5 ways to watch the financial health of your EHR vendor

You will be doomed if all of a sudden, your EHR vendor announces that they are going out of business due to losses and you can no longer avail their services. You are left in a conundrum. What should be the way out? After spending so much on the first EHR implementation, you will have no option but to go through the process again and make yet another investment in the system.financial health

So how could you watch the financial health of your EHR software vendor in the first place? Let’s give you a few tips which will caution you before any such event takes place.

  1. Stay alert: Set up Google Alerts about your EHR vendor and it will send you various alerts related to news, discussions, industry changes, developments, mergers or sells. This will be a great way to keep your EHR vendor in check.
  2. Ask the right questions: Find out how many installations and deinstallations your EHR vendor has had in the past one year. If you see there are many clients who are shifting to other EHR vendors, there might be something fishy going on.
  3. Check for developments: The EHR industry has fast development cycles and if your EHR vendor is keeping up pace with it, then you are in safe hands.
  4. Follow the money: You must check how the company is funded, what its annual statements are reflective of and how long it has been in the business. A small company with a better business model maybe more stable than an old company struggling with technology.
  5. Watch the market: Keep a close watch on the market trends and what new technologies are on the offer. Wait to see effects of any new development before deciding to shift.


These are a few ways through which you can keep a close check on the financial standing of your EHR vendor.


Cloud EHR – When Things Start Changing

Electronic Health Records (EHR) vendors are indebted to the guidelines imposed by the HITECH Act in regards to EHR adoption, which helped them capture the market share by encouraging physicians to use EHRs. Thanks to the legislation, physicians have been successful in ensuring the provision of quality care and enhanced patient safety, whereas EHR vendors have witnessed a major increase in sales volume.

Besides the HITECH Act, the requirements and needs of healthcare professionals is an indispensable factor that has helped established EHR vendors to make their mark in the industry. Having said that, it is believed that cloud EHRs have, without any doubt, helped EHR vendors in doing that.

Instant availability of patient records and other important information is a vital need to keep the care continuum intact. Unfortunately, there have been instances in which hosted EHR servers have failed to provide this facility to care providers. Imagine after making an investment of both time and money on learning and implementation of the application, eventually it does not serve the purpose – the end result would be nothing but frustration.

“It’s like you sell an old car to buy a new one, and at the end of the day this new car turns out to be extremely disappointing, something that you had never imagined. When you ask yourself the question whether it was a rational decision, that is when you finally realize your mistake”, says an annoyed, Michigan based physician.

Nevertheless, understanding that physicians require EHRs as a helping hand, established vendors introduced the cloud EHR. Cloud technology allows physicians to store, access, and retrieve patient information and related data from practically anywhere, at any time. It is because of cloud EHRs that physicians who once got agitated and wanted to step back to paper based documentation, ultimately changed their minds.

By allowing easy and secure access, cloud EHRs make patient data imperishable. Since all the information is stored online, the chances of physical damage are completely eliminated.

There are some physicians, especially solo providers or the ones operating small practices, who have this misconception that EHRs require an enormous monetary investment. Fortunately, established EHR vendors understand that not every physician has a bag full of dollars to finance such costly EHRs. Hence, they made sure that while introducing cloud EHRs, they considered the concern of affordability into account as well.

EHRs – Breaking the Constraints

The developmental pace of the health IT industry has been astounding. With numerous innovative products making their way into the market, the healthcare industry is headed for an extreme makeover. Healthcare reforms are the need of the hour considering the current economic crisis of the country, as they aim to bring affordable and quality care to every household in the US. The first step has obviously been the promotion of electronic health records. Serving as a cornerstone of healthcare reforms, EHRs will eliminate paper based medical trails while increasing efficiency through clinical decision support and electronic data interchange.

While EHRs have existed for a while now, their objective is significantly different from what it was two decades ago. Created only as a digital repository, EHRs had minimal functionality. Defining features were limited to input control and basic reporting. Today, the EHR is defined by its data mining capabilities. With the healthcare industry focused on population health management, the importance of ‘big data’ utilization is now more than ever.

Keith Smith, a health IT consultant explains that electronic health records (read more) are the platform for change in healthcare, “We are talking about re-inventing the system, introducing performance incentives for physicians and inducing a culture of accountability. We are talking about coordinated care and patient connectivity. We are talking about better care, lesser mistakes, population health and affordable care. To truly be able to transform to such an extent we must digitize healthcare. We must improve information accessibility and enable connectivity. We must move to EHRs.”

The idea is to remove the constraints of paper based system and enable better communication amongst healthcare professionals. Care quality is often determined by the information available to the attending physician. “There have been countless examples whereby physicians had to treat patients in emergency with little or no information, jeopardizing both the patient’s health and their own professional careers. It is a shame we have to go through these dilemmas in the 21st century,” explains a retiring physician from New Jersey. EHRs are designed to bridge this gap in healthcare by creating self sustainable digital health records, accessible to patients and providers across the care continuum.


