Welcome to EMR and HIPAA

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.

Today I came across the HHS Secretary Mike Leavitt’s blog. To be honest, I saw Mike Leavitt’s picture on the blog and I felt like I was meeting an old friend. No, I don’t really know Mike Leavitt from the next person on the street. We have never met before and the closest I’ve been to him is probably when I watched him pass by in numerous 24th of July parades in Utah. However, he was the governor of Utah for many of the years I lived in Utah and so I feel like I kind of know the man.

Reminiscing aside, I find Mike Leavitt’s blog completely captivating. He currently has been writing about his trip to China. For some reason I’ve always had an inner itch whenever I heard about China. I don’t know what it is, but I find the place completely fascinating. So, you can imagine my fascination with the HHS secretary’s interaction with the Chinese government. Plus, these posts about HHS and China give Mike a real personal quality that I find real and interesting.

Of course, I couldn’t begin to read the HHS Secretary’s blog without making sure to find some post about EHR or EMR. I quickly found a post entitled Value-Driven Health Care Interoperability which I think could more aptly be entitled “Electronic Health Records (EHR) Progress Report.” Of course, he is in government so that explains the title.

I’m grateful that the HHS Secretary is willing to engage the public in a discussion about EHR and EHR adoption, but unfortunately the post I found is so filled with political rhetoric. It sounds really good, but really has very little substance.

First, I’ll start with the good.

Three years ago, there were 200 vendors selling electronic health record systems but there was no assurance that the systems would ever be able to share privacy protected data in interoperable formats.

I think the concept of a certification for interoperability is good. It just makes sense that every EMR software vendor should be able to interact with another. Establishing a quality standard for this interoperability is valuable and even worth certifying.

Unfortunately, I think the HHS Secretary has been getting bad information when he says the following:

Since then, we have made remarkable progress.

An EHR standards process is now in place, and we are marching steadily towards interoperability. We created the CCHIT process to certify products using the national standards and it is functioning well. More than 75% of the products being sold today carry the certification.

Where to begin? First, Mike has suggested that there were 200 vendors selling EHR systems 3 years ago (It’s probably a few more than 200 EHR, but we’ll let this one slide). Mike asserts that “75% of the products being sold today carry the certification.” If that’s the case, then simple math tells us that there should be 150 certified EHR software, no?

If you look at the 2006 CCHIT Certified Ambulatory EHR list I count 92 EHR software products. Let’s see, that’s only 46% of EHR products that are certified. Plus, my count of 92 EHR counts some of the software multiple times since a number of the EHR software vendors certified multiple versions of their product. That sounds like less than 75% of EHR products sold to me.

Of course, Mike Leavitt certainly could say that 75% represents a percentage of actual products sold. Certainly the certified eMD’s has a lot more installs than any of the free open source EMR products out there. However, I think it’s a bit deceptive to say 200 EHR and then 75% of products sold if they aren’t the same thing.

I also love how it says 75% of products sold. I think we’re all aware of the outrageous failure rates of so many of the EHR products out there. It’s unfortunate that we don’t have a percentage of products installed. Then, you’d have a much better idea of how many doctor’s offices really have the possibility of interoperability.

Wait a minute! I was being extra generous above when I said that there were 92 Ambulatory EHR CCHIT certified. Why? Because it was 92 EHR certified with the 2006 CCHIT Certification. Correct me if I’m wrong, but I think that interoperability was taken out of the 2006 CCHIT Certification (along with the joke of the pediatric requirements). I’m pretty confident about this, because I work on one of the 2006 CCHIT Certified EHR and I have no way of sending a chart to another clinic other than manually going through the product and printing out the chart.

What does all this mean? That means that instead of 92 interoperable CCHIT certified EHR, there are only 31 EHR CCHIT certified in 2007. That represents 15.5% (not 75%) of the 200 EHR products on the market today are interoperable according to number of certified EHR.

I’m not really blaming Mike Leavitt for this. I’m sure him or his office was given a nice executive report with a bunch of data and they made it look as nice as possible. Reminds me a lot of what I call EMR sales miscommunications. Sometimes the data just gets lost in translation. Let’s just hope my trackback to Mike Leavitt’s blog gets read.

You thought I was done. Nope. Still plenty more to say and I’m just hitting the major points.

In addition, a National Health Information Network will start testing data exchange by the end of the year and go into production with real data transmission the year after.

