December 15, 2017

Financial Incentives for Non-profit Healthcare Providers Adopting Standardized, Electronic Health Records IT




HEALTHCARE PROVIDER INCENTIVES, PUBLIC AND PRIVATE (Nationwide, Not-for-profit Health Service), for the adoption of STANDARDIZED electronic health records and related health information technology

PROJECT 76, Nationwide, Not-for-profit Health Service (“NHS”), Health Information Technology(“HIT”), Electronic Health Record (“EHR”) and Personal Health Record (“PHR”) Adoption Incentives, Are for “NHS Member Associate”, Non-profit Healthcare Delivery System Providers, Who Participate With Benefit of the “NHS HIT ADOPTION FINANCIAL INCENTIVE PROGRAM”:

C. Stage – III (November 2011 through December 2012):

Prj76 demonstrates its second and third stage capital viability while offering WOULD-BE “NHS” providers, facilities and institutions:

  • Immediate, Cost-Free Assistance Qualifying for national government, Electronic Medical Records and Health Record Subsidies;
  • Post Subsidy, 100% NO COST (NO Fees and NO Cut of Practice Billings), Standardized, National EMR, EHR and Personal Health Record Software Upgrades, Hardware Maintenance & IT Technical Support Services from 2014-2016 Forward (First Applicants, First Served);
  • Interest free and subsidized healthcare delivery infrastructure capital and operating reserve support;
  • International health information database, metrics and modeling for addressing disparate care;
  • Universal access to standardized provider electronic medical and personal health records;
  • Substantially reduced projected annual increases in health plan premiums and cost of care;
  • Improved facilities, patient outcomes, safety records and consumer satisfaction;
  • Primary caregiver recruitment, retention, loan-repayment and housing subsidies;
  • Bulk pricing on supply, equipment, human resources and medication solutions; and
  • Revenue sharing from global health information database mining and advertising.



The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

Registration for the Medicare and Medicaid EHR Incentive Program is now open. Participate early to get the maximum incentive payments!

Attestation for the Medicare EHR Incentive Program is now open. Visit the Attestation page for more information.

Check on the links below for up-to-date, detailed information about the Electronic Health Record (EHR) Incentive Programs.

Use the Path to Payment page to find out how to participate in these programs.

Overview of the Medicare EHR Incentive Program.

Overview of the Medicaid EHR Incentive Program.

Calendar of important dates.

Downloads and related links.

Electronic Health Record (EHR) or Electronic Medical Record (EMR)?

Sometimes people use the terms “Electronic Medical Record” or “EMR” when talking about Electronic Health Record (EHR) technology. Very often an Electronic Medical Record or EMR is just another way to describe an Electronic Health Record or EHR, and both providers and vendors sometimes use the terms interchangeably.

For the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals, eligible hospitals and critical access hospitals (CAHs) must use ­certified EHR technology.

Certified EHR technology gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.

For more information about which EHR systems and modules are certified for the Medicare and Medicaid EHR Incentive Programs, please visit

The Medicare EHR Incentive Program

The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology.

Participation can begin as early as 2011.

Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There’s an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA).

To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.

Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment.

Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.

Note: If you are a Medicare Advantage Plan (like an HMO or PPO), please visit our Medicare Advantage page.

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The Medicaid EHR Incentive Program

The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years.

The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state.

Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program.

Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is 2016. Hospital payments are based on a number of factors, beginning with a $2 million base payment.
There are no payment adjustments under the Medicaid EHR Incentive Program.

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Important Dates

October 1, 2010 – Reporting year begins for eligible hospitals and CAHs.

January 1, 2011 – Reporting year begins for eligible professionals.

January 3, 2011 – Registration for the Medicare EHR Incentive Program begins.

January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose.

April 18, 2011 – Attestation for the Medicare EHR Incentive Program begins.

May 2011 – EHR Incentive Payments expected to begin.

July 3, 2011 – Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program.

September 30, 2011 – Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs.

October 3, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.

November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011.

December 31, 2011 – Reporting year ends for eligible professionals.

February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.

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EHR Incentive Program Timeline [PDF, 908KB]

Contact Information for EHR Incentive Program Inquiries [PDF, 110KB]
Related Links Inside CMS

Fact Sheet: Electronic Health Records At-a-Glance (July 13, 2010)

Fact Sheet: Medicare EHR Incentive Program Final Rule Overview (July 16, 2010)

Fact Sheet: Medicaid EHR Incentive Program Final Rule Overview (July 16, 2010)

Fact Sheet: Meaningful Use Final Rule Overview (July 16, 2010)

Frequently Asked Questions (FAQs)

Related Links Outside CMS

Medicare and Medicaid EHR Incentive Program Final Rule

Video on EHR Incentive Program Basics”


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  1. admin says:

