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Question and Answer with Lynn Scheps, Government Affairs VP for SRSsoft EMR

Posted on November 12, 2009 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I as many of you have been trying to closely follow what’s been happening in Washington in regards to the HITECH act. There are a lot of moving parts and it’s hard to keep up. One of the most recent topics the committees have begun discussing is how the ARRA EHR stimulus money and “meaningful use” will apply to specialists.

Lynn Scheps, Government Affairs VP for SRSsoft, has been attending the meetings and so I shot her a few questions about specialists and the EMR stimulus money.  The following are her answers:

Are ONC/Committees focusing too much on primary care and not enough on specialists?

It is clear that ONC intended to focus on primary care from the outset. Just look at the appointed membership on the HIT Policy and HIT Standards Committees. Of all of the physicians, only two are specialists—one a gastroenterologist and one a pathologist. And perhaps primary care is where the focus should be, since ideally that is where the management of care and coordination among treating physicians should take place. Twelve of the thirteen major medical problems that contribute overwhelmingly to the national cost of healthcare are treated by primary care physicians. These conditions are addressed in the currently proposed “meaningful use” matrix.

At the October HIT Policy Committee meeting, David Blumenthal stated that it was never intended that specialists would report on all of the measures in the matrix. However, it was not until very recently—in fact after SRS submitted the Voice of the Physician Petition in August—that specialists were even a part of the conversation. If you read the minutes from prior meetings, you will find not even a mention of specialists, except by members of the public during open comment periods.

If specialists are also expected to participate in a meaningful way, and will be subject to the penalties for non-participation in 2015, then the committees need to focus intently on making the requirements relevant—and meaningful—for them as well.

Do you see ONC moving in a direction to deal with specialists and “meaningful use”?

The HIT Policy Committee began to deal with specialists at its October 27th meeting. The issues raised by the invited panel members were complex—how to create relevant quality measures for 60 specialties and subspecialties, blurring of roles among specialists and primary care physicians, and how to encourage EHR adoption among physicians who, as a group, have adopted EHR technology to an even lesser extent than have their primary care colleagues.

What plan would you suggest for addressing specialists within “meaningful use”?

Widespread adoption by physicians—specialists in particular—will occur only if the “meaningful use” requirements are meaningful to the physicians and do not create onerous demands that negatively impact their productivity. As Albert Strunk, MD, (the representative of the American College of Obstetricians and Gynecologists on the specialists panel), testified, additional reporting requirements that do not benefit the physician will inhibit, not encourage, adoption. I agree with David Rath’s contention (presented in Healthcare Informatics) that micromanaging the myriad of measures that could be created for specialists is not the answer.

“Meaningful use” for specialists should focus on the following: closing the referral loop by communicating meaningful information to primary care physicians, ePrescribing to eliminate duplicate costs and increase patient safety, and making lab and diagnostic imaging results available to eliminate test duplication and accelerate the provision of care.

What are the best ways for people to share their opinions with Washington from what you’ve seen?

Currently, (through mid-November), there is a golden opportunity for providers to share their opinions and concerns with the decision-makers by posting comments on the government’s FACA blog. The HIT standards committee has asked for documentation of real-life EHR stories—both implementation successes and failures—and comments on the EHR standards being established.

There are also public comment periods at the end of every committee meeting, and people can access these opportunities by telephone, as well as in person. The schedule of these meetings can be found on the SRS website in the Government Affairs section. Once the CMS Notice of Proposed Rulemaking is issued at the end of December, there will also be a 60-day public comment period specifically on “meaningful use,” but it seems unlikely that significant changes would be made so far into the process.

– Lynn Scheps, Vice President, Government Affairs

Interview with SRSsoft EMR CEO Evan Steele

Posted on October 1, 2009 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been finding what SRSsoft and in particular their CEO, Evan Steele has been saying about the ARRA EHR stimulus money on the SRSsoft blog called EMR Straight Talk really interesting. They’re an EMR company that I think has taken a different approach to marketing their EMR software. So, I thought it would be interesting to interview Evan on a number of relevant topics related to his EMR and the ARRA stimulus money.

Let me know if you like the following interview and I’ll think about doing more of them.

Describe what you define a hybrid EMR is.

