Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

The State of the Meaningful Use

Posted on January 30, 2014 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.

UPDATE:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?
Responses:
*Michael Sherling, MD – Modernizing Medicine
*Shahid Shah – Influential Networks
*Joel Kanick – interfaceMD
*Michael Brozino – simplifyMD
*Dr. Michael Koriwchak
*Karen Knecht – Encore Health Resources

I recently wrote what’s been a really popular article on EMR and HIPAA called “Meaningful Use Program a Success…Depending on How You Measure Success.” I think we’re at an interesting point in the meaningful use program and it’s worth taking a step back and seeing where we’re at with meaningful use.

As I state in the other article, there’s no doubt that the EHR incentive money has moved the needle on EHR adoption. Those of us who believe that EHR holds lots of potential benefit to healthcare have to be happy about the amazing EHR adoption rate that has occurred thanks largely to $36 billion of EHR incentive money (we’ll save the question of whether we’ve gotten our money’s worth for another post).

While we could Monday Morning quarterback (appropriate football reference the week of the Super Bowl) the EHR incentive program and meaningful use, that won’t change the fact that it’s here and it’s not going anywhere. So, instead of asking whether we should have spent the money on EHR and whether we should have done meaningful use, I decided to take a deeper look at meaningful use and how we could improve the program. Which elements of meaningful use are really adding value and which parts of meaningful use should be removed? Or maybe it’s all great and we should just continue on the path we’re on.

I decided to use a simple approach to identify what’s good and what’s bad with meaningful use. I reached out to EHR vendors, doctors, practice managers, hospital executives, and other EHR experts and asked them a simple question. The answers to this question should provide a solid understanding of what’s meaningful in meaningful use and what’s not.

Here’s the question I asked:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?

The concept is simple. If there wasn’t some outside influence (ie. government money) influencing the requirement to do meaningful use, which elements of MU actually provide value to the users of an EHR. Those that provide value will continue to be embraced by an EHR vendor and those that don’t will be removed. Plus, this is the reality of what’s going to happen once the EHR incentive money runs out, so let’s find this info out now.

I originally thought that this question would lead to a blog post with quotes from a variety of people offering their unique perspectives. However, every person who’s answered so far had so much to say on the topic, that each of their responses was worthy of a blog post of its own.

With that in mind, over the next couple of weeks, I’ll be posting all of the responses as separate posts across the network of Healthcare Scene blogs. I’ll link each of these blog posts at the bottom of this post as they are published.

Open Call for Participation
As I considered this, I realized that hundreds of other people might want to participate as well. As a health IT community I think we can make a real impact. So, I encourage everyone who reads this to publish their response to the question above.

If you have your own blog, publish it there and link back to this post so we can add your post to our list below. If you don’t have a blog, wish to remain anonymous, or would just rather have us publish it, we’re happy to publish it for you. Drop us a note on our contact us page and we can work out the details.

I believe this will become an incredible resource of information to better understand how to improve meaningful use. Once I’ve gathered a good number of responses, I’ll be reaching out to ONC and CMS to make sure they take in the body of contributed work as well. Hopefully this simple approach will be effective at gathering a response from more people than the convoluted rule making process was able to do.

Meaningful Use will go down as one of the most impactful things to hit healthcare IT and EHR in my lifetime. It behooves us to do what we can to make the most of meaningful use.

EHR Certification Revoked for EHRMagic

Posted on April 26, 2013 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.

Yesterday HHS released news that they’d revoked the EHR certification of the EHRMagic-Ambulatory and EHRMagic-Inpatient EHR software. Looks like InoGard originally certified the EHR and they and ONC received information that had them retest the EHR software and it failed the certification re-test.

I think we all want government to hold bad actors accountable. So, it’s good to weed out EHR companies that aren’t doing what they should. However, they better also be careful. Imagine being a doctor of an EHR vendor whose EHR certification gets revoked. Does that mean that they have to give back the EHR incentive money the received? Those doctors trusted in InfoGard’s ability to certify an EHR vendor and InfoGard failed at that job. Should a doctor be punished for InfoGard’s failing? Now apply this to a hospital that uses a certified EHR and loses that EHR certification. That’s a multi-million dollar impact.

I guess EHRMagic better take down the info on their website that says they can get physicians $44,000 in EHR incentive money. Looking at their website, it makes me wonder who chose to use their EHR in the first place. That would be interesting to know.

