One of my readers sent me the following email…

New England Journal of Medicine survey:
46% of primary care physicians would quit if Obamacare becomes law!

I’m not sure I agree with the statement. Should I? If this does happen, how will it affect the EMR industry? Should EMR vendors should be preparing for the healthcare reform (Obamacare) in their projections?

CCHIT has published their comments made on the Interim Final Rule (45 CFR Part 170, RIN 0991-AB58), published in the Federal Register of Jan 13, 2010, “Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology.” Or as I like to call it, the EHR Certification criteria.

Here’s 3 paragraphs that kind of describe CCHIT’s broad feedback on the EHR Certification criteria:

Before offering detailed suggestions, the Commission wishes to highlight three overarching concerns with the IFR as written:

• Scope. While “Complete EHR”sounds like a desirable certification, the package of requirements in the IFR may not match the needs and expectations of doctors and hospitals, nor the realities of the marketplace, for EHRs. By including two functions of an administrative/billing system in the scope of EHR certification, ONC may exclude one third or more of the offerings in the current EHR marketplace, while suddenly forcing hundreds of billing products to undergo unnecessary certifications. In other areas, the scope falls short of being complete: for example, an EHR that does not offer competent electronic management of progress notes would be unusable and medico-legally unsound, and an EHR that fails to prominently display patient advance directives in an emergency could compromise patients’ rights at their time of greatest vulnerability.
• Interoperability. The Commission and its expert volunteer panels believe that certain criteria and standards in the IFR represent a step backwards in progress toward EHR interoperability. For example, well-defined standards for receiving electronic laboratory results in the doctor’s office and for exchanging clinical summaries had already been recognized by the Federal government and widely supported by industry – as evidenced by the certification of over 80 EHR products to those standards in 2008. Yet under the IFR, that standard for receiving laboratory results, and the specific implementation guidance for exchanging clinical data, have been dropped. Where one standard was previously recognized for clinical data exchange, the IFR offers two different, incompatible standards. Conversely, other interoperability criteria in the IFR, such as the requirement that EHRs be capable of transmitting biosurveillance data to public health authorities, could immediately increase EHR cost and complexity while benefits remain years away because public health authorities lack standards-compliant infrastructure and systems for receiving that data.
• Functionality. Some of the IFR criteria define required functionalities of an EHR too microscopically, adding unnecessary complexity and creating barriers to innovation. Other criteria are too vague to be reliably verified in a testing process, creating a risk that the expectations of providers, payers, and the public regarding the performance, safety, and benefits of Certified EHRs will not be met. A particular concern surrounds the reporting of quality measures, with the IFR calling for standards and measures that are yet to be defined or that require significant revision to make them computable from EHR-based data.

I’ll be interested to hear people’s comments about CCHIT’s feedback on the HHS EHR Certification Criteria.

I’m still working through some of the various wrap ups from HIMSS that I’ve found. Matthew Holt is always an interesting blogger. Turns out that he’s even more interesting in person. Here’s a few of his thoughts that I think are worth sharing:

Busiest booth?: I think Cisco wins. Maybe it was HealthPresence, maybe the magician—but it was always packed. What I think it means is that mainstream Internet tools are now coming into health care (with some little tweeks). But as MrHISTalk says, putting all the big guys in the A hall was a mite unfair on the C side—although I got to both a little.

Most intruiging announcement?: Epocrates will release a hand-held and web-base EMR app for the iPhone and other handhelds. Why is that interesting? Because they already have 275,000 docs actively using their tool on a handheld, most on iPhones. If their tool’s any good you have to assume they have a great marketing advantage. If this succeeds there’s no way they remain independent in 18 months.
…
Most interesting niche company you’ve never heard of whose CEO you randomly met at a party?: LiveProcess is a SaaS-based emergency preparedness tool. (I think CEO Nathaniel Weiss said) it has 500 hospitals paying $10K a year each with no customization.

Other interesting niche company?: CPM does CRM outbound marketing for hospitals and as nearly doubled in size during the downturn (video of them to come).
…
Most interesting philosophical chat?: Andy Weisenthal of Kaiser Permanente discussing how specialists are going to change entirely what they do now that everything in KP is online. One Hawaii endocrenologist is on a jihad to prevent diabetics ending up on dialysis—he’s completely reorganized how primary care docs treat their patients. It’s almost like his goal is to put himself out of a job. Andy said about Healthconnect’s finalization of the $6bn (?) implementation—”It’s not the end, it’s the start”.

