As I mentioned in my previous post about the race to be the first EHR certified (and the first ATCB to certify an EHR), there’s a lot more going on in the battle amongst the EHR certifying bodies.

The first interesting detail surrounds the previous CCHIT certified EHR vendors. This turns out to be a really great move by CCHIT. A quick look at CCHIT’s website has 49 EHR products (or modules of products) that have been certified for either the CCHIT 2011 certification or for the Preliminary ARRA certification. That’s 49 pieces of EMR software (a few less since some are different versions of the same product) have paid $22k+ in order to be certified by CCHIT.

I’ve talked to one of these EHR vendors and they said that CCHIT did a call with all current vendors and said that they will be honoring their previous commitment to provide the real ARRA certification at no additional cost to these providers. This turns out to be really smart if it means that many of the big EHR players like GE, Elipsys/Allscripts, NextGen, Epic, Athena, Pulse, Cerner, etc all decide to continue forward with CCHIT.

Many would ask why they would pay another $20k to someone like Drummond Group if they could get the EHR certification for free from CCHIT. Turns out their is a possibility if CCHIT isn’t able to deliver their certification in a timely manner and Drummond Group is able to do it much quicker.

Remember the list above are HUGE EHR vendors where $20k is basically a drop in the bucket. It’s kind of scary to consider that, but that’s the reality for most of the EHR vendors. Sure, it’s not what they’d like to spend if they don’t have to, but when did large corporations start worrying about wasteful spending? Ok, that might be a slight exaggeration, but you get the point.

The good thing for Drummond Group is that there are still 300+ EMR vendors that will need to be certified. In fact, many of the non CCHIT certified EHR companies are likely moving to Drummond Group for EHR certification since CCHIT is giving priority to their existing EHR vendors.

Yes, that’s right. Over the next month and half CCHIT will spend all its time doing a bunch of free EHR certifications while Drummond Group will be making just under $20k for each EHR certification that they do.

One final thought about the fun that is EHR certification. When I recently talked to an EHR vendor that is CCHIT certified and will likely be getting their now free EHR certification, I found it really interesting to learn who from their company was on the CCHIT call. In this case, the EHR vendor’s VP of Marketing was on the call with CCHIT.

Of course, this begs the question why the VP of Marketing would be on a call about EHR certification standards and compliance. Shouldn’t the clinical director be the one that wants to be on that call? I think it sends a compelling message that I’ve been preaching on EMR and HIPAA for a long time. EHR certification is not a benefit to the doctor. EHR certification is not a benefit to the patient. EHR certification is a means for EHR vendors to market their EHR software.

I’m going to be a little lazy today and just give you a couple links to the story of yesterday. I guess I get busy sometimes too. In case you missed it, the BIG news yesterday was Allscripts acquisition of Eclipsys.

I posted most of the relevant links on EMR and EHR yesterday along with some interesting user comments about the deal. Also, if you like this stuff, you’ll enjoy this lengthy analysis that was done on HISTalk about the acquisition.

Here’s my thoughts after reading the HISTalk analysis:
“After this merger, the new company will be trying to support eight EMRs systems and five practice management solutions with a sprinkling of inpatient technology”

Talk about an ugly situation. Plus, this quote doesn’t even highlight all the HIE software they’re dealing with.

I ran into a number of unhappy Misys users who were angry for Allscripts making them change. Just wait for these Allscripts resellers who are going to have to deal with the MyWay fall out.

Sometimes it’s the little things you catch at an enormous conference at HIMSS that are the most powerful. One of those came for me when I was talking to the VP of marketing from one of the EHR vendors on the floor. This was one of the most interesting people I met with at HIMSS.

As we were talking he kind of said off hand that one of the visitors to his booth had said Allscripts isn’t CCHIT certified.

Now I should clarify. Allscripts was CCHIT certified back in 2007. However, they didn’t do CCHIT certification and in 2008 but they still haven’t done any of the 2011 full CCHIT certification or Preliminary ARRA certification either.

