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The Impact of EHR Certification

In the comments of my post on EMR and EHR titled EHR Vendors Using EHR Certification Excuse, Jeff offered a frank comment about the realities EHR vendors face in this current climate:

I went through EHR certification for a EHR product – for the sake of this discussion it can remain nameless as you can insert any EHR name and it will share the same issues. The process was cumbersome and I agree is not worthwhile for our clients. However at least 90% of our clients were requesting it and all of our sales pipelines say they required it. The interaction you describe I have had. I don’t think it’s the fault of us as a vendor as much as the short sightedness of the committee that created the certification rules. We had to implement fields/screens/buttons that served no purpose in the type of practice we supplied our software to. That did not matter to the certification proctor, we had to show it or we failed and lost a lot of money. Getting certified threw off our development cycle at least 6 months. During that time we had to push off many good customer requested enhancements. In hindsight would our customers prefer we did not get certified – probably, but could our company take a chance at not being able to renew contracts or get new sales. No way, not for a government mandated push.

This reminds me of a video I recently saw that asked the question, “What do we want EHR certification to do?” The problem here is that I think everyone has a different answer to that question. Until we define what EHR certification should really accomplish, it’s hard to make criteria that are beneficial and easy to understand. In the rush to meet the regulatory requirements I think we missed creating the bigger vision of why we’re doing EHR certification at all. That’s why we’re where we’re at today.

October 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

A Medical Software Billing Company Story

I did a post on EMR and EHR called Medical Billing Software Lost in the EHR Mix and then cross posted it to a group on LinkedIn. In that group, I got the following story from Daniel McDonald who works at a practice management software vendor. The response was so interesting I had to share it with more people:

We have been a PM vendor for more than 20 years and we made the decision to not pursue our own EMR as we are a small company with very close ties to our customers. My partner even supported them prior to our 20 years. Some have been with her for 27 years.

We built both an API process and a HL7 process to do the necessary information exchange and pull back the charge and diagnosis data to our PM software. Originally we were under the assumptio this process was supposed to be all about the ability to share data with physcians as well as others involved in patient care.

Unfortunately we have customers who were never told by the EMR vendor they had the ability to share the needed data because it would limit the salespersons commision even though this would limit the disruption in the office and limit larger than needed expenditures on software, training and conversions. The large companies only cared about their stock prices and not about making the process of the implementation quicker, easier by keeping one big part the offices were comfortable with and knew so well. The PM software ultimately affected the entire office and is making the transitions a nightmare. We even have groups paying us to host their data in the event they pull the plug.

We have an office with an attorney fighting the fact the office asked about an interface and the vendor said it was all or nothing. A week later at a luncheon the office manager found out all of the other doctors that bought that package were continuing to use their original PM and were not changing.

So far all this has done is made the fat pockets fatter, disrupted the office, and is pushing the smaller PM vendors customers they have had for 27 years. For the last two years we have not been able to focus solrly on our PM. We found several economical solutions we interface with to meet MU but several customers have been scarred by verbage used by the fat cats in their sales presentations and tactics.

Everyone of our customers were happy and got their calls returned promptly and on the same day. We also have a medical billing company so our software customers would call us with their questions about billing, credentialing and what affects getting a CT or MRI might require or how to bill a code they had never billed before. Now they call an 800 number and they get someone who is hard to understand only to be told they will be placed in the queue and that initial call is not always even on the same day. We know our product like the back of our hands as we developed our own in 1994 so not only do they get a prompt call, they get an answer.

As best I can tell, the comment is about the ProvidrSoft practice management software. I’ve seen some of the practices that Daniel mentions in his above comment. I’m not sure it’s just the big EHR vendors that are telling them that they need an integrated EHR and PM. That message has gotten out far and wide.

As I read the comment above, in the back of my mind I could see a hundred other practice management software companies in my head who could probably share a similar story. I’m not sure how this is all going to play out, but I know that many doctors love their practice management software. They’ve been through many battles together and they won’t leave it behind on the battlefield.

