EHRs Especially for Specialists

EHRs Especially for Specialists

About five years ago, two cardiology practices shopping for an EHR surveyed the same field of vendors and made two different picks that illustrate what matters to specialists when they go digital.

The 16-physician, Fla.-based, Jacksonville Heart Center chose a system from NextGen Healthcare, a major vendor which sells to every specialty under the sun. The Jacksonville cardiologists didn't want to select a minor-league vendor that might fold three years later, or lack the resources to invest in research and development, says Mark Masters, the group's chief administrative officer.

"NextGen was a monster company with plenty of capital," says Masters. "They looked like a strong player going forward." In addition, he added, NextGen did a good job catering to their specialty's needs, setting up the Florida cardiologists with electronic forms, or templates, for echocardiograms, EKGs, and other matters of the heart.

However, NextGen wasn't good enough for the 8-physician, N.J.-based, Westwood Cardiology Associates, which chose an EHR from a niche vendor that the Jacksonville group had passed on — GEMMS, which makes EHRs only for cardiologists.

"We really wanted a cardiology-specific program," says cardiologist Elliott Lichtstein. He notes the competitors of GEMMS, such as NextGen, were more geared toward primary care. "It's hard to be good at everything."

Five years later, specialists of all stripes still ask the same questions about EHRs. Will this vendor be around tomorrow? And will it supply specialty-specific features? Pediatricians, for example, look for automated growth charts and a tool for calculating medication dosages based on a child's weight. Surgeons want separate templates for presurgical and postsurgical workups. And specialists performing consults want a system that will generate an impressive consult letter.

The good news in 2010 is that while some small niche vendors — often launched by a visionary specialist with a knack for computers — have indeed fallen by the wayside, others such as GEMMS have endured. At the same time, mainstream vendors once considered weak in building specialty-specific products are now earning gold stars.

"These companies are far, far ahead of where they were five years ago," says Rosemarie Nelson, a healthcare IT consultant in Jamesville, N.Y., with the Medical Group Management Association.

However, the issue of vendor robustness and survivability isn't going away, especially in light of last year's economic stimulus legislation that awards cash bonuses to physicians who demonstrate "meaningful use" of EHRs beginning in 2011, but promises to penalize nonadopters beginning in 2015. High-income specialists such as neurosurgeons might not bother chasing after the bonus — $44,000 over five years under Medicare, almost $64,000 over six years under Medicaid — like family physicians might, but nobody wants to lose money on account of their meaningful use status.

Now physicians are asking if a particular EHR will give them the necessary features to meet meaningful use requirements, including the ability to exchange data with other EHR systems. In addition, does the vendor have what it takes to get its EHR certified, another prerequisite for meaningful use money?

Alas, buying an EHR isn't as easy as buying a toaster, particularly if you're a specialist. But don't leave the store. We've gathered buying advice from a wide range of physicians, executives of medical software companies, and consultants.

Eyeing specialty needs

For primary-care physicians, some experts would argue the task of selecting an EHR has been made easier by the work of the Certification Commission for Health Information Technology (CCHIT). Since 2006, this private, nonprofit group has been vetting EHRs that meet hundreds of performance standards, such as the ability to display a problem list, transmit an electronic prescription, or create an audit trail identifying everyone who's looked at a patient's record.

These standards expand from year to year, motivating EHR vendors to have their products certified under the latest set. Plus, certification initially was time-limited — three years for products in 2006 and 2007, two years for those in 2008. So vendors that want the CCHIT sticker on their system have had to reapply for it — an expensive proposition in terms of the $37,000 application fee and the hundreds of thousands of dollars sometimes spent on software programming. So it takes a well-heeled company to keep its EHR certified.


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