Meaningful Use Stage 3 – Sneak Peek

With jury still out on the final rule for meaningful use (MU) stage 2, an advisory committee has already started planning for the next and the final stage of the federal incentive program. The committee co-chaired by Dr. Paul Tang from Palo Alto Medical Foundation and Dr. George Hripcsak from Columbia University will be working together to provide recommendations for the stage 3 rules. As before, the final stage is set to build on the requirements of the preceding stage. Several of the stage 2 menu objectives are expected to become the core objectives for MU stage 3.

However, the key focus of the final stage of MU will be on improved clinical decision support, machine readable data and medicine reconciliation. The last stage will also look to increase patient involvement through patient portals (read more) and EMRs. Industry experts believe that this will prompt widespread commercialization of health IT products. Tony Keller, a Meaningful Use consultant at CureMD, a leading EMR vendor adds, “The final stage for MU would be a fair reflection of the end goal, ‘the coordinated care structure’. Getting there requires significant changes, but meaningful use intelligently builds on its foundation, using a step by step approach. This has allowed the market to become more responsive, so when the time comes, I am sure that technology will support the transition.”

Among the newly added requirements, physicians would be required to enable nearly 10% of their patients to receive health readings, submit their medical history and modify or update their health information in the electronic medical records.

Working the spirit of coordinated care, physicians would be required to provide electronic care plans to referred providers and care sites in case the patient is moved. Whereas, referred providers would be responsible for updating the original patient care site with a percentile of the patient health information.

Shifting back to clinical decision support (CDS), the preliminary plan for stage 3 is calling for a minimum of 15 CDS rules. That is 3 times the amount set for stage 2. Tony Keller believes that this shows the intent of the government, “Patient safety and quality of care are the two most important factors deriving the technological change in healthcare. The end goal is better health and a happier life for every American.”

The advisory panel also recommended an increase in minimum requirement for electronic hospital medication discharge orders to insurance drug formulates, from 10% in the proposed Stage 2 rules to 30%. Providers are also expected to be required to record additional demographic information while some prior requirements such as smoking status may be eliminated, having met the state requirements.

Stage 3 would also require physicians to contribute towards population health using electronic medical records to generate lists of patients with specific conditions while maintaining a real time view using KPI dashboards to ensure improvement in quality of care, clinical research, practice outreach and reduction in care disparity.

According to the advisory board’s agenda, they would be able to release the final recommendation for meaningful use stage 3 to the HHS by May 2013. With the final rule for stage 2 expected to be released any day now, 2013 should effectively complete the picture for the healthcare reform.


EMR – Bespoke Vs Off The Shelf

The recent surge in health IT has helped several innovative companies proliferate the healthcare market. Healthcare in the US has traditionally lagged behind other industries in terms information digitization, but the government’s backing has lead to the rapid growth of health IT with CDC reporting an overall EMR adoption of 55% with the country.

While electronic medical records have existed for a long time, it was not until late 1990s that vendors began to produce commercialized solutions. Some hospitals at that time had already been using bespoke EMRs, that were specifically designed for their requirements. With limited information exchange at the time, these bespoke systems worked through intra office networks utilizing standard security protocols. Health Insurance Portability and Accountability Act (HIPPA) was introduced in 1996 anticipating growth of health information exchange.

Today providers have a choice between 800 EMR vendors providing a range of specialist products. EMRs have come a long way. Working closing with the early adopters, EMR vendors were able to focus on usability leading to the development of interactive solutions. However, with bespoke EMRs there was no standardization and interoperability was always an issue. The government attempted to sort this out through the meaningful use (MU) campaign, highlighting effective methods of EMR utilization.

While Health IT had already started to gain momentum by that time, the government’s support under the American Re-investment and Recovery Act brought a host of IT vendors to the healthcare industry. With the basic functionality outlined in the MU program, vendors had a base to build upon. More license based applications started making their way into the market. This trend also instigated a change in deployment models, as cloud and web-based models quickly began capturing significant market shares.

The license based products were more cost effective than their predecessors. Deployment time was quicker and there was a marked improvement in functionality while they lacked the extensive flexibility of bespoke systems. Bespoke design is in accordance with the organizational model, hence increases its competitive advantage.

However, since the application is uniquely configured, the organization’s reliance on the vendor increases significantly as well. Bugs and errors are a common place for bespoke software as testing is limited. Modifications and upgrades are expensive while development takes time and requires significant resources. Lastly, bespoke vendors usually don’t provide support services and practices have to employ technicians privately in most cases.

These hassles are greatly reduced by purchasing licensed software. Training manuals and support is readily available while extensive testing, modification and live runs reduce the chances of unexpected errors. In the world of health IT, established EHR vendors were quick to gauge the discrepancies in workflows. Application rigidity was a discouraging aspect for most providers, hence established EHR vendors allowed basic customization to increase flexibility.

