FISMA is becoming a roadblock for electronic health record implementation, Government Health IT magazine reported this week.

The Federal Information and Security Management Act (FISMA), passed by Congress in 2002 to better protect the federal government against cyber attacks, mandates information security standards for all federal agencies. This includes the flow of data between the Centers for Medicare and Medicaid (CMS) and their contractors—over 200 hundred of them, processing billions of Medicare claims. The new worry from CMS, according to Government Health IT, is that healthcare providers sharing EHR files will be required to meet FISMA standards, which include an annual security test and FISMA certification.

A CMS spokesperson is quoted as saying that this would be more than “burdensome” for both CMS and health care providers and organizations.

The conundrum is that information will be moving between the HIPPA world (the private sector) and the FISMA world (the government)—that latter of which is much more secure, from a protocol/standards perspective. Federal agencies are held to a higher standard than the private sector with respect to information security.

For a long time, consumer groups have argued that HIPPA is a weak standard for patient information security. Yet, many worry that if FISMA is applied to the private sector, there will be a compliance crisis that will be costly to remedy. But why shouldn’t the transfer of health information be held to the highest security standards? Advocates of a middle ground argue “yes,” but not quite as stringent as FISMA. They standards should be more of a more of a “HIPPA-plus” or “FISMA-lite,” in the words of Vish Sankaran, a program director for the Federal Health Architecture project to connect health information entities.

In other words, get health care providers better engaged in securing healthcare information but do not stunt the growth of the EHR movement by placing the bar too high.

In the end, the Office of Management and Budget will dictate the debate through their determination of what falls under the FISMA umbrella. In August of 2008, OMB issued some guidance, stating that FISMA applies to groups that “possess or use Federal information—or which operate, use or have access to Federal information systems (whether automated or manual)—on behalf of a Federal agency.” OK, that could include a ton of organizations.

Confusing? You bet. This is government language after, all. Much like statistics, just mold it to your current need.

There is still debate over whether, for example, health information exchanges (HIEs) that “exchange” information but do not “access” federal information systems need to be FISMA compliant. In any event, there is a strong and important need to address information security in the field of healthcare. Will FISMA be the best vehicle for achieving information security with respect to patient information? That remains unresolved, but hopefully, the work to find a middle ground, coaxing the private sector into requiring more robust security standards, will be the outcome.

Above article published on

http://ohmygov.com/blogs/general_news/archive/2009/06/30/fisma-a-roadblock-for-ehrs.aspx

Maryland further strengthened the goals of the stimulus package or the American Reinvestment and Recovery Act (ARRA) this past week by passing legislation that required insurers to provide “monetary” incentives for physicians to adopt electronic health records (EHR).

The bill, signed by Governor Martin O’Malley, is one of the first of its kind to give sharper teeth to the EHR movement. Insurers may choose from a variety of fiscal incentives including increased reimbursement and lump-sum payments, according to Health IT News. The effort is viewed as a double incentive to providers to join the digital transition that promises to increase health care system efficiency while reducing medical errors for patients. Maryland is not alone in its effort to promote the change from paper to portal; other states are reviewing similar measures that would jumpstart implementation.

Included in the Maryland bill is a requirement for the state to bring a piloted health information exchange (HIE) live by October 1. The goal of the HIE, often comprised of business and community representatives, is to provide support to health care system stakeholders with the goal of increasing efficiency and quality.

Wait, have we heard of an HIE before? Yes. For clarification purposes, regional health information organizations (RHIO) and HIEs are terms used interchangeably; the HIE is simply a new name for a RHIO—it has yet to be determined if it is also a newer and better RHIO. Lingo aside, HIE investment is up.

Other states are looking to HIEs/RHIOs to play a prominent role in EHR adoption. New York, Texas, and Florida are all investing in these information exchanges.

In New York, the Western New York Clinical Information Exchange, known as HealthElink, signed on 6 EHR software vendors to provide community pricing to its clients.

In Texas, the legislature passed two pilot health information exchange programs that promote data transfer between local agencies.

Florida, having received a $9+ million grant from the Federal Communication Commission (FCC), is exploring how to expand broadband access across nine rural hospitals to increase the speed and efficiency of health data transfer.

