To Wait or Not to Wait on Selecting and Implementing an EMR…

John Halamka recently posted the following about whether doctors and practices should wait to purchase an EMR. Here’s his response:

I’m often asked by clinicians and hospitals if they should wait to purchase an EHR because of the uncertainty regarding meaningful use and certification.

I tell them to move forward now.

The following is my response I made to him in the comments of his blog:

Thanks for sharing the timeline[also included in the blog post listed above and similar to my previous post on the EMR stimulus meaningful use and certified EHR timeline]. However, I do disagree with you that people should be selecting and implementing an EHR now. There’s no rush to do this. I can agree that users should start reviewing the various EHR vendors and technologies that are available so that they are familiar with the choices that exist. However, it’s premature for those users to actually select and implement an EHR.

Your suggestion of choosing a CCHIT certified EHR is also off base. The fact is that not even the onerous CCHIT certification criteria meets the meaningful use matrix that you reference. So, the certification criteria will change and it’s likely that not all CCHIT certified EHR will achieve HHS EHR certification (which is what really matters for the $$).

Instead, the wisest counsel that can be given to providers is to select an EHR based on which EHR software will best meet their business needs. If they do that, then whether they’re able to get the EHR stimulus money or not they’ll be happy with the decision they make. The EHR stimulus money will just be a nice bonus if it all works out well.

What do you guys think? Is the time now to purchase an EMR?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

14 Comments

  • I fail to see the harm in shopping on the CCHIT site for an EMR. Of course the conservative apporach will be to wait it out and shop around for the best fit. The problem is that most practices may never find the perfect fit. They will waste time evaluating where they could be getting up to speed on utilization (meeting meaningful use criteria won’t be overnight), getting eRx rewards, becoming a more efficient and profitable practice, maybe getting a credit on your med malpractice permium, ect, ect. Reaping the rewards of the EMR will take lots of time (months) and energy. Better to get the ball rolling now so when 2011 rolls around maybe you get something back from Unc Sam for a change.

  • I feel that practices should be doing all their homework now. In doing their research, if they find a vendor that seems like a good fit, I do not see the harm in implementation. To Jim, you are absolutely right by saying that there is no harm in shopping for CCHIT cert EMR, however, that is a very small window into the EMR world. If anything, a CCHIT certified EMR may mislead a specialist by offering “templates” for their practice rather than a specifically designed application that would suit the practice more effectively. Before the ARRA, EMR vendors were still around and making money because there were compelling reasons for physicians to adopt these programs. They saw the ROI, work/life balance, and other benefits prior to being enticed by ARRA. Its the vendors goal to sell around ARRA, get back to the basics, and if anything use the stimulus money as a “bonus” rather than an “incentive” if they achieve meaningful use.

  • I would like to know what standards are available for EMR? If a medical facility chooses an EMR today, and later want to connect to an HIE how will all the EMRs and HIEs co-exist?
    How will a patient transfer their EMR from one Dr to another and allow it to be read by the other Dr’s EMR?
    Isn’t HL7 far too outdated to allow ‘nirvana’ interoperability?

  • Why wait for the immediate benefits of installing an EMR System? Federal reimbursements for e-Prescribing and PQRI are available NOW. The higher insurance reimbursements and higher productivity of your medical practice is available NOW. The ability to operate out of multiple offices without duplicating, carrying or faxing charts is avaialable NOW. The better lifestyle of doctors who use EMR systems like UNIEMR’s Physician’s Solution to securely access, modify and update charts, notes and labs and tp message partners, associates, staff, patients and referring physicians (all through HL7 interfaces) securely from any computer with a browser, is available NOW. The ability to be ahead of the curve — instead of at the end of the line waiting for an EMR System to be installed and missing out on the first year’s ARRA reimbursement (or even worse, having your Medicare, Medicaid and insurance reimbursements reduced) because you didn’t demonstrate meaningful use of an EMR System in time — is available NOW. [Sales Pitch Removed]

  • Jim,
    I don’t have a problem with users looking at CCHIT certified EHR. I just have a problem when they don’t look at the hundreds of other EHR that arne’t CCHIT certified.

    I know very few doctors that have wasted time evaluating. I believe that it’s better for them to have more information and more experience with various EHR in order to select the one that fits their practice the best.

    My point isn’t that doctors should do nothing right now. My point is that they should be doing their due diligence. They should be preparing their practice including the culture, the IT, etc so they are ready for an EMR. However, I don’t believe that there’s a rush for them to select and buy now. There’s time ahead. Do it reasonably and thoughtfully. Not in a rushed state.

    Of course, you could also make the argument that they might adopt an EHR and then see nothing from Uncle Sam. However, that’s a topic for a different post.

