Some of you might remember that I relatively recently wrote an article about types of EHR consultants for MDNG magazine. It was a fun article to write. Considering my word limitations, I had to limit it to just a very specific topic. However, I still have a bunch of other commentary on EHR consultants that I plan on posting either on this blog or as an e-book eventually, but I digress.

What I thought was pretty cool about MDNG was that they took my article and not only published it online and as the cover story of the magazine, but they also did a podcast of a doctor reading my article on EHR consultants.

I love their use of technology in this way. I wish computer voices would improve and then I could easily publish this whole blog as a series of podcasts. Would be pretty cool.

A recent comment asked me what I thought about this person becoming essentially an EMR selection consultant. I started to reply in the comment, but it got so long that I decided that it was worthy of it’s own post. Plus, then all the EMR and HIPAA readers can provide other counsel and advice in the comments which will probably be even more valuable than what I have to offer.

Considering so many people are losing jobs and searching for new emr jobs (no, I wasn’t paid for that link, but I was paid for the EMR Jobs ad on this page), I think this post is timely. So, the follow is my advice to Jim about becoming an EMR selection consultant.

Jim,
I think there are a lot of doctors that could use this type of service. There are 4 things I think our worth mentioning to you.

1. Are doctors going to be willing to pay much for this type of service? It’s certainly a valuable service, but do doctors see this as necessary and worthwhile or do they think they can just do it on their own using some certification or recommendations from friends, organizations, associations, etc. In these economic times, don’t be surprised if many of them aren’t ready to spend money on this either.

2. Why should doctors trust you with this decision? I’m not speaking of you specifically since I don’t know you. My point is that this is a HUGE decision by a doctor. How will you make the doctors feel enough trust in you to have them help you make the decision? Once you earn their trust, it’s gold.

3. Many doctors are just browsing for EMR software. Be sure that whatever contract you create with the doctor, it’s clearly specified what your responsibilities are and what the doctors responsibilities are as well. They’ll HAVE to play a major part in the selection process. However, you don’t want to be stuck ready to go through the process and they’re not willing to commit the time. Then, you’ve wasted your time and won’t get paid. Also, don’t fall in the trap that they have to select the EMR for you to get paid. Otherwise, the doctors will just spin their wheels on the decision making and you won’t get paid for much longer than you planned.

4. Be very clear about any conflict of interests you may have. Try to avoid having conflict of interests at all. However, it’s sometimes too nice to not get paid a referral from an EMR vendor when you’re the one that sent them the business. You’ll have to work that through yourself. However, I ethically believe if you are getting paid to help someone select an EMR, they should be made fully aware of any conflict of interests you may have in your pocket. Now, if we could just get our government leaders to do the same (but I digress).

I know there are many other things, but I hope this helps. I really think there’s going to be a lot of work in the area of EMR selection for a while to come.

The more I read comments on this blog and on EMR forums, I realize that there’s a real need for some sort of simple but effective guide to understanding the EMR selection and implementation process. Basically, I’m talking about a mix of showing a realistic picture of selecting an implementing an EMR. A discussion of the realities faced by almost everyone implementing an EMR. This of course would be coupled with some strategies to avoid as many problems as possible. However, hopefully it would also help doctors have a better vision of what they can expect in the EMR selection and implementation process.

DrQ from EMRUpdate was one of my motivations for wanting to do this, so I feel I should give him some credit.

So, this weekend I’m going to start the process of creating a guide for just this. It may end up being a couple guides. Possibly one for EMR selection and one for EMR implementation. It won’t be comprehensive (that’s impossible). It will hopefully provide some value to those interested in entering the EMR selection and implementation process. Yes, process is the right word.

We’ll see how it all comes together. Don’t expect anything earth shattering if you’re well informed about the process already. I’m sure I’ll pull a fair amount of material from what I’ve posted previously on this blog and in articles I’ve written around the web. I also be tapping readers of this website and other EMR forums I participate in the process of creating these guides. My strongest trait isn’t that I know everything about the process, but I feel like I’m surrounded with an amazing online community of EMR users.

I’m still a little undecided on whether I’ll charge for it or not. I guess we’ll see how it all comes together and then decide. Regardless, I want to make sure that whatever money or even time is spent reading the guide returns a value to the reader.