Other states are vying to develop strategies for technology adoption that support EHR implementation as stimulus dollars dangle overhead. Now that EHRs are heavily banked by both federal and state government, HIEs and RHIOs may take a greater role in aiding communities in EHR adoption. These exchanges hope to serve as important providers of data warehousing as well as offering leadership for the development of criteria for data sharing and data quality. States view HIEs/RHIOs as vehicles for transporting dollars toward the development of technology infrastructure and they are moving as quickly as possible to get their take.

Above article published on

http://ohmygov.com/blogs/general_news/archive/2009/06/01/states-take-bigger-role-in-promoting-ehr-adoption.aspx

Show me the technology! That is the conclusion of a study from the Beth Israel Deaconess Medical Center (BIDMC) to be released in the Journal of General Internal Medicine (JGIM) in June. The study reveals that consumers who are defined as “internet-savvy” are ready to take a chance on electronic health records (EHR) despite warnings of potential privacy risks.

The study, supported by the Robert Wood Johnson Foundation (RWJF), investigated whether or not patients were comfortable making the leap with their health care providers to the digital age through the adoption of EHRs. In the tech-savvy cities where they held focus groups, the answer was a resounding ‘yes.’ Not a terrible surprise given that they investigated consumers in Boston, Portland, Tampa and Denver—some of the more tech-educated spots in the country. However, investigators did attempt to include a diverse group of people, drawn from both urban and rural areas. Additionally, they included health professionals in their study to compare their perspectives about health technology relative to consumers.

The findings should not come as a major surprise since an estimated 60 percent of households across all states have a home internet connection. Citizens are increasingly interested in managing their lives via computer—EHRs seems a natural progression in this evolution.

Yet, the study findings echo a sense of surprise at the willingness of consumers to give up some of their privacy in order to obtain greater transparency with respect to their health information. In actuality, it may be more of a reflection of the distrust and frustration with the current patient-physician/health care provider relationship where one may deem transparency of much greater importance than whether or not someone uncovers that they have kidney stones…

Above article published on

http://ohmygov.com/blogs/general_news/archive/2009/05/28/edit-me-patients-cheer-on-ehr-technology.aspx

HDM Breaking News,

The federal government should extend the transition to a fully functional electronic health records system beyond 2015, according to the American Hospital Association.

The AHA has sent a comment letter on the initial proposal of a workgroup of the HIT Policy Committee to define meaningful use of electronic health records to David Blumenthal, national coordinator for health information technology.

“Our members believe that the functional abilities of the EHR that would result from implementation of the draft definition are correct, but that the proposed sequence for adoption is overly aggressive and unrealistic for most,” according to the AHA. “Increasing the requirements for being considered a meaningful user every two years should provide enough time for adoption, but only if the initial requirements are set at an achievable level. The AHA encourages the committee, ONC and the Centers for Medicare and Medicaid Services to develop a ‘meaningful use’ adoption timeline that begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015.”

Computerized physician order entry, for instance, should not be required until after 2015 or beyond, the AHA contended in the comment letter. “Most hospitals are not prepared to make such significant advancements under the proposed implementation timeline, so rushing to adopt could compromise patient safety and the success of this effort,” the letter states. “Our members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.”

The AHA calls for the definition of meaningful use in 2011 to focus on getting the majority of hospitals running with a basic EHR. Appropriate functions for 2011 should include clinical documentation of patient demographics, problem lists, medication lists, discharge summaries, and results viewing for lab reports, radiology reports and diagnostic tests, the AHA advises.

The association, mirroring comments of the American Medical Association and some 80 other physician organizations in a separate comment letter, also noted that providers must work during the same time period to migrate to the HIPAA 5010 transaction sets and ICD-10 code sets.

Above article published on

http://www.healthdatamanagement.com/news/meaningful_use-38560-1.html

By Andis Robeznieks / HITS staff writer

Policies on security breaches, open source code, and government subsidies of electronic health-record systems have been adopted by the American Medical Association’s House of Delegates.

The policies concern physicians’ responsibilities in case of computer security breaches and support of electronic health-record systems based on open-source code. Another policy calls for the removal of penalties that are scheduled to affect physicians who are not using electronic prescribing by 2015, and another says that the AMA wants government subsidies for the implementation and maintenance of EHR systems to be adjusted for inflation.

AMA policy now dictates that, in response to a security breach, physicians are to place the interest of patients above those of themselves, their practice or institution. On open-source, delegates approved a resolution calling for the AMA to support law and public policy that makes open source EHR systems that meet certification and “meaningful use” requirements available to physicians at nominal cost.

