EMR Vendors on HITECH – Part Three of a Series

We asked several vendor executives a series of five questions related to the economic stimulus as it impacts electronic health records.

How is your company defining "meaningful use" of an EHR and how will ensure your customers can reach that level?

Allscripts – Glen Tullman, CEO

It is not our direct role to define “meaningful use” for the government. While the law has given us a sneak peek at what may be required, the new Secretary of HHS will further define the details. Accordingly, we are guiding our clients to understand that in order to collect the HITECH incentives, they will need to demonstrate that they are using a certified, ePrescribing-capable EHR that is connected for the exchange of relevant and appropriate personal health information (PHI) to the systems of other healthcare providers. Additionally, while we will not know for some time – likely not before 2010 – what the requirements will be for reporting on quality care measures (the third component of meaningful use), Allscripts is committed to ensuring that our products make it as simple as possible for our clients to comply with any directive that comes out of HHS at that point. Again, our best advice is for physicians to ensure that they are currently using or about to purchase a CCHIT-Certified Electronic Health Record and that the company they buy it from has the resources to invest in the future and is going to be around for years to come.

athenahealth – Jonathan Bush, CEO, President, and Chairman 

We define it as it is currently spelled out in the legislation that was signed – which we also believe will be expanded over time. We are aware of a HIT Policy Committee being formed to put more context to that and we welcome any new criteria that they will want prior to the start of the program and the subsequent years following. Again, anytime more data or the need to report complex data is required it further supports our network-based model.  To think over the five year program that CMS won’t want the number of measures and other data sets captured and reported on increased is short sighted. They will and the vendors that are able to keep pace with that beyond just some software upgrade will be the best positioned to assist providers.

eClinicalWorks – Girish Kumar Navani, President 

eClinicalWorks believes that “meaningful use” of an EMR involves making every aspect of the patient encounter electronic, which includes visit documentation, lab orders, e-prescribing and clinical decision support for preventative and chronic care. Meaningful use should enable physicians to eliminate reliance on paper charts and provide pertinent information at the point of care. Clinical decision support features help elevate the role of an EMR from passively collecting information to actively helping providers make informed decisions.

We have always invested heavily in our customers’ on-going training, providing around 20 free Webinars a week and multi-media educational materials. There is also an online users’ forum.

Eclipsys – Tom Cooke, VP and GM of Eclipsys Practice Solutions 

In our judgment, “meaningful use” can only be measured by how the software improves outcomes, whether these are clinical outcomes, satisfaction outcomes, efficiency outcomes, or financial outcomes. Today, the HCIT community has the opportunity to work together to develop industry guidelines for achieving “meaningful use,” which will then contribute to improved healthcare delivery and care.

We believe that one of the key guidelines should be proven interoperability between systems to enable clinicians to access complete patient information at any point throughout the healthcare continuum. Interoperability also will enable providers to quickly and cost-effectively deploy HIT solutions without ripping out legacy systems – an aspect that has become even more important in this economic downturn.

The “meaningful use” guidelines also should include support for a) the inclusion of evidence-based medicine and b) the sharing and implementation of industry best practices.

Eclipsys brings a wide variety of tools to our clients to help ensure “meaningful use” including:

• Demonstrated best practice rules and alerts
• Speed-to-value implementations
• Outcomes toolkits
• Evidenced-based order sets and documentation templates
• Social networking tools to allow client-to-client sharing of best practices, documentation templates, etc.

eMDs – Michael Stearns MD, President and CEO

The basic criteria outlined in HITECH include e-prescribing, interoperability and clinical reporting. We are hopeful this will be expanded to include clinical decision support and orders tracking. Fortunately our current level of functionality markedly exceeds these basic requirements. However, making sure our providers attain the meaningful use status, once it is defined by DHHS, will be a priority for our organization. We will be launching an extensive educational program for our clients. e-MDs currently offers practice optimization services and these will be modified to include meaningful use “certification.”

Greenway – Wyche "Tee" Green, President 

We are defining, just as the legislation states, that certified EHRs must have e-prescribing and interoperability capabilities, as well as outcomes and quality reporting. We feel that any company that has the most current CCHIT Certified products and is committed to advancing their platform along the CCHIT 09 plan is well-positioned to ensure their customers are afforded a solution that can be “meaningfully used.” Every company must stay nimble, flexible and adaptive to change in order to be successful in this area.

MED3OOO – Jay Anders, M.D., Chief Medical Information Officer 

This is a tough area to address specifically, as ONCHIT has great latitude in setting this standard. I believe that physicians and groups will be required to demonstrate meaningful use, either by reporting PQRI from the EHR or by applying a yet-to-be-determined code that their visits were documented within the system when they are sent to CMS for processing. Practices will also need to demonstrate that they are using EHR for the great majority, if not all, of their patients—75% use in this area has been alluded to in other parts of the law and will probably be adopted in the regulations. Given the latitude here, we are working with all our clients to fully adopt all the functionality of the EHR so that they will meet whatever criteria the regulations require.

Looking beyond the specifics of the HITECH Act into the motivations behind it, the “take home” point here is that EHRs are expected to do much more than automate current physician practices. Meaningful use of EHRs will enhance the quality of patient care, promote the portability of health care, create efficiencies in the delivery of healthcare services, and ultimately lower the aggregate cost of care. These are the higher standards which we’re helping our clients achieve.

