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EMR and EHR Ratings Confusion

Posted on October 30, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 recently got a comment from Tammie on my post about EMR and EHR rating websites. Here last line really hits home:

If we cannot trust the reliability of web published EMR/EHR ratings, then are we not to trust the surveys and polls conducted by the professional organizations or the selections by the Regional Exchange Centers either? I can’t recall ever researching something so thoroughly and have so much information available to me and yet be still so utterly confused.

It’s a definite challenge. I’d suggest going through a methodical process that’s described in my free EMR Selection e-Book. Still a challenge, but this approach helps.

Allscripts Sunsetting PeakPractice EMR

Posted on October 28, 2010 I Written By

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

It’s now official. Allscripts will be shutting down their PeakPractice EMR solution. In an FAQ for PeakPractice clients Allscripts gave more details. I’ve put a copy of the info below for reference. Honestly, this wasn’t much of a surprise for me. Allscripts had far too many EMR software in one company. It seems that Allscripts has chosen to go with: MyWay, Professional and MedFlow as their EMR packages going forward.

I do find it interesting that Allscripts plans to support PeakPractice through the first stage of meaningful use. I think the time frames were just too small to do otherwise. If there was a bit more time it would have made sense for Allscripts to use the stimulus money to motivate people to move off of PeakPractice and on to one of the other Allscripts EMR.

I’m honestly interested to hear how well the conversion goes between PeakPractice and other Allscripts EMR solutions. I think there’s going to be a lot of misinformation about what the can and can’t convert. Especially since it seems like what they’ll be able to convert will depend on which Allscripts EMR software you choose to convert to. Yeah, this has mess written all over it.

I’ll be watching for the next round of companies that take care of EMR conversions from PeakPractice. I remember the round when all the Misys users were ready to convert from Misys to something other than Allscripts. I expect we’ll see similar movement by PeakPractice EMR users. So much for going with a large company to ensure the stability of your EMR software.

Here’s the letter from Allscripts to PeakPractice Users:

Dear Valued PeakPractice Client,

When we brought together Allscripts and Eclipsys, we committed to you that we would share critical decisions as soon as they were complete.

After careful deliberation and review, we are making a change to our future plans for PeakPractice. In making this decision, our goal was to ensure that we could effectively meet your needs both now and in the future by providing you with systems that are stable, easy to support, and flexible enough to allow us to quickly respond to the rapidly changing market and regulatory requirements.

After careful analysis, we have decided to make the following changes.

We will continue development of the current version (5.5) of PeakPractice and ensure that it achieves ARRA Certification as a Complete EHR. We will be submitting this version for certification later in October. This will allow you, as a current PeakPractice client, to use the certified version to demonstrate Stage 1 Meaningful Use and claim your 2011 Stimulus incentives. With this version, you will be eligible for the first two years of incentives for Stimulus, totaling $30,000 under the Medicare program ($18,000 in year 1 and $12,000 in year 2).

We will continue development to ensure PeakPractice’s compliance with ANSI 5010, which will be released as PeakPractice version 5.6.

We will continue to provide support and hot fixes as needed for PeakPractice for the foreseeable future.
Relative to future versions, we will not develop net new features for PeakPractice once ARRA certification and ANSI 5010 compliance are achieved.

We will offer an upgrade path that includes both a FREE like-for-like, license-for-license swap and a FREE data conversion (see below) for current PeakPractice clients who want to upgrade to another Allscripts solution. We expect that many of our clients will choose to wait to upgrade until after you demonstrate Meaningful Use in 2011 with PeakPractice and receive your Stimulus incentives.

We have set up a PeakPractice Hotline at 877-611-1377 to both answer questions and arrange an assessment as to which Allscripts EHR/PM platform will be best for your organization.

We will work with you to determine the product and timeline that is designed to be most effective for you and have the least impact on your operations. We would encourage you to consider scheduling an upgrade to your EHR/PM solution at a time that is best for you, again, most likely after you have demonstrated Meaningful Use in 2011.

In terms of the upgrade we are making available, we will provide the following.

A FREE like-for-like, license-for-license swap between PeakPractice and a corresponding Allscripts EHR and/or PM solution (MyWay, Professional or MedFlow, depending upon your needs). We recognize there are many complexities surrounding the combinations of Practice Management and EHR products, but our program addresses each of these in detail.

We will convert data from your PeakPractice system to the selected Allscripts solution for FREE. Again, the scope of what will be converted varies depending on the systems from which and to which you are migrating.

