I frequently see, coming across Twitter or other social media, posts or articles about ‘Free’ EMR systems or EMR at ‘No Cost.’ This presumption here is that, if your practice qualifies for financial incentives from the Federal Government, your initial investment will more than be covered. And if you can talk your local hospital into giving you one of those inexpensive web-based EMR systems (or Saas Software-as-a-Service), you might actually come out ahead.

So, what’s the catch?

Well, this assumes that your practice and employees are ready to go with an EMR system. Just install the software and you’re off to the races! For free, gratis, zippo. And then it’s like you’ve always been using EMR, right?

Not exactly. You still need to consider such things as:

• ‘end-user’ hardware – computer and monitors
• network hardware – servers, switches, routers
• network software – to run the network
• wireless hardware
• network wiring and installation labor
• scanners to scan old records
• high-speed internet connection, extra bandwidth
• staff overtime costs for training on the new EMR system
• EMR technical support/maintenance charges for installed EMR software
• EMR monthly recurring fees for web-based (Saas) systems

Oh, do I sound like someone who is against EMR? (At this point, that would be like being against inflation or against aging – they’re kinda inevitable). No, we have successfully launched EMR ourselves. But, you need to be realistic when you hear someone touting a free EMR system. It is sort of like inheriting a free car from your great aunt: if you don’t think there will be any other associated or on-going expenses, you’re kidding yourself.

Comments? Do you have a ‘Free’ EMR system? Is it really no-cost?

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Although written two years ago, a post by Vince Kuraitis on the e-CareManagement blog seems timely:

“Google Health promises to simutaneously create and dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.”

What follows is an extensive analysis on the impact that Google could have on not only the individual patient but also on health system reform itself.

So, has anything changed since then? Well, there is still no central repository for PHRs. But with the heated debate about health system reform, Google, Microsoft, and their ilk are trying to stay in the fray. In fact, they aren’t too happy with what they are hearing from the Obama administration regarding health information technology (Health IT).

They would like to see Health IT information rolled out on web-based platforms (theirs, of course) instead of the network of “outdated database systems” that they feel the government is proposing.

What do you think? Do Google and Microsoft have our best interests in mind?

Is your personal health information fair game for free market capitalism?

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Unless you have been hiding in a cave, you can’t help but to get drawn into the debate on healthcare reform. Unfortunately, most of the time it is not so much a debate as it is a shouting match.

So, here are six ways to keep the discussion rational and (hopefully) civil:

1)  Try to stay objective

Before you ask for someone’s opinion, resist the urge to ask his or her political affiliation. This is bound to immediately taint their answer. Remember, one man’s patriot demonstrating free speech is another man’s ignorant thug trying to shout down any opposing view. I find it easiest to say that I am a tourist from Grenada here on holiday and I have no opinion on the matter.

2)  Turn down the radio (or television)

I am, of course, over-generalizing here. But understand that most of these people are trying to boost their ratings to increase their advertising revenue. Do you honestly think they are trying to deliver credible, unbiased information? Think ‘Death Panels’ and ‘Grannie Euthanasia.’  The real facts are usually quite boring (see #5).

3)  Do not forward anything you receive via email, unless you have verified its veracity

Realize that, like the children’s game ‘Telephone’, the message gets more distorted the farther it travels. Some tell-tale signs of sneaky skullduggery (see #4) are emails that get longer and longer, and ‘verbatim’ speeches from politicians that contain a hodge-podge of quotation marks, inconsistent tenses, and editorial commentary from the sender all mixed in together.

