Welcome to EMR and HIPAA

It looks like there is a decent group of people that have been spending a significant amount of time really developing the best Open Source EMR projects out there. They’ve even done an excellent review of a couple Open Source EMR projects. The information on this review page is really the heart of the open source EMR development

I really think that no doctor should use an Open Source EMR package unless they have a qualified technical person that can look at the information in the reviews and know what it means. Open source may often mean free to use, but that doesn’t mean that it is easy to implement. Don’t be confused when it is often described as Free EMR. It would be naive to think that an open source EMR would be easy to implement. I really hope over time this changes. Kudos to all those who have been spending their valuable time on such a great project. With time I can really see open source EMR being a viable option.

I also loved a couple links on the review that show a snapshot of how the Open Source EMR development is going:

Who’s Contributing to Open Source EMR Development

Open Source EMR Project Development Over time

The amazing part is their names on these pages are a large part of the recognition they get. Otherwise, developing an open source EMR(free EMR) is really about adding and developing for the greater good.

Excellent Work Open Source EMR Guys!!

I finally made some time to read a few of the EMR posts by Dr. Griever a Canadian EMR blogger. Besides being an excellent writer, she gives a lot of great detail. She also made one of the funniest(and true) statements I’ve read in a long time. It describes EMR implementation so well.

It can be challenging for the IT lead to maintain enthusiasm for EMRs in the face of the inevitable problems and delays. Starting an EMR is a bit like being pregnant: you get nausea and swollen ankles first, and the good part doesn’t come until much later. EMR transition is easier for some than others: I told one of my colleagues that I was having a normal vaginal delivery, while he was having a difficult C/section.

I think I’m about 8 months pregnant now.

I’ve finally decided to move my EMR and HIPAA blog to its own server and leave behind my beloved http://crashutah.com/emr It has been more of a pain to move it than I thought. If I would have known how painful it would be to move I may have put it off indefinitely. I have a feeling that I’ll be having some problems for the next couple days as DNS updates and I notify HITSphere about the new feed address, etc, but I think I’ve been able to do this without anyone getting lost. The content should always be there. I am going to be losing a little statistical data, but that’s ok.

Everyone should change their bookmarks/favorites to the new and improved www.emrandhipaa.com It is nice to see the real domain name there. I can’t imagine people could really take me seriously with crashutah.com. Please let me know if you see something that doesn’t look quite right. Thanks.

There was a recent Town Hall meeting with Mark Leavitt from Certification Commission for Healthcare Information Technology - CCHIT. CCHIT is currently taking a lot of heat for a new certification they are implementing to try and certify an EMR system. While I think the idea of helping doctors have an idea of the quality of an EMR system and which EMR providers have met a certain standard, CCHIT certification doesn’t seem to be the right way. I like the idea that they are looking at costs and making sure that they charge enough to keep the certification lasting. However, the costs are not reasonable for many of the mid range EMR providers to handle. Since CCHIT is heavily backed by the government I don’t think that it’s going to go anywhere for a while, but I’m not sure there are any easy solutions to this problem. Here’s some really interesting comments about the pricing structure discussed at the town hall meeting and were posted to EMRUpdate:

To put it bluntly, we are looking at a MINIMUM fee of $28,000 a year. We currently have a new release every 3 months, so technically, our fee could be MUCH higher. We could, of course, cut our own throats by restricting new releases to once a year and lose our pricing and customer service advantages.

The argument is that this certification is ‘Optional’ and we don’t have to do it. And then the rep from the MGMA gets up and says that they are recommending that their members only buy CCHIT certified EMRs and so does the AAFP, AMA etc. So how optional is it going to be? I don’t buy that argument at all.

One of our fellow EMRUpdate members at the meeting did mention the discussions here and essentially the response was ‘blogs never hurt me, so blog away!”

I am seriously convinced that the alternative certification option is looking more and more attractive. How many of the small vendors on this board want to pay a minimum of $28000 a year? The MGMA rep was essentially quoting a ‘per doctor EMR cost of $33,000 and so this is less than one sale’. How many of us charge less than a fraction of that per doctor? This certification pricing model is seriously flawed. If we used a model like this, our customers would leave a vapor trail out of our offices.

So bottom line? We could toe the CCHIT line and raise prices, cut innovation and eventually go out of business as all our competitive advantages will have evaporated. Or vigorously back an alternative standard. I think I know where I would like to be. All you thoughts and comments are welcome.

