A better system is needed to migrate to electronic health records

Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use.

We researched all available systems and decided upon MediNotes because it was a large company with an excellent record of service and their system met all the national requirements for certification. We worked through our local computer vendor’s family run business because they had supplied and serviced our electronic billing system well for years.  Their fees included an annual software maintenance fee and an annual hardware maintenance fee which, combined, cost several thousand dollars per year.

We were overjoyed when Congress passed the American Recovery and Reinvestment Act of 2009 which said that we would be reimbursed up to $44,000 per doctor over 5 years for our investment and the meaningful use of the system. Shortly after learning the details of the law, MediNotes sold out to Eclypsis – a gigantic computer company.  We were told that Eclypsis had developed an updated MediNotes product called Peak Practice that met the new meaningful use criteria of the law.  The Peak Practice system implemented recommendations from MediNotes users to improve upon the software and user experience.

We were informed we could convert our system, or “migrate” to the new system, by paying an additional $7500 in fees for training, software and integration of our system with our websites. Due to a backlog of orders to “migrate”, we planned on contracting in the fall of 2010 to convert in the spring of 2011.  Once our decision was made, we requested the contract and other documents from our local vendor.  However, they did not appear.  We were then informed that Eclypsis sold out to Allscripts. Allscripts is a large health care services provider that has a large hospital computer health record business as well as a small practice electronic health record package branded “My Way” which my vendor has yet to see.

I am all in favor of capitalism. I am also in favor of investors getting back their money with a profit. I am not in favor of absolutely no federal oversight of the medical record computer industry.  The vendors have created a feeding frenzy for physicians seeing $44,000 as the carrot at the end of the stick. The vendors won’t wait for the federal payments for meaningful use to collect payment for their systems. They want their money up front. Meanwhile, computer companies continue to sell out to larger predatory companies leaving physicians saddled with a computer system that is obsolete and has no future technical support.

There has to be a better way.

Steven Reznick is an internal medicine physician and can be reached at Boca Raton Concierge Doctor.

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  • rhonda

    sorry to hear this. another example of where government sadly has to step in because cooperations decide to abuse power & be greedy like the health insurance companies have been. ive been wondering how health IT was going to streamline costs eventually. i can certainly see how it can make things much more efficient once up & running universally. but thats going to take a long time….

  • rezmed09

    So the solution is more government rules and regulation?
    I know this will infuriate people, but what is the difference between:
    A) a company dropping a product, buying and selling product lines and putting the customer in a squeeze
    Versus

    B) A newly created concierge doctor closing his practice to hundreds of poorer patients who have invested years of their lives and health histories in a doc’s practice just so that the doc can have a better life or profit margin.

    The people in these EHR companies are also trying to make a profit and keep their jobs. They are not interested in small practices – at least not yet. Both situations are pure capitalism – of which I am a fan.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      The real difference is that the Federal Government is mandating that we install these computer sys

      • http://www.BocaConciergeDoc.com Steven Reznick MD

        the real difference is the Federal Government is necessitating implementation of an EMR system and will begin penalizing physicians financially who do not participate in meaningful use of an approved system.
        The decision to convert my practice to a smaller one was based on the fact that with reduced reimbursements and increased administrative costs created by private managed care insurers , I did not feel I was able to devote the time and attention to my aging patient population. As they became more complicated, less time was available to see each one. Insurance and administrative changes necessitated seeing three more patients a day to stay in the same place. I wasnt getting any younger and felt that doing an outstanding job on fewer patients made more sense than limiting my time on many. Many of my 3500 active patients chose me because I was on ” the plan.” Year to year they switched doctors routinely based on which insurance plan their employer chose. My oldest and most complicated patients were invited to stay with the practice regardless of ability to pay the membership fee. I interviewed twelve young internists in my community and chose four to suggest to my patients who did not join the concierge practice. No patient was left without a doctor. All records were copied and transferred at my expense.
        The financial problems of small primary care practices have been well documented on these pages and others. Having a concierge practice was my solution to a health care system in disarray with no relief provided by the AMA, ACP or our elected officials.

        • rezmed09

          I stand corrected and see the difference.

  • DrAshish

    Buyer beware. Emr industry does not need new. All new industries need time too mature. Regulations are not always the answer. I do however understand your emr dilemma. I invested in an EMR 4 years ago choosing Eclinicalworks for a couple reasons:
    1. Price- $10k license per physician one time, than I pay about $3500 per year total (not per provider) for maintence and ALL the bells and whistles I added. Most importantly free updates
    to meet all future standards, and included 24/7 support as well as an amazing independent large active community of users to problem solve with.

    I’m shocked that your provider charges ANY fee for updates and improvements. All emrs evolve and we should not be required to pay extra fees. It’s living developing software. That one of the many reasons why I find allscript To be a terrible choice for small practices.

    Disclaimer: I own stock in Allscripts regardless of whether I’d use it or not.

  • rwatkins

    This is becoming a, if not the, major reason many of us are resisting buying EMRs. Once you decide on a vendor, they can eat you for dinner on a daily basis and you have no power to stop this. No thanks!

    Dr. Reznick. I wonder if you’d tell us why you decided to purchase an EMR 6 years ago? Thanks.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    This is one of those, unfortunately common, stories that make one uncomfortable with being part of the “industry”.