This concept I really find intriguing. I look forward to seeing this go public and I’m glad it’s on the agenda. However, I fear that this isn’t more than political hyperbole. I’d love to see how they plan to address any of the following: unique identifier, the ultimate hacker’s health information paradise, economic model, motivational model and that’s just the list off the top of my head.

The primary reasons for low adoption rates among small practices are predictable: economics and the burden of change.

I’m glad you pointed out the obvious. If this was so obvious, then why did you support the implementation of a certification that costs so much money that EHR will inevitably raise the cost a small practice pays for an EHR? That doesn’t make much economic sense. Not to mention you missed what I think is the biggest factor in lack of implementation: fear. Not fear of change. Not fear of the expense. Certainly those are two major factors, but I believe that adoption rates by small practices are so low because most doctors have seen too many of their colleagues fail at implementing an EHR.

Let’s start waving the CCHIT certification flag again. Many will be willing to make the case that CCHIT certification helps supplant a doctor’s fear that their EHR implementation will fail. It may even supplant some fear, but what it doesn’t do is decrease the number of failed EHR implementations. It’s a problem I’ve discussed many times on this blog. Certifications don’t certify usability. They never have and never will.

I actually have a thought about what should have been done instead of CCHIT, but I think I’ll save that for a future post.

Thanks Mike for opening up the lines of communication with your blog. Now it will be interesting to see if Mike Leavitt and HHS have really embraced new social media and participate in the discussion they started. I’m certain that Mike’s blog is going to become one of my favorite reads.

This entire week my EMR vendor had someone in our clinic going over our EMR implementation. Yes, that’s nearly 4 entire days of our health and counseling staff meeting with our EMR vendor. You can imagine after the first few meetings it’s pretty hard to keep things straight. However, this type of EMR vendor site visit is so beneficial.

The biggest benefit is that it almost forces doctors, nurses, front desk staff, lab, pharmacy, etc to sit down and think about our EMR, how it could be made better and which parts of the EMR are just causing them pains, problems, frustrations, or other discomfort. We tried to make sure that each EMR meeting went over: our current EMR challenges, features of the EMR that we aren’t using and finally discuss ideas for enhancements to the EMR software.

We’re lucky that we selected a smaller EMR vendor that’s completely focused on the college health EMR market. That means that we have a strong relationship with the EMR company. In our final meeting the EMR “trainer” said that they really are our “partner” in not just the EMR, but they’re willing to support us beyond just software. The nice thing is that our EMR vendor really does try to do this. They don’t always succeed at it, but they certainly are sincere in their effort.

Another major benefit of having someone from the EMR vendor do a site visit is that they are looking at your clinic with fresh eyes. They can see things about the way your process works that you may not see. Plus, they have usually been to hundreds of other EMR installs and so they are aware of how other clinics are using the EMR software.

Of course, you can’t expect someone from your EMR vendor to come and work miracles. In fact, many of the ideas they have just may not work for the way you practice medicine. It takes a solid filter to be able to see the benefits, problems, and workarounds that will work best for your standards of care, legal regulations, and clinical organization. The biggest problems that an EMR vendor faces is that it’s really hard to build a one size fits all EMR. Different practices act differently. However, there’s something really valuable about discussing the various options of an EMR.

I highly recommend this type of collaborative approach to working with your EMR vendor. I believe it’s paid amazing dividends for our clinic. In the end, your EMR company better be a good partner or you’ll pay the price later.

A little while back I got an email asking me if I was interested in writing an article for Medscape about “Choosing an EMR.” I figured that might be a fun experience considering I’d written so much about the topic of choosing an EMR on this blog that it would be pretty easy to do.

Luckily, all went well and they accepted the article that I wrote and published it to their site. I think the article turned out pretty good and offers some decent insight for someone interested in selecting an EMR. I think the selection process is probably the EMR industries biggest barrier to adoption right now. The technology is certainly there now, but there are just too many choices right now that it is really hard for a doctor to know which EMR is best for them. Unfortunately, many just choose to not make a decision and just continue on with paper charts. Hopefully this article will help a few doctors offices get on the right track and implement an EMR successfully.

In the end, it was a really fun experience going through the process of writing an article that’s going to be published. It’s much more difficult than writing about EMR on this blog. It took hours of work for me to write that article. I wanted to make sure that I provided significant value to the readers of the article and that I didn’t leave anything important out. By comparison, this post that I’m writing now won’t take more than 10 minutes. Blogging is better that way, because I know that my insightful readers will correct me if I post something that’s way off kilter.

