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EmTech Session on EMRs

by John Moore | September 26, 2008

If you have read previous posts this week, you know that I was attending MIT’s EmTech conference. Event is a focused on technology and innovation of all stripes bringing together some pretty big names to discuss where we are today and where we are headed. For the first day, I had one continuous and long post, which in retrospect, I am not fond of – just too much to wade through to get to what may be important to you, dear reader.

The second day, I put up two separate posts, one on Craig Mundie’s keynote and the other on the Personal Genomics session. This approach came across clearer, and more focused.

So with that in mind, I am reposting the EMR session notes from day one. This will not be a verbatim repost as reflection on what I learned as well as comments by HealthVault’s Chief Architect, Sean Nolan, to the first post necessitated some revisions.

Recap of EMR Session:

Panel includes John Halamka (Beth Israel’s CIO), Karen Bell (HHS), Craig Feied, (Chief Strategy Officer, Microsoft Health Solutions, he developed Azzyxi at MedStar) and Girish Kumar Navani, (Founder & President, eClinicalWorks). Decent size audience, easily a third of the total attendees at EmTech (there are currently 3 concurrent sessions).

Karen started off basically setting the stage giving a broad overview of the challenges in healthcare and subsequently HIT, for the audience with the HIT Hierarchy of Needs slide (pyramid, privacy at the base up to public good at the pinnacle). For us in the HIT space, nothing new here, but for those in the audience, most of whom who do not work in healthcare, Karen’s presentation provided a good backdrop for follow-on discussions.

Halamka followed with the common statement regarding lack of EMR adoption. Halamka claims that EMR systems today are still too expensive. With an average cost of $40-60K per practice and the common drop in productivity of 25% for first 6 months after deployment, few physicians will shoulder this cost.

Despite this apparently prohibitive cost, Beth Israel is requiring all affiliated physicians to adopt and use an EMR. Beth Israel will subsidize adoption of EMR by offering a hosted eClinicalWorks solution for these affiliated practices at a big discount to encourage adoption. The plan is that through adoption of EMR, BI and affiliated practices will be able to better track and report quality and performance metrics that will result in higher payments, via P4P payouts, from CMS and other payers. This will augment the cost of hosting the EMR.

Halamka also talked of consumer’s abilty to move PHR data from BI’s PatientSite to either Google Health or HealthVault. Today, the only thing you can move into either repository from BI’s PatientSite is data pertaining to medications and allergies. Not much value there for the consumer, though this is the low hanging fruit of what physicians would want to see in a PHR, particularly in an emergency situation.

Kumar was next. eClinicalWorks is now in over 20k physician offices. Kumar talked in broad terms, not terribly specific. Does believe that “patient-centered healthcare” is the next major change in healthcare that will be a forcing function for EMR adoption. Not to surprising to hear from an EMR vendor.

The highlight of Kumar’s remarks was him stating that he does not like the term of EMR. For him, EMR is a static term that does not fully capture th purpose of an EMR, helping physicians deliver better, more informed care to their customers. Hmm, like this statement – he is absolutely right, EMR is a dead term, we need something new.

They just did a quick survey of audience, Managing Personal Health Information: 14% would trust lab or pharmacy, 32% would trust a company such as Google or Microsoft and 54% would trust only themselves or a doctor. Pretty liberal crowd here in that nearly 50% would trust a third party, beyond their doctor with the personal health information.

Craig talked about the development of Azzyxi and how what all he wanted to do was try to provide the most information possible at the point of care, in this case the ER. Believe that errors/failures in medicine are not about Execution, but in Planning. Unfortunately, he claims all the effort now is on Execution (meds, wrong patient, wrong procedure, etc.), rather than upfront Planning. Talked of the “Spectrum of Wellness” as core to MS’s health sector strategy – a rethinking of what healthcare is and how it is delivered, not only when you are sick, but when you are well. Good speaker, a bit heavy on the sales pitch though he does seem genuinely sincere.

Q&A Session: What’s the value to a primary care physician in adopting EMR. Halamka claims that P4P and quality reporting is becoming an ever bigger issue for physicians and that these systems can actually help doctors ultimately earn more and earn it easier (HIT can greatly facilitate all sorts of transactional processes). Kumar followed up stating that it will help physicians better understand what they are doing as well as help doctors prepare more effectively for patient visits. Supported Halamka’s view that quality and P4P will also push adoption going forward. These programs start to really put some cost justification behind EMR adoption. Craig thought that it is up to software vendors to create sufficient value in their solutions that will lead to adoption.

Status oF PHRs: Halamka – we have 40K users of PatientSite and believe in patient control, thus opening up to Google Health and HealthVault. Karen, still informative stages but right now pretty wide open as the apps are simple today and maybe not what consumer will use tomorrow.

Addendum to EMR Session – picked-up through conversations after formal session:

  • According to recent HHS calculations, there is over $700M in incentives, via payers, through various P4P and quality improvement programs that can be used to subsidize EMR adoption by practicing physicians. Clearly, there is money to be had, though I am not sure that most physicians know how to capitalize on it. Unfortunately, few, if any EMR vendors today are helping physicians understand that there is an opportunity to augment the cost of EMR adoption. Truly, a missed opportunity.
  • Today, Beth Israel is allowing their customer to export their PatientSite PHR data to either Google Health or HealthVault. Problem is, a BI customer can only export medications (includes immunizations) and allergies. I asked Halamka why they are not exporting the full record and he told me that neither Google nor Microsoft’s offerings can handle anymore than that and used the example of imaging data, stating that the data models for both Google and HealthVault just aren’t there yet. There may have been some misunderstanding as Sean Nolan quickly commented on the previous post that HealthVault was capable of accepting numerous data types, (e.g., labs, clinical notes, etc.) with the exception of images. Sean went on to check with Halamka who states that he was just referring to images when I initially spoke to him. But that just brings me back to my original question to Halamka: Why are you not allowing customers to export as much of their record as a service like HealthVault can accept? Will need to follow-up on this one.
  • eClinicalWorks is seeing no issue with reluctance in market to adopt EMR solutions. Kumar told me they have plenty of business and are still on a very rapid growth path. Early problems precipitated by a couple of huge orders (e.g., NYC) are behind them now and they are meeting target implementation and delivery dates. Also, despite all the rumors of eClinicalWorks relying heavily on offshore developers, over 80% of all employees are based right here in the US. Kumar does use resources in India, but on a flex model to address pressing, unexpected customer needs, which are not an every day occurrence.

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