Today I had an interesting conversation with MEDENT. It’s an EHR company that’s in only 8 states. I could actually write a whole post on just their approach to EMR software and the EMR market in general. They take a pretty unique approach to the market. They’ve exercised some restraint in their approach that I haven’t seen from many other EHR vendors. I’ll be interested to see how that plays out for them.

Their market approach aside, I was really intrigued by their approach to dealing with ICD-10. They actually described their approach to ICD-10 similar to how Google handled search. There’s all this information out there (or you could say all these new codes) and so they wanted to build a simple interface that would be able to easily and naturally filter the information (or codes in this case). A unique way of looking at the challenge of so many new ICD-10 codes.

However, that was just the base use case, but didn’t include what I consider applying AI (Artificial Intelligence) to really improve a user interface. The simple example they gave had to do with collecting data from their users about which things they typed and which codes they actually selected. This real time feedback is then added to the algorithm to improve how quickly you can get to the code you’re actually trying to find.

One interesting thing about incorporating this feedback from actual user experiences is that you could even create a customized personal experience in the EMR. In fact, that’s basically what Google has done with search with their search personalization (ie. when you’re logged in it knows your search history and details so it can personalize the search results for you). Although, when you start personalizing, you still have to make sure that the out of box experience is good. Plus, in healthcare you could do some great personalization around specialties as well that could be really beneficial.

I’d heard something similar from NextGen at the user group meeting applied to coding. The idea of tracking user behavior and incorporating those behaviors into the intelligence of the EMR is a fascinating subject to me. I just wonder how many other places in an EMR these same principles can apply.

I see these types of movements as part of the larger move to “Smart EMR Software.”

One of the really interesting things I noted while attending the NextGen user group meeting had to do with the move to SaaS based EHR and other SaaS based EHR software. I partially mentioned this in the write up I did at the conference, including a tweet where I talk about how Scott Decker really pushed the idea of NextGen making the move into the SaaS based software world.

I think there’s little doubt that NextGen sees the value of SaaS based software. I think they see the convenience to doctors of not having to manage a server. Most importantly, I think they see the value of not having the healthcare data stored in EHR in silos.

One thing that Scott Decker mentioned in his keynote was improving their coding rules engine based on the feedback and experience across all of their SaaS based EHR users. I found this really intriguing since it highlighted some of the challenges and limitations of the client server EHR model that’s so prevalent in healthcare.

After hearing these comments about NextGen’s move towards more and more SaaS based software, I wondered what users at the meeting thought about the move by NextGen to SaaS EHR. The nice part of a user group meeting is I had a chance to talk to a number of them.

One company I talked to said basically, “We have 30 Citrix servers in our NextGen EHR installation. That’s a huge investment we’ve made and I don’t see us changing that any time soon.” They’ve got an interesting point. There’s a lot of money invested in training, equipment, software, and general understanding of the current client server EHR installs that NextGen employs (or is it employed?) for its large EHR customers.

It’s quite a stark contrast to consider this entrenched client server user base that is unlikely to change even if NextGen’s direction is headed towards SaaS EHR software. To be completely honest, I’m not exactly sure how this “conflict” is going to play out.

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.

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.

I’m excited to welcome a new advertiser to the EMR and HIPAA family and suggest some options for advertising on EMR and HIPAA. As you can imagine with the increase in interest in EMR, more and more people have been reading this website which is extremely gratifying to me. Not only are the conversations in the comments enhanced, but it’s nice to be able to share my viewpoints and experience with more people.

So, I’d like to welcome our latest advertiser:
NextGen EMR – They are a quite large EMR vendor and a major player in the EMR world. I’m glad to have them on board. They are doing a EHR and Practice Management live demonstration on 10/20. Check here for more details.

