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From the October 2002 Issue Order in Chaos: Transforming Best-of-Breed Solutions Into Integrated Solutions |
You Say Tomato and …
By Richard R. Rogoski Physicians’ wide scale acceptance of newer practice management systems (PMS) has allowed them not only to automate back office functions, but also to quickly and easily access clinical data.
Yet, while technological advances have broadened the scope of practice management systems, the market remains one of the most diverse in the software industry, says Bruce Kleaveland, CEO of Seattle, WA-based Physician Micro Systems Inc. As the popularity of PMSs began to grow, so did the number of regional vendors, and for several years a prevalence of local suppliers dotted the horizon. That is beginning to change, he says. “The market is becoming less fragmented as smaller players are unable to compete with larger players and are willing to sell out to larger companies.” While large companies with a national presence have come to dominate the landscape, still the PMS market remains divided in a different way—based on the healthcare industry’s push to replace paper charts with electronic medical records (EMRs). Vendors appear to be aligned in two camps: those who develop and sell practice management (PM) and EMR systems that can be interfaced with other vendors’ systems, and those who only sell integrated EMR and PM systems. Degrees of Separation
Patrick Cline, president and chief operating officer of Horsham, PA-based NextGen Healthcare Information Systems Inc., says this schism exists because many vendors have just recently seen the importance of EMRs. “Many PM vendors have developed EMR capabilities as an afterthought. Consequently, many EMR products are weak products,” he says. His company has taken a best-of-breed approach with separate PMS and EMR development teams located hundreds of miles apart. By selling its EMR or PM system to those who already have a competitor’s product in place, he says the company can grab a larger market share than those that sell EMRs only to their own PM customers. “It’s a no-brainer. We interface NextGen’s EMR to 26 different PM systems.” Physicians do realize that eventually they will have to integrate an EMR with their PM system, says Kleaveland, so they want a solid infrastructure that will allow them to integrate if and when they are ready. But this is a market still in transition, he says, and that benefits both vendor and client. “The overwhelming majority of practices we sell EMRs to have an existing practice management system,” he says. “If the customer just bought a PMS and they love it, we’ll say, ‘Great, we’ll integrate to it.’ We believe that position will allow us to participate in more opportunities.”
Not everyone agrees. Some suppliers believe it is more beneficial for the physician to buy both products from a single vendor. Sheldon (Shelley) Newman, CEO of the Physician Systems Business Unit at Misys Healthcare Systems in Raleigh, NC, says his company only sells EMRs to customers who already have, or are willing to buy, a Misys practice management system. Newman says doctors want one-stop shopping. “They want to deal with the fewest number of vendors. They’d rather deal with one vendor who has all the solutions.” He contends that dealing with multiple-solution vendors can be “very inefficient” for small physician practices. If something goes wrong, they usually have to call at least two vendors to find out whose product is not working right.
Michael (Mickey) Singer, CEO of Medical Manager Health Systems, a division of Elmwood Park, NJ-based WebMD, also agrees that dealing with one vendor is the best strategy. Like Misys, WebMD sells its EMR to those who have the company’s practice management system. This is what the majority of physicians want, Singer says. “There are systems out there that can be interfaced. But what people want is a totally integrated system. You lose efficiency if you use two systems from different vendors that are interfaced together,” he says. “What physicians want is a single solution that moves them into the EMR world.” Users Rising While estimates of practices actually using EMRs range anywhere from 5 percent to 20 percent, their acceptance rate is rising, says Kleaveland. “Ten to 15 years ago, most practices didn’t have automated medical billing systems. Now, 95 percent have them. You’re going to see that same level of adoption of electronic medical records,” he says. Adoption is happening now, but “at its own pace.” He predicts that over the next three to five years the adoption rate of EMRs will reach 25 to 30 percent, and at that point it will accelerate. Basically, as more doctors install EMRs, that alone will validate their use, and as the technology advances, EMRs will become easier to install and use. Cline doesn’t necessarily agree, saying that many physicians are still reluctant to change, although advances in technology make it easier for practices to abandon paper charts. “The keys to physician adoption of EMRs are software flexibility and proof of a solid return on investment,” he says. Kleaveland agrees on that point. “On the PMS side, ROI is not a question they ask. They know practice management software is necessary to run the business. But on the EMR side, proven ROI is still important.” Newman, though, sheds light on the incremental aspect of the adoption issue and puts some of the responsibility for its future on vendors. He says many vendors adhere to a “big bang” approach that calls for physicians “to do it all and do it all at once.” Instead, vendors can and should roll out EMRs incrementally so that physicians can first put a toe in the water. Document management, transcription or a PDA formulary, for example, could be a transition into the EMR arena. When physicians feel comfortable at that level, they can then begin installing the basic modules of an EMR system, he says. Getting Connected Aside from being able to add an EMR, physicians also want electronic connections to clinical databases, payers and other practices. The average practice will be increasingly wired to the rest of the world. In the past, PM systems were generally self-contained, except for connections to payers. That’s changing, according to Cline. “Vendors are now pushing to increase the capabilities of their practice management systems,” he says. “Today, they are being extended into the community through interfaces to hospitals and even to other