4)  Check your facts

Don’t become part of the misinformation machine. Before you state or repeat something as fact, make sure it is a fact. Pundits on both sides have been either misstating, distorting, or downright making up ‘facts’. There is too much at stake and too many serious issues to debate to get sucked into childish arguments akin to whether the manned moon landing was a hoax. (Still falling for that one, are we?  Then check out the  MythBusters take on it)

Some good resources for fact checking include:

Snopes.com – this is a debunking site that researches questionable emails and internet-based scams

FactCheck.org - this is a project of the Annenberg Public Policy Center of the University of Pennsylvania and tries to cut through the spin slung from both sides of the aisle

PolitiFact.com – famous for its Truth-O-Meter, Politifact is a project of the St. Petersburg Times, one of the most respected newspapers in the country

Don’t take the chance of being called a stooge – avoid using any major network as a source, since these are allegedly tools of either fascists or socialists (see #5).

5)  Consider the source

Americans for Free Rights, Consumers for Insurance Choices, Patriots for a Better America…

Sound like your neighbors organizing to voice their opinions, right? Problem is your neighbors can’t even agree on what shade of beige meets the architectural committee’s by-laws or whose dog left the poop in old man Cratchett’s begonia patch. And how did they come by a multi-million dollar television advertising budget?

There are many factions that potentially stand to make (or lose) a lot of money depending on how this turns out, so you can bet that there are some big bucks being spent to get their message across to the masses.

Hey, here’s a thought: why not actually read the proposed legislation instead of conjuring up a Stephen King novel?

H.R. 3200 Text and other links from the Library of Congress

Actual text of H.R. 3200 – from OpenCongress, a project of the Participatory Politics Foundation and the Sunlight Foundation, a watchdog group

6)  Keep your emotions in check

Don’t write emails with ALL CAPS AND EXCLAMATION POINTS!!!

This goes for both ends of the political spectrum. Contrary to popular opinion, these belletristic tricks do not make one man more patriotic than another (nor sound more intelligent).

Now HAVE A NICE DAY!!!

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If you are a doctor, or any professional for the matter, you have undoubtedly been flattered by an invitation to be a member of the prestigious fraternity known as Who’s Who (and come in a variety of flavors such as Cambridge Who’s Who, Marquis Who’s Who, the Who’s Who Registry of Academic Excellence, etc).

Usually it comes in the form of an email or letter, but sometimes, as in my case, as a phone call. A pleasant-sounding chap informed me that I was chosen from among thousands of my peers to be included in this year’s edition. The last time I was ‘chosen’ to be in a Who’s Who directory was when I was in High School.

Now, I was a bit busy in clinic and somewhat distracted so I started answering the gentleman’s questions concerning my training and professional associations, figuring that inclusion in the publication was a given and that purchasing it was not obligatory. But I was wrong. It turned out to be a hard sell for a leather-bound tome as well as a wood-mounted certificate. And if you didn’t want the goodies, then they weren’t interested in adding you to their list.

Ben Rothke from CSOonline has a great investigative piece on the clever little scam of the Who’s Who industry, which basically peer-pressures ‘honorees’ into paying for glorified vanity publications that nobody really reads or subscribes to.

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Well, several of my colleagues said it was never going to happen, but not only are there federal mandates for the adoption of EMR but now the states are starting to push for it as well. If you still don’t think that EMR is going to happen….I just can’t understand where you have been living these past few months.

Anyways, according to an article in Kaiser Health News, state governments and agencies are both facilitating and enhancing the implementation of health IT through a variety of means, from incentives to loans to the creation of health information exchanges.

Of course, like a lot of things benefiting from stimulus money, on-going funding for many of these projects may be a challenge going forward. Backers of these initiatives hope that savings from enhanced efficiencies and decreasing costs will more than make up for any short-falls.

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According to an article by Lou Agosta in B-Eye-Network.com, 80% of healthcare is delivered by medical practices consisting of only 1 to 5 doctors. And most big players in the EMR software system arena are marketing to larger clinics and multi-specialty institutions.

Even existing and proposed open-source systems such as OpenVistA still require significant investments in infrastructure on the part of the clients. And the government seems to be pushing for more open-source solutions, catching the attention of proprietary vendors like GE Healthcare, who may be offering some less-expensive options.