    The key to health informatics going forward is to be found in re-engineered (open source) VA VistA HIT based personalization, commoditization and standardization of nationwide, not-for-profit medical records and globalized database modeling of health information, on throw-away mobile hardware and telephony hosted in the Cloud. And, as it will represent a non-economic and VERY substantial capital investment as significant as President Eisenhower’s building of the Interstate Highway System, it will need to be the following non-profit entity, or another existing tax-exempt corporation/organization committed to make the investment that will bring such a reality (for universal EHR and EMR) to life…

  2. AlxHamiltn says:

    Health Informatics Forum

    A Social Network for Health Informatics Professionals and Students


    Posted by Abbas Shojaee on August 17, 2011 at 8:22am in Electronic Health Records

    In spite of so many years of great efforts, for healthcare interoperability (I mean specially in definition of EHR required standards) yet existing standards are far from being actionable for practical uses by software industry and current implementations are coming in exchange of extensive efforts and costs.

    HL7 reference information model and CDA artifacts are great analyses of healthcare complexities, but to take an act on them, are disabling, I think due to the employing of a mixtures of methodologies, interacting in an unclear way. (e.g. several controversies and overlapping in definition of Activities, the entities subclasses and the way they act etc.)

    OpenEHR, seems a great step ahead, with a much more clear, Reference Model and the concept of Archetypes, and two level modeling. Yet it contains traces of gradual development. That means some early definition are preserved for backward compatibility while they deserve better implementation in a more elegant style with later developments. It also gets more inconvenient for physical implementation.

    In my opinion, both standards have mixed up the implementation perspective in conceptual abstract layer, and at the same time failed caring of software development best practices. Maybe a call for more clear, light weighted, easy to capture and implement standard, is needed.

    I think this might happen, with a fresh radical approach that learns from both standards, but leaves the burden of legacy designs.

  3. AlxHamiltn says:

    Where have all the PHRs gone?

    Posted on September 2, 2011 by Carol in EHR, HIT, HITECH Updates, PHR

    Jim Tate, Meaningful Use Expert

    In the pre-ARRA era, which I believe was right about the time the dinosaurs died off, there were Personal Health Records (PHRs) everywhere. Web-based, thumb drives, smart, dumb, tethered to EHRs, and on and on. They were everywhere and existed in every possible permutation of hardware and software. Everybody was developing them. It was the Next Big Thing. It got so ridiculous that even I was designing one. I’m not kidding and one day I must dust it off and try and sell it to somebody.

    We all knew that everyone needed a PHR, there was no doubt about that. Even CCHIT saw the writing on the wall and developed a certification program for PHRs. It was the 11th commandment: “Thou shalt maintain all personal relevant clinical history in a HIPPA compliant device”. The trouble was no one wanted to use a PHR. I guess a few did. Most folks just don’t like to get that up close and personal with their health records. They pay other people to do that. Maybe if Apple developed one and it plugged directly into our nervous systems we would use them. I’m not even sure if that would tip the balance.

    Several years ago I gave a presentation on my “dream PHR” to an audience of HIT stakeholders that included a former Surgeon General of the United States. I asked who had a PHR and no one raised their hand. I didn’t use one either. Now don’t get me wrong, I like PHRs. There is a real need for this type of interface with our medical records. We just haven’t found the right tool. It reminds me of the story about the man who only had one tool, a hammer, and he roamed the world looking for nails. Or the man who always wore shoes and so he thought the earth was covered with leather. There is a mismatch between current PHRs and the perceived benefits of using them. I guess that is one of the reasons that Google threw in the towel on their PHR, Google Health.

    The arrival of the CMS EHR Incentive Programs delivered a blow to PHRs. Stage 1 incentives did nothing to promote the use of PHRs and overnight they became the stepchild of HIT. I’m sure something will come to fruition but I don’t know what it will be. Maybe Stage 2 or Stage 3 will support and incentivize PHR use in some way.

    My “dream PHR” continues to evolve. What I want now is a elegant interface which gives me a real time dynamic look into my record located somewhere in the stratosphere. I don’t want to have to do anything. Please don’t ask me to input anything or make more than 2 or 3 decisions. Make it simple, intuitive, powerful, and available on the internet and I will use it. Maybe.

    Jim Tate is a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1.

    Text HITECH to 22828 to get our weekly news digest delivered to your email.

    Become a member of one of the most extensive online education portals available to gain a complete understanding of meaningful use and CMS EHR Incentive Programs

  4. admin says:

    Free EHR Model Has Bent the EHR Cost Curve – EMR and HIPAA

    EMR and HIPAA via to me from
    Free EHR Model Has Bent the EHR Cost Curve – EMR and HIPAA

    Free EHR Model Has Bent the EHR Cost Curve
    Posted: 07 Sep 2011 11:16 AM PDT

    One of the most fascinating people I met on my recent trip to San Francisco was a doctor named Aaron Blackledge from @CarePractice. We spent a great evening together talking EMR, healthcare and entrepreneurship in general. You may also remember me posting about Aaron drinking the CareCloud EHR kool-aid (See also an opposing view of CareCloud and my thoughts after seeing CareCloud), but I digress.

