Interesting blurb  - Misys is concerned with the slow adoption rate of the smaller offices, as are many in the industry. Are they right that part of the solution is a hosted delivery?

Opus

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Misys Healthcare Leading Efforts to Expand Adoption of Electronic Medical Records

Although EMR technology is prevalent in larger hospitals and medical practices, adoption has lagged among smaller medical practices and solo healthcare providers. Just 17 percent of physician offices are using EMR systems, according to the U.S. Department of Health and Human Services.

"This slow EMR adoption rate means a vital segment of the healthcare industry - medical practices with 10 or fewer doctors that account for 80 percent of all patient visits - lags behind the rest of the industry in using technology that can reduce costs and improve patient care," said Vern Davenport, executive vice president and general manager of Misys Healthcare Systems.

The delivery rate is not the issue.  The overall cost of the solution is not significantly different if it is hosted vs. not hosted.  Truth be told this will only set the doctor at ease that he will not have to manage backups and servers, this is a value, but not the reason for adoption issues.

http://www.emrupdate.com/forums/t/10766.aspx

I think that adoption issues are more likely caused by my statement in the other thread about this market segment.  Many physicians don't want to deal with EHR/EMR and in the case of small offices there is a lack of motivation even if the solutions were free and the computers were given to them.  They see the office as efficient, they have access to the charts and moreover they don't trust the computer to house information, local or not.

Don't underestimate this point, because I have now seen one major EMR/EHR hosted application go under and the servers were ceased by the Government of both federal and state for income tax and state tax evasion, and over 40 physicians lost the data until the courts release the assets.  I have also seen where servers were not properly backed up by what the practice thought were good IT folks running the system and entire charting systems lost.  So advantage is neither on ASP or local hosting of the application software.

Top that with the ineffecient data capture by a physician that currently does not have to capture data to make a visit, even if this is passed on by the nurse, and you have a low adoption rate.

 EMR/EHR vendors, the Government, and moreover, the technology currently on the market cannot in any way help with this adoption.

Bottom line if a physician does not want to buy into the EMR/EHR industry goals of data capture at the point of care and if the physician does not want to use a computer to practice medicine, there is no technical solution that will make this easy.   Small offices actually have the advantage here, think about it Bob, if you had to convince every doctor in a 50 physician practice that they are going to use your EMR/EHR or anyone elses of the the 380 or so on the market, you would never make a sale easily.  Practices with 5 or more doctors are partnerships, you only have to convince a select few and get the vote to implement the technology, and all the doctors and group are on-board, like it or not.

Now take those 50 doctors above and move them out of the group, say 30 practices of 1-2 doctor groups.  You would probably sell less then 10-15 of the practices on the philosophy/product (EMR/EHR) value to those practices.   As a result, in essense in a small practice every physician must be on board.

Moving the technology from one place to another does not ease this issue.   

Brendon:

Bottom line if a physician does not want to buy into the EMR/EHR industry goals of data capture at the point of care and if the physician does not want to use a computer to practice medicine, there is no technical solution that will make this easy.   Small offices actually have the advantage here, think about it Bob, if you had to convince every doctor in a 50 physician practice that they are going to use your EMR/EHR or anyone elses of the the 380 or so on the market, you would never make a sale easily.  Practices with 5 or more doctors are partnerships, you only have to convince a select few and get the vote to implement the technology, and all the doctors and group are on-board, like it or not.

Now take those 50 doctors above and move them out of the group, say 30 practices of 1-2 doctor groups.  You would probably sell less then 10-15 of the practices on the philosophy/product (EMR/EHR) value to those practices.   As a result, in essense in a small practice every physician must be on board.

Moving the technology from one place to another does not ease this issue.   