Hybrid EMR satisfies the demands of high performance physicians by providing process efficiency. This benefit is delivered through click minimization, ergonomic design, product flexibility and a non-proprietary, open software platform. The hybrid EMR is not exam note-centric, and therefore spares physicians the onerous data entry requirements associated with traditional EMRs.

Can you describe 3 features and how it’s done in a hybrid EMR versus a traditional EMR?
*Generating a ePrescription with only two clicks
*Reviewing a message, viewing the attached document (like a lab or a radiology report) and signing the document with one click.
*Generating a fully templated exam note from anywhere within the software with three clicks.

Will SRSsoft be participating in the ARRA EMR stimulus money program?

It all comes down to the meaningful use requirements – although, after 3 rounds of meaningful use discussions, the requirements are likely not to change significantly.  As listed in the most current “Meaningful Use” Matrix, they are quite onerous for physicians. The cost associated with reduced productivity that a high-volume, high-performance physician would incur by entering the data to meet the meaningful use requirements dwarfs the incentives being offered and the relatively small penalties which starting six years from now (in 2015).

How come I don’t see a CCHIT certified badge on your website?

CCHIT reached the apex of onerous requirements when it released its 2009 certification criteria which contained nearly 500 items. Since its formation in 2004, CCHIT has layered on more and more criteria each year, and vendors have been on a wild goose chase to program those requirements.  Most of these feature requirements are not used or valued by busy physicians. SRS made a conscious decision not to follow the herd and, instead focuses on features that busy physicians need to make their practices efficient so that they can manage their costs and take better care of patients.  The result is a highly ergonomic, usable EMR that actually meets the needs of high-performance physicians.  Sales have skyrocketed.

Interestingly, the new certification will be an HHS badge and not a CCHIT badge and there will be multiple certifying bodies. In addition, the HHS certification criteria will be only those features that are required to meet the meaningful use requirements.  CCHIT actually eviscerated their almost 500 requirements and announced that 88 requirements will be needed to meet meaningful use guidelines.  I feel sorry for the scores of companies that programmed hundreds of complex features only to find that they were unnecessary (all the while not focusing on what physicians actually want).  I also feel sorry for the physicians that paid for those unnecessarily complex products.

Listening to the voice of the physician is a winning strategy and always will be.

How did the HIT Policy Committee react to your “Voice of the Physician” petition?

Lynn Scheps, our Vice President of Government Affairs, went to Washington to present the “Voice of the Physician Petition” to the HIT Policy Committee in person, because we felt it was so important that the decision-makers understand how private-practice, community-based physicians view the expectations being placed on them. The government’s goal of widespread EHR adoption cannot be accomplished without buy-in from the physicians themselves, and the fact that a relatively small company like SRS could generate such a sizeable response in a short time, with minimal outreach efforts, indicates the deep level of concern among physicians. The “Voice of the Physician” petition was signed by SRS clients and non-clients alike, and over 150 of them feel so strongly that they took the time to submit additional comments.

As the petition was presented to the Committee, a number of members were observed browsing through the comments. I can only hope that all of the members take at least the amount of time to read them as the physicians took to write them. I think they will find them very insightful.

Is the government wasting their $19 billion in EMR stimulus money?

The government actually set aside $36 billion, anticipating $17 billion in costs savings from EMR adoption, so the net cost would be $19.2 billion if all goes as planned.
They won’t be spending it if doctors choose not to participate or if they are not able to meet the onerous meaningful use requirements (similar to their experience with the PQRI program.) In the latter case—a likely scenario—in which high-performance, high-volume physicians purchase the required software but are unsuccessful, the doctors will have wasted their money and the EMR vendor coffers will have been filled.

You claim increased productivity using SRSsoft.  Where does the productivity come from? Have you had any practices that haven’t had an increase in productivity?

It’s such a luxury to wake up in the morning, come to work and have 18 programmers who can carry out the vision of focusing purely on what physicians need to make them more productive. Productivity stems from automating processes and organizing information. The fewer clicks and less mouse movement it takes to store and access information, the better the result. Our mantra for the past 12 years is “DO NOT SLOW PHYSICIANS DOWN.”  We found that by automating the myriad of repetitive, labor intensive processes found in every medical office, massive productivity increases result every time. It’s just like any other business process improvement software that replaces antiquated paper workflows. It’s a big win if software directly addresses process improvement while positively impacting a company’s executives (in this case, the physicians). Employees become more productive and the executives benefit from having key critical information at their fingertips.

