Today’s been a really interesting first day of HIMSS. I’d heard good things about the Health IT Venture Forum in past years and so I was really glad to be able to attend this year. Of course, if you’re following @techguy and/or @ehrandhit, then you’ve already read a number of my updates.

I also posted what might be the biggest news coming out of HIMSS 11 today that meaningful use stage 2 will include EHR usability.

I was impressed by the Mitochon systems presentation at the New Venture Forum. I had a great talk with CEO, Chris Riley after their presentation. I really like his vision for what they’re working to create. The more I talk with Free EHR vendors like Mitochon, the more I can see the potential of their business model. Shahid, the Healthcare IT Guy, told me that he knew of a couple other free EHR at HIMSS. I didn’t get those requests, so I’m interested to know the other Free EHR competitors. (Full Disclosure: Mitochon is an advertiser on this site)

ZyDoc looks interesting. Taking on NLP, auto coding, and transcription. Lots of competition there now. #HIMSS11

February 20, 2011 8:01 am via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

As you can see from that tweet. I was really intrigued by ZyDoc. I’ve been fascinated with NLP since last HIMSS. Combine that with the increasingly popular auto coding engines that are coming out and it’s a really interesting offering.

One of the presenters at the venture forum said the following about the hospital connectivity market. I wonder what people think about it:

Hospital connectivity market just estimated at just over $1 billion. What do you think? #HIMSS11

February 20, 2011 8:43 am via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

AiDi – EHR in China. 30,000 hospitals in China. I wish I knew the chinese EHR market better. #HIMSS11

February 20, 2011 8:26 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

I’ve always been fascinated with China. Add in my interest in EHR and of course I loved the presentation on EHR in China. This company is even more interesting since they have built the EHR with the Chinese character set and it seems like they understand the Chinese healthcare culture.

The Rothman score from Rothman Healthcare is fascinating. Although, there are a lot of interesting practical questions. #HIMSS11

February 20, 2011 8:53 am via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

I loved how the Rothman score tried to quantify a patient’s condition for early warning. To see the score change on a graph really does change your view of a patient’s progress. I just wonder what a hospital’s liability is if the score changes and they don’t follow the alert. I also wonder how many false positives it would produce. Some sort of summary like this has to be the future. I really hope that they’re successful.

The following tweet was the best quote by Aneesh Chopa, CTO of the US. I also loved his energy. I bet he’d be a fascinating person to have dinner with.

New incentives plus information liberation = rocket fuel for innovation #himss11

February 20, 2011 11:56 am via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

I also had a chance to meet with Shareable Ink, but I think I’m going to save my discussion of their technology for an after HIMSS post. So, watch for that. It’s really neat technology.

The increasingly famous Brantley Whittington, CEO of spoof EMR company Extormity, stopped and chatted with me. I’m still holding out on saying who’s behind Extormity, but just look for the Brantley Whittington name badge and you’ll be able to figure it out early (or check back Tuesday when I’ll post it).

I also had a good chat with Dynamic Health IT during the HIMSS opening reception. Check them out for EHR certification and meaningful use consulting. Or as they describe it, the gap analysis for hospitals interested in becoming certified and showing meaningful use. Yes, they help with the hospital EHR self-certification.

In the evening, I got the chance to meet with Dana Sellers, CEO of Encore Health Resources. I told one PR person that emailed me that I have a policy of only meeting with smart people. Dana definitely fits this category.

As most of you know, a lot of my focus is on the ambulatory EMR world and so I appreciate Dana taking some time to talk with me (and really educate me) about healthcare IT in the hospital world. One of the most incredible things they told me was that Encore Healthcare has 143 employees and they’re only 2 years old. That’s some pretty good growth for an EHR consulting company.

One thing I was impressed with was Dana’s candor with her previous company (which was sold to IBM) and now what they’re able to do with Encore Health. Dana was partially embarrassed to admit that in the previous company they worried too much about processes and not enough on getting the data back out. She did say that she thinks that Encore Health is in a much better position based on changes to technology and the environment to really get the data out of these systems so they can focus even more on the quality of healthcare that’s provided.

So much more that I could share from my talk with Dana. It probably deserves it’s on post and most certainly the things she shared with me will come up in future posts. Needless to say I was extremely impressed with Dana and so it’s no wonder why Encore Health has been so successful. I might have to stop by Tommy Bahama’s again just to hang out with more smart people.

