My point is, to my knowledge, NO EMR has the ability to either import patient data from another EMR or to export its data to another EMR in the same manner that demographic and certain other data may be moved from one practice management system to another. The consequence is that a practice that does purchase an EMR that fails to work; is no longer supported; or simply outgrows its existing EMR is faced with losing all patient data.
This is unacceptable on at least 2 levels.; 1) It could have a significant impact of patient care; and, 2) No court has yet to decide on the medical-legal ramifications of no longer having access to these data.
From my experience it is better to have some standard rather than no standard.
That is where the issues are today, where are the standards to speak of. Yes they are there, but how long before they change, overnight? Not what we are used to, but it's a fast moving world out there today. Standards are becoming fractured rapidly. Some health care concerns do have to stay with certified products for various reasons, but with upcoming technology there's a whole new emerging software move taking place and yes, it confuses the heck out of everyone when it comes to decision time.
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wsivill: "to my knowledge, NO EMR has the ability to either import patient data from another EMR or to export its data to another EMR in the same manner that demographic and certain other data may be moved from one practice management system to another..."
My knowledge contradicts your knowledge. There is no standard way for one PMS to export data to another PMS. Some use HL7, some use a delimited ASCII format, and some simply provide their database schema.
There is a standard for one EMR to share demographic and some clinical data with other EMRs. It is called the CCR and it is an ASTM standard. Medtuity has bidirectional CCR capability, written to the entire ASTM standard, not a subset. We have read CCR data from a half-dozen or more EMRs.
mchasemd: There is a standard for one EMR to share demographic and some clinical data with other EMRs.
There is a standard for one EMR to share demographic and some clinical data with other EMRs.
The summary: Some EMRs can read some clinical data some of the time from some EMRs.
when you write:
"From my experience it is better to have some standard rather than no standard. It is certainly true that Certification does not mean a product is easy to use, or that the company is financially viable, or provides adequate support."...
I just can't believe that I'm reading this. You know that CCHIT doesn't guarantee anything with regard to functionality, financial viability of the vendor, or support after the sale........ but you still support it........ may I question what your motives are then????
Jamie M. Zayach V.P. of Sales mdTeknix jamie@mdteknix.com
Who gives a hoot about CCHIT certification? Vendors...that's all. They have to soley because of marketing concerns.
We know there are many claims being made by many EMR vendors little of which is evidenced based or proven. For sure there are shining examples of EMR usage but there is scant evidence that they save physicians money or time.
The same applies to CCHIT. There is no evidence that a CCHIT EMR is any better for the patient or the doc. It's a meaningless certification to those of us in the trenches and it's serving as a distraction from the core issues which is to create EMRs that perform well, save time and save money uniformly.
CCHIT is way too political to be of actual use the the end user and should be ignored in my humble opinion.
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
Good day all,
While the individual provider may care most about the functionality, usability, etc., of the EMR they are sometimes being forced to use, the EMR vendors are not marketing to the small practices - if they pick them up with very little effort, then they may take them. The EMR vendors are targeting the big practices, e.g. hospitals, fqhc's, etc. that have many seats and can generate good revenue.Unfortuantely, with these big practices sometimes comes the board of whatevers. These boards are scared to death that the government will mandate the use of certified systems and the investment in a non-certified system will be wasted.
Have a good one,
Dan
Dear Dr. Kleinman,
I couldn't agree with you more. I'm a vendor and have NO desire to feed into this process. I feel like sheep being led to the slaughter, doing just what we're told........ not questioning, not asking WHY, not saying "enough is enough.... this is rediculous".
It's the big-box vendors that want to squeeze out the small vendors and it's creating a vat of expensive EMR softwares that are NOT guaranteed to be fast, efficient, functional, or any other promise, so, I ask... what DOES being certified "MEAN"......? Vendors from top EMR companies got together and said, "here's what we have, now make everyone come up to our standard (much of which is unneccessary in the smaller markets) and if they don't, then they can't compete for business that's out there............ come on folks..... are you all really going to sit there and let this "not-for-profit" group of individuals with their own personal and professional agendas to dictate ANYTHING to us????? And, then, the real icing on the cake is the slap in the face rediculous cost for seeking and maintaining certification and then, even once you've done that, should you make even subtle changes to the version you've certified, you've got to notify CCHIT and pay an addtional 50% - 100% of the initial certification fee JUST to have them review changes????? geesh.... give me a break............
