IT, it rolls Downhill

I was having lunch with one of my more technical savvy, or so she thinks, doctor friends the other day. Just like most physicians, she’s contemplating implementing an EMR application for her family practice. After visiting with several EMR vendors, she decided that she was going to implement an open source EMR solution because of its cost effectiveness, plus she has a longstanding relationship with her current system integrator.

Since our last discussion, someone, another vendor, had convinced her that a software as a service (SaaS) solution was the way to go. It's quite possible that a good financial case can be made for an EMR SaaS solution as opposed to other EMR solutions. But what surprised me was that she was not aware of the inherent risks of implementing this type of solution. I reminded her of when her web site hosting company closed. The frustration it caused and length of time it took to get her site back online. Actually, the bulk of the frustration came from her trying to get the source code for her site (she never had a copy). I warned her that experience would be very similar if her SaaS provider tanked, only it would be MUCH worst. After our discussion, she realized she had more work to do before coming to decision.

I begin to wonder who responsibility is it to outline the risk of the various EMR solutions to a potential customer? Should each vendor outline the inherent risk associated with their solution? Or should a physician research and understand the inherent risk involved for each possible solution? For large clinical practices and hospitals, this is not an issue because this falls squarely on the CIO, IT Director, or to the most senior ranking IT executive. However, an IT executive would be aware of the inherent risk in each solution platform and would carefully and thoroughly explained the risk to all stakeholders ;)

As the healthcare IT reforms begin to be implemented, vendors, software developers, and system integrators will merge, disappear and possibly default. "Things" will begin to roll downhill and IT will be sitting at the bottom of the hill. If the magnitude of this problem is great, that hill will be Capitol Hill. We all saw what happened to the last industry execs that visited there.

CPT Code for Computer Support

The Los Angeles Times ran a story Sunday, “Electronic Medical records have people abuzz. What’s the reality?”

“Primary care physician Matt Handley believes that information technology enables him to provide better patient care. So much so that he recently spent an afternoon hooking up a computer and DSL line at the home of a patient so he can contact him more frequently.” Click here for the complete article.

I found this to be a very good unbiased article because here lately there has been some negative chatter in the press for electronic medical record applications by a few in the medical profession. So it’s refreshing to see a “real-world” physician publicly profess their support for healthcare IT in a major news publication.

BTW, what’s the CPT code for in home visit for computer support? Dr. Handley may need it..

Demand for Healthcare IT Consultants, Bust or Boom?

In my previous blog, I stated now is a good time for HIT Integrators to align with one of the open source EMR solutions. I ran across this article from Healthcare IT News “Healthcare IT companies prepare IT consultants for EHR implementations”. Basically they are highlighting the contrasting views on what the future holds for HIT consultants.

COO Rick Jung from Medsphere, a open source provider of OpenVista – an EHR product, is “...seeing a “glut” of interest [from potential business partners that want to get certified on their open source product], which he attributes to the economic recession and the attraction of open source’s value proposition-paying for services and not tools.”

John Hummel, CTO of Perot Systems’ Healthcare Group had a different twist, “The number of people who have completed successful electronic medical record implementations is few and far between….. Perot Systems created its Healthcare Academy a few years ago to train college graduates around the globe. The program has achieve a 100 percent placement rate….”

I’m not sold they have polar opposite opinions, heck I'm not sold they even have different opinions. My read on this article is if you’re a college graduate with a desire to learn about EMRs, there will be opportunities galore for those individuals. However, if you’re an experienced EMR professional and possibly an independent consultant, you may have a difficult time landing a contract because of competition in the marketplace. One exec addressed the employment landscape from a college graduate perspective and the other exec addressed it from an experienced professional point-of-view. They each addressed different segments of the market, not so much that they have different views of what the impact the demand of EHR will have on the marketplace.

Once the government establish the timeline for EHR implementation, the demand for HIT consultants will definitely increase. However, will the marketplace have a gluttony of EMR skills or will it have a shortage, no one knows. However, increase demand does bring about new opportunities.