As a side note, CCHIT has moved or taken down the previous years certification lists from their website (not sure why or where they moved them) (UPDATE: You have to drill down to the categories and you can find the previous years). However, they are listed on the EMR and EHR wiki.

The interesting point here is that Allscripts, an EHR company with possibly 21% EHR market share, hasn’t bothered with the CCHIT certification.

I have no doubt that Allscripts will be HHS certified (or whatever they end up calling the certification). However, they haven’t seen the need to go after the CCHIT certification. No doubt there sitting there waiting to get a cheaper EHR certification. This is true for a few hundred other EMR vendors as well.

Another interesting sign of the move away from CCHIT certification and on to the HHS certification.

And yes Allscripts, I am still mad at you for shutting me out of your party at HIMSS despite having registered and read the dozen or so emails you sent reminding me that I registered, but never telling me that I had to stop by your booth for a wristband.

A little while back I read an interesting EMR success story using the open source EMR appropriately named OpenEMR. The story is by Joe Holzer and I got his permission to republish it here for all to enjoy. You can find more about Joe on his website (not the normal website) or at his email im@holzerent.com I think you’ll enjoy his story and some of the unique ways he used OpenEMR to address some challenging problems along with his passion for open source EMR software:

I have implemented OpenEMR in a number of sites, and I advise on its use in their forums at Sourceforge.net. My wife Lynne was my first “client”, and her use of FREE OpenEMR allowed her to eliminate all need for my services as her business office manager, as well as all clearinghouse costs, as it prepares both X12 and CMS 1500 directly.

Because she has a house call practice, and G3 dependability is a joke, I converted the Linux web-based OpenEMR to stand-alone on her windows tablet notebook. That works especially well with the VPN I used, since her biller is at another location entirely, but can do the billing whenever Lynne is at a hotspot without Lynne even having to be aware of it. And every night it backs itself up to our server, which is always accessible by the biller for looking at information which is no more than 24 hours old.

What Lynne gets in her practice is first and foremost the ability to eliminate all the lugging of paper records and the risk of their damage by the elements, etc., to say nothing of the nightly HIPAA backup security which paper could never afford. She uses the hotspots to connect to Allscripts for her FREE e-Rx so she can get the Medicare 2% incentive for 2009, which was simple to setup in OpenEMR both because it is open source, so can be made to do whatever the user wants for greatest efficiency and effectivity for their individual practice, and because it is designed for flexibility in configuration. In fact, the latest version, 3.1.0 just released, is the ONLY EMR system I am aware of which is operable in the native language of the user on a shared system with multiple users. So an inner-city clinic with primarily latino population, but also english speakers, need not have ALL its staff be bi-lingual. And yet it is STILL FREE.

You can see some of the support I have provided others as a volunteer at the OpenEMR forums at Sourceforge.net as ideaman911.

That ANY intelligent user would pay for a proprietary system merely makes me question their grades in economics. Checkout oemr.org for details.

Many of you might remember me ripping on the EHR Stimulus Tour being a nice marketing idea for Allscripts. Ok, so maybe I went a little overboard when I said that the EHR stimulus tour sickens me and compared the EHR stimulus tour to an Amway or MLM convention. Yes, I did feel a little icky going to it and even leaving the event. However, I will admit that it was much calmer than I would have ever expected it would be. They did a pretty good job of leaving out the sales talk. Although, Allscripts really was the only vendor with much presence. A Citrix rep was there along with a local Embarq salesperson who had some Cisco IP representation as well.

Overall, I have a feeling that many will go away from the event disappointed. They did provide some good information on the amount of the EHR stimulus money and also how the EHR stimulus money will be paid. They also had quite a bit of information about ONC and other government organizations related to the ARRA funds. However, I’m guessing that many went home from the presentation seeing the dollar signs from the EMR stimulus money with little information on how to actually get the money.

