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HIStalk Interviews Janice Newell

September 5, 2009 Interviews 20 Comments

janicenewell 

Janice Newell is CIO at Swedish Medical Center, Seattle, WA.

Do you think the government’s strategy of subsidizing EMR purchases is the best way to improve patient outcomes with technology?

I certainly share their belief. I think the only thing that’s going to push adoption is money. Whether or not their approach is the best way to do that, I haven’t given a lot of thought to. But I don’t think anything’s going to move these docs but money.

Will subsidizing the purchase of EMRs themselves incent usage or will there need to be more steps that follow?

This is the easiest question?

[laughs] The second part got harder.

Well, yes. Certainly, incenting them to adopt it is a necessary first step. Then at the other end of it, there’s this little, minuscule penalty they’ll take if they don’t adopt it. That’s certainly more significant as time goes on, the penalty.

But I think the other thing that’s going to be key is really getting some significant measures of outcomes in performance, and how is this really changing the outcomes and cost, because if it’s not doing all that, why bother? 

Is your strategy any different at the health system based on what the government does or doesn’t do, or are you pretty much down the path that you plan to stay with?

We’re pretty much down the path. We had really made a huge commitment. We’re a relatively small health system, about $1.3 billion. We had already made the commitment that we were going all in with the Epic system, and so committed about, let’s say, $120 million to it over the past four years. We were going there anyway.

When you look back at that investment, would you say it has paid off as you expected four years ago?

I certainly wouldn’t say that it paid off yet, because in fact, we still have pieces that we’re implementing. But yeah, are we starting to achieve the things that we had outlines we were going to achieve? Absolutely.

What kinds of things were you looking for as measurable benefits?

Certainly we were looking for providers in general to have the information that they need as they’re actually caring for patients wherever they are. We’ve certainly achieved that, in that we have it available everywhere.

Also, in terms of improving our quality metrics, I’ll give you just one small example. Pain reassessment is always an area of interest as both a customer satisfier as well as a JCAHO requirement. Our pain reassessment measures were not that good. We made some changes to Epic in terms of what kind of notices the nurses get about pain reassessments being due. It has moved the pain reassessment measures from the low 60s to the mid-90 percent. The nurses are doing the pain reassessment in the timeframes that are required just by changing how the system was supporting them.

So certainly on the quality metrics, we’re starting to get some traction. Also, in the financial arena, we’re getting some traction. It’s a pretty broad swath there. Certainly it has improved the revenue cycle in terms of how long it takes us to get the bill out the door. It’s improved the level of billing we do, more accurate with better documentation.

Also, still in the financial arena, it’s also helping us standardize processes across the organization. One area that’s a biggie for us is the operating room. Before Epic, we had so much variation that it was incredible. The surgeons have taken it upon themselves with Epic to really start the standardization process of what supplies they use, what supplies come into the room, what ones shouldn’t be there at all. So all kinds of good fiscal outcomes.

But a lot of that must have been other than just technology. You must have had a lot of change initiatives to go along with it. How did you package up your implementation and your change management to make this all work?

It terms of actually sitting down and changing wholesale processes in our operations, we actually started out doing that. We quickly abandoned that approach because what we found out is, sure, we can sit down and talk workflow with our folks in operations. They would describe to us what they thought happened and how they thought things worked. But in fact, we found out that it was pretty consistently not happening that way.

We ended up adopting the approach of, let’s use a good model system, get it in, and make the improvements after that. So in fact, many of the process changes are coming afterwards.

It seems that anybody your size and bigger, along with some smaller, are buying Epic. What’s their secret sauce?

A couple of things. One is that they are an integrated system. I don’t even know how many modules they have any more, but they have one system that supports care in the clinics, care in the hospital, in the operating rooms, all of the billing and revenue cycle, pharmacy, lab, home care, you name it. They have modules to support all of the different functions.

Instead of us going on in a best-of-breed world, where we add two dozen different systems, each individual system, we now just have Epic. It is much more effective from both a user experience and an IT experience to have the same data, the same application be available wherever you are. If you think about healthcare as just a continuum of care, it just happens in different places, either the clinic or the hospital or the ED, it really supports that kind of a model if the organization itself thinks it’s a system. So that’s one reason.

The other big reason is that the Epic implementations are successful. They’ve done this enough. I think they provide very good support for organizations to actually have a successful implementation. I’m not sure I can say of all their competitors that their implementations go relatively smoothly.

