Home Forums Discussions Feedback and Recommendations AC to be Govt Stimulus / HITECH Act Eligible ?

I doubt Amazing Charts, in its current form, even version 4 will be eligible for the stimulus (bailout / government handout) payment. Is there any way to improve it just enough to pass? I know the Certification Commission for Healthcare Information Technology (CCHIT) certification is a huge hurdle.

Here is a edited post from Athenahealth on the subject:

athenahealth welcomes President Obama’s February 17th, 2009 signing of the Healthcare Information Technology (HITECH) Act (part of the Stimulus package known as the American Recovery and Reinvestment Act). ...
... The act includes up to $44,000 in total incentives per physician for “meaningful use” of an Electronic Health Record (EHR) starting in 2011. (Note: Physicians reimbursed by Medicaid can receive up to 65,000 based on state defined guidelines.) As you may have read, many of the specifics of the act will be written and released over the next year. ...

Though the Department of Health and Human Services (HHS) is currently shaping the details of the HITECH act, the following provisions are already clear.


In order to qualify for incentive payments, physicians must:
Use a “certified” EHR: The act does not specify what “certification” will mean or who provide certification. (Note, there is general consensus that the certifying organization will be the independent Certification Commission for Healthcare Information Technology (CCHIT). ... What the act does specify is that to be qualified as a certified EHR, the certified technology must include patient demographic and clinical health information and have the capacity to provide clinical decision and physician order entry. ...

Demonstrate “meaningful use” of an EHR. Again, HHS will be defining what “meaningful use” means in the year ahead. ... The following conditions for “meaningful use” have already been identified. The EHR must:

Use ePrescribing: ...

Electronically exchange information: ...

Submit clinical quality measures: ...

It is a beautiful program. We will run a 5000 mile hurdle race and all those who complete will be rewarded with a donut.

No, uncle Sam, thank you. I am pretty happy with my simple EMR.

PKA, a very serious question was asked. And the question again is will it meet all of the CCHIT standards for interoperability, security, utility whether it is beautiful or not.

When you doctors document information about patients you are trained to use SOAP notes.

The statement "It is a beautiful program" is Subjective. CCHITT standards are Objective.

In short, this is a very serious question, which deserves a serious answer.

In my humble opinion, it will be boom or bust of AC. If the government is going to give away nearly $44,000 for using a Certified EHR program, what is the BUSINESS CASE for AC deciding to stay put?

Let's say that AC has 1000 users. If the government will give every user 44,000 for using a certified program. This means is 44,000,000.00 out there for AC to capture, simply by making the necessary INVESTMENT to retain its users and capture that money.

So, I believe that AC HAS TO GO ALL OUT, to FINISH THE PROGRAM, by hiring a ROBUST DEVELOPMENT TEAM, of Coders, Testers, DB Architects. In essence, think BIG or don't think at all!

This being the case, AC vNext should not be a $1500.00 program, but rather a program built well enough, and broadly enough to CAPTURE much of that $44,000.00 over the next 3 years.

The program must be modularized, with the core functionality being separate and distinct from the other modules. Each module should essentially be a separate program with separate code base, sharing data from the core module. This way Doctors can mix and match the various modules they would like to use.

I think the question that all of us are ignoring is what the $44,000 mystical number is - it is a payment per year and depending on what article I read on the internet it may begin in 2010 or 2011. The money is not really just a giveaway - instead it is supposed to be used to upgrade your practice. The theory is that you are going to pay the 40,000 dollars to the EMR company - if what you want is a 40K program I am sure you can find some right now. Sadly the program does not even currently say what certified means - it may end up being an entirely new layer of government and completely revamped.

The other sad part is that many people may jump through hoops and still not get the incentive. Our state has a program that gives technology grants with an emphasis on rural underserved areas - many people apply and almost all of the grants were given to clinics in very large cities like Seattle, Spokane, Olympia and very few were really given to rural clinics. It is great to dangle the carrot in front of someone, but another to actually get the carrot.

That being said Jon recently posted here on the board that he had decided that the main focus of AC was to become CCHIT (or whatever it really is) certified and that he was committed to making this happen.

Steven, The money IS a grant to help doctors with the cost of automation.


The EHR you use WILL HAVE TO MEET CERTAIN STANDARDS, and they will have 2 years to meet those standards.

If the government mandates the use of EHR with out money, it's an unfunded mandate. If the government provides MONEY, a lot of Money, to fund the mandate, its big government.

