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Electronic Medical Records


Impact of meaningful-use criteria on EMR developers


Insights from the 2010 MSP/Andrew EMR Benchmark By Arthur Gasch, founder, MSP; and Bill Andrew, executive VP, MSP


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ecause of the emphasis by the Obama Admin- istration on converting 100,000 primary-care physicians using paper-based medical records to become users of electronic medical records (EMRs) that achieve meaningful use (MU), there is strong interest in how well the EMR market is doing. Medical Strategic Planning (MSP) conducts periodic EMR benchmarks of various capabilities of EMR prod- ucts, which includes the impact that national policy has on EMR developers. The 2010 (13th) EMR benchmark has been underway since April 1, 2010 and this is the fi rst article reporting some of its results. More than 700 EMR developers (or their resellers) were invited to participate. The term MU came into existence with the passage of the February 2009 Ameri- can Recovery & Reinvestment


Arthur Gasch and Bill Andrew are founder and executive VP, respectively, of MSP.


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Act (ARRA), which included the term meaningful use – but did not defi ne it – as a precondition for receiving reimbursement by physicians who adopted EMRs. The idea was to encourage 100,000 physicians currently us- ing paper-based charts in one- to 10-doctor practices to adopt EMRs that achieved MU and allowed them to put away their paper charts. It was a lofty goal.


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And it was left to the Department of Health and Human Services (HHS)


to defi ne the MU term in a timely manner. On Jan. 9, 2010 – almost 11 months after ARRA was passed – the term MU was defi ned in a 220-page document issued by HHS. This document drew tens of thousands of pages of comments from various stakeholders who were unhappy with various aspects of the MU defi nition and


18 July 2010


certifi cation requirements. One such comment was a letter from the United States Senate issued on March 2, 2010, signed by 27 senators (from both parties) to Char- lene Frizzera, acting administrator, Centers for Medicare and Medicaid Services, taking issue with various MU provisions. A subsequent letter dated March 30, 2010, to Kathleen Sebelius, secretary, Department of Health and Human Services, and signed by a broad coalition of 37 senators (from both parties), asked for a fl exible ap- proach to encourage hospital and physician participation in the inventive program. The current status is that the comments are being digested and a new (fi nal) version of MU is expected to be issued in the Federal Register by the time you read this article. Not surprisingly, in this climate of regulatory uncer-


tainty, neither hospitals nor physicians are rushing to buy EMRs, since they have no way of knowing if they will ultimately be reimbursed for their expenditures. Their reluctance is impacting the EMR market in some profound ways. The ARRA legislation was supposed to stimulate the adoption of EMR – but has it had that ef- fect? In fact, there is mounting evidence that ARRA has not had uniformly positive impact. The EMR market has become more complex, more expensive and less stable since ARRA was passed, as many physicians and hospitals, initially poised to purchase EMRs in 2009 and 2010, have retreated to the EMR market sidelines to camp out until the MU issues are fi nally clarifi ed. Survey results suggest that for a segment of the market, Washington’s actions have driven the EMR market into a 15-month (and count- ing) market stagnation. For some EMR developers, the impact of Washington’s bureaucratic delay has been like an elephant wading into a kid’s plastic EMR swimming pool and then sitting down – squashing a few kids (EMR developers) in the process and squeezing out most of the water (EMR orders) it contained. Here is the data.


Meaningful use-related EMR Benchmark questions EMR Benchmark question: “How did the delay in defi ning MU affect company (EMR developer) revenues


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