How does that work when basically they are young people trained usually from scratch with no industry experience? What are other vendors doing wrong that they can’t do what Epic does?

Certainly the young people without the industry experience has some downside to it. Frequently they’re great technicians without the industry expertise. And if something goes wrong, that could cause some problems. But in terms of the process for actually going about with kind of a project, they have been doing it long enough in documenting what the process is.

Just insisting that their customers go through this process, sure, we all have some variation in how we do it. But Epic is pretty clear in the way they want you to do things. And so we all do things in a somewhat similar manner in implementing Epic.

They are there the whole time. No matter what, you’re going to have an Epic team with you through the implementation.

Meditech and Epic seem to have a similar approach that, right or wrong, they genuinely believe they know better than the customer and protect them from doing things that don’t make sense. Do you think other vendors are too catering to their customers instead of saying, we know the product, just do it our way and it will work?

I think so. Yeah. And the other ones are run by a bunch of marketing people. Meditech and Epic are the only ones that are run by software people. The other ones have a huge marketing influence, sales and marketing.

You have to deal with the idiosyncrasies of Epic, but at the end of the day, if it works, it’s OK.

You’ve said that federal stimulus money must be carefully managed or it will go down a rat hole. Did you have something specific in mind or was that just a general comment?

[laughs] Yes, actually, I did have something very specific in mind. What I had in mind is that there is so much variety in the systems that people have now, and these are just the organizations who could afford to be moderately early adopters.

I mean, if you think about the hundreds of systems that are already in the marketplace, and then you think about multiplying that by some factor as every Tom, Dick, and Harry sees an opportunity in the marketplace and comes up with the $99 EMR, I think it’s scary.

And then you have these little offices who really don’t know that much about technology or how to really use it in their practice, or what can go wrong with that technology in your practice — you know, 99 bucks and I’m going to be able to get $44,000 from the government, how could I go wrong?

So while we already have the data exchange issue in healthcare, some of it because not many of us have much electronic data in front of it because there’s so much variety, but if you multiply that by whatever factor is appropriate with people going out and doing every Tom, Dick, and Harry system, it just seems that there’s a lot of opportunity for that to turn bad.

I think what the government is trying to achieve wouldn’t be achieved if we just end up with, instead of three million islands of information, now we have 23 million islands of information.

Do you think that the certification process as well as the “meaningful use” criteria are going to make that less likely to occur?

No. Say we double the number of EMRs in the marketplace so that people have on their plate trying to exchange data. They’ll not all pass certification, but it’s still going to be a data exchange challenge.

I read your local newspaper’s article that said, hey, what an irony, we’ve got three of the best hospitals in Washington that are basically almost in the same neighborhood, and they can’t exchange information. How do we address this issue of everybody’s being their own silo?

At the end, at making it Epic-specific — with our Epic system, we are actually in the middle of a project to bring our largest affiliated group, about 150 docs, on to our Epic system. So they will be using Epic in their clinics, their own service area. All they have to do is share clinical data with Swedish, and they’re using our Epic system.

Instead of just having a system that supports follow-up functions within Swedish, we now have a system that supports all of the patients in our largest affiliated group, too, that we cross over thousands of patients every year. Our intent is to do that with a lot more of our affiliated groups where they can create their own little space within Epic. They can have their own service area.

It’ll be like they have their own system, except that it will be our Epic system and we will all share clinical data. We won’t share financial data, but we’ll share clinical data.

Another piece, once again at the risk of being Epic-specific, Epic actually has a capability where there are a number of us now around Puget Sound that have Epic. We have it, MultiCare has it — that’s another billion-plus organization — Everett Clinic up north. Epic actually has a feature where in fairly short order, we can have the Epic systems exchange data with each other.

Was that something that led you to choose Epic initially?

At the time, no. It was more the integrated feature that let us choose Epic initially.

How about MyChart? Is that an important part of your strategy to get closer to patients?

Absolutely. It has the ability for them to get at their information without us being the guards at the gate. Sure.

If you look at where you are and where you need to be, what do you say are your most important priorities and your biggest challenges right now?

We still have a few big pieces that we haven’t implemented yet. Two of them happen to be billing. So we need to do those other two big pieces for the professional billing and hospital billing. We’ve actually started that.

The tail end of the spectrum that we haven’t done yet is home care. So we still need to do that. Also included in that is getting it out to our affiliates. So that’s one bundle of work, which is implementing it in more places, more functions.

