March 4, 2010

Tom Sullivan, M.D.

Things to Consider When Investing in an EMR/EHR

The word is out:
Starting in 2011 and ending in 2015, physicians and other “eligible professionals” who see Medicare and Medicaid patients will potentially receive between $44,000 – $64,000 in HITECH stimulus incentives under the American Recovery and Reinvestment Act (ARRA) passed and signed into law early last year.
Although every group practice and physician’s decision to get involved requires individual considerations, here are some very brief thoughts:
Paraphrasing “Maslow’s Hierarchy of Needs” in the Health IT world, e-prescribing is a proven, off-the-shelf, low-cost, low-risk first step towards computerizing clinical functions and populating an EHR with data. To help moderate IT investment costs, practices should consider adopting a strategic approach in which e-prescribing is the first clinical application as part of your overall health IT system – with other applications and functions added in a modular fashion over time.

The benefit of doing this is that a practice can make a very small initial investment in the standalone e-prescribing system while receiving current annual incentives averaging $2,000+ a year (MIPPA – in effect as of 1/1/09). Later on — a practice can scrutinize more knowledgeably the potential $44K over a 4 year period through ARRA beginning eligibility in 2011 (up to 64k for high volume Medicaid clinicians).
In addition, this approach allows your staff to ease their way into the clinical workflow changes surrounding the adaptation of new technology instead of taking one giant leap. Plus, so-called “Cloud Computing” represents one of the new approaches that have great promise in terms of being less costly overall and allowing flexibility and choice especially for small practices. DrFirst works with nearly 100 EMR/PMS vendors who can work with you on this stepping stone process of taking baby steps into your future EMR.

Should I try a free e-prescribing system?

I would advise caution to physicians who are thinking about getting a free e-prescribing program. Frequently, the ultimate goal of these “free” vendors is start with sub-standard or mediocre e-prescribing in hopes of leading physicians into purchasing an expensive, full package EHR from the same vendor in the future. In addition, the free programs usually require a la carte upgrades to make the product truly usable in an office setting. This is truly an example where “free is not cheap enough”. On the other hand, these upgrades come standard with most e-prescribing systems that require a fee, along with better customer service, better features, and fewer headaches.
DrFirst’s partnerships allow clinicians to move their patient data to one of our Certified Partners and selectively choose the right EMR for their practice based on factors such as specialty, financial resources, and workflow, as well as local support and market penetration of the vendor. Local support and penetration may be important factors when considering the potential for interoperability.
Stay tuned to these blogs as the field is rapidly evolving
* The requirements to actually see the money are a bit lengthy and complex. The interim proposed specifications and rules were released on December 30, 2009 and are subject to final tweaks and comments that will be published by CMS in late spring 2010.
** They generally revolve around employing Health IT tools and certain functions characterized as ”Meaningful Use” that are just starting to become incorporated in selected EMR/EHR packages.
Tom Sullivan, MD

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.