practices.” This becomes extremely important, for example, when a patient is referred by his primary caregiver to a specialist. Cline says systems also are being extended into the patient community. NextGen uses an Internet portal through which patients can gain access to their doctors’ offices. By being able to register and update insurance information online, patients don’t have to spend the first 20 minutes of their appointment time filling out paper forms, and office staff need not key that data into their computer systems. Improving efficiency also includes the ability to perform electronic insurance verifications and referrals, and to check medical necessity rules. “We can check all that up front, prior to the bill being generated, or even before the patient is seen,” he adds. With system capability to analyze pending/denial trends of a particular payer, practices know in advance which claims would be pended or denied. The wide scale use of handheld devices by physicians also is pressuring vendors to develop PM systems and EMRs that can accommodate this technology. “Most leading PM systems now have a complementary PDA solution, and most are linked directly to the PMS,” says Cline. This extension of a PMS, which is often used outside the office, can facilitate charge capture and medical necessity checking. Another way to get connected is through the Internet or intranets that require a Web browser. “Those who need a many-to-one connection are migrating to the Web,” notes WebMD’s Singer. HIPAA Concerns Providers must comply with the transactions and code set standards of the Health Insurance Portability and Accountability Act (HIPAA) by October 16, 2003, and vendors are trying to assure physicians that the EMRs and PM systems they buy now will bring their practices into compliance. “Providers want to know that HIPAA is taken care of and they don’t have to worry about it,” says Singer. But Singer makes a significant distinction between “HIPAA ready” and “HIPAA compliant.” The argument has long existed in the healthcare environment that people and organizations are compliant, but that software, in and of itself, is not “compliant.” “We give providers the tools to make them HIPAA compliant. We enable them. When we sell a new product, it’s HIPAA ready,” says Singer. Acceptance, adoption, and utilization of technology tools by providers are the keys to compliance. Unlike issues pertaining to privacy and security—many of which can be dealt with internally—Kleaveland says the transaction standards require a technical fix that puts the burden on software developers and payers. He says users should not have to face a steep learning curve, and that adjustments to systems must be made at the vendor and supplier end. That would come as good news to most physicians and group practices, who expect HIPAA-preparedness from their IT products. This mandate actually will make it easier for software developers, says Cline. Because standards overlap into certain clinical settings, “vendors won’t have to develop different software to be compatible with so many different transaction formats.” To him, watching practices preparing for HIPAA is reminiscent of the efforts made in 1999 to make systems Y2K compliant. “HIPAA is changing the replacement cycle of practice management systems,” he says, noting that the current market is being generated by about 15 percent of physician practices replacing outmoded systems. Kleaveland believes that in the short term, HIPAA is the “largest single factor facing both the PMS vendors and payers.” While he feels that HIPAA is not dramatically driving EMR sales, he admits that many customers recognize that monitoring patient records and complying with HIPAA’s privacy requirements is easier with an EMR. Also, the security and privacy aspects of HIPAA, scheduled to go into effect in April 2003, are now becoming a major concern of physician practices, notes Singer, who says most of the concerns involve patient consent and disclosure regulations. “The most complicated part of the law is that if you release any part of a medical record to a third party, you need a signed authorization from the patient,” Singer says, “and you must keep a record of each disclosure for six years.” Patients have the right to ask to see any and all disclosures, but there is a caveat, according to Singer. “The government can access medical records without telling the patient, and the government has the right to instruct the physician not to tell the patient that his or her record has been accessed for a specified period,” he says. To comply with disclosure rules, Singer says his company is now designing its Medical Manager suite of products to include a new database and rule sets to automate these disclosure processes. Customer Service Physicians also are concerned about the stability of vendors and the level of support they can expect—and rightfully so. Not surprisingly, the dot-com implosion sent shock waves throughout the medical community as companies that promised to deliver products or services either went out of business or were acquired at bargain prices. “It’s extremely important to look at the financial strength and viability of a company,” advises Kleaveland. “Look at the business track record before you buy products.” Newman agrees. He says healthcare clients are counting on their vendors being there for the long haul and that they want to establish a true, long-term partnership, not just a sales relationship. But value-added services play a major role and partnerships come with a price. Physicians expect their vendors to be intimately familiar with the market they serve, and to understand patient care issues and the regulatory environment. Because group practices make a large investment when they purchase PM systems or EMRs, they want to know they are using their funds and assets wisely. Newman advises physicians to do more than just check out individual vendors. “You need to talk to other physician groups similar in nature. It’s important to do your cross checking.” Richard R. Rogoski is a free-lance writer and a contributing editor to HMT. Contact him at rogoski@aol.com. © 2002 Nelson Publishing, Inc |
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While the practice management landscape has blossomed
with progressive technology, still differences exist in issues of EMR integration, and HIPAA endures as
the looming challenge of the decade.
Bruce Kleaveland
Patrick Cline
Sheldon Newman
Michael Singer