Getting physicians to use an Electronic Health Record (EHR) is not an easy task. Getting them to fork over thousands of dollars for one is even harder—and yet EHR companies have demonstrated an astounding ability to convince many physicians to spend ridiculous amounts of money for software that all too often actually decreases efficiency and increases frustration. How do they do it? Before I expose the secrets of how EHR companies get the unwary to sign on the dotted line, full disclosure is in order: I own an EHR company, and many of the issues discussed below could be construed as being self-serving (indeed, many are). Thus, keep in mind that these are my own opinions based on years in the field as both a vendor and a practicing physician, and may not reflect the opinions of the publisher of this magazine or anybody else.
In 2001, as a family physician wishing to use an EHR in my practice, I researched a number of solutions and found them to be overly complex and well outside my price range. Eventually, I gave up and decided to develop my own software, Amazing Charts. Since that time, in addition to running a private family practice, I’ve sold my EHR to more than 1,500 practices. Yet, I’m a Birkenstock-wearing family doctor first, and a salesman second, so I felt it was time to expose the seedy marketing and sales techniques that continue to fool so many physicians into adopting over-priced and overly complex EHRs. Physicians tend to learn from the experience of others, either anecdotally or from peer-reviewed sources. We assume the information presented to us by reputable institutions, experts, and our colleagues is unbiased and that potential conflicts of interest are fully disclosed. When it comes to the EHR industry, this assumption is incorrect.
Secret #1: (EHR awards have been bought!) What first provoked me to explore the dirty secrets of the industry was discovering that most of the coveted awards prominently displayed by EHR companies are judged by people who are getting paid by them. Although this may be reasonable under some circumstances (eg, the expert judge is also providing legitimate consulting services to the EHR company), it is completely unethical if it isn’t openly disclosed—and in the case of EHR awards, the judges’ monetary relationships are not disclosed.
If one can’t trust an EHR award, perhaps it is safe to get advice from an expert lecturing at a conference or a consultant you pay to evaluate your practice and make recommendations?
Secret #2: (That “non-biased” expert recommending an EHR to you may have been paid off too!) A significant number of the leading “experts” and practice consultants also earn money from the same vendors they recommend. Again, this situation is not necessarily a bad thing, unless a prospective buyer isn’t clearly informed of the relationship. Whereas the FDA oversees drug company-sponsored meals and requires full disclosure of speakers’ affiliations and relationships, there is no similar protection from the unscrupulous EHR expert/consultant. I’ve attended many lectures by consultants who had been paid by one or more EHR companies without any sort of disclosure before, during, or after the lecture. Similarly, many consultants, in addition to charging you for their “objective” advice, also quietly collect money directly from some EHR vendors for their referrals.
So, perhaps it is safe to get advice from another physician who uses one of the EHRs you’re considering?
Secret #3: (Even that EHR-using physician you’ve been referred to may have been paid off!) Clearly—and reasonably—an EHR company would try to avoid giving you the contact information of an unhappy client. But might the doctor to whom you are referred be getting compensated? Surprisingly, a number of EHR companies actually pay referring physicians to “compensate them for their time” in speaking with you. This can take the form of a direct cash payment or free/discounted software and services. Again, this is not necessarily unreasonable so long as the relationship is disclosed.
Secret #4: (The respected physician leader of your local society may also be receiving compensation!) Remarkably, I’ve even learned of physicians in leadership positions (such as your local medical society, IPA, etc) entering into financial relationships with EHR companies and not clearly informing the membership about the connection. Without clear disclosure, any of these examples at best is unethical, and at worst, is fraud. In the end, it is the EHR buyer who foots the bill for this insidious marketing. Determining the true cost of this deception is difficult. In fact, simply figuring out the real cost of an EHR can be surprisingly hard, since most vendors won’t provide this information.
Secret #5: (Determining how much a specific EHR costs is going to be difficult, and you are going to be nickel-and-dimed every step of the way!) Most EHR companies continue to avoid transparent pricing and will not openly provide an actual cost for their software and required services. Like a car salesman, even when asked, the majority of EHR vendors won’t give you a straight answer on price. Instead, they will try to obscure the issue with questions about how your office is set up, what interfaces are required, and the training needed to use their software.