The other priority is a combination of improving the systems that’s been installed and actually continuing to work out how we’re going to get value out of it. So using the system to be a facilitator for our standardization efforts or workflow improvement efforts. Those are big items for us.

Improving the system itself, making the system simpler, I should say, and using it to improve our work processes.

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Currently there are "20 comments" on this Article:

  1. I think you need to counter this trend of Epic accolades in your interviews by digging up some dirt on Epic. There has to be an Epic customer out there somewhere who is frustrated about something…

  2. You have to laugh…these CIO’s don’t a “strategy.” They just buy EPIC and talk about the virtues of that…indirectly.

    Like the old days they would buy IBM – “no one got fired for that…”

  3. Good interview. Mirrors my experience here at Kaiser with Epic. I was wondering if we were going to qualify for stimulus money retroactively, since we installed prior to the legislation.

  4. Hi Janice:

    Your interview was great, and I could see that you are pro-Epic, pro-vendor person who does not have a clue to why physicians aren’t buying into Obama’s dream of the certified electronic health record (c-EHR).

    >>> But I don’t think anything’s going to move these docs but money.

    Most doctors do not want c-EHR systems for many reasons, not just because of money.

    The current crop of c-EHR systems have a poor interface which is just difficult to use. Vendors want doctors to move to the c-EHR rather than the other way around.

    For example, before CCHIT got thrown under the bus by the HHS on 7/16/2009 they were promoting only c-EHRs that lacked free flow text, like what we use in our paper records. Everything was supposed to be encoded, every move a click and a choice.

    HITECH wants physicians to become secretaries, reporting BS for a pittance of a fee that for many of us in primary care is making it more difficult to survive and to feed our families.

    Yet they want to promote the use of PENALTIES to see the old, wretched complicated poor Medicare patients that I see on a day-to-day basis? You got to be kidding. What will happen is that you will see the enrollment in Medicare drop from 90% to 10% over the next half dozen years.

    They talk about 5% penalties after 2017, but isn’t that the year that Medicare is supposedly going to go bankrupt? Anyhow, I’m more worried about the 21% cut projected by 2010 to be levied on oncologists like myself already hit hard by cuts that have left our practices bleeding over the past 10 years, year after year after year.

    Do you really think that the measly $44000.00 will cover the true costs of “significantly using” a c-EHR? It’s obvious that you have not read my article at http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate which shows that the ture cost is about $60000.00 per year.

    HITECH and forced c-EHR use will destroy Medicare.

    >>> but if you multiply that by whatever factor is appropriate with people going out and doing every Tom, Dick, and Harry system, it just seems that there’s a lot of opportunity for that to turn bad.

    What you and other “enterprise” c-EHR proponents want is to kill off competition by cheaper, more usable, more popular EMR systems whose uptake is much higher. HIMSS tried to “cull the field” using it’s CCHIT certification system which functioned as a dreaded anti-competitive vendor initiative. Thank God its now near-dead.

    Check out this chart based on a CDC study of EMR uptake: http://i38.photobucket.com/albums/e103/alborgmd/Political/CDCreportonhit102007-1.png Notice how c-EHR uptake was found to be statistically flat, while the small guys seem to be enjoying exponential growth.

    Unless you can make c-EHR systems more popular, you will eventually see these expensive albatroses wither on the vine and die off. If you make them easier to use and cheap, and if you get rid of big government intervention (esp Obama big government), then EMR use will again grow rapidly.

    Al

  5. I, too, am tired of hearing about EPIC, Meditech and Cerner. They are very marginal systems, who spend most of their time marketing towards the C level egos, and not to the specialties that really need to go electronic. There are plenty of lower cost alternatives that provide a larger return (both clinically and financially) being developed by people with superb talent in their chosen area. The single data base argument is crap – any programmer worth their salt can interface between disparate systems, especially with current tools.

    We really need competent people in the hospital technology decision process. Competent in understanding business, current technology, and consensus building skills. In all my experiences in meeting with management of hospitals, evidence of those skills are seriously lacking. Well, maybe not the financial aspect, because the C-level players know how to pay themselves pretty well.

  6. Zimbu seems to suggest too much pro_Epic stuff is finding it’s way into HIStalk and is looking for some dirt. I could have prefaced my somewhat pro Epic comments above with a mention that I was virulently anti Epic prior to adoption having previously had a stint in the industry as a sales doc for an Epic competitior (while still working at Kaiser) and actively seeking dirt to throw at the CEO of Kaiser against his autocratic choice of Epic over what looked like better choices. The worst dirt I could throw:
    -An outpatient system with no real world inpatient experience.
    -The company was autocratic and expensive.
    -The programming was based in an ancient language.
    -The data input was cumbersome and time consuming.