Yes, I know it’s still early to be doing presentations with too much detail on “meaningful use” and “certified EHR,” but I think it would be valuable to talk about what those could potentially be. At least show them a timeline of when we’ll know more about those 2 all important terms. Instead, it was basically a presentation on the MONEY, 2 raw raw speeches about EMR use and then a sales demo over lunch.

The 2 speeches from doctors in the community were interesting. The first problem I had was that these 2 guys came from very large clinical practices. Much of what they talked about just isn’t possible for small practices. For example, one guy said we can report on anything. We just turn it over to this one whiz kid who can build a report to tell us anything. Unfortunately, small practices don’t have the whiz kid report writer to pull the data out of the EMR. That’s just one example, but you get the point. They talked about really cool things that are just hard to apply in a small practice setting.

One other note was that at least one of the speakers actually was a Misys user instead of Allscripts. I was so tempted to ask them how they felt about Misys being acquired by Allscripts and how much it was going to cost them to switch to Allscripts EMR from Misys. The timing was wrong and so I’m going to try and email him to find out. However, there were a number of other Misys users around me that were quite upset about the Allscripts purchase and the need to switch from Misys to Allscripts to get the EHR stimulus money (at least that’s what they told me).

I’ll do a few other posts about some of the technologies they showed in the demo. Although, I’ll admit that it was a horrible idea for them to do a demo like they did. Everyone around me had a headache since the screen was so small and he was clicking so much they just got confused. I didn’t mind it, but I’ve seen quite a few EMR before.

Of course, all in all it was a nice meeting for me. I made some good Las Vegas EMR contacts and got a free lunch.

No doubt many small EHR companies have been looking at themselves in the mirror long and hard and asking themselves how they’re going to survive this rough market. Not only did the HITECH act slow purchasing of EHR systems, but between “certified EHR” and “meaningful use” many are questioning where the small EHR vendor will fit into the EHR market.

I could (and probably will at some point) expound on each of the topics above, but I think that EHR vendors have an even more difficult challenge on their hands. The challenge comes in the form of incredibly large number of marketing dollars and splashy partnerships.

Here’s just one simple example of what I’m talking about. It was just announced that HEALTHeLINK, The Western New York Clinical Information Exchange, now has formal agreements in place with Allscripts, eClinicalWorks, McKesson, MedAppz, NextGen Healthcare Information Systems and Pulse Systems. [Hailing out of Buffalo, I'd love to meet up with the people at HEALTHeLINK sometime when I'm visiting family in the area.]

I’m not sure how much of an impact this particular partnership will have on EHR adoption in upstate New York. However, that’s not really my point. My point is that this is just one small example of a partnership that the “big boy” EHR companies are going to use to market their product. Consider that the marketing budget for these large EHR companies is quite possibly larger than some smaller EHR companies entire budgets. That’s pretty formidable.

I’m not saying that small EHR companies should close their doors and stop competing. In fact, I hope just the opposite happens. I’m all for innovation and the most innovative products usually come from small companies who have to be innovative to survive. I’m just saying that these small EHR companies better come ready to fight. It’s not going to be a pretty couple months in the EHR industry. Only the strong will survive.

Of course, all is not lost for small EHR vendors that survive. Assuming EHR implementation failure rates continue at their current dismal rates, then there will be a tremendous opportunity for a number of companies to take care of those who fail to implement unusable EHR systems.

I previously posted about the EHR stimulus tour (no link since I don’t want to promote them). Today I saw what seems to amount to a press release that talks about the “EHR Stimulus Alliance” and their tour to “educate 500,000 U.S. physicians about opportunities aligned with the American Recovery and Reinvestment Act (ARRA) of 2009.”

