Plug Into Meaningful Use, Don’t Try to Build It

Earlier this month I read in The New York Times (okay, someone read it to me), that hospitals and docs are saying “meaningful use” is just too much, too fast. I have to say, I would sympathize . . . if I didn’t know about the Internet!

If someone told me that the federal government was going to make (or at least ‘encourage’) everyone commute via hot-air balloon by 2011, I’d start to feel edgy right about now. How do you make or buy one? Who sells them?  What if the wind blows the wrong way?

This would be my panic—unless I knew about a little-known hot-air balloon service that DEALS with all of it. Like a taxi service. You tell it where you want to go and when and then boom! a balloon shows up piloted, prepped and ready.

Such a quandary exists in the EMR market today. Everyone thinks the government rules mean that meaningfully using electronic health information actually means meaningfully using information you BUILD YOURSELF! They think you have to buy EMRs and servers and program them to meet government rules and then re-program them to meet rule changes. This would give me hives, even if I were a giant health system. Even systems with big budgets don’t have a comparative advantage in programming software!

The result is that many, many practices are getting out of Dodge. I haven’t seen as many practices for sale since 1995 when the explosions of PhyCor and MedPartners caused practices to sell to hospitals in search of AR support. In a poll we did recently with Sermo, 60% of responding docs said they were considering selling out to bigger entities! Even if the industry is moving toward easier-to-manage options with “hosted” software, many versions need to be upgraded, and the government (and payers, and associations who create protocols of care) all keep changing. It’s too hard to keep up with the complexity, and that’s why physicians are selling their practices.

Similarly, hospitals are now trying to facilitate “health information exchanges” and they’re setting them up and trying to fly them. Whew! If I was in the middle of the air and the New York Times called me, I think I’d also feel like the Charles Grodin character in the movie “Midnight Run.” See below starting at about 0:55.

Okay, this is sounding so shamefully obvious…use a web-based service !

Why? Our web-based service allows us to respond to any changes from Washington. We can patch rules out nightly to all our clients if needed. We have an intelligence team that monitors all proposed changes to meaningful use and works with our EMR developers to make sure we comply. Finally, our back-office services help physicians enroll in the stimulus programs, collect payment, and report on necessary clinical measures. We not only run the balloon service but we run it in the “cloud” (sorry, couldn’t resist)!

Oh, and I am so confident our clients will meet meaningful use with a web-based service that I am guaranteeing their first government incentive check. You can even read the fine print if you want.

In other words, don’t build meaningful use – USE IT!  This is not lost on people because we see a lot of hospitals attempting to build their own information services! The problem is that they are BUYING legacy software and attempting to make it look like a service. Yeesh. (Citrix WinFrame anyone?) Aside from the clunkiness of making legacy software quack like an online network, there is the cost . . . but I’ll save that rant for another day.

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

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8 replies »

  1. “Use a web based system” Exactly!!!!!
    But use a FREE systems.
    Mitochon Systems is a FREE, CERTIFIED, CLOUD BASED,HIE/EHR/PHR system that can be up and running in any doctors office in less that a day. My father almost died last week due to his medication being administered twice. With open communication between doctors on systems like this the chance for mistakes can be greatly reduced.
    Jim Davidson

  2. Very interesting discussion. I also think that today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.
    Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
    Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the
    ’safe vendor challenge’ as discussed by many critics.

  3. There are several potential advantages of hosted solutions in this market but overall price vs. a client-server solution isn’t one of them generally. With almost every ambulatory EMR product on the market today, a physician practice will pay more for a hosted solution from a vendor than a client-server version even if they have to purchase new hardware up front.

  4. I agree that many providers are going to find a remote-hosted model to have the advantage of being more adaptable while not requiring these providers to become technology experts.
    To make a remote-hosted EHR model work the broadband connection between the using site and the serving site must be sufficiently capacious and reliable that providers can (rationally) make their mission critical business processes depend on it. An EHR-using site that can’t get access to the servers for even short times will either disrupt clinic operations (and cause $ loss) or limit EHR usage to back-office work that can be done without delaying care (which means that much of the meaningful use could not be accomplished). In short, a high-speed highly reliable broadband connection is essential to a successful remote-hosted EHR model.
    Most (according to my surveys) providers don’t have this level of broadband capacity and reliability today. Getting this kind of broadband connection at an affordable cost can be especially challenging in rural areas today. Providers with current typical connections are not terribly inconvenienced today by low reliability (say, having their internet connection down for a few hours each month) because they don’t use that connection for time-critical mission -critical business processes. But, to make remote-hosting of EHRs work as a general solution, a big change in broadband support, in general, is in order.
    This need is recognized in the new National Broadband Plan and in various projects in the FCC’s Rural Healthcare Pilot Program. The FCC, for the first time as I understand it, now has someone, Dr. Mohit Kaushal, assigned to assure that the new National Broadband Plan and subsequent FCC regulations and programs support these health-related broadband needs of providers and consumers. While it is encouraging progress that this issue is “on the radar”, it is far from solved and deserves to be solved to support remote-hosting of EHRsas well as other needs (e.g. telemedicine applications, general HIE needs).

  5. You would be hard-pressed to find another enterprise CIO that is a bigger proponent of cloud-based . We should all leave running data centers (storage, servers, etc.) to the experts.
    Having said that, this is about 5% of achieving meaningful use. To focus on that and to say that the rest is easy is an injustice to the topic.

  6. Oh, this is such a wonderful analogy….
    “If someone told me that the federal government was going to make (or at least ‘encourage’) everyone commute via hot-air balloon by 2011, I’d start to feel edgy right about now.”
    See, I wouldn’t get edgy, I would leave town. Why? Because we have high speed trains and jet planes and space shuttles and we have even visited the moon. So why on earth would anybody in their right mind want me to go back a century and use a balloon, which is unsafe, unreliable and ineffective?
    I can see mandating that I use a fuel efficient crappy little car. I won’t like it, but I can understand the drivers behind the mandate and I can understand that in due course, today’s crappy little car will get much better (like cell phones did), but I cannot understand balloons anymore than I can understand a new mandate to use telegraph.

  7. Repeating a comment I left on Wes Rishel’s last blog posting…
    Back in the early 1950s a group of AT&T folks were tasked with conceptually reinventing the phone system. That session lead to a stream of innovations such as touch-tone phones, long-distance dialing, high-speed (T1 and above) lines, and solid-state switches. The underlying network and its bits & pieces were, and still very much are, much more complex than the prior electro-mechanical switches and human operator system.
    The first people to use (and help refine) the new systems were the human telephone operators who were trained and observed. We also saw the emergence of phone hackers with their blue boxes, taking advantage of holes in the new system’s architecture. Much was learned from these early user populations. And some lessons were forced, such as the emergence of customer-supplied and -installed phones after some court fights to break the phone device monopoly.
    Fast forward… Now we can call long-distance and internationally without operator assistance, and the calls are less expensive in absolute dollars than they were 50 years ago. Domestic distance and time based billing is now replaced by connectivity-based fees.
    But the user interface stayed simple, except for the addition of area codes and numeric-only telephone numbers.
    Stretching the analogy only a bit, we now have cellular phones with all kinds of add-on features. We also have the simple “Jitterbug” models, targeted at those who want plain-old-telephone-service simplicity. Both use the same underlying complex network.
    I think we can achieve the same results for the NHIN, for all users. Let’s focus our collective energies on user simplicity and usability, not the complexities of the underlying network and protocols.

  8. Making meaningfuluse of meaningfully unusable patient care instrumentation is quite a challenge.

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