Medsphere – Mike Doyle, CEO 

Medsphere defines “meaningful use” of an EHR as Clinical Transformation. Is the EHR being used to improve care in statistically measureable ways? OpenVista was used to do exactly that at Midland Memorial Hospital, reducing patient mortality, infection rates, and unreconciled medications. An EHR needs to provide real-time physician access to relevant patient information from various points of care. It also must improve clinical outcomes, as OpenVista has.

NextGen – Patrick Cline, President 

Again, a vendor perhaps should not be providing such a definition as it would be hard to do so without it being seen as self-serving. Let’s just say that whatever the definition is, we feel comfortable that practices that have installed or will install NextGen under this program will be able to meet the requirements – both in terms of functionality and reporting – that will be instituted to verify "meaningful use." We do know that a portion of the requirement for meaningful use will be e-prescribing, connection to a health data exchange and submission of clinical quality data. Our current clients and those considering NextGen can take comfort in the fact that all three capabilities have been practically demonstrated in client sites, using the currently available NextGen 2008 CCHIT certified solutions.

QuadraMed – Keith Hagen, President and CEO

 
According to the HIMSS Analytics ‘EMR Adoption Model’ there is a major drop-off between Stage 3 (basically nursing documentation) and Stage 4 (CPOE with embedded clinical decision support). According to the 2008 survey, 36% of hospitals have attained Stage 3 but only 2.5% have attained Stage 4. Most of QuadraMed’s clients have achieved Stage 5 (closed loop medication administration), which is an area of strength for our QCPR product. Given this drop off we think the incentives being put into place today should be aimed at moving hospitals from Stage 3 to Stages 4 and 5. We will be focusing on moving our clients to QCPR with its integrated medication management functionality. We are confident that by implementing QCPR our clients will attain ‘meaningful use’. 

Sage – Lindy Benton, Chief Operating Officer 

While we wouldn’t be so presumptuous as to define the term, there are probably some assumptions that can be made. E-prescribing, the capture of discrete data during the encounter, and some level of interoperability will likely be required. Additionally, to meet the goals for comparative effectiveness research, some level of outcomes reporting will be involved.

One of the goals of our new services organization is to help customers – existing and those to come – meet the “meaningful use” standard once it is defined.

SRSsoft – Evan Steele, CEO 

We define “meaningful use” from the physicians’ perspective. “Meaningful use” of an EMR is achieved when that EMR successfully enables a physician to accomplish his/her goals for quality of care, cost-effectiveness, and outcomes measurement—and it is more likely to be achieved by technology that does not compromise productivity or practice style.

The government’s “meaningful use” requirements pose a significant hurdle to physicians who are tempted by the $44,000 incentives. How can physicians become meaningful users of systems that have been shown to reduce their productivity? Even the government, through the Congressional Budget Office, has said that EMRs may cause “financial harm” to office-based physicians.

There are 4 landmark studies that have demonstrated that “government” EMRs (traditional, CCHIT-style EMRs) impose hardship on physicians (http://www.srssoft.com/landmarkstudies.php). Not a single landmark study exists that concludes otherwise. If you can find one, please post it as a comment at the bottom of this interview.

With this backdrop, it’s easy to compare the stimulus plan to the government offering $44,000 of credits over a 5 year period to purchase a “government designed” car that has a maximum speed of 48 miles per hour. To get the incentives, the driver must first pay for the entire car up-front and then the driver must prove “meaningful use” of the car to a government agency via various reporting mechanisms. If he stops using the government car in a meaningful manner because he is always running late or he finds that 48 mph doesn’t suit the way he drives, he is stuck with the entire cost of the car. If it were known that over 50% of the time, drivers who purchase government cars abandon those cars and lose the entire investment, who in their right mind would buy a government car?

The same problem exists with government EMR. Everyone wants the EMR incentives, but the realities of a fast-paced, busy medical practice will cause physicians to abandon the EMR systems just as they have been doing en masse without the incentives. The incentives will only accelerate the demise of traditional point-and-click EMR systems as physicians with less IT proficiency and a lower level of IT support attempt to use the very same systems that have failed among the deep-pocketed, more technically savvy early adopters.

Thankfully for doctors, government EMR adoption is 100% voluntary and, over the next 9 years, the incentives are relatively small as a percentage of their total income. Therefore, doctors are free to purchase the digital solution that best meets their practices needs—one that incorporates the voice of the physician rather than the voice of government.

If an EMR can be built according to government specifications that we feel physicians can “meaningfully use” without being slowed down, SRS will develop such a product. If sometime late in the next decade CMS requires the use of an EMR, then SRS stands ready to provide its clients with the software they need. In the meantime, we keep listening to what our clients want and to provide a hybrid EMR that works wonders for their practices.

EMR Vendors on HITECH – Part Two of a Series

We asked several vendor executives a series of five questions related to the economic stimulus as it impacts electronic health records.

Providers will be required to implement “certified” software to participate. Who should perform the certification and what criteria should they use?