There is a huge difference when a company is not shackled by someone else’s vision (e.g., the government, certification bodies, etc.) of how technology should be applied in a medical practice.  Plain and simple: physicians know what they want for their practices and know what works, non-physician bureaucrats do not.

Every EMR company will claim that they focus on process and workflow improvement in medical practices. Not true! Just count the clicks required for simple, repetitive tasks and it becomes crystal clear what happens when companies cater to non-physician stakeholders. Any company can slap together a lab management module, an ePrescribing module, a messaging and tasking module, or a forms module, but it takes tremendous focus and dedication to integrate it tightly with the core software, make it intuitive to use and make it ‘fly’ in a medical practice. Clicks are the biggest source of lost productivity for physicians using EMR. Most private practicing physicians’ income is tied to productivity, so time is money. Therefore, every click costs money.

If EMR vendors focused 100% of their resources on usability, click-reduction and module integration rather than on hundreds of pie-in-the-sky features dreamed up by bureaucrats, adoption would flourish.

What are your thoughts on open source and open APIs in EMR software and how does your OpenPath technology fit into it?

SRS is a strong proponent of open architecture software.  At SRS, we have built the web right into the core parts of the software so anyone can customize it. They don’t have to rely on SRS to customize the software for them. SRS has many clients that have talented, tech-savvy employees who have used our Software Development Kit (SDK) to customize their SRS in amazing ways.

SRS spent a great deal of time developing its OpenPath™ technology so clients aren’t beholden to us for customizations. Many other vendors do just the opposite and require that clients go through them for customizations. It’s analogous to buying a house and then a few years later, when you want to add a new room, you find that you are handcuffed because you have to go to the builder for the addition and accept his design, his pricing and his timing. If SRS were the builder, we would be happy to build the addition, but you would also be free to choose your own builder, your own design and negotiate pricing and timing. That level of client control is sorely lacking in the EMR industry. For example, we have many prospective clients that have a strong desire to switch from an antiquated, traditional point-and-click EMR to SRS and they are petrified to ask the legacy vendor for assistance in moving the data from their system to ours. Over the short term, this is good for the legacy vendor, but it puts the medical practices’ long-term IT plans in jeopardy – they feel like the legacy vendor has put them in a straightjacket.  With the SRS OpenPath™ SDK, our clients have a document with our database schema clearly outlined so as to facilitate customizing our software or having the option to migrate to another software package should they want to at any point in the future.

What other customizations have been done by end users using your OpenPath™ technology?

SRS and its clients have created a myriad of customizations that leverage our OpenPath™ technology. Here are some examples:
*Using the SRS software development kit (SDK), a 100 provider primary care group completely rewrote their Clinical Summary web page that resides on the SRS desktop. In addition to a detailed summary of a patient’s key clinical information, the new Clinical Summary includes custom alerts and information fetched from their practice management software database (e.g., balance, alerts when balance is past due, etc.).
*A solo practicing ophthalmologist had SRS rewrite the Clinical Summary to match, perfectly, his thought process when reviewing clinical information before an exam.
*A 52 provider multi-specialty group had SRS customize their Clinical Summary so that with one click, they log the date and time a dictation was completed. They also created a custom transcription exception report that flags all transcriptions that have not been received within a certain timeframe.
*A 20 provider orthopaedic group also leveraged the SRS SDK to self-create a “PowerTab” that pulls up a fully integrated web page (right inside SRS) where the physician orders prescriptions for the patient which is then sent to the in-house drug dispensary.

What do you see happening in the future with EMR software?  What’s going to happen and what’s likely to happen?

Physicians are going to get hurt when they are “incented” to buy systems without being fully aware of what will be required and the lost productivity that they will incur. This will lead to non-use, and the consideration and purchase of more usable alternative solutions in the future. This is exactly what we are seeing in the marketplace today with legacy point-and-click EMRs.

Is EMR and HIPAA part of your daily reading?  If not, why not?  Lol

Of course, I love the writing and commentary!