Column: How To Obtain Quality IT Help

Pressure, Seduction, & Treachery

Succumbing to the pressure on physicians to have a “meaningful use” (MU) strategy, you may be considering how to implement electronic health records (EHR) systems to achieve MU and receive incentive reimbursements. If you’re in the market for software, it’s likely you’re being inundated with case studies from vendors demonstrating how you, too, can attain the success their clients enjoy. Don’t be fooled; it’s highly unlikely that your experience will be the same as the doctors’ in the vendor-sponsored case study. Those select case studies are inevitably chosen to seduce you with stories of physicians who doubled their incomes allowing them luxuries such as vacationing more often. Those tales are rarely true. Unless every patient presents in the same fashion every time for every condition with every provider in your practice, adopting clinical systems into your care routine will be challenging. Rather than merely accepting the scenarios described in the case studies, it would be wise to employ outside help.

Cautiously Start with Regional Extension Centers

The MU government regulations, and the technology required to implement it, were expected to be too complicated for you to understand and implement on your own. Therefore, it’s beneficial for you to know that the 2009 Stimulus Bill funded the creation of the Health Information Technology Extension Program. Via this program, the Department of Health and Human Services is required to invest in Regional Extension Centers (RECs). RECs are designed to offer consulting and technical support to help accelerate adoption of Electronic Health Records (EHRs).

RECs are responsible for offering advice and guidance regarding which products to buy; negotiation of price reductions for software through group purchase agreements; and technical assistance for implementation and deployment. Bear in mind that RECs are non-profit organizations and are groups that responded to the grant request in a manner that fulfilled the documentation required by the government and, consequently, receive government money to help physicians become meaningful users.

In the short run, these new RECs may not be much good to physicians as they will likely be inexperienced and, therefore, unable to offer much compared to other, more experienced, consulting shops. Since RECs will initially be paid by the government for each physician they sign on, they will be quite solicitous in conducting outreach to recruit your practice regardless of how well they can actually assist you. Still, it should cost you nothing to sign up and, again, the advice and assistance should be free to you. The good news is that the government has made it clear the RECs will be compensated in later years only if their clients become “meaningful users.” The bad news is that inexperienced management may be running your local RECs and the free advice could cost you in the long run.

How to Choose Consultants

After you’ve learned about RECs, investigate experienced, paid consultants by asking your colleagues. Many RECs will refer local consultants but you’ll need to vet them; RECs chose their consultants not because they are necessarily good at their jobs, but because they successfully marketed themselves to the RECs. One consultant won’t do -- you will need to include several specialty consultants in your search to cover various important functions:

Meaningful Use (MU) Consultant. An MU consultant is necessary only if you’re pursuing government stimulus funds. This professional should understand the nuances of how a medical practice works as well as all the legal and regulatory details involved with Meaningful Use. This is not a typical IT contractor or technical consultant; it must be someone who is focused on MU. Since you will not receive increased government reimbursements unless you meet MU (simply installing the software does not qualify), the MU consultant may be more important than your IT consultant. The MU consultant should help determine whether or not you qualify for incentives, how to optimize the incentive program, how to utilize RECs, how to ensure that you qualify for MU without disrupting your practice and losing money, and finally, whether you should even care about MU.

A good MU Consultant will advise you when to implement MU and, just as importantly, when to decide against going after stimulus funds.
The MU consultant must be knowledgeable about your local (not national) rules, regulations, and technology providers.
MU consultants should get some small upfront fees but should really get paid as you get paid; they should not be rewarded with full payment unless you receive incentive payments from the government. Remember that installing certified software will not get you to MU money; there is a great deal of labor involved to earn it even after the systems are implemented.

EHR Consultant. If you’re ready to purchase an EHR, the MU consultant can help you choose the product. However, it may be worth investing in advice from an EHR-focused consultant familiar with the hundreds of packages available. Be careful if your EHR consultant is coming from a REC or a vendor. They should disclose any financial ties to the products they are advising you to select and should be able to tell you how many products they’ve worked with; some only know a couple of products so that’s all they can recommend. Choose the consultant based on the type of knowledge you’re lacking. Some are business-focused and others are technically-focused; if you’re great at technology, choose a business-focused consultant (and vice-versa).

IT Consultant. This may be self-evident, but you should, indeed, seek advice on a whole host of requisite technological components including hardware, software, networking, telecommunications, Internet connectivity, and bandwidth analysis.

Integration Consultant. Most people overlook this resource because the need is not obvious; this consultant is vital to ensuring that all the medical records data you’re collecting can be shared between your systems, your hospital, and the government. Integration consultants must be well-versed in all the relevant standards such as HL7, DICOM, CCR, CCD, and XML, along with HL7 routers and the tools that share medical data records between your EHR, practice management system, and health information exchanges (HIEs).

Don’t Trust the Government to Help Make Your Decisions

On the surface, the case for technology in your practice seems clear:

The government believes your use of technology benefits the country and is, therefore, trying to incentivize you into becoming a “meaningful user” of certified technology.
You’ve been repeatedly told that IT can significantly improve productivity and perhaps you’ve made to seem foolish if you disagree.
One would be hard-pressed to find any medical practice that does not currently employ the use of one or more computers for basic office automation. If you’re not already electronic, patients may have the impression that your clinical skills are as outdated as your office practice.

Beware, though, that while the purchase and use of computers and their associated software has been popular, there has possibly been very little strategic planning for exactly how computerization should be optimized.

Most physician practices naturally increase their purchasing of almost all types of information technology as a result of incentives and initiatives from payers such as the federal government, their local hospital, or their insurance company. Here’s why these incentives are fraught with hidden dangers:

The installation and use of information technology in your practice will certainly provide significant benefit to others like local, state, and federal government users of medical data.
There is no compelling evidence to prove that implementation of electronic medical records necessarily has the same value to your practice.

The government’s incentives won’t keep you in business, treating patients in a consistently profitable manner with a proper business strategy will. The government may compensate you for automation since, ultimately, you’re performing its data entry and providing valuable information; however, you may not see the same value unless you do your homework and return on investment analysis.

Shahid Shah
Chief Executive Officer
Netspective Communications