EMR Ratings: A KLAS Act (Part 2)

Last week, I discussed the merits of the new KLAS Performance Report that categorizes EMR ratings based upon practice specialty. The industry has responded very positively to this major step forward, and I suspect that KLAS has received many requests for access to the publication.

One of the obstacles that KLAS faced in reporting by specialty was a lack of sufficient data in many of the categories and for many of the vendors. This data limitation leads me to several initial observations and raises important questions:

  • While there are 27 vendors rated in the primary-care section and 20 in family practice, there are only 2 vendors in ophthalmology, 3 in orthopaedics, and 5 in cardiology with sufficient volume to merit inclusion. Why is that? EMR vendors have been marketing to the specialty physicians for well over a decade. Does this confirm that traditional EMRs have only had real traction in primary care after all these years?
  • A disclaimer by KLAS says that vendors may be excluded from a category due to insufficient data points, yet I know from my own company’s sales experience that there are vendors who claim a large number of installs in specialty practices. Why are these practices not included in the survey results? Did they de-install their EMR? Did the implementation fail, or are the providers not really using the EMR so they chose not to respond to KLAS? Did vendors not supply KLAS with a sufficient number of specialists due to such problems? Whatever the reasons, the lack of responses from specialists is not surprising, given the dearth of specialists’ testimonials or EMR success stories on vendor websites and on industry and government blogs.
  • Some of the vendors that are not rated highly by clients in the specialty categories received significantly better KLAS ratings from their primary-care clients. This data validates the tremendous difference between the EMR needs of specialists and those of primary-care physicians, as I have discussed in numerous posts. The fact that traditional EMRs are designed to meet the needs of primary-care physicians was a concern echoed by the American Academy of Orthopaedic Surgeons in its EMR Position Statement, which said that the primary-care focus “can limit the utility of EHRs for specialty surgical practice.” Force-fitting an EMR designed for primary care into a specialty practice is what has resulted in the historically high failure rate of EMRs among specialists.

Limitations of the data notwithstanding, one conclusion is inescapable: The KLAS report is a great first step in providing specialists with considerably more information than they had prior to its publication, but the burden still remains on the specialists to do their due diligence to identify an EMR with proven success in their specialty.

From EMR Vendors: Fact or Fiction?

The Economic Stimulus legislation has presented an incredible opportunity for EMR vendors. Unfortunately, it seems that some of them are taking advantage of it by giving out misleading information and applying scare tactics so that practices will purchase their EMRs. Below is a sampling of such statements, which have been forwarded to me by physicians asking whether they are “fact or fiction.”

Have you had similar experiences? Please share them by submitting a comment at the bottom of this post.

What some EMR reps are saying:

  • “The government is requiring you to buy an EMR.” This one is a scare tactic since participation is voluntary.Section 3006 of the American Recovery and Reinvestment Act specifically states “…nothing in such Act or in the amendments made by such Act shall be construed to require a private entity to adopt or comply with a standard or implementation specification adopted under section 3004.”
  • “Your EMR must be CCHIT-certified to qualify for the incentive payments.” I hate to use the word “lying” but this statement comes close since the legislation neither identifies standards nor mentions any particular credentialing body, including CCHIT. The HIT Standards Committees, which just had its first meeting on May 15, is charged with recommending an initial set of certification standards by December 31, 2009. Recently, there has been a surge of rhetoric in the media expressing dissatisfaction with CCHIT, so it is by no means a foregone conclusion that CCHIT certification will be required.
  • “Simply buy a CCHIT-certified product, and you will qualify for the Stimulus money.” This remark is similar to “I have a great stock to sell you”—because EHR incentive payments are not guaranteed. Simply purchasing a “certified” EHR is not sufficient; the incentives require you to demonstrate “meaningful use” of the EHR every year, and to do so in the manner specified by and to the satisfaction of the government. “Meaningful use” has not yet been fully defined, and the legislation states that the requirements are to become more stringent over the period covered by the law.
  • “You must act now—buy an EHR now because in order to get the money from the government, you must be using the EMR by 2011.” As with used-car salesmen, “buy now” is always popular, but you actually have until 2013 to implement and potentially qualify for the lion’s share of the incentives. Even if you do not implement until 2014 (5 years from now), you would still be eligible for almost 80% of the money.

Have you heard any of these statements of “fact”? My advice: Do your due-diligence. Make sure you understand the real facts about the legislation and find an EMR that meets the needs of your practice. Have you heard other statements of “fiction?”—Please share them by submitting a comment at the bottom of this post.