    Dr. Blackledge has posted a thoughtful look at how the EHR cost curve has changed over the past few years. It’s an interesting read for those looking for an interesting take from a physician in Silicon Valley and his idea of the value of a widely adopted platform.

    I love the idea of a healthcare/EMR platform. Would you rather be a $100 million EMR company or a billion dollar platform company? Think those numbers are exaggerations? That’s the question that basically answered. They could have easily become a $100 million CRM company, but instead they’re now a multi billion dollar platform company. I won’t be surprised if we see the same happen for some company in healthcare.

    Whether you agree or not on the value of a widely adopted platform, one thing is certain: The Free EHR Model (with Practice Fusion as the first to make the big “free EHR” splash) has absolutely brought the cost of EHR down. I’m sure there were some other forces at play too, but I believe the Free EHR model held everyone else accountable for their pricing.

    As Dr. Blackledge says in his post, little by little EHR vendors couldn’t get away with charging $20,000 per user up front for an EHR. I started blogging about EMR when this was the norm. Most clinics would take out a hefty loan to buy their $100,000+ EMR software. It was a scary idea and certainly burnt a lot of physician bridges along the way.

    Along came a new pricing model where a doctor could pay a small fee per month. Sure, if you evaluated that amount over 5 years it was still a fair amount of money, but no longer were doctors on the hook for the entire amount even if the EMR software failed to deliver on their promises. Plus, the EMR vendor couldn’t come back later and charge them even more money for future upgrades (that’s right…$20k up front and then amazing upgrade fees).

    After that, the Free EHR model made a big splash. While certainly viewed with a fair amount of skepticism (myself included), many other industries are proving this model and doing quite well. We still have a ways to go to see which company is going to be able to execute the Free EHR model, but as I discussed in my recent Pharmacy Ads and Free EHR software post there are a lot of pharmaceutical marketing dollars on the table.

    Reminds me of the favorite thing my Dell sales and marketing guy loved to say, “Whether you go with Dell or not, we’re keeping prices low so that everyone else has to offer you lower prices.” I believe Free EHR companies have had that same effect on the EHR industry.

    Related posts:

    The Risk of Free EHR Starting to Cost I’ve been writing about Free EHR since I first started…

    The Right Open Source (Free) EMR Model I’ve had a huge interest in the open source EMR…

    When EMR Software Became Free…Or Does It Cost I’ve been meaning to write about a new Free EMR…

  5. AlxHamiltn says:

    Republican Candidates Healthcare Stances – EMR and HIPAA

    EMR and HIPAA via to me 6:48 AM (2 hours ago)


    Republican Candidates Healthcare Stances – EMR and HIPAA

    Republican Candidates Healthcare Stances
    Posted: 09 Sep 2011 09:32 AM PDT

    Dr. James Coffin, VP of Healthcare and Life Sciences at Dell, has a post up on the Dell Healthcare Community site that looks at the stances of the various Republican candidates for the US Presidential nomination. It’s an interesting read if you haven’t been following the republican candidates very much.

    What the article doesn’t address is these candidates stance on the HITECH Act. The key here is to realize that the HITECH act isn’t part of the Affordable Care Act which every GOP candidate is saying they will repeal if they become President. So, where does that really leave the HITECH Act should a republican president be elected?

    The problem is that no one really knows. Those who argue that the HITECH Act is safe often lean on the ideas that EMR and EHR has always had bipartisan support. Many often mention that the push for adoption of EHR software was started by a republican president, George W. Bush. I actually agree that both sides of the aisle want to have widespread adoption of EHR. We could certainly argue the benefits or detriments of EHR adoption, but for a relatively uninformed senate, house and president when it comes to EHR, they’re going to easily grab on to the idea that technology can improve healthcare. We may agree or disagree with this point, but I think we’d be hard pressed to find a senator that thinks we shouldn’t have EHR technology in healthcare.

    The problem with the above discussion has to do with the way that EHR is being paid for. Again, this isn’t about whether the idea of paying doctors to use EHR software is right or wrong, good or bad. This is more about the political stance of the republicans and how they want government to spend money. It seems very clear to me that Republicans are going to keep sitting on their no spending/cut spending soap box. If a republican becomes President, we’re likely to see widespread cuts. Could HITECH money be a casualty of those cuts? Absolutely. Will they be a casualty? Can anyone predict what Washington will really do?

    Should doctors and practices then be afraid of going after the EHR stimulus money? Well, I’ve been advising doctors and practices for the last couple years to not implement an EHR in order to get the government hand out. Those that are doing EHR for “free” government money are going to be disappointed. Not only because the money could be cut, but because sooner or later that money will be gone. So, if you’ve followed my advice, then the loss of the EHR stimulus money will be unfortunate but not too terrible.