One of my other advertisers also asked me to put together a list of possible advertising opportunities that I had available for them in the coming year. I thought that others might be interested in some of the ideas I sent them:
-Advertising on EMR and HIPAA – Check out all the details of advertising on EMR and HIPAA.
-Advertising on EMR and EHR – This is a relatively new site I’ve started which currently tries to highlight some of the various EMR and EHR related news items along with covering things that I don’t have time to cover on EMR and HIPAA. The ads work the same on this site as EMR and HIPAA, but at a much reduced rate.
-Advertising on my EMR and Healthcare IT focused twitter account – This Twitter account has 2400+ followers and will likely have about 3000 followers by the end of the year and is a highly focused group of people interested in EMR and healthcare IT. This advertising could be in the form of the background of my twitter profile page or through a number of tweets advertising your company over a certain period. I would plan on disclosing that it was an ad using something like a “#sponsor” tag (or something similar).
-HIMSS Conference Coverage Sponsorship – I’m planning to attend this year’s HIMSS annual conference and blog extensively about it. This will likely include video interviews of those I meet at the conference. The idea would be to have a few companies sponsor all of my posts from that conference. So, at the end of each post I would write, this post brought to you by “insert company name”. Something to that effect.
-Advertising on the EMR, EHR and HIPAA wiki – This is a rather new website that’s just starting to grow, but has provided some pretty good click throughs for EMR and HIPAA.
-EMR Related Book Sponsorship – This is still in the process of being created, but my plan is to create a number of e-Books and likely all together a physical book related to EMR selection and implementation. I’d consider having a section for sponsors of the book.
-EMR Conference – This is still in development as well, but I’m considering the possibilities of hosting an EMR conference in Las Vegas and sponsors would help keep the costs low.

I’d love to hear feedback on these various options. Let me know if you have any other questions or need more information on our Contact Us page.

Selection of EHR software has definitely slowed. I predicted EHR adoption would slow back in February and I’ve definitely seen the selection process slowing. One of the main reasons people are waiting to adopt is they want to know what’s going to be defined as a “certified EHR” and “meaningful use.”

In order to combat this slow down in EHR purchases, we knew it was only a matter of time until EHR vendors started promising to support whatever is required to become a “certified EHR.” The first one I found with an EHR guarantee was NextGen. Here’s a summary of their commitment:

• A solution that will always evolve to meet the standards and certifications for federal stimulus reimbursement programs of interest to physicians using NextGen Healthcare products.
• A solution that uses open standards and enables generally seamless communication across the healthcare community.
• A fully-functional solution, and swift and professional implementation.
• Top quality training and support.

This is a really smart business move. They’ve got to do something to keep making sales. However, I’m a little concerned by anyone who selects an EHR based on this commitment. I must admit that I don’t see any reason why NextGen won’t do everything in its power to become a certified EHR. It would be detrimental to their sales staff if they don’t. However, don’t be surprised if a lot of doctors don’t get swallowed up in the wake of misunderstanding.

To illustrate what I mean, take a look through the above commitments and tell me one of them that can be easily defined and measured. Whenever there’s ambiguity involved, the lawyers in the room start to salivate. However, how many doctors offices are really going to spend the time and money involved in enforcing this guarantee? Very few if any. They’ll spend as much on lawyers as they will on recovered damages.

Sadly, the above seems like a better mission or vision for an EHR company than it sounds as a guarantee. If any EHR company really meant this stuff, they wouldn’t need to make a guarantee. All people would need to do is talk to previous customers and the writing would be all over the wall.

Moral of the Story: Select an EHR because it’s the right software for you as a clinic. Don’t base EHR selection on EHR stimulus money or some guarantee.

I recently posted about CCHIT joining Twitter. Seems like a decent number of EMR and HIPAA readers are also on Twitter, because I’ve been getting a pretty good number of new followers in the HIT and EMR field.

As my 1423 followers and 2302 updates prove, I like Twitter a lot and really enjoy the way it can help people to connect (I’m techguy if you want to follow me). It’s really quite amazing how 140 characters could turn out to be so valuable and to a wide variety of markets too.

What was really interesting is I recently saw 2 EMR companies join the Twitter revolution: eMDs and NextGen. I think that it’s really smart for an EMR company to join the conversation. At least if it’s done right. So far they only have 8 tweets and 41 tweets respectively. It will be interesting to see how these 2 EMR vendors use twitter over time.

I tweeted one of these companies the following tweet, “How do you plan on using Twitter? Do you have a plan or are you just testing the waters?”

Their response was, “We’re just getting started, but hope to expand communication w/ customers & others in the industry & connect w/ the EHR community”

One thing is certain, we’re just seeing the beginning of what’s possible with Twitter. It’s going to be really fun to see what creative people are able to do with twitter and healthcare.

If you know of other EHR vendors or other important HIT people on twitter, please let me know in the comments.

As most people know, I’m always open to guest posts from everyone and anyone that can provide a thoughtful perspective on a subject.  In the following guest post, Charlie Jarvis, AVP at NextGen, shares some of his thoughts on the HITECH act’s impacts.  I don’t necessarily agree with everything in this guest post, but I do believe that Charlie’s description of the “ambivalent” EMR buyer seems to be pretty accurate.  This will be a major challenge we need to overcome.  I’m hoping to follow up this post with an interview of Charlie.

