In a previous Meaningful Use Monday we wrote about a bunch of the Meaningful Use 2011 statistics that were put out by ONC and CMS. I know that my readers love statistics and information about Meaningful Use. Carl Bergman sent me a PDF file that contained some really interesting data on Meaningful Use stage 1 in 2011. The first pages we basically covered in the previous post, but starting on about page 10 or so there are some more detailed numbers.

Take a look at let us know which numbers you find interesting and/or unique.

HITECH Answers recently posted a great post that gives a run down of the EHR Incentive program’s progress in 2011. Here’s their list with my own analysis and commentary of each point.

123,921 Eligible Professionals have registered for EHR Incentives, 15,255 have successfully attested to meaningful use in the Medicare program.
This seems like such a HUGE difference in numbers. That’s just over 12% of Eligible Professionals that registered attested to meaningful use. Does this mean that we’re going to see a tidal wave of meaningful use attestation in 2012? Possibly.

I believe that we’ll see more eligible professionals attesting to meaningful use in 2012. However, the question is how many of those other 108,666 will attest to meaningful use in 2012 and how many are like the Happy EMR Doctor who just registered to see the MU process. I wonder how many first hand meaningful use experiences by doctors will scare doctors away from MU attestation.

3.077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.
This is almost 20% of hospitals that have registered that have attested to meaningful use. It’s not surprising that this number is a lot higher than eligible professionals. I still believe that the wave of meaningful use attestation will come from these other 2473 hospitals and probably many more that still haven’t registered. I haven’t seen a good number of how many hospitals are in the US. Does anyone know that number? The EHR incentive money that goes to hospitals will dwarf those of eligible professionals.

$2,533,689,145 has been paid out in Medicare and Medicaid Incentives.
$2.5 billion sent out in 2011. I just went back to the first time I tagged meaningful use on this site on April 3, 2009 (coincidentally I have 19 pages of 10 posts each tagged with Meaningful Use). Amazing to think that it’s taken basically 3 years to spend $2.5 billion on EHR.

277 hospitals have received payments under both Medicare and Medicaid and of those 12 were CAHs.
That’s about half of the hospitals that have attested to meaningful use under Medicare are also getting the Medicaid EHR incentive money as well.

22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.
I must admit that I would have thought that the percentage of family doctors that got paid EHR incentive money would have been a lot higher. I guess when you have so many other specialty areas I shouldn’t be that surprised. I also wonder why the internal medicine number is so high. These numbers actually make me believe that a lot of family practice doctors are sitting out when it comes to meaningful use.

41 States Medicaid programs were open for registration. Two additional States launched in January of 2012.
I wonder what’s holding back the other 7 states. From what I’ve seen all the states will eventually get there.

More than 1500 EHR products have been certified by ONC-ATCBs.
That’s a lot of EHR software. I still put the EHR company list at about 300 EHR vendors. 1500 includes multiple versions of the same software, partial EHR certification for products like data warehouses, ePrescribing, etc. The best thing that’s come from the ONC-ATCB program is that it has made EHR certification basically irrelevant in the EHR selection process. Every EHR vendor is certified now. This is much better than the false assurances that EHR certification provided before. I still dislike what EHR certification has done to the industry, but at least it’s not misleading doctors the same way it was before.

LinuxMedNews just posted the announcement that OpenEMR is now a certified EHR. Here’s the quote from their announcement:

It’s official! OpenEMR has passed all ONC certification tests as a fully qualified emr that can be used to attest for incentive moneys. The official posting: http://onc-chpl.force.com/ehrcert/EHRProductDetail?id=a0X30000003mNwTEAU&retURL= appeared on the website 2011/08/19. Congratulations to all involved! OpenEMR 4.1 should be ready for download in a few weeks.

This is a really big announcement for the open source ambulatory EHR community. A number of other open source EHR are certified, but they’re mostly for the hospital EHR space. So, it’s a great thing for OpenEMR to provide an open source EHR to the ambulatory space.

Plus, I have to admit that it’s pretty great that an open source community can pull together the funds to actually be certified. The programming and development time is one thing, but getting the $20-30k to be certified is a big deal that I’m sure took a lot of effort. I actually wish I knew more about the process they used to achieve the EHR certification.

Now, OpenEMR users better start digging into resources like Meaningful Use Mondays. EHR Certification is the first step, but showing meaningful use of that certified EHR is the next one.

Big thanks to an avid follower of OpenEMR – Jojo the HITMAN who informed me of the news.

Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)

Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.

This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.

On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.

On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.

That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.

