Reductive Positivity Amidst the Mire of Uncertainty

Dearest Readers,

Sure, sure, sure, we're all like, "What's going to happen with EMR?" "What if I don't get my incentive payment?" "Why won't Craig call me back?"*

(*This concern may, in fact, apply only to me.)

Friends, I have the answer: We must accentuate the positive. Because my last post was a real downer. And because things could always be worse. You could, for example, be Amy Winehouse. And -- what's more -- there have been some truly encouraging developments in the past few months with respect to EMR certification:

1) CCHIT is working around the clock alongside ARRA to define meaningful use for EMR vendors. Sure, it's still half-baked, but we can nevertheless smell its cake battery goodness emanating from the kitchen into the living room as we watch cartoons with our baby brother and fight over the remote control. And, sooner or later, Mom's gonna call us in for dessert. And by "Mom" I mean CCHIT/ARRA, and by "dessert" I mean we'll know for sure what the heck "meaningful use" means. And then lots of $$$ for you and your practice via the stimulus package's incentive payment plan.

2) Who am I really to push you to make a decision before you're ready, but: when you think about it, there is actually no reason to fret about the impending certification criteria. As I wrote in this article, EMR vendor compliance is an absolute, unconditional, take-no-prisoners, definite MUST. As in, vendor survival will depend solely on this compliance. As in, no need to delay. As in, what are you waiting for? As in, I won't hold it against you if you continue to wait, but there are some extremely important reasons why you shouldn't, like this one, for example.

3) IO Practiceware continues to be awesome. If you're not part of an ophthalmology practice, I'm sorry IO can't offer you our ophthalmology-specific software -- but if you are, you can smile broadly and pat yourself on the back for choosing the field in which the best EMR vendor in the universe has chosen to specialize. And then you can buy our software. (Why are we the best EMR vendor in the universe? Here are a few reasons why.)

So there it is folks, as promised. Reductive positivity. Because, in the words of the atomic particle: "I was pretty bummed yesterday when I lost my electron -- but you know what? Now I'm more positive."

--FR

Not Enough EMR to Go Around?

Did you not have your dose of Cold Hard Truth this morning? Well, here's a pill or two:

There is an impending capacity overload for EMR vendors. IO Practiceware and, from what we've heard, our competitors have been working around the clock to accomodate the ever-growing surge of interest from practices planning to adopt EMR systems.

And while we will continue to provide the best possible service for every practice that's been queued up for a 2009 implementation, there's no freaking way we'll be able to support this level of interest if it grows at a more steeply exponential rate. Which means we'll have to cap off the volume of our customer base, and increase in the number of implementations per quarter at a much more steady, deliberate, and slow-moving pace. Which means some potential customers will, sadly, lose out.

The EMR industry as a whole -- and IO Practiceware in particular -- is having difficulty imagining how the EMR industry can satisfy the coming demands. Delivery times are lengthening, not only for IO, but for others in the industry. And the unfortunate reality for buyers is that practices that persist in twiddling their thumbs will ultimately lose out. Because, quite frankly, there won't be enough EMR to go around!

Think Christmas, Tickle-Me-Elmo, Ferbie. Same idea. Except, like, way, way more important.

If you're a prospective buyer, identify what's holding you back, and then demand that your questions be answered. IO Practiceware understands the Buyer's Dilemma with respect to CCHIT, but we've made our response pretty clear. (Article here.)

So: no pressure. Actually-- yeah, pressure.

Survey on Smartphones from SoftwareAdvice.com

Do you use a Smartphone? You might want to post your two cents via this survey from SoftwareAdvice.com that closes Tues. July 28 @ 5PM. From the accompanying article:

The smartphone industry is on fire. iPhone, Blackberry, Palm Pre and Google are all in the hunt for dominance. We want to know one thing: Which phone will become the device of choice for healthcare providers?

Briefly: "Meaningful Use" Response from CCHIT

After the ONC (Office of the National Coordinator) published its Meaningful Use guidelines and objectives (available here, with annotation), CCHIT responded with a cover letter assessing the value and anticipated shortcomings of those guidelines.

IO Blog commentary coming soon...

EMR: The Buyer's Dilemma

Catch-22. Cart-before-the-horse. Chickens-before-they-hatch.

Pick an idiom. It seems from your email messages that any of the above encapsulates the conundrum of buying an EMR system before it has been certified. And we at IO Practiceware feel your pain. But we'd also like to put you at ease. But not in a sleazy way, involving low lighting or Barry Manilow music. Because, c'mon, Barry Manilow makes you uncomfortable, and you know it.