It’s also worth linking to Matthew Holt’s interview with Epocrates about the Epocrates EHR. Although, I also just remembered I could embed it below:

I was glad that I had at least one chance to talk with a vendor about Smart Cards at HIMSS. Sure, smart cards have been around for a really long time, but I wanted to see what was happening with this relatively old (25 years or so) technology.

Well, I had a chance to do this video with Gemalto to talk about Smart Cards in healthcare and also the possibility of your cell phone becoming your smart card. Could be really interesting to see that evolve. Check it out:

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

Ever since I first saw Fred Trotter’s post about CONNECT being the future of EMR interoperability, I was really interested in the open source software CONNECT. Of course, when the PR person from ONC emailed me with an opportunity to talk with someone from ONC, I jumped at the chance.

The following is a short video where I tried to capture what ONC is doing with NHIN and CONNECT so that people can be more informed on these 2 projects. I hope you enjoy:

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

I rated the HISTalk party at HIMSS as the Wildest party in my Best and Worst of HIMSS post on EMR and HIPAA. No doubt the HISTalk party was an event to remember with a lot of really influential people there. However, probably the best part of the night for me was this Meaningful Use rap by Mr. HIT. I can’t imagine how much he practiced this since he did this 2.5 minute Meaningful Use rap flawlessly with no notes. That’s impressive. If you read this blog regularly, I think you’ll enjoy it too:

I always love when people are interested in doing guest posts on this site. This is going to be the first in a series of blog posts about some of the misinformation that’s out there about the EMR stimulus, certified EHR, and meaningful use. I hope you enjoy!

My name is David Lee and I am a principal of a healthcare technology consulting firm called eRECORDS, Inc. Day in and day out, I talk to independent physicians, practice group owner and community clinics about HITECH Act and “meaningful use”.  My company takes pride in providing accurate and up to date information to the physicians and clinics so that they can make intelligent decisions about meaningful use.

I am continually amazed at the misinformation surrounding meaningful use and the one that scares me more than anything else is ”My EHR vendor told me that if I implement their certified EHR, I will meet the meaningful use requirements and collect EHR incentive payments.”

It is true that a “certified EHR”  is a key component to meeting the requirements of “meaningful use”.  However, a “certified EHR” is not the silver bullet to meaningful use.  Let me share some important facts:

• Fact: Although the definition and requirement of a certified EHR has been released by the ONC, there is no organization recognized or approved by the CMS to certify EHR to meet the requirements of the meaningful use criteria.
• Fact: Even if your organization implements a certified EHR (when certification bodies are appointed and your EHR vendor passes the certification), this does not get you to meaningful use..
• Fact: Meeting meaningful use requirements involve qualified providers meaningfully using a certified EHR and reporting clinical quality measurements.  The key words are “meaningfully using” and “reporting” not simply having a certified EHR.

Don’t be fooled by any vendor claiming that they are certified or promising they will be certified.  Although some EHR vendors are better prepared to meet the certification when available, not a single vendor today is certified for the EHR incentive payment program.  More importantly, you cannot meet the requirements of “meaningful use” by simply implementing a certified EHR. It is vital that you find experts who can provide accurate assessment and plan for “meaningful use”.

This is a continuing series where David will share and hope to clear the myths about HITECH Act and “meaningful use”.

About David:
David Lee is the Principal at eRECORDS, Inc.  David has provided successful healthcare technology, CRM and financial product consultancy for the past two decades and most recently, guiding healthcare organizations to “meaningful use”.   You can reach David at david.lee@eRecords.com or visit www.eRecords.com.

HISTalk had this insightful point:

From Day Tripper: “Re: ambulatory EMR vendors. I asked several EMR vendors if they have seen a big increase in buyers, especially now that we at least have the interim final use definitions. The general consensus is that many physicians are still dragging their feet.” I’ve heard that comment as well. Either because of fear or because it sounds like a good excuse, many physicians are waiting until the MU guidelines are truly final and the certifying entities are identified. Perhaps a minority of physicians are savvy to understand that the RECs will offer some free implementation services so they are waiting for those to ramp up. And, likely others are waiting to see what opportunities their hospitals may offer to affiliated physicians. In other words, if you are looking for an excuse to not move forward, there are plenty to choose from.

I ask a number of EMR vendors the same question. A few had seen some increase, but for the most part they were all still waiting. I think Inga’s comment that there being plenty of excuses to not implement is true. This is unfortunate, since before the EMR stimulus most of the excuses had played themselves out and nearly disappeared. It seems that the EMR stimulus offered up a new set.