    I don’t know if, and to what extent, government should be involved, but the crux of the matter here is the contract. Perhaps this was not as easily seen 5 years ago, but today any EHR contract should include provisions for change of ownership, discontinuation of support and any new enhancements.
    If a company decides to sunset an EHR for any reason, M&A included, there should be no migration charges for existing customers. Maintenance fees should, by definition, contractually include all software upgrades and all new functionality.

    The problem here is that there seems to have been a local Value Added Reseller involved, and Peak Practice is not an upgrade to MediNotes. It is a completely different product acquired by MediNotes from Bond Technologies, just like “My Way” is a leftover from a Misys/iMedica (now Aprima) deal. Yes, it isn’t pretty at all…

    If I were in the author’s shoes, I would look elsewhere for a long term solution, and I know it means that all the previous investments are down the drain and the migration will be painful.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      thank you

  • http://www.BocaConciergeDoc.com Steven Reznick MD

    I decided to purchase an EMR system six years ago because I thought it would make my practice more efficient, eliminate handwriting confusion, lead to an easier time tracking preventive health items and anniversarys and prepare the practice for the coming technological changes of the future

    • jsmith

      Dr. Reznick, I would value your opinion. Overall, has the change been worth it? Why or why not? Sorry to be late to the party here.

  • solo dr

    Many of the EMRs and Billing companies have fine print that they own the bills bills that you send to them. You have to pay them for the data, if you migrate to a new system. Annual update fees and tech support fees are the norm. The $44,000 may seem like a deal, but give it 5-6 years of paying $3,000-$9,000 a year in update fees and it is not such a bargain.

  • John Ryan

    I have been using a basic small practice EMR called Amazing Charts since 2007. $2K per doc, $1K per year optional support & updates. Google it and decide yourself. I’m not selling it, just a user who is hoping if they get enough takers, it won’t go the way of MediNotes.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      A consultant from the MGMA recommended Amazing Charts. I looked at it and loved it. Thanks for the suggestion. It is on my final four list.

  • Marc Gorayeb, MD

    These posts highlight why well-drafted contracts matter in business transactions, why an active marketplace in EHR systems ensures price and service competition, why any monopoly in EHR – including one sanctioned by the government – is bad, and why mandates by the government, rather than organically-driven demand, distort the whole business.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      I couldnt agree with you more Dr. Gorayeb.

  • Leon from Redding CA

    Doctor Reznick:

    Through the 80′s and 90′s I made my living as a “value-added reseller” successfully selling and implementing “practice management” computer systems for physicians with the hope of migrating into the EMR market. Over those years many of these physician/clients became friends and the EMR market was too volatile to commit to migrate our clients.

    Then came the American Recovery and Reinvestment Act with its promise to pay our clients to convert to EMR systems. This sounded so positive that our firm finally committed to making the transition to selling and supporting one of the top named EHR systems and I set out to convince my clients (friends) to commit to the change. Then the reality of dealing with the government set in. Our government can come up with a 2,000+ page law with complexities we are still learning about but in two years it couldn’t decide on what “meaningful use” meant.

    Being an honest salesman (yes there are many) I ended up counseling my clients to “wait a little longer.” In the end our small business collapsed and one of our partners ended his life in despair. Most of our former clients that are still in practice are functioning on twenty year old software and badly need to move on.

    My hero, Ronald Reagan once said: “Government is not a solution to our problem, government is the problem.” I’m convinced if government got out of our businesses, we could work these problems out on an individual level. Yes, “A better system is needed to migrate to electronic health records” but don’t be looking for the government for the answer, it is problem.

    • http://www.ehiconnect.com Anthony Subbiah

      Hi Doc; your situation is unfortunate but reality as well. Yes; consolidation in this nascent industry is expected and will continue for some time to come. Having said that, independent, value oriented private companies such as eClinical Works and for that matter our company Enable Healthcare will continue to thrive in this atomosphere of growth.
      Most of the web based systems do not require you to invest so much in CAPEX. With a nominal implementation fee upfront (less than $5K) and a monthly fee of less than $500 you are able to get a decent certified EHR integrated with a latest billing and claims module as well. With no requirement to have a Server within the premises your total cost of ownership is also way low.
      Industry will take some time to mature; there is no short cut to the timelines. Yes, some of the early adapters like you, will go through hiccups. While I feel the pain, its something that has to be faced and grow with the industry.

  • http://none Owen Linder MD

    When incentives are aligned the barriers seem to go away. By working wtiha giant isurance company, Humana, I pay nothing for electronic medical billing on avaiity.
    For data storage of billing I use a free system sourced off the internet called EZclaim.
    For network maintenance I pay $50 a hour for services renderd toa bright younger person.
    I store all office notes in open office. org which comes with a PC.
    We are backed up on Crash Plan, on external hard drives and again at my home.
    Incoming material has been scanned into hardrives for storage.
    Amigo Doc creates prescription which are legible, as Rx storage stored by patient and categorizes by any rubric, time, drug, etc.
    It is an elegant system and run by the software writer. for single PC users he gets a licensing fee of $300 a year. For a multiuser license on my networked PC and full tech support of his software the annual fee is $800.
    I can cut and paste or burn discs of any portion of my records.
    I can laboriously paste it to email and send it off.
    I could allow logmein by an auditor if they could ever agree to it.
    I hand rxs to my patients or fax them to pharmacies. Amigo Doc is not emailing Rxs. I do not gain the incentive from M/C
    It is unreasonable meaningful use. My way is knitted together and works quite well. I don’t have any significant upfront cost and function quite well.
    I could install word recognition but I have improved my typing tothe speed and ease of composition I don’t need it.