    At the time Halverson made his choice, it was more a courageous choice rather than the ‘IBM’ choice as there was no precedent. Since then, EVERYONE, has been choosing Epic with a rare notice of an Eclipsys or a Cerner install. The system works. I can sit at home as a call center doc and I have access to every KP patient in Northern Ca: images, ecgs, labs, recent visits, problem lists, medications, communications between the patient and the doctor. With this information I can make safer and more cost effective decisions on wher to best direct patients for care.

    The company was autocratic and expensive but I’m over that. The language is old but what the hell do I care about language if the program works (see above). Inputing documenttion still takes more time than I like as is navigating through more screens than is desirable but I have Dragon to help me with that and it can flip through screens entering data faster than I could possibly type and mouse. In my region, Dragon has been made available to every doc who wants it and outpatient transcription is close to zero.
    In conclusion, I was prepared to hate Epic and I know there are better best of breed products covering niches but when you have a massive enterprise like Kaiser spread over a geographic area larger than most countries, a reliable (yes, there has been very little downtime and I cannot remember the last time one affected me at all), a tremendous benefit accrues to the simplification of 100’s of legacy programs to a few core programs with simplified lines of communication.

  7. BestOfBreed says: “The single data base argument is crap – any programmer worth their salt can interface between disparate systems, especially with current tools.”

    You don’t seem to have much experience with dealing with healthcare clinical data and processes. I assume many here are programmers worth your salt, and will try to give an analogy to explain why the single data base is essential to having a usable system.

    One of the basic principles in Computer Science is that a multiprocessing computer system is non-deterministic. In order for specific processes to provide deterministic outcomes to end-users, the use of locks, semaphores, etc. are used. Usually, their use is applied by the operating system, and applications are not managing them on their own.

    Here comes the analogy – claiming that interfacing tightly coupled, time-sensitive disparate systems is as easy as operating on a single database, is the same as claiming that moving all the inter-process synchronization mechanisms from the operating system to individual applications is just as simple as current programming practices, where such interprocess synchronization is managed by the operating system (or development framework).

  8. I agree with Anonymous. Single database is not required. It is just a sales gimmick. Integrating different programs on to a system with a single user interface or GUI is possible with current tools.
    It will be a sad day for software people if such opinions continue to exist in today’s world.
    It is possible that software people may find it difficult to convince people who want to spend someone else’s money – and drain resources from Uncle Sam’s coffer.

  9. Janice,

    Your comments about doctors is an insult. Do you truly believe doctors will purchase and then use a product that is user unfriendly and endangers patients? Nurses find it user unfriendly.

    Did not Justen Deal, in an infamous email at Kaiser< complain about EPIC? Was he completely wrong? or are the problems of the users being ignored?

    Suz

  10. Suz,
    I agree with you that Janice was mildly insulting toward doctors. In fact, Epic is a kind of top down solution that must be kinda of forced on the docs AND I shared Justin Deals concerns about Kaiser’s implementation of Epic BUT it just hasn’t panned out that way for us docs as users (I will leave the ROI aside, beyond my paygrade). It’s working, we use it and some good things are happening becasue of that.
    A Kaiser doc

  11. Reports are surfacing that the metrics of anakysis of the performance of these systems of care record devices are yielding erroneous output. Vendors say “hush”.

    Thus, the reports of medical care improvement may be nothing but hearsay until this equipment is validated as providing accurate information.

  12. @healthfreak: You are not agreeing with me, since my point is that a single database is NOT a sales gimmick, it is an architectural component which enables building a safe and usable system. Yes, it is possible to build a safe and usable systems without a single database, but the difficulty and cost of building and maintaining such a system will rise exponentially with the size of the organization.

    @Suzie: Janice’s comments can be easily interpreted that the physicians will not purchase and use a product that is user friendly and improves patient care, without the stimulus money. Every change, even change for the better, will cause disruptions, and therefore costs. Having additional financial resources to offset the cost could be the tipping point for adoption.

  13. Anonymous has an interesting point of view. Not disagreeing, I’d add a third point to the mix: single-database systems tend to be more tightly coupled and behave as a single program, not as a group of interconnected modules. Systems this large should not be designed as a single system, even if they technically can be.