“Off the shelf electronic medical records are less of a hassle. Most physicians today are more tech savvy. I myself use a tablet for most tasks. I think it’s more about getting a good vendor with reliable support and decent functionality. Everyone would like a custom-made EMR but simply cannot afford it. More importantly, we just don’t have the time.”, says one physician.

While there are advantages and disadvantages of both types of EMR systems, the size of the enterprise is the key factor in determining product selection. However, there are plenty of good off the shelf EMRs to choose from today. All you need is to find the right fit for your practice.


The Incremental Approach Towards HIEs

Connected healthcare is a maze of landmines to be trodden lightly. Micky Tripathi CEO of the Massachusetts eHealth Collaborative points out in his recent article, the dangers of overbuilding HIEs. Although, this is not the first attempt at healthcare information exchange (HIE) as Micky has referred to the publicized failure of Santa Barbara Care Data Exchange and the ill fate of Community Health Information Networks in the 1990s. “I’m delighted that we’re moving rapidly in this direction, but one concern keeps nagging away at the back of my mind, and that is the propensity to pursue over-architected HIE solutions”, he says.

The problem lies with the ideology of constructing a comprehensive solution that is capable of handling inter-industry information exchange, along with providing electronic support to remote clinical sites which themselves are a mere concept for now. What the government must understand is that the process cannot be sped up to reflect drastic changes and thus must follow a natural course. Incremental changes will allow the industry to respond appropriately while developing sustainable solutions that can be built from the ground up. Forcing instant change will not yield the benefits attributed to a HIE.

EMRs have been a prime example of why there is no single pill solution. Despite the rapid development in the industry, EMRs have not attained a form that could be considered complete in any regard. The world of technology is ever developing and nothing can truly be a final form. Changes are likely to occur as usability increases. While we may have a general idea of the risks associated with information sharing and health networks, actual usage will be more likely to shape a sustainable design.

The HIE infrastructure is still in its infancy whilst most practices lack the resources or adequate training to support the transition. However, it is expected for the industry to develop substantially over the next few years, with the private sector likely to lead the charge. A recent report by Chilmark Research highlighted the phenomenal growth in HIE(s) during 2011, increasing to a colossal 40% per annum.

HIEs can change the landscape of healthcare and while Accountable Care Organizations may be the initial goal; HIEs will inevitably shape a new world of care delivery.


Are Regulations Shaping EMR Design?

The world of health IT is continually evolving under the umbrella of affordable and accessible care ideology. Countless unique ideas are being implemented by innovative health IT companies. The EMR market alone has grown to around 800 vendors, while thousands of distinct mobile health solutions have penetrated the lives of patients and medical practitioners. We are witnessing the transformation of the healthcare system itself and the re-alignment of its culture. The emergence of Accountable Care Organizations along with the projected use of health IT and EMRs to drive improved care quality is helping foster a culture of constant growth in the healthcare industry.

However, as the government establishes the foundation for the health IT industry, it should be wary of the influence it places on EMR vendors. Standardization has been effective in driving appropriate use of EMR systems. It helps users and developers in streamlining operations and identifying product weaknesses respectively. Meaningful use incentives for the use of EMR systems, has influenced vendors to design a product according to the requirements set forth by CMS. While it has addressed certain issues, it has also resulted in the oversight of the usability of EMRs by vendors. Creating a balance between the two is often complex and most EMR vendors have to settle for a compromise. A number of physicians feel that this causes the workflow to become restrictive and unappealing.

That being said, health IT experts argue that standardization is mandatory since it outlines an operational framework. For example, while using a patient’s medical information electronically or otherwise, security is of paramount importance. With EMRs poised to pave the way for connected care, they must comply with regulations such as HIPAA and the HITECH Act to help ensure patient health information security.

A health IT expert pointed out that meaningful use is in fact instigating the growth of health IT. “EMRs must become interoperable or lose face. Physicians have invested significantly in these systems and they expect to be able to fulfill the meaningful use requirements”, he commented in light of meaningful use stage two requirements.

A number of government funded research groups including Regional Extension Centers (RECs) work closely with EMRs to identify usability requirements. Some have created a broad infrastructure to help EMR vendors develop more user specific software. However, despite the increased efforts some vendors feel that regular intervention would eventually lead to most vendors providing identical solutions, thereby restricting competition and innovation.

An independent source explained how interoperability will force most EMR vendors to shift to a universal platform for documentation. “Britain’s plan to standardize EMR solutions did not end well, if anything the US government should learn from mistakes they made.”

Another source shared a different opinion, suggesting that interoperability was always included in the initial plan, “Vendors should take the responsibility to provide physicians with interoperable EMRs. The government has always been clear on how to utilize the systems.”

Improved care Quality With EMRWhile there are different schools of thought, the diverse EHR market in the US will definitely pose a problem for standardization. However, vendors must not use standardization as an excuse for their shortcomings, but in fact should try to provide doctors with capable EMR solutions that help in enhancing the quality of care.