Opportunity Awaits, Open Source EMR

Linux, MySQL, PHP, Joomla, Audacity, the list goes on. I love open source technologies and applications. The lure of an open source medical practice software package is its price, FREE and there are several packages to choose from:

OpenEMR - a free medical practice management, electronic medical records, prescription writing, and medical billing application.
MirrorMed - a web-based application that is capable of running a healthcare practice. MirrorMed shares code with FreeMED, and OpenEMR.
FreeMED - GPL-licensed Electronic Medical Record and Practice Management system for medical providers that runs in any web browser in multiple languages. It provides an XML-RPC backend and multiple import and export formats, as well as reporting and other features.

The concern, or opportunity, with open source EMR applications for small physician practices is ongoing support. During the early 90s in my professional career as a regional IT Integrator we installed Linux running SAMBA fileserver in small offices. At that time, if a small business wanted to install Windows NT server along with the appropriate license fees cost an “arm and leg”, so to say the least we did VERY well. What I learned during this time was most small businesses had a brother, brother in-law, a kid in high school, nephew, or some other family member that provided basic computer support, i.e. adding users, shares, etc. However, Linux wasn’t a OS that was being discussed in A+ training classes, nor discussed in basic networking classes and only the most geeky of brother in-laws even knew how to pronounce Lin-us, oops, I meant Linux. So after implementation, these small offices had to contact us, or should I say contract with us, for ongoing support. In most cases, even with the ongoing support fees, the Total Cost of Ownership (TCO) was still much less than the TCO of Windows NT Server and the appropriate license fees over a 3 year lifespan. This was a WIN/WIN scenario for both the supplier and client.

But we did have a subset of clients that were upset their TCO were more than the intial cost of implementing the solution because of ongoing support costs. Although the ongoing support fees were explained upfront prior to implementation, this subset of clients believed their “family hackers” would be able to give them free support as they have always done. When their displeasure with our support fees drove them to seek another vendor there was none in the area that was familiar enough with Linux to support it, and there was no manufacturer to call because it was an open source product, so in a way we were the only ones that could assist them.

In any case, as the face of Healthcare IT radically changes, and with the federal government stimulus package earmarking loans and grants for providers to deploy e-health records, now is the time for savy IT Integrators to develop a niche market using open source EMR applications.

Healthcare IT War Games

Over this past weekend, MIT, Columbia, Northwestern, and Penn business schools competed in Fuld and Company War Game simulation. This year’s theme was “The Battle for Healthcare Information.” One of the predictions, among several reached during the war game, was that most prominent companies in the healthcare information technology and healthcare delivery industries, including Microsoft, McKesson, Kaiser-Permanente, and Allscripts, will quickly move to create alliances and in certain cases merge with their rivals—to take advantage of the government push to adopt EMRs. Click here for details.

The last time I checked, Microsoft doesn’t merge with anyone. Once Microsoft set their sight on a company, they will either buy the company (i.e. Visio) or squash the company (i.e. Netscape). My concern is if Microsoft becomes one of the major players in shaping the new healthcare IT paradigm, would the best solution emerge? I’m not bashing Microsoft, but Microsoft is responsible for creating value for its shareholders and they have the clout and resources to bully everyone in such an alliance. Basically for me what it balls down to is, can Microsoft be trusted to act in the best interest of the greater good in such an alliance?

$51.80 A Day For Internet Service

For the long Easter weekend, I took team Henderson on a little road trip to Niagra Falls. We stayed at Embassy Suites Niagra Falls – Fallsview, not a five star hotel brand, but a solid brand for a family retreat. So I never would have thought getting an Internet connection, correction, a wireless Internet connection, at an Embassy Suites would have been problematic. However, among other issues (a condescending front desk clerk, wireless connection only in the atrium area of a 42 story hotel, just to name a few of the other issues), the hotel's procedures does not allow for a guest to connect more than 1 device wireless without ponying up an additional $12.95 for the additional device. So for my family of four traveling with 3 laptops and an iPod Touch, the cost for Internet service would have set me back $51.80 per day ($12.95 per device per day to allow for simultaneously wireless connection), if I allowed everyone to have wireless Internet access. So is $51.80 the going price for wireless Internet access when a family of 4 travels? If so, I'm in the wrong business.