Interesting perspective Brendon and as one who has spent the last three years working to make our application a consistent choice in the small practice market, a perspective where we agree more than disagree. Where the rub comes for many of the small groups is not just the outright cost of the system but also the care an feeding of a system once it is installed. Resources available to manage the system and the network are sometimes difficult to come by and for the small rural practices, maybe unavailable. Thus the attractivness of the hosted solution. I agree that there is significant remaining resistance to having your data and application stored off-site and the majority of systems we sell are still client/server. But there is a definite movement towards hosting and I think if the trend continues, we will see as much as half the market going that direction in the next 3-5 years. Let's see what some of other folks have to say.

 In my area the docs are concerned about having their data off-site. It makes little sense to me, but that's their concern.

Why does it have to be one or the other? Why can't there be n off-site solution that includes and on-site mirrored storage to alleviate data worries? 

I think that most of these docs have been in practice for a while, and their paper system works for them.  Why change it?  I can tell you what they see:

-$500/month for software: $5000.00 hardware;  added IT costs; $100/month for reliable internet.

The headlines in magazines discuss the IT failures, etc.  We hear about failed implementations from our colleagues.

What is the benefit for these doctor's to implement an EMR?

-ROI--to most doctors, this is ridiculous.  This is some accounting BS that we have seen everytime somebody walks through our door to sell us something.  And I can tell you what is going through their heads----"Hmmm, best case scenario, I put 20,000 extra in my pocket, but I really don't believe that will happen.  And even if it does, is it really worth the headache, nighmares, and possible loss of employees?  And worst case--don't want to think about it.  I'll lose my shirt, and be back worse off than if I do nothing.  Will it improve my care?  Gee they say it will in my tracking of patients, but I'm worried about proper input of data.  How much is going to drop through the cracks in the first couple of years until it all gets ironed out?  Will it help speed things up?  I don't see how, and I don't care.  I'm pretty happy with my practice the way it is.  Sure, we can improve things, but its not worth the risk.  How about sharing data with other doctors?  Oh, I still have to print off the notes and send them manually?  How does that help anything?

I'm an EMR supporter, and I love my product, and wouldn't do it any other way, but the big problem with adoption is that until we have interoperability and it is a true liability to have paper records (difference in payments, etc), the impetus to change for most physicians isn't there.  BTW, I don't agree with what I just wrote, but I really don't have compelling arguments against them

DrQuit:

In my area the docs are concerned about having their data off-site. It makes little sense to me, but that's their concern.

Why does it have to be one or the other? Why can't there be n off-site solution that includes and on-site mirrored storage to alleviate data worries? 

That's the model we adopted.  We host your data, and can also backup your data to another site of your choice for which you have access.

azalea_runner:

I think that most of these docs have been in practice for a while, and their paper system works for them.  Why change it?  I can tell you what they see:

-$500/month for software: $5000.00 hardware;  added IT costs; $100/month for reliable internet.

The headlines in magazines discuss the IT failures, etc.  We hear about failed implementations from our colleagues.

What is the benefit for these doctor's to implement an EMR?

-ROI--to most doctors, this is ridiculous.  This is some accounting BS that we have seen everytime somebody walks through our door to sell us something.  And I can tell you what is going through their heads----"Hmmm, best case scenario, I put 20,000 extra in my pocket, but I really don't believe that will happen.  And even if it does, is it really worth the headache, nighmares, and possible loss of employees?  And worst case--don't want to think about it.  I'll lose my shirt, and be back worse off than if I do nothing.  Will it improve my care?  Gee they say it will in my tracking of patients, but I'm worried about proper input of data.  How much is going to drop through the cracks in the first couple of years until it all gets ironed out?  Will it help speed things up?  I don't see how, and I don't care.  I'm pretty happy with my practice the way it is.  Sure, we can improve things, but its not worth the risk.  How about sharing data with other doctors?  Oh, I still have to print off the notes and send them manually?  How does that help anything?

