On January 27th, I posted a piece on HealthBlog titled A “right-sized” EMR? Tablet PC + Microsoft Office OneNote. I explained how many doctors who can’t afford or don’t like the well known, branded EMR solutions currently on the market, have turned to lower-priced, sometimes home-grown commodity solutions. I gave the example of a dermatologist in Los Angeles who has been using Microsoft Office OneNote as his EMR. I also mentioned the Ablet Factory, a company that has for several years been selling an EMR documentation solution for Tablet PCs that uses Microsoft Office OneNote as its foundation. But in closing, I cautioned that:
If there is a downside here, it is that this EMR solution isn’t “certified” by ONCHIT. It also may not meet “meaningful use” criteria. So, if you are looking for a government handout to pay for your EMR, you are likely out of luck.
I went on to say, On the other hand, thousands of docs in solo or small group practices have found an easy pathway to digitizing patient records that is simply “good enough”, at least for now. And this solution will only set you back about $700 for software….. At those prices, who needs a bailout from the government anyway?
Yesterday, I received an e-mail from President Obama’s Chief Technology Officer, Aneesh Chopra. Apparently he or someone on his staff subscribes to HealthBlog. I wanted to share what he said because I think he has a very important and uplifting message for physicians and perhaps for the EMR industry itself. Mr. Chopra wrote:
Dr. Crounse – my reaction to your post (which was terrific) largely reflects my interest in making sure our regulations and incentive payments enable the kind of product innovations you referenced in the blog. While the OneNote+Tablet might not be sufficient to achieve “meaningful use”, it most certainly could be a component that, when combined with other components, could deliver a physician-friendly solution that happens to also be low-cost and value-creating.
Aneesh Chopra’s message resonates with work currently underway by the Clinical Groupware Collaborative (CGwC)—a group, and really a kind of movement, that I’ve also written about here on HealthBlog.
My friend and colleague Dr. David Kibbe, who has been very supportive and quite involved in CGwC, provides a thoughtful overview of the opportunities and challenges for Clinical Groupware in his February 7th post on The Health Care Blog titled EHR Redux. Speaking of the recent reforms put forward by the federal government, Dr. Kibbe notes that:
“Taken together, these reforms will have profound changes on the marketplace for EHR technology over the next five years. Already, new entrants are poised to bring innovative products and services to the 85% of physicians who don't yet use EHR technology in their practices. PracticeFusion, Optum/UnitedHealth, Medicity, RMDNetworks, Relay Health, Covisint, DocSite, AthenaHealth, and McKesson/HP are among the companies who have recently announced a "meaningful use EHR technology" offering that makes use of a "platform" with some degree of exchangeable, modular applications, along the lines of what is described in the IFR (Interim Final Rule). And there will be many others. Costs for these products are generally lower, and in some cases significantly lower, than the comprehensive EHRs with which they will be competing.”
So perhaps on this Friday as the world turns its attention to the opening of the Winter Olympics in Vancouver, Canada, there is hope for the future of clinical computing and electronic health records. Thank you, Aneesh Chopra, for opening a door to the possibilities and potential of Health ICT solutions that are so sorely needed by clinicians and consumers around the world.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
This seems to be encouraging that Mr. Chopra is paying attention. However, any experienced clinician will tell you, the proof is always in their actions. So far this government has said all the right things but done all the wrong things.
A few examples:
1) CMS has yet to place a monetary value for for CPT codes that describe non face-face visits; hence private insurers have no incentive to reimburse for such services.
2) The PQRI program that CMS started in 2007 is nothing short of a disaster in terms of its complexity, so it is nearly impossible for a small practice without a dedicated IT/coding team to ever satisfy its criteria.
3) Anybody that has gone through the process of setting up e-Rx via Surescripts or the NCQA certification can tell you that a root canal seems less painful.
So, words are cheap, Mr. Chopra. If you are serious, you should start by talking to physicians that have working experience with EMRs and have suffered through this process while still trying to improve the care processes. Simply hobnobbing with the CEO's of IT companies in DC will not do the trick. It will be vital to work with community physician practices to allow a workable, practical, economical system to emerge, in contrast to those of the recent past.
I am impressed that Aneesh Chopra (or one of his people) reads blogs about EMR and healthcare IT. However, I personally don't think that he's really in touch with what's happening with the EMR stimulus money. It's one thing to say that one could put together components like one-note and a tablet with other components to get the EMR stimulus money. It's yet another for a doctor to show "meaningful use" of a "certified EHR" in that way. Especially a small doctors office.
Add in all the other side factors such as the lack of defined requirements, lower medicare reimbursements and not more than a handful of physicians will get EMR stimulus money in this manner.
Most providers are motivated by intrinsic factors and a real desire to meet the health care needs of their patients and not to simply avoid a stick or earn a carrott. The stimulus money is one of the project resources (time, money, people, etc) and not the actual goal of either the stimulus package. In fact health IT is also not the goal but simply a tool to achieve high quality, patient centered, effective, care.
Health IT was a multi billion dollar industry before the stimulus package and shouldn't be the main driver in the industry. If a product adds value like Microsoft's one note combined with tablet or mhealth technology people will adopt it.
There is also no question in my mind that many providers and patients will pay for and use whatever technology meets their needs. I for example use a simple mobile health apps to track sleep cycles (cost .99), and many providers have simple in office customized applications that can work hand in hand with complex hospital based systems to coordinate care.
Govt pays for over 50% of all health care so it makes sense that they would want to be sure that they are getting something of value for their investment but that doesn't mean that companies like Microsoft and other players can't also provider solutions that either stand seperate from or leapfrog some of the CMS rules and regulations.
Oh and Aneesh Chopra has been and continues to be very heavily involved in the health IT world and will be on the new National health IT taskforce so don't count him out just yet. He is a strong ally of entrepreneurial solutions and has a real grasp of both Govt 2.0 and Health 2.0