Ok, so thanks for letting me think out loud on my blog. I certainly want to welcome everyone in on the process. Let’s start by hearing 5 lessons learned during your EMR selection and/or implementation process.

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.

Whenever government decides to spend $20 billion, there are bound to be a lot of winners. The money has to go somewhere. I previously posted how I think that EHR adoption won’t significantly increase because of HITECH. However, there will be some BIG winners from this legislation. Lets’s take a quick look at a few of them.

• EHR Vendors – I don’t think there’s any doubt that vendors will benefit from $18 billion of investment in EHR.  The legislation was signed yesterday, and I’ve already seen ads for Allscripts talking about learning about the EHR stimulus.  Marketers for every “certified” EHR are going to beat this stimulus like a dead horse.
• Health Care IT Consultants (ohhh…maybe I should become one) – Business should be just fine for EHR and health care IT consultants despite the current economic crisis.  I didn’t think there were enough before.  Even a small increase in EHR adoption will mean higher demand for health care IT consultants.
• Existing EHR Users – Despite my feeling that this stimulus won’t stimulate EHR adoption, I do think that already implemented EHR users should benefit from this EHR stimulus.  I didn’t read any “first time home buyer” provision in this legislation.  This could mean a bit of free (minus a little paperwork) cash for those who find themselves already using a certified EHR.
• CCHIT (if they get chosen) – This is a big IF, but I believe that CCHIT’s survival hinges on them being chosen as the certification required to receive stimulus.  It would say a lot if they weren’t chosen.  Let’s hope HHS has the guts to not choose them despite the incredible lobbying efforts I’m sure they’ll receive.
• Hospital Systems – I’m familiar with one hospital system that has over 100 multi specialty clinics with many of them using a centralized EHR.  Seems like a great investment to pay someone to make sure they meet the required standards.  100 clinics X number of doctors in a clinic X $40k = a lot of money
• Health and Human Services (HHS) – Even just the $2 billion in discretionary funding is a huge boost to that organization.
• Obama’s HIT Donors

Anyone else I should add to the list?

In a recent Wall Street Journal article on electronic medical records, they talk about Allscripts’ CEO’s take on the governments planned $20 billion investment in EMR.  Here’s a portion of the article:

Glen Tullman, chief executive of the health IT outfit Allscripts-Misys Healthcare and an advisor to the Obama campaign on health information technology issues, argues that that any legislation should first help doctors buy and install electronic medical records, then give them financial incentives to actually use them in a way that could reduce waste and improve care. “That one-two punch would dramatically change the adoption rate for physicians,” he said in an interview with the Health Blog.

I’ve talked about Obama EMR many times before on this blog and over the next 6 months I expect I’ll talk about it a lot more.  This could be the most significant change in health care IT that we’ve ever seen.

However, it should scare all of us that Obama’s health information technology advisor is the CEO of Allscripts-Misys Healthcare any EMR vendor.  I know Obama’s from Chicago, but could this be a more blatant conflict of interest?  Why not call in the tobacco companies to see if they think that smoking will help improve the condition of America.  I’m pretty sure I know there answer.  Why would an EMR company be any different?

Even more interesting is this quote from the same Wall Street Journal article on EMR:

He[Glen Tullman] points to the success of a similar incentive program, courtesy of Medicare, to get more doctors to use electronic prescriptions — Allscripts’ other big business besides electronic health records. 

I just wanted to thank Glen Tullman for pointing out that not only does he have a huge conflict of interest in regards to EMR adoption, but he’s also had success influencing other Medicare legislation for which he would be even more biased (Allscripts being the most widely used e-prescribing software).  This sure doesn’t sound like the CHANGE that Obama’s been talking about.  Sounds like business as usual to me.

I can understand why Obama would want to talk to some of the main EMR vendors out there.  It would be interesting and insightful to hear their biased point of view.  However, I’m talking about a discussion with these EMR vendors.  I’m not talking about having them as an advisor to Obama.  Are there really no unbiased consultants that can inform Obama on the challenges of EMR implementation?  There has to be something better.

I just think that Obama and the US governemnt don’t have anyone telling him the true realities associated with EMR implementations.  Nothing proves this more than the idea that the government will probably use CCHIT certified EMR as a criteria for who will get some of the $20 billion allocated to healthcare in the economic stimulus package.

