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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.

EMR Updates in SaaS EMR World

Posted on September 18, 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.

When I was writing my last post about updating your EMR software, I knew that I had to also write a post talking about the update process for an SaaS (often called hosted) EMR solution.

Basically, updating your SaaS EMR is a two edge sword. Hosted EMR vendors will often talk about how great a hosted solution is because you never have to go in and update your server’s software. The updates just happen and are all managed by the EMR vendor itself. Kind of like if you use any of the free email services like Gmail. It’s updated all the time and you don’t have to worry about it. Essentially updates to an SaaS EMR work similar. The updates are applied on the server that’s managed by the EMR vendor and you automatically get the latest updates.

It’s worth noting at this point that this really is a huge time saver. I hate dealing with updates of client server based EMR software. I even push out the updates to my over 100 computers using an automated solution, but I still hate doing it. There’s always some sort of issue with some computer not updating properly. In an SaaS EMR solution you just have to make sure that your web browser’s updating doesn’t screw things up. Otherwise, no need to worry about updating every computer in your clinic when your EMR decides to update.

However, the second edge of the sword is that you EMR software will just automatically update. When all goes well this is great. When there is a problem with the update then you didn’t have a chance to test it first. You don’t get to choose when the updates happen (usually) and that includes delaying an update while you wait for another enhancement to fix what the update breaks. I will say that most SaaS EMR software are much quicker to fix if something really bad does happen with an update. The point is that you’re much more at the mercy of your hosted EMR vendor when an update is done. It’s nice to have it hassle free, but sometimes the hassle is worth it.

Let’s hear your stories. I know you all have them. That includes challenges with updating both in the hosted (SaaS) or client server world. Share it with us in the comments.

EMR Updates

Posted on September 17, 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.

It seems like I’ve covered EMR updates quite a bit before. However, I keep hearing more examples that are very good illustrations of the challenges associated with software updates to an EMR.

Today’s example has to do with a simple change to the template interface on an EMR. This was a small change in relation to the 116 pages of release notes/documentation that was provided with the update. All it did was make the Submit, Cancel and Reset buttons always appear at the bottom of the template. It’s kind of like freeze panes from Excel if you’ve ever used that.

This is a great feature if you’re filling out a long template and half way through you want to submit the template and come back later to finish it. Who would have ever expected that this would become a problem?

Well, turns out that the same template interface is used for doctors who are filling out templates and also for patients who are filling out templates when filling out their paperwork at check in (something we’ve loved doing for the past 4 years). The problem is that now that the Submit, Cancel, and Reset buttons always appear at the bottom, the patients don’t realize that the intake paperwork has more questions. Most of them don’t look at the scroll bar to see that they’ve only filled out a portion of the paperwork. So, the patient submits the paperwork half done. You can imagine how nice that is for a clinic.

I won’t go into how to resolve this issue. There are a ton of different options from educating the end user to requiring certain questions to getting our EMR vendor to change it back to the old way. However, the point of this isn’t how to fix it (maybe a topic for another post).

The point is that a minor change to your EMR software can have some really annoying unintended consequences in places you might not have ever considered.

Many might argue that this is a reason not to implement an EMR. However, that would only be looking at part of the story. I could list a dozen other features that were added during the update which improve how we care for patients.

So, is it painful when an update causes problems? Absolutely. Is this an important reason to have a tight relationship with your EMR vendor? Absolutely. Should you still update your EMR regularly? Absolutely. Is EMR still the future of healthcare? Absolutely.