Allscripts – Glen Tullman, CEO

We believe the Certification Commission for Healthcare Information Technology (CCHIT) is very well positioned to perform the certification of EHRs. Allscripts has been a strong supporter of CCHIT – one of the industry’s primary product certification bodies – since its inception.  We are pleased that Congress appears to recognize the good work CCHIT has done through its certification process and that HHS will likely base many of its go-forward standards on that work. Today, all of the products in our EHR portfolio have current CCHIT certification, and we intend to ensure that every one of our clients is in a position to participate in the new Stimulus incentives that will become available starting in 2011.

Regarding criteria, we believe CCHIT is on the right track with its Roadmap for Expansion of Health IT Certification. We support CCHIT’s plans to include advanced interoperability, advanced quality, advanced security and advanced clinical decision support in their 2010 and 2011 certification programs. Doing so will contribute to ensuring that the widespread adoption of Electronic Health Records envisioned by President Obama results in true transformation of our healthcare system. It’s critical that physicians use EHRs that reach beyond their own practices in an interoperable fashion rather than becoming simply another “software silo.” To get there, we need to ensure that physicians and patients alike feel confident that their information will be secure. We need to ensure that certified EHRs are capable of capturing and analyzing information needed for participation in pay-for-quality programs. And we need to ensure that physicians receive real-time, accurate clinical decision support to harness the power of information.

With a certification process that measures all four of these areas – interoperability, security, quality and advanced decision support – we have a real chance to truly improve the quality and lower the cost of providing patient care in the US today.

athenahealth – Jonathan Bush, CEO, President, and Chairman 

As we all know CCHIT handles this process, and we are currently in the midst of certifying for 2008 and will look to certify athenaClinicals for every single year moving forward. I am sure more and more standards and privacy entities will appear in years to come and athenahealth will incorporate whatever measures they require into our national network just the same as we do today . There will be no cumbersome version “whatever” launch and subsequent failure for athenahealth as we see with traditional software players. We release 6-8 major new versions of athenaNet a year across our entire national base over night. We also update athenaNet daily with new payor and clinical rules, security, and privacy measure etc. Today we have over 40 million various scenarios that require our proprietary rules engine in athenaNet to fire in order to guide providers away from making billing or clinical documentation errors that would lead to a poor outcome – unpaid claim or incomplete patient record. To this end, we have a website http://www.athenahealth.com/campaign/hitech/index.php , as do most HCIT vendors on the HITECH Act and issues around certified systems. However, we tried to communicate the realities of this program and attempt to give providers a moment of pause before they select the very same stagnant software systems that have proven not be adopted and utilized for many years. Certification of certain software functionally does not directly correlate with ROI or adoption. We believe providers are getting savvier to the fact they need much more flexible clinical systems that will be able to change with an evolving healthcare system and not wait hat in hand for the latest and great upgrade. I think we even saw some interesting research from Avalere Health researchers on this issue that indicated a solo or small group physician practice will spend an estimated $124,000 over the five year period of 2011-2015 to adopt and maintain a traditional EHR, and could receive up to $44,000 in federal incentive payments.  The resulting financial deficit would be $70,000, or an average of $14,000 a year. The value has to come from both vendor and the incentive – software functionality is only a small part of this.

eClinicalWorks – Girish Kumar Navani, President 

Interoperability is a key objective for eClinicalWorks. Standards should focus on sharing patient records in a way that is private and secure. It is also important that technology promotes patient care, preventative measures and disease management. We would like to see standards in place that support these aspects. Whatever standards the government decides on, we are confident that we will meet them.

Eclipsys has been, and remains, a supporter of CCHIT as the proverbial Underwriters Laboratory (UL) for HCIT. We believe it is in everyone’s interest for the industry to police itself through this independent “Good Housekeeping Seal of Approval” process. Eclipsys believes that the roadmap for functionality and interoperability being laid out by CCHIT is reasonable and appropriate to create standards of certification.

eMDs – Michael Stearns MD, President and CEO

Our EHR has been certified by CCHIT in 2006, 2007 and 2008, including the child health and cardiovascular specialty certifications offered in 2008. Regardless of what direction the DHHS secretary and national coordinator decide to take, we fully commit to being compliant with any and all EHR certification requirements.

To date, CCHIT has provided the most effective and thorough certification process. The industry as a whole has invested millions into certification, interoperability, privacy and security with tremendous achievements in the last three years. Products that are currently certified with 08 CCHIT criteria have a high level of functionality that deliver long-term and interoperable solutions. CCHIT is currently the only recognized certification body (RCB) by the Secretary and by starting over; we will take considerable steps back.

The bill has language that puts the oversight of the certification process in the hands of ONCHIT. The logical assumption is that CCHIT will continue as the organization that will recommend criteria to the office of the National Coordinator, with input from the new national HIT policy and standards committees. Overall, CCHIT has done a good job in setting criteria that advance EHR functionality. I believe they should continue in this role, with oversight from ONCHIT.

We can’t say exactly who should perform the certification, and we don’t really want to. That may not be much of an issue. What the certification focuses on and requires is more relevant. Now, might the requirements demand that government oversee or take some roll in the process? Yes, they might.