While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.

I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.

The decisions don’t end after deciding on an EHR system for your medical practice. An EHR contract is an important and legally binding document, and it’s absolutely essential to consider every line of fine print before accepting the terms. O’Toole Law Group founder William O’Toole strongly believes that contract terms should be one of the top criteria in the EHR selection process.

Consulting with a lawyer before you sign is the best way to avoid difficult and expensive problems in the future. The following five issues arise frequently in EMR/EHR contracts, which are being rushed to execution by many practices that are aiming to qualify for federal funding under ARRA/HITECH. This is by no means an exhaustive list, but it aims to shed light on a few of the most frequent contract issues.

1. The EHR may not have the required certification. In order to qualify for federal funding under the ARRA’s Meaningful Use requirements, your EHR must be certified. Certification isn’t a totally black-and-white label, however – an EHR could be certified for the present but that certification could be withheld later on in the reimbursement period. The vendor is responsible for maintaining certification, so it’s important to determine for exactly how long the certification is guaranteed.
2. Your EHR vendor cannot guarantee that you will qualify for Meaningful Use. Meaningful Use – that is to say, your meaningful use of the EHR – is determined by you and your practice. Simply buying and setting up the EHR does not mean that you will qualify for reimbursement unless you follow the legal requirements and use it appropriately.
3. Your contract should include training time and support. Your staff will not be able to use the EHR system effectively without proper training, and if your contract does not guarantee a certain amount of training time (as well as specify exactly how and where the training will take place), your practice could be in trouble. Similarly, you will undoubtedly run into problems and your contract should specify support options for both day-to-day problems and long-term EHR product development by the vendor.
4. The EHR may not be guaranteed to be up and running by your deadline. If the EHR system is not ready to use in time for your Meaningful Use deadlines, you will certainly run into problems and lose reimbursement. While the vendor can’t guarantee a timeline for the work required of your practice, they should be able to promise timely delivery of all materials and support necessary on their part.
5. You could be surprised with licensing fees if you don’t carefully consider what type of license you’re paying for. In general terms, the license agreement with your EHR vendor could be one of two types: a perpetual agreement under which license fees are paid once up front, or a temporary SAAS-type license that requires ongoing payments and expires once your contract ends. Though an SAAS license may be less expensive initially, your costs could increase if you choose to stay with that same EHR vendor after the contract ends. A good legal representative can help you negotiate escalation amounts for the end of your contract.

About O’Toole Law Group
William O’Toole founded the O’Toole Law Group, specializing exclusively in healthcare information technology, following his long tenure as Corporate Counsel at Medical Information Technology (MEDITECH). Known and respected by executives, attorneys and consultants throughout the healthcare industry, O’Toole now represents healthcare provider entities and technology companies in all aspects of technology acquisition, development and distribution and stands among the most experienced and successful negotiators in the HIT industry.

For further detailed information on these and other hot topics regarding EHR contracts, see the popular white paper offered by O’Toole Law Group, entitled Selection and Negotiation of EHR Contracts for Providers (pdf).

HITECH Answers has just released the 3rd edition of Jim Tate’s The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1 A Manual for Medical Practices. Version 3.0 of the manual that has been helping practices, consultants and vendors across the country understand the step-by-step process of achieving meaningful use is now available. Written by Jim Tate, a nationally recognized expert on the CMS EHR Incentive Program, certified technology and Meaningful Use objectives,The Incentive Roadmap® looks at what steps are needed to get ready for meaningful use and is downloaded immediately upon purchase.

I consider Jim Tate one of the foremost experts on meaningful use and certified EHR. So, I was excited when he decided to publish a resource on the details of the EHR incentive program.

In The Incentive Roadmap®, Jim Tate covers all of the details that you need to know if you’re considering participation in the EHR incentive program.

The first section is actually incredibly valuable since it covers who is eligible for the EHR incentive money and also includes a comparison of the various EHR incentive programs. Plus, it walks a clinic through the process of determining which program it is eligible for. Certainly many people have already gone through this process, but for the rest of you this is a great resource that will guide you through the EHR incentive options.

The next section of the The Incentive Roadmap® covers the details of the meaningful use criteria. This is the section that I think most people will be interested in having now. Certainly many of these details can be found on the CMS website and we’ve covered a lot of them in our Meaningful Use Monday series. However, if you want to get all of the meaningful use details in one place without all the legalese that CMS loves to provide, then check out the The Incentive Roadmap®.

I also love a later section of the The Incentive Roadmap® where Jim Tate provides some practical strategy advice on how a clinic should approach meaningful use.