    On the other hand, those people who only did EHR because the government was waving the carrot and the stick are likely going to be quite disappointed. Particularly if the practice focused on the governments EHR requirements instead of their own individual practice needs when it comes to an EHR. Sadly, I believe there are many clinics in this boat.

    I’m sure there are other Washington DC insider workings that are in play as well. Hopefully many of you will share some of what you know in the comments.

    Personally, I’m still fairly confident that the EHR stimulus money will play itself out. I’ll be a little surprised if indeed it does get cut. I think republicans will have larger fish to fry. However, there’s certainly that possibility, so doctors should take this into account when they’re selecting and implementing an EHR.

    • admin says:

      The notion of a caregiver, provider or practice adopting electronic health or medical records, primarily to benefit from the one-time financial incentive created by the Stimulus Act, is an important consideration for some, how many, who knows, as the above blog post has observed.

      For the prudent non-profit EMR-EHT adopter (member of or affiliated with a nationwide, not-for-profit health service (‘NHS”)), however, the combined HIT incentives, public and private (NHS), work to the larger advantage of facilitating the opportunity for providers to see the totality of HIT cost, including updating, hardware and support services removed as cost items from its income statement.

      In fact, with related NHS “revenue sharing”, such a provider would be able to turn those former cost items from expenses to a new, and fairly significant revenue stream.

      i.e., new earnings, for example: that could facilitate stronger balance sheets by way of a new resource for accumulating much needed operating and capital reserves: the lack of which has proven to be a notable weakness for non-profit healthcare delivery institutions and has made them vulnerable and appetizing targets for private-equity and for-profit healthcare conglomerates.

      That said, the Question becomes, which non-profit entities will grasp that opportunity and which will see a given-up-for-dead non-profit institution across town, suddenly acquired and being brought back to renewed and competitive life as an affiliate, subsidiary or NHS member entity?

  6. AlxHamiltn says:

    How Critical is the October 1, 2011 Deadline? – Meaningful Use Monday – EMR and HIPAA

    EMR and HIPAA via to me

    How Critical is the October 1, 2011 Deadline? – Meaningful Use Monday – EMR and HIPAA

    How Critical is the October 1, 2011 Deadline? – Meaningful Use Monday
    Posted: 12 Sep 2011 08:27 AM PDT

    Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

    As October approaches, providers who want to apply for the 2011 EHR incentive—and their vendors—are scrambling to implement in time to allow for the 90-day reporting period. An EMR and HIPAA reader submitted the following question:

    Under the EHR Incentive program, in order to receive payment for 2011, the 90- day reporting period must begin no later than 1 October 2011 [Technical point: October 3 is the actual deadline]. Does this mean that the ONC Certified EHR must be in place and operational at that time or can it be installed after 1 October 2011 as long as the pertinent patient data is entered into the EHR once it is installed?

    The EHR must be in use during the entire 90-day period. Data must be reported for the entire 90 days; some measures require something to “be enabled” for the entire period, (e.g., a clinical decision support rule, drug formulary); and other measures have time frames attached, (e.g. provide a clinical summary within 3 business days), which would not be possible to accomplish retroactively.

    My suggestion is that you take the pressure off by postponing meaningful use—and the receipt of your incentive—by just 3 months. If you begin reporting on January 1 instead, you will still have the opportunity to earn the full $44,000 over the 2012-2016 period. You can attest at the end of March and expect your incentive by May. This schedule has the additional advantage of allowing you to earn a 1% ePrescribing bonus for 2011, which you would forego if you earn an EHR incentive since you cannot collect both in the same reporting period. Focus your energy this year on ePrescribing for 25 Medicare encounters and on successfully implementing your new EHR in 2012.

  7. AlxHamiltn says:

    September 14, 2011
    Epocrates EHR Should be Free
    Written by: John FILED UNDER:

    I came across this article on Lab Soft News (he does great work) that talked about some Ethical Questions that related to Epocrates recently launched EHR software and their existing pharmaceutical relationships. Here’s one section from the post:

    Very distressing to me, however, is the clear link of the company [Epocrates], and its software, to the pharmaceutical industry. … I have also reluctantly come to the conclusion that even apparently trivial advertising connections to Big Pharma can lead to mischief. I had previously thought that inconspicuous advertisements in EMRs by drug companies might be tolerated if the companies were to bear the costs of these systems. I now believe that allowing these companies even a tangential relationship to physician-office electronic medical records is too risky.

    I’ll leave the highly discussed topic of pharmaceutical influence for another post and the comments section. However, when I read this I couldn’t help but wonder why Epocrates isn’t offering a Free EHR.

    If you think about most Free EHR models, one of the core revenue paths is through advertising. Let’s not kid ourselves here. When they talk advertising, they’re talking about pharmacy ads. Sure, they might sell some other ads, but the majority of the big dollars for EMR advertising is from pharmaceutical companies.

