EMR Stimulus Counterproductive

The Washington Times recently had an article by Tevi Troy and Dr. Jason D. Fodeman about the EMR Stimulus program which talks about how the program might be counterproductive to its goal. The final paragraphs are an interesting perspective:

Unfortunately, Congress and the administration have decided to prioritize “getting it done” over “getting it right.” Other than being able to bring those signs saying “Project funded by the American Recovery and Reinvestment Act” that pop up across the nation’s highways to our hospitals sooner, there does not appear to be much benefit from this approach.

It will take much more than bombarding hospitals with extra computers and complicated, expensive software for health information technology to attain its true promise. It will require the right computers with the right software with properly trained support staff and physicians who know how to use them. All this takes time to establish and time to work out the kinks.

Unfortunately, for whatever reason, the administration is unwilling to devote the time and would prefer to roll the dice and pick up the pieces later. The administration’s rush to establish an interoperable health information technology network may very well prove counterproductive. It easily could waste money, endanger patients and, possibly, do irreparable harm to the technology’s reputation.

I’ve been preaching some of these things for a while, but it’s interesting that the mainstream media is finally starting to pick up the story.

I’d only caution that we not confuse the EMR stimulus with EMR. EMR is no doubt the future of healthcare IT. It’s just important to consider if EMR stimulus is the right approach to getting people to use as the article says “the right computer with the right software.”

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.


  • One of my concerns regarding a “stimulus focus” (i.e., an incentive money fixation) in lieu of a broader “business case focus” goes like this, if you will permit what may be a simplistic example:


    [1] an average 2 minutes additional MU documentation burden per chart (that’s only 6 seconds on average to navigate to/”touch”/verify/enter each of the requisite 20 measures as needed for each patient during the attestation period);

    [2] 100 patients seen per week, 50 weeks per year, or 5,000 charts touched annually;

    [3] That’s 10,000 minutes, or ~167 hours;

    [4] Multiply by a blended, fully G&A cost-multiplied FTE rate of $40/hour;

    [5] 167 hrs/yr x $40/hr x five years = $33,400 MU labor,

    exclusive of the FTE burden associated with the additional CQM reporting (“Clinical Quality Measures”). Now, recall that the max provider Medicare MU incentive reimbursement over the 5 years is $44,000 (and that money will be taxable income).

    Worth it? Draw your own conclusions. Play with the input assumptions.

    Now, obviously, the task (from my REC Adoption Support perspective) is to so effectively re-design workflow as to totally mitigate/eliminate any additional MU documentation burden while streamlining workflow ops more broadly, so that the MU incentive money is neither effectively erased nor appreciably diminished by all of this, and the provider is better off both financially and in terms of care quality and patient satisfaction.

    We shall see, I guess.

    While my illustrative scenario proffered above is rather simple and to a degree hypothetical, it is nonetheless based to a degree on my own playing around, stopwatch at the ready, in a “sandbox” e-MDs login provided us by the vendor, noting the navigation paths to the various MU “money field” target destinations.

    A few seconds here or there, annualized, adds up quickly.

  • Bobby you are correct.

    Without workflow redesign … anchored in place by the right EHR matched to the practice’s clinical needs … then there is no way for the numbers to work. Further … when the incentives expire… the “MU work’ remains uncompensated.

    So workflow redesign is key first to enable a practice to grow capacity and revenue potential. Then the deployed EHR can contribute positively to the practice mission.

    As I think I remember from posts of yours here or on your own blog … RECs don’t have the hours they can provide to a client because of their own ARRA reimbursement limits.

  • Great analysis BobbyG as always. The productivity loss (or potential productivity loss) is a potential problem. Planning for and avoiding it will be an important part of an EMR implementation that wants to show meaningful use.

  • @Don –


    As far as our REC FTE resources go, the original anxious concern was “how’re gonna possibly manage all the work?” But, given the recruitment resistance to date nationally, the question is becoming “am I gonna be laid off by year’s end?” given our milestone payment structure. No one at ONC wants to talk openly about this. You just get wafts of the difficulties here and there.