Also, hidden charges are the norm in the EHR industry. Features you would reasonably expect to be covered by the base price often are not. For example, most vendors charge extra for “optional” modules we all use every day, such as ICD, CPT, and medication databases; spell-checking; document management capability; and scheduling. These add-on modules will dramatically increase the EHR’s price, which may not become clear until after you have started using the product in your practice.
Charging for “training” to teach you how to document a note is simply ridiculous. You’ve already paid a lot of money to your medical school and residency for this training, and you learned quite well how to document an encounter. If you must be taught how to use software that isn’t intuitively designed to fl ow like your own office, surely the price of that training should be included.
Secret #6: (Your patient data will be a bargaining chip to prevent you from leaving an EHR company!) Perhaps the most egregious hidden cost (often apparent only well after you’ve signed a contract) is the fee charged by some EHR companies to practices when they try to get their data back from the company. It is the rare EHR vendor that actually provides a mechanism within its software to export your patient demographics and notes en masse without having to contact the vendor. Although many salespeople tell you the data is yours, when you actually ask for the data, you’ll be charged thousands in an attempt to hold your data hostage and discourage you from switching to another EHR system. Without that data, you would have to reconstitute your electronic notes.
In justifying hundreds or even thousands of dollars a month just to use their software, many companies will rely on theoretical calculations that prove you can make money by spending money.
Secret #7: (The return on investment (ROI) argument is another way of saying “this solution is overpriced!”) If a company has to bombard you with white papers and intricate examples of how its EHR system will save you money by eliminating the need for your secretary to pull a paper chart 30 times a day, then they are looking for every theoretical penny of savings in an attempt to justify a price that is obviously too high. Companies that resort to the ROI argument as a way of convincing a practice to pay thousands of dollars up-front in order to save theoretical money are selling only theoretical savings. If you can’t immediately appreciate the potential benefits of purchasing an EHR system, the software isn’t designed well enough, the price point is too high, or both.
Secret #8: (EHRs don’t improve quality of care and often make you less efficient. And since you won’t figure this out until you are actually using the product, EHR vendors won’t let you try-before-you-buy, and there is no return policy!) Th is is the biggest secret of the EHR industry. Th e products’ abilities to produce accurate, improved, and rapid documentation—what should be the most important features of any EHR—are often woefully inadequate. Navigating through window after window, clicking multiple checkboxes, and inaccurate documenting by exception are all-too-common features of the overpriced EHR. To make matters worse, all this window-hopping and clicking may well distract you from providing high-quality care.
In fact, two recent studies have shown that using an EHR might actually hamper your ability to meet quality guidelines! Publishing their results in the July 9 issue of Archives of Internal Medicine, the authors of a Harvard/Stanford EHR study reported that “EHRs were not associated with better quality ambulatory care.” For example, their results indicated that, for one of the quality indicators studied (statin prescribing to patients with hypercholesterolemia), “visits to practices using EHRs had significantly worse quality.” A study of the relationship between EMR usage and diabetes care quality published in the May/June 2007 issue of Annals of Family Medicine found that practices not using an EHR were more likely to meet guidelines than those using an EHR.
So, if EHR software doesn’t really work well, why is it that so many of us are buying it? The answer is simply that EHR companies are good at selling, and that—combined with the misplaced market hype that EHRs are the solution to our healthcare crisis—has been enough to cajole many physicians to quickly adopt a solution that isn’t affordable, usable, or proven.
Many vendors tout CCHIT (Certification Commission for Healthcare Information Technology) certification as the answer to these issues. Ironically, it may be CCHIT that is causing much of the problems.
Secret #9: (A CCHIT-certified product, by definition, is often more expensive and less usable than non-certified products.) The theory of a standard certification process makes a lot of sense. CCHIT certification had the potential to markedly improve the industry and speed EHR adoption by requiring interoperability and reasonable functionality. Instead, CCHIT has allowed overpriced vendors to hide their poor usability behind the guise of being a certified solution.” Alas, when one examines the certification requirements, it is evident that the very nature of this certification actually increases product cost, discourages EHR technology advancement, and—most concerning—worsens usability.
CCHIT certification is unjustifiably expensive ($28,000 to apply, then $4,800 annually), and this expense is most certainly passed on to the users. Whereas overpriced EHR companies can absorb this cost easily, requiring such a large application fee makes it difficult for reasonably priced vendors to compete and may prevent a small start-up company, which might have the ultimate solution that does actually improve care and efficiency, from ever entering the fray.