There are those doctors who will reject this initiative completely. Good for them. Time does not stand still nor does it move backward. For them it will be an extinction level event!

Jon,
Would you please bloat AC to say... "EPIC" proportions so that you can charge $44,000 dollars for it. That way we can get it for "free" from the government and save that oppressive $995 fee.
Thanks, comrade,
Dave

Comrade Dave, can you please tell me how your transfer a patient's record from Amazing Charts to another physician who is using Amazing Charts or another EHR?

YOU SEND HIM/HER Paper records don't you? You think you can get that ability to transfer DATA from your system to another physicians system for that "Oppressive 995 fee?"

pay up to $45,000 for another EMR when AC does what we need to do today? even if we actually saw the money, I think it would be a waste of cash as we like AC the way it is. A PM system with the other fancy bells/whistles isn't worth that much of an extra expense. no thanks to the govt cash when we are happy with AC today.

I would think that $45,000 handout could be spent on computer hardware also. I could imaging the existing Amazing Charts program being renamed "Amazing Charts Light", and a new version "Amazing Charts Premium" with a price tag of $5-10K that could be bundled with hardware. My 7 year old computers are starting to show their age. I don't agree with all these govt handouts in the stimulus package, but that doesn't mean I'll turn down money either.

Don't get me wrong - Amazing Charts works fine for my needs now, but the government is changing the payment policies and pretty soon I'll bet our pay will get docked if our EMR is not "certified."

Transferring records from another office into mine or vice versa -- burn a cd with all notes exported to it (one file - either text or HTML) and then copy that pt. imports - when I recently received a CD from another AC user I did a batch import of all imported items and my scanning person changed headings to reflect what they were (left as batch import so it is clear that they are not my records).

I think that the issue of certification will be an issue, but I don't think the stimulus will help anyone but the big groups who know how to play the game.

What EMPIRICAL evidence do you have so support your position of what it will cost?

Some of that money will also be used in assisting doctors to CONVERT their paper files to SCANNED ELECTRONIC DOCUMENTS. My doctor, who has been practicing in AZ for 10 years, opened her new practice in October. More than 1500 of her patients followed her; and had their records transferred.

She now has in her possession 1500+ patient files each with about 125 pages in them. That totals 187500 pieces of paper that need to be scanned. If the cost to scan, and catalog each page in a document management system is 10 cents. The cost would be about $18,750.00.

Should I continue with the other costs such as training etc?

Steven, I'm sorry but that is not what we mean when we talk about transferring data. What I mean is that the system would generate a data which your system can "consume" WITHOUT the need to scan.

Finally, Jon Bertman has already stated that AC will be CCHIT Certified.

While there are those who like AC just the way it is, Jon surely understands that AC is a business, and he has to position it to be competitive, or his business will not survive. He has already made the decision to move forward...

I remember back in the early 90's I did some consulting work for WordPerfect on their foray into electronic forms. I called up the Product Manager and told him I was having difficulty printing a form. He told me that Print in WordPerfect was not CTRL-P but SHIFT-F7. I told him in Windows every app supported the Windows print standard. He proceeded to tell me that WP users preferred WP to Windows and blah, blah, blah! Today the question is "what is word perfect?"

Then there was Borland's Phillipe Khan...who developed this great programming language tool called Delphi, just as MS was rolling out Visual Basic 6. Khan developed Delphi to challenge and take market share from Visual Basic. Instead he got into a "standards" battle with the various component makers.

He decided rather than making Delphi ActiveX compatible he was going to use VCL. The large component makers did not have the resources to build and sell VCL components so Delphi whithered on the vine.

These are only two examples of what can happen to TECHNOLOGY COMPANIES that REFUSE STANDARDS. There are so many more.

I guess the issue is what you want as data in your chart - I actually don't want the data from the other offices in my data - I love to have historical data, but that data would interfere with my data when it comes to things like PQRI, etc.

From a computer programmer or data analyst standpoint it is great to have the numbers for all eternity in the chart, but not from a physician standpoint.

Scanning costs are also not always relevant - my office has scanned 1000 plus charts in the last year or so, and all new patients have not generated paper charts in the last 18 months. Much of this could actually just be left off as the older history becomes less and less relevant over time. The only reason we do it is to say we did it and empty shelf space. The longer I have been paperless the less I need to look back - since almost all of my pt. have mammograms in the chart, comprehensive labs, x-rays, ekg's etc. along with lots of data from my visits and I really don't need to look back. As a matter of fact many of the chart notes from other providers are less than useful - if I take the cardiologist note, the pulmonologist note and a hospital H&P to compare I find many discrepancies - I was asking a pt. about history and he wanted to know why I couldn't just look it up. I think physicians know why we ask directly .... trying to get the best information. I often think it would actually be best if when I asked for patient information I only asked for the last 1 year's worth - most info needed is there and less liability for information from other sources.