At the end of the day, it’s really fun to see my writing published and my name alongside a contribution to the medical community. I also got a big kick the other day when I was helping one of my PA’s with something and I saw he subscribed to Medscape. Made me feel good that I was being published in what he considered to be a credible medical source.

One final thought, I’d love to hear people’s feedback on my article “Choosing an EMR.” Leave all your thoughts, good and bad, in the comments.

I think I’ve written enough speculative posts about Google Health. I decided to turn to something EMR or EHR related.

I’m interested to know how people have sifted through the vast array of EMR and EHR software offerings out there. I personally think we’ve almost reached the peak number of EMR software companies and that soon we’ll start seeing consolidation and less people trying to enter the EMR market. Regardless of that speculation, I’d love to hear the process people used to select their EMR software.

Even more important than the process you used, I’d find it very interesting to know what was the key factor people used to finally select their EMR. Also, what would you have done different if you had the chance to go through the process again?

I have a few of my own thoughts, but I thought I’d put it out their for readers before I clouded your ideas with mine.

Part five of our five part series on the benefits of an EMR or EHR consultant is improved clinical buy-in.

Improved Clinical Buy-In

Hiring a proven EMR consultant alleviates fear and increases clinical buy in. However, more importantly, EMR consultants are able to provide a clinic the tools needed to show an EMR implementation’s ROI. EMR consultants should do a comprehensive analysis to show how an EMR implementation will reduce costs, increase revenues, and better care for patients. Quantifying the potential returns on an EMR investment generates significant buy in at all levels of a clinical organization.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part four of our five part series on the benefits of an EMR or EHR consultant is comprehensive technology support.

Comprehensive Technology Support

By providing a comprehensive set of technology support, a technical EMR consultant can alleviate doctor’s concern over the implementation of new technology. An EMR consultant’s proven track record of implementing these health care related technologies in doctors’ offices allows them to do it in a robust, efficient, and cost effective manner. Doctors save time searching through the numerous technology choices because EMR consultants can point them to the best brand of technology or even to technologies the doctor didn’t know existed.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part three of our five part series on the benefits of an EMR or EHR consultant is clinical process mapping.

Clinical Process Mapping

One of the hardest things for a doctor new to EMR to do is see how their current clinical processes will work electronically in an EMR. To alleviate this fear, EMR consultants can first map out a doctor’s clinical processes. They can then use their experience with other EMR implementations and show how current clinical processes will be done using an EMR. This will save doctors a lot of time mapping out these processes. It also provides a clear understanding of what a doctor’s clinic will look like electronically. However, the most important part of this process is that it provides a way to find problems that may occur with an EMR before you’ve actually implemented.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part two of our five part series on the benefits of an EMR or EHR consultant is EMR Training.

EMR Training

Using an EMR consultant’s experience in successful EMR implementations, they have a strong ability to train doctors on EMR and other related technologies. Some of this training occurs in an initial meeting where they discuss challenges related to EMR selection and implementation. EMR consultants also provide ongoing training on how to best use their EMR in their clinic. Furthermore, EMR consultants can train clinical staff on using the various technologies associated with using an EMR.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

A while back I wrote something about why having an EMR or EHR consultant could be beneficial to a doctor looking to implement an EHR. Here’s the first part of a five part series on reasons why I think a well qualified, experienced EMR or EHR consultant is valuable. The first part is how an EMR or EHR consultant helps with the selection process.

EHR Selection Process

By first evaluating a doctor’s needs and preferences EHR consultants are able to eliminate a majority of the EHR companies and provide doctors with a short list of high quality EHR vendors to evaluate. By providing a smaller pool of EHR vendors, doctors are more comfortable with the selection process and don’t get discouraged seeing hundreds of EHR vendors that don’t meet their needs. EHR consultants also help doctors through the evaluation process. EHR consultants often provide a list of questions that can be used to evaluate EHR vendors. These questions have been designed to tease out information which will better enable doctors to select the right software. EHR consultants also assist doctors that need help negotiating with EHR vendors. These services include requesting enhancements to meet doctor specific needs or even ensuring that EHR vendor pricing is comparable to other EHR implementations.

When it comes down to it, a good EHR consultant can save a doctor large amounts of time and money that would have been wasted looking amongst the hundreds of EHR companies. It’s not hard to say that doctor’s most precious commodity is time.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in