In a perfect world, an EMR vendor would be completely focused on the customer in developing their EMR software. They’d be very deliberate in their development process where they’d consider feedback from existing users while still finding the perfect balance of planning for future needs and satisfying the current needs. It’s a pretty simple concept to talk about the customer driving the development of EMR software. Yet, it’s much harder to actually do.
What makes this even more difficult is the EMR stimulus money. Ok, not the money itself, but the regulations around becoming a certified EHR and doctors needing to show meaningful use. Instead of EMR vendors focusing their development effort on what is best for the customers (doctors and patients) they will instead be focusing their development on a set of criteria that the government has imposed on them and doctors.
Here’s an example of what I’m talking about. It’s from an email I received from an EMR vendor:
At least I have a target that I can aim for. Up to now, it has just been a matter of speculation. Whether I like the criteria or not, it is now definitive and the arguments of whether it really makes a doctor productive are now academic.
Unfortunately meaningful use has started to dominate the EMR landscape and there’s no end in sight. Instead of having EMR vendors focus on creating innovative products that solve customer needs, they’ll have their focus (at least temporarily) moved to the list of government requirements. Oh, and the good news is that this is just stage 1 of the meaningful use guidelines.
If we assume that the meaningful use guidelines are the way that EMR software should be developed, then we should end up with a good result. If the meaningful use guidelines point to the wrong targets, then we’re going to have a set of EMR software that no one really wants to use.
Then there’s the reality. Meaningful use does have some good components that will benefit EMR development and healthcare in general and has a number of components that don’t make much sense at all. The problem I have is that the good components were things that EMR software were doing already. So, what are we really achieving?
Are there any EHR vendors left that plan to pave a development road map that doesn’t fulfill all of the meaningful use requirements?
The problem is not so much the carrot. Practices must always decide what is best for their business and their patients.
The problem is the threatened stick. Providers are already penalized for serving Medicare/Tricare and Medicaid patients. Reimbursements have already been cut to the point that application of a penalty for not achieving a FED-inspired regulatory MU “hoop” will result in further limit on access to health care services as practices turn away or terminate services to publicly covered beneficiaries.
The penalty provision of ARRA legislation is ripe for rollback when local providers and citizens roast their local politicos for the short sightedness of the stick.
So a vendor with a vanilla uncertified product that would not be able to compete against a similar feature, similar priced ARRA-certified product may suffer market losses. A vendor with an innovative yet uncertified product that brings value to the practice and its patients is another thing altogether. It’s up to the practice to decide. They can always go this route and simply stop seeing those public program patients.
“it is now definitive and the arguments of whether it really makes a doctor productive are now academic.”
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Wow. Depressing statement. Moreover, as I have written about at some length elsewhere, if there ends up being significant additional labor involved in documenting MU, the net ARRA incentive reimbursements may well themselves be “academic.”
Bobby… you don’t really think anyone is ever going to be recognized as achieving MU AND get the incentive payment they expect?
Corollary to the Law of Unintended Consequences:
Whenever the government tries to “improve” something, it turns to crap.
One of the California RECs listed their “selected” vendors and to no one’s surprise it is the usual suspects. http://calhipso.org/index.php?option=com_content&view=article&id=46&Itemid=19
Jack,
That’s like a list of my Jabba the Hut EHR vendor selection. Does anyone have a copy of the RFP that the had the EHR providers provide?
John… CalHIPSO has taken down its vendor RFP. (Bet Bobby has a copy).
From CalHIPSO’s public statement on its progress in Stage 1 selection and the Stage 2 objective:
“CalHIPSO has completed STAGE I of a two stage process to identify and contract with selected Electronic Health Record product vendors. As a result of a comprehensive Request for Proposal, eight vendors have been identified for STAGE 1 in four provider categories. These STAGE 1 Vendors will participate in a contract negotiation process managed by Council Connections, CalHIPSO’s group purchasing partner. The outcome of STAGE II will be standard terms and conditions, as well as discounted pricing on products, available to CalHPSO members. The standard contract requirements are being developed in collaboration with other state-wide organizations to capture not only Meaningful Use requirements, but future capabilities, such as health information exchange that will be integrated into the products under contract.”
So 8 vendors in 4 categories … so hope California providers are happy with a choice between 2 products from the “Jabbas”. Not going to be too much new thought in any of those products. Although safe bet that at the end of the day that voila they become EHR ARRA certified.
Found this interesting item on CalHIPSO’s site written by a CalHIPSO attorney:
Provider Assignment of Incentive Payments
http://www.calhipso.org/images/stories/pdf/ProviderAssignmentofIncentivePayments.pdf
Two of the questions addressed are:
-May a physician assign his or her incentive payment to another entity?
-Can a physician assign an incentive payment to a REC or an FQHC?
Looks like CalHIPSO is trolling for money from those providers who use their service. I thought incentive payments were to offset the investment in the EHR capital outlay? Looks to me like CalHIPSO shakes down the vendors … and then shakes down the providers.
Are we sure this isn’t Chicago?
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I finally met Bobby today and had a great discussion with him. A very smart man that really does live and breathe the HITECH act.
After many of my talks today, the RECs get worse and worse. Except for ones like the one Bobby works for that have stayed vendor agnostic.
Why can’t software providers accomplish both? Before MU was even a thought, software providers like Aprima Medical Software were at the forefront of technological innovation, ease-of-use, easy-to-implement, and had a healthy return on investment. Maybe new upstarts are solely focused on MU and forgetting the bigger picture, but more mature EMR providers like Aprima Medical Software continue to focus on innovation while providing a healthy ROI, regardless what short-term incentives may exist.
Matt,
It doesn’t necessarily have to be an all or nothing proposition, but based on the number of meaningful use requirements it often becomes the case for EMR vendors. Actually, this post is a partial attempt to wake up EMR vendors to the fact that they’re giving the wrong impression to doctors if they do shift all their focus to MU criteria while ignoring their customer’s needs.
I just today realized that a provider does not need to sign up with a REC to receive stimulus money. I believe that many of the RECs have been vague on this concept so that providers think they have to sign-up with a REC to achieve meaningful use. How could the government have spent so much money on the RECs? Most providers have no use for their services unless there is something that I am missing?
Jack,
I’m sure you could make an argument for why a REC could be of value to a provider even though as you properly point out, there is no requirement that they use the REC.
In fact, Bobby (who commented above and works at a REC) has said that they should have required working with a REC if they expected the RECs to meet their goal. Without that requirement it’s going to be a real challenge for RECs to get enough interest from providers.
I agree that you can certainly make the case that the money spent on RECs could have been spent better in other places (ie. even just as straight incentive to providers).
John … Yea I remember distinctly making that point and Bobby counselling me severely.
Way that ONC has structured the mission and resources available to RECs as I understand it is that they are not as well structured as a for-fee management consultant would be to address workflow processes, lead EHR selection, guide deployment, and ensure effective training.
If you drill into CalHIPSO you find its staff is only 9 people and they sign up supporting casts to provide the actual engagement with their practice clients in what could become a very ad hoc piecemeal support net.
This fractured support structure for albeit some RECs is what is giving all RECs bad names … and is why I believed at the outset that a better option would have directly funded practices to secure expert support and deploy their EHR.
This trickle down reimbursement if practices pass MU test every quarter until they’ve enmassed their ARRA fortune … will prop up jobs and RECs and have created a ‘weed field’ of prospective EHR vendors.