate about EMR and the effect that it can have on healthcare. I think a ton of things need to be done to improve its implementation, but it’s needed as a platform for the future of healthcare. It will be fun to see it evolve over the years.

Also, I wanted to wish everyone a Merry Christmas and a Happy Holidays. May you enjoy the season and celebrate with those you love and care about.

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.

EMR and Healthcare IT Job Search

If you’ve been reading my blog for any amount of time, then you know that I currently work in College Health at my local University. I started this job about 3 years ago and it has been a great learning experience for me in learning about EMR and healthcare IT.

When I started the job 3 years ago, I took advantage of working at the University and started classes for my Masters in Information Systems. Happily I completed my Masters a few weeks ago. With the completion of my Masters degree, I’ve decided to start looking around for other job opportunities. I already have a few leads, but I thought I’d post my availability to my blog in case any of my readers have potential job openings.

To be completely honest, I’m really jack of all trades when it comes to technology. I’ve done everything from server and database administration to workstation rollouts. I enjoy optimizing processes and analyzing how to revamp a process using technology. I don’t want to be a programmer and will probably avoid doing any hard core system or database administration, but those things are fine as a small part of my job. I much prefer working in a strategic position where I can plan and organize in a way that the company is well positioned for the future.

If anyone has some potential job openings in the EMR or Healthcare IT field, then I’d love to hear about the opportunity and I’ll have my resume handy. You can either leave me a comment or send me an email at john [at] emrandhipaa {.} com

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.