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EHR Adoption Will Be Slowed Significantly by HITECH

Posted on February 28, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

HITECH’s Fundamental Assumptions and Plans

Posted on February 27, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was browsing through a document on the House Ways and Means website and I was really interested in what I found listed for what I believe is the basic assumptions and plans Congress and the House used to pass the HITECH act through congress.

Health Information Technology for Economic and Clinical Health Act
or
HITECH Act

Health information technology helps save lives and lower costs. This bill accomplishes four major goals that advance the use of health information technology (Health IT), such as electronic health records by:

  • Requiring the government to take a leadership role to develop standards by 2010 that allow for the
  • nationwide electronic exchange and use of health information to improve quality and coordination of care.
  • Investing $20 billion in health information technology infrastructure and Medicare and Medicaid
  • incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health
  • information.
  • Saving the government $10 billion, and generating additional savings throughout the health sector,
  • through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care.
  • Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.

As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade.

The opening line underscores what I believe is their basic assumption “Health information technology helps save lives and lower costs.” The main problem with this assumption is that it’s not complete. A more complete assumption would be “Well implemented and designed health information technology helps save lives and lower costs.” Unfortunately, you can take a look through this long list of cases to see that poorly implemented EHR can do just the opposite. My strongest hope is that doctors will understand this and choose an EHR wisely instead of focusing on the potential stimulus money.

We could discuss many of the other points in more detail, but the one that stood out to me was the purported $10 billion in government savings from the HITECH Act. At least all of the other bullet points had a section in the document which at least at a high level described how it would be done. Somehow the description of how the HITECH Act would achieve $10 billion of government savings was missing from the document.

Can we seriously believe that the $10 billion in government savings from the HITECH act is anything but conjecture? I can’t remember the last time I looked at my savings and it ended on a nice round number like this. Maybe this calculation was done in the math class I never took in college.

I’m not saying that HIT can’t save the government money. I’m a huge proponent of leveraging technology to save money and improve quality. I just wish the HITECH act would tell me how they think this is going to happen.

Meaningful EHR Use Timeline

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw a link go across my Twitter feed called “The Meaningful Use Timeline.” The title of course was interesting and so I had to check it out.

The basic idea presented is a big image showing the potential time frame required for doctors wanting to become a Meaningful EHR user in order to cash in on the EHR stimulus from the HITECH act.

The conclusion of the article is that you can show meaningful EHR use by 2011, but you need to start now.

Until we really know what HHS is going to require of an EHR user to receive some EHR stimulus money, then it’s really hard to guess how long a user will need to have used an EHR to show meaningful use. However, it’s more than reasonable to make a goal of implementing an EHR by 2011.

I personally implemented a local doctor starting a new office in about a month and a half. Would have been much faster, but we took our time to look through the EHR and make a decision on which one to implement. I’m not necessarily suggesting this as an EMR implementation model for all doctors, but mostly saying that it’s possible to implement an EMR very quickly when necessary.

The Health IT Stimulus Package… for 2011?

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m always happy to have people smarter than me do a guest post on EMR and HIPAA.  There’s far too much going on with Health Care IT for me to be able to cover everything that’s going on.  So, I’d like to thank Randy Pickard for sending in the following guest post about the HITECH stimulus act.

There is almost a Kafkaesque quality to the likely short term impact of the stimulus package upon adoption of Electronic Health Records (EHR) systems. The passage of the stimulus package will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act).  

A quick glance at the income statements of four publicly traded vendors that receive a significant portion of their revenues from EHR systems provides an indication of steady revenue growth from EHR sales. Income has been increasing by 10% or more per year for these four vendors, Allscripts, Cerner Corp., Eclipse, and NextGen.  (Although the increases in income is not simply due to EHR related sales. Acquisitions of other vendors and sales of other software products has also contributed to the revenue totals).