I think this thread can certainly degenerate like so many do on the user's board into a fight over whether certification is good, whether Jon is doing everything that everyone wants and whether the government plan is good or bad..........when all is said and done I think it doesn't really matter and we all should wait and see what transpires and if the money is worth it....

Isnt PQRI a government mandated standard?

George,

Sorry, no way it is 10 cents per page. I scanned in over 1,000 patients. Cost? About $400. That is like all those EMR companies that tried to tell me that they would save me $1.00 per chart to file. Right. It took my receptionist about 15 seconds to file a chart. Not exactly $1.00. People like to talk about "time is money," but they were overestimate how much money.

George, Does your wife use AmazingCharts?

Scanning is one of those things that is all relevant about cost - my wife who does billing, coding, A/R, A/P and then scans in her spare time (still manages to work less than 40 hours per week around the kid's school schedule) has scanned in over 2200 charts over the last year and a half. She gets irritated when people talk about how hard it is to scan and how they need to hire someone....

I agree.Ask Adam about scanning his charts. Guarantee you it didn't cost $18,000.

My wife actually is very anal about scanning -- sometimes she won't just put things in as a bulk scan even though I don't care. She just won't let it go -- she also has scanned in every EKG, PFT, x-ray report, consult report,path etc. I have received over the last year and a half since we went paperless. She feels like it should not be that big of a deal to have things scanned. Since we went paperless in 8/07 we have scanned everything in the office. As an idea of volume - my little office had something around 4,700 pt visits including office visits and well child exams in 2008.

No offense, there IS a COST for her work. Every practice does not have a wife to do their scanning, they actually have to pay for that service.

And, I would think they would be lining up at my door for $18,000.

I realize there is a cost (I pay my wife a salary) but I think everyone jacks the price up too high for what it costs to scan. I particularly think that the price is higher if we all think we can get a government grant to pay for it..... in the long run we all pay for these free giveaways.

I think I see how these posts get sidetracked - what does this have to do with whether we can get a stimulus with AC or not? When all is said and done it is not clear that anybody who already uses an EMR will get the money or that CHITT or whatever will be the standard for certification. I think these arguments are all rather silly since no one has the answer.

But, isn't that what an argument is? Actually, I guess it is when everyone thinks they have THE answer.

George,

You failed to answer the question...does your wife use Amazing Charts?

Leslie

We have a demo version and it is under consideration. Now that version 4 is released I will look more closely at it.

Thanks George,

I have always wondered what your fascination was/is with AC. Your computer knowledge is broad and helpful. Just thought in the vein of full disclosure....

I am confused at times as you know there is a good chance that AC will never be that EMR that you seem to want. Have you spoken with Jon directly as to some of your ideas?

As for a stimulus package how about a six pack of Viagra samples?

The ultimate digression. Let's get back to work.

Bert, I'm fascinated with all kinds of technology. But on a more serious note, an EHR system, for me, is not a decision to be taken lightly. After all once, you commit to a system, you are committed for life, no matter what the company does.

So I am evaluating and doing an analysis of 4 EHR's and will produce a scorecard on which our decision will be made.

Needless to say, where it was not before, CCHIT will now dominate the scorecard!

George,
Thanks for the transparency. I think many of us can see through you much better now. I hope you find (and can pay for) that elusive EMR you imagine. Perhaps, with your tremendous knowledge, the best thing would be for you to develop your own program. And I am curious. Given your previous posts about the need for an EHR to gather and store data in a method which is easily transportable, then why would you feel that, once you commit to an EHR, you are committed "for life". As far as I know, none of the more popular EHRs, and certainly one would hope none of those expensive CCHIT-certified ones, could hold your data hostage. We lucky AC users just happen to have that issue specifically addressed by Jon in his EULA. Personally, my first EHR was SoapWare and I am now using AC...no lifelong committment to either.
But now if CCHIT is your dominating decision-maker, then I guess it is safe to say that AC will not rank high on your scorecard and we will not be seeing you here on our boards for much longer.

Leslie

Wow! Go Leslie. Leslie for moderator.

