ehr

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What's More Profitable: Demonstrating Meaningful Use or Managing Your Productivity?

We continue to get daily calls and requests for information about the ARRA funding.  We were even told by a potential client that they went with a well-known (but little liked) vendor now in order to maximize their ARRA $$, even though the money itself may be a mirage and they don't even know what their state is going to do. 

Big sigh.

Buried, which seems to be my status since August.  Some interesting items:

I don't like to think about the blog on weekends - hey, we're busy preparing for Nowruz! - but I saw this post from Dr. Russell Libby and had to share it.  I wish I had thought to do a similar calculation, but the credit goes to him:

I've had a lot of surprisingly hopeful emails hit me referring to all the "free money" docs expect to get as a result of the Obama stimulus package.  Put your cynical hats on, folks, because if you think that the HIT-driven stimulus money as it's designed right now is going to benefit you or your patients, you are mistaken.

As you may know, I am on the CCHIT Child Health Workgroup.  My participation is related, I believe, to my criticism of the certification and it’s misuse.  But if you’re not part of the solution, y

With the Obama administration arrival only a few weeks away, the discussion about CCHIT’s long-term viability is starting to heat up.  Even though I am on the Child Health Workgroup and appreciate the effort and intelligence of the civilians working with me, I still have grave concerns about the process and it’s effect on EHR development.  I’m sure it has benefited any number of physicians, but in the sphere that I work in (private pediatric offices), all it has really done is increase costs and eliminate vendors.

CCHIT has announced the new optional Child Health Certification Criteria. Click on the link, read the PDF, get a sense of what hoops the pediatric EHR world is going to have to jump through shortly.

I have been critical of the CCHIT certification process before. My position hasn't changed: CCHIT certification is misused and misunderstood by too many people in this business and it is driving up development costs, especially for private practice pediatricians. I don't think this is directly the fault of the organization itself, per se, but it is the practical result. I might have some input on this matter in the future, but for now, I will take a few minutes to examine some of the problems I see with the new child health criteria.

First, needs outside of pediatrics being pushed into our realm. In 2008, EHR vendors will need the following functionality:

The system shall capture patient growth parameters:

including weight, height or length, head circumference;

and vital signs including: blood pressure, temperature,

heart rate, respiratory rate, and severity of pain as

discrete elements of structured data.

That sounds great...until the last item. Severity of pain? Is that really necessary as a requirement for a pediatric office? You can't even begin to measure this subjective vital, as a practical matter, until the children reach a particular age (6? 8?) without using things like the FLACC scale (which, and forgive me if I'm wrong, I've never actually seen in regular use in a private pediatric practice). According to CCHIT itself, this is because of JCAHO requirements.

You'll note that other folks in my shoes have similar questions (look at line 7).

Is it a big deal? No, it's not the end of the world. But now, any EHR vendor who wants to focus on pediatrics is going to be forced to add the "Pain" vital when I don't know a single pediatric office that has asked for it. It will take up important space on the screen, it's another data element to track, and resources are spent on something whose impact on improved or more efficient is minimal, at best.

How about this item:

The system shall synchronize immunization histories with a

public health immunization registry according to applicable

laws and regulations.

Now, note that it says "a" public health immunization registry. So, all PCC would have to do is interface with, say, Vermont's registry, and we'd be certified? Forget that VT serves a handful of pediatricians when compared to NY or TX or CA? Don't get me wrong - CCHIT has its hands tied on this one. The state of immunization registries in this country is an absolute disaster (believe me, PCC interfaces with more of them than anyone). To make this a requirement when there is no standard among them is a mistake. As much as we want to have our registries integrated with EHRs, I think CCHIT should have chosen a standard and pointed to it instead of leaving it helplessly defined.

Finally - for now - I see some big gaps in the understanding of improved pediatric care. Where are the demands for tracking preventive care? Chronic care? Instead of ensuring that the system can indicate that the gender of each patient is unknown (<sarcasm>now THAT feature is long overdue</sarcsasm>), why not have an EHR tell you when a child is overdue for a physical? Or for a recheck? Why not interface with the Bright Futures schedule?

Why will CCHIT require, in 2009, that "The system shall capture the breast milk aliquot identifying data, amount, route, expiration date and date/time of administration" and not have any proper understanding of family mechanics (it only requires custodial information; it has no linking of siblings or families)? Talk about features missing from just about any non-pediatric system now, and we're forcing vendors to track breast milk data?

I'm not the only one so have this frustration with CCHIT. Check out the SEEDIE certification and Extormity. I admit that I laughed out loud. [Thanks to HISTalk for those.]

Back in March, I reacted to a piece from softwareadvice.com about CCHIT certification and even though I ripped through it honestly, I think they were appreciative of the coverage and sent me a reference to a new piece:

5 Ways Physicians Can Profit from Using an EMR.

I'm on vacation this week, so I don't have the time to go through it like I did the other piece, but I think it does a decent job of touching on most of the big ROI features of an EHR. However, I think it's missing a few much more important items:

• Time saved by the physician. Many of our clients, once they get good at using their EHRs, find themselves leaving on time at the end of the day or not having to track down charts themselves. What's that worth?
• Remote access! It's 3am and you get that emergency call. Electronic access to your records can be priceless.
• Most importantly: the opportunity to provide much better care. Whether it's medication checks, clinical warnings, legible notes, etc., etc., the primary benefit of your EHR had better go to your patients - and reap the benefits of that!

Still, I wouldn't toss up this reference if it weren't a helpful, quick read, especially knowing that softwareadvice.com supports many of our competitors!

In a week or two, I am going to rip through their piece about ASPs!