My favorite part of HIMSS is meeting all sorts of interesting people. One of those people I met was Lyndsey Coates from Nuesoft. I have a soft spot in my heart for Nuesoft since they were the company that trained me on my first EMR. I still remember the 3 day intense training in their office. Lyndsey and I had interacted a few times before the conference and so it was nice to meet her in person. It was just too bad that we didn’t get to spend more time together.

What does this have to do with EMR backups?

Well, Lyndsey and I didn’t have much time together at the conference, but she sent me a nice bloggers “love note” in the form of a blog post about offsite EMR backup systems after meeting me at the conference. She even sent me a friendly tweet to let me know about the post.

I was a little busy with HIMSS and all, but I’m always happy to share in a little blog sparring. So, Lyndsey, here we go.

I’m really glad to hear you respect my opinion, but I’m a little surprised that you didn’t like my post about offsite EMR backup services. I guess I could have imagined that a SaaS EMR vendor might have a different view. In fact, you make a nice case in your blog post about the challenges of backup with the client server model. Definitely a number of good points for doctors to consider when selecting their EMR.

However, somehow your post left out some of the problems related to backups with a SaaS EMR. No worries though, I’ll be happy to share;-)

First and foremost, I can’t believe you think that doctors will trust an EMR vendor to back up their EMR appropriately. I mean seriously, we’re talking about my whole clinical practice stored on your servers and trusting that your IT staff are doing my backups? I don’t think so. I barely trust my own staff to do backups, so why would I trust my EMR vendor’s staff to do something as important as the backups of my EMR?

No, I’m definitely not trusting you and your IT staff to backup my EMR. Maybe there are a lot of doctors that don’t do backups properly, but there are a lot of large vendors that don’t do backups properly either. Yes, even the all powerful Google lost some data because they didn’t have the right backups.

Plus, if you’re doing my backups that means that you establish the policy and time frame that the backups are done. If I do them in house, I get to schedule the backups, verify the backups and see the reports and logs about when backups are done. I get to choose when and how often those backups are done. With you, I just have to hope that you’re doing them.

Plus, there’s just something that doesn’t feel right about you having the backup of all my data. Maybe you don’t remember that the data stored in the EMR is my life. Not my literal life, but the life of my practice. Maybe you feel comfortable with my life being stored in your redundant data centers across redundant servers who mirror the data and all sorts of other cool backup processes. Personally, I feel comfortable knowing I have a backup of my life in my office with me. I can see it, touch it, pet it and know that it’s safe in my loving arms.

Finally, let’s not call out my previous post about Offsite Backup Service for EMR for “missing the mark a bit.” While SaaS EMR are doing very well, there’s still a VERY large number of people who will select a client server EMR. Better to help them get their client server backup services right than to just tell them that they should have bought a SaaS EMR.

Plus, maybe Nuesoft and other SaaS based EHR should consider partnering with one of these offsite backup solutions. I imagine a lot of doctors would love to have their SaaS EHR backed up to an offsite backup provider like the ones I mentioned in that post. Basically, a location that the doctor can access and control. Could be an interesting service to offer your clients.

Your turn Lyndsey!

P.S. I personally don’t care either way. I think that the client server or SaaS model are legitimate EMR solutions. Long term SaaS EMR are likely to win the day, but that’s still a long ways away. I do enjoy playing devil’s advocate though.

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I must admit that one person that I was very excited to meet at HIMSS was Evan Steele, the CEO of SRSsoft. Evan and I had interacted a number of times online. Plus, I love an EMR vendor CEO that has a blog. Not just any blog, but one that broadens the discussion about EMR software and provides an alternate view to EMR adoption.

Turns out that many people at HIMSS don’t like the hybrid EMR style of software that Evan Steele and SRSsoft are trying to create. There is certainly an argument to be made against it, but personally I like to see people approaching the challenge of clinical documentation in different ways. I also love how SRSsoft focuses so much effort and energy on the physician. If more EMR vendors had this focused, we’d have much better EMR software.

Now this kind of sounds like a sales pitch for SRSsoft. It’s not. SRSsoft has its flaws and weakness like every other EMR software out there. I do think that they’ve done a good job broadening the discussion so I knew for sure that I had to talk with Evan Steele on video. In this video, he makes a really interesting point about CCHIT certification, now HHS certification, the new ICD 10, etc all working to make many EMR vendor’s software clunky (my word, not his).

Enough talk, check out my interview with Evan Steele, CEO of SRSsoft.

I should also mention that Evan and I were on a Meet the Bloggers panel together. That was a good time too.

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Try to get a straight answer on how much an electronic health records system cost for a hospital (yes, I sometimes talk about hospital EMR on this blog too) and it’s nearly impossible. Of course, it’s the number one question on most hospital executives’ minds in light of stimulus funding, a simple price tag is still hard to find and you simply can’t find a straight answer.