Here’s the full press release from HHS on the EHR revocation:

Two electronic health records, previously certified as products to be used as part of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, have had their certifications revoked. Farzad Mostashari, M.D., the national coordinator for health information technology, announced today that the products do not meet standards and providers cannot use these products to meet the requirements of the Medicare and Medicaid EHR Incentive programs.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both developed by EHRMagic Inc. of Santa Fe Springs, Calif., no longer meet the EHR certification requirements. The EHRs must be certified by a certification body (ACB) authorized by the Office of the National Coordinator for Health IT (ONC) before regaining certification.

Both ONC and an ONC ACB, InfoGard Laboratories Inc. (InfoGard), received notifications that the EHRMagic products did not meet the required functionality and the products should not have passed certification. InfoGard analyzed the additional information from the notification and contacted EHRMagic, launching the ONC authorized certification body required surveillance activities. InfoGard concluded that it was necessary for the EHR products to be retested for select requirements. EHRMagic, Inc. participated in retesting and failed.

“We and our certification bodies take complaints and our follow-up seriously. By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” said Dr. Mostashari. “Because EHRMagic was unable to show that their EHR products met ONC’s certification requirements, their EHRs will no longer be certified under the ONC HIT Certification Program.”

Information about ONC’s certification process for EHR technologies is available at http://www.healthit.gov/providers-professionals/certification-process-ehr-technologies.

EHR Incentive Sequestration and Guidance on Meaningful Use Attestation

Posted on April 25, 2013 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.

The CMS website has a great resource with answers to a number of FAQs. For example, here’s two questions that related to sequestration’s impact on EHR incentive and meaningful use attestation.

Question: Will incentive payments earned in the Medicare and Medicaid Electronic Health Records Incentive programs be affected by sequestration?

Answer: Incentive payments made through the Medicare EHR Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible hospitals will be reduced by 2%. This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction.

Please note that this reduction does not apply to Medicaid EHR incentive payments, which are exempt from the mandatory reductions.

Question: For the Medicare and Medicaid EHR Incentive Programs, how should an EP, eligible hospital, or critical access hospital (CAH) attest if the certified EHR vendor being used is switched to another certified EHR vendor in the middle of the program year?

Answer: If an EP, eligible hospital or CAH switches from one certified EHR vendor to another during the program year, the data collected for the selected menu objectives and quality measures should be combined from both of the EHR systems for attestation. The count of unique patients does not need to be reconciled when combining from the two EHR systems.

If the menu objectives and/or clinical quality measures used are also being changed when switching vendors, the menu objectives and/or quality measures collected from the EHR system that was used for the majority of the program year should be reported.

EHR Incentive Money and Sequestration Update

Posted on April 11, 2013 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 HIMSS, the news was tweeted out about the impact of Sequestration on Meaningful Use and EHR incentive money. I’d seen little other details about the impact of sequestration on the EHR incentive money until now. CMS just sent out the following update on the mandated sequestration.

Mandated Sequestration Payment Reductions Beginning for Medicare EHR Incentive Program

Incentive payments made through the Medicare Electronic Health Record (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011.

Incentive Payment Reduction
The American Taxpayer Relief Act of 2012 postponed sequestration for two months.  As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible hospitals will be reduced by 2%.

Reduction Timing
This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction.

Please note: This reduction does not apply to Medicaid EHR incentive payments, which are exempt from the mandatory reductions.

The 2% will be a little annoying for a doctor’s office, but the 2% off the multi-million dollar EHR incentive a hospital receives is going to add up to a pretty penny. At least the information is out there so that hospitals can plan. Although, it’s not like you can stop the EHR implementation at this point in the cycle.

October 3 is the Last Day for EPs to Begin the Medicare EHR Incentive Program in 2012

Posted on September 25, 2012 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.

Wednesday, October 3rd marks two important deadlines for the Medicare EHR Incentive Program:

  1. The last day for eligible professionals (EPs) to begin their 90-day reporting period for calendar year (CY) 2012 for the Medicare EHR Incentive Program. For EPs, this means that they must begin their consecutive 90-day reporting period by October 3rd in order to attest to meeting meaningful use and be eligible to receive an incentive payment for CY 2012.
  2. The last day Medicare EPs can start participating and receive their maximum possible Medicare incentive payment. This is the last year that EPs can begin participation in the EHR Incentive Program and get the full Medicare incentives of $44,000 per EP. If first-year Medicare EPs have not started their 90-day reporting period by October 3rd, they will not be eligible for a CY 2012 payment, and can only receive $39,000 in Medicare incentives if they successfully participate in 2013.