The Florida delegation had introduced a resolution that would declare federal EHR incentive programs to be “noncompliant with AMA principles” and essentially a pay-for-performance program. After hearing testimony on June 14, a committee drafted a substitute resolution that stated federal programs should be made compliant with AMA principles by removing penalties for nonadoption.

“Resolved, that our AMA support the concept of electronic prescribing, as well as the offering of financial and other incentives for its adoption,” read the new resolution that was approved by delegates, “but strongly discourage a funding structure that financially penalizes physicians that have not adopted such technology.”

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090617/REG/306179993/1153&AssignSessionID=373357728181706

By Steven Kraus, DC, DIBCN, CCSP, FASA

This spring, I traveled extensively to Washington, D.C., for a variety of reasons, mainly to advocate on behalf of chiropractic physicians as our government initiates massive health care reform efforts.

I attended the HL-7 Conference, which is an invitation-only gathering of health care officials dedicated to setting the programming standards for health information exchanges (HIEs) and standards for required data for electronic health records (EHRs).

The conference, sponsored by the Agency for Healthcare Research and Quality, has historically been limited to hospital and allopathic audiences. This year’s group was expanded for the first time to include other health care experts, and I was the designee from the chiropractic profession. My goal and commitment to the profession remains clear: I want to ensure that the interests of chiropractic physicians are considered in any and all discussions related to policy-making for health care information technology. And in the case of HL-7, chiropractic participation is critical so the concerns of our profession with regard to the development of HIEs will be heard.

The catalyst for broadening this conference audience was presumably the economic stimulus package, formally known as the American Recovery and Reinvestment Act (ARRA) of 2009, which includes more than $19 billion to fund the introduction of electronic health records in every physician office in America. The section of the ARRA that deals specifically with this appropriation is the HITECH Act, which outlines the requirements for funding eligibility. To be qualified for incentive payments offered through the legislation, doctors must adopt qualified EHRs that have the functionality to communicate with HIEs, making the standards by which HIEs are governed extremely important and elevating the prominence of interfacing capabilities with other systems.

I’ll discuss more about the requirements for incentive payments later in this article, but the main reason I share my involvement with the creation of health care information technology standards is to demonstrate how the general health care industry is finally opening its arms to the chiropractic profession. We’ve been dancing on the periphery for years, but finally, we are gaining recognition as an essential component of health care delivery and actively participating in these important discussions regarding policy, standards and reform.

Reform = Collaboration + Technology

Speaking of reform, during that same visit to D.C., I also met with Sen. Tom Harkin’s staffers as well as government relations personnel from the American Chiropractic Association to discuss the evolving model of reform for our health care system. As I shared in a previous column, elements of several models are under consideration including the Medical Home Model, which relies heavily on collaboration among health care professionals in order to improve the quality of patient care. Harkin and several of his colleagues are outlining a comprehensive national health care reform plan we can expect to be introduced later this year.

The cornerstone of that plan will be collaboration, and the framework to support collaboration will be driven by technology. While many uncertainties still remain, these two elements are certain. And with collaboration at the forefront, Harkin and others understand that chiropractic physicians and other nonmedical providers are an integral element of national reform. The reform movement is committed to supporting true wellness, something doctors of chiropractic have been preaching for years.

Now it’s time for us to rise to the occasion and continue walking our talk, while we have people watching us and listening. The first step in walking the talk is adopting EHRs. Why? Because technology will create the path to collaboration by assisting case management through registries, database queries, instant access to information, alerts and reminders, and all the related tools the digital age provides us. We need technology to form the health care teams that will improve patient care for every American.

With the anticipated health care reform model so heavily reliant on technology, those who do not adopt an EHR will be left out of the health care framework. In fact, the government is emphasizing the critical role an EHR will play in successful reform so heavily that it is funding the digital transition in its entirety. In order to adapt to the new model of health care, we must adopt an EHR. Since the government will pay for our EHR (up to $44,000 for each physician), we’re simply being asked to fund the energy and effort to implement it. Seems like more than a fair deal to me.

How to Access Your $44,000 Incentive

As I mentioned earlier, the process to fund your EHR is structured through incentive payments to physicians who adopt such systems. Not all health care professionals will be eligible for incentive payments, but doctors of chiropractic are an approved group, as they are covered by the Social Security code defining physicians, which the ARRA is using as its definition.