    So, for example, instead of each module isolating its own view of what a patient is and keeping track of the data it thinks is important (e.g. the pharmacy needs totally different data from what patient billing needs), you TEND to glob the data together all in one place. It takes a great deal of restraint to prevent modules from talking to each other in this way (or “sharing intimate details”). What is convenient in a small system can collapse a large one.

    This is a subtle point–it is POSSIBLE to build large systems in a decoupled, modular manner, but it takes RESTRAINT to prevent “intimate coupling” between the modules.

  14. Maybe my comment above can be summarized as “building hospital systems aren’t a computer science problem, they’re a software engineering problem.”

  15. Epic seems to be the most successful of the large vendors at providing basic automation of the processes at the front and back end of the patient encounter through medium and large scale healthcare enterprises. The single database allows for access to the data for viewing anywhere and (at least theorectically) the sharing of the data with other systems. Bravo! After 30 years of way over promising the healthcare IT industry has one vendor that has accomplished the bare minimum of what should be expected and routinely provided by this industry. The truth is that the real “heavy lifting” of healthcare IT (meaningful use anyone?) is the entry of structiured data for clinical doumentation and orders by Doctors and Clinicians at the point of care. All of the large Vendors promise this functionality accross the board and none of them deliver on that promise accross the board. They can’t possiblly manage to deliver the approriate standardized content to make it work, and so we have the “shell game” where clinical systems are delivered with grossly inadaquate conetent and user interfaces that are not tailored to the specific workflow requirments of the caregivers. Until the large vendors own up to this fact and allow instituions to purchase and integrate systems for the clinical areas that the large vendors don’t service in an easy inexpensive manner, we will continue to see frustrated users

  16. The hospital transfer records generated by the Epic Care Devices are more clinically useful compared to the piles of paper spewed by the Millenium and Sunrise architectures.

    BUT, there were duplicate medications on the patients’ instructions and the progress notes are pregnant with useless information, designed to enable over billing, thus ripping off Medicare. They load up on information the effective clinician find useless. The list of diagnoses, active and chronic problem lists are evanescent.

    What is helpful is an MAR grid with the generic and brand names of medications on the same line and lab data format that is user friendly. Unfortunately, the tops of columns on pages after page one do not have days or dates listed. Both still have too much clinically irrelevant information cluttering the fields.

    In 10 years, if they try hard and heed the users, EPIC might enable safe, efficient, and cost effective care.

  17. DJ – in your conclusion “until the large vendors…” are you suggesting that no vendor provides a process of capturing structured data?

    If so, who would you suggest set the bar for what “structured data” is required? Is there currently a governing body for this? If not: lets get one created.

    Isn’t there a current vendor that is capturing structured data across the continuum and then providing an infrastructure where hospitals can create & share what works best, by care setting? A vendor that allows the sharing of “order sets” & protocols & best practices?

    Also, I agree with all the Pro-Epic & Meditech comments. Lets be serious, there are brilliant people at other companies that are turning out rock-solid products: Epic is capturing all of the current noise – this will fade when/if other vendors start coming out with remarkable, game-changing features/products/services….it is just a matter of time. Tis the nature of America and this beautiful capitalist system we enjoy.

  18. Al, just to be clear here, the CDC study is ambulatory doctors only. It’s clearly important when talking about why there is more uptake of smaller suppliers than the big 3 (see below regarding size of practice and uptake).

    The following study sites two other studies, the commonwealth fund study and the American Academy of Family Physicians that states 80% of Ambulatory physicians want EHR. That’s 27% of Ambulatory doctors currently user EHRs, and the bigger groups have a rate of 57%.

    http://content.healthaffairs.org/cgi/content/full/24/5/1180#R1

    As I would expect “The EHR adoption gap is especially profound between large and small practices. In the Commonwealth study noted earlier, 57 percent of physicians in practices with more than fifty physicians used an EHR, compared with only 13 percent of solo practitioners, and there was a strong relationship between practice size and adoption rate”

    Here another study finds while uptake has been slow, it’s not because people don’t want EHR’s’

    http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=143144

    “There’s no doubt, however, that EHR adoption is growing fast. Of the doctors who say they’re using an EHR, fully half have had them for less than two years. Moreover, 23 percent of respondents say they plan to acquire an EHR within the next 12 months”

    The study of nearly 2,000 doctors also shows they are generally satisfied or very satisfied with the EHR. It does break on age, with younger doctors being happier.

    Another study full of positives from Physicians about EHRs, including 69% think ““stimulus money” is a big incentive to adoption.

    You seem to be selecting your evidence to fit a case here.