May 31, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Paper vs EMR – Learning from Each Other

For those of you who read this site and don’t read EMR and HIPAA, you should go and read this post called Paper Has Healthcare Spoiled. While some might see it as an anthem for paper in healthcare, as I said in the comments of the post, it’s really an attempt to help EHR vendors see some of the advantages of paper and hopefully they’ll find ways to get those same benefits from EHR.

A Davis (who I believe is a doctor) also offered these insights in response to the post:

There’s no doubt that for one patient, in one office, paper is the absolute leader over EMRs in terms of ease of use. When considering multiple patients in multiple locations, the potential advantage of the EMR is easily seen.

The challenge is to transfer the benefits of paper to the EMR. That challenge has gone largely unmet, and it is the primary reason why uptake of EMRs among physicians has been so poor.

Medicine is a very personal undertaking. Physicians treat patients one at a time, and that’s how patients want it. That treatment is detailed, can be very personalized/customized, and documentation of that treatment varies to meet those individualized demands. EMRs, in their current state, are not user friendly to that type of documentation. While the government, insurers and hospitals are interested in aggregate data, physicians are not – at least not in the exam room, where their documentation occurs.

For an ever-shrinking number of physicians, typing is a problem. The problem is self-resolving over time.

For every physician, the “hunt and peck” mode of documentation is a problem. There are many variants – check boxes, radio boxes, drop down lists, “type ahead” automatic completion, etc – but there are hundreds, if not thousands, of locations in any EMR where the physician is required to choose among multiple options in a list. And there is no efficient way to do it. In a paper chart, the required entry simply flows from the tip of the pen. In an EMR, the physician’s attention must shift to the appropriate entry field, the mode of selection must be determined, the proper entry must be found and selected and, often, it must be confirmed, by clicking, by tabbing to the next field, etc. It takes a few seconds longer than simply writing the word and, when multiplied by the dozens or hundreds of times it must be done in a single patient encounter, the time lost becomes significant. Despite this limitation, it isn’t the method of data entry which is the primary problem.

The issue is how much data is required. Because hospitals and physicians are forced to accept fixed payments from the government and insurers, the natural evolution of EMRs as patient care tools has been altered. Rather than innovating to meet the needs of doctors and patients in the exam room, EMR vendors were forced to focus on the billing aspects of the EMR in order to justify their fees in a fixed-price economy. Therefore, EMRs are designed to elicit the information needed to justify the highest allowable payment rate from any given patient encounter. This is good for office and hospital economics, but is actually counterproductive to patient care.

For a given patient problem, the EMR doesn’t change the physician’s diagnosis and treatment decisions, but it does slow down the visit process by asking, typically, for more information than the physician needs for those decisions in order to get the required billing justification info needed to maximize the “billing code” for the patient encounter. This process is not only counterproductive to efficient care, but also increases the cost of medicine overall.

This problem is not inherent to the difference between paper and EMRs; rather, it is the result of the development of EMRs in a government-constrained environment. But it matters, because it is the basis of the very real fact that most physicians would prefer to use paper over an EMR. Until EMR vendors are able to innovate with the goal of improving the documentation needs of patients and their physicians, rather than government and insurers, paper will remain the medium of choice in the exam room.

As I’ve said for years, the biggest problem with legacy EHR software is that they’re big EHR billing engines.

Watch for more posts on EMR and HIPAA covering how healthcare is spoiled in other ways as well.

March 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

300 EHR Vendors and the Challenge of Interoperability

@GrandRounds4ODs posted an interesting tweet that caught my eye.


New Post by @:Why should there be 300 or so kinds of EMR software? http://t.co/cwBNwu2
@GrandRounds4ODs
Richard Hom OD MPA

The tweet links to his blog post where he talks about the challenge of so many EHR vendors, overcoming a legacy model of building closed systems and the challenge of interoperability.

Here’s the money paragraph for me:

In a business sense, there is absolutely no business rationale to write software that cooperates with a competitor. Governmental regulations can “force” or “compel” interoperability, but if done with resentment, there will never be true information sharing.

I wonder what @GrandRounds4ODs thinks about the post I did on EMR and HIPAA about EMR Consolidation (or lack thereof).

July 14, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.