I know I’ll be keeping my copy of The Incentive Roadmap® close by as a reference. It’s a lot easier to go through than the HHS/CMS/ONC websites.

For those of you that are relatively new to EMR and HIPAA, you might not appreciate this post as much as long time readers of EMR and HIPAA. A few years back, I admit that I was pretty harsh on CCHIT and their EHR certification. I remember one guy stopping me at a conference and after realizing who I was asked, “so what’s your issue with CCHIT?” I was happy to answer that I thought they misled the industry (doctors in particular) by saying that the CCHIT certification provided an assurance that the EHR was a good EHR. They never came outright and said this, but that’s what EMR sales people would communicate during the sales process.

In fact, EHR certification was incorrectly seen by many doctors and practice managers as the stamp of approval on an EHR being of higher quality, more effective, easier to use, and was more likely to lead to a successful EHR implementation. EHR certification today still has some of these issues. However, the fact is that the EHR certification doesn’t certify any of the great list above. If EHR certification of any kind (CCHIT or otherwise) could somehow assure: a higher implementation success rate, a better level of patient care, a higher quality user experience, a financial benefit, or any other number of quality benefits, then I’d support it wholeheartedly. The problem is that it doesn’t, and so they can’t make that assurance.

So, yes, I do take issue with an EHR certification which misleads doctors. Even if it’s the EHR salespeople that do the misleading.

I still remember the kickback I got on this post I did where I said CCHIT Was Marginalized and the post a bit later where I said that the CCHIT process was irrelevant. Today, I came across an article on CMIO with some interesting quotes from CCHIT Chair, Karen Bell. Here’s a quote from that article.

In addition, the Office of the National Coordinator for Health IT’s (ONC) new program has provided two new reasons for certification: proof that an EHR can do the things that the government wants it to do, and to enable eligible providers and hospitals to get EHR incentive money.

“The idea is not to assure the product will do all things that are desired for patient care, instead, the idea is to stimulate innovation,” said Bell. As a result, the program is considered a major success because more than 700 certified health IT products are now on the ONC website. “The idea was to get a lot of new products started. This is a very different reason for certification than what we began doing several years ago,” she said.

However, just because CCHIT or another ONC-Authorized Testing and Certification Body (ONC-ATCB) doesn’t test and certify for a particular ability, that doesn’t mean the EHRs don’t have it. “It’s just up to [the provider] to make sure the vendors have it,” said Bell.

I first want to applaud Karen Bell and CCHIT for finally describing the true description of what EHR provides a clinic assurance that:
1. The EHR does what the government wants
2. You are eligible for the EHR incentive money
Then, she even goes on to say that it’s up to the providers to make sure the vendors have the right capabilities for their clinic.

I imagine Karen and CCHIT would still probably say that the CCHIT “complete” EHR certification provides assurance that…< fill in the blank >, which the ONC-ATCB EHR certification doesn’t provide. The happy part for me is that even if CCHIT says this, no one is really listening to that message anymore.

Yes, CCHIT has essentially become irrelevant.

I can’t remember anyone in the past year asking me about CCHIT certification. From my experience, many people care about ONC-ATCB EHR certification, but they really couldn’t care less if it comes from CCHIT, Drummond Group, ICSA Labs, SLI Global, or InfoGuard (That’s all of them right?). Have any of you had other experiences?

I also do enjoy the irony of this post coming right after my post about differentiation of EMR companies (Jabba vs Han Solo). CCHIT is the reason that I know so much about the challenge of EHR differentiation. CCHIT’s efforts provided some very valuable (and lengthy) discussions over the past 5 years about ways to help doctors differentiate between the 300+ EHR vendors. As you can see from my comments above, I was just never satisfied with CCHIT being the differentiating factor. As you can see from my post yesterday, I’m still searching for a satisfactory alternative for differentiating EHRs. Until then, we’ll keep providing an independent voice a midst all the noise.

In a previous post, Anthony made this basically off the cuff comment which hit me:
“many a time, the functional requirements take priority over UI”

We see this all over the software development world. In fact, it takes a really unique company to be willing to keep UI over functionality. Ask any salesperson and they’ll tell you that new functions are easier to sell than a great UI. So, it makes sense why this happens. Unfortunate, but makes some sense.

However, this comment also had me asking myself the question, “I wonder how many meaningful use and/or EHR certification requirements caused issues with an EMR UI?”

