Editor’s Note: The following is an update to a previous EMR and HIPAA blog post titled “EMR Companies Holding Practice Data for “Ransom”.” In this update, James Summerlin (aka “JamesNT”) offers an update on EHR vendors willingness to let providers access their EHR data.
Over the years I have been approached with questions by several solo docs and medical groups about things such as the following:
- Migrating to a different PM or EMR system.
- Merging PM’s or EMR’s such as when a practice buys out another practice.
- Interfacing the EMR and PM.
- Custom reports.
- More custom reports.
- LOTS MORE CUSTOM REPORTS!!!
And there have been plenty of times I’ve had to give answers to those questions that were not favorable. In many cases, it was with some online EMR or PM and the fact that I could not get to the database and the vendor refused to export a copy to me or the vendor wanted thousands of dollars for the export. With the on-premises PM and EMR systems, getting to the data was a matter of working my way around whatever database was being used and figuring out what table had what data. Although working with an on-premises PM or EMR may sound easier, it too often isn’t. The on-premises guys have some tricks up their sleeves to keep you away from your data such as password protecting the database and, in some cases, flat out threatening legal action.
A few years back, I wrote a post on a forum about my thoughts on how once you entered your data into a PM or EMR, you may never get it back. You can see John Lynn’s blog post on that here.
My being critical of EMR and PM software vendors is nothing new. I’ve written several posts on forums and blogs, even articles in BC Advantage Magazine, about how hard it can be to deal with various EMR and PM systems. Much of the, at times, downright contemptuous attitudes many PM and EMR vendors have towards their own clients can be very harmful. Let’s consider three aspects:
- Customization. Most of the PM/EMR vendors out there would love to charge mega-bucks to write custom reports and so forth for clients. However, this isn’t all it’s cracked up to be. First, most clients simply aren’t going to pay the kind of money many PM or EMR companies want to charge. Second, custom reports have to be maintained. Eventually, you have all these clients running around needing changes to their reports and the PM or EMR vendor simply can’t get to them all in a timely manner without hiring lots of technical (read: EXPENSIVE) staff which turns what was once a money-making ordeal into a money losing one. And, of course, the client’s suffer since they can’t fine-tune their practice to the degree needed in today’s challenging economy.
- Interfacing. What happens if a client wants to interface encounters and demographics from their EMR to their PM system and then interface dollar amounts and so forth from the PM system with receivables and expenditures in Quickbooks or other financial software into a series of reports that give a total view of how the practice is doing? We are talking about the ability to, day-by-day, forecast incoming receivables from carriers and patient payments (within certain limits, of course), with expected expenditures (payroll, taxes, etc.) from the accounting software to get a financial outlook for the practice for the next few weeks or even months for long-term planning. A PM or EMR vendor, already dealing with HIPAA or meaningful use, may not want to get involved in that kind of hard-core number crunching, yet the practice is demanding it.
- A second part to interfacing. Getting the EMR and PM vendors to get along. Often what you see is the EMR vendor has a certain way they do an HL7 interface and the PM vendor has a certain way they do an HL7 interface and if they don’t line up properly, you’re just out of luck. Either it works with reduced functionality or it doesn’t work at all and neither vendor will budge to change anything. And that’s assuming they both use HL7!
In situations like those above, the best way to resolution is for the practice to perhaps obtain its own technical talent and build its own tools to extend the capabilities of the data contained within the various databases and repositories it may have such as the databases of the PM and EMR. Unfortunately, as I have reported before, most PM and EMR systems lock up the practice’s data such that it is unobtainable.
At long last; however, there appears to be a light at the end of the tunnel that doesn’t sound like a train. Some of the EMR systems that doctors use are beginning to realize that creating a turtle shell around a client’s data, in the long run, doesn’t do the client nor the PM/EMR vendor any good. One such EMR I’ve been working with for a long time is Amazing Charts. Amazing Charts has found itself in a very unique situation in that many of its clients are actually quite technical themselves or have no problem obtaining the technical talent they need to bend the different systems in their practices to their will. The idea of having three or four databases, each being an island unto itself, is not acceptable to this adventurous lot. They want all this data pooled together so they can make real business decisions.
Amazing Charts; therefore, has decided to be more open regarding data access. Read only access to the Amazing Charts database is soon to be considered a given by the company itself. Write access, of course, is another matter. Clients will have to prove, and rightly so, that they won’t go spelunking through the database making changes that do little more than rack up tech-support calls. Even with the caution placed on write access this is a far jump above and beyond the flat out “NO” any other company will give you for access to their database. I consider this to be a great leap forward for Amazing Charts and, I’m certain, will set them apart from competition that still considers lock-in and a stand-offish attitude the way to treat clients who pay them a lot of money.
Perhaps one day other PM and EMR vendors will see the light and realize the data belongs to the practice, not the vendor, and will stop taking people’s stuff only to rent access to it back to them or withhold it altogether. Until then, Amazing Charts seems to be leading the way.