Please note that while templates are not included in this conversion, we can recommend resources that can assist with template conversions, if you wish to pursue them. Likewise, other services (such as ASP fees, support, set-up, hosting, and EDI, such as through Payerpath) are available for the Allscripts products, but are not part of the free upgrade. We will be happy to discuss how to arrange for those services with you. This free upgrade is available through December 31, 2012. This should give everyone ample time to decide which route they wish to pursue.

We do not make this change lightly, as we recognize and appreciate the investment that you have made in this solution.
You will likely have many questions about this process, and we hope this link to our Frequently Asked Questions document addresses many of them. If you have further questions, please call the PeakPractice hotline (877-611-1377) or your Allscripts representative.

We intend to provide you with a pathway that allows you to achieve all stages of Meaningful Use and protects the investment you have made. We are committed to working with you as partners during and after this transition.

iPad EMR Eases Doctors Concerns

Posted on October 27, 2010 I Written By

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

At least the above is the title of the Information Week article on ClearPractice’s iPad EHR interface called Nimble. You might remember that I did a short review of the Nimble iPad EMR previously. I still stand by my comments of the Nimble iPad interface not being perfect for the iPad. The keyboard was clunky and slow to appear and the boxes were surprisingly small for a native iPad app.

Here’s the doctor in the article’s take on the iPad EMR:

Having a small office, there’s no space for a desktop in the exam rooms, so prior to recently using Nimble on the iPad, Dr. Lianna Lawson, a solo-practitioner, wheeled a laptop on cart to exam rooms.

“Laptops on carts — I don’t like that, it seems impersonal,” said Lawson, whose practice, Lawson Family Medicine and Aesthetics is based in Daleville, VA. Lawson has been using ClearPractice’s web-based EMR on a laptop for about a year. Lawson added Nimble to her practice in September.

Nimble running on the iPad, “has the feel of a [paper] chart,” Lawson. “Many doctors are traditionalists, so the comfort level with technology is difficult,” she said. “But for physicians not particularly tech savvy or reluctant of about how they’ll meet the meaningful use requirements, this gives a little more comfort and confidence,” she said.

It’s true that laptops on carts are a mess. As I recently argued in a post on healthcare mobile devices, the iPad does seem to have the right size and feel. That combined with the 3G connection helps to change the game. Although, I think we’re going to see more devices that build on top of the iPad’s innovations and provide an even better user experience for doctors.

Here’s another quote from the Doctor about the use of the Nimble iPad EMR:

Now Lawson said she brings the iPad with her wherever she goes, responding to patients “24 by 7,” when they have questions over weekends, or other after-hour concerns. In the office, she can use Nimble “while scooting around” in her exam rooms caring for patients.

There’s been other surprise perks to using the iPad-based product, namely engaging patients while using the EMR, she said. “I didn’t expect this to be the result, but patients can see” and talk about what’s on the EMR as she uses the iPad near them. The interactions can help in building a more solid dialogue between physician and patient — and can even help make records more accurate.

While Lawson was using the iPad during a patient exam recently, the patient saw that an entry on the list of medications in her health record was incorrect, and the patient reminded Lawson that she was no longer taking a particular drug. Lawson updated the information.

The first paragraph highlights what some doctors hate about an EMR. They want to leave the office at the office. They don’t want to be proverbially chained to the office since it’s all literally at the touch of their fingertips. Maybe this is why there were so many work life balance sessions at the AAFP conference I attended recently.

Patients seeing what you’re doing in your EMR has often been seen as good and bad. Some doctors love it and embrace the participation with the patients. Other doctors hate having the patients look over what they’ve done and have to answer more questions because a patient saw something on the screen which they didn’t understand. I think we all know which doctor we’d rather see. Although, we can all appreciate the uneasy feeling of someone looking over our shoulders.

The article did remind me of the images that the Nimble EMR makes available to a doctor. That part is actually really cool and the iPad is the perfect way to display and navigate those images as a doctor describes something to a patient.

I should also remind people, the iPad still doesn’t print. Although, that should be remedied relatively soon. Or there are a few hacks out there to make it happen.

Avoiding the EMR Company Sales Tricks

Posted on October 26, 2010 I Written By

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

Today I came across this blog post by the Gerson Lehrman Group (not sure who they are, but the content was good). In their blog post/news post/whatever they like to call it, they suggest 3 risks you should avoid to prevent being a victim of EMR vendor tricks.