  • Scott,
    I agree. I have no problem with someone who’s done their homework and has a well thought out plan of how implementing an EMR will benefit their office regardless of stimulus money. No need to wait then. Like I said above and you repeated. Just treat the stimulus money like a bonus that may or may not be worth trying to get.

    The problem is those who do little homework, think that CCHIT provides them some added guarantee of having a successful implementation (which it doesn’t) and then purchase an EHR without a good plan of why they’re doing it.

  • Jonathan,
    The standards for interoperability are really poor right now. CCR and HL7 are two that come up regularly, but like you said it won’t provide the “nirvana” interoperability. At least in their current state.

    I wish they would have focused a lot of these EMR funds on interoperability standards and methods. Since otherwise, there’s not a good business model for doctors to be interoperable. Too late for that now.

  • Mitch,
    I think we could debate about how available the e-Prescribing and PQRI incentives are. I’ll just simply ask how many doctors do you know that got them? My answer is not many (if any). I know some that are upset that they tried and didn’t get them.

    That minor detail aside, your point about there being other benefits to EMR software that are available now is a VERY fine one. On that note, I think you’ll really enjoy my tongue-in-cheek post I did a couple months ago: https://www.healthcareittoday.com/administrator/2009/08/06/top-reasons-to-get-an-emr-or-ehr/

  • I’d have to say choosing the EMR based on the POSSIBILITY that you get stimulus funds for picking a certified system is a bit risky. Certainly, there are many benefits to utilizing an EMR system and the choice should be made based on those, not on the chance that your system will qualify or that the funds will even appear.

  • John Halamka referred to clinicians and hospitals. If an hospital has not started looking into EMRs by now they will run out of time for getting benefits and possibly avoiding penalties. These are not 6 months projects. Consider also the demand and supply of qualified resources in the marketplace to implement these projects (sucesfully) and how waiting is likely to create potentially a spike in demand with price (=cost) increase vis-a-vis everything else going on (X12 5010, ICD10, RAC etc.). Finally if a hospital is not ready to buy now it probably means that it is not in next year’s capex plan (or even strat plan) – so you are looking at a potential 12 months cycle. Getting ready to buy now, the way I read it, means get all your ducks in a row. I would not be too concerned about CCHIT certification vs. HHS MU certification for the EMRs already CCHIT 2008 certified. Sure, some may not make it but it will be the minority. Legacy(in-house) and open source EMRs is another story…the earliest I expect anyone (CCHIT or other TBD certifying organizations) to certify these in-house or OS is 12 months from now (i.e. circa Federal FY 2011)…kind of cutting close if a hospital wants to demonstrate MU by 2011/12 and maximize potential benefits. Not as much time as it may semm when one factors in all the aspects of a decision making process and the implementation…get going!

  • Fabrizio,
    It’s a good point. John Halamka does come from a hospital perspective and I should have factored that in. No doubt the process for a hospital and associated bureaucracy is more than in an ambulatory environment.

    Just to be clear, I’m not advocating doing nothing. I’m just advocating delaying the purchase decision if you really want to get the stimulus money.

    Also, the backlog of qualified people is interesting and in a hospital environment might be more of a challenge too. However, it reminds me of this interesting take on the potential EMR backlog: http://www.emrandehr.com/2009/08/19/simple-emrs-and-the-emr-backlog/

  • A few things about the new EMR requirements:

    – They will be very heavily medicare/medicaid focused (even if there is some new public plan that comes along, it will be built on CMS)
    – Electronic billing and coding will be a component – with real-time transmission to CMS, eliminating paperwork

    – They will be tied to PQRI software initiatives

    If you are going to work with a vendor, be sure that they already have systems that are compliant with the stated points. You can be sure that they will continue to be ahead of the curve and certification worthy in the future. One other option, be sure each of your vendors have integration with each other & CMS.

    The hospitals & physicians that will be receiving a bonus, or grant, will be paid out through 2014 if approved EMR systems are implemented. Starting in 2015, hospitals and physicians will be fined if they have not yet adopted a compliant software system. There is a 12 – 18 month cycle in adopting such a system from decision to install and implementation of a new EMR program (on average)…do your research, but don’t wait too long.

  • I can only say that if you wait until everyone else starts getting on board with electronic medical records, you will lose your “negotiating” power with emr vendors.

    Every provider right now should be negotiating hard with emr vendors for pricing, length of training, hardware upgrades, etc.

    These vendors are equipped to sell “software”, however they are not equipped to provide training and support should there be much more of an increase in EHR sales.

    Check out the popular sites for EMR – they are all hiring training people, software support, etc.

    You do not want “trainees” when it comes time to implement your emr.

    Now is the time to negotiate – especially on the training end.

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