Two major areas will be evaluated by our government when determining payment approvals. First, the EHR system must be qualified, and second, the system must be used meaningfully by the chiropractic physician. A qualified EHR system must have the capacity to handle patient demographics and clinical health information, and also must have clinic management capabilities, as outlined by the entity that certifies qualified EHR. Only a certified EHR system will be eligible. The certifying body has not yet been announced, but the industry anticipates that the Certification Commission for Healthcare Information Technology (CCHIT) will be the likely choice since it was approved in 2006 by the government’s Office of the National Coordinator of Health Care Information Technology and Medicare to manage such efforts.

The second requirement, “meaningful use,” is determined by three important measures: (1) connectivity to health information exchanges and other EHR systems so they can share information when authorized by the patient; (2) regular reporting of quality measures to the Centers for Medicare & Medicaid Services (CMS), including capturing outcome assessments and performance of pain assessments; and (3) e-prescribing capability. Because we don’t have prescribing privileges, it is unknown at this time whether this will remain a requirement for doctors of chiropractic. With regard to reporting requirements, the general structure of the plan suggests that reporting of quality measures will likely be managed by the PQRI (Physicians’ Quality Reporting Initiative), a standardized mechanism that already exists.

As much as $44,000 can be paid as an incentive to a doctor for investing in a qualified EHR system. And in clinics with multiple physicians, each physician can qualify for the incentives, as long as the aforementioned terms are met. And while we know that CMS will be involved, its specific role is still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program. For example, minimum billing thresholds such as an annual $25,000 in covered services to CMS are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met. So, if you average 16 Medicare patient visits a week, you would likely qualify. I will follow-up on this issue in a future article once the policies and standards relating to the Department of Health and Human Services and Medicare have been formally released.

To access the full $44,000, which is paid through Medicare in stages (four annual installments starting in 2011), the EHR system has to be qualified and used in a meaningful way starting in 2010. To clarify the timing, it is necessary to explain PQRI’s influence on the process. PQRI, which is expected to oversee reporting requirements, currently requires reporting on at least 80 percent of patients. To accommodate this requirement, the EHR system would need to be in use for the majority of the year prior to the first incentive payment, assuming adherence to PQRI standards will be required. Hence, EHR implementation in 2010 is necessary in order to receive an $18,000 first payment in 2011 and maximize the incentives available.

For new users, implementation of an EHR system typically requires 90 days to six months. Given the expectation that meaningful use will be necessary for the better part of 2010 in order to get a 2011 incentive payment, the implementation process for chiropractic physicians should begin promptly in 2009. Those who had the vision to implement a qualified EHR and can demonstrate meaningful use are already eligible for the full incentive payments.

Penalties for Not Transitioning to EHR

The Evolving Health Care Landscape: Technology Front and Center Those who choose not to transition to an EHR system will be penalized beginning 2015 and continuing through 2018. These penalties will be assessed through a reduction in your Medicare claims reimbursement on services billed. To further motivate adoption, some states have already passed laws that mandate EHR use after 2014 in order to attain a license to practice or to renew a license, concurrent with the stimulus plan. With financial and legal ramifications in play, the incentives to adopt an EHR now are enormous.

The Reform Cube

Given the benefits the government is providing chiropractic physicians, it is a wonder that any of us are still waiting to implement EHR. If the financial incentives are not enough motivation, doctors of chiropractic must consider what role they will play in the health care reform cube. Our health care landscape will soon shift to a different model; consider a cube in which quality, cost, and delivery of care through collaboration and access exist at each point, while technology sits squarely in the middle. Technology improves quality by offering reminders, alerts and other assistive techniques; technology lowers costs by reducing duplication of services; and technology improves collaboration and access by providing a mechanism to share patient health information across all providers. All of this allows for a robust clinic management system.

As chiropractic physicians, we strive to improve quality, we seek to reduce costs, and we crave the opportunity to collaborate on the health care team, so the cube is the ideal home for us. When we adopt the proper technology, we gain not only substantial financial support, but also membership in the cube. And isn’t membership what we’ve been asking for from the health care community all these years? This membership is not for the sake of privilege, but for the sake of having other providers refer patients to receive the benefit of chiropractic care, achieve wellness, and experience cost-effective and efficacious care naturally. Accept the invitation now - it won’t be offered again.

