Welcome to EMR and HIPAA

I’m moving hosts for EMR and HIPAA. I’m excited to consolidate my hosting and move EMR and HIPAA to hopefully a little faster and more reliable host. Not to mention, I think that this host isn’t located in Canada and so Google won’t be confused and send me the Canadian traffic. Not that I have anything against Canadians, but I always thought it was interesting that Google.ca sent me all sorts of referrals.

It will take a few days for everything to transfer over, so I’ll probably wait to post for the next couple days. Always better to let everything settle before I make to many other changes.

By the way, if you are looking for a good host, you might want to consider Bluehost. I’m planning on moving all of my domains to them. In fact, I already have 3 on there. Here’s the banner with what they offer.

I recently came across a healthcare IT related blog that I really enjoy called Health Train Express. They recently posted an article about the Boston Health Network requiring all their physicians to adopt EHRs by 2009 or else they’ll be removed from the network. The article then says that they “expect to lose between 15 and 20 primary care physicians this year because of the mandate, and it could lose some patients if those physicians stop referring patients to Partners hospitals.” The article goes on to say that “To retain their network status, about 5,000 physicians in the network will be required to adopt either Partners’ or GE Healthcare’s EHR or sign an agreement that they will adopt EHRs during 2008.”

A number of things I’ve read about this article have people crying for Partners Community HealthCare to start putting up money to help those 5000 physicians that will be required to adopt an EHR system. I honestly don’t understand this reasoning from a business point of view. The article said that they’ll only lose 15-20 physicians this year. That seems like a very small amount since 5000 others are going to implement a new EHR and how many others already have implemented an EHR? I don’t know all the economics of this particular situation, but on face Partners Community Healthcare is making a great decision and shouldn’t need to pony up some money to help these doctors use an EHR.

Of course, it would be a nice thing if Partners Community Healthcare helped out these doctors, but what about all those doctors who already implemented an EHR without any help? Those are the ones that Partners should be rewarding. Those doctors are the ones that have probably been saving Partners money doing things electronically.

I think there’s another important reason why I think it’s a great decision for Partners Community Healthcare to not subsidize their physicians purchase of an EHR. Looking at the percentages of failed EHR implementations, you can almost guarantee that a large number of physicians will have major problems implementing a new EHR. The physicians for these costly “failed” implementations are certainly going to incur expense over and above anything Partners would have offered as a subsidy. This increased cost to physicians will incur the same type of backlash that they are experiencing from not subsidizing at all. So, Partners would gain almost nothing from these subsidies.

Furthermore, I don’t have hard evidence to prove this fact, but I think it’s fair to assume that physicians who are paying for their own EHR will make much better decisions, be more invested in the decisions and work harder to make the EHR work for them. I believe that the amount of buy-in by physicians in the EHR implementation process is a key determining factor in a successful implementation. Making physicians pay for the EHR, increases physician buy-in.

Now I don’t think everything is rosy with what Partners Community Health is doing. I don’t quite understand all the details from the article, but it seems like physicians are pigeon holed into a specif set of EHR systems: Partners’ or GE Healthcare’s EHR. The article says the caveat of “sign an agreement that they will adopt EHRs during 2008.” Does this mean that a physician can choose their own EHR or not? I imagine that if they choose an EHR other than Partners’ or GE Healthcare EHR, then they’ll be required to create some sort of interface between their chosen EHR and Partners Community Health.

This makes it a very tough decision for a provider. While specifying a certain EHR software product can lead to reduced pricing of an EHR software product, it’s not always the case and can mean that many physicians will have to pay more for an EHR that has less features or features that don’t match their practice. I think that every EHR vendor knows that it’s hard to create an EHR that works for pediatrics, GYN, neurologists, dermatologists etc etc etc. They just have very different needs. Pediatricians want nice graphs and charts of children’s growth while dermatologists want pictures and drawings of things.