With all the confusion going on, there are 3 risks you should avoid when making your EMR selection:
1. Paying too much for an EMR solution;
2. Buying a solution with little or no training or support;
3. Buying from a vendor who currently has or develops financial troubles or goes out of business.

The first two are INCREDIBLY important and I see people falling into those two traps all the time and I can barely understand why. There’s just far too many EMR and EHR vendors out there to be trapped into paying a TON of money for EMR software. Not to mention, many of them are more than willing to give you price quotes so you can compare the pricing.

Plus, don’t underestimate the need of training and support. Make sure that’s part of the package. In fact, many EMR vendors will give you unlimited training and support as part of your purchase. They can provide unlimited because they believe in their system and that you won’t need a TON of support. That’s a great thing.

The third item listed above is a little harder. Certainly there’s some you can do to evaluate where the company is and where the company is going. However, crazy stuff sometimes happens and you couldn’t have been aware of it. So, be aware of the third thing and make sure that there are things in your contract that take care of any situations like this happening.

CALLING ALL DOCTORS Take 2! EMR Software Opinions Wanted

Posted on October 25, 2010 I Written By

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

One of my readers came upon a post that Dr. Jeff did back in July of 2009 called CALLING ALL DOCTORS! EMR Software Opinions Wanted. They loved reading the comments about the various EMR and EHR vendors (I did too) and they thought maybe it was time to call for doctors to offer their opinions and evaluations again. So, here’s some sections of the original post to get you thinking:

This is a SHOUT OUT to all doctors who use EMRs. Which EMRs do you use and how do you like them. Do you love them or hate them? Are you luke warm in your like or dislike? Tell us which EMR you have and how you feel about it. Also tell us what you would do (the mistakes and the good moves) if you were looking into getting an EMR at this time.

Can you comment on the cost and the usability?. Let’s share information so we can help other doctors choose systems that are usable, simple to learn, effective and efficient.

If you don’t have an EMR and are looking into one, what questions would you have for those “who have gone before you”? What advice would you be interested in receiving?

Also, if you’re someone who likes to hear a doctor’s perspective on EMR and EHR, check out this just launched blog called The Wired EMR Doctor where Dr. Koriwchak will be writing about EMR and EHR from a doctor’s perspective. We’ve primed it with 8 or so posts to get him started. I think you’ll enjoy it.

HIMSS 11 Offers RFID Tracking at Annual Conference

Posted on October 21, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 got an interesting press release from HIMSS today announcing that they’ll be using RFID technology to track foot traffic to exhibitors at the HIMSS annual conference:

HIMSS and Alliance Tech have partnered to offer booth traffic reporting and analysis for HIMSS exhibitors at the 2011 Annual HIMSS Conference & Exhibition scheduled for Feb. 20-24, 2011 in Orlando, Fla.

“Understanding the needs and preferences of attendees at our annual conference has always been a priority for HIMSS,” says H. Stephen Lieber, CAE, HIMSS President and CEO. “With the incorporation of RFID technology at HIMSS11, we are expanding conference benefits for both our exhibitors and attendees as they work together to find the best technology solution needed by the healthcare organization.”

It seems like an exaggeration to say that this is a benefit to attendees. I can see the value for the exhibitors. It’s going to be interesting to see how this is used. I’m not sure what I think about that tracking, but we’ll see how it’s used. I think many attendees will be less than happy about the idea.

What do you think of this?

EMR and EHR Rating Websites

Posted on October 20, 2010 I Written By

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

There are a number of EMR and EHR rating websites out there. The problem that I have is that none of them are really very good at all. They all have MAJOR weaknesses and some are just completely and utterly flawed. Some require the EMR and EHR vendors to pay them to be rated. Doesn’t that just wreak of conflict of interest?

There’s just so many ways to have the ratings of EMR and EHR vendors be skewed. Dr. Oates, Founder of SOAPware, recently wrote a blog post about the problems with many of the EMR and EHR rating websites and reports. Certainly he has a vested interest in his EMR software to be ranked highly, but this part aside he raises some very important questions about the accuracy and value of these various ranking systems.

