I just read one of the best posts I’ve read in quite a while by Marc Holland, CEO of System Research Services about HI(TECH) Anxiety. One of the best parts of the post was a list he did of the concerns physicians and their staff have about the EMR stimulus:

• I don’t have enough Medicare revenues to qualify
• I don’t have enough of a Medicaid patient volume to qualify
• I’m reluctant to shop, let alone buy, until I know what criteria I must meet for my usage to be considered “meaningful”
• The vendors I have spoken with don’t offer a version suitable to my specialty; a general purpose EMR simply doesn’t meet my needs
• I have no personal capability or interest in becoming my own IT department and I don’t have the luxury of staff with the necessary skills
• I haven’t begun to shop and don’t know where to start
• The software I have seen doesn’t match my needs; usability is a key concern
• I’m concerned about sharing my patient information with competitors and with the government, how do I preserve the confidentiality of my patient information?
• How do I obtain and manage patient permissions?
• I need help; lots of help

These concerns really aren’t new. Plus, none of them are really all that significant. It’s just the learning curve that’s required to implement an EMR. Sadly, I think that far too much focus has been on shoving the EMR down people’s throats instead of educating them properly on EMR and the inherent benefits of those EMR.

Today I got an email from HIMSS stating that they’ve launched a “complimentary afilliate membership program for RECs.” Looks like HIMSS wants to be able to influence help these RECs with their resources and perspectives. So far they’ve only signed up 10 regional extension centers to the program. Here’s the list that signed up so you can know if you’re REC has joined up with HIMSS:

• HITArkansas
• Colorado Regional Extension Center
• Illinois Health Information Tech Regional Extension Center
• CHITREC
• HealthBridge
• Massachusetts eHealth Institute
• Wide River Technology Extension Center
• Monroe County Medical Society
• North Texas Regional Extension Center
• Michigan Center for Effective IT Adoption

The good news is that this is only 10 of the 60 or so RECs out there. I can’t blame them. HIMSS conference attendance is expensive and free is much better.

I guess I just have a real mixed feeling about HIMSS. As a self proclaimed physican advocate myself, I think that HIMSS has too much EMR vendor influence to be a true physician advocate. I think that being physician advocates is key to successful EMR adoption and will be essential to any REC’s success.

I always like it when people ask me questions about EMR. That way, I know that I’ll be providing at least some value to someone. Brian asked the following question in the comments:
Do you know who actually makes the decisions to purchase EMRs? For example, at large hospitals or medical groups, is it CIOs, and in small practices is it physicians?

This is a really hard question to answer. In fact, it’s likely one of the reasons why making the EMR sale is pretty hard. Each organization is very different. I guess this is a byproduct of the capitalist society that we live in.

That said, in hospitals, it usually is the CIO that is making the final decision to purchase an EMR after the CEO’s approval of course. Although, many times the work of selecting the EMR software and going through the EMR review process is delegated to a committee of people in the hospital organization.

The medical groups are harder to analyze since they come in all shapes and sizes. Not to mention varying governance structures. I would likely define these practices in two categories: physician run groups and manager run groups. You can guess who makes the decisions in these two categories. With that said, the doctors can really make an EMR implementation miserable if they’re not on board with the EMR selection. So, even if the practice is not physician run, you better consider these doctors in the process.

Small groups are generally more heavily influenced by the physician’s choices. Occasionally you’ll come across a strong practice manager, but usually that person is strong because they know how to work well with the doctor and their needs.

Certainly there a lot of other variations, but this is generally what I’ve seen.