Evan D. Steele, SRSsoft CEO
The cheerleading is fast and furious. The federal government and various medical organizations continue to hail the nearly $19 billion health information technology portion of President Obama's economic stimulus as the catalyst needed to break down barriers to widespread use of electronic health records. Yet there's an undercurrent of caution among providers, HIT entrepreneurs and the popular media.
Take, for example, the April headline in The Washington Post: Electronic Health Records Won't Save Us. Or the April BusinessWeek headline: The Dubious Promise of Digital Medicine. Enthusiasm for the HIT stimulus, BusinessWeek said, "is obscuring the checkered history of computerized medical files and drowning out legitimate questions about their effectiveness."
With more than 80 percent of small physician practices without digital recordkeeping (and that's where more than 50 percent of America's healthcare is delivered), will a $44,000 incentive over five years really be enough to turn the tide? Medical News Inc. asked two chief executive officers of EHR companies, one an established firm and one new to the space, whether they expect an EHR rush. Neither is holding his breath.
"The de-installation rate is a lot more than people suspect, when the doctors just throw up their hands. Depending on the specialty, you hear anywhere from 40 to 80 or 90 percent. But my fear is the type of systems that the government will allow under the stimulus plan will be the same systems that have had spotty track records of success. Just because they're throwing more money at it doesn't mean that they're going to be any more successful," said Evan D. Steele, CEO of New Jersey-based SRSsoft. The company's high-profile clients in the Southeast include orthomemphis and Campbell Clinic in Memphis, Raleigh Orthopaedic Clinic in Raleigh, N.C., and the Cardiovascular Institute of the South in Houma, La.
Early HIT adopters have, for the most part, been large practices and hospital systems with deep pockets, a professional IT staff, project managers and consultants to ensure proper installation and training, Steele noted. Yet what about less technically savvy practices with less money to spend on IT implementation? "What will be the success rate for those practices?" he asked, adding, "It could be an unprecedented opportunity if it's done right, but it's electronic medical records from the makers of Medicare and Medicaid."
SRSsoft defines its product as a "hybrid electronic medical record" with software
modules available from which physician-practice clients pick and choose – e-prescribing, PQRI (Physician Quality Reporting Initiative) reporting and reminders, outcomes tracking, order management or simple chart access. This hybrid EMR doesn't require complex physician data entry, and the product is geared specifically toward high-performance practices that are high-volume and typically high-revenue. "They're very, very impacted by small changes in productivity," Steele explained. Used nationally by more than 4,000 physicians over the last dozen years, SRSsoft enjoys a 100 percent compliance rate, and ease of implementation is the reason why, Steele said.
Henry I. Balogun, PhD, is president and CEO of ClinicTools®, a Pennsylvania company launched earlier this year and marketing an Internet-based EMR nationwide. Asked if the stimulus will be a boon to his businesses – he has more than one – Balogun said, "We are not really sure at this time, because every healthcare provider is a little bit leery jumping into this stimulus program. I don't see a rush towards it."
Balogun is executive director of MedNet Healthcare Systems, which operates outpatient psychiatric clinics, home health services and supplemental staffing, plus consulting and training. ClinicTools was borne out of Balogun's frustrating search for an application specifically designed for mental/behavioral health, home health and basic physician practices. The author of several IT-related books, including "Microsoft Office for Healthcare Professionals," Balogun designed ClinicTools "based on our needs to access a patient's record anywhere. We needed something unique." Thus, ClinicTools requires no software installation or upgrades and is easily accessible via an Internet connection and proprietary passwords. In addition to patient records, ClinicTools includes patient scheduling, employee time management and productivity management.
"Right now, as far as the stimulus package is concerned, we are all staying away for the fear of not knowing what to do and what not to do, where to go for this and where not to go for that," Balogun said. "You don't want to be accused of fraud; so many providers are a little bit cautious."
Under debate in HIT circles is just how much interoperability is needed – and also how much is possible. Should the government run the show, with strict standards and regulations, or give entrepreneurs room to move? Steele called that "an interesting conundrum." He added, "How do you get over the hump of first creating standards and not entrepreneurializing it, but on the other hand, allowing for enough innovation so that systems are developed that are user friendly and attractive to doctors? You need the entrepreneurial approach to spur innovation." In that vein, SRSsoft's OpenPath™ Technology software is non-proprietary, affording clients the ability to interface with other technologies.
Saying that he is "a firm believer in standards," Steele applauded the federal government's e-prescribing initiative. "Look at the Surescripts certification," he
said. "It goes through one standards body, and everybody who does e-prescribing in the country, which is a huge number of doctors, go on the same standard. That's the only reason we've gotten to where we are, where there's some nice adoption going on." Steele suggested that the federal government should let it be known what data it needs, and then leave it up to the private sector to figure out how to deliver that information in a "readable and digestible" format.
U.S. Sen. John D. Rockefeller believes the answer is open-source software, and to that end, he introduced a bill in April to create universal open standards for EMRs. Called the Health Information Technology Public Utility Act of 2009, the proposed legislation would implement a grant program to facilitate the development of open-source software and open standards. Balogun gave the idea kudos, but was still cautious, concerned that such a move would "flood the market with so much confusion and chaos" as unqualified players in the sector misused the technology.
When it comes to standards, and HIT implementation in general, Steele warned that the federal government is missing the boat by not seeking more input from front-line physicians. He criticized the composition of the Health IT Standards Committee, a Health and Human Services advisory board charged with making recommendations on HIT standards, implementation and certification. The committee, he charged, is composed of corporate representatives who don't represent primary-care medicine. "The process appears to have been a little bit politicized," he said. And the result could be standards that leave small practices scrambling toward unmeetable goals. "Until they address the usability issue and until they stop putting a certified stamp of approval on products that have not been researched yet and proven effective and adoptable, the paltry adoption rates that we've been experiencing will continue."