Here’s one sample of the challenge of ranking and rating EMR and EHR vendors:

In addition to accepting user evaluations, many of the ranking systems require that vendors also fill in yes/no to a large list of features. Historically, many vendors have demonstrated tendencies to answer “yes” to functionalities to which a “no” would have been more accurate. Because we tend to answer honestly, we have sometimes ended up inaccurately appearing to be less functional than some others.
There are inherent problems with each of these surveys in that the survey results can, and often are, manipulated by the vendors who are paying a the most of attention to them. Because these surveys are the result of users offering information, some vendors will expend great effort to be certain that many, mostly happy users of their product are in some fashion encouraged to participate in the surveys. SOAPware has typically avoided such activities, because it ends up being a game to see who can motivate the most satisfied users to engage the ranking system.

This is just a small sample of the challenges of trying to honestly and effectively get quality ratings and reviews of EMR and EHR vendors. Yet, providers and practice managers have an insatiable appetite to try and get information on the various EMR and EHR vendors.

Trust me, this is not an easy issue. If I knew the solution, I’d have already done it myself. I write about this since I think it’s a valuable and important message for doctors to be very very careful trusting any of the data coming out of these EMR and EHR ratings websites. Instead, go download the Free copy of my EMR Selection e-Book and do the work necessary to rate them based on your specific practice needs.

David Blumenthal Addresses Disparity in EMR Adoption In Minority Communities

Posted on October 18, 2010 I Written By

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

David Blumenthal, National Coordinator for HIT, published a letter today calling on the EMR vendor community to provide EMR opportunities to physicians and other healthcare providers “working within underserved communities of color.”

Dr. Blumenthal also says:

We are writing to solicit your assistance in making sure that we are not creating a new form of “digital divide” and want to make sure that health IT vendors include providers who serve minority communities in their sales and marketing efforts.

I must admit that I’d rarely considered the idea of EMR adoption being a racial issue. I’d certainly put some thought into the community health care initiatives that serve poor communities. I’ve given some thought to the challenges of EMR in a rural health setting. I haven’t given much thought to it being a racial issue. Now that I’ve read this, I’ll certainly be considering this possible “digital divide” more.

My initial reaction is to question why there’s this disparity. I know a lot of EMR vendors and I’m quite sure that they’d be MORE than happy to sell their EMR software to a clinic with no regard to their color or ethnicity. I think it’s reasonable to say that most EMR software companies aren’t deliberately choosing not to serve these “communities of color.” So, it begs the difficult to answer question of why these communities aren’t seeing the adoption of EHR at the same level of other communities.

The other question worth considering is if EMR vendors are missing out on a real opportunity to grow their business if they focused their sales and marketing efforts on these minority communities.

These are definitely not easy questions to answer, but I’m glad that Dr. Blumenthal started the discussion. I know it will be on mind more now.

More EHR REC Discussion

Posted on October 15, 2010 I Written By

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

My previous post about the RECs possible failure has brought on some really in depth discussion on the topic of RECs and the challenges and opportunities they face. I encourage you to go and read all of the comments and join in on the conversation, but here’s a few of the in depth comments on that thread (since I know that many of you don’t read the comments):

Margarlit Gur-Arie, from On Health Care Technology, started the discussion with these comments:

1) Doctor’s aren’t moving as fast as the money is flowing
The money is NOT flowing independent of the docs’ movement. The money only flows AFTER a particular doc decides to “move”. RECs are operating on a P4P model.

2) The market already delivers on what RECs promise
The REC promises to touch every single small practice in rural and underserved areas. The market was never able to do so because the cost of selling to these docs was way to high. The RECs also promise to deliver about $5000 in consulting services to each provider practically for free and no strings attached. The market never in its wildest dreams offered anything like that.

3) “Preferred vendor lists” limit choice and free markets
Every consultant employed by a practice usually narrows the choices down based on research and knowledge of the market (some do it for kick-back). The RECs are going through a process to establish vendors capabilities and willingness to serve a particular State needs. The “free market” is just fine. The RECs are operating within that market. Not to mention that RECs only make recommendations. They will work with any vendor that a particular provider chooses.

4) RECs won’t get doctors to “meaningful use” fast enough
Fast enough for what? Incentives? I thought doing a good job at selecting and implementing a proper EHR is more important than a few thousand dollars handout. The goal is for the use to be meaningful to the practice. The rest will take care of itself.

5) The REC model leads to under-staffed, ephemeral entities
How so? Every start-up starts small. Some grow bigger and some die. This is exactly what will happen to these 62 start-ups. I’ve seen RECs hire and train pretty talented folks in rural areas. Salaries expectations are lower and with the current unemployment, it doesn’t seem to be such a monumental task to find good talent if you know where to look. I actually think that RECs are in a better position to find talent than national vendors.