I'm an EMR supporter, and I love my product, and wouldn't do it any other way, but the big problem with adoption is that until we have interoperability and it is a true liability to have paper records (difference in payments, etc), the impetus to change for most physicians isn't there.  BTW, I don't agree with what I just wrote, but I really don't have compelling arguments against them

Good post AR, but with all due respect, not what we are talking about. Which is of course is, if the practice has decided despite the stuff you have posted above to do this, what makes the most sense - client/server or hosted? Lowell of course being Lowell ()wants to have it both ways and it certainly is possible to do. However the attraction for many people with the hosting is greater simplicity - you pay someone else to worry about all the server stuff and oh yeah, you don't have to buy the servers in the first place and then replace them every 3-5 years. Bringing a duplicate server back on site seems to cut against that grain.

How about the offsite data storage worries - is that still a major concern in this day and age? How about application access - again is it still an area of concern.?

BTW AR - didn't mean to slam the door on you - if you want to start another threat that discusses the really big question of should small practices do this at all, I would welcome that and jump on with my 2 cents!

Bob,

You started this thread with Misys attempt like many to move from Client Server to hosted solution.  The reason was for the change to get more small practices on-line.  Here is the issue as I have seen it, ASP models are not much cheaper then Client Server solutions.  With that in mind, and I am sure you have researched on the part of your company, the model would have to overcome this barrier.

As you state, in rural areas IT knowledge is often a long way away.  On the flip side the issue at hand is more about acceptance then on the technical delivery of the deliverables (i.e. the application software, implementation, training, etc...).

I am sure that in rural areas they fear the internet going down when they have patients from around 30 miles away or more sitting in the exam room and over 50 to see.  I have a rural family practitioner in the mountains of Georgia and I was shocked how many patients they saw a day.  I think Rural is often confused with low volume, my experience has not backed that theory up completely.

Rural single practitioner would have to have a compelling reason to invest time and money in this technology.  If they do decide to go in this direction I think that ASP or Client/Server will work for both.  If your company or others offer the software for less then the annual maintenance on a annual basis, then I think you might have something.  Even with this, I don't think if you give it away they will necessary come.

Just because you build it does not mean they come, unless of course it is a baseball field. 

How about the offsite data storage worries - is that still a major concern in this day and age? How about application access - again is it still an area of concern.?

Dam well should be Bob.  There is historical data of practices loosing all the charts to a ASP that goes under.  For the Vendor to take responsibility for this data is extremely high responsibility.  Maybe a Nextgen will be there in the long haul, so will Misys, but ASP is a bet your data proposition and some of them have failed.

As I stated so is poor IT in house, it is also a bet your data proposition.  Bottom line point I have made often on this forum is Physicians and busy medical offices are often the worst custodians of data.  As a result, many practices could go to ASP as you indicate to take standard IT management of Data in a Enterprise Class Data Center with great IT staffs.  I have seen a great model of cohosted RHIO type /IPA organizations hosting and managing IT for groups.

Regional Nextgen centers where by the IT support is local and the data central is the BOD solution for this concept.

 Regards,
Brendon

Brendon:

How about the offsite data storage worries - is that still a major concern in this day and age? How about application access - again is it still an area of concern.?

 

Dam well should be Bob.  There is historical data of practices loosing all the charts to a ASP that goes under.  For the Vendor to take responsibility for this data is extremely high responsibility.  Maybe a Nextgen will be there in the long haul, so will Misys, but ASP is a bet your data proposition and some of them have failed.

As I stated so is poor IT in house, it is also a bet your data proposition.  Bottom line point I have made often on this forum is Physicians and busy medical offices are often the worst custodians of data.  As a result, many practices could go to ASP as you indicate to take standard IT management of Data in a Enterprise Class Data Center with great IT staffs.  I have seen a great model of cohosted RHIO type /IPA organizations hosting and managing IT for groups.

Regional Nextgen centers where by the IT support is local and the data central is the BOD solution for this concept.

 Regards,
Brendon

 Thanks Brendon - anyone else want to chine in? ( As you may have noticed, I am trying to engender a little real discussion on what I see is an interesting point in our market. This is what I believe this board could do well and where it could give valuable advice to people coming to the site to look for information on how to do an EMR )

In our next interview session for the Getting Started section, due to be published later this week, Mark Anderson briefly describes medical offices he has seen where the servers are kept on the floor, where every night, they are bumped by vacuum cleaners and sloshed with cleaning fluid.