Well, the people at MedSphere (memorable for their VW Bus pic at HIMSS) have put out a hospital EHR stimulus ROI calculator. The required fields are provider number and number of beds. As always I’m a bit skeptical about any sort of ROI calculator, but I like to have as much data as possible. So, here’s one other reference for those trying to calculate the EHR stimulus ROI.

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Time for a break from the regularly scheduled HIMSS programming (sorry there’s just a lot of HIMSS content to still be published) for some thoughts and comments on the EHR Certification Interim Final rule. What can I say? I was inspired by CCHIT’s comments on the EHR Certification criteria.

First, since I mentioned CCHIT’s comments, I have to admit that I think that CCHIT made some very reasonable comments. I’m not sure I really disagree with any of the detailed points that they offer in their comments. What’s probably most interesting in CCHIT’s comments is the last two sections where they talk about the adverse impacts that this rule is likely to have on small EMR vendors and more importantly, small healthcare facilities. I’m not sure I agree completely with their analysis, but it was nice to see CCHIT backing the small businesses.

Now, just a few comments of my own about the major problems with the Interim Final Rule. I’m not going to go through the finer points. Just some major thoughts about what ONC better avoid as they adjust the criteria.

The first challenge that I think they face is the times that they apply certain criteria to hospitals and ambulatory the same way. They’ve actually made a good effort to separate the two entities, but they need to do more since a hospital EMR is VERY different than an ambulatory EMR. In fact, CCHIT even points this out a number of times in their comments as well.

Probably the largest problem I see with this criteria is their inability to take into account the various specialty needs when it comes to an EHR. The criteria basically treats all doctors offices the same. This is a problem that is going to have a widespread effect and is likely to really hinder EHR adoption.

ONC really needs to take a hard look at the criteria and think through how that criteria is going to affect the various specialties and specialty EMR software out there. One concept they should consider is that maybe they aren’t trying to define a certification criteria for an “EHR software” for one market (healthcare), but instead are trying to define a certification criteria that will work for “EHR software” across 100 markets (each of the specialties).

Certainly, we’re going to see a lot of consolidation happening in the EMR industry. However, the more I think about it, the more I think that there’s not just one EMR industry, but that there’s a whole collection of industries out there. Every time an EMR software is installed in a new specialty, it’s like they’re trying to enter a new industry. Now, just imagine trying to create a criteria for software that applies across all these industries. No wonder it’s a major challenge.

Next up, ONS should place much less emphasis on the certification criteria and let many of those criteria be shown in the meaningful use guidelines. Let EHR vendors innovate in how they are to accomplish the meaningful use criteria. It’s simple for an EHR vendor to create new features. That’s just a matter of time and cost. However, it’s much different for an EHR vendor to focus its energy on creating a usable system.

If the “certified EHR” component of the stimulus requires EHR vendors to build too many features, then we’re going to end up with a number of poorly designed and unusable EHR systems in clinical practices. Implementing these unusable EHR systems will do nothing but hinder the adoption of EHR systems.

Not to mention, if the EHR vendor shoddily implements a feature to become a “certified EHR” and then the feature is too cumbersome to actually be used, the doctor will be the one left holding the cost of the EHR with no access to the stimulus money. This will also help to hinder EHR adoption.

ONC should focus less on features (EHR Certification) and more on results (meaningful use) and allow the various EHR vendors to innovate on how they will provide the results.

Finally, ONC should focus the certification efforts around establishing standards where EMR vendors are unwilling to standardize. This type of focus will provide a real an actual benefit to doctors who can benefit from this sort of interoperability. Stop focusing on features and functions that will provide little value to doctors.

At the end of the day, the criteria need to be simplified to apply more broadly and to not stifle innovative EMR software companies. Too strict criteria will hinder EHR innovation and more importantly, long term adoption of EHR software.

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Well, as you might have noticed, I decided to take the weekend off from the blog. I figured it was reasonable to take a weekend off after the craziness of HIMSS. I still have a ton of content from HIMSS 10 that I’d like to post. So, watch for more of that over the next couple weeks as well.

I thought a nice video to kick off the new week would be nice. This video is of Robin Daigh from MD-IT and Craig Mercure from MxSecure talking about their partnership with Verizon to create a really interesting health information exchange. I talked about this Medical Transcription Service Consortium previously, but it was really neat to talk about it in person with Robin and Craig (Full Disclosure: Both Robin and Craig advertise on EMR and HIPAA). I also talked with the CMO from Verizon about it and so more details on that to come later.

For now, enjoy what I think is an interesting play in the HIE space to bring together all the transcription companies and now anyone who wants to participate and start sharing clinical data.