    With this understanding, doesn’t that mean that Epocrates relationships with these pharmaceutical companies would be perfectly positioned to execute on the Free EHR model?

    I just checked the Epocrates EHR pricing page and it has the pricing as a $359 monthly subscription per seat. It’s also interesting that they’ve chosen to integrate with Nuesoft’s PMS which will cost $200/month per seat. They also require the purchase of the Epocrates EHR Quick Start Package. Not sure the cost on that. Sounds a bit pricey to me, but that’s a topic for another post.

    I keep asking myself as I’m writing this post, Epocrates is perfectly positioned to execute the Free EHR Pharma advertising model and yet for some reason they’ve chosen not to do it. Remember, Epocrates has been executing the free software for Pharma advertising for a long time. Why did they choose not to do the same model with their EHR? Do they know something we don’t know?

    I don’t know the answer to these questions, but I’m sure to ask them next time I see them. Maybe they’ll be at AHIMA or MGMA.

  8. AlxHamiltn says:

    Healthcare Business News

    Four more states registering for EHR payments

    By Joseph Conn
    Posted: September 16, 2011 – 12:01 am ET

    Four more states recently opened registration for their Medicaid electronic health-record incentive payment programs, bringing the total of states with functioning programs to 27, the CMS has announced.

    Providers could begin signing up Sept. 5 in Florida, the nation’s fourth most-populous state, as well as in Illinois (fifth), Georgia (ninth) and Oregon (28th). Three of the five most-populous states, including second-ranked Texas, now are accepting registrations, according to CMS and Census Bureau data.

    “We’ve passed the halfway point” in terms of states that have Medicaid EHR incentive programs up and running, said Jessica Kahn, technical director of the CMS’ Center for Medicaid, CHIP, and Survey and Certification. California, by far the most-populous state at nearly 36.6 million people, and New York, No. 3 at nearly 19.5 million, are “both still on target” to open registration this fall, she said.

    Of the 27 states with operational programs, 17 are making payments to providers for their demonstrated meaningful use of EHRs, Kahn said. Payment capacity is separate from registration and varies by state, Kahn said. “It has to do with their overall readiness,” she said. “We require that they take attestation (from providers) in three months and make payments in five.”

    Medicaid payments under the EHR incentive program, established by the American Recovery and Reinvestment Act of 2009, began flowing in January. They totaled $389 million through August, with the money going to 118 hospitals and 1,297 physicians, nurse practitioners and other “eligible professionals,” Kahn said.

    She said the original expectation was that the Medicaid EHR programs would be running in all 50 states and U.S. territories in 2011, but it looks now like that won’t quite be the case.

    “We think we’ll have all but three or four states and maybe a couple of territories by the end of the year,” she said, adding that all programs should be ready by spring. EHR incentive payment money comes from federal stimulus-law appropriations, but states must foot 10% of the cost to administer their programs.

  9. AlxHamiltn says: via to me 6:04 AM (10 hours ago)

    EMR Under Construction (Implementation) Sign – EMR and HIPAA

    EMR Under Construction (Implementation) Sign Posted: 22 Sep 2011 10:53 AM PDT

    I saw a tweet of a picture from the front desk of a doctor’s office that’s implementing an Electronic Medical Record in their office. I’ll embed the image below, but since it’s a little hard to read, here’s the text from the sign:
    Pardon us while we improve your visit.

    In order to provide you with the most efficient visit possible, MedExpress is installing an EMR (Electronic Medical Records) system.

    This technology enables MedExpress to provide you even more vonvenient care, and ensures that your records will hold more accurate documentation, in a safer, more concisely stored location.

    By 2012, it is federally mandated that healthcare providers initiate electronic health records. MedExpress is keeping up with the current health information technology. In addition, this promotes “green practices” to lower our paper usage.

    Please bear with us, as we are currently in training with this system.

    This sign brings up a lot of interesting talking points. The first one that hits me is back about 5 years ago when I heard someone propose (mostly jokingly) the idea of having a “Got EMR?” sign for offices. This isn’t quite the same, but does use some of the same idea of the value of EHR to patients.

    I’ll set aside the part of the sign that talks about the government EHR mandate since we’ve talked about it plenty of times before (and how it’s not really a mandate). I’ll also avoid commenting on the “green practices” section of the sign, but it’s amazing how green has infiltrated marketing.

    Instead, does anyone else find it amazing that the anticipated slow down for this clinic’s EHR implementation was so big that they typed and printed up a sign explaining the slow down? Maybe it’s just during the time that the doctors are training and not actually a slow down that has to do with actual use of the EHR after training. Although, I know many EHR vendors that are now rolling their eyes when they hear about the EHR training and implementation time and its effect on physician productivity.

    I can’t help but wonder which EHR software this clinic is implementing. That would be interesting to know.