That doesn’t sound too good. They described the reason for the charges in this manner:

$28,000 up front to start the review process. 3 reviewers (1 doc and 1 security tech will be on each team) shall conduct the review for 8 hours. If the review takes longer than 8 hours, then the vendor will be charged for the extra. For the 8 hours, the Doc will be paid $1200 - $1600 and about $1200 each for the other 2 reviewers out of the $28,000 collected.

The real question I have is how do I get on that review board. That’s a lot of money to be reviewing an EMR system. Maybe I should created the EMR and HIPAA review board and charge them half the price. I’d be more than happy to review an EMR provider for $14,000 using the same criteria that CCHIT has already published. I wouldn’t even need $14,000 each year to renew it. After having seen it the year before it shouldn’t cost nearly as much to certify it again. I think it should also contain some component of actual user base information. You could spot check to make sure that the user base isn’t being tainted by the EMR provider, but if the user base says certain components haven’t changed over time then why should you check it again?

It looks like some of the Health IT media has picked up on the CCHIT meeting also. Neil Versel - the Healthcare IT Blogger wrote an article on this CCHIT meeting in Health IT World. Since I think the cost of the certification is one of its main problems, here’s an excerpt from the article:

Certification testing for 2006 costs $28,000, regardless of the size of the vendor seeking approval. Of that, $23,200 goes to the actual testing process and $4,800 is the annual fee to maintain certification. Vendors may use a certification for up to three years as long as they pay the annual maintenance fee, though they may choose to re-test annually to get a current-year certification stamp.

The cost and the renewal process were key targets of vendor ire. Several vendors promised that they will raise their prices if they have to pay the $28,000 testing fee. They also worried about spending money for a full re-testing next year so as not to appear that their products were out of date with a 2006 sticker in 2007.

Leavitt tried to assuage concerns by saying that certification will help business. “If you don’t see an acceleration in the [EHR] market, then we’ve failed,” he said.

I agree wholeheartedly that the $28,000 plus annual fees plus recertifications will raise prices for EMR providers which will get passed on to the doctors. More importantly, I believe that this large of a fee and the requirement for recertification with every major release will stifle innovation which sounds just like where many clinics are today. Lack of innovation would be the worst thing that could happen to EMR.

The wonderful HITSphere is a really nice website that collates a bunch of Healthcare IT blogs into one place. I decided I would get a bunch of the Healthcare IT bloggers upset by posting my 10 favorites and letting the rest of them post comments about why their blog should have made it. Then, I can comment on why they didn’t make EMR and HIPAA’s top 10 Healthcare IT blogs. If a blogger doesn’t come to my site and declare that they should be in the top 10 then they really don’t understand why I love blogging and definitely shouldn’t make the list. The interaction of related blogs is what makes blogging fun.

Here goes. My top 10 favorite Healthcare IT Blogs:
1. Healthcare IT - Short and Sweet(although sometimes I wish there was a little more because it is so sweet)
2. The Healthcare IT Guy - Shahid does an excellent job with nicely written posts and good insider information
3. Neil Versel’s Healthcare IT Blog - I won’t dock him points since he is a professional writer
4. GNU/Linux and Open Source Medical Software News - Great resource for information on Open Source projects and news in the Healthcare industry
5. Dr. Greiver’s EMR - True EMR blogging in its purest form. Great content despite being Canadian
6. HealthBlog - Microsoft’s reference on Healthcare. Good Material
7. Consumer Health Informatics News - A different kind of Healthcare IT blog
8. The Candid CIO - Great Content that just isn’t updated enough
9. The Health Tech Blog - Interesting posts. Needs more posts!
10. Christina’s Considerations - Tons of RHIO Information(maybe too much?)

Sweet, now that I’ve ruffled the feathers of Canadians, people who don’t post enough, RHIO lovers and the rest of the healthcare IT blogging community who I left off the list, let’s hear why you should make the list and why you think I placed the blogs above in the wrong place.

I was just going through the list of exhibitors at TEPR 2006. It is amazing how many companies are interested in selling an EMR. Granted the entire list isn’t EMR systems, but a good majority of them sell an EMR. I wish I could go to the conference because I would love to see all these EMR systemss at the same location. However, I don’t think I can justify the price just for my own kicks and giggles. I’ll be interested to see what other people post on the event. I’ve read a lot of criticism of TEPR in the past and so I’m interested what will come from TEPR 06.

Read more…

I finally made it to the big time. The wonderful Healthcare IT News posted a link to my facial recognition post in their related links for a biometrics in healthcare article they wrote. I love when other people recognize that work I’ve done could be useful to other people.

I also loved how the article pointed out that while Healthcare IT lags way behind in their overall implementation of technology, they are way ahead of other areas in healthcare’s use of biometrics. I think biometric vendors can thank HIPAA for the widespread use of biometrics in Healthcare.