“Forcing” certain EHR software can also be a challenge on a physician’s budget if the “chosen” EHR software use the very popular model of a huge up front cost to the physician. This would be very unfortunate, because there are a ton of different EHR packages out there that have creative pricing models that better match a doctor’s cash flow. However, I expect that many physicians won’t choose a separate EHR package since they will want the software to integrate nicely with the other Physicians in the network.

My suggestion would be that Partners Community Health allow doctors to choose whichever EHR fits their practice the best. Then, Partners Community Health foots the bill to integrate that EHR with Partners’ system. It’s a win for the doctors that want a specialized and inexpensive EHR. It’s a win for Partners, because they now have an even more robust set of interfaces with a variety of vendors. Unfortunately, if they do this, then they might have to pay back GE for all the nice meals and golf games they’ve gone on.

Disclaimer: I only know what I read in the linked article about Partners Community Health. In this post I make a lot of assumptions about this specific case to illustrate principles of EHR adoption. I’d love for someone from Partners Community Health to correct any of my assumptions, give us more details on the mandate and provide commentary on why my assumptions might be flawed.

I get quite a few emails from people that are interested in having me write something about their company or website. I always welcome those emails as long as they are not spam to hundreds of websites. I must get 100s of emails asking me to buy lists of doctors. Do they really think if they keep sending me spam emails that I’ll finally change my mind and buy one of their lists. Never. I already have thousands of doctors reading my blog. I don’t need some snail mail method of communicating with doctors. I digress, but my point is that if someone wants to contact me, then they better use something that doesn’t look like spam and looks like they took time to look at my website.

Once such email did just that. I could tell it was more than the average spam. How many other people include EMR and HIPAA in an email subject line and body. No spammers I know. They asked me to review a new website that is suppose to help with software selection. I’m not sure if people realize this or not, but asking me to blog about your website doesn’t mean I’m going to say nice things. In fact, you can properly assume that I’m going to be as critical as possible. Sure, I’ll point out great things too, but my readers expect to get it straight from me. So I’m going to comment on whatever I see. Let me guarantee you that EVERY website has good and bad points.

It turns out that the afore linked to website called Software Advice has a really simple 3 question form you fill out and then it gives you a list of EMR software vendors. Wouldn’t it be nice if it was all that simple? Turns out that EMR selection takes a little more than 3 questions and a click of the submit button. This medical software advice website is nothing more than a nice way for them to gather referral fees from EMR software vendors. I’ll give them credit for that. It’s quite lucrative to refer people to EMR vendors. However, I think that it would take a pretty uninformed person to use this well presented website to start demoing EMR software. Here’s just a few of the problems I see.

First, Medical Software Advice is missing a TON of EMR software vendors. In fact, they’re missing some of the very best EMR software companies out there. Let me help them. Here’s a list of EMR software companies. Once you have all of these companies in your database, then you might get close to something. Until then, stop showing us a short list of EMR software companies that really just seem like they are the ones that are going to pay you to refer people to them. I did say seem, because I don’t know. I guess it’s also possible that you just hope to one day have relationships with these vendors, but even more reason why you shouldn’t have such a limited list.

Second, increase the number of criteria that you are using to determine a proper EMR software company. Three criteria can barely even be called a filter. However, even if you add more criteria, there are a ton of subjective elements that will make it hard to filter down to a small set. I think it’s possible to do a pretty good job, but you’re not even close. I have about 0 confidence looking at your initial offering that you’ll be able to create a quality filter using serious criteria. For the industries sake, I hope I’m wrong.

Third, I love how each of your EMR software products has a couple big buttons that say Free Demo and Pricing. First, I can guarantee that any commercial EMR software product is going to have a Free Demo and Pricing available to you. In fact, many will bend over backwards to get your business. They’ll do multiple demos, site visits (if you’re large enough), and entire RFPs to get your business. Just contact them directly and you’ll get all the attention you want. So, if Software Advice wanted to offer a good service, they’d stop linking us to forms that we could fill out at the EMR vendors website and start giving us actual information on EMR pricing (already partially done) and links to actual online demos of EMR systems (like this one).