This, as opposed to a hospital IT center with up-to-the-minute backups, hard drive redundancy, and 24/7 air conditioning. 

I can see that the environment does matter when it comes to keeping a server fit and ready for action.

Bob:

I don't agree with the premise of this topic - "the way to go for the small practice" implies a one, best-solution answer.  That's nonsense.  There is no one, best solution for small practices - just numerous options; some better than others.  But if the software is glitchy, clumsy or difficult to navigate, then the network vs. ASP debate is useless.  That said -

 I have a small practice, and I have used an ASP for my EMR/PM system for three years - from patient #1 for this office.  Here is why I did it:

1) Real estate cost $215 per square foot.  I opted for an extra exam room instead of a filing room because I can make money in an exam room.  And I bought an exam table and other equipment rather than filing cabinets.

2) The ASP also worked with  Dragon voice recognition - no money has been spent on transcription.

3)  The ASP meant I could get started with two tablets; one printer, a scanner and one workstation - all wireless (well, not the scanner); no server and no build-out costs for running cable.

4) I live in an area where high-speed internet is available via a small dish pointed at a cell phone tower.  No copper or fiber optic cable to be dug up by careless construction workers.  My neighbors chose fiber, and it has been severed on occasion.

5) Most importantly, I started from patient #1 with EMR/PM - with no legacy data.  If I had already would have documented 10,000+ patient encounters on paper, I never would have attempted it.

6) It's nice having all patient records available 24/7 via the web when you are solo.  And being able to send the records to another doctor via e-fax or email - that's a nice feature, too.

There are downsides - the endless tweaking of templates and dropdown menues and too many clicks and pen taps for daily navigation are three of my pet peeves.  

The ASP is not a panacea.  But for me, it was and is a viable alternative. 

Robert Gleeman:

In our next interview session for the Getting Started section, due to be published later this week, Mark Anderson briefly describes medical offices he has seen where the servers are kept on the floor, where every night, they are bumped by vacuum cleaners and sloshed with cleaning fluid.

This, as opposed to a hospital IT center with up-to-the-minute backups, hard drive redundancy, and 24/7 air conditioning. 

I can see that the environment does matter when it comes to keeping a server fit and ready for action.

Robert,

You shameless shill for Mark Anderson

You ( or Mark actually, I guess) make a good point

I had a very nice lady pediatrician call us in tears one day because she received her server and because she ran her small office out of her home, she "didn't know the server would be so big and she did know where she was going to put it".

Mind you, this was not a big rack mounted server, but something akin to a large PC. Well we talked a little further and decided that maybe she wasn't ready for an EMR quite yet and I let her out of the contract and we parted ways on a friendly basis. Who knows, if we had been able to offer her a hosted solution at that point, she might have hung in there.

I for one would invest in a Nextgen ASP model as a physician because I know it would be hosted in a proper data center.   On the other hand Mark Anderson is going to talk about the wonderful benefits of hosted applications over that server that the cleaning person just spilled the mop bucket onto.

As I state in banking, as in medical, ASP in a proper data center hosted by a third party or a very reputable (betting the farm here) vendor is a good thing.

The problem is when the company goes under, you are better off with that dead server with a good hardrive and getting another cleaning lady.  Lets reference a Northwestern ASP that I received as a customer that had a great Data Center and the Government came in and locked the doors.  No access to data center.

This is an extreme example, but it is a real example.

Buyer must be very aware of the company in this case.

Regards,

Brendon

Bob,

Tying into the wisdom of this forum and yourself.  After 3 years of hard work trying to motivate small practices how much do you see delivery of IT infrastructure and support thereto as the actual factor in purchasing EMR/EHR by said practices?

I welcome any knowledgable feed back on this from our esteemed lurkers and members.