For more information on how incentive payments are distributed, take a look at the EHR Basics page of the newly updated EHR website. For EPs who have already completed their reporting period, CMS has a number of tools available to help prepare for attestation, including the Meaningful Use Attestation Calculatorand Attestation User Guide for Eligible Professionals.

Looking Ahead
Take a look at all of the other EHR Incentive Program important dates that are coming up by going to our Health Information Technology Timeline.

Meaningful Use Stage 2 Final Rule Published

Posted on August 23, 2012 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.

UPDATE: For those not wanting to go through all 672 pages of the meaningful use stage 2 final rule, ONC has put out this summary PDF.

Today, CMS publishes the meaningful use Stage 2 Final rule in the Federal Register. The MU stage 2 final rule is 672 pages long.

The HHS press release announcing the EHR incentive money stage 2 final rule also offered these important points to note:

  • Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
  • Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
  • Modify the certification program to cut red tape and make the certification process more efficient.
  • Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

The second point annoys me a little after hearing about some of the EHR certification fraud and issues it could cause providers that attest to meaningful use.

The press release also offered the following EHR incentive participation numbers:
-120,000 Eligible Health Professionals have participated
-3,300 Hospitals have participated
-More than half of all eligible hospitals and critical access hospitals and 1 out of every 5 eligible health care professionals

Watch for more detailed coverage of the meaningful use stage 2 final rule in our ongoing Meaningful Use Monday series.

Meaningful Use Stage 2 Comment Period Ends May 7th

Posted on May 4, 2012 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.

ONC and CMS sent out the following email about the meaningful use stage 2 comment period. It closes very soon and so I encourage everyone to submit their comments on meaningful use stage 2. I’m a real proponent of the benefits of crowd sourcing and if enough people comment on meaningful use stage 2, I think we’ll receive the benefits of the crowd participating in the discussion and improving MU stage 2. I encourage doctors in particular to share their comments on the meaningful use stage 2 NPRM.

Please note that the comment period closes on Monday, May 7 for the notices of proposed rule-making (NPRMs) for Stage 2 of meaningful use and updated certification criteria.

The Office of the National Coordinator for Health IT (ONC) rule proposes the capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to, at a minimum, support the achievement of “meaningful use” by eligible health care professionals beginning with the EHR reporting periods in FY/CY 2014. The rule also proposes revisions to the permanent certification program for health information technology, which include changing the name of the program to the “ONC HIT Certification Program.”

ONC’s rule complements the newly released Centers for Medicare & Medicaid Services (CMS) proposed rule for Stage 2 of the EHR Incentive Programs, clarifying the specifications necessary to meet the criteria for these programs.

Comments Can Be Submitted in 4 Ways

Both ONC and CMS rules identify that comments can be officially submitted in 4 ways:

  1. Electronically through www.regulations.gov – this is the preferred method
  2. Regular mail
  3. Express mail or overnight mail
  4. Hand-delivered/courier

Faxes are not accepted.

To enhance the public comment experience, ONC and CMS have made a copy of the rule available in Microsoft Word to make it easier those who comment to access and copy portions of their proposed rule for use in their individual comments.  Visit http://www.healthit.gov/providers-professionals/meaningful-use-stage-2 for more information.

Love it or Hate it, Meaningful Use Stage 2 is Fast Approaching

Posted on February 15, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Valentine’s Day may be behind us, but I still wonder how many providers would be willing to write love notes to their EHR vendors, especially with rumors swirling that CMS will release Meaningful Use Stage 2 requirements in the next few weeks. (John Moore at Chilmark Research is apparently taking bets via Twitter, if anyone’s interested in doing a bit of gambling in preparation for the big HIMSS event in Vegas next week. He predicts it will be the Friday after HIMSS. I think it might just make good fodder for Farzad Mostashari’s keynote next Thursday morning, as he has been vocal about delaying the start of Stage 2 until 2014.)

Whether they’re released during or after the show, I decided it would be a good idea to bone up on Stage 1 versus Stage 2, and how what may or may not be included in Stage 2 will lead providers to love (or hate) their systems all the more.

I fortunately came across a very well written and comprehensive (though not too long) report from CSC entitled “Moving Ahead with Stage 2 of Meaningful Use,” which provides a very clear-cut picture of the challenges providers found with Stage 1, and what they are likely to encounter as challenges in Stage 2. It’s a brief, informative read that I highly recommend folks take a look at before they head to HIMSS in just a few days.

My biggest take away from the report was that the providers surveyed had done very little in Stage 1 to engage patients and coordinate care, which is not surprising given that most were concentrating on getting their EHRs up and running in time to fully attest for Stage 1. Combine this with the fact that formal ACO rules weren’t released until late last year, and I can understand why engaging patients and coordinating care just wasn’t on the radar of most healthcare facilities.