Leslie, I understand your zeal about AC. There is nothing elusive about evaluating EMR systems. Because I understand the technical aspect of how these things work, my decision making is guided by my expertise.

Perhaps you missed Jon Bertman's post that there will be NO FURTHER ENHANCEMENTS to AC until it meets the requirements for CCHIT Certification. That was the premise of the original post in this thread, when KenP wrote

I happen to concur with the premise, and I am willing bet that Amazing Charts vNext will be close to a complete re-architecture of the software as is possible.

Unlike you, I am well aware that there is no viable BUSINESS PLAN for ANY EMR, without it having CCHIT certification in the next 24 months. J. Bertman has already recognized this. It does not matter how much zeal you and other users of AC have, the product is going to change.

George - I guess Leslie's point is that we all think Jon is making changes as he can and has made a major step recently with Version 4 - it seems that some people have nothing but problems with the program and I think that I and Leslie think that someone who does not use the program in a real practice setting has a hard time telling US how it works or does not work.

If you cannot make a decision in 9 months of whether you think the program is going to work or you need to go another direction then AC is not right for you. I cannot see how you can talk about scanning in 1500 charts yet you obviously are not even using an EMR.....how does that work ?

George,

I don't think saying that Leslie does not have the insight that you have about CCHIT certification and a business plan is really helpful. We are all aware that chasing an elusive and probably now going to change governmental hurdle is great, but right now many of us are USING AC in our office's and feel like it is heading in the right direction. I also think that since CCHIT certification requires certain features that Jon is working on some enhancements, but is not going to release as many versions as he has in the past while he works on it.

I currently use a document management system. That is how that works. I understand that one of the biggest impediments to implementing a EMR is the acquisition of documents that are not already in electroninc (PDF) format.

Perhaps you should review the original premise of the thread.

It will require a substantial re-architecture of the program. I don't "think," I know.

I am not a stranger to Leslie's barbs. When I originally suggested that SQL Server performance would be a far better option than the Access DB, she said the users were quite HAPPY with access and that SQL, from her prior experience with SOAPWare was fraught with problems, and I should take my opinions elsewhere.

Well, looky here...AC v4 is using what? SQL Server.

I guess the issue with Leslie and her experience is that supposedly Soapware had a tremendous problem with their conversion to SQL.

I think that most of us are happy with whatever programming changes that Jon thinks is appropriate. When he felt that it was time to go to SQL he did - now he is working on CCHIT. Again I think he has the best interest of his users in mind.

I have no doubt that the changes above will require major programming efforts, but I also think that we as end users can offer suggestions, wishes, recommendations on what the product does or what the end result is, but realistically how he writes his program is really his business. Your comment of I don't "think," I know I assume was directed at my quote of thinking... I am not a software guru, but I do know that the program works in a real world setting - it got me through over 4,500 office visits last year and it continues to improve.

I just think that Leslie is using her AC in the real world, as are many of us. It is one thing to sit back and contemplate, compare and nitpick - I hope the clinic you are working with has set down and used an EMR of any type for a days worth of visits (or a week, month, whatever) and see what it can do. I find that I can take an established visit and within 3 minutes do a complete note, scrips, code, and check out (that is the actual note process - still have to see the patient, but no searching through stacks of paper for labs,x-rays, etc.). If they try Amazing Charts for a few days and it doesn't work then you can take it off your list, print out the notes from those visits and move on. I wonder if all the rest of your programs let you test drive it in a real world setting.

I will grant you that I use computers a lot, but I was writing notes after the fact with AC day 1 and within a couple of days was doing them in the room.

Back to the beginning of the thread - NO ONE KNOWS what a certified EMR is or whatever else the requirements are.... let's just wait and see. We aren't even sure based on the announcement whether anyone who adopts emr before 2011 will even qualify or if those of us who are "early adopters" will get left out in the cold - maybe those clinics who stall and wait another year or two will get money, but I am happy to be using my EMR now.

George,

I give up. My only further comment to you is that if in fact you have been using AC for the last 9 months, in any capacity, you owe Jon $900. If you are not using it and have no plans to use it, then why do you insist on posting on the USER'S board?
And, lastly, believe me. If Jon changes the program in ways I feel are detrimental to my practice, I will drop AC just like I did SoapWare and go back to pen and paper. The only allegiance I have to anyone is to myself. Unlike you, I have no illusion of being everything to everybody and I understand no EHR out there or yet to be developed should either.

Leslie