EMR update

IN THE RUSH TO PARTICIPATE IN the federal incentives program to install electronic medical records (EMR), healthcare providers are faced with a glut of vendors—some household names and some emerging companies, some certified and some not.

Choosing the right vendor and EMR system is a high-risk gamble for healthcare providers with profitability, efficiency, staff morale and even patient safety at stake. With 139 vendors certified and more to come, providers are considering the merits of choosing established legacy sellers, whose certification guarantees that a hospital or health system will see some reimbursement for its investment, or perhaps dealing with a smaller company that hasn’t been certified, but offers innovation and, maybe, a smaller price tag.

The market for EMR data transfer equipment and applications could reach $1.6 billion in 2013, according to market research firm Kalorama Information. A growing number of small vendors, as well as technology giants such as Intel, General Electric, Microsoft and Qualcomm, are vying for the business.

The Certification Commission for Healthcare Information Technology (CCHIT) is contracted through HHS to certify health IT vendors. By law, the Centers for Medicare and Medicaid Services provides grants only to those doctors and hospitals that buy certified systems.

CCHIT has come under criticism by some experts who question its ties to its parent, Healthcare Information and Management Systems Society (HIMSS), which represents 350 technology vendors. Specifically, they argue that the certification mandate that EMR be supplied by a single vendor limits a provider’s options. Also, they contend that CCHIT certification prohibits many simpler EMR applications with fewer features. It also prevents end-users from assembling software from separate vendors and submitting this for certification.

Sharona Hoffman, professor of law and bioethics at Case Western Reserve University and co-director of its Law Medicine Center, believes rigorous certification and approval processes make it simpler for providers to find the right EMR.

“It is true that demanding certification or approval requirements may keep small entrepreneurs out of the market,” Hoffman says. “However, it is extremely important that only vendors who can produce safe EMR systems that will not compromise patient welfare be allowed to sell their products.”

The federal Health IT Policy Committee is considering a proposal from one of its workgroups for three tiers of meaningful use, with corresponding deadlines in 2011, 2013, and 2015. The term “meaningful use,” which indicates a significant number of the right results-oriented measures of success, is part of the language used in the legislation that will help determine whether providers qualify for part of $17 billion in Medicare and Medicaid incentive payments.

To be a meaningful user of EMR in 2011, providers must electronically capture, report and exchange key clinical health information.

SMALL, NIMBLE COMPANIES

While larger companies may scoop a big share of stimulus dollars, their success is not guaranteed, says Brian Klepper, PhD, a healthcare market analyst and founding principal of Health 2.0 Advisors Inc. He predicts the market will support smaller, more nimble companies that offer Web-based technology that turns out faster, cheaper and better EMR products.

CCHIT spokeswoman Sue Reber says the majority of CCHIT vendors of certified products are considered small, with annual revenues of $10 million or less. One-third have revenues of $1 million or less. CCHIT is looking toward offering more than just single-vendor options.

The certifying body in June unveiled three new certification approaches, including one for electronic prescribing, personal health records, registries and other technologies. CCHIT says the plans “appeal to providers who prefer to combine technologies from multiple certified sources”—some of which would likely come from smaller vendors.

Recently, KLAS Enterprises LLC, an independent, Utah-based market watchdog firm that reviews healthcare vendor performance, found few offering creative solutions for health IT requirements, including EMR. The KLAS report is based on feedback from dozens of CIOs and other healthcare executives.

According to the report, 28% of providers have accelerated or changed the direction of their IT plans since the announcement of stimulus package, with 43% ready to move forward. But buyers are aware of the dangers in purchasing the wrong system.

The Joint Commission last year called on providers to be “mindful of the safety risks and preventable adverse events” of new technology.

Problems can happen if a system fails to meet provider expectations, says Jeffery Daigrepont, senior vice president of business development for the Coker Group, Atlanta, which helps 3,000 clients a year identify and install EMR systems.

Part of its job is bailing out providers who have installed ill-fitting systems.

“Thirty percent of our projects are de-installing or removing failed EMR systems,” Daigrepont says. “I refer to these as career-defining decisions.”

According to Daigrepont, the top reasons for buyer’s remorse are:

• Vendor overpromised and underdelivered;
• Vendor’s product was defective, not usable at the point of care;
• Poorly designed system configuration and/or policies;
• Unsustainable infrastructure; and
• No integration of important information such as labs, results and pharmacy.

Klepper says the low adoption rate nationwide can be blamed on the high cost and limited performance of many EMR products.

Case Western’s Hoffman has two recommendations for avoiding EMR problems. The first is a “premarket” approval process, including testing the product at several facilities for at least six months. She also recommends healthcare providers form committees to field test and monitor the product.

Buyers should insist vendors provide quality support, project management, and a demonstrated return on investment, Daigrepont adds. They should avoid unnecessary features and functions and get promises in writing.

A provider must be diligent in identifying the right vendor, says John Jenkins, chief information officer of nonprofit Moses Cone Health System in Greensboro, N.C.. Moses Cone has spent three years planning a nearly $2.5 million investment in EMRs for its five hospitals and several outpatient clinics, and is about halfway to its goal of implementing EMRs across all of its 29 hospital clinics by the end of the year, Jenkins says.

He recommends that hospital CIOs contact various vendors and make numerous visits to providers where their products are operating. Also, administrators should compare notes and make no decision without extensive input from the physicians.

David Bennett is a senior editor in Advanstar Communications’ Centralized Content Group.

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