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

Readers write to say that electronic medical records cost more than you think; that companies should be required to make matching 401(k) contributions; and more.

CFO Readers - CFO Magazine

CFO welcomes your letters. Send them to: The Editor, CFO, 253 Summer St., Boston, MA 02210

E-mail us at ScottLeibs@cfo.com, or contact a specific author by clicking on his or her byline. You can also post a comment directly on CFO.com by clicking on the appropriate link at the end of any article.

Please include your full name, title, company name, address, and telephone number. Letters are subject to editing for clarity and length.

Although “Strong Medicine” (May) does provide some insight into why insurers want electronic medical records (EMRs), it has a lot of misconceptions and misstatements. Among them:

1. “Just as technology streamlined industries like retailing and financial services, it should create efficiencies in health care that will slow premium growth from its traditional annual rate of about 7%.” There are no citations offered to show a decent study demonstrating such “efficiencies.”

2. “Malpractice insurers have already linked electronic systems with better-quality care; some will reduce premiums by as much as 5% for doctors who have gone digital.” Very few have actually decreased their premiums. In fact, EMRs can actually result in increased errors, decreased quality, false documentation, and the loss of privacy.

3. “…only about 9% of the country’s 5,000 hospitals and just under 20% of its 800,000 physicians use computerized recordkeeping….” The only data of importance is what falls into the category of “meaningful use.” The actual numbers are 2% of hospitals and 4% of physicians.

4. “Rand…estimates that when 90% of…providers use such systems, the savings will amount to $77 billion a year.” This has never been proven.

5. “…ROI calculations of such a move showed some modest financial benefit.” Studies have shown that for every group that makes an EMR work, another 50% have a failed installation. And of those that do make their systems functional, only about 10% actually use them “significantly.” Why didn’t the author interview angry doctors who have lost thousands in the quest for the EMR ROI?

6. “For small practices…the price of implementing an EMR system could reach nearly $40,000 per physician.” That’s only the initial cost, which ignores the average $1,500 per month ongoing fees and the cost of “significant use.” Overall, the average five-year cost is estimated to be about $300,000 per physician.

7. “CFOs…may soon develop an affection for EMRs, especially if the technology proves to be an antidote to soaring health-care premiums.” Again, these systems are expensive, rarely show an ROI, and have never been shown to decrease health-care costs.

Alberto Borges, M.D.
Arlington, Virginia

The Author Responds: In most cases, Dr. Borges is referring to projections, estimates, and tangential issues beyond the scope of the article. Previous studies haven’t tested EMRs under the same kind of conditions that will exist should substantial adoption come to pass; that is, with certification, standardization, training — and motivation.

The story did refer to doctors who have had EMRs for many years; they aren’t unhappy, but the systems they use are more like electronic order-entry than EMR. Their views may change, however, if they find out there is no cheap way for them to plug their systems in to the government-sanctioned network. They seem to expect that one of the existing companies (or an up-and-comer) will target them as a desirable market and come up with a solution.

Above article published on

http://www.cfo.com/article.cfm/13687654/1/c_13720245

Patient privacy rights are at the heart of research by a University of Virginia professor.

The Federal Stimulus Package is pumping $20 billion into the healthcare system to move it completely to electronic records, but state privacy laws may slow that down in Virginia and across America.

Electronic Medical Records (or EMRs) have been around since the 1970’s, but today less than half of America’s hospitals have a basic EMR system.

Virginia is one of several states with strict privacy protection for hospital patients.

“There is this idea that there may be identity fraud, in particular medical identity fraud,” says University of Virginia Economics professor Amalia Miller.

While the enhanced rules should protect hospital patients in Virginia, at the same time, they could slow down vital sharing of information between hospitals.

“One of the big benefits of going electronic about sharing information could be suppressed or blocked, and this would be an unintended consequence of these strong privacy regulations,” Miller says.

Miller says the investment in a widespread switch to electronic records would not only save lives, but up to $34 billion nationwide.

“It could save money by reducing costs spent on the administration of the hospital,” she says, “reducing time that staff has to spend on paperwork.”

Miller also says there are worries that the switch could compromise privacy.

“You can imagine with certain conditions, patients or individuals wouldn’t want their insurers to know, they wouldn’t want their employers to know if they’re getting health insurance from their employer,” says Miller.

Still she believes lawmakers can find a way to computerize records and still give patients the privacy they want.

“I think it’s important for policy makers to think about the potential conflict between these goals and to navigate them together, rather than think about them in place in isolation where they might be acting against each other,” Miller says.

A standard EMR system costs a hospital more than $17,000 annually per bed.

Miller says stricter privacy rules mean the system is even more costly because of the enhanced privacy filters and other design factors that must go into the system.

Above article published on http://www.nbc29.com/Global/story.asp?S=10473911&nav=menu496_2_1