Above article published on

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53922

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Bernie Monegain, Editor

CHICAGO – The American Medical Association has adopted new guiding principles for physicians in the event a patient’s electronic medical record is breached. AMA members approved the guidelines at the group’s annual policy-making meeting earlier this week in Chicago.

“Protecting the privacy and safety of patient information, whether in a paper record or an electronic medical record, is a top priority for physicians,” said AMA board member William A. Dolan, MD. “Physicians need a standard protocol to follow to maintain patient security in the event of a breach of personal information.”

Medical information housed in an EMR travels from patient to healthcare provider to health insurance industry with limited regulation and oversight, Dolan noted. Security breaches can happen and physicians need guidance about their responsibilities if health information has been compromised.

The new AMA guidelines ask physicians to:

• Ensure patients are properly informed of the breach,
• Follow ethically appropriate procedures for disclosure,
• Support responses to security breaches that place the interests of patients above those of physician, medical practice or institution, and
• To the extent possible, provide information to patients to enable them to diminish potential adverse consequences of the breach of personal health information.

“EMRs are the wave of the future, so it is important for both patients and physicians to feel secure” Dolan said. “These new guidelines prepare physicians to help patients in the unfortunate situation of an information breach.”

Above article published on

http://www.healthcareitnews.com/news/ama-weighs-emr-security-breaches

If some of the paranoia about health IT that I heard last week at the American Medical Association annual meeting really is representative of practicing physicians — and not just the protectionist Medical Establishment — this country is in trouble.

As much as the AMA purports to speak for all doctors, only about one in five U.S. physicians is a dues-paying member these days, and the membership does largely seem like a clubby collection of aging white males who stubbornly cling to the status quo — particularly when it comes to IT. This is a remarkable situation, given that the status quo in health IT has changed like never before with the the stimulus legislation that allocates a net $19.2 billion for health IT over the next eight years, the bulk of which goes to help doctors and hospitals purchase electronic medical records.

Funny thing is, cantankerous AMA delegates repeatedly claimed they had no input in drafting of the stimulus. Yes, the lobbying group that likes to project the image that it speaks for the nation’s physicians felt closed out of the process that is going to provide billions of dollars of aid to medical practices.

Frankly, that’s a ludicrous assertion. How come numerous medical specialty societies, particularly the American Academy of Family Physicians, got heard? Why was the relatively small Medical Group Management Association, representing practices of three or more physicians, successful in lobbying on behalf of its membership? The final bill incorporated provisions that had been under consideration for at least three years, and subject to many, many congressional hearings and lobbying opportunities.

Those with a bone to pick included St. Petersburg, Fla., neurosurgeon David McKalip, who believes the incentive program actually penalizes doctors by forcing them to go electronic. McKalip said that an EMR would cost his solo practice $120,000 over five years, much less than the maximum bonus of $44,000 from Medicare or $63,750 from Medicaid. In fact, he’s planning on taking the Medicare fee cuts for not using EMRs that take effect in 2015. “It’s cheaper for me to take the penalty than to put the system in,” he said.

But that was only the beginning of his assault on the stimulus bill, which also boosts federal funding for “comparative effectiveness” research to study and recommend best practices. McKalip called this program “a tool for controlling care and rationing care,” believing that Medicare would use the research to tell doctors how to do their jobs and refuse to pay for treatment not meeting official guidelines. That’s Big Brother at its worst.

Interestingly, outgoing AMA President Nancy Nielsen said that the organization supports comparative effectiveness research.

The AMA did find many other things wrong with the stimulus, though. The organization’s House of Delegates passed a resolution stating that the rush for doctors to install EMRs by the time the incentives start in 2011 will cause a spike in demand for IT products and services, likely driving up prices. That’s a fair argument. However, another resolution directs the AMA to tell the federal government that the EMR incentive program “should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems.”

It’s one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.

Above article published on

http://industry.bnet.com/healthcare/1000797/fear-and-loathing-at-the-american-medical-association/

Technically Speaking. By Pamela Lewis Dolan, AMNews staff.

If you talk to 10 physician practices after a major technology implementation, you’ll likely get 10 different stories about the lessons they learned.

So what is the biggest mistake? Experts say it’s not listening to those doctors and learning from their experiences.

