This is the second in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Muir can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our http://www.emrandehr.com/contact-us/“>Contact Us page.

Dr. Peter Muir of Springfield Center for Family Medicine was interviewed recently concerning his acquisition of the maximum Medicare Incentive for showing Meaningful Use of a Certified EHR. The Ohio based primary care practice has been using NextGen Ambulatory since 2003 and NextGen Management since 2006.

Dr. Muir stated that their practice chose NextGen EHR because the company focused on clinical offices. Dr. Muir and NextGen EHR share the philosophy of always searching for ways to improve the product. Dr. Muir not only believes in this philosophy but also attended a development think tank along these lines at NextGen’s headquarters. He was also drawn to NextGen because he wanted the capability of customizing his templates.

Having demographics, scheduling, clinical and billing information all on one database has had a huge impact on Muir’s practice. He feels that having a centralized database “makes reporting much easier and more comprehensive than those EHRs with separate databases or separate vendors”. The doctor admitted the conversion from paper charts to EHR was stressful for the first year but well worth it in the long run.

Since Muir’s office has been using EHRs (since 2003), there have been relatively few changes needed for Meaningful Use and any required upgrades to the system came as part of the standard NextGen maintenance fees. There was data that had to be added which was not normally collected by his practice as it had little relevance to his patients but from the patients’ perspective, there was no change in the attention patients received from Springfield Center.

The family practitioner Muir credits the CMS web site and NextGen Healthcare for not only the upgrades to their EHR software but also for their pathway documents and webinars which helped them show meaningful use. He also credits GBS of Youngstown, Ohio (his NextGen vendor for hardware, software) who also helped them implement security upgrades in 2010 in anticipation of the process.

Additionally, being a part of the ONC Meaningful Use Vanguard Program was a benefit to Dr. Muir because “it provides recognition which may allow a greater input in system design and operation.” Muir is concerned, though, that the Program’s flow of information may be difficult if multiple database silos remain in service and a lack of standardization isn’t addressed.

Especially with respect to Meaningful Use Stages 2 and 3, the doctor believes it is critical to have professional health providers utilizing some form of regional system – versus individual systems – in order to have a seamless flow of information. Muir has begun such a system within his own state of Ohio.

The doctor was intricately involved in starting CCHIE (Collaborating Communities Health Information Exchange) in Springfield, Ohio. CCHIE chose HealthBridge as their data engine and together they have partnered with other healthcare providers to provide electronic access to patients’ lab and radiology results as well as to admissions, discharges and transfer information. They have added regions in Southern Indiana and two regions in Northern Kentucky.

Dr. Muir’s advice to fellow doctors is that unless they are planning to retire within the next couple of years they should not delay in the implementation of an EHR. The longer they wait, the more difficult and time consuming the transition will be because, with time, the activities of daily practice will be much broader and more demanding. Additionally, he suggests providers select a system that does not just meet Meaningful Use requirements. His advice is to “select a system that assists you in providing better medical care”.

Read the full transcript of Dr. Muir’s interview.

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.

Casey Quinlan wrote a really fantastic article about why “What’s the ROI?” is only half the question in healthcare IT. She quickly identifies the real challenge with putting an ROI on an EMR implementation by acknowledging that an ROI discussion quickly leads to a financial discussion. Indeed! The financial side is only have of the EMR ROI question.

I’ve written about the EMR ROI up down backwards and forwards. You have the camp that wants EMR software saying that it provides a great ROI and you have the camp that doesn’t want EMR saying that it doesn’t. The correct answer is that they’re both right. Your EMR ROI is often what you make of it. Not to mention that what you make of it starts with your EMR selection.

In any ROI discussion, I quickly point people to this list of EMR benefits. In EMR presentations, I like to divide that list of benefits into “Guaranteed Benefits,” “Possible Benefits,” and “Debatable Benefits.” In fact, I should probably do the same on that page when I have some free time.