The assumption seems to be that CCHIT will be the certifying body, though the organization isn’t mentioned in the legislation. Historically, CCHIT certification has not incorporated considerations such as interoperability, transparency, or affordability, which were alluded to by Congress. Maybe the requirements that come out in April will. Medsphere thinks certification must incorporate these elements. Perhaps government oversight will be required to ensure they are addressed.

What criteria should they use?

• Proven (evidence-based) to improve clinical outcomes: Medsphere’s OpenVista EHR is built on VistA, the proven and popular VA EMR system field-tested by the U.S. Department of Veterans Affairs (VA) for two decades in more than 1,300 sites of care, including 160 medical centers and 850 clinics. VistA was designed specifically for the outcomes-oriented management of patients with chronic disease, which sets it apart from most health information systems. The changes resulting from VistA at the VA are considered the largest case study ever of objectively improving care. Peer-reviewed research has documented the VA’s higher compliance with performance standards, unparalleled patient safety improvements, and better overall health outcomes than private-sector organizations resulting from its use of VistA.
• Affordable / Cost-effective: Medsphere’s OpenVista EHR leverages the multi-billion dollar public investment in the comprehensive and highly-acclaimed VistA EHR. In commercializing an already valuable tool, Medsphere has transformed VistA into OpenVista, a feature-rich EHR designed to meet the needs of acute, ambulatory, and long-term care environments as well as multi-facility, multi-specialty healthcare organizations.
• An innovative pay-as-you-go subscription pricing model enabled by open source technology incorporates no mandatory upfront implementation costs, a departure from traditional “vendor lock” solutions. Medsphere creates ongoing value via product upgrades and application support included in every subscription, helping customers get the most from their solution now and for years to come. Plus, the most a hospital is eligible for under the federal legislation is $11 million, which will easily cover OpenVista implementation. Ask Cerner or Epic if they want to do an implementation for that price.
• Interoperable: OpenVista works with existing hardware and software, thus preserving legacy IT investments. When deployed across the enterprise, the integrated platform delivers superior time-to-value and time-to-benefit. The interoperability incorporated into OpenVista also enables health information (HIE) exchange and broader coordination of patient data where other solutions simply don’t. We clearly seem to moving toward more information flowing to hospitals and clinics around the county. How is that possible if patient records are locked up in proprietary systems that won’t play nice?
• Fosters collaboration: How would healthcare progress if advances in medicine were retained by individual hospitals or research facilities? The same question is relevant with health IT. When a hospital or university develops an effective application or template, there is something unconscionable about not sharing it with other healthcare providers, particularly if it can directly and positively impact patient care. As an Open Source solution, OpenVista and our Healthcare Open Source Ecosystem encourage people to get under the hood and create. There are a hundred ways to approach a task, and only through a diversity of opinion unfettered by corporate orthodoxy can we find the best one.

As a vendor, it may not be appropriate for us to comment on who should perform the certification. But let me be clear that we support the need for the body to be well respected by all participants – including physicians. As far as the criteria needed, it probably makes sense to look towards the CCHIT 2008/2009 criteria, at least as a starting point. Various stakeholders can certainly be included in the process to make sure that all sectors are represented. It is likely that their additions, expansions, or even deletions and corrections to the CCHIT criteria should help the process gain widespread acceptance.

It makes sense that CCHIT will be the certifying body. The group has done a good job of establishing “harmony,” credibility and legitimacy among vendors, payers, providers and other 3rd parties. Additionally, there is synergy with the CMS demonstration programs since the new incentive program leveraged the CCHIT certification criteria.

However, the legislation leaves specifics unfulfilled. We will be closely monitoring developments to ensure we meet all certification requirements.

Certification requirements should be determined by a group led by the end users—that is, the busy, practicing physicians who will be using the software. The software they would structure would be easy to use, increase their productivity rather than ask them to be data entry clerks, generate reports based on the outcome measures they identify, and streamline practice workflows.

In contrast, the starting point for government EMR standards under the Stimulus Plan will likely be CCHIT. It is unfortunate that the 21-member CCHIT commission lacks significant representation by front-line, private-practice physicians. There is nothing in the certification criteria that requires that features be usable and convenient for the doctor. Of the 477 feature-focused CCHIT certification criteria for 2008, not one addresses usability. For example, it can take a doctor 20 productivity-sapping clicks to accomplish a task with a certified feature, but as long as it produces the desired result, that feature will pass certification with flying colors.

Compounding the frustration, the HITECH legislation creates a newly formed HIT Policy Committee charged with setting overall policy and overseeing the distribution of the Stimulus Plan funds. Unfortunately for front-line physicians, the committee will consist of a group of 20 politically appointed individuals with only one physician representative. This does not bode well for the development of usability-based criteria that physicians will find adoptable.

Instead of focusing on features alone, EMR developers should focus their energy and R&D budgets on producing elegant, streamlined, and efficient products that are highly usable. This has always been, and remains, the focus at SRS. Alternatives to CCHIT-type EMRs, such as hybrid EMRs, should be evaluated for their ability to boost the EMR-adoption rate.

EMR Vendor Executives on HITECH – Part One of a Series

We asked several vendor executives a series of five questions related to the economic stimulus as it impacts electronic health records.

