An HIT Moment with … Sandy Pitman, President and CEO, SuccessEHS

An HIT Moment with ... is a quick interview with someone we find interesting. W. Sanders Pitman is president and CEO of SuccessEHS of Birmingham, AL.

What were your conclusions about the HIMSS conference and the interests of those who attended it?

HIMSS is the largest tradeshow in our industry, and despite the struggling economy, a record number of people were in attendance this year. This is a very expensive venue for the vendors and each year seems to bring a new level of extravagance.

There is so much information and hype it is very difficult for even the most experienced healthcare executive to discern the true differences among the many vendors at the show. For the novice, I would expect that they came away confused and hardly able to truly differentiate the offerings of the many vendors as it relates to their specific practice and set of circumstances.

I do think, however, that HIMSS is a good opportunity for various vendors to identify complementary offerings and business relationships.

What steps are you taking to get your clients to Meaningful Use?

We have numerous initiatives underway to ensure that our providers can capitalize on the EHR incentive programs. From the start, we sought to help our clients achieve Meaningful Use by seeking certification at the earliest moment possible; we were among the first in the country to achieve certification as a Complete EHR.

Following our certification by CCHIT, an ONC-ATCB, in September of 2010, we launched a series of weekly webinars for our clients, educating physicians on the incentive programs and on changes they could begin making in their workflow to achieve Meaningful Use. Recorded classes were published to our Learning Management System (LMS) so clients who were not able to participate in the webinars could access this information at their convenience. These webinars are still being offered live on a weekly basis.

We also developed a comprehensive Meaningful Use Toolkit which was distributed to clients and is also available for on-demand access via our LMS. This toolkit contains an introduction to the incentive programs, information on enrolling and understanding the program, an overview of all Meaningful Use measures, a Physician Toolkit, a System Administration Toolkit and links to additional resources. The Physician Toolkit is designed to provide physicians with concise information and screenshots demonstrating the system functionality to support Meaningful Use, while the System Administration Toolkit guides practice administrators through the system configuration changes needed to support the Meaningful Use measures. We designed this toolkit to walk our clients step-by-step through the process of achieving Meaningful Use.

Our goal is not just to provide the tools needed to achieve Meaningful Use, but to partner with our clients to make sure that they understand what they are eligible for, how to use the system to obtain it, and that the system/staff proactively work with the physician to ensure compliance.  We will be providing configuration options to “prompt” physicians when compliance opportunities are being missed in an effort to maximize physicians’ opportunities to achieve compliance at the point of care.

Lastly, we have not changed our pricing nor are we charging our current clients an additional fee for the Meaningful Use features, webinars, or toolkit.

What are the specialized requirements of Community Health Centers?

Community Health Centers (CHCs) are, in many cases, run more like a business than a lot of private practices. Typically the physicians are employed, the clinics rely heavily on grant money (which can be a daunting application process for the practice), and they have strict reporting guidelines. These factors make the workflow for the clinics more detailed in regard to data capture and do not allow the flexibility private practices sometimes enjoy in determining the extent to which they want to engage with the EHR.

To some extent, it seems these organizations are a testing ground for what is coming in healthcare reform.  Requirements that have been placed upon CHCs for years are now making their way into private practices.  For example, CHCs participate in Disease Collaboratives that require reporting on protocol compliance for patients with depression, diabetes, and more. Managing clinical protocols and reporting on compliance has now made its way into many of the initiatives for private practices. Many of the initiative programs that are around today in private practices have existed for years in some form with the CHCs.

Specialized requirements for CHCs include the need to:

• Manage sliding fee scales for indigent patients
• Perform monthly, quarterly, and annual reporting such as UDS, cost reports, Ryan White, collaborative reports, and more
• Submit claims with very specific formatting requirements – CHCs have different billing guidelines for Medicare and Medicaid. These are typically paid on an encounter basis, so there are special requirements for billing, posting payments, and transferring balances. 

It has been our experience that Community Health Centers really take to heart the mission of serving the underserved. There is a genuine interest in improving the quality of care for patients. They are often providing a wide scope of services, including comprehensive primary care, dental services, behavioral health, and HIV care while documenting the data necessary to meet federal reporting requirements. Clinical decision support is important to achieving the goal for these clinics of not just meeting the federal reporting or billing requirements, but improving patient care.

There are hundreds of EHR and PM vendors out there. If a practice is interested in choosing one, what criteria and methods should they use to distinguish one from another?

Evaluating EHRs is a daunting task, with so many vendors to choose from and so many features to comprehend. Of course, certification is a huge help in determining which products include core features needed to operate efficiently and profitably.

Unfortunately, the evaluation process only starts with selecting a certified vendor. The disconnect between Certified EHRs and Certified EHRs that can deliver value is significant, and if you choose incorrectly, you may end up with a vendor who is not aligned with your goals and offers no assurance that you will actually receive value. There is a way to accurately measure the potential of Certified EHR vendors — you must consider more than the features and functions a system brings to the table.

When evaluating EHRs, keep in mind that single-database, integrated EHR and practice management systems work the most seamlessly, as there is no need to build and maintain an interface between the two systems. Be sure to consider whether the system is scalable enough to meet the changing needs of your practice. Also evaluate the level of support offered by the vendor, as this varies widely across the spectrum of EHR providers and can make a huge difference in the level of satisfaction with the software.

Quite often the relationship you develop with the vendor is just as important as the feature set you are buying. At some point you are going to run into serious issues (it is almost guaranteed). Having a stable company with experienced leadership that you can count on in a real time of need can be the difference between success and failure.

Do you think usability will be rolled into Stages 2 and 3 of Meaningful Use? Are vendors doing enough to design and test their applications to comply with formal usability standards?

There is talk of trying to roll in usability, but it will be extremely difficult. With most government certification programs you must have a clear set of guidelines that are not subjective. For phase 1 Meaningful Use certification, ONC utilized both CCHIT and Drummond Group. They were very clear that the requirements must be followed to a T with no deviation.

Since usability is largely a subjective issue, I do not know how they can establish ironclad guidelines to quantitatively measure it. With different certifying bodies and many judges employed by each certifying body, it will be virtually impossible to insure continuity.

I think EHR vendors are going through the natural progression that follows any new developments in technology. We first all scrambled to meet the fundamental requirements as dictated by ONC. I am sure that most vendors did their best to consider workflow while developing the base requirements, but given the fact that the core requirements were not finalized until the summer and we early birds were testing in the fall, there is always room left for improvement which, again, follows the natural progression.

ONC has dictated a set of fundamental requirements which is a good thing for the industry, but I think it is up to each vendor to focus on usability in their own way. At the end of the day, it is up to the free market to decide what is “usable” and what is not.

In the automobile industry, there are governmental guidelines that must be adhered to for safety and emissions, but the individual features like color, style, and usability of available options are up to the consumer. In that same vein, I believe that having specific feature requirements as dictated by ONC is a good thing, but in the end, usability and personal taste depend upon the individual consumer.