The Economic Stimulus legislation has presented an incredible opportunity for EMR vendors. Unfortunately, it seems that some of them are taking advantage of it by giving out misleading information and applying scare tactics so that practices will purchase their EMRs. Below is a sampling of such statements, which have been forwarded to me by physicians asking whether they are “fact or fiction.”

Have you had similar experiences? Please share them by submitting a comment at the bottom of this post.

What some EMR reps are saying:

• “The government is requiring you to buy an EMR.” This one is a scare tactic since participation is voluntary.

  Section 3006 of the American Recovery and Reinvestment Act specifically states “…nothing in such Act or in the amendments made by such Act shall be construed to require a private entity to adopt or comply with a standard or implementation specification adopted under section 3004.”

• “Your EMR must be CCHIT-certified to qualify for the incentive payments.” I hate to use the word “lying” but this statement comes close since the legislation neither identifies standards nor mentions any particular credentialing body, including CCHIT.

  The HIT Standards Committees, which just had its first meeting on May 15, is charged with recommending an initial set of certification standards by December 31, 2009. Recently, there has been a surge of rhetoric in the media expressing dissatisfaction with CCHIT, so it is by no means a foregone conclusion that CCHIT certification will be required.

• “Simply buy a CCHIT-certified product, and you will qualify for the Stimulus money.” This remark is similar to “I have a great stock to sell you”—because EHR incentive payments are not guaranteed.

  Simply purchasing a “certified” EHR is not sufficient; the incentives require you to demonstrate “meaningful use” of the EHR every year, and to do so in the manner specified by and to the satisfaction of the government. “Meaningful use” has not yet been fully defined, and the legislation states that the requirements are to become more stringent over the period covered by the law.

• “You must act now—buy an EHR now because in order to get the money from the government, you must be using the EMR by 2011.” As with used-car salesmen, “buy now” is always popular, but you actually have until 2013 to implement and potentially qualify for the lion’s share of the incentives.

  Even if you do not implement until 2014 (5 years from now), you would still be eligible for almost 80% of the money.

Have you heard any of these statements of “fact”? My advice: Do your due-diligence. Make sure you understand the real facts about the legislation and find an EMR that meets the needs of your practice. Have you heard other statements of “fiction?”—Please share them by submitting a comment at the bottom of this post.

Related posts:

1. The Machinery Behind Health-Care Reform
2. This weekend, The Washington Post published an investigative report entitled...
3. Challenge EMR Vendors to “Put Your Money Where Your Mouth Is”
4. Change has arrived. The government, through the Department of Health...
5. President Obama signed the American Recovery and Reinvestment Act of 2009 today, which includes funding for Health Information Technology.
6. Despite all of the buzz surrounding the creation of this...

The vice-chair of the HIT Standards Committee, John Halamka, MD, opened the first Standards Committee meeting by charging the committee with “recommending standards, implementation specifications, and certification…in support of meaningful use.” But “meaningful use” has not yet been defined, which begs the question—Are we putting the cart before the horse?

In fairness, the Standards Committee, as well as the other planners and implementers of the EHR provisions, are under significant time pressure to meet the ambitious deadlines contained in the Economic Stimulus legislation. The initial set of standards for EHR certification is due by December 31, yet “meaningful use” has yet to be clarified—David Blumenthal “hopes to provide a direction and some specifications in the late spring, early summer.” Therefore, in the interest of time, all parties are discussing “meaningful use” and standards concurrently.

To compound matters, it appears that the certification/standards decision has essentially been made already—underlying the conversations is the ubiquitous assumption that CCHIT will be the government’s standards for EMR qualification. Perhaps this is driven by the need for expediency in the face of the looming deadlines, or perhaps it stems from the recommendation made by HIMSS. (See last week’s blog below.) In either case, how can we already know what standards are necessary to ensure meaningful use before we have a clear and complete definition of “meaningful use”? How do we make certain that the standards are applicable to all physicians, including high-performance, private-practice specialists, when CCHIT standards are primary-care focused? Do we need another set of standards for specialty practices? In any case, isn’t this a classic example of putting the cart before the horse?

Related posts:

1. The Sea Changes at CCHIT
2. Last month, in a post entitled, “Putting the Cart Before...

This weekend, The Washington Post published an investigative report entitled “The Machinery Behind Health-Care Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records.” The reporter, Robert O’Harrow Jr., clearly hit a nerve when he exposed the origins of the EHR funding portion of the Economic Stimulus Bill—The Washington Post received so many comments that it had to stop accepting responses! I am sharing my comments here, along with the original article.

Dear Mr. O’Harrow:

Thank you for exposing the behind-the-scenes efforts that led to the creation and funding of the Economic Stimulus Plan’s EHR incentives program. Industry insiders have long-recognized these inherent conflicts of interest, but have been reluctant to make them public.

It is important to understand that the situation is being perpetuated—the people now charged with developing the specific regulations regarding how the money is to be dispersed and the standards which will determine to whom it will be given are the very same stakeholders who were behind the legislation. One has only to listen to the recent “meaningful use” hearing in Washington and look at the appointments to the HIT Policy and Standards Committees for evidence.

First, to clarify your premise—it is not the entire industry that lobbied. It is the traditional EMR vendors who are positioning themselves to receive the benefits. Only the big, CCHIT companies have been invited to the table to be part of the conversation in any significant way other than through very limited opportunities for public comment. No vendors of alternative technologies, i.e., non-CCHIT-certified products, have been given any formal role, regardless of their successful adoption rates and greater physician satisfaction.