What changes will your company or area make, both for the short and long term, in preparation for HITECH legislation?

Allscripts – Glen Tullman, CEO

Within hours of President Obama’s signing of the American Recovery and Reinvestment Act, Allscripts began a process of educating the market on the HITECH elements of the Act. Our outreach included a series of webcasts (such as one this week with Glen Tullman and Newt Gingrich), a new website (www.allscripts.com/thetimeisNOW), a white paper, and a variety of other tools that help physicians better understand the implication of the new programs on their practice. Additionally, we will soon be introducing innovative new pricing oriented around the Stimulus. And you can expect to see major new Allscripts announcements related to the Stimulus very soon as we ramp up our national program to help physicians take advantage of the HITECH incentives to enter the Electronic Healthcare Highway.

Internally, Allscripts continues to hire new people as the need arises, with every expectation that the Stimulus will drive significant new hiring down the road. From a development standpoint, we expect to accelerate our efforts around interoperability and connectivity, ensuring our clients are ready to connect.

Overall, it’s important to keep in mind that there are already compelling reasons to start using an EHR today, with very significant financial incentives from the Centers for Medicare and Medicaid Services (CMS) for electronic prescribing as well as the CMS Physician Quality Reporting Initiative (PQRI) and other pay-for-quality programs from many local health plans. These existing financial incentives enable physician practices to start generating new revenue streams today, even before the HITECH incentives kick in – good news in these difficult economic times.

athenahealth – Jonathan Bush, CEO, President, and Chairman

We have already been in the process of developing an extensive clinical content team much like our payor rules team that will update, qualify, and build various clinical quality measures directly into our national EHR platform allowing all of our clients using athenaClinicals to more easily participate in whatever pay-for-reporting program is developed for the HITECH Act but also as more commercial insurers launch P4P programs. athenahealth’s analyst teams already today help practices capture and report for these programs unlike traditional software, whether it’s client server or hosted, the burden is on the end user to use various functionality in an attempt to participate. We believe this is why so many medical providers had frustration attempting to report out for PQRI using software-only systems. In contrast, 100% of athenahealth clients that participated in PQRI received their bonuses. The government’s incentive program will only further the need to innovate network-based services that medical groups will need to leverage moving forward.

eClinicalWorks – Girish Kumar Navani, President

 eClinicalWorks is holding regular meetings with the department heads to forecast the staffing needs of each department. New employees were starting even before the stimulus, but we are hiring more aggressively now. We are also looking for ways to streamline processes to ensure that we are running as efficiently as possible.

Eclipsys – Tom Cooke, VP and GM of Eclipsys Practice Solutions

Eclipsys, the Outcomes Company, is excited about new sources of funds coming into HCIT from the Federal Government, and believes that it will stimulate even greater market demand for Eclipsys solutions. Our mission to maximize client return on investment while delivering improved patient outcomes mirrors the goals expressed by the administration and will not fundamentally change our corporate strategies. As such, we continue to assist our clients with the following:

• Automate as many endpoints with Eclipsys solutions as practical, and as quickly as possible. From the ICU to the family practice, from the ED to the laboratory shop floor, Eclipsys provides world class automation, extraordinarily high adoption rates, and measurably superior outcomes for our clients.
• Design interoperability into every portion of our solution portfolio. While some of our competitors strong arm providers to automate every community endpoint with their solutions, we recognize that widespread IT adoption means supporting a realistic, heterogeneous environment. Each of our solutions has a multiplicity of ways to interoperate with other solutions and technologies, and we have introduced our Health Information Exchange technologies to provide this community interoperability at the lowest cost, and highest degree of effectiveness possible.
• Work seamlessly with the interoperating community of stakeholders to monitor performance, identify and eliminate waste and duplication, and improve financial and operational performance through revenue optimization and cost reduction.
• Transform practice at the point of care by integrating evidence-based medicine into daily clinical processes through knowledge-based and decision support solutions.
• Introduce and monitor performance of evidence-based medicine throughout the community through the instantiation of protocols and pathways published in peer reviewed literature.
• Amass, normalize, and research clinical, operational, and financial data in order to allow our clients to further contribute toward the evidence-based medicine available.

eMDs – Michael Stearns MD, President and CEO

e-MDs is preparing for very significant growth in all areas of the company, including training, support and ASP hosting services. We have committed significant resources towards educational efforts related to HITECH and the other HIT related provisions in ARRA. This company has accelerated efforts to strengthen alliances and partnerships with other organizations, academic centers and government agencies. We are also working directly with communities interested in developing HIT regional extension centers.

Greenway – Wyche “Tee” Green, President

In the short term, we are paying close attention to any developments that will impact both our customers and our company, such as the definition of “meaningful use” and the final certification process, which we hope will align with CCHIT as much progress has been made during the last three years. We recognize that Greenway will continue to experience rapid growth and that’s something our team is prepared for.

MED3OOO – Jay Anders, M.D., Chief Medical Information Officer

MED3OOO is well positioned to help our clients, both physicians and hospitals, to maximize their potential with the stimulus bill. In the short term, we are working with current clients to help them analyze their qualification status and to make sure they meet the meaningful adoption criteria to qualify them for the incentives. In the long term, we believe there will be a “gold rush” of prospects looking for systems to be quickly implemented and meaningfully adopted.

