Welcome to EMR and EHR

I find it interesting that I was sent another EMR YouTube video. No doubt YouTube can be a great tool for getting the word out, but so far the views on EMR videos are pretty low. However, I must admit that this video by GE Healthcare is much more interesting than the previous meaningful use video I posted. Plus, they focus on physicians number 1 concern: productivity and reimbursement. Take a look for yourself.

Today we got news of the new ONC-ATCB EHR certifying bodies: CCHIT and Drummond Group. However, this is really just the start of the EHR certifying bodies. ONC released that “Applications for additional ONC-ATCBs are also under review.”

One of those possible additional ONC-ATCB EHR certifying bodies is Weno Healthcare. This EMR Daily News guest blog post (Thanks Michelle for pointing it out) asserts that Weno Healthcare has submitted their application to be an ONC-ATCB EHR Certifying body. They also offer this interesting insight:

Until recently, only one body was promoted to do this testing and certification. Because of no competition, their prices were out of the ballpark for smaller technology companies who may have built the better and cheaper mouse trap for doctors and hospitals, but could not afford the fees for certification. The technology companies that certified their products earlier are not considered certified by the new rules today, so all technology vendors must go through an ONC-ATCB in order to be re-tested and certified, if they choose to do so.

If Weno is approved as an ONC-ATCB, more technology vendors can afford the testing and certification fees. Weno savings can be as much as $19,000 for complete EHRs. These savings will certainly provide physicians and hospitals with more cost effective certified technology options to choose from. Again, competition is a good thing because it brings prices down and quality up.

Comparing the Weno Healthcare EHR certification price above with the CCHIT and Drummond Group EHR Certification prices, it’s going to be really interesting. That puts the costs of EHR certification (not counting software development costs) at:
Weno Healthcare: $14,000-18,000
Drummond Group: $19,500
CCHIT: $33,000

Of course, this assumes that Weno Healthcare becomes an ONC-ATCB and that the prices don’t change. I won’t be surprised if they do change. Plus, there could be other EHR certifying bodies.

It’s been a couple weeks since the news came out that Microsoft was shutting down its operations and sales for Amalga HIS. It always felt awkward for me to see Microsoft purchasing a software that was so specific. It just didn’t make sense to me for Microsoft to go after this type of specific product.

John over at Chilmark Research has a good post with his reasons why Amalga didn’t work well for Microsoft. I’m still pondering his comment that the EMR market is mature. However, his take away is a very good one:

Performing a viability assessment on a potential vendor may not reduce one’s risk. Even a big, viable company such as Microsoft may change its mind on occassion and chose to exit a market.

The only clarification I’d make is that a viability assessment does not equal evaluating if the company is big and viable. I cover this topic in my EMR selection e-Book and in these two posts. Not to mention this post on open source (free) EMR software viability.

I think the viability assessment is useful and essential. Just don’t make the simple assumption that large means viable. Ask Misys users about that one.

Yes, that’s right. Medical records just thrown away at the dump. Now that’s what I call some investigative reporting. Here’s the story:

Four Massachusetts community hospitals are investigating how thousands of patient health records, some containing Social Security numbers and sensitive medical diagnoses, ended up in a pile at a public dump.

The unshredded records included pathology reports with patients’ names, addresses, and results of breast, bone, and skin cancer tests, as well as the results of lab work following miscarriages.

Of course, you might be asking yourself how these records were found at the dump. Well, here’s the answer:

A Globe photographer discovered the records July 26 when he was dumping his trash at the Georgetown Transfer Station. When he got out of his car, he said, he saw a huge pile of paper about 20 feet wide by 20 feet long. Upset that the paper wasn’t being recycled, he looked more closely.

The photographer said he saw health and insurance records from at least four hospitals and their pathology groups — Milford, Holyoke, Carney, and Milton — mostly dated 2009. The Globe notified the hospitals. It is unclear how many other hospitals’ records might have been discarded in the dump.

Word is that the records were scanning into an EMR and then dumped the cheap (and illegal) way and that’s how they ended up at the dump. I think unemployment numbers in Boston just increased too since I’m sure someone will be losing their job for this.