Hi Dan,
I represent a company that IS going after the smaller offices, not to say that we can't handle large ones as well, but we try to offer pricing that is affordable, functional, easy to use, helps docs to maximize reimbursements thru great documentation, and we don't take folks to the cleaners either. Again, our frustration is paying the outlandish fees for CCHIT and as a result, we are being "forced" out of the marketplace on a day-to-day basis. It's simply an unfair, stacked deck. Until the playing field is leveled, the road we're going down will only get more uneven and imbalanced.
Jamie Z.
From the data side of things, I feel the process will soon choke itself...and the rapid growth of technology and what's available today will begin a push coming to shove effect here. Many on the forum have made comments to the effect of not over looking those that are not certified, and technology and what the programmers are developing today play right in to this.
I wrote about Vanderbilt Unveristy a while back on the blog, and the program they created for Sepsis detection, and granted this is not a full EHR program but it involves patient records, yes. Silverlight certified yet...not. LINQ certifed yet...not. It is a business intelligence system to track Sepsis from patient records...sign of things to come and it's saving lives. You can also find the story on the the blog from Dr. Crounse from Microsoft who wrote it up as well about a week after I had posted. The same line of thought is in action with the progression of EHR development, so again, I feel the process is going to have a difficult time of continuing in the same fashion as it exists and the stamp of approval is going to lack some of the luster it has enjoyed thus far as the process is not going full circle and the values of the process are becoming questionable at minimum as more jump outside the box for solutions.
AOI also used the Microsoft Silverlight™ browser plug-in development tool to create the main launch page and primary navigation home page for the solution. “We used Silverlight to develop a visual style for this application that’s quite unique when compared to traditional Web applications,” McGeath says. “We modeled it after the Windows Media Center navigation metaphor, so some of the menu and command navigation scroll vertically as well as horizontally. It’s very dynamic.”
We are one vendor that just became CCHIT certified (market-conditional) and does concentrate on small physician offices, Approximately 80% of our customers are in officies with 3 or fewer providers.
While CCHIT is somewhat expensive, I don't see how a vendor can be viable if they can't afford to become certified. We used existing staff to make and test the required programming changes. I am not a huge fan of CCHIT but I also see where they add value, especially with the 2007 requirements which were heavily weighted toward ePrescribing, health maintenance and patient safety features.
C Huddle VP, Market Development www.Sevocity.com
Can you share what the health maint. and safety features are?
And please also share with us your plans for 2008 certification.
The 2007 Functional Criteria are on CCHIT's website. The Drug interactions begin on line 160, abnormal test results are on line 136 and disease management begins on line 180.
As long as certification is required for Stark exemption and FQHCs and/or any major government initiatves we intend to certify each year, including 2008.
It costs money and for a vendor its a nerve wracking experience (where else do you have to pass over 100 questions and can only pass with a 100.00% correct?). However, I can appreciate how we got here. Especially with government funding going to pay for EHRs (and it has for years before CCHIT with big grants to FQHCs) and with so many systems of widely varying capabilities, the only proper thing to do is have minimum standards. Have the requirements gone too far? Maybe, but I can also see the value.
C Huddle: Have the requirements gone too far? Maybe, but I can also see the value.
Have the requirements gone too far? Maybe, but I can also see the value.
That's because you are a vendor :) Seriously, the end user sees something else entirely. There is value in having features (as opposed to standards) but that should be defined by the user as they shop and choose their product.
I find it ironic that we talk about standards before we talk about evidence that EHRs work. We have standards on documentation yet the process slows down many offices. We have standards around abnormal test results yet we can't even get labs into the EMR without glitches. We have standards around disease management yet we have users wanting to turn off the bothersome popup windows and other reminder systems.
The powers that be at CCHIT seem to have assumed that EMRs are ready for prime time and that now we need standards. Does that not seem to be premature?