Remember that the greatest incentives are offered to physicians who implement EHRs in (or before) 2010. Typical in-house EHR implementations can take six-to-nine months, with additional time before and after spent in preparation, negotiations, training, and implementation. That doesn’t give physicians much time to get ready. MED3OOO’s Software as a Service (SaaS) implementation and InteGreat EHR’s browser-based deployment allow our customers to be “live” on their EHR in less than half the time required by traditional EHR product installations. Also, through the SaaS service model, monthly service fees can be paid entirely using the HITECH incentive payments.

Lastly, it’s important to note that the legislation wisely rewards, not the installation of EHR technology, but the effective use of that technology. MED3OOO has its roots in practice operations, and we’ve used this expertise to design and implement technology in ways that physicians can use to improve outcomes for their practices and their patients. Our InteGreat EHR, for example, gets high marks for its “intuitive” interface and the ease with which it can be effectively installed and utilized. We believe that a collaborative approach with physician practices, and a grounding in the operational requirements of those practices, will be essential factors in the successful implementation of EHR systems.

Medsphere – Mike Doyle, CEO

Like many health IT providers, Medsphere is preparing intently for the impact of federal healthcare IT legislation. We are anticipating some sort of certification requirement and developing accordingly, and we recently finalized a services partnership with maxIT and conducted the first session of Medsphere University to get them up to speed with OpenVista and the Clinical Transformation it enables.

We’re also preparing for the legislation by tailoring a solution that fits within the parameters (time and money) of the federal program. Medsphere is better prepared than many other health IT companies to enable full funding for hospitals when money becomes available. We’ve implemented OpenVista in anywhere from 5 to 18 months, depending on the specifics of the implementing hospital, and we’ve developed a process that incorporates a great deal of flexibility. Medsphere has demonstrated that we can implement an interoperable solution incorporating all necessary clinical functionality for roughly ½ the cost and in 1/3 the time of other solutions. We can implement a system for the amount of money available to hospitals. A lot of other healthcare IT provides can’t say the same.

NextGen – Patrick Cline, President

There are several ways to answer this question. First, with respect to the legislation, its interpretation and the surrounding process: Things are still evolving and, at this point, information is still incomplete. To help keep our customers current, we have developed a microsite, http://www.nextgen.com/stimulus/ that presents our current understanding of the legislation, regularly updated pertinent information and a set of Frequently Asked Questions (FAQs). We have also started a series of educational webinars discussing the legislation, as well as services we are offering providers who are using or have decided to select NextGen solutions.

With respect to the long term, we think we’re well positioned product-wise, but we continue to work on our ability to scale the company and train the new customers that we hope will come at an increased rate. We intend to open additional training centers, enhance our computer-based training programs and make our software even easier to use.

QuadraMed – Keith Hagen, President and CEO

As a result of the ARRA, QuadraMed is now extremely focused on having our enterprise clinical product, QCPR, meet the to-be-determined NIST certification criteria. In lieu of these criteria being formally defined, we are using the CCHIT criteria as a target. We feel we meet the majority of these criteria today but are fast-tracking other development projects around advanced clinical decision support and CDA/CCD support. Additionally we are working on extending our integrated medication management functionality to support areas like e prescribing. Our plan is to be in a position to submit QCPR for certification by Spring 2010.

Sage – Lindy Benton, Chief Operating Officer

In the short term, we are investing in service infrastructure, employee education and reevaluating processes to become more efficient and proactively prepared to respond to the increased demand for solutions and service. Additionally, over the past two years, we’ve invested in technologies that reduce implementation efforts for both the customer and Sage – so we can quickly meet market demand without large increases in human capital.

We’re also optimizing our portfolio of intellectual property and services – ensuring we offer the right value to our customers. For example, we are launching a Center for Knowledge Excellence organization that will provide optimization and education services. These services will wrap around our products and help practices become more efficient and achieve specific clinical goals and outcomes. We want our customers to leverage the products to create maximum value and, specifically, to assist practices in achieving the “meaningful use” standard.

Even with these efforts, it is expected that we will most likely need to increase our human capital investment over the longer term.

SRSsoft – Evan Steele, CEO

Why should we change? We challenge ourselves with this question every day. Why would we abandon our focus on efficiency, usability, and 100% successful implementations? We have yet to be given a compelling case to do so, even with all the incentives being dangled before practices. In fact, why does the industry need incentives to implement technology at all? If traditional EMR offered such great benefits to patients, physicians, and the medical ecosystem in general, why has adoption been so slow and been marked by so many failures? Will incentives provided by the government for these same EMRs result in a different outcome?

The hybrid EMR has significant advantages over what we are calling the “government” EMR in terms of speed, ease of use, and adoptability. It successfully provides ePrescribing and PQRI capabilities, robust reporting, and data management functionality, and it also enhances practice workflow and physician productivity. SRS will continue to listen to exactly what our physicians want and to develop features that make them more efficient and enhance their ability to deliver high-quality patient care.