In another great comment from BobbyG (who works for a REC), he talks about the realization that states have the option to opt out of doing the Medicaid part of the EMR stimulus if they want. The following is the full explanation of the discovery and why they’d make such a decision. Plus, it highlights the challenge of understanding all the regulations around the HITECH act.

Here’s just one example of the difficulty you run across. Yesterday we were on a CMS conference call MU incentives presentation in which they said that states’ participation on the Medicaid side was “voluntary.”

We all went “WHAT?! How did we miss that?”

Sure enough: on the CMS website you see “The Medicaid EHR incentive program is voluntarily offered and administered by States and territories. States can start offering their program to eligible professionals (EPs) as early as 2011″

“voluntarily”, “can start”

Not “shall” or “must”.

Now, we knew from the IRF that (paraphrasing here) “there is no statutory basis for the manner via which states disburse incentive payments” but it somehow escaped us that states could simply opt out entirely.

I went back to the ARRA legislation itself (on the assumption that the FR cannot, beyond operational implementation mechanics, mandate additional requirements not in the legislation). Beginning on page 375 you see “Subtitle B—Medicaid Incentives SEC. 4201. MEDICAID PROVIDER HIT ADOPTION AND OPERATION PAYMENTS; IMPLEMENTATION FUNDING.”

You get to page 380 and then only see stuff about the administrative and reporting “requirements” for states getting the “FFP” money (Federal Financial Participation).

And that’s it.

I searched ARRA from beginning to end and found NO explicit wording that states’ Medicaid participation is “voluntary.” You just have to infer it from the Section 4201 language.

What is one potential adverse upshot? Your REC could be signing up a boatload of providers coming in on the Medicaid side, and if your state opts out, well you now have what’s known as “Reputation Risk” writ large (not to mention a torpedo below the waterline in your Ops plan and its milestone payments assumptions).

Why would a state opt out? Because they are only federally funded for 90% of their “reasonable” administrative expenses for the EHR incentive program. They have to find the other 10%. My state (NV) is currently wrestling with a three BILLION dollar budget gap. Similar relative woes exist elsewhere in statehouses (can you say KAHL-EE-FOR-NEEYA?).

You better know where your state stands before recruiting Medicaid providers if you’re a REC or a consultant or VAR, etc.

Many people that read this blog have never heard of Medical Informatics Engineering (MIE) until they saw this blog post. Honestly, before HIMSS this year I hadn’t really ever heard of them either. However, at HIMSS I was introduced to their story and was really intrigued. Yesterday they announced a new CEO, Bruce Lisanti to lead the company. Here’s a section of the press release:

“With the pending changes in the US healthcare system and with meaningful use criteria now finalized under the HITECH Act’s electronic health records (EHR) incentive program, there is an unprecedented opportunity for growth and expansion in the healthcare IT industry,” said Mr. Lisanti. “Electronic health records can enable physicians, hospitals, labs and patients to work together more easily. When combined with fully functional personal health records (PHR), electronic communication and access to information can substantially reduce the overall costs of the healthcare system. As one of the only fully integrated, web-based EHR systems available today, MIE has an enormous opportunity to become a leader in this space.”

“MIE has already demonstrated an impressive ability to promote the broad adoption of this technology on a regional scale,” Lisanti continued. “The MIE Health Information Exchange is currently utilized by over 90 percent of the physicians in Northeast Indiana with 55 percent of these doctors using the WebChart EHR system from MIE. Our goal is to take this model nationally, positioning MIE as a leader in healthcare IT.”

What I find most interesting about stories like this is that they’re happening every single day. With over 300 EMR vendors out there, there are hundreds of MIE like EMR vendors that don’t see all the headlines, they don’t have big fancy conferences, but they’re just grabbing their portion of the EMR market.

I guess that’s why I mostly just laugh when I see someone try to calculate the EMR vendor market share. The company with the largest EMR market share is called “Other” and includes the 100′s of EMR vendors that most people don’t know about.

In this post, Susan White looks at the real challenges that we face with integrating medical devices with EMR software. The lack of real industry wide standards is really at the crux of this issue and I don’t see a solution to this in sight. First, we probably need to narrow down the more than 300+ EMR vendors to something more manageable.