Company Symbol Period Ending Annual Revenue in ‘000’s Increase Vs. Previous Year
Allscripts MDRX Dec ’07 $281,908 24%
Cerner Corp CERN Dec ’07 $1,519,877 10%
Eclipse ECLP Dec ’07 $477,533 12%
NextGen Healthcare QSII Mar ’08 $186,500 19%

It seems likely that the revenue for these firms from new EHR sales will be greatly reduced in the near term, as purchasers sit on their hands waiting for answers to questions about how they can obtain reimbursement for their EHR spending. The HITECH Act designated that reimbursement would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet by the Secretary of HHS, who has not been appointed yet. Further, the bill indicates that reimbursement will go to establishments that show “meaningful use” of health IT, an undefined description that will likely deter healthcare organizations from rushing to purchase an EHR system. Given that the details of the plan to stimulate the adoption of EHR’s are far from being flushed out, is it any wonder that the Congressional Budget Office has estimated that a mere 2.3 percent of the health IT funds would be distributed in fiscal years 2009 and 2010?

About the Author – Randy Pickard is Vice President of Product Innovation for User Centric, Inc. a user experience research firm. User Centric recently released EHR and PHR white papers: How to Select an Electronic Health Record System that Healthcare Professionals Can Use and Google Health vs. Microsoft HealthVault: Consumers Compare Online Personal Health Record (PHR) Applications

Thanks Randy! If you’re interested in doing a guest post, feel free to Contact EMR and HIPAA.

HITECH Basically Excludes Open Source EHR If They Select CCHIT

Posted on February 26, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m a major proponent of the open source software movement. In fact, pretty much everything that I use to run this website is open source (WordPress, Linux, MySQL, PHP, Apache, etc). Wow, I didn’t even include all the software tools I use to publish EMR and HIPAA. Anyway, I’m a firm believer in what open source can accomplish. You may have read my previous posts about the Free and Open Source in Healthcare Un-conference this summer or possibly what I think is the right open source EMR model. I’ve also cautioned about whether “free EMR” is really free. Ok, I could go on for a while covering all the posts I’ve done, but here’s 2 links to all my free EMR posts and my open source EMR posts.

My point is that I believe in open source can do and I think it could have a major impact in health care. In fact, I sincerely hope that it will have an impact. The problem is that if HHS decides to use CCHIT as the certification criteria for the EHR stimulus, then the HITECH act will basically be excluding open source EHR and EMR packages from being part of the “certified EHR.”

Sure, I guess a community of users behind an open source EHR could pool together enough money to pay for CCHIT certification, but realistically I don’t see this happening. In fact, the thought of paying so much money to CCHIT is almost counter to the open source movement. I just don’t see why any open source EHR would make CCHIT a priority in their development life cycle.

Yes, I do know that HITECH includes a provision (if that’s the right term) that allows HHS to provide an open source package. Does that also mean that HHS will provide an exception for the government provided open source EHR package? Will users of that open source EHR be able to get the medicare and medicaid bonuses? I’m not sure that HHS even has the authority to do this. However, even more important is that they’d still be excluding the dozen of other open source EHR software programs out there.

This is just one more reason why HHS should not use CCHIT and should consider creating their own set of certification criteria. Looking at my recent CCHIT As The HITECH Certification Criteria Poll it looks like at least the majority of my readers would prefer a different certification criteria as well.

HHS Secretary MIA

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve read this blog, then I’m sure you know that Tom Daschle withdrew his nomination for HHS secretary. Some people have suggeste Howard Dean to be a nice replacement for Tom Daschle as HHS secretary, but unless I missed something in the midst of the HITECH act mania nothing’s been officially announced by Obama.

All of this means that HHS is without a secretary to implement the HITECH act along with the $2 billion of discretionary funds, choosing an EHR certification criteria, and defining meaningful EHR use.

I can’t imagine the people at HHS are just sitting on their hands, but I sure wonder what impact not having an HHS secretary will have on Obama’s health care reform.