    Related posts:

    Common EMR Implementation Issues – Unexpected EHR Expenses This is the start of a new series of posts…

  10. AlxHamiltn says:


    August 19, 2011

    Common EMR Implementation Issues – Unexpected EHR Expenses

    Written by: John ( via to me

    This is the start of a new series of posts that I plan to do over the next week or two. I’ll probably try and space them out so that they don’t overwhelm anyone. However, it’s going to be a series of common EMR implementation issues that I hear over and over again.

    This series was prompted by a post on HIStalk by Inga where she talked about her visit to the doctor and his complaints about his EHR implementation. As I read through the list of complaints, I realized that they were all complaints that I’d heard before. If I’ve heard them all before, then they must be pretty common and worth talking about more.

    Ideally the discussions in this EMR implementation series will help practices and doctors that are implementing an EMR to avoid these issues. I also know that I don’t necessarily know all the answers to avoiding these problems. So, I welcome others feedback on ways to avoid these problems in the comments as well.

    Today’s Common EMR Implementation Problem: Many Unexpected Expenses

    I can’t tell you how many times I’ve heard a doctor or medical practice talk about all the hidden expenses that they incurred during their EHR implementation that they didn’t plan for. Here are 3 tips to help you avoid this situation.

    Unexpected EHR Expense Tip #1 – Plan for hidden expenses. Add $5000+ to your budget for hidden expenses. Hopefully you won’t have to use it, but if (and likely when) you need to use it you’ll already have it in your budget.

    Unexpected EHR Expense Tip #2 – Get your EHR vendor to outline everything and anything they could charge you for. Once they’ve done that, consider putting the list of expenses in your EMR contract so that new expenses from your EHR vendor won’t appear. Here’s just a few EHR expenses that you might incur (and may not expect):
    -Up front fee (almost everyone just focuses on this)
    -Maintenance Fees (monthly, annually, etc)
    -Upgrade Fees (to update your software…these are sometimes called Hot Fixes)
    -Interface Fees (both sides of the lab and EMR company)
    -Device Integration
    -Training Fees
    -Support Fees
    -Licensing Fees (to license their various databases and/or clinical content)
    -Install Fees
    -Other non-standard modules – You mean you didn’t realize that the patient portal was an extra $150/month?
    -EHR or PMS data migration Fees
    -Template Creation Fees
    I’m sure there are others that I’ve missed. I look forward to seeing the comments on this. I’ll update the post with other suggestions as they come in. As you can see, EHR vendors can charge you in lots of interesting ways.

    Unexpected EHR Expense Tip #3
    While EHR vendors can often throw unexpected fees at you, it’s probably even more likely that the other outside purchases you have to make during your EMR implementation will be a surprise. Here’s a list for you to consider the other EMR implementation related fees that might come unexpectedly:
    -Server cost (almost everyone focuses on this)
    -Software cost (including the operating system or third party software your EHR vendor might require)
    -New Desktop/Laptop Costs
    -Upgrading Desktop/Laptop Costs – You might find that your existing computers aren’t powerful enough to run the EHR you chose. This is particularly true if you’re using something like voice recognition with your EHR.
    -Fax Server
    -Fax Server Software
    -Scanners – Yes, that is plural and people often start with one scanner and then have the unexpected cost of another scanner because they could really use 2+ scanners. Other times people use a cheap all in one scanner which quickly dies after they start scanning in bulk and they realize they need to buy a $1000+ scanner that can handle the required scanning
    -Printers – You’ll likely need a few of these to print our prescriptions, patient education, etc etc etc. Plus, you’ll often need a better printer than the one you have.
    -Dragon Medical Voice Recognition – The software, the mic (spend extra for a great one), etc. Some don’t realize all of this costs and doesn’t usually come with the EHR software.
    -New Network Ports – You could go wireless, but many like the reliability of a wired connection. This costs to run the lines and cut out new internet connections
    -Bigger Internet Connection – This is particularly true with a SaaS EHR setup. You think your current internet connection is enough and then you realize you need to pay for a bigger pipe (internet connection) or possibly even a second “backup” internet connection
    -Backup Software
    -Backup Hardware
    -Off site Backup Service
    -Cables – Lots and lots of cables required. Sometimes you even have the cable, but then realize you want a longer one. Unexpected expense!
    -Power strips and other peripherals – $10 here and $10 there. This stuff starts to add up. Plus, get ready for things like your mouse to start breaking now that you’re using it a lot more.
    -UPS (uninterruptible power supply)
    Chip Hart added the following suggestions (Thanks!):
    -Practices should purchase 25-50% more laptops/tablets (and/or batteries) than they expect.
    -All those laptops and tablets will need a SECURE storage and recharge barn.
    -You may be paying a carpenter and electrician.
    -Integration fees? Data conversion fees?
    -Will you need hands-free headsets for your staff, now?
    -Maybe it’s time to get bigger monitors.