Finally, a couple interesting tweets I saw during the show:

Discussion of tactics for dealing with detractors. Listen to them, understand their motivation. Some will be right #CDS #HIMSS11

February 20, 2011 9:53 am via TweetDeckReplyRetweetFavorite

@psweetman_live

Pauline Sweetman

and

Usability design…mobile first….Keep the common tasks easy and the uncommon tasks possible. #HIMSS11

February 20, 2011 9:16 am via HootSuiteReplyRetweetFavorite

@biomedsociety

AFBS

Isn’t it cool that I can cover sessions that I didn’t even attend thanks to Twitter?

Much much more tomorrow. Unless I’m too tired from all the parties;-)

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

Looks like the people at HHS and ONC have been working hard. On Monday this week they published the Permanent EHR Certification Program Final rule. You can find the press release about the Permanent EHR Certification final rule on my new EMR News website (if you have other EMR news, please let me know).

You can download the full Permanent EHR Certification final rule here (Warning: PDF). Although, I must admit that I found the permanent certification fact sheet very interesting. Here’s my summary:
*Testing and certification is expected to begin under the permanent certification program on January 1, 2012 (with an exception if it’s not ready)
*NIST (through its NVLAP) will continue with accrediting organization to test EHR and to work with ONC to create test tools and procedures
*A new ONC-Approved Accreditor of ONC-AA will be chosen every 3 years
*All ONC-ATCB (those bodies certified under the temporary) must apply to be ONC-ATB (permanent certification bodies)
*ONC-ACB have to renew every 3 years
*Gap Certification will be available for future EHR certification criteria.

The most interesting part to me was that ONC will be selecting an ONC-AA (Approved Accreditor) through a competitive bid process. So, they’re going to accredit an accreditor to accredit the certifiers? I think you get the gist. I can see how ONC saves so much by only having to have to deal with one ONC-AA and not the 6 ONC-ATCB (that was in the sarcasm font if you couldn’t tell).

It does make sense to have a gap certification so that EMR vendors that are already certified don’t have to certify against all the criteria every time. I guess in theory changes an EHR vendor has made could have caused issues with their previous functions, but that’s pretty rare. Especially since their users will need it to be able to show meaningful use (which is why EHR certification has little meaning beyond it being required for EHR incentive money).

Whether you agree or disagree with EHR certification (I think you know where I stand), you have to give ONC credit for pushing out the EHR certification program so that there are plenty of certified EHR software out there to choose from. Looks like they’re well on their way to implementing the permanent EHR certification as well.

One of my readers recently linked me to an article from back in July that talks about providers lack of understanding of EHR certification and the possibility of EHR certification bodies beyond CCHIT. Here’s an excerpt from the article:

The Office of the National Coordinator for Health Information Technology has made it clear that it wants multiple EHR certification bodies, but that message apparently has not made it out to many physician practices. According to a survey by Burlington, Vt.-based consulting firm CapSite, 69 percent of healthcare providers are unaware that there will be alternatives to the Certification Commission for Health Information Technology in terms of certifying ambulatory EHR systems.

Additionally, 52 percent of the 850 providers surveyed incorrectly believe that CCHIT certification is a prerequisite to receiving Medicare and Medicaid bonus payments for meaningful use of EHRs. In reality, ONC will designate authorized testing and certification bodies, which then will test and certify EHRs on behalf of vendors.

As most of you know I have a real disdain for misinformation. I’m all about exposing the truth and spreading the knowledge as far as possible. So, you can imagine my reaction to providers not understanding that there are multiple EHR certification bodies and that all of the EHR certification bodies can provide doctors access to the EMR stimulus money.

The only problem is that I’m guessing that most readers of this blog already know this information. I like to think that readers of this blog are smarter and more informed than those who don’t. I was going to do a poll to see who knew what. Only problem is that reading above you’d know the answers.

Either way, if readers of this blog work to inform the people around them that there are multiple EHR certifying bodies (Drummond Group and InfoGuard with others on the way) and that it doesn’t matter which EHR certifying body you use then I think we’d have some impact for good on the EHR world!

In a recent discussion I had, someone brought up a really interesting question about module certification to me. Obviously, proving that you use a certified EHR is quite easy if you just use one EHR software that’s a complete certified EHR based on the ARRA guidelines. Then, you can fitfully say that you use a certified EHR.

Even this isn’t that confusing if you use one complete EHR software for everything, but say ePrescribing. Of course, the ePrescribing vendor would need to be certified for those modules, but you can easily show that both are certified EHR and you use all the modules.

The questions start coming in when you start to talk about module EHR certification when you just purchase parts of a software. Let’s say you purchase only part of a certified EHR software (ie. no ePrescribing and no Patient Portal). You don’t purchase those 2 modules since you already use other software to match those needs and their certified for those modules.

