The Rhode Island Blues has provided $5,000 per physician, plus performance incentives, to 250 primary-care doctors who’ve adopted EMRs, according to chief medical officer Augustine Manocchia.
It has also supplied about $1.5 million to EHR of Rhode Island, an organization of 1,100 doctors who have pledged to computerize their practices. Recently, the Blues announced that it would give primary-care physicians who implement EMRs an extra 5 percent raise on top of other fee increases.
Uncle Sam and health technology
The Bush Administration has been promoting health IT since 2004. Its most recent initiative is a three-year pilot program launched by the Department of Health and Human Services. In this demonstration project, 1,200 small- and medium-sized practices in 12 markets will be given incentives for acquiring EMRs. The as-yet-unspecified rewards will be provided for EMR implementation in the first year, for quality reporting in the second year, and for “showing value” from using electronic records in the third year.
The Centers for Medicare & Medicaid Services is also on the EMR bandwagon. For the past couple of years, CMS has required its quality improvement organizations in every state to help a limited number of small practices choose and acquire EMRs. As a result, hundreds of physicians received free assistance in preparing for the digital leap (but no subsidies). Also, as part of a five-year demonstration project, CMS is signing up 1,200 small- and medium-sized primary-care practices that will receive subsidies for acquiring EMRs and using them to improve quality.
In 2005, CMS released a modified version of the Department of Veterans Affairs’ VistA EMR for use in private practices. Known as VistA Office, the open-source program is being marketed by several small vendors, but up to now has had few takers. Why? Because physicians find it difficult to customize and expensive to support. As a result, this “free” EMR costs as much as a medium-priced commercial product.
Both Republicans and Democrats have lauded the potential benefits of health IT. To date, neither Congress nor any state has approved direct grants to physicians for EMRs. But stay tuned on that one.
EMR, Google style
Besides VistA Office, there are several so-called “free” EMRs available in the commercial space. The most publicized is the product of San Francisco-based Practice Fusion, which will charge you just $50 a month, relying instead on targeted ads to finance its remotely served EMR.
Ryan Howard, CEO of Practice Fusion, says that the ads, provided by Google and other marketers, don’t pop up in the electronic record. “The messaging is non-intrusive, it’s completely private, and doctors don’t have to click on it if they don’t want to.” Howard denies reports that his company is selling de-identified data to payers, researchers, and pharma companies, but adds, “We reserve the right to.” He claims 200 doctors have signed up for the software since it was launched last October.
Certified? Maybe, maybe not
Neither Practice Fusion nor other “on-the-house” EMRs, like that of Amplus — which is supported by drug companies — have been certified by the Certification Commission for Health Information Technology, as all EMRs subsidized by hospitals must be. So it’s difficult to determine how their functionality, security, and interoperability compare with those of CCHIT-certified EMRs.
Meanwhile, a couple of certified EMR makers are putting out stripped-down versions of their products at a reduced price. E-MDs is readying a “lite” version of its CCHIT-certified EMR that will sport a price tag of $2,000 max — much less than the certified version, which goes for about $4,500 per doctor. Physicians will be able to use the Web-based EMR-lite gratis for the first 100 patient visits, using digital “tokens.” You can buy extra tokens up to a maximum of $2,000, after which the program is yours. Or you can get the EMR for free by subscribing to e-MDs’ revenue cycle management (Web-based billing) services.
Spring Medical Systems is selling its SpringCharts Essentials EMR for about $2,500 — half the price of its certified product. To get the full EMR, company president Jack Smyth explains, physicians merely need to pay for an activation key to turn on the other features.
This modular approach makes sense if you’re leery of tackling all of an EMR’s facets at once, says Randall Oates, president of SOAPware, whose company makes one of the more popular low-cost EMRs. “As vendors, we really need to be focused on transition tools,” he says. “This big-bang approach, where you try to put in a centralized, complex system is showing a failure rate of around 30 percent. Our philosophy is to introduce the functionality at the rate a practice can adopt it.”
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