By Arthur Gasch
September and October saw three significant medical conferences: the new Digital Medical Office of the Future in Las Vegas, the 2010 AHIMA conference in Orlando and the Health Summit West in San Francisco.
HITECH definitely has the attention of integrated delivery networks, but individual physicians were underrepresented. Those with whom we spoke cited several factors keeping them on the EMR sidelines: a pending cut in CMS reimbursement; confusion about meaningful use and CCHIT certification; and concerns about HIPAA 5010, ICD-10 adoption and where they fit into accountable care organization structures and the Medical Home Initiative.
Many of the 100,000 practices that HITECH has targeted are waiting to see if any new changes will be coming. This has caused the EMR market to contract and new revenues to dry up for smaller vendors, but it has blessed about 10 vendors with new sales to pursue. By the end of the Health Summit West conference, 40 EHR products had been certified as ONC-compliant, but only about 18 of these companies have been selected by a regional extension center (REC), so their potential ROI is questionable. EMR developers are folding and merging rapidly, causing group practices to wonder if the vendor they pick today has the ability to survive tomorrow.
Ingenix, a company known for its position in medical coding, is buying into the market, recently acquiring A-Life, Picis, Axolotl, ENS and Executive Health Resources. Likewise, Allscripts has acquired Eclipsys, and GE has acquired MedPlexus (which now becomes Centricity Advance, extending Centricity down into the smaller group practice setting). More acquisitions will occur in the next six months.
Regrettably, the ONC has taken a shotgun approach, launching all aspects of many programs at once, rather than in a slower, more logical sequence. Nothing is actually ready to go yet. The announcement of the last two regional extension centers (RECs) was made in early October; some RECs are getting organized, while others are up and open for business. The ONC educational initiatives are in progress, but ideally market education should have preceded the REC initiative. RECs are taking diverse approaches to the task of creating the next 100,000 meaningful users. We get the feeling that all of these different approaches are going to vary in their success, and that the waters of EMR adoption are going to be deeper than some of the organizations expect. The grants only run for two years before falling off, and that doesn't leave much time, which is a big part of the problem.
A persistent theme at all three of these conferences was the scope of technology change that smaller group practices and hospitals face in the widespread adoption of EMR technology. There were certainly encouraging success stories, but failure and dissatisfaction with EMR rates are also running high (at 30 and 60 percent, respectively), so EMR adoption is so far achieving a very mixed result. Some have expressed their concerns to the ONC, formerly or informally, and have found their concerns falling on deaf ears. We didn't find that many were convinced the objective would be met on time, and many were concerned that if the government spends the money and fails, or continues to distort and disrupt the EMR market, that it could do more harm than good because it could drive 300-plus EMR vendors out of the market. When two companies merge, not all products remain on the market with active development; some are acquired for their market share only. The state of the EMR market right now is supercharged, turbulent and a Wild West scenario.
Gasch is author of “Successfully Choosing Your EMR” and founder of Medical Strategic Planning. Contact him at email@example.com or 732-219-5090.