    Hopefully the above lists will help you plan for all of the various fees that are associated with an EHR implementation. Many of these EMR costs are necessary, but end up being really annoying when you didn’t know they were coming. Check through this list to see if you’ve planned for all the EHR costs.

    In a future post, I’ll see if I can’t take the above list and give you some ideas on how you can save on some of the costs above.

    Related Articles:

    Common EMR Implementation Issue – EHR Performance Issues
    Common EHR Implementation Issue – Inadequate EHR Templates
    Avoiding EHR Performance Issues in the First Place
    EMR/EHR Selection and Implementation Guide Plans
    A Case for EMR Implementation – Multiple Locations

    » EMR and HIPAA

  11. admin says: via to me

    September 29, 2011

    Common EHR Implementation Issue – EMR Upgrade Problems
    Written by: John

    I’m really excited that this Common EHR implementation issues series has been so popular. If you missed it, you can see the previous posts in the series: Unexpected EHR Expenses, EHR Performance Issues, a little follow up to avoiding the EHR performance issues altogether, and inadequate EHR templates.

    This weeks common EHR implementation issue is: EMR Upgrade Problems

    I’d like to categorize this EHR implementation issue into two areas. One is upgrading to an EHR from an old legacy EHR and/or PMS. The second is upgrading your existing EHR that’s just outdated. I’ll take them in reverse order.

    Upgrade of Existing Outdated EHR

    In this world of your web browser and operating system auto updating at regular intervals it’s sometimes hard to remember that not all software does that. In fact, it turns out that most software doesn’t auto update (often for good reason). Of course, this problem doesn’t apply to a SaaS based EHR software since those updates are applied whether you like it or not. The nice part is that the SaaS EHR updates appear to the user to just happen automatically with little to no intervention on their part. Of course, we’ll save what happens when a SaaS EHR update causes you problems for another post. In the client server world of EHR (or hybrid EHR as some like to call themselves when they’re web based on an in house server) you will have to deal with updating your EHR.

    I think with rare exception, it’s a huge mistake to not keep your EHR software up to date (goes for most other software as well). I’m not suggesting that even client server software should auto update. Considering the deployment and upgrade model of most EHR software, it’s almost essential to review the new feature list before doing an update to ensure that the update won’t cause you unnecessary heartache. Understanding the changes that will happen with the EHR Upgrade will let you warn your users about it so that they don’t come running into your office after the upgrade wondering why their favorite feature was changed.

    What’s the problem with not upgrading? Many might just think that they don’t need to update their EHR software since they don’t want/need the extra features that are part of the upgrade. This is a bad strategy for a couple reasons. First, there are often security fixes that are part of the EHR upgrade that you’ll be missing out on if you don’t upgrade. Second, a bunch of relatively minor updates is much better on a clinic than one massive one that requires a ton of change. Third, when a future update comes that has a feature you do want, it’s not always pretty to go through multiple upgrades at the same time. Fourth, try calling the EHR support when you’re on an old version. Most of the time they’re going to say you need to upgrade for them to appropriately support you.

    One other suggestion on EMR Upgrades now that I’ve supported the idea of upgrading. Just because I suggest you upgrade to the latest version of your EHR, doesn’t mean you have to be the beta tester for the company. Do the upgrade early in the process, but not necessarily so early that you’re going to be the bug tester for the company.

    Upgrading an EHR from a Legacy EHR or PMS

    This situation happens most often when either a clinic decides to switch from their old hasn’t been updated legacy PMS (which might include some basic EHR features) or when a clinic decides to move off their existing EHR to a new one.

    Upgrading from a legacy PMS could easily be a whole series of blog posts. Suffice it to say that the biggest challenge with the upgrade from the old legacy PMS system is often getting the data out of it. Some legacy PMS systems don’t provide that data willing. In fact, many will even charge you to get access to it. They’ve basically lost you as a customers, so they’re trying to maximize whatever revenue they can get. It’s not pretty.

    Even if you can get access to the data, there’s often a lot of data manipulation that will have to occur. A common problem that’s related to this is whether you even want to get the data out of the old PMS. Far too often, the data in the old legacy system has so much junk in it, that it’s worth considering the option of starting from scratch. It’s not pretty to upload inconsistent and ugly data from a legacy system into your nice, new EHR software.

    Switching from one EHR software to another is becoming more and more common. In 2-3 years I believe we’re going to see an amazing influx of EHR software switches. It will be the topic du jour. We’re already starting to see it in a number of situations: an EHR that isn’t certified, an EHR that the doctor hates, an EHR that’s gone under, an EHR that’s sold to another company, etc.

    The biggest problem right now with switching EHR software is that there’s no standard for the data to be exported and imported into a new EHR company. Some of you might remember my post asking EHR vendors to consider the value of EHR data liberation. In it I describe why not only is it the right ethical thing to do, but it also can make a lot of business sense to do so. Sadly, I’ve only really seen one EHR software that has embraced the concept of really liberating the data in their EHR.

