With the CCHIT certification being so onerous on small companies writing EMR softwares, I have written to CCHIT, medical economics, ACP, FTC about the absurdity of fee structure for certification. I would suggest that other users of small sized EMRs think about this (as you are trained to be thinkers), if you feel it is appropriate, so that we the users of small sized EMR softwares do not get obsolete, write letters to CCHIT and other forums of medicine and other medical organizations (eg., ACS, AGA, AMA, State Medical Societies etc) you belong to, the way you feel about this issue. The links are: for CCHIT first register and then submit public comment- http://www.cchit.org/comments/register.asp http://www.cchit.org/comments/comment.asp For American College of Physicians: http://www.acponline.org/cgi-bin/feedback For Medical Economics: http://www.memag.com/memag/static/staticHtml.jsp?id=109644
For Federal Trade Commission:
https://rn.ftc.gov/pls/dod/wsolcq$.startup?Z_ORG_CODE=PU01I have enclosed a copy I wrote to CCHIT: ____________________________________________________________ This letter is regarding the fee for CCHIT certification and why you urgently need to change your fee structure and make it easier for small vendors of EMR. I should say that I don't agree about this certification process just because of what I view as unfair fee. We have been using Amazing Charts EMR for more than 2 yrs, we are happy with the use, the developer Dr. Jon Bertman is a practicing Family Practitioner and is constantly making improvements. We are running a chart-less office (paperless office in common parlance) with Amazing Charts. The program is stable, solid and ideal for small practices. As I understand it costs an EMR company about $28,000 for 3 yrs and another 9,600 for 2 yrs to maintain the certification process. It costs about $200,000.00 for an EMR company to go through the certification process. These costs will ultimately be borne by public; initially vendors pay, then they pass on to medical practices. Ultimately patients and insurers will pay more, as it will work its way up into payment formulas. This I believe is rather unnecessary and expensive proposition. Many of the EMRs small practices use EMRs that cost around $1000 (what we use - Amazing charts cost $995.00 for 1 user). The software developer will have to sell 200 copies of software just to pay for this certification process!. This cost will be somewhat fixed for all companies selling EMR. I sincerely hope you will not succeed in your endeavor if your fee is priced as it is now. Your organization may crush small EMR vendors who are doing a terrific job in supporting the small practices throughout the nation. If your main aim is to allow interoperability, then that is already done by many EMR companies in the form of CCR. We have that capability too in Amazing charts. Or on the other hand CCHIT may become obsolete if you keep your current fee structure as only big companies will get certified, pass it on to Physicians, who will totally ignore you as they are not ready to pay those high fee indirectly. I think the CCHIT certification is absurdly priced, it is not logical in that even the expensively priced ones will have problems on a day to day use as you will find out talking with doctors who use them. I wanted to share my opinion with you regarding what my feelings are and what I think the physicians in USA should do. My opinion and suggestion to doctors in small practices who are contemplating to buy CCHIT products is -- look at the overall cost of ownership say for 20 yrs, or longer if you are going to be around practicing medicine, don't buy products just because they are CCHIT certified. In my opinion it means nothing in running your day to day practice. If you pay $20,000 for just software, close your office for 5 days training to you and your supportive staff, and pay 20-25% support fee per year you will not recoup that money anytime, however you calculate. Many doctors who bought expensive softwares (read CCHIT certified) feel they are stuck with it, as they have already invested heavily in that software and breakups cause a lot of interference in day to day operations. I also hope CCHIT will not abuse the power it has to twist the arms of Medicare etc to allow only CCHIT certified products to participate in P4P etc. Hopefully this letter will you some food for thought about your fee. As you have seen already only big companies who charge huge amounts for their software are getting certified by you. I would suggest you visit EMRupdate.com (if you have not done that already) to get a feeling how the physicians and EMR vendors feel about your organization and what you are doing will eliminate the innovation and crush small vendors (This I believe is against the principles on which this great Nation is built upon). And hopefully you will revise your fee structure based on cost of software. signed---- _____________________________________________________________ Regards.
AC user.