  • No one wants to openly talk about it for the record. I’ve already been trashed internally by one of my Sups for even writing my independent REC blog (scrupulously on my own time, BTW), because, in her words, it “exceeds your scope,” and isn’t Polyanna-ish enough, I guess, given that I offer honest views of some of the realities and barriers as I see them (and notwithstanding my explicit support expressed therein for the HITECH effort).

  • Must be hard to develop a client commitment when there are no ARRA certified products on which to advise them.

    If I was the head of ONC I would have established 2 programs … a general practice management component as Phase 1 … and an EHR consultant component as Phase 2 each with their own funds. If you don’t maximize workflow first… then a well engineered and mature EHR is not going to “fit” on top of the practice and results and capacity of the practice will never reach optimum.

    This was the reason I was opposed to the concept of statewide RECs doing what management consultants were in a better position to deliver. Not that RECs didn’t have smart, skilled, experienced, multi-disciplined staffs … its the fact that their customer is ONC (that’s where the money comes from) … not the ‘client’ practices.

    That’s why as a practice manager or owner I would have a problem getting what is presented as free help from a REC. As well meaning and committed as the staff of a REC must be … they simply have limited resources to provide the entirety of what a practice needs or asks for help in.

    Hard to make a case for signing up with a REC to assist a practice in EHR selection… for the purpose of attaining a government defined meaningful use proficiency in order to obtain ARRA incentive payments … when there are no ARRA certified EHRs to pick from.

  • This is a big issue for Medscribbler. We also have done the math. The even bigger problem we have is Medscribbler is about 90% compliant now, but the 10% is a problem because if we add it within the time frame allowed it adds to the price we sell for! What is a reasonable ROI without raising prices?

    Worse the certification adds complexity that is now handled by Medscribbler without complexity. For a simple example for discussion, the rules require “Provide certain users with the ability to adjust notifications provided for drug-drug and drug-allergy interaction checks”

    This is added because of the pop up warnings and other intrusive methods of legacy e-prescribing. Medscribbler an advanced eprescribing that has full and multiple alerts that are visable but non-intrusive so there is no need to to add this. The requirements were made only with old legacy EMR common capabilities in mind. It means we need to figure out a way to meet the regulations without ruining the ROI or adding to workflow?

    For this example its a minor nuisance, but for others it is major. The final rule itself figures it will cost and EMR between $250,000 and $3.5 million to certify. You need to double this in terms of investment risk. This basically closes innovation and new EMRs off. It means only what we have now is going to be available. Will the new sales of EMRs be so big as to overcome these costs, I doubt it very much.

    The bright spot for Medscribbler is we can certify, if sales are driven. And it effectively helps keep other innovators down from challenging us!

  • Bobby: Forwarded John an item from the Aug 18 Nevada Review-Journal: Northern Nevada groups land stimulus funds for Internet projects. You may have seen it too.


    Question I had for John was whether he thought Bobby’s REC might be able to deliver more wellness value through a different use of the $7.1mil.

    While contracted broad band capacity may someday also support deployment/extension of the NIHN … I’m betting that more demand by the 1500 people it will support will be on increasing their ability to surf the Web.

    Ironic to read your initial post … and seeing the NR-J item the same day.

  • @Don B –

    “Not that RECs didn’t have smart, skilled, experienced, multi-disciplined staffs … its the fact that their customer is ONC (that’s where the money comes from) … not the ‘client’ practices.”

    Thanks for your great comments. Irrespective of the institutional source of the funding, my personal philosophical view is that my clients are [1] the providers, and [2] by extension the patients. Period. I feel an ethical mandate to use taxpayer funds effectively in pursuit of improving the “general welfare.” Whether that aligns with the egos and bureaucratic imperatives of the likes of a CMS and ONC etc, is a distant and minute backburner concern of mine. Not that I assume any right to contravene policy, just that when we say to our REC prospects that “our only interest is your interest,” we — at HealthInsight, anyway — really mean it.

    A tough sell nonetheless, at least in my state.

  • @BobbyG
    Unfortunately, I think that you and HealthInsight are in the minority here. Probably not intentionally done by most RECs, but if you don’t intentionally shift your focus then it just happens naturally based on the government incentives.

  • Will the I.R.S. impose taxes on HITECH Stimulus funds received by For-profit hospitals and Physician Groups ?

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