Nothing is ever perfect, and as you know, I have been critical of many other “initiatives”, but I think that the REC concept is a valiant attempt to reduce disparities and bring technology and better health care to traditionally neglected populations and their equally neglected doctors. This is the #1 reason I want to see the RECs succeed.

My response was the following:

1. So, it’s poorly worded. The fact doctors are too slow to implement EMR means the RECs won’t be able to “perform” and won’t see money flowing.

2. Where did you get that RECs are touching “every single small practice in rural and underserved areas.” I’ve seen them mostly operating in big cities. Is there part of their mandate that I’m not remembering? $5000 in biased consulting is not a benefit to the market. Sure, some RECs are providing quality service, but many are playing the numbers game.

3. Another one that’s poorly worded. Of course the free market can still work. In fact, it will continue to work even if doctors select a bunch of unusable EMR. It will just take a long while for it to correct that mistake. The idea of a preferred vendor list is messed up though. Why would a doctor ever leave it up to another organization to go through the EMR vendor selection process for them. It’s an impossible task to try and have a preferred vendor list when you’re representing such a diverse population. There were much better options than what most have done. Props to the RECs who have indeed stayed vendor neutral and avoided even the appearance of impropriety.

4. If RECs focus too much on providing something meaningful to the practice they’ll miss their P4P goals and then they’ll end up leaving the doctors who they were trying to help all alone with no where to turn. Or doctors will have to start paying for the service they were told was going to be free.

5. Scaling up quality staff is an incredibly hard job in any industry. Getting quality staff to come and work at a REC that may or may not exist and therefore you may or may not have a job in a year is a challenge. It’s not impossible, but is a HUGE barrier to overcome.

Of course, I’m playing devil’s advocate above. I don’t think that EVERYTHING that the RECs are doing is terrible. In fact, there are some really sincere and smart people that I’ve met that are working at the RECs. BobbyG on this thread being one of them.

Maybe one of the bright spots of the RECs is that it’s at training ground for smart people like BobbyG to get experience and connections that will allow them to be some of the future leaders in really pushing forward EHR adoption. It just seems like the money could have accomplished the same thing and better spent other ways.

Margarlit then replied:

1) If the docs don’t adopt and the RECs don’t get money, the tax payers get to keep the funds. That is as it should be.

2) Part of the RECs mandate is to service underserved and rural populations. There are plenty underserved in big cities I guess, but the intent was not to serve Cardiologists in Beverly Hills. It is exclusively about Priority Primary Care Providers (small practice & underserved). If the RECs don’t go where they were directed to go, that’s a completely different story.
Why are you assuming that the consulting is biased? What possible incentive could a REC have to be biased? Unlike many “consultants”, they don’t make more money based on a physician’s EHR choice.

3) The population served is not as diverse as you may think. Primary Care docs in small practice – that’s all the RECs currently represent. I think you know as well as I do that the main reason for EHR failure is not really the software, but the lack of planning and change management and here is where the $5000 should be spent. There are happy users for any given EHR and there are miserable failures for the same software in the exact same type of clinic. This is what needs to be addressed.

4) Most RECs are signing docs on a yearly subscription basis. We all know that a PCP small practice can be successfully implemented and brought to Meaningful Use in 3 to 4 months start to end. I don’t see a problem here. MU is really not anything too terribly onerous for Stage 1.

5) Yes, scaling up with good talent is hard. But remember, John, some of the REC grants went to entities that were already staffed (NY is a good example), other went to Universities and others to Quality Improvement organizations. Very few are starting from scratch.

All that said, I don’t think this REC business is a walk in the park and I fully expect a big chunk of RECs to disappear after 2012. But the ones that survive will be very strong and very useful public resources.

As to the EHR vendor market, there are many benefits to the docs and their patients in areas where one EHR has a large presence, particularly if it is a decent product (see eCW in NY). To be honest, I am not too terribly concerned with how vendors fare. I am more concerned with enabling information exchange and quality improvements on behalf of patients. It is easier to accomplish that with a handful of vendors instead of a gazillion disparate systems, some of which will surely go under.
Yes, we could wait for the perfect EHR to come along, but I have a funny feeling it never will, so why not do the best we can with whatever is available now? We can always make adjustments as technology grows and improves.
Right now, if we are to put a dent in the 17% GDP consumed by health care, clinical information exchange is imperative, even if it’s not perfect.

