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In addition to what I wrote about in my previous post, Marc Holland also does a pretty detailed analysis of the resources that RECs will have available to help resolve these physician concerns. He estimates in New York (where there are 2 RECs), they will have $4850 per physician available. The Ohio REC has $4750 per physician and the Michigan REC has $3300 per physician.

Of course, this per physician rate is a little misleading since these RECs won’t get their entire grant if they don’t perform. So, depending on how they do, it could be even less.

He also estimated based on the above numbers and the average cost for an EMR consultant that the RECs to break even would be able to provide “roughly two person-weeks in total – for contracting, for site planning, for training, for installation and first line post-implementation support.” Then, he suggested that wasn’t likely enough.

I generally agree that 2 weeks is not enough. However, it depends on the EMR consultants and more importantly, how creative the RECs become in using their EMR consultants and other resources. I’ve implemented in a clinic in two person weeks total spread out over a bit of time. So, it’s definitely possible. However, is that the best use of the resources the RECs have been given?

I personally don’t see the RECs providing this type of “free EMR consulting” services. I think the RECs are going to focus on more broad based strategies. The problem is that if you’re too broad based, then you aren’t that helpful. However, if you’re too focused then you can’t help enough people. Walking this line is going to be an interesting challenge.

Marc Holland, also suggests from the above numbers that the New York RECs alone will have to ramp up staffing to at least 100-120 analysts in the next 60-90 days. For me, that’s just funny to even think about. How many qualified EMR analysts (consultants if you will) are there in the US? And how many of those that are really qualified will want to go and work for a REC?

This is going to be really interesting to watch.

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.

Over on EMR and HIPAA I posted a poll this weekend asking people to share their plans for the EMR stimulus money. Basically, how important is the EMR stimulus money to them? Will they be going after it no matter what or will it just be a nice bonus if things work out. I encourage readers of this site to go and vote also. The more people that vote the more interesting the data.

So far, It’s kind of split between people who are planning on the EMR stimulus money and those that “if they get it…great.” Although, a decent number of people use EMR and don’t care about the EMR stimulus. Granted it’s still early in the voting. So, it will be interesting to watch this evolve as more people share their opinions.

I’ve preached this point many times since we heard about the EMR stimulus money, but I can’t help but repeat it over and over so that as many doctors as possible will get the right message. Bill Karmis from Media Spider left the following comment which aligns pretty well with my thoughts on EMR selection:

As you have seen in many of my posts, I believe the real reasoning behind choosing a method and using it should not be based on recovering money for doing so. It should be done for the core reasons that EMR EHR systems were invented.

1 To be more efficient in the workplace.
2 To more effectively collaborate with your peers.
3 To be responsible for the information you are to maintain and a physician.
4 Reclaim valuable office space.

In either case, the stimulus money is a carrot being dangled my our government. The same government that is probably 10 years behind the average technological curve.

The same government that we know puts more spin on everything they get involved with than any individual would be allowed to do.

In case you don’t read my other blog, EMR and HIPAA, I released my first e-Book. This book focuses on EMR selection. So far I’m quite happy to report that a bunch of people have bought the book.

Shahid, the healthcare IT guy, wrote up a full review of my EMR selection e-book. Here’s just a few of his comments [emphasis mine]:

“I now recommend it as a must-read for anyone that’s looking to purchase an EMR and wants to know how to make sure they don’t get sold a lemon by a vendor.”

“The final selection guidelines and the contract negotiation section itself is worth the price of the book alone.”

“If you’re looking to select an EMR, this is a great book to start with. No fluff, just sound advice and a “how to” guide that you can trust to get you to a good selection and purchase decision.”

I look forward to hearing more feedback on the book.

It seems like everyone is trying to get in on the EMR selection game. At the end of the game, I think this is actually a really good thing. I’m all about lots of competition which drives people to provide better service and quality at a lower cost.

The latest entrant I’ve seen to this arena seems to be basically an EHR Selection Consultant group. It’s being run through the wholly-owned subsidiary of the American Academy of Family Physicians, TransforMED.

There are three consulting paths that they offer as follows:

EHR Prep-Select is a 10-step project that is further broken down into nearly 40 individual assignments. The program includes four hours of consulting with an experienced industry expert and provides access to a Web portal that contains electronic worksheets, templates, surveys and tables designed to streamline the process of capturing, analyzing and disseminating EHR project data between internal staff and EHR vendors.

EHR Prep-Select “Plus” provides additional consulting time to help supplement the internal resources required to complete a full EHR selection project, and the Prep-Select “Premier” offers consulting from start to finish.

No doubt there’s a need for doctors to have some help in selecting from the 300+ EMR vendors that exist out there. The problem today is that doctors need to hire a consultant to tell them which EMR consultants are good and which ones are smoke and mirrors. For example, I find the above program interesting, but I have no clue how good it really is.

If I were starting the EMR selection process today, I’d go and check out EMR Consultant first. Hard to get better than a free service.