We refuse to pour resources into developing overly complex products when we know that physicians do not find these types of products usable. Sadly, this is the path that CCHIT has followed, as a reading of the CCHIT criteria reveals. At SRS, we have the voice of the physician built into our software, which has led to a level of user satisfaction that is the highest in the industry by a wide margin, as validated by KLAS.

News 3/17/09

From: Neil Finn.”Re: Specialists and EMR. The author kind of misses the point; these specialists have enough revenue and margin they can go EMR or not and being in Plano, their Medicare/Medicaid mix isn’t all that great.” Neil is referring to this article discussing how a group’s failed EHR experience is now causing them to be cautious about going down that road again – stimulus money or not. Neil claims the group struggled with the old A4 product years ago. How many other profitable specialists will snub their noses at stimulus money, either out of fear or because the money just isn’t enough?

Current and former physician employees of Medical Edge Healthcare Group (TX) file a suit against the company, charging them of improper billing and practices that violate state laws prohibiting corporate control over physicians. The doctors say Medical Edge used “deceptive accounting practicing” and charged them unfairly for taxes, benefits and other expenses.

A RAND Corporation study finds that California physicians given financial incentives to improve the quality of medical care are beginning to adopt new quality measures, including adding EMR and tracking physician performance. However, the financial incentives averaged between $1,500 and $2,000 annually per physician, which failed to stimulate significant change among most doctors. Those declining to participate suggested incentives needed to be two to five times higher in order to achieve quality improvements.

Fifty physicians are set to receive their first rewards for participating in New Jersey’s Bridges to Excellence Program, which is designed to recognize and reward providers that demonstrate safe, timely, effective, and patient-centered care.

Fair Lawn Diagnostic Imagining Center (NJ) selects IMAGINEris and IMAGINEradiology for practice management and RIS billing and collection.

Technology Partners, Inc. (dba IMAGINE Software), a leading provider of medical billing technology, announces that Fair Lawn Diagnostic Imaging Center (FLDIC) of Fair Lawn, New Jersey, has chosen IMAGINEris and the IMAGINEradiology™ practice management system for their RIS/billing and collection needs.

The LA Times publishes an article discussing how HIT has the potential to advance healthcare. The piece discusses some of the benefits realized by a 10-doctor family practice group, including the elimination of 6-1/2 FTE’s and tens of thousands of paper charts.

KLAS releases a report entitled “The Rise of eClinicalWorks: Separating Fact from Fiction.” KLAS examines why ECW is growing faster than any other EMR vendor and whether if it could sustain the grown and still provide effective support. While customers expressed strong satisfaction on functionality and cost, support was noted by many users as the worst aspect of their ECW relationship. Users also claim that integration with other clinical systems was a challenge.

If you read HIStalk you may have seen the notice that Mr. H is in the world of no Internet this week, so Inga is flying solo. I am awaiting encouragement.

USF Health, Allscripts Launch Paperfree Tampa Bay, an E-Health Pilot Program

USF Health and Allscripts initiate a pilot program called Paperfree Tampa Bay that aims to convert 100 percent of physicians in the Tampa Bay area to electronic prescribing. Program leaders view this as a first step toward the implementation of EHR in the region and is expected to create 100 jobs in the region.

We caught up with Allscripts CEO Glen Tullman and asked him for more details on the initiative.

So, what is in it for Allscripts?

First of all, let’s talk for one minute about the opportunity. What we see happening here is President Obama’s vision of an electronic, inter-connected health system is becoming a reality in Monday in Tampa Bay. This is really a pilot, if you will, for what can happen in the rest of the country. That’s important when you think about what could happen in the rest of the country. We have lined up wholes series of communities who are doing their own particular take on this. The take on this in Tampa is: “Let’s start with electronic prescribing, let’s get a coalition of organizations, including major hospitals, physician groups, the mayor. Let’s get Congressional support – and there is strong Congressional support: Congresswoman Castor, Congressman Young, and Senator Nelson are all strongly behind this – and let’s drive this forward.” What’s makes this unique is they are hiring 100 electronic “ambassadors” is what they are calling them, that are going to visit the 8,000 offices and train them on electronic prescribing, and then they are going to introduce them to the stimulus benefits for acquiring an electronic health record. And, hopefully they’ll see the market for the adoption of electronic health records. So, #1 it creates jobs for new-hires who, #2, are going to be trained by a curriculum designed at the University of South Florida, who was one of the original NEPSI members and who has already rolled out an electronic health record. They are designing a curriculum to train these people and presumably others. Then these people will start doing the office-by-office work. Dean (Stephen) Klasko calls its “changing the DNA of physicians, one office at a time.” Which I kind of think is a really brilliant analogy because physicians do require that. By the way, it’s a very interesting contrast to just yesterday, Wal-Mart comes out and says we are going to have this thing in the store, a physician will show up and spend 25K, take it back to their office and implement it. Those aren’t the physicians we know because we have been doing this 10 years. Physicians aren’t likely to do that. We say we know what model works and we are going to be out there doing it.