Because CCHIT certification has hundreds and hundreds of specific criteria defining how an EHR must work, and since every one of these criteria is required for certification, a CCHIT-certified EHR ends up being bogged down by all the required features. Simply put, the bells and whistles mandated by CCHIT certification result in programs so complex with menus, buttons, and options, they make Microsoft Word look simple.
Some examples of their onerous requirements include criteria #71a, which mandates the EHR be capable of recording comments by the patient or patient’s representative regarding the veracity of information in the patient record. Sure, it may be good to have this ability, but should it be required?
Similarly, criteria #238 requires an EHR to be able to display medical eligibility obtained from a patient’s insurance carrier. Again, potentially a nice feature for some users, but must every EHR have this, along with the associated complexity, cost, and loss of valuable window real estate? Multiply this requirement a few hundred times, and you have an unusable and expensive product. (Okay, since this secret might land me in hot water, I should disclose that my EHR isn’t CCHIT-certified, and while I may be forced to become certified to continue to compete with other EHRs, I have avoided it thus far for the reasons noted above.)
With the myriad of EHR companies hawking their wares, how can you get through the background noise of paid-off experts, certification nonsense, and glossy marketing campaigns?
Secret #10: (There are alternate ways to determine if an EHR, and the company selling you the product, will work for you.) Thankfully, there are a number of less-biased forums where compensated and non-compensated users can freely voice their opinions on the software they’ve purchased, as well as the company selling it. The AAFP’s (American Academy of Family Physicians) Center for Health IT has a wealth of information, including a rating system scored by actual physician users. And although the AAFP does have some partnerships with various vendors and accepts advertising dollars, it is one of the more objective places to compare EHRs. The AAFP also has an e-mail listserv for AAFP members that provides a daily Electronic Medical Record Digest, where anybody can comment on their experiences, opinions, and problems.
Another place to find uncensored information is the online board, where users, vendors, and experts voice their frank opinions on the industry and all it encompasses. A relatively new and refreshing concept called the Ideal Micropractice also provides a forum that promotes open and uncensored discussion on running an affordable, high-quality medical practice. Among other things, actual EHR usability and pricing is frequently addressed.
Finally, a number of more progressive venues are beginning to arrange “document challenges” where various EHRs can run through a standardized patient, thus demonstrating how each deals with the same patient data. The Medical Records Institute is one such group pushing this competition. Although this is a promising development because it allows a more objective comparison of EHR software, it still is not optimal, since a significant payment from EHR vendors is required to participate.
Today’s EHR industry remains a sea of unrealized dreams. Although it seems obvious that adopting technology in your practice should improve efficiency and decrease costs, unscrupulous marketing campaigns, unabashed corporate greed, and pseudo-public certification have all played a role in obscuring our ability to separate the wheat from the chaff . Until we cease to accept the party line and choose EHR technology in the same way we pick other technology—on usability and price—many of us will end up paying money we can’t afford for products that actually impair our practice. The solution, as it is in most industries, is understanding the deceptive marketing techniques, demanding transparent pricing, and encouraging head-to-head EHR competition. The results are predictable: decreasing EHR prices and an overhaul of overly complicated EHR designs, the secrets that haunt today’s EHR companies the most.
Dr. Bertman is Physician Editor-in-Chief of MDNG: Primary Care/Cardiology Edition. He is a Clinical Assistant Professor of Family Medicine at Brown University and president of AmazingCharts.com, a leading developer of Electronic Health Record (EHR) software. He also is the founder and of president of AfraidToAsk.com, a consumer website focusing on personal medical topics. He is in private practice in Hope Valley, RI
Comments
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Jim:
Because of his training, knowledge and experience a physician's time is extremely valuable. He should not need to use his/her time to do essentially secretarial work which is what filling out the medical record of a patient encounter is, whether electronic or paper. You do not need an M.D. degree to write things down in a chart or click on a computer screen. In order to maximize the use of my time I used a scribe (we used paper charts and I am now retired). One could use a scribe with electronic records just as easily. And the benefit of EHRs for the practice is not primarily the physician's efficiency, anyway, at least it seems to me. The benefit is primarily for the effeciency and productivity of the office staff that supports the physician. Perhaps with the additional benefits, one would hope, of greater accuracy and improved patient care. January 21, 2008 - 12:00:00 (CST)
Rajesh:
I'm still in training but will be out in a year and plan to go into private practice. I'm starting to become aware of many issues out there including difficulty in chosing an EHR so I appreciate this article. I'm no better off at knowing how to actually make a good choice for my future office, however. The EHR program that my residency uses is too cumbersome with far too many mouse/keystrokes required and multiple levels of checkboxes for the physical exam and review of systems that seem neverending. It takes me more time to do the documentation in the EHR than it does to see the patient. And if it's a new patient visit, my stomach churns with anxiety of what a nightmare it will be to complete that patient entry.
Someone mentioned using an open source EHR as an alternative. Can you provide a link/info about where I can find these? How do they compare to the more popular propriatory EHRs? January 16, 2008 - 12:00:00 (CST)
Jerry:
"You do not get a quality EHR if you want to spend only $20,000 or $30,000 but you can get quality if you are willing to do your homework and pay a reasonable amount for what you get. Does it cost? You bet." Actually this is not true. There are many open source EMR's available that are fine pieces of software. When we could not find an EMR that worked the way we work, most want you to change your workflow to match the software instead of the other way around. Our solution was to write our own software. It has saved us hundreds of thousands of dollars (63 doctors) and has the Rx, Labs, etc. like the big (read expensive) EMR's. Not to mention we do not pay 15% annual maintenance fees. September 28, 2007 - 12:00:00 (CDT)
Michael:
Great article! I completely agree with secret #8. September 28, 2007 - 12:00:00 (CDT)
Jack:
Dr. Bertman:
You are correct on all accounts in my opinion. I am also a Physician in RI and a Developer with a very similar focus. My only question is why would the CCHIT add complexity to any EMR? XML data storage should merely be that, and not actually affect the EMR interface itself. The interference by the CCHIT in any EMR perhaps is only a reflection of bloated poorly executed code.
Thank you for your comments. September 27, 2007 - 12:00:00 (CDT)
Ronald:
I totally agree with everything you have stated. Having been a victim of the Dr Notes/Hewlitt Packard Financial scam, I have learned my lesson well. The software, although not being supported, is still being used in our medical group. Although it has marginaly improved re-embursement, it has increased the time necessary to process a patient. Codeing and pharmaceutical modules are not updated and the scanning of documents is excessively tedious. It is not financialy logical for us to invest in any new system while still in debt for the old one. All of our Docs are turned off on the thought of any new EHR. September 27, 2007 - 12:00:00 (CDT)
Daniel :
My group is using Centricity EMR and it's driving me nuts. I takes forever to document even simple visits; just to put in a normal basic exam takes over 50 clicks. IT has cost us multiple thousands of dollars and since the last GE update, everything has been sluggish. As a group we are spending way too much. Every doctor in our group is seeing fewer patients or spending more afterhours time to "clear of my desktop."
I found you're article fair and enlightening. (Should be required reading for anyone considering buying an EMR.) October 10, 2007 - 12:00:00 (CDT)
Jyoti:
Great Article Dr Bertman. This article is an eye-opener for many.
I have used Misys in the past. I reasearched a lot before I signed up for AC. I can't believe I am getting lot more for the $ I spent. It is simply a no brainer.
I believe EHR should be inexpensive and efficient. October 3, 2007 - 12:00:00 (CDT)
Robert :
emr companies....hmmmm? simplicity, cost, and freedom. SIMPLICTY= of emr program so anyone can use and leverage the efficiencies that increase medical operation value. COST=it hs to fit the cost structure of a clinic. FREEDOM= to cut bait and run with your patient database if you are exposed to the business risk of the emr company. I am an AC user and a fan of its creator. Great Article Jon! September 29, 2007 - 12:00:00 (CDT)
Nancy:
As a college professor who teaches students to use EHR I have found this article and the additional posting very interesting. Is there anything you think we should be adding to our training to help you in your practices? September 28, 2007 - 12:00:00 (CDT)
Niraj:
Dr. Bertman,
It is a very well written article. It narrows down to exact issues what a small vendor faces when they want to do honest marketing to physicians.
We at Mednet System are sticking to our basics (just like you) in providing simple software, with transperant pricing, and simple 2-page contract (with no legal mumbo-jumbo). There are hundreds of physicians that are loving it. September 28, 2007 - 12:00:00 (CDT)
Alan:
I think Dr. Bertman woke up on the wrong side of the EHR bed.
I do agree that SOME of the secrets he cites are valid but we have had an excellent experience with our EHR. We have been "live" for 4 1/2 years and right from the start we saw a savings in the number of staff we had to have to deal with insurance claims and files. One of his major premises is that the EHR is all about improving care. That premise is certainly not the case. The major reason for an EHR is ECONOMY, ($$$$). A physician can provide excellent care to their patients with NO charts at all but it would be difficult to relate information to another physician and problematic following chronic problems. The Major reasons to document a visit are a). to get paid by an insurance company, and b). to protect you in a lawsuit. Therefore the ROI argument is definitely pertinent to your decision to purchase a particular EHR.
I do agree with his secret #5 as well as #9. It is difficult to pin down a vendor to a price until you factor in all of the "options" that you need, the obvious solution is to only sell the EHR with all of the options installed to all physicians and charge them all a higher price, and CCHIT does certainly make things complex, but then when has any certification of any kind actually made things EASIER?
Some people complain about a yearly maintenance fee for their EHR but if you had ever been in the business world and had to deal with large software packages, this is the norm. As is the piecing out of options when you buy the software.
As far as secret #6 goes, every EHR I have seen has had the option for you to print the patient chart for any patient that you wanted. The difficulty is in converting to a competing EHR, but that is no different than the fact that each automobile manufacturer has seperate items on their car that are not interchangeable with any other brand of car. The only time this is a real concern is if you have opted for an ASP type of connection to your EHR and then in my opinion you chose that restriction yourself in return for not having to worry about IT problems.
There are a lot of EHR's out there that offer a wide variety of features and I agree that Secret #10 is important but I do not think it is really a secret. It is just a matter of doing your research and opting for quality. I always keep in mind a saying my father told me "You don't always get what you pay for but you NEVER get what you don't pay for". Many doctors offices I have spoken to, No I am not paid by our software company, seem to want something that will solve all of their problems and save them tons of money while not having to invest anything to start with. We invested $75,000 to start with for 1 physician (including hardware and software) and have had to invest roughly $35,000 more as we added two more physicians to our practice. We have saved roughly $95,000 in salaries in the 4 1/2 years we have been using our system and if you figure a cost of $10 per chart to create and maintain a chart, we have saved another $70,000 to date in chart costs. Plus we never have to hunt for a chart that is misplaced and we do not have to hunt for the chart to process a prescription refill. Both of these items save a lot of time which is represented by additional employee payroll savings.
The largest drawback is that the physicians are a little less efficient and see a few less patients per day but that is more than offset by the built in E&M coder that makes sure we bill out the correct level for all of our visits. Our E&M coder is integrated with our chart and tracks the CC, ROS, PE, and A&P, including ordered lab and radiology. At the signoff the coder tells us what code the visit should be billed and our average billed encounter is a 99213.75 which, compared to other office managers I have talked to, certainly makes up for seeing a few less patients and it allows our physicians to actually spend a few more minutes with each patient which they really appreciate. We have had chart audits by BCBS, Health Advantage and United Healthcare and never had a charge downcoded or adjusted because we did not have sufficient documentation, our E&M coder checks that for us.
Did I mention the Surescripts e-prescribing interface? or the bi-directional lab interface?
You do not get a quality EHR if you want to spend only $20,000 or $30,000 but you can get quality if you are willing to do your homework and pay a reasonable amount for what you get.
Does it cost? You bet. Will it save you money in the long run? I think so, at least our experience has proven to be great. I hope you keep in mind Secrets #2 and #3 when you read this article written by a physician who is hawking his own EHR. Many of his points are valid but he could not be considered unbiased. September 24, 2007 - 12:00:00 (CDT)
Timothy:
Avandia was not removed from the market as of 09-19-2007. September 19, 2007 - 12:00:00 (CDT)
greg:
great article. thanks. August 31, 2007 - 12:00:00 (CDT)
Michael:
I attended one of the meetings planning the EHR certification requirements, and it was obvious back then that a bloated certification process would produce bloated EHRs.
I think we will see a new approach coming out of the world of blogging. A patient's chart is in essence of group blog about a patient, with some added security. Blogging software is widely available and many younger doctors already know how to make blog posts and comments, much as we are doing on this page. A simple EHR product based on blogging software would have many advantages, including the ability to link to many resources. We illustrate how such blogs could link to diagnostic decision support software in our Cases Blog at http://www.simulconsult.com/cases/. Similarly, adding images and videos is quite routine today. It is even simple to have comments as required in CCHIT criterion 71a. Wouldn't it be wonderful if those annoying green hyperlinks that automatically add advertising to blogs instead add hyperlinks to useful material?
The best way to design an EHR is to put together the parts that doctors want. The rest can be added on to the blog EHR in a way that doesn't disturb the doctor's work flow. September 16, 2007 - 12:00:00 (CDT)
Alexander:
Secret #6 : I am presently developing software and I need our pt data but the EHR refuses to provide acces. What recourse options do you suggest? September 11, 2007 - 12:00:00 (CDT)
Michael:
we spent over two years evaluating EHR products and to our disgust had to purchase a lesser product due to secret #6. Not only are EHR products proprietary, so are many of the management solutions and they refuse to interface their products to hold you hostage.
thanks for the article
so very true September 8, 2007 - 12:00:00 (CDT)
Fahhad:
Check out YourMedChart.com It is a great tool for private practice physicians or those on the go without the price tag of those more expensive EMRs. It is a PHR and PM software solution in one. September 18, 2007 - 12:00:00 (CDT)
David:
Thanks. In a different lifetime I was a systems engineer at EDS. I am especially frustrated by #8 "accurate, improved, and rapid documentationwhat should be the most important features of any EHRare often woefully inadequate". You are 100% correct.
The remainder of the issues are bloated features that would be nice if the core objectives were met. And avandia was not removed from the market.
September 2, 2007 - 12:00:00 (CDT)
jonathan:
Woa - some great comments here. Thanks for taking the time to discuss your thoughts!
Alan, you are right, I certainly did wake up on the wrong side of the bed. Now, mostly, this is because being in primary care practice today, in a word, sucks. But to be charged thousands for software does indeed put me in a bad mood.
I can't imagine what specialty you are in, but based on what you admitted to paying for your practice - "We invested $75,000 to start with for 1 physician (including hardware and software) and have had to invest roughly $35,000 more as we added two more physicians to our practice" - it can't be primary care (or if it is, you must know something that I don't)! I would say you fell hook, line, and sinker for secret #7. September 26, 2007 - 12:00:00 (CDT)
Bert:
Alan,
I simply have to respond to your post. I will have to reply to many of your comments so I will follow your quotes with my comments.
One of his major premises is that the EHR is all about improving care. That premise is certainly not the case. The major reason for an EHR is ECONOMY, ($$$$). A physician can provide excellent care to their patients with NO charts at all but it would be difficult to relate information to another physician and problematic following chronic problems. The Major reasons to document a visit are a). to get paid by an insurance company, and b). to protect you in a lawsuit. Therefore the ROI argument is definitely pertinent to your decision to purchase a particular EHR.
You seem to contradict yourself here. You say you can provide excellent care with NO charts at all; but how can you provide excellent care when A) you cant relate information to another physician, and B) you cant follow chronic problems. I would add its difficult to provide excellent care when you dont know the medication list or the PMH or the last exam, etc. The ROI argument is only valid if the company can show that THEIR software provides a higher ROI than another. Since, one can document just as well on an EMR that costs less than a thousand dollars than one that costs $75,000, the ROI will be higher on the first.
&..every EHR I have seen has had the option for you to print the patient chart for any patient that you wanted. The difficulty is in converting to a competing EHR, but that is no different than the fact that each automobile manufacturer has separate items on their car that are not interchangeable with any other brand of car.
I am not sure what being able to print out a progress note has to do with changing over your EHR. Are you suggesting that it is not important to be able to move your data from one EHR to another because you can print out the 10,000 encounters you have? The automobile analogy just isnt a good one. You dont need to be able to move things from one car to another. When your car is old, you buy a new one. There is nothing in an automobile which is mission critical if you need to move to a different car. With an EHR, you should have the ability to easily move data to another program.
We have saved roughly $95,000 in salaries in the 4 1/2 years we have been using our system and if you figure a cost of $10 per chart to create and maintain a chart, we have saved another $70,000 to date in chart costs. Plus we never have to hunt for a chart that is misplaced and we do not have to hunt for the chart to process a prescription refill. Both of these items save a lot of time which is represented by additional employee payroll savings.
I dont think I could match saving that much money in salaries. Obviously, everyone saves payroll expenses by using a good EHR. I guess one can do anything with statistics, but $10.00 per chart seems a little high. What costs are there to maintain it? And, while I agree that there is a ROI for not having to hunt for a chart or look for one to write a script; the point is not that the expensive EMRs dont have a ROI, its that they have no higher ROI than less expensive ones. Amazing Charts allows one to be paperless and not have to search for charts; it allows one to print scripts without looking for a chart. What Dr. Bertman is saying is that the Logicians of the world try to sell their product by getting one to believe that the $40,000 to $60,000 up front cost is worth it, because you will save that over time. One should look at ROI as value. Amazing Charts can save one just as much in going paperless as eMDs, but it does so at a much lower cost. My two favorite ROI arguments I heard from these vendors were look how much you will save on dictation we dont do dictation and every time your secretary has to pull a chart, it costs you $1.00. That must be an awfully slow secretary.
The largest drawback is that the physicians are a little less efficient and see a few less patients per day but that is more than offset by the built in E&M coder that makes sure we bill out the correct level for all of our visits. Our E&M coder is integrated with our chart and tracks the CC, ROS, PE, and A&P, including ordered lab and radiology. At the signoff the coder tells us what code the visit should be billed and our average billed encounter is a 99213.75 which, compared to other office managers I have talked to, certainly makes up for seeing a few less patients and it allows our physicians to actually spend a few more minutes with each patient which they really appreciate.
With Amazing Charts you can see MORE patients per day. While I cant afford the bells and whistles of the other EHRs, I will admit that I am very envious of your E & M coding. You do get higher CPT codes. I remember using Logician Internet which then became Medscape Encounter before it went belly up. It had that feature, and it was nice.
I hope you keep in mind Secrets #2 and #3 when you read this article written by a physician who is hawking his own EHR. Many of his points are valid but he could not be considered unbiased.
I think Dr. Bertman was more than up front when he explained he owned an EHR. No, he is not unbiased. He stated that his opinions were only his. You and others certainly have a right to disagree with his views; in fact, it is healthy to have these discussions. Yes, I do use Amazing Charts, A) because it is an excellent EHR, and B) I cant afford any of the others. Dr. Bertman has provided a level playing field for those of us who dont have tons of capital. I am not defending Dr. Bertman simply because I use AC. In fact, if you want to see otherwise, go to ACs message boards as he suggested, and you will see many comments which take him to task.
You do make many excellent points. For full disclosure, what EHR do you use? J
September 27, 2007 - 12:00:00 (CDT)
Brandon:
Regardless of your feelings for CCHIT, example #238 (or probably many other features) should not be feared if the developer has the resources to add in little features here and there, especially if the market is asking for the feature.
In regards to #238 it actually says:
"1. The system shall provide the ability to display medical eligibility obtained from patient's insurance carrier, populated either through data entry in the
system itself or through an external application interoperating with the system." (essentially a unidirectional interface with the PMS)
With the side note saying:
"The EHR need only provide information for the physician as to whether the patient is covered by that insurance plan. This can be accomplished by a text note following verification."
If your EMR collects insurance information (which it should if you want to do things like automate lab orders, imaging orders or generate superbills) then I do not see a problem in adding a text box/checkbox to the insurance information tab nor would it complicate the usability.
Another example I remember was something along the lines of removing a patient from the practice (maybe they are deceased or divorced from the practice) while maintaining their medical record. Some people saw this as excessive -I assume that is because their EMR did not offer advanced reports.
When Avandia was removed from the market our users ran reports to find all patients on Avandia so a letter or phone call could be made. The deceased/divorced from practice patient does not need that letter/phone call so why should they show up in the report? The same scenario applies to the patients due for health maintenance guidelines.
The more office automation an EMR offers the more one will appreciate SOME of the CCHIT features.
I am not for or against CCHIT. It has a nice checklist of features. They will be worth their weight in gold if they put out guidelines for interoperability AND they actually verify (ie., no self-verification) the EMR's interoperability as well as usability.
With all due respect to AC, I doubt many people expect it to be CCHIT certified. Nor would one expect to see AC in IPA's, RHIO's or hospitals. I have yet to see the data, but CCHIT seems to be useful only for large organization like IPA's, RHIO's or hospitals. In my humble opinion, CCHIT acts as a large scale RFP and nothing more. It does not verify usability or interoperability.
I believe those shopping for EMR's should stop by the CCHIT website to get some ideas on features they want to look for in a demo. Medtuity added in nice CCHIT features that we nor our users had thought of. A number of these features are used everyday. August 31, 2007 - 12:00:00 (CDT)