It was also very nice to see that MD Tech Guide eDigest made EMR and HIPAA their blog of the week.

This is a little late to be posting, but I’ve had too much else going on to post it previously. It looks like Google Health is finally a reality and is using lessons learned from wikipedia to help in their health portal. I think it is a good idea and the Google Health co-op might just work.

However, I think until some doctors see and evaluate the type of content that is created we won’t really know how good this co-op is going to work. Another Healthcare blogger has posted a lot more on the Google Health portal and how it works. He also gives a good description of someone who is participating in the Health co-op:

See Enoch Choi’s interesting post on his experiences as an individual contributor to Google Co-op. It will provide you with a “ground-level” view of what it is like to participate in this new service.

I’m thrilled to say that we just passed 30,000 visitors to EMR and HIPAA. It really is something else to think that so many people have come to this site to find out about EMR and HIPAA. I’m really happy to see its success. In fact, I didn’t realize how well I was doing at attracting visitors until I looked at a great Healthcare IT blogger recently posted that since tracking his statistics since September 2004 he just hit 10,000 visitors. Pretty amazing that I just started blogging in December 2005.

It’s been a roller coaster getting it started. Now that I’m a little more established with some quality content in place I have been taking a step back to see where I want to take my EMR and HIPAA blog. I definitely want to work on some of my fixed pages:
EMR and EHR Vendors
EMR vs. Paper Charts
EMR Evaluating and Purchasing
EMR Features
EMR Implementation Ideas

I also want to work more on giving details to those interested on implementing an EMR. I want to start doing my initial vision of reviewing various EMR systems. I’ve already started some of the reviews, but I’ve been debating the best way to review an EMR system in an unbiased and professional manner. If you have any ideas please post a comment so I can have your feedback.

Mostly, thanks for helping me reach 30,000. It’s amazing to me that I have gone from 0 to 30,000 so fast. Espescially since this EMR blog was started as a Christmas whim. Who would have thought I’d love EMR so much?

I had someone email me asking me what I thought about a small group of doctors developing their own EMR. Then, I was helping a doctor implement an EMR in a new office and his friend asked me why I didn’t just create my own EMR and make a ton of cash. All I have to say is….Are you CRAZY????

While developing your own EMR is a very nice thing because you are able to customize the process exactly the way you like I honestly think this is a big mistake. You will honestly be spending just as much money developing your own EMR as you will spend purchasing from an EMR vendor. Doing this for a small group of doctors is even worse. Gaining a consensus of these doctors on what is “best” for an EMR is like asking which type of ice cream is best. There are certainly some that are better than others, but it really just depends on a person’s preference. EMR choice is pretty much the same.

One of the biggest problems of creating your own EMR from scratch is what happens once your EMR is “created”. You have to continue paying development to continually create enhancements. If you stop enhancing your EMR program then you get farther and farther behind and lose some of the advantages of an EMR. If you go with an EMR vendor then you continue to benefit from the enhancements that they continue to create. Often there is a small update fee, but much less than you developing all these features yourself over time. An EMR vendor is able to generate a lot more revenue which can be funneled into enhancing your EMR. Do you really think that one programmer can compete with a whole team of programmers? Besides the time factor it is really hard to find a programmer that can do all of the specialized programming for an EMR. They would have to know how to do an HL7 interface, learn CCR, document management, reporting, just to name a few.

Even more important is it is just not realistic for one programmer to be able to build an EMR that has all the feature set of a good EMR system. Sure, I have the technical skill to program an entire EMR. It would just take time. Not a little bit of time, but hordes of time. Individual components of an EMR system really aren’t that complicated. When you pile them all together it would just require a lot of work to develop an EMR from square one. I really think developing your own EMR is a poor strategic decision.

Another point is that there are some great EMR companies that are reasonably priced and will certainly pay for themselves over time. There are even some different pricing models that don’t require an enormous up front fee which allows a doctor to minimize the risk of EMR implementation.

Here’s a few examples you might look at:
Doctors Partner - http://www.doctorspartner.com No up front, just a monthly fee
Medtuity - http://www.medtuity.com/ Charged per visit(does not include a PMS)
I know both of these companies personally and they are quality organizations and people with a unique cost structure.

There are so many EMR vendors to choose from. In fact, look at my enormous list of EMR systems.

Every doctor should be able to find an existing EMR system that meets their needs(pricing and features).

One other quick tip is to choose an established, but smaller EMR. These smaller EMR’s are able to listen and implement your specific requests much more quickly than a larger EMR that receives tons of requests.