The problem with this scenario is how do we know that the main EHR software that you purchased has all of the certified EHR functions if you never purchased two major components? How do we know that the ePrescribing component actually also did some other part of the EHR certification that wasn’t part of the ePrescribing module certification?

Of course, you could easily argue that it doesn’t really matter because if you’re able to show meaningful use with what you bought, then does it matter if your combined EHR software with the other modules wouldn’t technically have passed an EHR certification? It absolutely doesn’t matter. In fact, that’s exactly why EHR certification is a shameful waste of money and time. If I can meet the meaningful use guidelines using a typewriter, then who cares if the typewriter is certified or not?

Moral of the Story (since this isn’t one of my clearest posts): This whole idea of modular certification is going to be messy.

One of my more interesting meetings at AAFP was with a company called SLI Global Solutions. The meeting was so interesting, because SLI Global Solutions plans to apply to become an ONC-ATCB organization very soon. This coming after the announcement of the first ONC-ATCB certified EHR from Drummond Group and CCHIT along with the announcement of InfoGard as an ONC-ATCB and Weno Healthcare’s plans to become an ONC-ATCB.

We obviously had a long conversation about the EHR certification, but suffice it to say that SLI Global Solutions is going full steam ahead to become an ONC-ATCB. It sounds like they’ve been doing a number of other certifications previously. They’ve even done some consulting work in healthcare.

When I asked SLI Global Solutions what they thought would help them to differentiate themselves from the other ONC-ATCB, one response was that they were really good at providing feedback and helping organizations through the certification process. I personally think that many EHR vendors and other healthcare organizations that need to certify for the EMR stimulus money are nervous about the unknown issues related to certification. If SLI Global Solutions can provide them a feedback loop then it could go a long way to relieving the nerves. This is the main suggestion Jim Tate makes in his post about selecting an ATCB.

I asked SLI Global Solutions how much they planned to charge for the EHR certification. Here was their response, “We have not finalized the pricing yet because we are contemplating ancillary services pre and post certification but we will likely be in the $20,000 USD ballpark.”

With SLI Global Solutions, that would make 5 ONC-ATCB and I’m guessing there are other companies like this that will become certifying bodies as well. I’m all about competition and so the more ONC-ATCB the merrier.

It does make me wonder how many ONC-ATCB the market can support. Not to mention, there’s the interesting question of whether they’re a bit late to the party. I guess time will tell.

Today, CCHIT announced their first ONC-ATCB certified EHR a day later than Drummond Group’s ONC-ATCB announcement. Although, CCHIT is announcing 33 EHR vendors (21 complete ONC-ATCB certified EHR and 12 module certified). No real surprises on this list. They were the previously CCHIT certified EHR companies. That gives us 36 total ONC-ATCB EHR right now (or 24 if we’re talking complete EHR certification).

Here’s the list of Complete ONC-ATCB certified EHR:
ABEL Medical Software Inc.
ABELMed EHR – EMR / PM

Allscripts
Allscripts Professional EHR

Aprima Medical Software, Inc
Aprima

athenahealth, Inc
athenaClinicals

CureMD Corporation
CureMD EHR

The DocPatientNetwork.com
Doctations

eClinicalWorks LLC
eClinicalWorks

Epic Systems Corporation
EpicCare Inpatient – Core EMR

Epic Systems Corporation
EpicCare Ambulatory – Core EMR

GE Healthcare
Centricity Advance

gloStream, Inc.
gloEMR

Intuitive Medical Software
UroChartEHR

MCS – Medical Communication Systems, Inc.
iPatientCare

Medical Informatics Engineering
WebChart EHR

Meditab Software, Inc.
IMS

NeoDeck Software
NeoMed EHR

NextGen Healthcare
NextGen Ambulatory EHR

Nortec Software Inc
Nortec EHR

Prognosis Health Information Systems
ChartAccess

Pulse Systems
2011 Pulse Complete EHR

SuccessEHS
SuccessEHS

Here’s the list of module ONC-ATCB EHR Certifications:
NOTE: CCHIT does make a comment that some of these may become complete EHR certifications later.
Allscripts
Allscripts ED

Allscripts
Allscripts PeakPractice

Health Care Systems, Inc.
HCS eMR

NexTech Systems Inc.
NexTech Practice 2011

nextEMR, LLC
nextEMR, LLC

PeriGen
PeriBirth

Sammy Systems
SammyEHR

T-System Technologies, Ltd.
T SystemEV

Universal EMR Solutions
Physician’s Solution

Vision Infonet Inc.,
MDCare EMR

WellCentive
WellCentive Registry

Wellsoft Corporation
Wellsoft EDIS

Drummond Group just posted the news of the first 3 EHR vendors which have been officially certified EHR for the ARRA EHR stimulus money. Looks like Drummond Group won the race to be the first to certify an EHR.

