Just Trying to Do the Right Thing…

In February of 2009, members of the Federal Government set the lofty goal of revolutionizing health care management in the United States.  Mitigating the trepidation in physicians and hospital administrators associated with making such a significant transition, the government incentivized electronic health record adoption by offering upwards of $44,000 in federal stimulus money to participating providers. The passing of the ARRA/HITECH marked the beginning of the government’s efforts to get the healthcare industry to a place in technology-use where other industries have been for nearly two decades, but the road to adoption hasn’t been without bumps and sharp turns.

Small physician practices, clinics, hospitals and health networks spent the greater part of 2009 and 2010 trying to grasp  the “what and how” behind meeting these expectations and then moved either towards satisfying or resisting the federal mandate to integrate electronic medical record systems into their practices.

While some medical practitioners are encouraged to achieve meaningful use simply because they see EMRs as the best way to go about improving patient care and facilitating physician-patient interaction, the promise of stimulus funding – or fear of financial penalization if they do not abide by “meaningful use” health technology adoption – has served as a main driving factor for the majority of adopters.   And even the savviest practitioners have significant questions about which of the 300+ EHRs will be right for their business needs – what are some of the unseen costs? How much money is too much money for an EHR? How will the EHR integrate into my practice management?  Are there annual updates and renewal costs? Will I have to train new staff members?  The list goes on and on, but one question few have asked is – what happens if the Federal Government takes the incentive away?

The House’s Spending Reduction Act of 2011 (H.R. 408) shines a light on some substantial gaps surrounding EHR adoption that providers should take seriously.  The bill—introduced in January of this year—seeks to reduce federal spending by roughly $2.5 trillion by cutting financing for certain government programs. One cut may come in the form of “taking back” the $27 billion built into the federal budget for disbursement to healthcare providers leading the way in EHR adoption. This serious possibility was discussed in a recent article in Healthcare IT News.

The threats associated with a tough economic time for the country mean that stimulus funds are always in jeopardy, but for many hospital and health network administrators, news of the House bill comes after they’ve invested upwards of $35,000 for initial EHR purchases and nearly $1,500 per month for ongoing support. In addition to exorbitant costs for initial set up and maintenance with large EHR vendors, physicians and hospital administrators have to weather EHR certification processes with vendors which sometimes produce additional costs.

Amidst the stimulus debate, physicians and administrators are caught somewhere in the middle. They are understandably hesitant to continue to move toward electronic medical record system integration due to high cost and waning guarantee of financial reimbursement, but current legislation requires they achieve “meaningful use” of health information technology systems by 2014. How do they do the right thing?

It is important to keep in mind that EHRs were never intended to be the “silver bullet” in improving the quality of healthcare so whether managing a network of hospitals or a solo practice, making the decision to adopt electronic health record technology should be driven by the needs of the practice’s physicians.  EHRs help physicians better care for patients by organizing data, providing better access to the data and eventually connecting the data across health systems. The intention is to simplify the otherwise cumbersome processes to save time for health workers so that they can better focus on caring for patients.

The true test of a good EHR is if it is both affordable and usable.  In order to realize the benefits of EHRs, programs cannot be so complex and confusing that they actually require more time to navigate than paper charts or leave physicians with little time to actually use the information to the advantage of the practice and patients. Concurrently, programs should not be so costly that they severely limit the capacity of a hospital or clinic to make updates to systems or that they would successfully bankrupt a practice should federal incentives cease to exist. Ideally, a practice’s information technology decision-making team will choose solutions that support quality of care, facilitate record keeping and mobility and advance evidence-based medicine while maintaining scalability per the unique needs of the clinic or hospital.

Today, when the EHR industry is growing rapidly, healthcare executives are tasked with wading through the clutter to find a vendor that best suits the needs of the practice and physicians. While proponents of the ARRA/HITECH Act assert that the SRA bill will not likely pass, other barriers to effective EHR system integration continue exist.  So if you just want to do the right thing, select an EHR that fits your practice – and that is affordable and usable for you and your staff.