Still, there is a a lot of potential for EMR vendors who can target small medical practices, possibly with the SaaS (software as a service) or ASP (application-service provider) models.

Click here to read the entire article.

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Much of the new regulatory information coming out of Washington is getting increasingly more difficult to translate into English. I was recently asked whether a medical practice could use Google’s free email service GMail instead of spending money on a mail server and its associated server software. After checking with our own head of IT, I discovered it is a bit more complicated than just picking where you want to store your emails.

Buried deep within the HITECH (Health Information Technology for Clinical and Health) Act’s Sub-Title D is the language on privacy directly related to HIPAA (Health Insurance Portability and Accountability Act). Since most of us (health care providers) are considered “covered entities”, we must ensure that not only our employees and staff abide by these rules but our “associates” do as well.

If we started using GMail for our practice’s communication, there would be patient information located on Google’s mail servers and Google would, in fact, be considered one of our associates. This would require entering into a Business Associate Contract with Google, Inc. What do you think the chances are of Google, or a similar technology firm, signing a confidentiality agreement with perhaps thousands of medical practices across the country? I thought so.

Digital Business Law Group has an analysis of the language found in HITECH’s Sub-Title D – Privacy section that makes it a bit easier to comprehend.

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There is a very interesting blog post by Steve Brown that gives us a novel way of approaching the massive challenge that is healthcare reform. While politicians and pundits are arguing about how to spend stimulus bill money, nobody is thinking about how to improve the dissemination of information. This, after all, is the holy grail of EMRs (electronic medical records). Not just the reduction of medical errors but also the great benefits of EHR (electronic health records) which promise greater efficiencies in the delivery of medicine.

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According to a recent report from McKinsey, the US Congressional Budget Office (or CBO, always described by the media as “non-partisan”) predicts that the stimulus incentives for EMR adoption will have a significant effect on medical practices in this regard, as compared to projections without the incentives.

Part of this is due to the fact that the incentives, which may amount to as much as $44,000 per physician, would more than cover installation costs of an EMR system, particularly for web-based type systems. These systems, known as ASP (application service provider) or SaaS (software as a service), generally incur less up-front costs since they do not require on-site hosting servers and their associated infrastructure but rather reside on the vendor’s servers.

The CBO also predicts that adoption rates under the stimulus incentives will climb to 90 percent by the year 2019. The slice of the stimulus pie earmarked for healthcare IT is $40 billion. And while physicians will realize many benefits from the use of EMR, the main beneficiaries are expected to be medical payers, since the expected decrease in both healthcare costs and medical errors will improve profitability.

McKinsey expects hospitals and physicians to spend about $170 billion on EMR over the next ten years. This is good news for information technology vendors and medical equipment manufacturers. So, rest well, knowing that the money you spend on your EMR system will not only help insurance companies keep a better eye on you but will also be good for their bottom line.

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A recent article in the AMA news discussed some of the continued ambiguities of the “Meaningful Use” prerequisites handed down by the Health IT Policy Committee. Nevertheless, it does give everyone an idea of where they are headed. Generally speaking, meaningful users are defined as healthcare-providers who are using E-Prescribing, that their EMR technology is connected in such a way that there is an electronic exchange of health information, and that clinical quality measures are submitted to the government via electronic means.

For practices that fail to have meaningful use by the end of the set timelines, not only would there not be incentives, there would actually be penalties in the form of reductions in Medicare reimbursements – unless the practice could demonstrate some type of financial hardship that would prevent adoption of EMR.

If you don’t think the financial incentives are worthwhile, thing again. SoftwareAdvice.com has a nice explanation of what medical practices have to gain by getting the ball rolling and not waiting until the perfect EMR solution falls out of the sky and hits them in the heads (note: it ain’t gonna happen).

To give you an idea of the timeline we are talking about, here is a graphic from a committee report (courtesy of Digitized Medicine). So, what are you waiting for?

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