The crazy part is I feel like I shouldn’t blame Obama for these decisions.  I hope and think that he’s trying to make the best decisions he possibly can with the limited information he’s receiving on the subject.  Does anyone have Obama’s blackberry number?  I’d like to send him a short message with my thoughts on his proposed investment in EMR.

Thinking along those lines, I think I might send a tweet to John Culberson, Congressman from Texas.  Talk about someone who’s really trying to listen to the people and have an open dialog about subjects.  I’ll let you know how that goes and if he even cares about electronic medical records.

I know that I have a number of EHR consultants that regularly read this blog. Plus, many of my readers have used, are looking to use or have heard stories about EHR consultants. I’m currently working on an article about EHR Consultants and so I’m interested in hearing people’s feedback about their experience with or as an EHR consultant. Here’s some things i’m interested in hearing about:

• Benefits of an EHR Consultant
• Challenges of an EHR Consultant
• Finding a good EHR Consultant
• Making the most of an EHR Consultant
• Does an unbiased EHR Consultant exist?
• etc…

Basically, I’m interested in answering the question of whether an EHR consultant has your best interest in mind and things you can do to ensure a quality experience with a consultant.

Also, you might look back at my five part series on EHR consultants to get you thinking.

I think we need more people like this that offer some words of advice and encouragement for new EMR users.

Start slow, don’t hesitate to ask for pointers, and get some good habits started at the outset.

And you’ll do fine.

The last part is the best part. You really will do fine. Many have implemented an EMR successfully before you and you can do it also. It will take work and effort, but it will make it that much more meaningful and fulfilling to you in the end.

Today I came across an organization called the Electronic Health Record Association (EHRA). It looks like it’s kind of a consortium of EHR vendors that are also members of HIMSS. I’ve just begun reading some of the work and goals they have. A very interesting organization. I have much to say about what I’ve read, but one of their main initiatives seems to be the EHRVA Interoperability Roadmap. I took a quick look at version 2 of the document to try and gain an idea of how they were trying to accomplish the lofty and difficult goal of interoperable EHR/EMR software.

Briefly looking at the document one section in particular caught my eye that was called “Prerequisites for Achieving Interoperability.” I was excited to read what they thought was important for interoperable EMR software and the following is what I found:

The path to interoperability is fraught with challenges. Some of them are technical – determining what standards should be used to achieve interoperability and implementing those standards within HIT systems. Some are cultural – encouraging both vendors and providers to share information. And some are financial – identifying sources of funding needed to acquire the technology and to establish and sustain health information exchanges.

Nonetheless, we believe that interoperability is achievable, under certain conditions outlined in this Roadmap.

I was really disappointed in their list of prerequisites. Not one mention of the legal issues related to interoperability? That seems like one of the largest problems with interoperable medical records. It kind of falls under cultural, but it still should have at least been mentioned under cultural if that was their intention. An interoperable EMR is no use if legally you can’t exchange those records easily.

At least they did talk about the need to find a motivation mechanism for vendors and providers to share information. The honest truth is that interoperable EMR software doesn’t sell more software. Not to mention, there’s very little financial benefit for a doctor to spend time sharing information either.

The key is that interoperability is important and finding ways to meet/overcome these prerequisites is important and worthy of significant attention.

I’m sad that I didn’t see this list until now. Mike Gleason provides an interesting list of reasons why small practices aren’t implementing an EHR as fast as we’d like them to implement. Here’s his list of 10 reasons:

Fear
Ego
Money
War Stories
No one wants to go first
Product not perfected yet
Waiting on Govt mandates
Waiting on hospital install or Stark gift
I have people for that
Change

A really great list. Mike also discusses each of these points. As time permits I’d love to take some of his points and write some comments on each.

More important for this post, I wondered what other reasons might be missing from this list. Here’s a few others that I came up with:

I’m retiring soon
I don’t like computers (similar to “Computers Scare Me”)
Procastination/Lazy
Commitment problems (can’t decide on which EHR system)

Those last couple sound a lot like why many people don’t get married. Pretty interesting since I’ve compared implementing an EMR to marriage multiple times. Any other reasons for not implementing an EMR that we’ve missed?