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TECH: Don’t buy your PCP an EMR, Mrs Worthington

Medical Economics, a magazine doctors actually read, probably just set back the cause of getting EMRs into small practices about 10 years with this article called: Why EHRs falter (Hat-tip to KevinMD)

My take is that this needs to be an ASP business wrapped into the billing service. I think that it’s nuts for a small practice to take on the responsibility of integrating an EMR with their billing system, and even crazier for them to buy and manage software and hardware. They’re already paying somewhere between 6% and 12% of revenue for billing services, and they should be making their billing services provide them with an ASP based EMR. And quite a few out there will do that.

And think about this. My friend who is a physical therapist at Kaiser tells me that she is going to halve the number of patients she sees for six weeks and have a full-time consultant helping her individually when she gets put on the HealthConnect/Epic system.  And that’s probably the right approach. How many small practices can genuinely take that time or make that investment?

(If you’re not a Noel Coward fan and don’t understand the title reference, look here)

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andy HallMatthew HoltFred TrotteremrandhipaaG. Hinson, MD Recent comment authors
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andy Hall
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Dear Doctor Hinson, I wanted to take this opportunity to introduce CureMD Corporation to you. CureMD is the leading provider of innovative health information management solutions that transform the administrative and clinical operations of healthcare organizations of all sizes. CureMD’s revolutionary technology simplifies decision making, streamlines operations and ensures compliance to industry standards and best practices, ultimately saving time and effort to maximize value and returns. CureMD EHR is designed to personalize care delivery, enhance quality and patient safety, optimize efficiency and minimize cost. Our integrated platform includes practice management, electronic health records, patient portal and mobile solutions making CureMD… Read more »

Tom Leith
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Tom Leith

> I’ve seen a number of IT service companies being > started around supporting this small setup which > should be beneficial and cost effective for you. Which is precicely because managing a server isn’t nearly as easy as managing a desktop machine, which isn’t nearly easy enough for non-specialists to do in the first place. Which in turn is why so few desktop machines in small businesses are managed well (or at all). A small data center has nearly every problem a large one has, and I don’t think having one’s own is a good way for a small… Read more »

emrandhipaa
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“Because I do not want to manage my own data center.” Managing one server for an EMR isn’t managing a data center. Managing a server is nearly as easy as managing a desktop machine. I’ve seen a number of IT service companies being started around supporting this small setup which should be beneficial and cost effective for you. “Because the coupling between clinical processes and billing is getting tighter, not looser.” This is why an integrated EMR/PMS is such a good idea. “Because I want someone with a vested interest helping me understand the relationship between clinical documentation and being… Read more »

Tom Leith
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Tom Leith

Greg, your points are well-taken, and I am glad you have had a successful implementation. I would be interested to hear in what ways having an integrate PM/EMR system has made you a better doctor. Whether or not EMR services bundled with billing services (note that I do not say the EMR is “free”) can work depends on the vendor. If there is a billing service who wants to “Give You A Free EMR, as a Thank You Just for Using Us!” I quite agree this will be most likely a disaster. It seems to me the most straightforward thing… Read more »

G. Hinson, MD
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G. Hinson, MD

My point is simply that one size does not fit all. Small practice docs are the fasting growing part of the market. Some are making mistakes by buying without enough care. As such, I think this article will make some of them think twice and make their decision with more care. A free EMR, whether it comes with the billing service or from CMS/VA, is not likely to work for most practices. If you think a practice is unable to, or unmotivated enough to implement a well-established EMR like NextGen, then they certainly will not be able to make a… Read more »

Tom Leith
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Tom Leith

And of course I missed a perfect opportunity to point out that implementation services are transparently priced which leads customers to believe they are:
1) too expensive, and
2) in any case optional.

Tom Leith
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Tom Leith

> what the hell do I know!? Well, Matthew, you know enough to agree with me, and I know more than a little (20 years’ worth) about this stuff. > What are you going to do? Either listen to a salesman, chisel the vendor on price, turn down customizations, implementation consultants, and training training of all kinds, try to do it myself evenings and weekends because I just know I’m smart enough to do this Trivial Technical Task better than Sparky the Sales Support technician who can’t possibly understand my unique circumstances, have a project failure, and gripe forever about… Read more »

Matthew Holt
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Matthew Holt

I agree with all of you (especially Tom and Fred) but as Doc Hinson says, what the hell do I know!?
But think about this. You’re a small practice doc just thinking about maybe perhaps moving to put in an EMR, then you read that article. What are you going to do?

Fred Trotter
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Failures of this sort will continue anytime you have a system where once the product is sold, the vendor has no incentive to perform well. Enter open source, where you can fire your vendor, but keep your software.
Regards,
Fred Trotter

Tom Leith
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Tom Leith

> Why would you want your billing service > to offer you an EMR? Because these are closely related business processes that share practically all their data. Because I have already a business relationship and technical interfaces working. Because I do not have the time or the expertise to even specify “adequate programming”, much less accomplish it. Because I do not want to manage my own data center. Because the coupling between clinical processes and billing is getting tighter, not looser. Because I want someone with a vested interest helping me understand the relationship between clinical documentation and being paid… Read more »

emrandhipaa
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Why would you want your billing service to offer you an EMR? That’s like asking your doctor to work on your teeth. I think the article gives doctors a healthy dose of reality so they can plan accordingly. EMR implementations are a challenge, but with proper planning and proper evaluation of EMR programs you can make it work great for your office. For every failed example there is a great success story.
John
http://www.emrandhipaa.com

G. Hinson, MD
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G. Hinson, MD

Matt, no offense, but what the hell do you know about EMR’s? This is an extremely complex industry and trying to match the right product with the right physician can be tough. And there are a lot of physicians that just buy the one that the practice down the street is using without ever seriously shopping for what would be the best fit. What works for one practice, may not work for another. And the EMR this article profiled, NextGen, is genuinely one of the better ones out there. I can point you to several practices that are successfully using… Read more »

Jordan Glogau
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I just read the EMR article in Medical Economics. I am in total despair because this might be considered a positive view of the state of EMR adoption! Our billing service, Preferred Health Resouces, offers our Practice Management service, including scheduling, with personal training, and most doctors don’t bother to signup, let alone ask for full EMR. Oh, by the way, it comes free with the billing service. They would rather just put their paperwork in an Airborne package and have us deal with the problem. I have seen everything the article talks about. Only some of the doctors using… Read more »

Tom Leith
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Tom Leith

Yes, I think you’re right about the hosting model for the small practice: not even an Englishman would be mad enough to bring these ugly ducklings in house. It is difficult enough to use them properly, much less manage them. As for the six week implementation cycle, what does anyone expect? I don’t think going the ASP route will help very much with this — it doesn’t take but a day or two to prepare hardware. It is getting the data sorted-out and loaded that takes the time, and that wouldn’t change a bit. But I don’t think your friend… Read more »