EMR update

August 1, 2009

Smaller companies might offer innovation with a lower price tag, but they might not be able to achieve proper certification for incentives

IN THE RUSH TO PARTICIPATE IN the federal incentives program to install electronic medical records (EMR), healthcare providers are faced with a glut of vendors-some household names and some emerging companies, some certified and some not.

Choosing the right vendor and EMR system is a high-risk gamble for healthcare providers with profitability, efficiency, staff morale and even patient safety at stake. With 139 vendors certified and more to come, providers are considering the merits of choosing established legacy sellers, whose certification guarantees that a hospital or health system will see some reimbursement for its investment, or perhaps dealing with a smaller company that hasn't been certified, but offers innovation and, maybe, a smaller price tag.

The market for EMR data transfer equipment and applications could reach $1.6 billion in 2013, according to market research firm Kalorama Information. A growing number of small vendors, as well as technology giants such as Intel, General Electric, Microsoft and Qualcomm, are vying for the business.

CCHIT has come under criticism by some experts who question its ties to its parent, Healthcare Information and Management Systems Society (HIMSS), which represents 350 technology vendors. Specifically, they argue that the certification mandate that EMR be supplied by a single vendor limits a provider's options. Also, they contend that CCHIT certification prohibits many simpler EMR applications with fewer features. It also prevents end-users from assembling software from separate vendors and submitting this for certification.

Sharona Hoffman, professor of law and bioethics at Case Western Reserve University and co-director of its Law Medicine Center, believes rigorous certification and approval processes make it simpler for providers to find the right EMR.

"It is true that demanding certification or approval requirements may keep small entrepreneurs out of the market," Hoffman says. "However, it is extremely important that only vendors who can produce safe EMR systems that will not compromise patient welfare be allowed to sell their products."

The federal Health IT Policy Committee is considering a proposal from one of its workgroups for three tiers of meaningful use, with corresponding deadlines in 2011, 2013, and 2015. The term "meaningful use," which indicates a significant number of the right results-oriented measures of success, is part of the language used in the legislation that will help determine whether providers qualify for part of $17 billion in Medicare and Medicaid incentive payments.

To be a meaningful user of EMR in 2011, providers must electronically capture, report and exchange key clinical health information.

SMALL, NIMBLE COMPANIES

While larger companies may scoop a big share of stimulus dollars, their success is not guaranteed, says Brian Klepper, PhD, a healthcare market analyst and founding principal of Health 2.0 Advisors Inc. He predicts the market will support smaller, more nimble companies that offer Web-based technology that turns out faster, cheaper and better EMR products.

The certifying body in June unveiled three new certification approaches, including one for electronic prescribing, personal health records, registries and other technologies. CCHIT says the plans "appeal to providers who prefer to combine technologies from multiple certified sources"-some of which would likely come from smaller vendors.

Recently, KLAS Enterprises LLC, an independent, Utah-based market watchdog firm that reviews healthcare vendor performance, found few offering creative solutions for health IT requirements, including EMR. The KLAS report is based on feedback from dozens of CIOs and other healthcare executives.