Technology is supposed to make our lives easier and more convenient, but when said technology makes us adopt roundabout ways to do work and takes up more of our time in the process, it is worse than useless. In such cases, it becomes a white elephant that costs more than it is worth, and it’s better to do without the technology than spend hundreds of thousands of dollars on something that’s not more than a showpiece. This is exactly what’s happening with EMR systems – they’re supposed to make medical history access, updates and management as easy as pie for hospitals and other healthcare facilities; instead, they’re becoming a headache because of integration problems.

In an ideal world (the one that the EMR was designed for), medical devices could be hooked to EMR systems which would automatically record readings for patients and store them in the right records. However, in reality, the machine spews out the values and nurses or technicians record them on paper and then feed them manually into the EMR. If this is the norm rather than the anomaly, why invest in EMRs? Why not just use a regular patient database that can be queried for patient records and updated manually?

The problem is not that the medical devices or the EMR are faulty – rather, it is the fact that there are serious integration issues between the two. Direct capture seems to be something that is destined to remain the stuff of dreams because different manufacturers adhere to varying standards and this means that the integration protocol changes. There is no industry-wide standard for the integration of medical devices and EMR systems and because of this, integration becomes a thorny issue.

The very purpose of using EMRs is to reduce medical errors, decrease the amount of paperwork, boost staff productivity, and deliver clinical results in an accurate and timely manner. When manual data entry is used as opposed to automatic data capture, all the above advantages are nullified, and this means that the healthcare facility has wasted money in the course of the EMR investment.

The trouble here is that connectivity to and integration with medical devices is an afterthought for EMR manufacturers. Besides, with each company following its own standards for connectivity hubs, there is no way that all EMRs can be uniformly hooked up to all medical devices. There are ways to resolve this issue, but it has to be consciously addressed by the healthcare facility that is investing in an EMR. They have to ensure that their devices are connected to the EMR to facilitate automatic data capture, and if they are not, they must work with the EMR provider or the device manufacturer or a third party vendor to provide a suitable connectivity interface.

But with cost being a substantial factor, most healthcare facilities are averse to such extra efforts; this leaves the future of EMR systems in a limbo – how long will people continue to invest in elephants if they know that they are white and so prone to expenditure without proving their worth? Only time will tell!

This article is contributed by Susan White, who regularly writes on the subject of surgical technician schools. She invites your questions, comments at her email address:susan.white33@gmail.com.

The people over at FierceIT recently reported that a hospital employee was recently fired for comments the employee made on Facebook. Here’s the story:

An employee at Oakwood Hospital in Michigan was fired after she posted negative comments about a patient on Facebook, WJBK Fox 2 reports.

In her post, Cheryl James said she came face-to-face with a cop killer and hoped he rotted in hell. She also posted another remark WJBK would not repeat.

The hospital gave the following reasons for the firing:

A statement released by the hospital referred to HIPAA rules and noted that “we all have a legal and ethical responsibility to put our personal opinions aside and provide the care required for any patient who has entrusted us with their health.”

James plans to fight her termination, claiming she did not share the patient’s name, his condition, or the name of the hospital.

Doesn’t seem like a HIPAA violation to me. Although, it is poor discretion and in poor taste. I am often amazed at what people post to Facebook. Some people just don’t realize how public it really is. I guess after things like this, the idea of a Facebook PHR isn’t very likely either.

I must admit that I’m also amazed that the hospital worker had access to Facebook. Hospital computers are some of the most guarded computers I’ve ever seen. Unless of course she posted from her phone. We’re bound to see a lot more of this. In fact, at some point we’ll see pictures and/or video of patients posted to Facebook.

I wrote previously about the Signapore government accepting proposals for a national EHR. Today I got the news that Accenture has been contracted to implement the Singapore National Electronic Health Record (EHR) system. Obviously Accenture is a big name and a big group. I’ll be interested to learn which EHR software system they plan to implement to create the national EHR system. International EMR movement like this is very interesting.

Here’s the press release from Accenture about the announcement.

