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Cost to Update to Meaningful Use Certified EHR Software

Posted on September 20, 2010 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 my previous post about the EHR certification costs, a reader emailed me that I’d missed an important downstream cost. It’s not as much a cost for the EHR company as it is for the current user of an EHR system. It’s the cost for a current EHR user to upgrade their software to the latest and greatest version of the EHR software. You know, the one that is certified and allows you to show meaningful use of that EHR.

All EHR Will Need to Update
Lest you don’t think this is going to happen, I can pretty much guarantee that EVERY EHR company will need to upgrade their software to become a certified EHR and meet all the meaningful use requirements. The good thing is that most EHR users have a contract that provides them with all the upgrades free. Although, there might be some users that will incur a cost to upgrade.

Less Visible Update Costs
Beyond the potential cost to get the upgraded software, there’s also the cost to physically update your EHR software. There’s the very apparent cost of having to run a software install on all the computers in your clinic. This is pretty negligible for a small clinic with only a couple computers. However, in one clinic I supported we had 100+ computers and so the update process did take time.

However, more important than the actual software update is the process of preparing for the update. Certainly you could just update the software and go forward with it. Although, this is far from recommended and can be really problematic. I should cover this topic in a future blog post, but suffice it to say that the upgrade process goes much better when you 1. Look over the new features/changes to the EHR softare 2. Test the changes to see how they work 3. Train your staff on the new changes and how it will affect their workflow. These are all pretty academic steps, but they do take time.

SaaS EHR Vendors
Of course, the SaaS-hosted EHR vendors will all really enjoy this part of the process. They can easily update their EHR software to meet the guidelines with little interaction or work from the customer end. They still could cause the headache of an update to their EHR software affecting a clinic’s workflow. However, most SaaS EHR software companies are doing many regularly scheduled smaller updates as opposed to the large traditional client server EHR updates. These smaller changes generally cause fewer issues or at least spreads those issues out over time.

Even More Hidden Update Costs
I recently was aghast to learn of the EHR update requirements for a certain very popular EHR vendor. They’d told a clinic (or at least given them the impression) that in order to update their clinic to the latest EHR software that met the meaningful use and certified EHR guidelines (which is kind of silly since there still aren’t any officially recognized Certified EHR, but I digress) that the clinic would need to have computers that ran the Windows 7 Operating System. The sad news for this clinic was their current Windows XP machines weren’t powerful enough to run the Windows 7 operating system.

Let me translate what this means for the less tech savvy readership. The clinic would need to buy all new computers and the Windows 7 operating system (which should come on the new computers) in order to upgrade their EHR software to the latest meaningful use-certified EHR software. One could certainly argue that the clinic might need to upgrade these older computers anyway, but something doesn’t feel right about this being “forced” on a clinic. I personally still use Windows XP and don’t see much benefit to pay for a new computer with Windows 7. I will at some point, but there’s no compelling reason for me to move now. Why should clinics be forced into this expense by an EHR vendor?

Certainly Windows 7 and Windows XP are not ALL that different, but be sure that the change will cause some heartache in a clinic. Some mundane task that a user use to do easily in Windows XP will require a change to make it work in Windows 7. It’s easy to quantify the cost of new computers with Windows 7. It’s much harder to quantify the cost of this heartache.

Ongoing Update Costs
Many of these costs aren’t generally meaningful use specific. These costs or some variation are going to be part of the EMR update costs going forward. Unless your EMR vendor stops updating. Although, if your EMR vendor stops putting out updates, then you have a much different problem to deal with.

Weight Loss Compared to EMR Implementation

Posted on April 26, 2010 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 for a while you know that I love to compare EMR implementation to other parts of life. It’s always amazing to me how similar other parts of life are to EMR selection and implementation. In case, you’re a newer reader, go and read my posts comparing EMR to Marriage (also talks about divorcing your EMR), EMR implementation to Pregnancy, and Marrying an EMR for Money (VERY important with all this EMR stimulus money). A presentation on comparing EMR to life would be a fun presentation to give, but I digress.

The other day I came across a comparison that will be familiar to all types of people, but doctors will be acutely aware of this comparison (even more so than I). EMR implementation is very much like weight loss. Yes, that’s right. Weight Loss!

Think about it, there are a lot of similarities. Most patients that need to lose weight know that they need to lose weight. Deep down they really know they need to lose weight, but a part of them is still trying to argue that they don’t need to lose weight. A part of them still kind of wonders, “what’s so wrong with being overweight?” Sounds like many doctors looking at an EMR implementation. They know deep down that they need to implement an EMR. However, they just keep asking themselves “Why can’t I just keep using paper charts?”

No doubt many older people that are overweight have basically given up the fight to lose weight. They figure that they’re older and they have no need for weight loss anymore. Sound a bit like older doctors and how they approach EMR?

Of course, the most interesting comparison between weight loss and EMR implementation comes when applied to the actual implementation itself. Weight loss requires a huge change in someone’s life. Thus, it usually requires a lot of “hand holding” and reminders about the value of losing weight. They’ll often lose motivation and need someone to pick them up and help them continue to make the changes in their life so they can lose weight.