I’m sure I could go on about a lot of other things, but I think that’s enough for now. I appreciate people who want to help increase the number and success of EMR selection and implementation, but as their website stands now, it seems much more like a referral engine to me.

For those of you who can’t afford a skilled EMR consultant to help you wade through all the litany of EMR companies, I’d suggest using the EMR selection tools at EMR Consultant. They are certainly far from perfect, but they have a hundred times better product offering than the website I list above. They actually include EMR’s that don’t pay them for referrals. What a novel concept.

Sorry if this post is a little harsh, but it gets under my skin when people try to act like something they’re not.

The day is fast approaching for me to present at the Pacific Coast College Health Association conference in Hawaii. In fact, I have less than a month to finish my preparations. I feel pretty good about my ability to present and also my knowledge of EMR, but presenting something always gets my nerves going. I think once I get started talking about EMR, then I won’t be able to stop. My real hope is that the people that attend my session will be interested in what I have to say, find it useful and ask good questions. Honestly, a part of me really wishes that I was a member of a panel where I just answered questions about EMR. I think that would be a lot of fun.

Since it’s not a panel, then I’d love to hear any feedback from people on things I should include in my presentation about “Lessons Learned from EMR Implementation.” I have a ton of things already planned about EMR implementation, but I’m sure there are some important things that I’ve missed. Time has a way of doing that to you.

Either way, I’ll be happy if one person in my session on EMR goes away saying they were better prepared to implement an EMR system, then I’ll be happy.

My previous post about Microsoft’s HealthVault was my initial reaction to the announcement of Microsoft entering the healthcare market. While I still haven’t personally had a chance to really review HealthVault in depth, I still think that this could be one of the biggest announcements in healthcare in a long time. Some people might say that says something about healthcare IT, but I think it is just the beginning of a lot of big players in the technology industry to take a serious look at healthcare IT.

Of course, that would make me happy, because I’m certain that EMR’s and EHR’s are the future of healthcare and competition is great for the consumer.

Well, here’s some other things I’ve found about Microsoft’s HealthVault. Most interesting is going to be watching the Microsoft HealthVault blog. Maybe that’s because I’m a crazy blog lover, but I love the idea of being in contact with the people that make it happen. Open communication is the best.

Also, here’s an interview with Peter Neupert talking about the significance of his group’s acquisitions of Azyxii and MedStory for clinicians and consumers and of course HealthVault.

Today I’ve been reading about the news that Microsoft has entered the health care space with a major offering that will certainly make Google and Google Health take a hard look at their electronic medical record plans. Microsoft’s Lifelong Electronic Health Record is called HealthVault.

I’ve been reading this Microsoft Health Blog for a while and as expected, there was a nice blog post about HealthVault. Read it with the knowledge that he works at Microsoft and you’ll get some good information and figure out where it is good old PR spin. Here’s just one example of where I think you need to read between the lines:

* The Microsoft HealthVault record you create is controlled by you.
* You decide what goes into your HealthVault record.
* You decide who can see and use your information on a case by case basis.
* Microsoft does not use your health information for commercial purposes unless you are asked and you clearly tell Microsoft they may.

This is a good list of information. However, the last one concerns me. I’m afraid that Microsoft “asking” to use your information will be something akin to a really long privacy policy that no one reads and everyone clicks through. We all know about these and it’s very common. However, is that really Microsoft “clearly” telling you what they’re going to do? Of course this is my speculation, but it’s a pretty common practice and I wouldn’t be surprised if Microsoft employs it in HealthVault.

I’ll have to save a full review of Microsoft HealthVault until I have more time to really dig my teeth into it. However, a few parting thoughts.

-I think that many people will use this, because most people aren’t afraid of sharing their medical history. Essentially the ones that have “nothing to hide.” More on this in the future.
-I hate that Microsoft uses the Net passport as the login. Give me a special login and don’t make me log in and out of my email passport and my health record passport.
-Microsoft needs to look at getting the info into their system using something like CCR. Otherwise, people just aren’t going to update it which basically renders it useless.