Consultants say no matter whether you are a hospital or small physician practice, or whether you are implementing an electronic medical record or an e-prescribing system, there are patterns in the mistakes made during the shopping for and implementing of technology.

“In medicine, there will be times when people try things and they will turn out to not be the best things to do. You don’t want to be in a situation of making a mistake when “all you had to do is check with somebody to find the appropriate way to do things,” said James Jose, MD, a pediatric critical care doctor who is chief information officer of Children’s Healthcare of Atlanta.

Richard C. Howe, PhD, vice president of business development at Healthcare Informatics Associates, said he, too, has seen several implementation projects fail after trying to go it alone without asking for advice from experts or peers. HIA, based in Bainbridge Island, Wash., provides health IT consulting and implementation services.

Experts such as consultants, trade groups and user groups, have a wider pool of experiences to draw from, Howe said. And peers are important because they can provide an overview of what problems they ran into and how they solved them.

Finding the right practice to talk to, and figuring out the best questions to ask, may take some homework and planning. But it’s worth the time and effort.

Karen Colorafi, RN, an independent consultant from Phoenix, said most practices start with a long list of possible vendors. Once that list is narrowed down to two or three, “I would definitely recommend not just picking up the phone but, if you can, do a site visit” to a practice using the system.

Every vendor has a list of references for potential clients to talk to. While references can be helpful, they shouldn’t be your only source of information, Dr. Jose said. National conferences are a great place for networking and meeting people, he said. Other references often can be found through national organizations such as the Healthcare Information and Management Systems Society or the American Medical Informatics Assn.

But the best source, according to Dr. Jose, are the “benchmark organizations” that you look up to. Find the practice that is where you want to be five to 10 years from now. Talk to the people there and find out how they got there and what was learned along the way. Dr. Jose said most practices are willing to share their experiences.

What to ask EMR veterans

Experts say there are a handful of key questions that should always be asked of references, whether you found them on your own, or through your potential vendors:

• If you had it to do over again, what would you do differently?
• Would you recommend the same vendor?
• Did you budget correctly?
• What are the ongoing maintenance costs?
• How long did the system take to implement and what were the problems you encountered?
• How did you handle converting data from paper to electronic? How was data abstracted?

Just being aware of the most common problems can help guide you through the process, experts say. HIA’s Howe said even if a practice is satisfied with its vendor overall, chances are things did not go perfectly and something was learned along the way.

Sidestepping pitfalls

The following are among the most common mistakes that have clearly been defined, and can be avoided.

• Underestimating workflow changes. Talking to practices of similar size and scope will help give you realistic expectations. Dan Rodgers, president and CEO of MedCo Data, a Tampa, Fla.-based consulting practice said practices also should evaluate workflow before implementation and develop the ideal workflow for postimplementation.
• Not allowing enough time for training. Howe said he has heard several vendors use the sales pitch that their systems require no training. Talking to someone who uses the system will verify that’s likely not the case. There are no plug-and-play systems, experts say.
• Treating the project solely as an IT project as opposed to a business decision. “If you are a pediatrician, you are in the business of treating kids; if you are an orthopedic [specialist], you’re in the business of running an orthopedic group,” said Howe. Whatever system you select should support that business.
• Failing to consider future needs in negotiations. Rodgers said just implementing the core will likely mean the practice will have to go back to that vendor for more. Rodgers said practices should negotiate those prices at the time of the initial implementation and have the vendor sign off on a statement of intent to purchase. Otherwise, you are stuck with a vendor who, after the fact, can set any price, he said.
• Not defining a clear path for return on investment. Rodgers said many practices jump in, accepting the vendors promise of profit, but don’t sit down and develop a plan to get them there.
• Not having a legal expert review the contract. “When you are getting ready to sign a $50,000 contract, it’s worth a couple hundred bucks to have someone review that contract for you,” Colorafi said.
• Going cheap on the infrastructure. Rodgers said he has heard from several practices that say their systems aren’t performing the way they were promised. In reality, he said, they were running the systems on older, less-expensive computers and servers that weren’t allowing the system to run at optimal levels.
• Delegating the implementation to nonphysicians. Colorafi said she has seen many implementations fail because the job of selecting a system was delegated to a practice manager instead of a physician who will be using it. Others can be used to gather background information, she said, but taking the systems for a test run should fall to the physician.

Above article published on

http://www.ama-assn.org/amednews/2009/06/22/bica0622.htm