However, Casey, in the article linked above asks a very important additional question, “What will it cost to do nothing?” Then she suggests, “The answer to that question shows the way forward.”

I got the following email from a reader of EMR and HIPAA which really hit me when it comes to providing the right resources for medical practices that are researching and implementing an EMR system in their practice.

I remember achieving a feeling of solace after discovering your site.

When initially researching and realizing how much misleading information is out there, it’s very overwhelming and leaves the researcher of a very important IT addition to a medical practice feeling very alone.
Your transparent and no bones about it approach (whether positive or negative) is appreciated by many.

Don’t ever change.

While I definitely appreciate and am flattered by this reader’s nice comments, I was struck even more by their description of the challenge a medical practice has in finding quality, transparent, and unbiased information in what someone in my recent survey called a “sea of bias.” The “feeling very alone” is something that I’m sure most wouldn’t admit but many have likely felt. I know I’ve certainly felt it.

All of this has me pondering more ways that I can get better information into the right hands. My e-Book on EMR selection was a good start. More “cliff notes” like versions of my websites would probably be good for doctors since they likely don’t want to read all 1000+ posts on EMR and HIPAA and 500+ posts on EMR and EHR.

I also think that Meaningful Use Monday is a good series to help providers that are evaluating meaningful use and the EHR incentive money. I just feel like there’s probably more that I could and should be doing to connect doctors with good information.

In fact, writing this post reminds me of something someone I respect told me at HIMSS, “John, you have a platform now and you better use it for good. And I’m going to hold you to it.”

To be honest, I wasn’t exactly sure how to take the comment. I guess now that I’ve had some time to digest it, I find it an awesome responsibility even though I still just consider myself a regular old blogger. I do find the concept that this is a platform that can be used for good very inspiring. Hopefully, I and now the other Healthcare Scene bloggers can live up to this high standard.

With that in mind, I’m always open to hear new ideas on how a regular old blogger like me can have an even greater impact for good in healthcare IT. Let me know in the comments or on the EMR and HIPAA contact us page any ideas, pain points or other thoughts on helping doctors.

The always opinionated Anthony Guerra has an article up on Information Week that describes why he thinks the Meaningful Use sky is falling. Add that to a recent comment I got on a previous post that links to a Healthcare Data Management article talking about the potential repeal of the HITECH act and it seems worthwhile to assess the state of meaningful use.

I’ll start with the potential repeal of meaningful use first. We’ve known for a long time that the house was going to be going after healthcare reform once the republicans took over control of the house. In fact, we posted about the potential impacts to HITECH from the new Congress before.

I personally get the feeling that not much has changed on this front. I’m going to reach out to some of the government liasons for EHR vendors that I know that follow this even closer than I do. However, I still believe that:
1. The HITECH funding or at least the Medicare and Medicaid stimulus funding is safe from Congress. I’ve read this a couple of places and so I believe it to be true.
2. Any legislation that is passed by the house still has to pass through the democratic controlled Congress and avoid the Presidential veto. These two seem unlikely.

Of course, when it’s government work you could always be surprised by some loophole in the process that impacts funding or legislation. I won’t be surprised if one of these loop holes appears and affects the HITECH act. However, I still argue that if something does happen to HITECH, it will likely be a casualty of some other political agenda (ie. cutting whatever costs they can find) and not actually because they were specifically targeting HITECH.

Long story short: I still feel like the EHR incentive portion of HITECH is likely safe. Maybe some of the other funding will be cut short. We’ll see.

Now to the points that Anthony Guerra makes in his article. He describes the challenges that many hospitals are facing in regards to meaningful use. Plus he highlights the potential difference in the number of people who “think they qualify for the money” and those who “plan to apply.”

I might argue that if EHR adoption is the goal, then this might not be such a bad result. The idea of “forcing” meaningful use on people has always bothered me a little bit. Encouraging people to show meaningful use is only as good as the meaningful use criteria. If the meaningful use criteria is not very good, then do we really want everyone showing meaningful use?