I just returned from the 2006 AAFP Scientific Assembly where I sat in on a talk by Dr Steven Lane, a board member on CCHIT. While his talk was about the basics of CCHIT, including their mission and a discussion of the certification process, the Q&A session afterwards was quite interesting. A SoapNotes user was very worried that his product was not among the initially certified, and wanted to know if he should switch at some point. Dr. Lane's answer was, "Does it work for you? Does it do what you need? If yes, then there's no reason whatsiever to change..." In fact, he seemed to go to great strides to suggest that CCHIT certification is not the final word in usability. Rather, he seemed to suggest that he anticipates there will remain into the foreseeable future functional, purposeful 'non-certified' products as they fill an obvious need.
Thus, I wonder if maybe we think CCHIT certification has more sway in the world of EMR's than it really does. Or do we?
When we started our own private practice 8 yrs ago after being employed for years, here in Michigan about 800 doctors/practices had a billing software from BCBS Mi called MBA. [the cost was $5000.00 for network version, no workstation fee. Medic (now know as Misys) was $10000.00 or more with charges per patient encounter to transmit, whereas BCBS MI EDI was free] (I think there are about 14000 licensed doctors in Michigan- part time, full time, self-employed, salaried, Professors, non working etc). The program was very good, served the purposes. They were in market for about 20 yrs (yes twenty yrs). Price was reasonable, monthly fee was reasonable. I heard from BCBS rep at that time that they were billing company with most customers. We bought it for functionality, we were in majority group, what can happen?? Then the standards changed in about 2001/2002. Government brought in HIPAA.
Then BCBS Mi said we can't change the program to meet the HIPPA standards. For us that $5000.00 was lost after just 3 yrs of software use due to changing standards of transmission, when everything was working just fine. Overnite these 800 practices were left stranded. We were SCRAMBLING to find one reasonably priced billing company that would suit our budget and so were the other 800 practices. You have to be in that position to understand how hard it is when you are under time pressure, when it is your practice income. With EMR at the least you can go to paper, but with billing? We did find one eventually but that is a different issue.
The issue here is why you need to be worry about CCHIT. Just like they say in any contract, any verbal assurances/comments made by company sales rep or for that matter CEO (who can be replaced and kicked out tomorrow or may decide to leave due to the say for eg - family reasons or jumping to greener pastures), can't be taken. Tomorrow only the written words will be taken into consideration. So if some company rep says like this, if it important, I would ask them to put it on company website, make it their official policy. Will he do that? I bet he will not. Why should he? For me the CCHIT motives are suspect.
So I strongly believe the users of small EMR should be really worried about this certification process. Hope this motivates the users of small EMR to take action now (better be early than sorry in this issue).
Regards--
Graham http://www.synapsedirect.com/ Synapse - the EMR for smart users
Yeah- and there is a worldwide interest in expanding this, especially if it takes hold in the USA.
I've added this thread's URL to the anti-CCHIT grass roots effort index:
http://www.emrupdate.com/forums/ShowThread.aspx?PostID=56268#56268
It's updated several times a day due to the large volume of stuff that is being generated; it's the only way to keep everything organized and in reach.
Al Borges, M.D.
● Oncologist in a Small Group Practice in Virginia
● My website URL: http://msofficeemrproject.com/
Here is one more contact address for ACP members--
Staff Liaison Maxine ToppingE-mail: mtopping@acponline.org
http://www.acponline.org/college/localcon/borlist.htm?in
to request to change ACPs position on this issue.
http://www.cchit.org/payers/learn/Professional+Endorsements+of+CCHIT+Efforts.htm
http://www.cchit.org/files.lib/pdf/endorsementACP.pdf
Letter written to:
http://healthdatamanagement.com/html/Letters.cfm
For all the people- Doctors, EMR vendors and well wishers- great news--
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>>> So I strongly believe the users of small EMR should be really worried about this certification process. Hope this motivates the users of small EMR to take action now (better be early than sorry in this issue).
Actually, I've always stated that the users of large, expensive EMRs are the ones most at risk. If any problems occur, more money is lost. The lifespan of any software program is measured in months, not a "lifetime" like many are made to believe.
For nonbelievers, check out http://nextag.com, the site that I use to buy stuff when I can't get it on eBay: