The Certification Commission for Healthcare Information Technology (CCHIT) just announced a proposal that marks a dramatic change in the way they approach electronic medical record (EMR) certification. CCHIT is currently the only government-recognized body that certifies EMR software. The goal is to “accelerate” the adoption of EMR software by assuring physicians that certified software meets certain standards for functionality, thus eliminating uncertainty from the market.

One major problem with CCHIT is expensive application fee. Application and renewal fees are approximately $40,000, not counting development costs needed to meet CCHIT’s exhaustive standards. This keeps certification out of reach for many smaller vendors. Some have even ventured to say that CCHIT is purposely trying to keep smaller vendors out of the market.

Regardless of whether or not this is true, many smaller vendors fear CCHIT might be selected as the certification criteria for the HITECH stimulus package. In order to qualify for stimulus money, physicians must purchase and use a “certified system,” according to the meaningful use guidelines. If CCHIT is selected in its current form, many EMR vendors could be driven out of business.

Furthermore, the vast majority of EMRs are uncertified; statistics show fewer vendors pursue certification each year. If only a handful of vendors are allowed to provide EMRs for the nation’s physicians, there will not be enough time for the majority of practices to qualify. Many of the larger, CCHIT-certified systems already have six-month implementation backlogs. This will only get worse as 2011 approaches.

However, CCHIT recently proposed three new certification options that might solve these problems. Dr. Mark Leavitt, CCHIT chairman acknowledged the need to accommodate “broader swaths” of the market. The changes would make it easy for smaller vendors and open-source software to achieve certification. One of the proposed certification tracks could cost as little as $5,000, and scholarships may be available for non-profit EMR providers.

The proposal has three tracks, EHR-C, EHR-M, and EHR-S. EHR-C is the most comprehensive, similar to the status quo. EHR-M is geared towards software that focuses on a specific medical specialty, and EHR-S is aimed at vendors who build systems from noncertified components.

CCHIT is certainly on the right track. These are welcome changes which could solve many problems in the EMR industry. CCHIT should implement the new proposals as soon as possible, so vendors can apply before the HITECH requirements are published in January. Failure to do so could jeopardize success of the stimulus package.

Isn’t it amazing how we can travel the world and pay for nearly anything with a credit card? This is possible because credit cards are simple: they use a standard device; they are relatively secure; and they use a common data standard. In the world of electronic medical records, we should strive for this same level of interoperability. Just like a credit card, we should be able to use our medical records anywhere in the world, anytime we choose, and maintain personal control over our information at all times.

Credit cards use a standard device to store information; all of the data is encoded onto a magnetic stripe. Since credit cards don’t carry much data, this works well. Medical records, however, are quite complex and sometimes require a substantial amount of storage, especially when including x-rays or other images. Another important difference is that medical records must be constantly updated. Carrying outdated medical records is more dangerous than not having any records at all. Credit cards aren’t designed to have their data added to or changed, they are “read only.” Medical records need a standard device, similar to a credit card, but with the ability to read and write data. USB storage devices are easy to carry, and offer plenty of storage space; and some are even designed to fit in your wallet. Almost every computer built in the past 12 years has a USB port, so they should be nearly as universal as credit card terminals.

Credit cards are relatively secure. The cards are protected by security codes, expiration dates, and encryption when used online. Most people keep their credit cards in a wallet or purse, so they are accessible at all times. Medical records should be used in the same way. Patients should have their data handy at all times. Just like making a purchase, their health information should only be available to physicians they choose. One key difference is that credit card purchase information travels over a network. Sending medical data over networks is where the model fails. There are many reported health data breaches every year, many of which lead to identity theft. Rather than using a network like the banking industry, medical records software should save data in a standard format on a USB drive. Just like with online purchases, encryption can protect sensitive medical data.

Credit cards use a common data standard. Terminals all over the world can read credit cards, regardless of manufacturer. This is possible because of standard data formats. Magnetic stripes have been exactly the same since their introduction in 1975; however almost everything has changed in medicine in the last 35 years. Even though medical technology will continue to evolve, interoperability will require a common way of storing and communicating data. Extensible Markup Language, or XML, is a common way to store and communicate data. It is used everyday by millions of websites and software programs worldwide. There is already a version of XML, known as Health Level 7, or HL7, that is specialized for communicating and storing medical data. Choosing a standard data format is necessary for any interoperable system.

The Solution to Interoperability is SIMPLICITY. Rather than complicated and insecure national health networks, we should look to the credit card as a model for an interoperable health system. First, an interoperable medical records system should use a standard device, like a USB drive. Second, it should be secure, using strong encryption and personal control over the USB drive. Finally, an interoperable system should use a standard format to store and exchange data. The result would be a simple, secure medium that allows individuals complete control over their comprehensive medical information.

See www.XLEMR.com product page for a description of the MI5 solution which employs these concepts exactly.

The United States is moving steadily towards Electronic Medical Records (EMR). The HITECH Stimulus Act is like a hurricane-force wind, driving practices towards the electronic age. Many doctors have conflicting opinions about EMRs. Are they a treasure island, full of benefits like increased productivity and revenue, or is it a dangerous iceberg that could sink your practice?

I have been using an EMR in my practice since 2003. I have had a fantastic voyage along the way, and I would like to share my experiences with you. Follow me, and I will show you how to chart a course to the EMR treasure island and avoid the EMR iceberg. There are three things I would like to discuss with you: getting “buy-in” from your practice, reasons to adopt an EMR, and results you can expect from a well-implemented system. If you follow my advice, you can successfully implement an EMR in time to participate in the HITECH Stimulus Act. Don’t miss the boat!

Convincing your practice to adopt an EMR can be a difficult task. Moving ahead without getting buy-in from your staff could lead to mutiny, or worse, a failed implementation. I would like to address several of the most common concerns. First, many doctors think EMRs are too expensive. Prices range from free to over $100k. You get what you pay for, this is true, but most doctors do not need a hugely expensive system. Find a system that meets your requirements without a lot of unnecessary features. Second, doctors may be afraid of purchasing a complex and difficult system. This is understandable; no one wants to look computer-illiterate in front of their patients. Furthermore, many complex CCHIT systems have a three to six month installation backlog. My EMR was inexpensive, easy to install, and simple to learn. My staff and I are not computer geniuses. Our EMR is based on Microsoft Office, so we could learn it quickly. Third, doctors do not want to make a poor decision, or purchase an EMR the government disqualifies from the stimulus act. Since it is based on Microsoft Office, my EMR is also easy to change. It can grow and adapt along with my practice, and I have no worries that my system will comply with the HITECH stimulus requirements.

There are many reasons to adopt an EMR system, apart from the HITECH act. Knowing these reasons will help you get your office on-board and allow you to make an informed purchase decision. First and most importantly, an EMR can improve your quality of care. A good system should be more thorough than your paper charts. It will allow you to track vital signs, weight, and lab results graphically, so you can tell how your patients are doing at a glance. Second, Improved history notes and other documentation can help you pass an audit, as well as communicate more effectively with other caregivers, and reduce the risk of malpractice litigation. Third, an EMR system can improve your finances. Better documentation may allow you to qualify for higher reimbursement levels. This works because your paper forms don’t capture much of the work you already perform. EMRs also eliminate the expense of managing paper, such as hours spent filing, scanning, faxing, and searching for lost paper charts, in addition to paper, ink and toner expenses.

A well-implemented EMR system is a virtual treasure island; it will provide enormous benefits to your practice. As I already mentioned, an EMR system can improve your finances. My system DID allow me to code at a higher level, because so much of my work went undocumented under the old paper system. In addition, my office ran more efficiently. My expenses went down dramatically, and as my staff members left over the years, I did not need to replace them. I began with six staff members, and currently I operate with only two. Since my practice is more efficient, I can leave the office on time every day. My wife is happier now because I have more time to spend with the family. I am constantly amazed at the flexibility of my system. My system is constantly adapting to my needs. I was able include things like lab interfaces, x-rays, electronic faxing, e-prescribing and many other features that makes my life easier. My EMR can do billing and automated book keeping through an interface to QuickBooks. Automating the books has saved me tons of time and more than a few headaches!

The key to finding the EMR treasure island and avoiding the EMR iceberg is to go with a simple and adaptable system. Shop around with many different vendors and demand in-depth demonstrations. Keep in mind my reasons to buy an EMR and the benefits you should expect. Ask every vendor about these key points! Please also take a look at www.XLEMR.com; they did a great job building my EMR. XLEMR has ready-to-install systems for many different specialties. If you have any questions, please feel free to give me a call. You can reach me on my cell at 770-846-2627. I look forward to hearing from you.

Dr. Bob G. Lanier, MD

The HITECH Act, a component of the American Recovery and Reinvestment Act of 2009, aims to subsidize EMR adoption by allocating up to $40K per physician, broken into yearly payments. Most of the money comes in the first two years; $15K, and $12K respectively. In order to claim this money, physicians must be a qualified professional using a certified system in a meaningful way. However, there are a few factors that will likely cause the HITECH act to fail. Physicians dragging their feet on EMR purchases, the limited installation capacity of CCHIT-certified vendors, and the difficulty of implementing CCHIT-certified systems will make it very difficult for physicians to qualify in time to receive payouts for the first two years.

Despite the hype about the HITECH Act, many physicians are still dragging their feet. According to experts, physicians take 6 months, on average, to decide on an EMR package. This is normal for any expensive purchase. However, the HITECH Act has made things worse. No one wants to buy an EMR until the definition of “certified system” has been settled. The committee is scheduled to publish the standards by January, 2010. This delay makes it more difficult for physicians to qualify for the first year payout.

While the “certified system” specifications have not been written at this time, many assume “certified” will mean “CCHIT Certified.” CCHIT is an independent body that certifies EMR systems. Because CCHIT systems are so complicated and time-consuming to install, many vendors have installation backlogs of up to six months. To make matters worse, only about 8% of all EMR vendors are CCHIT-certified for 2009. The backlog will increase as 2011 approaches and physicians feel the pressure to purchase. EMR Vendors have a finite ability to install systems. Even if they hire more technicians to install EMRs, it will still take time to train them and get the implementations going. As a result, it is unlikely they will be able to ramp up their production to meet demand.

CCHIT-certified systems are often complex and difficult to implement. Most of these systems require servers, and physicians may also need new computers, printers, networking gear, and other hardware. All of this has to be ordered and set up before the system can be installed. The CCHIT standard contains hundreds of criteria that makes systems unwieldy. As a result, training can be time consuming and frustrating. Experts estimate that it can take anywhere from six months to a year to start using a new EMR system in a “meaningful way.”

Physicians dragging their feet, vendor backlogs, and implementation difficulty make it unlikely that the majority of physicians will qualify in time to receive the first two payouts. Is the HITECH Act Doomed? Not necessarily. The public has started to recognize the problem with CCHIT-certified systems, and there is a good chance the committee will opt for more appropriate criteria. To guarantee your participation in the program, get started as soon as possible by selecting a simple and efficient EMR that’s quick to install, easy to learn, and easy to change. If you follow these criteria and get started soon, you should have no problem.