Recent stimulus-induced EHR deals show sooner-than-expected adoption, especially in the hospital sector, according to investment firm Piper Jaffrey.

The second half of 2010 and all of 2011 are likely to show a large number of EHR deals, Piper Jaffrey analyst Sean Wieland wrote in his analysis Friday.

Wieland noted a growing trend of hospitals buying or subsidizing EHRs for physician practices.

“We continue to believe that mega-deals will continue as hospitals seek to capture first-mover advantage and HHS’ finalization of stimulus criteria will act as a catalyst for stand-alone physician/group practices to jump into the deal foray,” he said. -source

I’d be interested to know where Piper Jaffrey got their numbers that support their conclusion that EHR adoption showed better adoption in late 2010. I guess maybe they’re comparing their numbers to what they thought it would be. Maybe they expected adoption to be close to 0 and it was just over that.

I do think that Piper Jaffrey is dead on when they say that EHR deals will see a huge increase in 2010. It’s going to be the season for EHR adoption.

Do you think that the “mega-deals” involving hospitals subsidizing the EHR will be the reason?

I’m always fascinated by the various EMR initiatives that are happening around the world. I think there’s a lot to learn from other countries that are smaller and have different healthcare systems which don’t cause the same problems we have in the US. One project I heard about recently has the Singapore government inviting EMR vendors to make a proposal for a Singapore EMR system. Here’s some details of what Singapore’s doing from Future Gov.

The Singapore government is inviting vendors to submit proposals to ‘design, develop, supply, deliver, install, test, commission and support’ a clinical management system (CMS) cum electronic medical record (EMR) system for general practitioners.
…
The GP Clinic Electronic Medical Record and Operation System (“Project CLEO”), will comprise of a CMS and a GP-oriented EMR, with the focus of ‘facilitating better quality and safer patient care in addition to optimizing clinic operations for better and more efficient patient service’, according to the Information Systems Division of Ministry of Health Holdings (MOHH), subsidiary of the Ministry of Health which takes care of the country’s public hospitals.

MOHH is also responsible for the development of the country’s National Electronic Health Record (EHR), an ambitious project to realise ‘one patient, one record’ in the island-state.

Sounds like an ambitious and very interesting EMR project. If you know of other EMR projects happening around the world, please let me know.

Check out this quote from an article at health care IT news that talks about the challenges the HIT Standards Committee has had understanding the committee’s recommendations:

However, some standards for 2011 – particularly those governing security and privacy – have been difficult to grasp, even for committee members. “They don’t understand what we’re recommending and how the pieces fit together,” said Dixie Baker, chairman of the committee’s privacy and security workgroup.

The security standards the committee has recommended are based on the HIPAA security and privacy rule, she said. Those include requirements to authenticate identity, control access to health information by authorized users, encrypt and decrypt information, and create an audit trail to track who has accessed data.

In explaining the security standards for 2011, Baker said they “are used on a daily basis when we use the Web even if you don’t realize it.” For instance, the standard that the committee used for identity authentication is the same standard used to conduct commercial transactions securely over shopping Web sites, such as Amazon.

“When you’re about to present a credit card (online) a picture of a lock appears in the lower corner (of the Website),” said Baker. “What locks that is an approach that’s called the Transport Layer Security,” which authenticates one or both ends of the exchange, she said.

Does this scare anyone else? First, you have to wonder what those people are doing on the committee. Second, you have to ask if the committee (who should be well educated on these subjects) has a challenge understanding their recommendations how are busy doctors going to do with the regulations? Doctors must be so excited to go through the 692 pages of Meaningful Use regulations.

A number of people are starting to write about the meaningful use criteria. I’ll plan on highlighting a number of the comments happening around the web about meaningful use here on EMR and EHR. The first up is the always interesting HIStalk’s thoughts (see bullet points below) on the recently released meaningful use interim final rule and a link to HISTalk’s excel file listing the provider requirements for meaningful use (a good place to start for doctors).

• I’m trying to figure out who the big winners will be if these criteria are approved. Consultants for sure. Companies like RelayHealth that provide eligibility, claims, and information exchange services. Companies that can perform a security analysis. Vendors that offer a usable medication reconciliation function. Vendors with patient portals. Companies that can help put vital signs information directly into the EMR.
• Losers: EMR vendors already strapped to pay for CCHIT certification who now have to cough up another million or two to meet the additional requirements. That’s another blow to small and innovative vendors who aren’t raking in the cash, meaning the market tilts even more in favor of the older, bigger ones whose sales were so limited that the government decided to intervene in the free market in the first place. Market consolidation is probably good, but I expect the development agenda will now be even more driven by Uncle Sam, not users (especially since the HITECH sales window is small, so even sales-driven innovation may dry up once everybody has chosen their dance partner).
• Lots of folks, me included, expected the criteria to be a slam dunk for moderately tech-savvy hospitals and practices. Not so: considering the small percentages of them using CPOE and e-prescribing, the minority that can provide electronic copies of information to patients, and the small number of practices that can provide patients with fast access their online health information, the these are stretch goals. I bet those requirements will be dialed back in the final version for that reason.
• Good luck with providing the denominator number for the reimbursement measures. You will need to know the total number of prescriptions generated, the number of orders issued, and the number of episodes in which medication reconciliation should have been performed. The document indicates an estimated time to generate the denominator at one hour using the EMR’s capabilities, which is surely a mistake since the EMR doesn’t help you count paper orders.
• The CPOE requirement is generous to hospitals, which have been screwing around since the 1980s trying to get doctors to use CPOE with dismal results. They are required to hit only 10% CPOE usage since “CPOE is traditionally one of the last capabilities implemented at hospitals.” (like, decades after buying it?) Practices, most of them considering their first EMR in a quick ramp-up to earn HITECH money, need 80% usage right out of the gate. I expect changes here, too, with the hospital target raised and the practice one lowered.
• With the minimal CPOE usage required for hospitals, the five required (and undefined) clinical decision support rules won’t have much impact on patient outcomes.
• The report cites a pseudo-fact that, “Some vendors have estimated that EHRs could result in cost savings of between $100 and $200 per patient per year.” Vendors say a lot of things, but I believe only those that are enumerated in a contract, preferably with rewards or penalties to encourage backing up self-serving statements with risk. I’m not sure I would have included that stat.
• The report used the high estimate of EHR cost from a range of $25,000 to $54,000 per provider, stating that “we believe the cost of such technology will be increasing.” Why should software costs increase when user bases are increasing, which should allow vendors to spread their fixed software development costs over more users? The only one factor that would raise the price is the vendor cost of complying with certification requirements (government meddling in free markets never comes free).
• That higher upfront EMR cost makes the elusive $44K jackpot even less enticing. Doctors were already avoiding EMRs because of cost and negative workflow impact. Providers are questioning whether they can qualify for the incentives and whether they trust the government to pay them.
• Conclusion: if you like the idea of having the government use taxpayer money to encourage the use of specific products in the pursuit of lofty and possibly unrelated goals, this at least pushes some theoretical behavior change in the users who choose to participate. If you’re a provider trying to decide whether the government money has too many strings attached, this might convince you that it does. And if you asked me how the odds of high EMR utilization changed with the release of these proposed requirements, I’d say they got worse.