The interesting thing for me is the list of 3 EHR vendors that became the first certified EHR:
PARADIGM (QRS Inc.)
ifa EMR (ifa united i-tech Inc.)
ChartLogic EMR (ChartLogic, Inc.)

I consider myself pretty well informed about EMR vendors, but I only realy knew 1 of the 3 and I’d maybe heard of one other, but just by name. As all the ONC-ATCB certified vendors start completing their EHR certification, I think we’re going to learn about a WHOLE lot of EMR vendors that very few people knew about previously.

I also find it interesting that all 3 EHR vendors have already updated their website in some way to represent the new ONC-ATCB EHR certification.

Note: We need a new way to identify the certified EHR. ONC-ATCB just doesn’t have the right ring to it. I might work on this problem.

I’ve written previously about the cost of EHR certification with Drummond Group and CCHIT. However, this just addresses the hard cost of certification that’s paid to the certifying bodies. This cost doesn’t take into account a lot of other costs associated with becoming a certified EHR like the cost to develop and test the features that certification requires.

Keith Boone on his blog Healthcare Standards has done a great blog post that evaluates the other costs associated with certifying an EHR software beyond the fee you pay to the certifying body. If you’re an EMR vendor, this is an article that you definitely want to look at and consider. Plus, I’d love your feedback on things he missed or where he might have missed costs or estimated to high on costs.

Here’s Keith’s projections for EHR certification costs based on his estimates:
Average yearly developer salary: $80,000
Fully Burdened yearly cost: 200,000 – 240,000
Times the length of the project (~5.5 years)
Total certification labor cost: $1.1M – $1.32M

Of course, this number matches the estimates that came out with the HITECH act as well. ONC estimated between $500k-$1.5 million. So, this is pretty close.

I’ll leave the impact (good or bad) of this expense open for discussion. I think most people know where I stand on it.

I can’t remember when or where I saw it, but at some point I saw someone reference Jim Tate from EMR Advocate as the expert on EHR certification. I’d known Jim electronically for quite a while having followed his writings online and on Twitter. I even haphazardly bumped into Jim where we both looked at it each other and recognized our pictures from Twitter.

After Jim stopped by to comment on my previous EHR certification post, I emailed Jim to ask him if he wanted to do a guest blog post for EMR and HIPAA. He is busy with 3 stage 1 EHR certifications this week, but did send the following info which I found interesting and useful. I’m also looking forward to taking a look at his manual on meaningful use. I hear it’s highly targeted at doctors and clinical practices which fits in line with my style too.

The HHS/ONC Authorized Certification Program has really broken loose. We were in the eye of the storm, but the eye has passed and the windows are being blown out. Vendors are desperately trying to get a testing date in October and not Novemenber or later. The ability to get Stage 1 Certified and listed on the ONC website is now a giant business issue. A two month’s delay in being able to market and sell certified technology is a handicap. We will see the effect that decisions made over the past year by vendors will play out in the market. Those that applied for the CCHIT Preliminary IFR Stage 1 test are sitting pretty as their can choose test dates based on their application date. Those vendors that elected to wait may pay a price in delayed certifications. Of coursethere are presently 2 organizations authorized to test and certify and I expect maybe 2 more in coming weeks. That may help the crunch. The Drummond Group is charging $23,500 for all Stage 1 testing for EPs and has begun accepting applications for testing. Information about their program is available at: http://www.drummondgroup.com/pdfs/EHR_Testing_and_Certification_Guide_Rev_A.pdf (PDF). A number of my vendor clients have applied and have been given test dates in mid to late November. CCHIT will hold a Town Call next Monday at 1 PM ET: http://www.cchit.org/about/towncalls/CCHIT-Town-Call-Authorized-HHS-certification-program. The fees for their Stage 1 testing will be announced at that time and applications will begin to be accepted that date. Vendors who had already applied for CCHIT’s Preliminary Stage 1 Testing will begin testing against the CMS Final Rule next week. By the end of this month we will Certified Technology listed on the ONC website.

Due to the complexities of the CMS EHR Incentive Program for EPs I have written a manual, The Incentive Roadmap, to help guide medical practices through the process. It is being updated continually to reflect the changes in the incentive program. It is being sold at HITECHAnswers.

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.