But oh what a difference a few months can make! The CSC report notes “Stage 2 is coming soon and a full year of operational use of capabilities will be required (rather than three months for Stage 1). Waiting until the final rule is issued to start moving is simply not an option.

“Now is the time for organizations to work in earnest to build capabilities to engage patients, coordinate care and electronically report on quality.”

And finally, the report notes that:

Three essential areas where organizations need to start now are:

  1. Providing patients with access to their health information electronically through patient portals or directly from EHR systems.
  2. Electronic capture of physician notes, including diagnosis and treatment, plus rationale for excluding patients from treatment recommendations.
  3. Exchange of patient information at transitions in care.

I’d be interested to hear from our readers that have successfully attested for Stage 1 how they view these predictions for Stage 2. Are they manageable? Do they fit with your organization’s current strategy? Please share your thoughts in the comments below.

US EMR Market to Exceed $8 Billion in 2016

Posted on January 2, 2012 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.

In case you missed it, I’ve moved a lot of my discussion of the EMR and Health IT markets to my site: EMR Thoughts. I’ve done a lot of posts on that site that look at the EMR market, the health IT investments, the Health IT incubators (or accelerators if you prefer), and other movement in the EMR, EHR and Health IT markets. If you like that type of content, you should definitely subscribe to the EMR Thoughts email list.

Even though, I’ve moved a lot of my EMR market discussion to the other site, every once in a while I’ll drop in some EMR market stuff on here as well. In the article linked in my Costco EMR post, they discussed the size of the EMR market:

Millennium Research Group said in its November report, “U.S. Markets for Electronic Medical Records 2012,” that the U.S. market for EMRs will exceed $8 billion by 2016, with the fastest-growing segment occurring in the small-practice market. Web-based EMRs that don’t require an expensive information technology infrastructure are contributing to the growth, the report said, because they are an affordable option for small practices on tight budgets.

I always hate when they don’t split the EHR market into ambulatory EHR and hospital EHR. I also still haven’t figure out a good way to reconcile that the EMR market in the US will be $8 billion in 2016, but we’ll have spent a good portion of the $36 billion of EHR stimulus money by 2016. Those two numbers don’t jive very well.

I also find it interesting that the fastest-growing segment of the EMR market is the small-practices. I’m not sure I agree with this. I think the larger sales and hospital EHR sales are brisker than the small practice EMR market. Much of the small practice market is still “waiting and seeing.”

Pediatrics Face Unique Set of EMR Challenges

Posted on October 26, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

My recent blog about Sandhills Pediatrics and its successful implementation of an EMR prompted, fortunately, a very intriguing comment from Chip Hart, a Director of Sales and Marketing at Physicians’ Computer Company who also maintains the blog “Confessions of a Pediatric Practice Consultant: True Stories from the land of Pediatric Practice Management.” He wrote: “I’ll spare everyone the diatribe about how ARRA deals with pediatricians and how only about 1/2 of them qualify, as I write to make one quick statement.” There’s a story there, I thought to myself. So, being an avid observer of pediatric EMR news and views, I reached out to him to gauge his thoughts on where healthcare IT solutions fit in the world of pediatricians.

What sort of challenges are you seeing pediatric practices facing when it comes to implementing EMR systems?
“On one hand, most of the challenges they face are hardly unique to pediatrics: resistance to change, practice differences, the lack of time and resources to be trained and configured properly, poor support, etc.

“Specific to pediatrics, there are two major issues.  First, children are not simply small adults and EMRs, as a rule, are written for adult medicine. There are many pediatric-specific features and functionality that a pediatric practice needs that simply aren’t met by your large, generic system. Simply claiming “pediatric templates” isn’t enough.

“Second, although every specialty complains about the hit that EMRs take on their productivity, pediatricians are obviously in the worst shape. Their volume is the highest and their payment is the lowest. Just adding a minute to each encounter means an extra 30 minutes of charting a day … and I hear stories, daily, of practices adding another 1 to 2 hours! Pediatricians can’t afford to see 5-percent fewer patients. Radiologists can. And pediatricians really like to eat dinner with their families.

“One second-tier issue is that less than 50 percent of all pediatric practices don’t qualify for ARRA and the regional extension centers (RECs), as a rule, don’t understand the Medicaid rules well.  Thus, we have clients and potential clients calling us to ask how they can get money they’ll never get, or to tell us some crazy thing a REC person told them.”