This type of puffery just makes me sick. No. Not the educating 500,000 physicians. That’s a good thing and part of the motivation for this blog. The thing that makes me sick is this seems like just a big marketing campaign for Allscripts. Sure they have a list of other partners, but they’re basically partners of Allscripts. Check out the list: Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft Corp., and Nuance. The press release calls it a “broad coalition of healthcare and technology companies.” Too bad Allscripts is the only true healthcare company in that list. All the others are technology companies that sell some healthcare products.

I just don’t like when an “education tool” is really just being used as a marketing tool for a certain EHR company. If they really wanted to help adoption, they’d sponsor a tour with a whole variety of EHR vendors where they can help doctors to be able to see the wide variety of EHR vendors that exist.

Someone recently emailed me about any conferences that exist for a doctor to be able to evaluate EHR companies all in one place. I know there have been a number of other ones in the past that no longer exist. The only one I know is still going is HIMSS. Does anyone else know of other places where doctors can see a bunch of great EHR? I ask this knowing that many really great EHR just haven’t seen the benefit of these types of shows.

Also, if anyone has a chance to go to one of these EHR Stimulus tour stops, I’d love to have you do a guest post on the experience. I sent them a tweet asking if they can stop in Las Vegas so I can check it out.

Turns out the fish are starting to feed. Check out this website that talks about the “EHR Stimulus Tour: Educating the Nation.” Ok, I don’t really want you to check out the website, since I think it’s kind of sad. At the bottom it lists the “EHR Stimulus Alliance.” The following companies are listed in this EHR alliance:
Allscripts
Cisco
Citrix
Dell
intel
intuit
Microsoft
Nuance

What a group of large companies trying to sell a bunch of product. I guess we should have expected something like this, but maybe I’m just a little surprised that they made a website for an EHR stimulus tour and everything. Interestingly the twitter link on the site goes to an Allscripts twitter account. I think we can clearly see who’s behind this website.

Honestly, this reminds me of an Amway or other MLM convention. Is it any wonder the type of information that will be given at this type of tour? I guess $18 billion is a lot of motivation to market your EHR software. I just wish they were stopping in Las Vegas so that I could go and check them out.

I finally had a few moments to watch the Matthew Holt interview of Glen Tullman, Allscripts CEO at HIMSS. Allscripts is no doubt a large player in the EHR industry (like it or not). This is especially true after Allscripts acquisition of Misys. So, Glen Tullman will have a large effect on the EHR industry so it’s worth listening to hear what he has to say. I’ll include a few quick comments of my own below the video.

Overall a pretty low key video. There were a few things that are worth commenting on.

The first thing that hit me was that Glen Tullman thought that the controversy over CCHIT was that CCHIT certified over 300 EHR vendors. Glen makes the argument that government wants a smaller footprint of EHR vendors and that 300 was too many. I guess I can kind of see why government might not want to certify 300 EHR providers since doctors just don’t have time to look through that many. However, it was the first I’d heard of that CCHIT controversy.

What does make a lot of sense is why the CEO of one of the largest EHR vendors would want the certified EHR vendor list to be a really small list that includes them. So, it would make sense for him to lobby the government to keep the list small.

I’m glad that Matthew Holt brought up at least another reason that CCHIT as the EHR certification is a problem. How about you just start with the controversy that CCHIT certification doesn’t provide benefit to doctors. Solve that one and we can find a way to deal with any other CCHIT controversies.

Of course, at the end Glen Tullman also said “CCHIT has done it [EHR certification] very effectively.” Effectively? Seriously? Can he provide me some data on how effective it is? It might be effective for his organization’s interests. So, maybe that’s what he meant.

Glen Tullman did make a great comment about SAAS EHR versus client server EHR. He basically said that most users don’t know the technology behind SAAS EHR and client server EHR. Glen suggested that most users just know the financing model of the two EHR options. A very fine point. I’d just add that they know the financing part AND the IT support part of the equation (ie. SAAS EHR means you [the EHR vendor] do the IT. Great!) Glen does seem to understand how to sell an EHR product to his customers.

There you go, there’s my quick comments. What can I say? I type fast.

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).

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.