Amazing Charts Reluctantly Raises Prices

On the Amazing Charts user board, I recently announced new pricing for our products and services:

• Amazing Charts Electronic Health Record (EHR/EMR) License: $1995 per provider (one time charge, which now includes the first year of our Guardian Angel Support & Maintenance)
• Guardian Angel Support & Maintenance: $995/year per provider (includes maintenance, updates, support, and ePrescribing)

This new pricing goes is effective November 1, 2010, so I recommend all existing practices, and those in their trial period, purchase the correct number of provider licenses before that date.  We have enhanced our Pay Portal site to allow current customers to pre-purchase two years of Guardian Angel Support & Maintenance at the current price to thus “lock-in” the older price for the next 24 months.

Nobody likes to see prices go up, but we feel it is necessary to continue to advance our software and services to remain in line with the new government regulations relating to the ARRA/HITECH stimulus money and continue to add the features our users want in the time frame they need.

And just to keep it all in perspective,even at our proposed new price, Amazing Charts remains not only the highest rated EHR according to a number of independent EHR user surveys, but we are still – by far – the least expensive EHR – whether calculated for a solo or multi-provider practice and regardless of whether the other EHR was delivered as a full client/server system or leased as an ASP.

Our biggest assets (low cost and simple usability) are also our biggest difficulties (limited resources and figuring out how to make complex certification requirements easy to use). We must set difficult priorities and implement them in an order that sometimes changes based on government and third-party changes, and sometimes means we don’t get the perfect solution the first time around.

For example, we had to delay Practice Management to allow for CCHIT certification, Surescripts certification, and improved eRx. We have held the letter writer and making order tracking and immunization entry easier as we strive to ensure that we can support the PCMH and meaningful use requirements since money from these is imminent and delaying these means less money for the majority of our users.

Amazing Charts must be eligible for every extra penny that may be available to help supplement the lousy reimbursements that most physicians experience, even if this means some users will be frustrated with certain features they know could be done better. And while I understand that not everybody agrees with these priorities, they are the tough decisions we’ve had to make to ensure we will be around for years to come.

So let me outline our current priorities. Our goal is to get the new ONC certification for meaningful use done by the end of the year and PM complete within that time frame (or very soon thereafter). These are currently our top priorities based on many of our users opinions, as well as the reality that the money is only available for a period of time starting in 2011 and ending in 2016.

Getting the promised features done in a time-frame that is promised, and with minimal bugs, is also something you have demanded and is absolutely a reasonable expectation. To that end, we have hired a bunch of developers, added a QA department to minimize the risk of bugs in our releases, and painstakingly attacked annoyances found in prior versions. Version 5.1, for example, literally has over 200 fixed “bugs” and other issues in addition to the major features of improved electronic refills and Surescripts certification. But these priorities trumped fixing the letter writer and other items that may seem easy to solve, but actually “touch” a lot of other areas of the program and will be quite programmer-intensive.

We have also added many new Help desk folks, and the learning curve of training these folks and getting them up to speed with our product, services – and most importantly, our corporate culture of fairness, honesty, hard-work, and dedication to our clients – takes awhile. (We have also had to fire folks who just couldn’t get the standard corporate bureaucratic mindset out of their head.)

For those who have been with us the longest and witnessed our steady progression, I would hope you are confident we will get there and end up with it done right. It may sometimes be slower than you would like (it certainly is slower than I would like), and there may be some hiccups along the way, but we learn and adapt and step by step, Amazing Charts will continue to strive to provide the absolute best tool to help run your practice – and do so at a reasonable price.

Update on Meaningful Use Roadmap

Let me provide an update on where we are with meaningful use (MU) and ARRA/ONC certification, and our current plan for upcoming enhancements. We are currently working on adding all the required fields as well as incorporating this directly into the office flow that will allow easy addition of MU data data as one documents ones notes. This is slated for Amazing Charts V5.2, and we expect to apply for certification this year so that all our practices will have more than enough time during 2011 (the first year of MU incentive payments). Keep in mind that a provider need only attest to using their Electronic Health Record (EHR/EMR) system meaningfully, and only has to perform “meaningful use” for a total of 90 days in 2011.

The big picture of our upcoming releases are:

V5.1 (expected to be released to beta testing in the next week or so). This version has improved eRX refill ability (and is SureScripts certified), and should have our iPhone “Amazing Charts OnCall” app to allow after-hours documentation of patient phone calls.

V5.2 – expected to be released by years end, and expected to be ARRA/HITECH certified for MU as well as the ability to generate reports to allow incentive payments (this version may be renamed V6 depending on certification requirements).

V6 – expected to be released early in 2011 and contain our Practice Management ties for eligibility, direct clearinghouse connection, etc.