The latest flu bug that’s been going around has hit me pretty hard. I’ll be back tomorrow (assuming all goes well) with more posts.

Until then, some interesting news items for you to consider:
SOAPware Announces Release of PMS – They’ve been working on this for a while. Plus, it’s interesting to see the pure EMR companies getting a PMS. Check out this interview I did previously with the SOAPware president.

SRS and Ingenix Collaborate to Deliver PMS and EHR – Another case of an EMR partnering with a PMS system. Plus, now SRSsoft can get to meaningful use. As expected, EVERY EMR vendor is likely going to need to be able to say, “Our EMR can show meaningful use.”

I was recently reading a post on EMRUpdate (great EMR Forum) by a man I highly respect who goes by CEOMike. In his long post, he made the following short analysis that I thought was really interesting:

I thought by now you would have figured out EMR vendors are LIARS, making some of the bankers look like choir boys. I have done other posts on the install base claims of vendors. Figure it out 4% (studies show) of approx 400,000 primary care docs is only about 16,000 EMRs in use. Divide that by the approximately 400 EMRs [see my list of over 400 EMR companies] that have been listed in the last three years = 40 users per EMR Or go at the other way – take all claims by EMR vendors and add them up (I did this exercise a few years back) and you get something like over a million doctors using EMRs???

The million EMR installs seems a little high, but the point is well made. How do we really get accurate data about install base? The answer is that you really can’t from most vendors.

When we first implemented our EMR, we were told that they had close to 100 college health centers. Little did they ask (I wasn’t there when they selected this particular EMR) how many of the 100 health centers actually used EMR versus just their practice management system. Let’s just say I was quite surprised by the reality.

That didn’t deter me. In fact, if anything it motivated me to make it happen. Still today I think our clinic is the most cutting edge in our category for use of EMR. I enjoy that feeling and I enjoy when other clinics want to come and take a look at what we’re doing. Yes, I am sure they want to see our EMR and not just have a trip to Las Vegas.

An EMR and HIPAA reader, recently pointed me to a post on a Google Group called “Response to HIMSS ‘Call to Action’: Interoperability First.” The response starts with a short discussion of the need for government to promote and support some sort of interoperability standards. I’ve said a number of times before that interoperability should be a focus of government, because interoperability is more of a public health benefit than it is a benefit to doctors.

After discussing interoperability, the response discusses reasons why CCHIT certification is an inappropriate standard for the HITECH act to use to determine “certified EHR.” Take a look at the reasoning:

As it currently exists, CCHIT certification is an inappropriate standard for federal funding, authorization or endorsement of HIT systems:
*CCHIT 2009 certification has over 450 separate requirements, the collective effect of which tremendously increases the cost and complexity of IT solutions. Many of these requirements are “functional specifications” that should be determined by customer needs and priorities, rather than by committee. These requirements foster (if not mandate) the development of rigid, monolithic systems.

*The monolithic approach to certification taken by CCHIT does not reflect the current advances in information technology being leveraged by other industries where integrated solutions are used to support the complete “end-to-end” business process. Integration and interoperability are essential to leverage the potential of “cloud computing” and other service orientated delivery mechanisms.

*CCHIT works to the benefit of a small number of large EMR vendors that can command a high price from the relatively small segment of the market able to currently afford their products. It is essentially anti-competitive, and establishes a major barrier to entry by new vendors and open source projects (where the majority of innovation will take place).

*A quick count from the CCHIT website gives the following results for the number of systems certified for ambulatory EMR (including conditional certifications and multiple certified products from a single vendor):
i) 2006 = 93
ii) 2007 = 55
iii) 2008 = 14

*At this rate of attrition, the number of certified products will dwindle to the single digits.

*The shrinking number of vendors that are capable of meeting CCHIT certification exposes a fundamental flaw in its current organizational structure – CCHIT is funded by the very vendors it certifies. In order for it to maintain revenue, it needs to provide a reason for vendors to continue to either:
i) re-certify on a regular basis
ii) apply for new certifications

*The problem with this model is that, in order to justify ongoing re-certification, CCHIT must continue to add new certification requirements year-to-year. The driver for more requirements is not necessarily the needs of customers or the best interest of the healthcare system, but the need to have new requirements against which to certify vendors. This is illustrated by the fact that CCHIT has recently reduced the length of the certification from three to two years, and is adding numerous supplemental certifications in areas like child health, cardiovascular, etc. There is no end to the number of requirements to which this could lead, but there is no evidence it will serve anyone well in the long run, other than the few large vendors with the resources to keep up with this process, and CCHIT itself.

*Although in theory vendors can apply jointly for CCHIT certification, in practice the monolithic certification process will limit the ability for vendors to provide component solutions from which customers can choose to create best-of-breed, low cost solutions that best fit their needs. For instance, in the ambulatory arena, this might typically be a combination of Practice Management, EMR and e-Prescribing solutions.

*Certification of Practice Management systems in other markets (e.g., UK) has arguably reduced innovation and investment, increased the total cost of ownership and consolidated the market to such a point that there is limited choice and the barrier to entry for new entrants into the marketplace is unaffordable.

I think this is just the start of what could be said, but it raises some really important points about certification.

I received an email not too long ago from a medical billing company who talks about the crazy costs associated with medical billing. In their email they offered the following statistics on the costs of medical billing.

The statistics below represent industry averages taken from the MGMA.

Claims Rejected on 1st Submission – 30 %
Underpayed Claims – 20%
Gross Collection Rate – < 60%
Preventable Denials - 90%
Denials that are Recoverable - 67%
Average days in A/R - 52.32
Cost per claim - $5-$7
Cost per FTE physician - $30,000-$60,000
Cost of billing operations - 18-22%
Cost of Billing Personnel - 58-62%
Cost of Technology/ Practice Management Solution - 18-22%

Source: Avisena whitepaper

I must admit that billing is far from my expertise, but it’s a well described necessary evil for almost any practice. Plus, the better you do it, the more money your clinical practice can make.

Of course, my question is how did implementing an EMR in your clinic either help or hurt these various costs? Were you better able to process claims, because the charting was done electronically and the coding done at the time of visit? Were you able to process claims at a higher rate because your documentation was more complete using an EMR? Could you more quickly process denied claims because it was electronic? Did you need more or less employees to do your billing after implementing an EMR?

I guess it would also be important to know if you decided to go with an integrated Electronic Medical Record and Practice Management System or if you tried an interface between your legacy system and a new EMR system.