I’ve already had a few EMR demos where I said, what’s that button/function doing there. The response was, oh that was to meet meaningful use/EHR certification requirements. I’m sure many other doctors that use an EMR have seen the same thing. They wonder why an EMR has certain functions since they don’t provide better patient care. Certainly meaningful use and EHR certification is likely to blame for a lot of these possible UI issues. However, I’m sure that many more have to do with EMR software vendors that want to be all things to everyone. When you go down that path, it’s hard to maintain a great UI.

I’ve been starting to think more and more about various EMR UI. Especially with the recent launch of an EMR screenshots website. I’m grateful for the EMR vendors that have been great about sending over their screenshots. It provides an interesting view into the various EMR UI’s. I’m hoping to do some future posts where I take one or more of the screenshots and analyze some of the details. We’ll see how well that goes with an EMR screenshot.

One of my favorite EMR people, Matt Chase from Medtuity, wrote this interesting comment over on EMR Update.

Times are achanging. I think a recent install is a good example. The group purchased a decently well-known EMR and it failed. So they went with a second well-known EMR and it failed. Both were certified. Both had a very active sales team. The second one flew in some upper level sales people from the coast when there was talk of deinstall.

After spending half of the national debt and a looming closure of the practice, they called in a consultant. He made his recommendation. They did their demo and they asked the really hard questions– show me how to create new clinical content, show me how to create a new template, edit an existing one, how to fax a single encounter to another practitioner, then multiple encounters but not all encounters of a patient, track any lab value over time, send a reminder to a staff member, assign faxes and scans, etc, etc. Their list was very long. They did not want to hear promises and they did not want a canned demo. They wanted to see the software perform the steps that were lacking (but promised present) in their previous software.

The underlying theme here is that practices believe that certification is truly a functional seal of approval. It is not. Secondly, because certification exists and so many EMRs (>450) are certified, it implies a mature product offering– like buying a hard drive or a computer. You can expect certain functionality to be present simply because the maturity of the market would have eliminated the company. Unfortunately, just the opposite is true.
…
Just this week I learned that a very large practice in our town is out shopping another EMR. Yes, they have a certified one, but they certainly aren’t paperless.

Functionality will become the watchword of EMR, not certification.

That’s some interesting projections. I remember one EMR vendor telling me that a large portion of their sales were to existing EMR users. In fact, I think they said that there favorite implementations were existing users that were switching to their EMR. I also love the observation of how much better an organization is at selecting an EMR the second time they do it.

If you’ve been following this blog for a while, then you probably remember my many rants about the lack of value in EHR certification. In fact, Jim Tate asked me at HIMSS where my dislike of CCHIT came from. I think I told him that I probably got it from EMRUpdate. Certainly that’s where I learned a lot about EMR and EHR and certification in general. However, as I consider his question, my real distaste with CCHIT and quite frankly EHR certification is that it provides little to no value to doctors.

Looking back at all the discussions I had last week with those attending HIMSS, I’m really happy to say that EHR certification was almost never a discussion. Pretty much everyone either was a certified EHR or was almost done with the EHR certification process (which is in line with ONC’s desire that all EHR software be certified).

I still feel that certification provides little value, but I’m really happy to see that EHR certification has basically left the discussion. If everyone has it, then doctors don’t and won’t look to it as a way to select an EHR. I think that’s a very good thing.

As I’ve thought more about EHR certification, it’s funny that someone hasn’t come out with some healthcare IT certifications that would actually provide value to doctors and healthcare. Here’s just a few ideas off the top of my head of items that could be meaningfully certified:

• Privacy
• Security
• Data portability
• Freedom of data
• SaaS hosting services

The interesting thing is that many of these certifications could be provided well beyond EMR software and into other healthcare IT products (and even beyond if someone so desired). Certainly the existing EHR certifications try and provides some of these items, but they’re so general and non specific that they aren’t very useful.

For example, the privacy certification could include not only that the data is encrypted but could specify which type and level of encryption is used. Plus, the certification could actually test the encryption to make sure it was implemented properly. I know some eFax vendors that would love this type of certification.

A certification that provides value wouldn’t likely be a simple pass fail certification. Maybe you do set a bar for each requirement that allows you to place a certification badge on that product. However, users should be able to dig into the details of the certification and see what was found during the process. For example, if you make sure they handle passwords correctly, a certification should provide a list of protections that are built into the software that’s being certified (ie. minimum characters, required characters, 2 factor authentication, number of failed passwords before lockout, etc).

If I weren’t so busy with my healthcare IT blog network, I’d consider doing some of this myself. Not only is it a great business, but could really provide value to healthcare. If you start it, just save me a spot as an advisor.