For example, imagine that a doctor or hospital decides to use an EHR based on the EHR software’s ability to improve the efficiency of their office and the quality of the services they provide to the patient, but deems meaningful use as contrary to those goals. This seems like a great outcome to me. In fact, it seems like a better outcome than a doctor trying to force themselves into the meaningful use hole.

Obviously there are parts of meaningful use that can be very beneficial. For example, having an EMR that can communicate using a standard format (CCD for example) is important and valuable. If it is beneficial, then I see most doctors implementing these features regardless of whether they showed meaningful use or not.

One thing definitely seems clear from all the surveys and other stats I have: interest in EMR has never been higher. Whether that translates to “meaningful use” of a “certified EHR” or physicians meaningfully using an EHR of their choice, is fine with me.

You know my mantra: Select and implement an EMR based on the benefits that you and your clinic want to receive from the EMR. Don’t select and implement it based on a government handout. Those hand outs will be gone after a few years, but your EMR will be with you long after.

The following is an interesting comment that’s kind of an extension to my previous post about a visit to an EMR using Doctor’s office. I think many of you will enjoy it.

Can you imagine this in a manufacturing environment? If GM, Ford, etc were legislated (incented?) to implement automation and safety changes that caused them to cut production in half…and cause the workers to be a bit distracted from what they were doing on the other 50% (then maybe tax them higher if they don’t put the changes in place within 3 years)….how healthy would that be for GM? And for the cost and quality of the cars being built?

Of course, not all EMR software causes you to cut production in half. EMR also doesn’t have to mean you’re distracted the other 50% of the time. Take a look at this post by Dr. Koriwchak that talks about some of the principles he used in his EMR implementation. My favorite comment he made was that he “rejected the notion that we would have to decrease patient volume and lose revenue, even temporarily, to get EMR implemented.”

So, if you see the HITECH act / EMR Stimulus money incentivizing what’s described above, then maybe….just maybe…you’re looking at the wrong EMR software.

I have often found doctors talking about the 2014 mandate for adoption of EHR software. In fact, this post was inspired by a bunch of people searching online for the term “2014 EHR Mandate.” I think that they found my site because I previously did this post about Obama’s goal of Full EHR adoption by 2014.

If I’m remembering right, this was actually just an extension of Bush’s goal of having 100% EHR adoption by 2014. Obama took Bush’s original EMR aspiration and kept it going.

Although, I do have a real problem with people who like to call it an EHR mandate. It’s really not a mandate. A mandate for me implies that you are required to do it or there’s some grave consequence to it. It’s not like you’re going to be thrown in jail for not using an EHR or not be able to practice medicine if you don’t use an EHR (although some have hinted at this idea). Certainly the HITECH act has provided some Medicare penalties that could be considered a grave consequence to not adopting an EHR. Although, when you consider this example of the Medicare penalties it doesn’t look all that grave of a concern to me.

What other penalties are there to not adopting an EHR by 2014?

There certainly are other potential issues with not adopting an EHR that are worth considering:
1. Ability to Sale Practice – I don’t think we know all the details of how this will play out, but be sure that many younger doctors are going to want to purchase a practice that has an EHR. The common thinking I’ve seen going around is that a practice will be more valuable if it is electronic.

2. Government Mandated Reporting – While the government can’t really mandate the use of an EHR, it seems reasonable that the government could require certain reporting be done. Of course, you could manually do this reporting, but at some point the manual way will be much harder than using an EMR where the reporting can be automated.

3. Reimbursement Requirements – At some point the insurance companies are going to require their data electronically. So, if you’re going to want to keep accepting insurance, then you’re going to need to be electronic. I think the insurance companies are still watching and waiting to see what happens with meaningful use before they decide how they’ll approach it. However, you can be sure that they want more data and electronic is the way to make that happen. Of course, you could always go back to cash pay if you don’t like it.