Thanks Charlie!

As the national debate over the economic recovery plan and specifically the entire stimulus package continues, the HITECH sections of the American Recovery and Reinvestment Act (ARRA) may be “relatively” less controversial to the American public than other sections of this law But HITECH may wind up being just as important as other more visible pieces of this law-and central to the discussion around health care reform. HITECH will drive EMR adoption as we all know. But what does this really mean, beyond the sheer massive amounts of money being thrown at this effort?

I contend that HITECH is going to “stimulate” the following actions in our health care sector, beyond the obvious ones of job creation and expanded health care automation:

• the evolution of coordinated care (among independent doctors), around the individual patient- a concept known as patient –centered care
• a focus on true quality of care outcomes, and the necessary paradigm shift in physician behavior to a focus on the health care outcomes of patients rather than simply the results of individual treatments or procedures
• the necessity of independent small (1-5) physician practices to either consider joining with their hospital, creating larger independent groups, or affiliating with an IPA or other such organization that can support their technology needs going forward; their ability to remain independent will suffer dramatically (an after many economic activities in the past have failed to unite doctors, this one appears to be able to have that effect)

All of these actions are going to challenge the medical practitioner to adopt a new view of their practice and indeed of medicine in general. And all of us who support physicians are likewise challenged with the responsibility to support physicians through this potentially overwhelming process. Our job is to focus not on independent opportunity for success in this new model but rather to understand and accept our role in helping reform care achieve its intended goal- the improved health care service to the patient, at a price they or their insurance carrier can afford.

While there is a great deal of excitement among many with the availability of incredible amounts of money to support HIT adoption, we must remember that a large portion of the medical community is viewing this “technology explosion” as something being forced upon them rather than an action that they enthusiastically embrace. And in an environment where the right EHR product is not always obvious (the government’s definition of certified HIT products and issuance of a certified HIT product list is not ready yet although everything points to CCHIT remaining their certifying body), we have a potentially disenchanted and ambivalent “buyer”.

And this purchasing “ambivalence” does not even begin to address the concern most doctors have over the fact that how they will be judged as caregivers in the future, will be largely dependent on reports of data which they will be required to capture and report. (And finally, if that is not enough, their ability to automate successfully will be published on the government’s health website for all the population to see.)

This may be an exciting and tremendously opportunistic time for America to reform its health care system- but the automation plan is going to have it’s challenges. We had better be up to it as a team!!

Charlie Jarvis
Assistant Vice President Health Services and Government Relations
NextGen Healthcare Information Systems, Inc.

I’m always happy to have people smarter than me do a guest post on EMR and HIPAA.  There’s far too much going on with Health Care IT for me to be able to cover everything that’s going on.  So, I’d like to thank Randy Pickard for sending in the following guest post about the HITECH stimulus act.

There is almost a Kafkaesque quality to the likely short term impact of the stimulus package upon adoption of Electronic Health Records (EHR) systems. The passage of the stimulus package will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act).  

A quick glance at the income statements of four publicly traded vendors that receive a significant portion of their revenues from EHR systems provides an indication of steady revenue growth from EHR sales. Income has been increasing by 10% or more per year for these four vendors, Allscripts, Cerner Corp., Eclipse, and NextGen.  (Although the increases in income is not simply due to EHR related sales. Acquisitions of other vendors and sales of other software products has also contributed to the revenue totals).

It seems likely that the revenue for these firms from new EHR sales will be greatly reduced in the near term, as purchasers sit on their hands waiting for answers to questions about how they can obtain reimbursement for their EHR spending. The HITECH Act designated that reimbursement would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet by the Secretary of HHS, who has not been appointed yet. Further, the bill indicates that reimbursement will go to establishments that show “meaningful use” of health IT, an undefined description that will likely deter healthcare organizations from rushing to purchase an EHR system. Given that the details of the plan to stimulate the adoption of EHR’s are far from being flushed out, is it any wonder that the Congressional Budget Office has estimated that a mere 2.3 percent of the health IT funds would be distributed in fiscal years 2009 and 2010?

About the Author – Randy Pickard is Vice President of Product Innovation for User Centric, Inc. a user experience research firm. User Centric recently released EHR and PHR white papers: How to Select an Electronic Health Record System that Healthcare Professionals Can Use and Google Health vs. Microsoft HealthVault: Consumers Compare Online Personal Health Record (PHR) Applications

Thanks Randy! If you’re interested in doing a guest post, feel free to Contact EMR and HIPAA.