If you think the $51.80 Embassy Suites was asking me to pay for my family of 4 would never happen for a business traveler, not so quick, Grasshopper. Let say two healthcare professionals attend an out-of-town training class. Because of their institution's travel policy, they room together. In addition, each employee has a laptop and an iPod Touch loaded with medical apps. That’s 4 devices among the 2 of them needing wireless wi-fi access. If this training class is taking place at Embassy Suites Niagra Falls, it would cost them $12.95 per day per device, in other words, $51.80 per day for Internet service the same as I would have paid for my family of four to have wireless Internet service.

Yes, I know there were ways I could have circumvented the process and got everyone wireless Internet service with only incurring the $12.95/day charge, i.e. an Apple Airport Express would have worked nicely in this situation. The point here is, currently in healthcare IT we’re fighting over EMRs, EHRs, and PHRs standards, Google and Microsoft fighting the government over HIPPA privacy laws for their PHR apps, which mobile healthcare apps really add value, and the list goes on. However, the real question is, is the basic infrastructure needed in place and easily accessible to fully utilize and leverage the things we're currently debating? I understand what happened to me at Embassy Suites isn't the typical "textbook case" of broadband inaccessibility, and my theoretical scenario is just that, theoretical. But what it does highlight, broadband Internet service is far from being a commodity service. In order for healthcare IT to deliver on the projected efficiencies in the healthcare industry, broadband must be easily accessible under all, except the most far-flung, scenarios just like broadcast television and telephone service is today. Do you really want to receive a call every time a physician and/or other healthcare personnel you support needs help setting up an Apple Airport Express in their hotel room?

It's EHR, not EMR, To The Rescue

While sitting in the dentist office the other day, I perused an April 6, 2009 issue of Time magazine. The article that got my attention was “Wrong Prescription” by Scott Haig, M.D. He made a couple of points, if not totally inaccurate, they were a far stretch from practicality. So much so, that I finally decided it was time for me to start my Healthcare IT blog, an idea that I've been tossing around for about a year.

In his viewpoint article, he ascertains “that the Obama administration thinks it has discovered a magic bullet in the drive to lower health-care costs: electronic medical records (EMR).” Firstly, the current administration plan calls for the implementation of Electronic Healthcare Records (EHR) not EMRs. The media toss these two terms around interchangeably however there is a difference. Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference, a HIMSS Analytics white paper by Garets and Davis described it best, “the EMR is the legal record created in hospitals and ambulatory environments [or any provider's environment] that is the source of data for the EHR. The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual. Stakeholders are composed of patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government.” The EMR is for a specific provider's entity and EHR is to be shared. This ability to share a patient’s EHR among the various stakeholders is where efficiencies are gained, hence lower health-care costs.

Secondly, Dr. Haig suggested that an EMR will make it easy for a physician to create hyped-up diagnoses and inflated bills. An EMR will not make it any easier for a physician to create a hyped-up diagnosis than a blank prescription pad does. For providers that want to partake in fraudulent activities, an EMR application will not stop it, just like a copy machine doesn’t stop a person from producing fraudulent documents. So should progress in this area be stopped just because of what a small minority of sinister providers may do? I think not.

Basically, the majority of research does suggest implementation of EHR will lower health-care costs. In 2005, Health Affairs published a study, “The Value of Health Care Information Exchange and Interoperability” by Walker, Pan, Johnston, Adler-Milstein, Bates and Middleton which summarized net savings from national implementation of a fully standardized interoperability between providers and five other types of organizations [EHR] could yield $77.8 billion annually.


The bottom line is this, if we are to deliver higher quality, safer, health care at reduced costs, digital records are needed to help both providers and suppliers achieve this lofty goal.