I then posted this response:

My take on the bias of RECs is that if they have a preferred EHR vendor then by its very nature it’s biased. Plus, it’s creating a bias in what I consider to be the most important part of an EMR implementation process: the EMR software selection.

So, while I do agree with you that poor planning leads to some failures, I don’t think it’s the main cause of failure. I actually think selecting the right EMR and the process that’s used to select the right EMR is the key to a successful implementation.

Part of my reasoning for this is that selecting the right EMR and having the right process for selecting an EMR creates a clinical buy in that pays off in spades when you get into the dirty details of implementing an EMR. I think lack of clinical buy in is what leads to most EMR implementation failures and that’s often directly related to the EMR selection process.

I guess that’s why I get my pantyhose all bunched up when I see the EMR selection process tainted.

Certainly a doctor could get up and running and show meaningful use in 3-4 months, but that’s going to be the rare exception. Life and their practice gets in the way and makes it take much longer. Plus, these time frames start once the providers have firmly decided to make the jump. It’s that decision that slows the process more than anything.

I don’t care about the EHR vendor market either, but I do care that the best software is implemented by doctors since that is what will lead to the best patient care and patient outcomes. I don’t want the EMR vendors to be implemented just because they have great marketers.

Health information exchange is great, but until we have them using EMR’s it’s not even a possibility. A bunch of doctors implementing unusable EMR software which they hate will do more to hamper the widespread adoption of EMR software than anything else. This is why I’m so passionate about the best EMR software being implemented. Otherwise, it will take a lot longer to reach the health information exchange nirvana.

Margalit then answered:

The REC recommended list should be created through a stringent screening process which includes RFPs, demos and I’ve heard of one very large REC which has a usability lab just for this purpose. I would hardly call this process “tainted”, particularly since the screenings seem to be performed by practicing physicians.

To David’s point, the recommended list is just the beginning. Each individual practice is then expected to go through the usual vendor selection process and any and all certified EHRs will be considered. As David noted, RECs are obligated to work with any ONC certified EHR and the particular brand will not in any way affect their payments.

I think the RECs bring to the table resources for screening vendors that a solo practitioner does not have. They are also bringing with them certain strength in negotiating favorable contractual terms with recommended vendors. This must be a good thing for the docs.
Will this change the vendor landscape to a certain degree? Yes, I believe it will, but I also believe that the vendor landscape is in dire need of some changing.

I answered:

“The REC recommended list should be created through a stringent screening process”[emphasis mine]

The problem is that many of them haven’t been stringent.

Another “should” is the RECs working with a doctor that has any certified EHR. Of course they will work with them. They need their numbers. The question is what value will they provide that physician? Physicians who don’t use their preferred EHR vendor list won’t be motivated to work with the RECs. Not to mention the overall distrust of the RECs that I’ve seen from physicians.

Margalit,
I agree that they could have used the group buying power for some real good in negotiating favorable contract terms with an EHR vendor. I just wish that they’d actually asked the doctors whom they represent which EHR vendors they should negotiate with. This would have dramatically changed my view of RECs and what they could have offered.

Just remember that change doesn’t always mean a change for good. It could be a change to something worse. I learned that very early on when I had a boss who was less than favorable. Turned out he had his weaknesses, but his future replacement had even more. Fine lesson learned.

Of course, there were some comments in between as well that are definitely worth reading. Go and read the whole thread to see what I mean.

Who said I don’t write long posts on my blogs? lol

5 Reasons Why EHR RECs Will Fail

Posted on October 14, 2010 I Written By

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

This article by Software Advice about the RECs offers 5 reasons why the RECs are going to fail in their mission of helping providers become meaningful users of an EMR:

  • Doctor’s aren’t moving as fast as the money is flowing
  • The market already delivers on what RECs promise
  • “Preferred vendor lists” limit choice and free markets
  • RECs won’t get doctors to “meaningful use” fast enough
  • The REC model leads to under-staffed, ephemeral entities

It’s a pretty damaging list of flaws. I’m not so sure about the second item actually working. Although, I don’t think the RECs are going to be able to do better than the market, so it still stands as a decent point.

I personally think the real problem with most of the RECs is that they’re too worried about their future business model than they are about really fulfilling the mission of helping doctors. Sadly, it’s kind of a feature of the requirements that have been imposed upon them.

Reminds me of the phrase, what you incentivize you will get. Unfortunately, the incentives are tied to numbers and not actual usefulness and quality.