Posted by: Peggy Salvatore
The other day I was talking to a technology venture capitalist who has been investing in health IT businesses. His group has financed two health IT software companies: one failed, and one is, in his words, “on life support.” He didn’t have to look further than his own doctor’s office to see some of the problems inherent in electronic records adoption and why those investments were not the gold mines they first appeared.
About six months ago, this venture capitalist visited his physician’s office where a sign hung in the waiting room asking patients to have patience while the office implemented its electronic records system. Six months later, he returned for a checkup and asked the receptionist how the implementation turned out. Turned out, it didn’t. She said the office experienced so many hurdles and problems and delays that they scrapped the electronic records system and returned to the wall of file folders behind her.
On Monday of this week, the Medical Group Management Association President William F. Jessee, MD, wrote a 5-page letter to the National Coordinator for Health Information Technology David Blumenthal, MD, spelling out the problems that its 22,500 member organizations have experienced in trying to take advantage of the incentives to implement electronic health records.
To summarize five pages using a broad brush, Dr. Jessee told Dr. Blumenthal that the meaningful use criteria need to be crafted to take into account real physicians, in real practices, practicing with real patients, under real conditions, with realistic target dates. Or the meaningful use criteria will be meaningless, and the incentives will be unattainable.
Some of Dr. Jessee’s observations about the meaningful use criteria:
- “. . .an inappropriate definition of meaningful use and inefficient administration of the program will lead to failed implementation. . .and result in the needless squandering of resources and significant disruption to the nation’s healthcare system.”
- “. . .encourage you not to impose arbitrary ‘thresholds’. . .for example, physicians clearly cannot force patients to undergo tests which (i) may be physically uncomfortable for the patient, (ii) one that the patient objects to, or (iiii) one for which the patient’s health plan covers only part of the cost, or none of the cost.”
- “. . .it is critical to avoid imposing criteria that do not have widespread experience in the small and rural clinic settings.. . “
- “administrative transactions currently outlined in the meaningful use matrix.. .do not take into account the reality of current practice workflow or the inefficiency of the current standards themselves.”
Dr. Jessee follows up with some constructive suggestions that include:
- Conduct pilots with a small number of vendors in a variety of practice settings to ensure the criteria are achievable and practical
- Provide adequate government logistical support, such as short response times and attainable correction timelines
- Be flexible; do not impose pass/fail measures
- Monitor the EHR marketplace to make sure IT providers are offering appropriate and cost efficient products
- Keep the reporting process simple so the largest possible number of medical groups can do it and achieve the targets
- Reconsider extending tight deadlines, such as the 2011 start date for incentives
- Oversee the IT vendor suppliers to make sure they are properly installing and supporting their products
- Communicate with us through websites, webinars , conference, forums, and phone assistance.
As any venture capitalist looking at investing in a fledgling health IT company might conclude that this is a very rich pipeline of customers. But the customers are skeptical, need a lot of support, the regulations are numerous, the timelines are tight, and there are waiting rooms full of patients who might run out of patience.
Thanks for sharing that VC anecdote. That's really really enlightening. I've seen a number of opportunities available in the EMR startup company world. There's no doubt that obtaining customers interested in your EMR software is hard to do for the reasons you specify.
My only question with the MGMA letter is where was it 4-6 months ago? Seems kind of late to be sending this now.
Posted by: John Lynn | 12/08/2009 at 04:26 PM