An HIT Moment with … Mark Anderson

An HIT Moment with ... is a quick interview with someone we find interesting. Mark Anderson is CEO and healthcare IT futurist with AC Group, Inc.

We saw a number of HIT companies consolidate last year. Do you think the trend will continue?

Yes. With over 370 vendors in the marketplace selling EHR products, the consolidation trend will continue. However, we believe more companies will just close their doors rather than being consolidated. If an EHR vendor does not have at least 2,500 physicians using their product by the end of 2009, we do not believe that can afford to stay in business. Therefore, physicians risk losing their money if they select a vendor with a small EHR footprint. 

Additionally, vendors that are not CCHIT 2008-certified by March 2009 will have a very hard time selling their EHR product. Not that physicians are really requiring CCHIT, but from a marketing campaign standpoint, competitors will scare physicians from purchasing non-CCHIT 2008-certified products.

As the EMR market matures, products seem increasingly similar in terms of features and functions. What should physicians selecting an EMR evaluate beyond features and functions?

Functionality is important, but it should not be the only consideration. When evaluating products, we rank each vendor from a scale of 1 (low) to 5 (high) in each of the following characteristics:

1. EHR product functionality
2. PMS product functionality
3. PHR product functionality
4. Company viability
5. Management
6. Long-term support
7. End user satisfaction
8. Initial pricing
9. Second-year pricing
10. Contracting terms
11. Negotiated contracting terms
12. Performance guarantees
13. Community hub pricing
14. Community hub functionality
15. Initial installation, training, and configuration
16. Overall rating

In the past,your company has been accused of bias when compiling your annual AC Group rankings. How do you respond?

The best way to answer this question is to ask our clients if they think we are biased. What you will get is that we are extremely hard on all of the vendors. 

I have to agree with many of the vendors that our reports back in 2004-2006 were not totally fair since we only provided rankings based on functionality. Vendors receiving high ranking were those with the best functionality, not necessarily the best solution for any one physician.

We listen to the critics and, starting in 2008, we revised our rankings based on the 16 categories listed above. Now functionality only counts 18% of the total vendor ranking.

Starting in 2009, we are ranking vendors based on five levels of sophistication. This means that a physician can use our reports to determine the top nine vendors based on what "type" of EHR product they are looking for. This means that vendors with low cost, ease of use, and maybe not as many functions (level 2 EHR) can be ranked in the top 10 and will not be compared to products that might cost the average provider over $35,000 during the first three years.

Of course, there are always vendors that do not like the ranking system and the ranking that we provide them. Like the BCS college football ranking system, our ranking is partially based on real data and based on our perceptions and the perceptions of our clients.

The toughest part of any evaluation is determining the EHR vendor’s company viability and end user satisfaction of clients. Since 92% of the EHR vendors are private, they do not have to report any data on clients, revenues, and financial viability. This makes it very hard for a practice to evaluate a vendor.  

When it comes to end user satisfaction, if you believe vendor market data, every practice loves their product and they have no issues. When it comes to end user satisfaction, we believe that KLAS has the best data.  Even there, vendors always complain to use that we should not be using a third party study, but that we should only believe what the vendor tells us. Sorry, I am not interested in beach front property in Arizona.

You were an early supporter of RHIO efforts, yet most have struggled financially.  What will it take to make a RHIO or HIE successful long term?

We believe that the RHIOs will be as effective as the CHINs of the 1990s. Very few will create any benefit to the community.  

However, the concept still makes sense. A community of physicians and hospitals must come together to create a community-based EHR that will allow clinically pertinent data to be exchanged within a local community, not a region. Before we can have a region (RHIO), we need local communities. 

Additionally, the community needs to provide multiple EHRs based on provider needs along with an "EHR Lite" for the majority of the providers who want to start slow. 

Finally, the community EHR needs to provide one consolidated PHR for all of the patients who would like to opt in to a community data exchange. Patient demographics and selected clinical information (lab results, eRX, etc) need to flow between treating physicians following the government’s CCD/CDA data exchange standards.

Do you have any predictions for 2009 in terms of industry trends or technology innovations?

The number of EHR failures will continue to increase. Just look at the numbers so far. According to multiple studies, only around 17% of providers have installed an EHR and less than 5% of the providers nationwide are using EHRs for full documentation, clinical orders, clinical decision support, and for outcomes measurements. Additionally, the majority of the EHR vendors provide inadequate training and support when it comes to changing business and clinical processes. The vendors are teaching physicians how to use the software, but most are unaware of the clinical and operational transformation that must occur before true adoption will occur for the masses.

CCHIT will continue to drive EHR purchases. However based on our studies, 67% of providers do not want all of the functionally and the costs and they are not willing to adopt the operational changes required to fully utilize a fully functional CCHIT EHR. The main reason is not the cost, but the operational change that providers perceive the CCHIT product will require. For example, the average provider spends an average of 33 seconds handwriting or dictating their note on a returning patient visit. Since every patient is new the first time they are seen using the EHR, the amount of time required to enter the information averages 295 seconds, an increase of  over 800%. Over the average clinic day, the EHR would require an additional three hours of charting time, basically eliminating all of the benefits that are promised by EHR vendors. However, the problem can be minimized if we change our approach towards pre-populating the EHR with patient data before the provider starts using the EHR.

The next generation EHRs will enter the marketplace — "DRT-enabled EHRs". DRT stands for Discrete Reportable Transcription. A DRT-enabled EHR allows the physician to continue to dictate clinical notes for a specific period of time. The difference is that the DRT-enabled EHR populates discrete data via the transcription, reducing data entry time by 87%. In most cases, dictation is eliminated within the first nine months once the majority of the patients have been seen using a DRT-enabled EHR. Using multiple methods, a DRT-enabled EHR populates up to 95% of clinical data required for the creation of a clinical note, for orders, and for clinical outcome reporting.

Along with DRT technologies, physicians will learn that a majority of clinically pertinent data can be enter without touching the keyboard. We have determined that up to two years of patient lab results can be obtained electronically along with patient medications, diagnostic codes, and numerous other data via upfront data conversions. If we can pre-populate patient data, the transition period can be eased. Additionally, through community data exchanges and PHRs, we estimate that 72% of patient information can be captured without the keyboard.

EHR purchasers will switch from individual practices to community purchasers. From our research, 87% of EHR licenses were sold to individual physicians/practices in 2007. By the end of 2009, we estimate that 43% of EHR licenses will be sold to community-based initiatives including hospital-sponsored community EHR, IPA-sponsored EHRs, and not-for-profit EHR communities. These types of community EHR initiatives  can help reduce upfront costs by 45% and, via a community data exchange, can help reduce data entry time by 68%.