Accenture Wins Contract to Implement Singapore’s National Electronic Health Record System

SINGAPORE; Aug. 2, 2010 – The Singapore Ministry of Health has awarded Accenture (NYSE: ACN) a contract to implement the National Electronic Health Record (NEHR) system, a key enabler of Singapore’s vision toward a national, integrated health care system. The NEHR is designed to improve the quality of healthcare for citizens, lower the costs of health services, and promote more effective health policies.

Under the NEHR, key medical information such as patient demographics, allergies, clinical diagnoses, medication history, radiology reports, laboratory investigations and discharge summaries will be exchangeable among healthcare providers. Patients also may benefit from proper, right-sited disease management and cost savings, as duplicate or unnecessary tests are eliminated and medication errors are reduced.

“As the centerpiece of Singapore’s connected health vision, the NEHR is intended to provide a holistic view of a patient’s health information. With this market-leading offering, health care providers can have the right information at the right time to make the best care decisions,” said Stephen J. Rohleder, group chief executive of Accenture’s Health & Public Service operating group. “We congratulate the Ministry of Health for taking this bold step to create a new foundation to help support meaningful advances to Singapore’s health care system.”

The National Electronic Health Record vision – “One Singaporean, One Health Record” – was previously announced by Singapore Health Minister Khaw Boon Wan. With the initial system release in April 2011, Singapore will be one of the first countries in the world to implement a national electronic health record system.

The Accenture team includes Oracle, Orion Health, Initiate Systems, Inc., and Hewlett-Packard.

UPDATE:
Mark told us who will be providing the software for the Singapore EHR in the comments. EHR Software is being delivered by 3 Partners;

Oracle’s HTB is the core Clinical Data Repository
Initiate is providing the Master Patient Index; and
Orion Health the Clinical Viewer & Messaging fabric using their Concerto & Rhapsody products.

Some really big news dropping yesterday that Pulse and Cegedim Healthcare Software (CHS) (a European company) were merging. As part of the merger, Pulse is getting a $13.5 million capital infusion.

I’ve been very interested in what the future of Pulse would be after meeting with them at HIMSS. This looks like a good step forward for them and a nice infusion of money to be able to really attack the US EMR market full on.

I think this also illustrates the potential market opportunity that’s available for EMR vendors. I’ll be interested to see what Pulse is able to do with all the cash. Hopefully, they’ll use a very small part of it to advertise on the EMR and HIPAA & EMR and EHR websites.

As is usually the case with mergers and acquisitions of EMR vendors, the next question is what’s going to happen with the company and the software product after the merger. Seems like this is mostly just an investment by the Cegedim Group in the US market and not about merging and sunsetting product lines. Looks like Pulse will continue to operate as it has in the past, but with a bunch more money in the bank.

Here’s the letter from Pulse President and CEO, Basil Hourani, that was sent to Pulse clients:

I am pleased to announce the strategic investment and merger of Pulse and Cegedim Healthcare Software (CHS) – a division of Cegedim Group. Through the merger, Pulse will continue to operate independently with our existing management team, personnel, locations, products and services. As part of the transaction, Pulse received a $13.5 Million capital infusion which will immediately provide capital to accelerate aggressive growth of our Electronic Health Record (EHR) and Practice Management (PM) solutions as well as development of next generation Pulse products including our web-based solutions. Pulse growth plans include the addition of more than 350 new employees in all departments by the end of 2012 and additional offices in key expansion markets.

CHS is the European leader in medical software including EHR products geared to the European markets. CHS currently serves 119,000 physicians and 16,000 pharmacies in Europe but does not have any medical software presence in the US. The Pulse existing and future products and services will serve as the platform for the US markets going forward.

We are very pleased and energized about the investment in the Pulse solution. It is recognition that our EHR and PM software is a future-ready solution and the right platform. This investment strengthens our ability to continue Pulse’s strong momentum and record setting growth that we have been experiencing, and take advantage of the expected growth in the healthcare IT market fueled by the unprecedented government incentives.

As you have always been accustomed, you will continue to enjoy the personal service and support from Pulse management and personnel. Pulse will continue to be headquartered in Wichita, KS with offices in; Boston, MA, Dallas, TX, and Kansas City, MO. We look forward to our mutually beneficial continued relationship with you and thank you for your patronage.

Best Regards,

Basil Hourani
President and Chief Executive Officer
Pulse Systems, Inc.