Electronic health records: Déjà vu all over again

By Michael Uretz, DrBicuspid.com contributing writer

April 27, 2009 -- A few years ago, when speaking at medical conferences to physicians and practice administrators about how to select, purchase, and implement electronic health records (EHRs), I regularly fielded audience questions and comments such as, "Why do I need it?" "I've been practicing for 20 years just fine without it," "I'm worried about privacy," and "It's just too expensive."

“The dental industry today is exactly where the medical industry was five to 10 years ago.”

Fast-forward to 2009. Today my phone is ringing off the hook with very different questions and comments: "How do I choose a good EHR vendor?" "Can you help me negotiate my EHR contract?" and "How fast can I implement an EHR system?"

When it comes to understanding and embracing EHRs, I think the dental industry today is exactly where the medical industry was five to 10 years ago. The same questions are being asked, the same concerns are being raised, and the same skepticism is coming out of the woodwork. Just as the medical industry was once dominated by a few prominent legacy practice management software companies, so is the dental industry today. But EHR technology, the Internet, and a fervent entrepreneurial spirit changed all that in medicine, and I have no doubt these same forces will yield similar results in dentistry.

In fact, when it comes to EHRs, the dental community has a key advantage over the medical community: lessons learned. So what is the first lesson the dental community can learn from tthe mistakes physicians have made? Begin the process now, don't wait! It typically takes a medical practice much longer than they imagine to research, select, implement, and adopt these technologies. As the saying goes, there is no better time than the present to start understanding this technology and give yourself the best chance of success when you finally decide to adopt an EHR system into your practice.

Where have all the vendors gone?

Not so long ago in the medical industry, a few large software vendors held a substantial portion of the market share. Having established themselves as "the" players in the market, these vendors were often known for their overpriced software, poor support, one-sided contracts, frustrating implementations, and "my way or the highway" attitude.

I recently had a conversation with a dentist about software selection, pricing, and contract negotiation. He was convinced that, because only a few dominant players are in the dental software market, dental practices are pretty much held hostage by the vendors' rules.

I wish I had a dollar for every time I've heard this over the years when talking to physicians. As it so happens, however, this vendor attitude eventually led to a reduction in market share for a number of legacy medical software companies. The growing adoption of EHRs in medical practices has been an important contributing factor to this evolution. As the popularity of EHRs grew, the large practice management companies began trying to fit a square peg in a round hole and add an EHR "option" to their systems.

Unfortunately, these EHR modules were basically an extension of the existing management software, and so didn't necessarily address all the features a true EHR needs to have. But the companies were betting that their existing customers would choose their EHR offering because they were already doing business with them and it would be difficult to interface with a competitive vendor's EHR system.

A few years ago, I was working with a small medical practice that had been using a legacy practice management system for a number of years but liked the features of a competitor's EHR system much better. So we asked the practice management vendor to work with the EHR vendor to develop an interface so the procedure codes could automatically migrate from the EHR point-of-care clinical documentation system to the billing and claims processing systems.

The practice management vendor, one of the largest software vendors at the time, refused and instead kept pushing its own EHR system. We eventually opted to get rid of the original practice management system and purchase a completely integrated practice management and EHR system from the competitor.

By just being willing to meet our needs, the legacy vendor could have kept my client as a customer at least on the practice management side. Instead, they lost the whole account because of their "my way or the highway" attitude.

Can't we all just get along?

At present, dentistry does not have as many EHR options as other medical disciplines do. But the times they are a-changin'.

The EHR industry has been developing standards for the exchange of health information, and we should begin to see these efforts include dental charts. I have been a member of the working group for the Certifying Commission for Health Information Technology (CCHIT), an organization that is responsible for developing certifying criteria for EHR vendors. Requiring vendors to adhere to interoperability standards is a growing responsibility of CCHIT. While this does not directly affect dental software providers today, it will eventually, and those who begin to incorporate the idea of such standards into their product development today will be a step ahead of the competition.

Such standards especially come into play when building community health information exchanges. These frameworks, growing in popularity throughout the U.S., allow medical practices, hospitals, pharmacies, labs, imaging centers, and other short- and long-term healthcare facilities to share critical information about patients. As dentists become more involved with the medical aspects of their patients, they should begin to be a part of a patient's growing health information network as well.

In fact, wouldn't it be nice if all the medications that have been prescribed for your patient by all providers were available at the touch of your fingertips, as well as allergies, previous diagnoses, and other pertinent information? And having updated clinical guidelines and protocols for decision-making delivered real-time electronically can only enhance your options as a provider.

In addition to standards development, we are beginning to see changes in software development. As once happened in the medical field, smaller dental software vendors are developing more robust, cost-effective, and user-friendly dental charting and related packages that leverage the latest software development capabilities and technologies for computing and telecommunications.

But interoperability is key. Looking ahead to the next few years, dental software providers large and small will be challenged to develop products that will allow dentists to be part of their patient's overall healthcare. The end result, however, should be nothing short of revolutionary.

Michael Uretz, executive director of EHR Group, is an authority on health IT selection and contract negotiation. The EHR Group helps providers, practice managers, and administrators select health IT vendors, structure and negotiate contracts, and ensure that projects meet budget and timeline requirements. He can be reached at mikeu@ehrgroup.com.

For more tips and advice, download his free white paper, "7 Mistakes Made When Purchasing Electronic Health Records."

Copyright © 2009 DrBicuspid.com


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