4. Patients – It hasn’t happened quite yet, but get ready for a new patient base that wants their doctor to be electronic. No, you won’t have a “Got EMR?” sign outside your office to market to patients like we once talked about on EMRUpdate. It will come in more subtle things like the ability to schedule an appointment online. The ability to request refill requests electronically. Not having to carry (and possibly lose) their prescription to the pharmacy and then wait for it to be filled. Not having to fill out the same paperwork over and over and over again. Once patients get a real taste for these features, they’re going to be more selective in the doctors they choose to use.

5. ROI for Your Practice – There are plenty of arguments for and against the use of an EMR from an ROI perspective. I personally side on the positive ROI side based on this list of potential EMR benefits. Certainly it takes a smart EMR selection process and a well done EMR implementation to achieve the ROI, but I know a lot of people who’ve saved a lot of money thanks to their EMR. Add in things to come like doctor liability insurance discounts and the ROI will get even better over time. I know one practice who was having tough times financially. Their implementation of an EHR helped to solve some of those financial issues.

I’m sure there are plenty of other reasons that could “force” you to move to using an EMR. Of course, this CDC study on EHR adoption says Physician EMR use is at 50%. Although, in that link I use their study to show that it’s probably closer to 25% EHR adoption. Either way, we still have a long way to go to achieve Obama’s dream of 100% EHR adoption by 2014.

Yesterday I was attending a conference that had almost nothing to do with EMR. However, in one of my conversations a young girl told me that her dad was a doctor. She went on to tell me how it is all that her dad can talk about her.  He was trying to convince himself why he should ignore the stimulus money and not do EMR.

Of course, this part isn’t that interesting since I think we all know many doctors who are doing something similar. What was very interesting was that the daughter of this doctor explained how she was trying to convince her dad why he should do EMR. In fact, she suggested that she might have read my EMR site before because she’d done searches to learn more about EMR so that she could convince her doctor father to use an EMR.

This discussion of why you should or shouldn’t use an EMR is really nothing new. My challenge with the discussion is that I’ve seen first hand the benefits of EMR. However, I’ve also heard many stories of EMR implementations which utterly failed.

I don’t know all the answers to this situation, but it is something I want to think about more.

I do think that selecting the right EMR is the first step in the process. The other challenge is finding the right person or people to support your implementation.   Now, how do we simplify and improve those two objectives?

A reader of EMR and HIPAA asked the following interesting question:

I was wondering if you had or heard of anyone coming up with a way to measure if the EHR implementation was successful. Other than “its in!”. Im trying to help some clients define this but cant seem to find anyone who has done this. Im thinking something like:
Were all staff trained prior to go live?
Were project goals achieved? etc

Here’s my response that I hope you’ll find useful as well:
It’s an interesting question. I’d suggest you download my free EMR Selection e-Book.

In the book, I cover the various areas where a practice can get benefit from implementing an EMR. I suggest that each practice evaluate which of the benefits they are looking to achieve with their EMR implementation. Then, it works out nicely that it’s the criteria you can use for selecting an EMR and also for measuring how successful the EMR implementation has been.

That’s how I’d approach measuring the success or failure of an EMR implementation. Of course, you could also add in any unforeseen events (good and bad) that happened during the EMR implementation too.

The real key is to establish a set of goals or expectations for what you want to get out of the EMR implementation so you have a way to evaluate the EMR software and the EMR implementation. Then, it’s good to actually look at this criteria after the implementation to see if you fell short of those goals and what you could do to actually achieve them.

Implementing an EMR is a living, breathing thing. The best EMR implementations are evolving and improving as you continue to roll out more features of an EMR or better utilize the existing features. Not to mention all the new features that an EMR vendor will roll out as they upgrade their software.