No doubt implementing an EMR requires change. Weight loss is about changing habits. EMR implementations are about changing habits too. Often they are habits which were instilled many years ago during medical school. I don’t have to describe why changing habits are hard (although, here’s a couple change pictures to illustrate what I mean). That’s why so many people have a challenge losing weight and why so many people have avoided implementing an EMR.

Yes, and most EMR implementations require a certain amount of hand holding along the way. That’s more a feature of change than anything else. The real question a clinic should be asking themselves is who will be doing the hand holding. The answer might surprise you when you find out that it will likely not be one person, but many.

Balancing Workflow Customization with an EHR

Posted on January 4, 2010 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 HUGE proponent of mapping your current workflows and evaluating how that applies to your EMR implementation. It’s absolutely essential to be able to do it right. It’s not an easy or necessarily fun task, but it pays big dividends when you go live with an EMR.

However, far too many people get caught up with “my workflows” versus the “EMR workflows.” Some people like to argue that an EMR vendor should be able to customize their software to be able to support my current paper work flows. Other people argue that you should toss aside your current workflows and adopt the “best practices” standards of your EMR vendor.

Of course, the real answer is as it should be: somewhere in the middle. The EMR should be built so that you can customize many of the features to match the way you see patients and the way you practice medicine. In fact, this should be part of the evaluation process when selecting an EMR vendor. However, let’s not also be naive enough to think that some things in the electronic world won’t be easier to do than they would have been in the paper world.

You better hope that your EMR implementation does change some of your current processes for the better. That’s part of the reason why your implementing an EMR. You want to improve something about your clinic. If nothing changed, then where would the improvement come from?

Like everything in life, workflow customization just requires balancing your current workflow with the EMR vendor’s suggested workflow and the features of the software.

Change in an EMR Implementation

Posted on October 20, 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 love when EMR sales people try to say that doing an EMR implementation will be just the same as what they’re doing now, but electronically. While this might be true in many respects there’s no way you can get around change. It’s an essential part of an EMR implementation. I apologize if you’re tired of hearing about this topic since I’ve talked about it over and over (some nice pictures on this one) and over again in the last 4 years. I just think it’s important that people have realistic expectations.

One thing I recently heard at a conference was related to change in an EMR implementation. They said that you should “Change Enough to matter, but not so far that you have to change jobs.”

I loved that description. It describes perfectly the need to change something of substance so that people want to change and that they see progress being made. However, you don’t want to go after everything and fail. This is why many people including myself often recommend the phased in approach to an EMR implementation.

One other important aspect when change is about to happen during an EMR implementation. You must prepare staff for why you are changing. If you don’t, it’s a recipe for failure. The fact of the matter for an EMR implementation is that users are likely to lose some functionality and gain some functionality. We all deal with these changes a little better if we know about them beforehand.

Changing the Art of Medicine

Posted on April 13, 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.

In a recent article in the new CMIO magazine, W. Ed Hammond, MD, professor emeritus of biomedical engineering at Duke University, says “The art of medicine has to change. It’s wasteful if it doesn’t.”

This is not a message that many doctors want to hear. Unfortunately, it’s the raw truth. Change isn’t easy. However, if we want to realize the full potential of an EHR and health care in general then doctors and other health care providers need to change the art of medicine to be more effective, more efficient and more accurate.

Is it EMR or EHR…Am I Missing the Boat?

Posted on November 8, 2007 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’ve been looking through my statistics lately (which I actually do most days) and it seems like most people aren’t searching for EMR anymore. It seems like there is a shift going on in people’s minds that they are now starting to search for EHR as opposed to EMR. There’s a whole discussion on wikipedia about whether the Electronic Medical Record (EMR) and Electronic Health Record (EHR) articles should be merged.

In my book they are pretty much the same in most people’s minds. Sure, some people like to argue that EHR has features that reach out to patients and allow patients to enter medical data, but most EMRs have those type of features anyway. I prefer to look at it as an EMR with a patient portal. However, the in thing to do seems to be to call a company’s EMR an EHR. The fact is that most people that have an EMR have a number of patient facing portions of their EMR. Does that make them all an EHR?

Regardless, I’m just wondering if one day I’m going to need to rename my blog to EHR and HIPAA. I’ve kind of grown fond of EMR and HIPAA, but I’m definitely not oblivious to the fact that people are starting to seach for EHR and not EMR. Renaming my blog might be a great thing to help with getting better google searches on the subject. Yes, I do enjoy having a lot of traffic to my blog. It makes me happy to think that people read my stuff and that I’m participating in at least some small way to shape the evolution of EMRs EHRs.

Clinical Staff’s Resistance to Change

Posted on November 6, 2007 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 did a presentation recently on an organization’s resistance to change and the effect that has on software implementation. An EHR implementation is definitely no exception. In fact, it seems that many doctors are even more resistant to change than other industries, which is why we have the roughly 10% EHR and EMR adoption rate.

In my presentation I found two images that described the challenge of adopting an EHR and resisting change very well.

Does this remind you of discussing implementation of an EHR?
EHR Resistance to Change

This one is a great one, but might take a second to truly understand.
EHR Resistance to Change
Did you notice the wheels in the wagon? Seems a bit like a $60,000 EHR system sitting on the shelf to me.