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

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I first came across these laptop carts when I first started working in healthcare about 5 years ago. Basically, we wanted somewhere we could store the laptops that was safe and that it could still be charging over night. So of course I wasn’t that interested in these carts when I passed by their booth at HIMSS. However, their hershey’s chocolate bar (full size in fact) drew me in. Then, I found out about the “brains” that are built into these carts now and I thought that others might be interested in it also. Pretty innovative.

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

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The Drummond Group has just officially announced on their blog their intent to apply for and test EHR software to provide an alternative EHR certification to CCHIT. Here’s a few portions of their announcement:

After a thorough review of the recent NPRM along with months of consideration, DGI is excited to announce that we will be applying to be an ONC-ATCB this year.

As mentioned before, receiving the HHS requirements to become an authorized EHR testing and certification body was the missing piece in our decision to move forward. Now that we have that piece, we feel confident in announcing our intention to formally apply.

In our review of the NPRM, we found it sound, reasonable and a big step forward for formal testing and certification criteria to support Health IT. We will offer our comments as requested, but overall it was an excellent effort.

And this point about Drummond Group’s long term plans for EHR certification:

Last point. We won’t spend too much time here on this blog talking about the Permanent Certification program given the more immediate concerns of the Temporary Certification program. We will say we plan on being part of the Permanent Certification program. More importantly, we want to convey that since our initial press release last November, we have known that we are not in EHR testing for the short haul, but rather, the long term.

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Sometimes it’s the little things you catch at an enormous conference at HIMSS that are the most powerful. One of those came for me when I was talking to the VP of marketing from one of the EHR vendors on the floor. This was one of the most interesting people I met with at HIMSS.

As we were talking he kind of said off hand that one of the visitors to his booth had said Allscripts isn’t CCHIT certified.

Now I should clarify. Allscripts was CCHIT certified back in 2007. However, they didn’t do CCHIT certification and in 2008 but they still haven’t done any of the 2011 full CCHIT certification or Preliminary ARRA certification either.

As a side note, CCHIT has moved or taken down the previous years certification lists from their website (not sure why or where they moved them) (UPDATE: You have to drill down to the categories and you can find the previous years). However, they are listed on the EMR and EHR wiki.

The interesting point here is that Allscripts, an EHR company with possibly 21% EHR market share, hasn’t bothered with the CCHIT certification.

I have no doubt that Allscripts will be HHS certified (or whatever they end up calling the certification). However, they haven’t seen the need to go after the CCHIT certification. No doubt there sitting there waiting to get a cheaper EHR certification. This is true for a few hundred other EMR vendors as well.

Another interesting sign of the move away from CCHIT certification and on to the HHS certification.

And yes Allscripts, I am still mad at you for shutting me out of your party at HIMSS despite having registered and read the dozen or so emails you sent reminding me that I registered, but never telling me that I had to stop by your booth for a wristband.

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For one of the New Media Meetups at HIMSS we met at the Pervasive booth on the exhibitor floor. I must admit that I wasn’t quite sure what I’d find at the Pervasive booth, but I’d had a few interactions with the people behind the company and so I was excited to meet them in person.

Turns out when I first got there I was told about how Pervasive was taking the data stuck in EMR software or other healthcare software and was helping revenue cycle management companies extract that data out. I thought what they were doing was pretty interesting and so I caught this video explaining a little bit more about Pervasive:

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

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During a meeting I held with the CEO of Aprima (previously iMedica), it came out that Aprima has created a learning management system for users of the Aprima EMR system. Ok, before you stop reading, hear me out.

Sure, every EMR vendor has some sort of online help or learning system by now. What I found interesting about the Aprima EMR learning management system is that it actually graded the doctors on what they learned.

Ok, doctors might hate to hear that they’re being graded, but that’s kind of missing the point. There’s a number of reasons why grading a doctor’s (or I guess other staff too) comprehension of the online learning is important.

First, is that it gives the EMR vendor an idea of how well the practice has actually learned the training. We all know that it’s one thing to go through a training and another to really learn what’s being taught. Second, based on the number of times the user had to retake the “test” you can gain a decent idea of how quickly that person is able to pick up technical concepts.

Plus, I think this type of testing can also provide the EMR vendor some feedback as to which trainings need to be improved. If everyone fails the prescribing module, then maybe you need to improve the product or improve the training that’s being given.

Finally, having a learning management system like this in place could also extend to training doctors on how using that EMR can help you meet the meaningful use guidelines required to receive the EMR stimulus money. Yes, pretty much everything has to come back to meaningful use, doesn’t it?

I’m not sure that Aprima has taken their learning management system this far, but it sounds like they’re heading down some of these paths.

Another quick side note from my visit with the CEO of Aprima was their “Take a Tablet” program that let’s doctors take a tablet to play with during the sales cycle. Basically, they want the doctor to learn to be comfortable using a tablet for other things so that using the EMR on the tablet will be natural as well. Pretty interesting way to “train” the doctors on the tablet technology.

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