I figured it was about time for me to do a post updating one of my top posts from 2009. This was a post I posted on February 19, 2009. It was REALLY early on in our understanding of the HITECH act and EMR stimulus incentive program. In the post, I predicted the Big Winners of the Obama EHR stimulus program. Let’s take a look at this list, see if anything’s changed and look at new additions to the list.

First, I loved the premise of my original post that with the government spending $36 billion (in the previous post the estimate was $20 billion) there have to be some people who dramatically benefit from the spending.

Here’s a look at my original list of Big Winners and my thoughts today:

• EHR Vendors – In the short term I think that EHR vendors have taken a real hit. While we waited for the government to define meaningful use and certified EHR there was a dramatic slow down in EHR adoption. Now that we’re coming out of that funk I can see a lot of excitement and energy out of the EHR vendors. I predict this HIMSS is going to be absolutely electric. It’s easy to note that interest in EHR software has increased thanks to the stimulus money. This interest is going to spill over to every EHR vendor out there. Some will do better than others, but all will start seeing some sales now. Long term, those that provide the best service to these initial adopters (or cash out first) will be the long term big winners.
• Health Care IT Consultants (ohhh…maybe I should become one) – First, I’m not likely to become a consultant any more than I am now. This blogging gig is far too good. Although, I’ll keep that in my back pocket. Me aside, the good healthcare IT consultants I know have a lot of work. Some have changed their names to meaningful use consultants or EHR certification consultants, but overall they’re doing well. A bunch are also working at RECs which doesn’t seem like a bad gig at all (as long as they meet their targets).
• Existing EHR Users – I still see them winning. The doctors I know with an EHR are loving the idea of the EHR stimulus. First, it doesn’t matter too much to them if they get it or not. Second, they see it as something that likely won’t take that much effort beyond what they’re doing now. We’ll see if they change their minds once they get into the nitty gritty details of meaningful use. They might find changes for meaningful use harder than they think.
• CCHIT (if they get chosen) – Well, CCHIT wasn’t chosen. Although, CCHIT made a really smart move to do the Preliminary ARRA certification as a way to basically lock in most of the top EMR vendors to their EHR certification. I guess I don’t see CCHIT as the big winner, but still a winner. EHR certification is still a requirement and will be for a while to come, so they still are in business. They just finally have some competition.
• Hospital Systems – There’s just far too much money available for them to ignore the EMR stimulus. Not to mention the penalties are meaningful at the scale they have. I guess I can see this going both ways. Those hospital systems with great leaders and effective organizations are going to do very well. Those with less effective leaders and poorly run organizations are going to have issues.
• Health and Human Services (HHS) – Maybe I should have said ONC or the healthcare IT portion of HHS. It’s an exciting time for healthcare and I think Blumenthal has worked hard to do things right. It is government work, but I applaud what seems to be some real sincere effort.
• Obama’s HIT Donors – I’ll leave this one alone.

Now for a quick look at the other winners that I might not have considered almost 2 years ago:

• IT Companies – I’m not sure why I didn’t consider this, but I’m amazed at how many IT companies out there are helping with EMR implementations and their businesses are benefiting from the EMR stimulus.
• HIE – It’s a bit early to tell exactly how this is all going to play out, but the EMR stimulus and meaningful use requirements have extended the life of a bunch of HIE companies. Not to mention many have been acquired because of all the activity. It’s a good time to be an HIE company.
• Trade Organizations – I think many organizations have seen all this buzz around EMR as a great opportunity for them to expand their services. It’s amazing how many different trade organizations have gotten their hands into the EMR world.
• EMR Bloggers – Let’s just say, the EMR stimulus money has worked for my family. I’m thankful for that!

I’m sure there are probably others I’m forgetting. I tried to convince myself that doctors and patients should make this list, but couldn’t find a way to do it. Certainly some doctors and patients are going to receive the benefits, but I fear that many practices are going to select the “Jabba the Hutt EMR software” that is large, powerful and difficult to use and regret it. I hope I’m proven wrong.