The Problems with CCHIT Certification

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a really thoughtful post on HISTalk, Dewey Howell MD, PhD, Founder, CEO Design Clinicals, Inc. wrote a n article called “The Real Problem with CCHIT Certification.” In it, Dr. Howell basically makes the case against CCHIT, because it doesn’t take into account all of the various specialized EHR which only need to do a few things really well. His example was an EMR for “ambulatory, inpatient, and emergency settings.”

These arguments remind me when near the beginning of the CCHIT certification process it included such things as growth charts. Sure, growth charts are essential to a pediatric EMR, but not so much so for other EMR companies. Luckily, the vetting process did remove this criteria and what CCHIT ended up with was much better than what they started to create. Unfortunately, it’s still an onerous process for a specialized EHR to be CCHIT certified.

Dr. Howell also provides this really interesting insight:

Another deficiency of the current certification process is the lack of requirement for certification of results or outcomes. How do we certify and validate that the system actually delivers the outcomes that we are trying to achieve? The current process encourages vendors to throw a button or screen into their application that produces a specific action or display. But, there is no accountability to the patient and quality of care delivered with the tool. It encourages technology for technology’s sake, presuming that outcomes will be “better” just because a product is certified, instead of really validating results. Maybe this is a much tougher nut to crack, but it is considerably more important than things like, “The system shall provide the ability to allow users to search for order sets by name.”

I like how he described the need to measure results or outcomes. We’ve often mentioned on this blog CCHIT’s biggest problem is actually measuring usability, but results and outcomes are another way to look at the challenge of certification.

List of EHR Companies for Survey

Posted on February 25, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently got a survey from someone evaluating EHR implementations and the motivations around an EHR implementation. I’m suppose to get the results of the EHR survey. If there’s something interesting, I’ll post it on here for all to see and enjoy.

One thing that interested me was that the survey had one question that asked which EMR or EHR an organization implemented. They offered the following choices:
Unknown [honestly how could someone not know?]
Allscripts (3 different versions)
athenahealth
Cerner
eClinicalWorks
Eclipsys
e-MDs
Epic
GE Centricity / IDX
Greenway
LSS Data Systems
McKesson / Practice Partner
MED3000
Misys (4 different versions)
NextGen
PracticeOne / e-Medsys
Pulse Systems
Sage
Other

I thought it was interesting to see the EHR they decided to list on the survey. Does this represent the majority of the EHR implemented? Anyone have a study that shows possible market share for various EHR companies? I’m thinking many on this list shouldn’t be there and that others probably should be listed that aren’t. Am I way off?

One thing is certain, I need to add all of the above EHR companies to my EMR and EHR company matrix.

My Article on Understanding the Types of EHR Consultants

Posted on February 24, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I mentioned previously that I was working on an article about EHR consultants. I wanted to sincerely thank all those people who commented on EHR consultants and sent me feedback on things I should include in my article.

As you’ll see, I used a lot of the feedback that you gave me to form the article. That’s really the power of the internet to bring a bunch of bright people together to create something of far greater value than I could have created on my own. Thank you for your feedback.

I’m told the Magazine has been sent to the presses and those of you who get MDNG magazine will see my article soon (hopefully someone will get one to me). The cool thing is that my article is the cover story for the February issue of MDNG.

For those that don’t want to wait for the magazine or don’t get the magazine, my article on EHR consultants has already been posted online. It’s called: Does Your EHR Consultant Have Your Best Interests in Mind?

Let me know what you think about it.

CCHIT As The HITECH Certification Criteria Poll

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The HITECH act designated that in order to get the $40k+ of EHR stimulus money you have to implement a certified EHR. However, the HITECH act lets HHS decide which EHR certification criteria to use. All CCHIT vendors are hoping it will be the CCHIT certification. Many people don’t want it to be the CCHIT certification. I decided to see what readers of EMR and HIPAA think about CCHIT certification as the criteria. So, vote for which EHR certification criteria should be selected by HHS as the certification necessary for receiving EHR stimulus funds.