I will say that I’m not so sure how much “free” help the RECs will end up giving. I really wonder what most of them are going to do. One of my projects since HIMSS is to make contact with a number of the RECs.

Anyone that works in Healthcare IT knows who John Halamka is and so of course I was interested in his post of his top 10 impressions after HIMSS. It’s an interesting list and I think he does a pretty good job of looking at things from a very high level. Here they are as posted on his blog:

1. Meaningful Use is everywhere. Vendors are promising EHRs, modules, appliances, and services to help clinicians achieve it. I had dinner on Monday night in a small Indian vegetarian restaurant. Sitting next to me were 3 engineers from Bangalore who were arguing about the details of Meaningful Use in between bites of vegetable curry. I could not escape Meaningful Use anywhere!

2. Certification is everywhere. It’s particularly ironic that many vendors claimed their systems were certified, even though the certification NPRM was just released today, making compliance with the new certification process in time for HIMSS impossible.

3. Cloud computing, Software as a Service and ASP models are popular tactics to accelerate EHR rollouts. There are still lingering concerns about how to ensure privacy in a cloud environment.

4. Several firms such as Intersystems, Axolotol, and Medicity are offering HIE platforms that include many of the standards noted in the IFR. The marketplace for HIE products is just emerging and it’s hard to predict who will become the market leader.

5. The Continuity of Care Document is gaining traction. I found many vendors supporting CCD exports from their EHRs. A company called M*Modal , has developed natural language processing technology that captures dictated content in its original context (ontology-driven
rules) as a CDA document.

6. Consultants abound. It’s clear that Regional Extension Centers and Health Information Exchanges will require expertise and staffing from professional firms. They all had large booths at HIMSS.

7. 30,000 people attended, including 10,000 I did not recognize (just kidding). It’s clear to me that many IT professionals, even those with limited healthcare domain expertise, attended HIMSS to better understand how they could participate in the euphoria of HITECH stimulus dollars.

8. Self service kiosks for patient identification and self-registration are now mainstream. Just as we print our airline boarding passes, we can now use credit cards or biometrics to check into ambulatory care appointments and automatically settle all co-pay balances.

9. Image exchange in the cloud is being offered by several vendors. As I mentioned in Monday’s blog, Symantec announced an appliance for small clinician offices that cloud enables all imaging modalities using a facebook-like social networking invitation to share/view images.

10. PHRs and patient engagement are becoming more mainstream. Google and Microsoft continue to innovate in the non-tethered PHR marketplace.

Today at HIMSS, the findings of a research study by the FCC was released.  I find it pretty interesting that the FCC is looking at healthcare IT.  The research study did an analysis of the healthcare IT infrastructure and its ability to support the growth of helathcare IT. Here’s a short summary of their findings:

FCC research has found that the current broadband available to physicians is cost prohibitive and can be a barrier to important developments in health IT.

• Physician offices with less than 5 doctors can have their needs met by currently available commercial offerings, usually at a reasonable cost. Even so, roughly 3,600 small practices lack access to even the basic broadband services they require to achieve Meaningful Use.
• Practices with more than 5 practitioners face a larger challenge. They need a higher level of broadband, and tens of thousands of offices in this category face prices that differ significantly, often by $45,000 or more per year for the same level of service. The gap is substantially larger for rural providers

These disparities offset meaningful use incentives and can prove to be a barrier to health IT adoption.

The FCC plans for a major expansion in its efforts to bring high-speed broadband service to healthcare providers. The program is authorized to spend up to $400 million per year, making it the largest sustainable fund for healthcare connectivity. Currently the FCC only spends approximately $70M per year of the $400M due to limitations in how it is authorized to spend the funds. Funds can currently be let through:

–   The Rural Healthcare Support Mechanism subsidizes telecommunications expenses of rural non-profit and public healthcare providers that face higher broadband prices than their urban counterparts. Also covers 25% of the internet service fees

–   Rural Healthcare Pilot Program—a one-time program with 63 projects (totaling $417M) to build dedicated healthcare broadband networks

National Broadband Plan Recommendations:

The FCC would like to substantially expand broadband subsidies to healthcare providers where service is unaffordable, including in urban areas. FCC is requesting a change to improve the health IT infrastructure, including:

• Allowing private institutions to be eligible for funding (not just non profits and public institutions)
• Supporting deployment of new broadband networks where they are insufficient by creating a permanent infrastructure program
• Linking FCC funding to outcome metrics such as “Meaningful Use” to ensure support goes to locations that use health IT in support of guidance from the Office of the National Coordinator for Health IT