I had planned on including an expanded version of my June 5th post (HI(TECH) Anxiety) in the upcoming edition of SRS’ QuickHITs monthly newsletter. So in doing some additional research, I came across some interesting websites and facts that I thought I would share with www.healthsystemcio.com readers.
First of all, the readership of www.healthsystemcio.com not only continues to grow dramatically, it now seems that its content is feeding other blog sites, as well. Congratulations, Anthony. This afternoon I stumbled across a blog site that I had never seen before, called “EMR and EHR”, authored by “John the Blogger”. It contains several posts that reference my “HI(TECH) Anxiety” post. Here’s the link: http://www.emrandehr.com/tag/marc-holland/
“John the Blogger” – not to be confused with John the Baptist, unless of course, John works at Baptist Memorial Hospital – makes a good point: that despite the implication in my earlier post, there is no quid pro quo which requires the RECs to offer their services for free.
So let’s set the record straight. When the concept of the RECs was first described in the language of ARRA, when REC grant applications were being solicited and again when each round of grants was awarded, nowhere was it stated that the RECs could not charge for their services. However, that said, many in the industry (myself included) assumed that if not free, the RECs would offer their services at heavily discounted prices in order to promote the intent of the ARRA adoption incentives by offsetting more of the costs associated with becoming a meaningful EMR user.
For example, I point you to the ONCHIT website and suggest you review the supporting materials ONCHIT used in the webinars they held to assist potential REC grantees prepare and submit their applications. Here’s a link to the PowerPoint file used in their October 15, 2009 Technical Assistance Call: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_907415_0_0_18/REC_TA_Call_10152009_Final.pdf
If you download the PowerPoint file, the following can be found in the FAQ section at the bottom of slide 30.
The FAQ reads:
“Is it ONCHIT’s expectation that in addition to the provider’s commitment of costs in purchasing the EHR and providing staff resources for the implementation that letters of commitment also include a monetary fee for the HITREC’s technical assistance program? If so, is there a minimum required?”
(N.B. the letters of commitment referred to are letters from the providers to the RECs, which are part of the ONCHIT documentation and audit standards an REC must comply with.)
“Providers will not need to fund the HITRECs.”
Another data point to consider is an article in the April 2010 edition of Health Affairs entitled “Easing The Adoption And Use Of Electronic Health Records In Small Practices”, by Phyllis Torda, Esther S. Han and Sarah Hudson Scholle of the NCQA. For an abstract of the article, see: http://content.healthaffairs.org/cgi/content/abstract/29/4/668
In a written response published on May 17th to reader comments on the original article, the authors wrote:
“The program leaders we interviewed were concerned about their ability to meet the ARRA objectives with the level of funding provided.”
So shame on me for being so naïve as to assume federal assistance was more than simply a subsidy. Here’s a contrasting data point I found during this afternoon’s research. In an article published on the AMA’s AMEDNEWS.COM website on May 17, 2010, the author, Pamela Dolan, described an interview she held with Mat Kendall, acting director of the Office of Provider Adoption Support at ONCHIT.
Ms. Dolan writes:
“(Mr. Kendall) said each center will offer a unique menu of services. Those services could include getting a practice connected to a health information exchange or letting physicians subscribe to a center’s own EMR system. Many services will depend on the expertise of center employees. Practices will need to seek help from other consultants for services not offered, Kendall said… As each center will have its own business model, the price of services will vary from center to center, according to Kendall. Some may offer consulting services at no charge, while others may charge for all or some services.”
Here’s the link to that article: http://www.ama-assn.org/amednews/2010/05/17/bica0517.htm
OK, so let’s assume that the RECs have the right to charge their physician subscribers a fee to offset implementation costs — costs that would likely exceed the $4850 figure cited in my earlier post. While this would provide the funding to allow them to provide more staff hours per implementation, it will require that they ramp up to even higher staffing levels. And, as discussed in the Part I, this may be a very tough hill to climb, especially in the short run.
But if NYeHC planned on charging for their services, why wasn’t it mentioned or even implied in the June 4th presentation I sat through at the Westchester Marriott Hotel? In my view — of course, I could be wrong — it’s because they don’t currently intend to charge for their services. If that’s true, then my earlier premise is correct – either the physicians and their staff will have to do the lion’s share of the work – work they are not well-equipped to handle – or they will need to supplement their own and the REC resources with other external, and much more expensive, ones. Who might that be? One alternative is the EMR vendors, which are themselves short of staff, or their business partners.
I was invited to give one of the keynote speeches earlier this week at the Xchange Public Sector conference, which was held in Jacksonville, Florida. It was a conference devoted to “the channel” – the small to medium sized VARs and system integrators which market to the public sector and healthcare industries and serve as channel partners and subcontractors to large SI and independent software vendors (ISVs). Healthcare IT was the hottest topic at the conference, even for those firms which historically had done very limited healthcare business. All seem to be scrambling for a piece of what they perceive to be a fast growing market. Many have, or are forming, reseller and partnership agreements with the big name ambulatory EMR vendors. I saw very familiar EMR company logos printed on the “authorized reseller” areas of many of the business cards I was handed.
Moreover, I believe the physicians who are the RECs target market will quickly learn that to be a meaningful user will require a lot more than merely buying a certified product and learning to use it in a “meaningful way”. Unlike the RECs, firms such as those represented at this week’s conference have the experience with the companion infrastructure and software technologies needed for these physician practices to have a complete and professional EMR implementation and an ongoing quality user experience. This includes products and services related to infrastructure deployment and management, hosting services, email services, security, backup and recovery, system integration, systems management, help desk services, voice communication, unified communications, and much, much more.
So isn’t it reasonable to ask “why use two different sources to provide my implementation support?” In my opinion, by pursuing this strategy, the RECs could potentially be caught between the proverbial “rock and a hard place”, unless they figure out what constitutes a successful business model. Rather than competing with the VARs and SIs, I believe the RECs — and their potential clients — would be better served if they simply served as the broker of deals with the vendors and their business partners, provided project management and oversight services and, most importantly, provided the healthcare domain expertise and the educational and professional services to ensure that their physician clients can comply with stage 2 meaningful use criteria, where health information exchange and quality reporting will be the primary focus. The pot of federal gold is not bottomless. As an industry, we need to make sure we leverage the limited resources we have been granted in the most effective way possible. We had better not squander them; we won’t get such a gift again.