So what’s in it for Allscripts? When people ask as us about the NEPSI, our answer then and our answer now is getting physicians to adopt the tools is good for healthcare long-term, and good for patients and good for Allscripts. Why is it good for Allscripts? Well stage one is electronic prescribing and they will get that free. What we hope follows from that is the adoption of electronic health records. Once a physician is comfortable using electronic prescribing, we believe they will conclude they should quickly move to electronic health records. At that point, given we are the market leader, we should benefit. Will we get all those? Of course not. But we think we’ll get our fair share, maybe more than our fair share of that. The real goal, first and foremost, is to address this absolutely key patient safety issue that is saving lives and saving money by getting physicians to use electronic prescribing. And if that was all that happened I would be happy. Because imagine being a part of something where you can say, “This isn’t about making money. This is being able to say we helped make this happen in Tampa Bay.” If this works, we will absolutely save lives in Tampa Bay. Remember, every year 7,000 Americans are dying from preventative medication errors, and a million and half are injured every year. It cost billions of dollars, it has an enormous quality impact on people’s lives, and we can stop it, and we are going to do it now in Tampa Bay, beginning Monday. Very quickly thereafter In Hartford, Connecticut, Iowa, Pittsburgh, in HoagHospitals in Newport Beach. We have leaders coming up from all around the country who are saying, “We are going to do it and we are going to do it now under President Obama’s leadership, and the standards that CCHIT has set, and the substantial incentives that have been provided.” The CMS incentive of $3,000 to $5000 for electronic prescribing is available today as of January 1 of this year. The PQRI incentive of $3,000 to $5,000 is available right now, and of course, the $44,000 that’s from the stimulus package, $18,000 of which will come available next year if you are using a total electronic health record right now. Imagine if you are a physician in Tampa Bay and someone comes to the office and says, “Let me get you up and operating on this tool. If you use it you will qualify for between $3-5,-000 of funding from CMS and it is highly likely your own payer has additional incentives for you. What does it cost me? It doesn’t cost you anything. Pretty good deal. Now there’s someone standing there, an energetic, committed person who says, “I will help you do it.” That is how we will change healthcare, change the DNA of healthcare and the physician. One office at a time. As the rest of the communities see that there are going to say, “Wow, not only does it work, there is a good chance we might even get stimulus dollars to help us do these types of programs.” In Tampa Bay, Stage 1. In other communities they are saying, “We are going to push the development of the full electronic records and we are going to connect them.” Hartford is saying, “Connected Hartford,” instead of “Paperless Tampa. What does that mean? We have enough hospitals and major practices already using Allscripts that we are going to connect them all together connect very quickly and very cost effectively. We are committed to interoperability. We are happy to connect everybody. We are ready to start very quickly with demonstrations that will connect huge parts of the market. Why? Because it is safer for patients, more convenient for patients. That is the program. Not that I’m not excited about it…

What do you estimate Allscripts’ out of pocket costs will be for the Tampa Bay project?

From our perspective, #1, they are using NEPSI software, which is already based in all our numbers. And, #2, in terms of people commitment and the like, we will be deploying members of our teams, our e-prescribing teams, our connectivity teams, and, obviously used some of our promotional people, creative people. It is not about a dollar commitment per se. The big expenditure will come as USF and other members of this coalition hire people, and we are hopeful that this will in fact be one of the many programs that HHS and the Secretary decide to support through the HITECH provisions of the stimulus act. Remember that the government has basically said that we want to support programs that are furthering the aims of the HITECH act and the President’s objectives, but, we don’t them to be green-fields. We want them to be programs up and operating that we can see. All 100 people won’t begin Day 1. We are beginning to hire people; we are beginning to train people. Initially, some of our folks will fill some of those roles. Some of USF people will fill some of those roles. As we move forward, we have the commitment from the representatives in that area to take the Paperfree Tampa Bay program and present that as one of the many pilot programs that the Secretary may be interested in funding. If the Secretary chooses to fund the program, that will accelerate it. It will go forward under any set of circumstances. Whether it gets accelerated will in part be determined by the Secretary. But there is a commitment from the participating partners to move the program forward in any case.

So, there is hope that there may be some amount of funding that will filter down to fund some of the initiative?

To the initiative, yes. To Allscripts, no. From the initiative itself, there is no benefit from that. The benefit is longer term, to the extent that physicians decided to buy electronic medical records. Imagine the impact if every community says, “Hey, this works.” Take the top 100 communities, they each hire 100 people who are trained to talk to physicians about electronic prescribing, and also about the benefit of using a full electronic health records. Talk about the full benefits. Now you have 10,000 evangelists going out to convert these. Imagine the impact that would have, not just for us but also all our competitors. That’s what’s so exciting about this pilot program.

So the initial 100 people will be paid for by a combination of USF and Allscripts?

No, we will start with a smaller number of people that will be funded though a combination of USF, Allscripts, and the other constituents which will be announced on Monday. Those will include some state programs already focused on electronic prescribing. A variety of different participants will all be contributing people. The longer term goal is to have new-hires. We’re hopeful that our people will not have to be there longer term. But, we are committed with USF, with Baycare, and the other participants.

I hope you share with us the excitement of what this could mean. Do that math. Imagine if the top 50 communities in the county each hired 100 people, and you had all those people visiting physician offices. Imagine that kind of effort and what kind of change would occur. It would all be terrific for the industry. Hopefully this drives that kind of change, and we think it will.