It is no wonder that CCHIT is the presumed set of standards which will be used to qualify EMR software for Stimulus Plan payments. The legislation was rushed through with such a short timetable for implementation that it is hard to dispute the conclusion that there is no time to develop new standards. The HIT Policy and Standards Committees are predisposed to CCHIT—the vendor community representatives on each committee are from large, CCHIT companies, and at least one committee member is a CCHIT commissioner. It does not seem to be of concern that these EMRs are the very ones that have experienced miserable adoption track records, (see Landmark EMR Studies), particularly among specialists, nor that evidence does not exist to show that CCHIT certification has improved this adoption record.

In an effort to push the implementation along, the interests of high-performance, private-practice physicians are not represented in the process. There are no full-time, private-practicing physicians on the Standards Committee, who can appreciate first-hand the impact the wrong EMR can have on a provider. The seven physician members spend most, if not all, of their time in informatics-focused positions at their respective institutions. Furthermore, the needs of non-primary care physicians are being ignored. By virtue of its composition, the Committee will focus on primary care—of the physicians on the Committee, five are internal medicine-certified, one is a pathologist, and the vendor representative trained as a neurologist. For primary care physicians, CCHIT-type software may be more usable than it is for specialists.

In the era of transparency, it is important that all of these issues be understood and then addressed before the enormous sums of money are dispersed with limited potential to achieve the desired outcomes.

Related posts:

1. President Obama signed the American Recovery and Reinvestment Act of 2009 today, which includes funding for Health Information Technology.
2. Despite all of the buzz surrounding the creation of this...
3. Lost Opportunity: EMR Reform Was within Our Grasp
4. In October of 2007, the government (or specifically, CMS—the Centers...
5. The Voice of the Physician
6. I’ve gone through the $19 billion healthcare IT Stimulus Plan...

The 21 members of the HIT Standards Committee have been appointed, and unfortunately I was not among those selected. However, HHS Secretary Kathleen Sebelius and National Coordinator for Health Information Technology David Blumenthal did assemble a highly credentialed, very impressive group of health IT experts who will contribute much time and extensive experience toward the recommendation of the qualification criteria for EHRs under the Economic Stimulus Plan.

My concerns remain as anticipated—that the Committee, as impressive as it is, will not represent the interests of high-volume private practitioners, particularly the specialists, who are on the front lines of delivering patient care on a daily basis to the majority of Americans.

• There are no full-time, private-practicing physicians on the Committee. The seven physician members spend most, if not all, of their time in informatics-focused positions at their respective institutions.
• By virtue of its composition, the Committee will continue the focus on primary care—of the physicians on the Committee, five are internal medicine–certified, one is a pathologist, and the vendor representative trained as a neurologist. There is no one with first-hand experience regarding the vastly different issues facing specialists. Who will make sure that EHR use will be defined “meaningfully” for them?
• Committee members are associated with large, closed-loop medical institutions, (albeit venerable ones, such as the Mayo Clinic and Kaiser Permanente.) Their environments facilitate utilization of EMRs in ways that are typically beyond the reach of independent, community practices.
• The Committee appears predisposed toward CCHIT—one member is a CCHIT Commissioner and the vendor community representative is from a CCHIT EMR company (as is the vendor on the HIT Policy Committee). No alternative EMR technologies are represented—i.e., there are no alternative voices to broaden the Committee’s perspective regarding other EMR solutions with successful adoption track records.

Rest assured that, although I am not a Committee member, I will participate as a member of the public via Web access to the meetings. SRS Government Affairs will monitor both the HIT Standards and the HIT Policy Committees’ meetings, and I will keep you informed in future blogs. Stay tuned.

Related posts:

1. The Machinery Behind Health-Care Reform
2. This weekend, The Washington Post published an investigative report entitled...
3. The Voice of the Physician
4. I’ve gone through the $19 billion healthcare IT Stimulus Plan...

On Day 2 of the Government’s Hearing on Meaningful Use, there was finally some recognition of the need for physicians to be able and actually willing to use their EMRs. Three speakers from the audience, including SRS, presented testimony reminding Committee members of the dismal track record of traditional EMRs to date, and warning that different results should not be realistically expected simply because financial incentives are offered. It was clear from the concerned looks and head-shaking by the Committee members that they were starting to acknowledge that CCHIT was not the easy answer they had expected to the complex issues surrounding adoption and meaningful use of an EMR.

Dr. David Classen, from the University of Utah and Computer Sciences Corporation gave very interesting testimony in which he suggested that the focus must be on finding EMRs that anticipate the needs of users and are easy to use. While some standard criteria should be established, he maintained that the issue is implementation and use, not criteria alone. In fact, he shared results from a study in which a number of major CCHIT-certified products did not fare very well in meeting several test measures of improvement in quality of care. When asked about the correlation between performance on these measures and specific product criteria, he responded that he did not find any.

While no specific alternatives were put forth, “usability” was identified as an important criteria. This means more than simply adding a usability measure to existing CCHIT criteria. It means ensuring that the EMRs included in the legislation add value to physicians’ practices, and maintain or enhance, rather than decrease, their productivity. It also means “usable” by all physicians, not just primary-care physicians—the providers around whom the “meaningful use” discussion continues to be based. Our testimony, which was echoed by the other speakers, emphasized that the only way enduring adoption and true meaningful use will occur is if physicians themselves deem their EMR usable. There can be no “meaningful use” without actual use, and we will not see any of the anticipated quality-of-care and cost benefits if physicians are not using the EMRs we incent them to buy.

Related posts:

1. Specialists and the Final Rule on Meaningful Use
2. The Final Rule on Meaningful Use has erased any lingering...
3. Stage 2 Meaningful Use: Specialists Still Left Out
4. The rules for Stage 1 meaningful use and EMR certification...
5. Specialists’ Societies Speak Up about Meaningful Use
6. Despite the ongoing and concerted advocacy efforts by medical specialty...