Technology Feature - January 2007
ByErin Prather Stafford
Do you use an electronic medical record (EMR) system in your practice? If you answered no, you're not alone. A 2005 Texas Medical Association survey showed that only 27 percent of Texas physicians were using an EMR system. Doctors reluctant to go electronic cited concerns over costs and reliability of the systems.
And a national study cited by Healthcare IT News revealed additional barriers to EMR adoption: fear of being sued over privacy issues and worries that EMR systems would become obsolete too quickly through vendor mergers or technology upgrades.
Those concerns are why Dallas pediatrician Joseph Schneider, MD, MBA, says physicians should pay attention to the Certification Commission for Healthcare Information Technology (CCHIT).
"CCHIT tests whether an EMR meets certification standards. A time will come when physicians probably will need to use certified EMRs to get paid for performance from Medicare and insurers," said Dr. Schneider, a member of CCHIT's Commercial Certification Process Advisory Work Group and chair of TMA's Health Information Technology Committee.
In the Beginning
Spurred by President Bush's call for expanding the use of health information technology (HIT), three industry health care information management and technology associations - the American Health Information Management Association, the Healthcare Information and Management Systems Society, and The National Alliance for Health Information Technology - formed CCHIT in 2004. They provided initial funding and staff.
In 2005, additional funding came from the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), the California HealthCare Foundation (CHCF), Hospital Corporation of America, McKesson, Sutter Health, UnitedHealth Foundation, and WellPoint, Inc.
The U.S. Department of Health and Human Services (HHS) awarded CCHIT a three-year contract in 2005 to develop and evaluate certification criteria and create an inspection process for HIT in three areas:
- Ambulatory EMRs for office-based physicians or health care professionals;
- Inpatient EMRs for hospitals and health systems; and
- The network components through which they interoperate and share information.
Companies seeking CCHIT certification must allow their products to be inspected. A jury of three EMR experts (including at least one practicing physician) observes a demonstration of the system's capabilities. This inspection typically takes a full day and covers four clinical scenarios. The criteria used and test scripts followed are available on CCHIT's Web site at www.cchit.org.
CCHIT's product certification process has four goals:
- Reduce the risk of HIT investment by physicians and other health care professionals,
- Ensure interoperability (compatibility) of HIT products,
- Assure payers and purchasers providing incentives for EMR adoption that the return on investment will improve quality, and
- Protect the privacy of patients' personal health information.
CCHIT certifies a product for three years that it has met the criteria for the year in which it was tested. Vendors can recertify their products annually to keep pace with new criteria. CCHIT will add new requirements for certification each year.
CCHIT certification is expensive. Small vendors have voiced concerns that the price is too high. The first-year inspection and maintenance fee is $28,000. The annual maintenance fee is $4,800.
"The fee is an issue for smaller vendors," Dr. Schneider said. "It has been discussed that certification costs should best be borne by all those who benefit from EMRs … including the government and insurers, not just the vendors and doctors."
CCHIT has certified 33 EMR products since July. The list of certified products is online at www.cchit.org/cchit-certified.
HHS Secretary Mike Leavitt says the CCHIT "seal of certification removes a significant barrier to widespread adoption of electronic health records. It gives health care providers peace of mind to know they are purchasing a product that is functional, interoperable, and will bring higher quality, safer care to patients."
If a physician purchases a CCHIT-certified EMR product and it doesn't perform as the vendor says it will, he or she should always turn to the vendor first for resolution. If there is evidence a product being marketed as CCHIT-certified is not substantially equivalent to the version submitted for testing, CCHIT has a formal process for investigating.
CCHIT recommends physicians also request that remedies for false claims of product performance be included in their sales agreement with a vendor.
Additionally, physicians can report the vendor to KLAS Online (free to TMA members), a research and consulting firm specializing in independent monitoring and reporting of the vendors' performance. Although KLAS does not certify vendor products, it does compare vendors' implementation, product quality, and ongoing services. (See "Selecting an EMR System With KLAS.")
Dr. Schneider advises physicians to look around at what other practices are using before selecting an EMR system.
"Don't buy an EMR system if you're the only one using it in your area. You'll be like a person speaking one language in a country that speaks a different one. Check what other practices are using and then do research into the vendor's product and support."
Although TMA does not have a list of those currently using EMRs, its Health Information Technology Department plans to collect such data so physicians can have an idea of who is using systems in their communities.
"There are lists of physician ratings of EMRs, including the KLAS lists. The 2007 CCHIT list will be a good place for physicians to start looking for an EMR system," said Dr. Schneider.
Erin PratherStafford can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at Erin Prather.
TMA Provides HIT Help
TMA's Health Information Technology Department is dedicated to helping physicians successfully implement office technologies. For more information, contact TMA at (800) 880-5720 or HIT@texmed.org.
The TMA Web site also provides resources for physicians making the transition to electronic medical records.
Visitors to the site can find information on many topics including:
- Choosing health information technology;
- Avoiding buyer's remorse;
- The EMR payoff: EMRs save money and increase revenue;
- Answers to the technology questions most commonly asked of TMA;
- TMA's 2005 EMR survey results;
- Funding and grant resources; and
- A vendor comparison guide.
Selecting an EMR System With KLAS
Are you and your practice ready for an electronic medical record system? Have you begun the selection process? TMA has a tool that can help you with your decision - KLAS Online. KLAS is a research and consulting firm specializing in independent monitoring and reporting of the performance of health information technology (HIT) vendors.
KLAS Online is a live database of vendor performance information that rates more than 500 products from 300-plus vendors. KLAS gathers its information through detailed interviews with physicians, managers, and executives at more than 4,500 hospitals and 1,500 clinics. The database is refreshed with new evaluations daily.
With KLAS, you will be able to compare vendors' implementation, product quality, and ongoing services; trend a company's service and business indicators over time; and examine peers' overall impression of a vendor's price estimates, support costs, and contracting experiences.
As a TMA member, you can access KLAS without charge if you are willing to share - confidentially - your own experiences with software vendors. The evaluation takes about 10 minutes and is validated with a short follow-up phone call from a KLAS representative. Here is how it works:
- Go to the KLAS page on the TMA Web site at www.texmed.org/klas.
- Fill out KLAS' online 40-question confidential questionnaire about your experiences with various software products in use in your practice.
- A KLAS representative will call you to verify your responses.
- Immediately after you complete the evaluation, KLAS will e-mail you a password that grants you access to KLAS Online for one year.
- Log on to KLAS Online to search for ratings and commentary on the HIT products and vendors in which you are interested.
Within 30 days of completing the evaluation process, you will receive, via e-mail, free copies of the KLAS Ambulatory Billing and Scheduling Report and the KLAS Ambulatory EMR Report.
TMA's Health Information Technology Department is dedicated to helping physicians with the successful implementation of office technologies. For more information, contact TMA at HIT@texmed.org or (800) 880-5720.
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