You may have many reasons to delay your EMR decision until next year or beyond, but concerns about CCHIT certification should not be one of them. IO Practiceware -- and all other EMR vendors -- have no choice but to follow the ARRA rules. It's true that certain consultants and other industry figures say that practices must wait until vendors get certified -- but this presumes that there's a high level of uncertainty and/or ambiguity surrounding the process and guidelines for certification. But there simply is not. Companies can either choose to take the necessary steps or choose not to.

For everyone's sake, we choose: certification.

And, it's like, um, obvious. Not only are we being compliant for our customers' sake, but getting certified is an unconditional must if we -- or any company -- hope to remain on the market as a viable EMR vendor.

IO Practiceware will be certified as an EMR-C ("Comprehensive"), as opposed to -M ("Module"), by CCHIT for the 2011-2012 period -- which is the soonest possible period for all vendors. (There is no freestanding 2009-2010 certification. In fact, all currently CCHIT certified vendors must be re-certified for the new period.) Testing will begin in September 2009, and we are gearing up for this process by developing all the necessary enhancements for our software. (Here is an article that breaks down the timeline in greater detail.)

So, believe it or not, you can start to breathe easy. In a world of relative uncertainty and inexplicability -- where haircuts like this achieve national celebrity -- CCHIT certification should be a comfort, not a source of angst. Given the recent revisions to its criteria, CCHIT has become a means by which EMR can achieve high functionality, uniformity, and interconnectivity. Vendors like IO Practiceware, committed to the success of customers and the EMR industry, will do what it takes, get certified, and work to improve American health care.

--FR

More on CCHIT from ModernHealthcare.com

Article on exploring the effects of the new meaningful-use criteria.

The Latest from CCHIT: "New Paths to Certification" (Recap)

If you didn't have time to take part in today's Town Call with CCHIT (or, if you did, and would like a pared-down recapitulation), here is a list of major points worth knowing:

There are now three paths to certification, and three different certification types therein:

• 1) EHR-C - which stands for EHR Comprehensive
• 2) EHR-M - which stands for EHR Module
• 3) EHR-S - which stands for EHR Site

All three constitute certification, but differ in their requirements.

Comprehensive - "Rigorous certification of comprehensive EHR systems that significantly exceed minimum Federal standards requirements." Needs to meet all of the Meaningful Use Objectives.

Module - "Flexible certification of Federal standards compliance for EHR, HIE, eRx, PHR, Registry and other EHR-related technologies." Needs to meet one or more of the Meaningful Use Objectives. Applies to many specialty-specific EMRs.

Site - "Simplified, low cost certification of EHR technologies in use at a specific site." Applies to "any physician office, clinic, hospital, other facility or network that has self-developed or assembled an EHR from various sources and wishes to apply to ARRA incentives."

Process of Applying for ARRA Incentive Payments

• Certification by CCHIT allots various certification "codes" to the EHR vendor -- which apply specifically, and exclusively, to that vendor, and vary depending on the corresponding status (EHR-C versus -M versus -S have different codes) . These are then conveyed to the health care provider upon usage.
  
• Health care provider submits these codes in their ARRA incentive payment application.
• Health care provider must also submit additional "measure data" required for ARRA's own definition "meaningful use" (separate from CCHIT criteria).
  

Other Info / Points of Clarification

• Providers do not apply to CCHIT for the incentive payment; they apply to HHS. The means by which this will be done is still unclear, and has not yet been stipulated. Will it be a contractor? An online site? Via regional extension centers? What we do know is it will be through some government-named body that will 1) accept CCHIT codes and provider application; 2) assess, reject or accept quality measure data; 3) send or withhold the incentive check.
  
• EHR-M status can be awarded to groups of vendors. If certification is awarded to a group of vendors, they collectively must cover all (as opposed to one, or a few) Meaningful Use Objectives.
• Certification awarded in two year increments.
• Certification no longer "locked" into a software's parent version; all upgrades that maintain the previously approved Meaningful Use Objectives maintain those corresponding approval codes.
• A provider's site can be certified as EHR-S, even if the EHR software has not been approved as EHR-C or EHR-M. If a site uses an EHR-C or EHR-M, then it is certified as an EHR-S. The converse, however, is not true: EHR-S does not confer -M or -C certification status onto the software in use.
• CCHIT testing will begin in September of 2009. There will be no freestanding certification for 2009-2010. All testing will be geared toward the ARRA requirements for the upcoming 2011-2012 period. In other words, there will be no maintenance of any old CCHIT certification. (Click here for more on ARRA timing.)

If you have additional questions, you can email dwilson@cchit.org, me, or you can submit your comment below.

Complete CCHIT Presentation slide show available here.