    I’d love to support a movement from EHR vendors that embrace the concept of EMR data liberation. I imagine most are too afraid of giving their users an easy option to leave their EHR. It’s too bad EHR vendors are so focused on protecting their business instead of focusing everything they do on the customer experience, but I digress.

    Considering the above described state of EHR data export, you can see why moving to an EHR is such an issue. It’s worth mentioning this topic before you even select an EHR. Before purchasing the EHR, ask the question, What if this EHR is terrible and I want to switch? This is water under a bridge if you’re already in a compromising position under contract with an EHR you don’t like.

    Unfortunately, I don’t really have very many great suggestions for those in this position. Just some words of comfort. First, switching EHR software can actually be easier than implementing an EHR in the first place. You already have the computers and IT infrastructure. Plus, for some reason second EHR implementations have a much higher success and satisfaction rate from what I’ve seen. Second, while it’s a bitter bullet to bite, everyone that I know that’s done it wishes they’d done it earlier. Although, don’t rush into another EHR just because. Take your time to select an EHR properly if you’re going to switch, but don’t be afraid to switch based on what economists call sunk costs. Third, this is one case where it’s often good to hire someone who’s done these type of EHR switching before. They can be a big help.

  12. AlxHamiltn says:

    British EHR fiasco shows U.S. may be on the right track

    October 1, 2011 — 5:43pm ET | By Ken Terry

    Is it possible that the Obama Administration is doing something right in its ambitious health IT program? The U.K. National Health Service’s failed, decade-long effort to implement a nationwide electronic health record system suggests that, in many ways, the U.S. government is taking a wiser approach to encouraging widespread EHR adoption. On the other hand, it is still possible that the federal government might overreach and hit the same brick wall that the Brits did.

    In a recent New York Times piece, reporter Steve Lohr asked three top experts–Dr. David Brailer, Dr. David Blumenthal (both former national health IT coordinators) and Richard Alvarez, who heads Canada’s health IT effort–what lessons they drew from the NHS fiasco.

    Brailer and Blumenthal stressed the importance of having physicians involved in health IT planning; Brailer went so far as to say that physician resistance to the U.K. National Programme for IT (NPfIT) had “brought [the NHS] to their knees.” All three pointed out that a top-down program of this scope cannot work because health IT must be implemented at the local level–which is also the message of the NHS press release about the dismantling of its IT program.

    “A modernised NHS needs information systems that are driven by what patients and clinicians want,” Sir David Nicholson, chief executive of the NHS said. “The NPfIT has provided us with a foundation but we now need to move on if we are going to achieve the efficiency and effectiveness required in today’s health service. Restoring local control over decision-making and enabling greater choice for NHS organisations is key as we continue to use the secure exchange of information to drive up quality and safety.”

    Perhaps with the U.K. example in mind, the Obama Administration has avoided boxing physicians in with too few choices. In its Meaningful Use and EHR certification regulations, the government has taken pains to ensure that its EHR incentive program would not give an unfair advantage to bigger vendors at the expense of smaller ones. As a result, American physicians have a very wide choice of EHRs and EHR modules that are certified for Meaningful Use–nearly 900 products at latest count. If anything, some observers say, doctors and hospitals have too many applications to choose among–and many of them are unusable.

    As I pointed out in this space a few weeks ago, the Administration also has shown a strong interest in working with the private sector to solve problems, rather than imposing solutions from above. For example, the Office of the National Coordinator for Health IT (ONC) has enlisted help from private-sector experts in building the CONNECT gateway to the National Health Information Network, designing the Direct Project secure messaging protocol, and testing metadata standards. ONC also is providing funds to 17 Beacon communities to find innovative ways of using health IT, and is sponsoring cash-prize contests designed to do the same thing.

    But the Meaningful Use program itself is a top-down government initiative. While some physicians and consumer representatives are included on the Health IT Policy Committee (which advises ONC on the Meaningful Use requirements), the committee members seem less concerned about the difficulty of meeting the criteria than on whether they move the healthcare quality and efficiency agenda forward.

    Judging by conversations I’ve had with some doctors, I don’t believe that the Stage 1 criteria for Meaningful Use contain any obstacles that most physicians cannot surmount if they have a decent EHR and learn how to use it properly. Hospitals will have to work harder, especially in the areas of computerized physician order entry and quality reporting. But many hospitals also will qualify for Meaningful Use either this year or next.

    The real challenge is going to be Stage 2. This is where ONC and other government agencies should start thinking hard about how far and fast they want the healthcare industry to go. If there are lots of laggards in Stage 1, maybe Stage 2 should be designed to push providers forward a little, but not too much. When all is said and done, the industry-wide transition to a transformative level of health IT is going to take a decade. And if people are pushed too hard, they must just push back. –

    Ken (@FierceHealthIT)

    Read more: British EHR fiasco shows U.S. may be on the right track – FierceHealthIT

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