Are there different sets of challenges for those that are private practices versus those that are hospital/healthcare system affiliated?
“Unquestionably – the big one being that hospital/health system pediatricians simply won’t have a choice or even a voice in the process. Yes, I’ve worked with some who appear to be at the table, but in the end … you get what they hand you. Right now, Epic is pushing everyone out but that pendulum will swing back.

Also, those employed physicians don’t have to consider the impact on their productivity in the same way. I’ve met too many peds offices whose docs didn’t take home checks for a few months after implementation – that’s not right.”

Why do you think practices like Sandhills “get it” in terms of moving forward with HIT implementations, and just being forward thinkers in general?
“If I could answer that question, I’d only be working with those practices! Every successful practice I know is successful in a different way for different reasons, but there is one common trait I see in many of them: They run their practices like the businesses they are. Keep the docs in the exam rooms, where they can generate revenue, and hire professionals to actually run the business. Just because it says “MD” after your name doesn’t mean you’re the best-qualified person to run your office. Would Dirk Nowitski or Lebron James make good coaches? I doubt it.

“In the case of Sandhills, they have some excellent, excellent staff who bring some non-healthcare experience to the table. Although I’ve seen it fail, having some management that comes from outside the healthcare system to ask and answer some tough questions pays off for a lot of practices.

“We’ve enjoyed working with them.  I should also add that they, like the other ‘heads up’ clients I know, realize that we’re on the same team. That helps tremendously.”

How long have you offered the PCC EMR? What sort of up tick in implementations have you seen since ARRA/HITECH came about?
“Our PM has had pediatric clinical features (immunization tracking, registry interfaces, well visit recall, etc.) for almost 30 years, but the official EMR itself was released about 2 years ago.

“When ARRA was first announced, we received a lot of calls, all along the lines of, “Where do I get my free money?”  It was very frustrating to explain that it would be state dependent (about a quarter of them still can’t get it) and half of our clients will never qualify due to the Medicaid requirements.

“Things are starting to settle down and get organized.  Still, we are busier right now than we have ever been. We are telling potential clients they might get installed in May or June. A nice problem to have, but it’s not fun to get some excited only to explain it will be 6 months, especially when it used to be 6 weeks!”

Are any of your pediatric clients thinking of becoming involved in ACOs?
“Thinking?  Yes.  They’re all being told how if they don’t get big, they’ll be out of business, which is utter BS. The rules, as we know them now, seem to make no sense whatsoever for pediatricians. I did see a compelling presentation by Colleen Kraft at the AAP NCE last week that very much supported the ACO-esque model she employs, but I think her situation is both unique and not potentially an ACO.

“With some issues – 5010, PCMH, etc. – we take a pro-active stance. With ACOs, I’m glad to let someone else jump first.”

How will your solutions enable your customers to integrate with ACOs or coordinated care programs?
“Far too soon to tell.  In general, I can say, “Hey, we have had really good reports that have tracked patient populations for years.”  Our clients use them all the time, as it’s both good medicine and good business.  As a practical tool, I’d put our patient recall program up against anyone’s – your front desk can crank out a list of kids who need flu shots or asthma followups in seconds – but we don’t know quite what the ACOs will need.

“One thing we’ve learned, though: when a small peds office puts its data in the hands of a large entity, it’s worth double-checking the results. For more than 20 years, I’ve helped our clients fight insurance companies (which an ACO emulates) and the insurance companies never have the data right. Ever. So if a private peds office can work with us and still be in an ACO, they’ll be able to confirm the accounting.

“Here’s my prediction: As ACOs grow, the practices who participate are going to regret losing control of their data. I’m really going out on a limb there, I know.

What do you think is the greatest challenge being faced by pediatrics when it comes to keeping up with healthcare IT?
“Not getting run over by the Juggernaut.  Everyone else’s demands are put ahead of the pediatricians and the peds usually get served what everyone else is eating.  And it rarely suits them.

“I also tell them all the time: ignore the Meaningful Use money. Completely. And ignore the “deal” that you can get from your local hospital/IPA/etc. Pick the EHR that suits you the most and go with that. All the discounts or federal checks in the world won’t make up for even a 5-percent hit in your productivity or having to spend an extra 10-20 hours a month on charting or IT work. If you do like the local deal, great!  But don’t feel like you have to leap in.”

So there you have it folks. I’d be interested to hear from a pediatrician or two who has gone through or is going through some sort of HIT implementation as a follow-up to these views. Feel free to get in touch with me via the comments section below.