    Also when you say things like; “The reasons that 96% of physicians despise certified electronic health records (c-EHR) systems and thus are not purchasing c-EHR are that”, you rather undercut your case. It’s a very large leap from 97% (a number the study above undercuts) have not purchased EHR, to they “despise” EHR’s. Inflammatory rhetoric.

  19. Hi Blah:

    RE: American Academy of Family Physicians that states 80% of Ambulatory physicians want EHR

    The problems that I have with the study that you quoted are:

    1) Wanting an EMR vs owning it are 2 different animals.

    I *** want *** to drive a Porsche, but I simply can’t afford it. Same goes with EHRs. In fact, this point was highlighted in a recent 6/2009 Healthcare IT News survey where they found that “74 percent believing EHRs can have a positive impact on the healthcare industry overall,” but then state that “The biggest challenge to implementation cited by providers was, “lack of budget” (82 percent) followed by “lack of awareness and expertise.”

    They state that:

    “Fifty-nine percent of providers surveyed said they have already implemented or plan to implement EHRs in the next 12 months but only 17 percent are participating or planning to participate in a health information exchange.”

    That is about right on par with the CDC study where in 2007 only 4% were using all of the features of their EHR, compatible with what many could consider “significant use” and about 23% were using EMRs.

    http://www.healthcareitnews.com/news/survey-reveals-providers-doubts-about-healthcare-it-funding

    2) They contacted 35,554 people, but only 5517 responded (that’s only 15.5%). I surmise that those that believe in EMR are more likely to take part in the survey as compared to those that prefer paper records. This is poor study design.

    3) Unlike the CDC study that I initially posted, they do not differentiate between simple, cheap EMR use vs “enterprise” significant-use ready EHR. THAT is a big oversight. I would have been part of that 80% since I use an EMR that I programmed myself, but which is purposely NOT HITECH ready.

    4) Lastly, they mention that “Fragmentation, caused by the use of hundreds of unique systems, is a major barrier to proliferation of these systems.” without stating why specifically. It does make me think of the now “thrown under the bus” CCHIT organizatoin that wanted to get rid of competition by certifying “enterprise” level EHR systems to the detriment of smaller, cheaper systems. It shows that they have an agenda and are trying to come out with data to support their position.

  20. Hi Blah:

    >>> The study of nearly 2,000 doctors also shows they are generally satisfied or very satisfied with the EHR.

    Can you give us a quote? Did they differentiate between the cheap, more usable and simple EMR vs the “significant use” EHR? This flied in the fact of the numerous studies that have reported an average of 50% failed installation rate and in one study, once implimented, there is an 8% deinstallation rate. Modern Medicine this month came out with a report that Phoenix Arizona, where the EHR was forced upon physicians, the deinstallation rate now is higher than that!

    http://www.modernmedicine.com/modernmedicine/Medical+Economics/EHR-deinstallation-trend-hits-Phoenix/ArticleStandard/Article/detail/613601

    >>> Another study full of positives from Physicians about EHRs, including 69% think ““stimulus money” is a big incentive to adoption.

    Only time will tell what will occur with the stimulus money’s effect on the uptake of EHR. Instead of being an up-front payment, it’s structured to be a rebate, with the rules changing from month to month and with a time frame that is extremely short. History has shown that in prior PQRI demonstration projects most of those that participated came out empty handed. I believe that HITECH will fail miserably.

    In an MDNG article that I recently wrote where I calculated the overall cost of significant use, I came out with a figure of $300,000.00 over 5 years, which means that the HITECH act grants are too little to really jump start EHR uptake.

    http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate

    >>> Also when you say things like; “The reasons that 96% of physicians despise certified electronic health records (c-EHR) systems and thus are not purchasing c-EHR are that”, you rather undercut your case.

    I didn’t say that. I did quote a study that came out with the finding that only 4% of physicians are using their EHRs “significantly.” Big difference.

    Don’t get me wrong. I ** like ** EMR a lot. I don’t like “enterprise” CCHIT certified bloated, I don’t like expensive EHR systems. I don’t like ARRA, I don’t like HITECH, I don’t like forced EMR use, I believe that penalties for noncompliance with EHR use short-sighted and will eventually destroy Medicare, and I don’t particularly like Obama and the idea that he is surrounded by EMR vendor lobbyists.

    Heck, I have a site dedicated to EHR use including a book on how to make your own MS Office EMR!

    URL: http://www.msofficeemrproject.com/

    Al







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