The third component says that there must be "quality measure reporting." Five years ago, there were 10 basic measures. Now there are 43, and the talk is that it will go to 70. Measures include just about everything, such as, "Did you give a patient admitted to the emergency ward with chest pains an aspirin?"
These three requirements alone will mean a good deal of training from IT, as well as maintenance to keep up with the latest patches and changes to regulations. But in terms of needing IT, the last requirement is what Blumenthal says will be the straw that breaks the camels back: interoperability.
Interoperability and the rise of EHR SaaS
EMR systems will need to tie into HIEs (health information exchanges), and this is the biggest opportunity for IT.
"Everyone is talking about it," says Blumenthal.
There are numerous HIEs now, and none talk to one another. Blumenthal believes the entire initiative will fall apart if the various vendors' EMRs can't communicate with the numerous HIEs and the various HIEs can't talk to one another.
Wes Rishel, Gartner vice president and distinguished analyst, says no medical practices with fewer than 50 doctors, maybe even 100, can really afford -- even with the stimulus -- a dedicated IT department. The solution, as Rishel sees it, comes down to four choices:
- The traditional client/server system in an office with an Internet connection for submitting bills for reimbursement
- A managed service with servers in the office but managed by an outside provider
- A managed service with the software on your local server but managed remotely
- A cloud or SaaS service with any computer as long as it has an Internet connection
As far as I can see, over time SaaS will be the winner, with dozens of SaaS providers offering soup-to-nuts solutions, all the way down to e-prescription services.
It will take time. Rishel says that E-Clinical Works, a service that hosts patient data, surveyed its doctor clients and found that 75 percent will not accept putting patient records outside of the office. They will pay more for local management of operations. The reasons are manifold, from feeling a duty to protect patient privacy to fears of vendor lock-in.
"The idea of starting over is intolerable," Rishel says. They are even concerned that despite vendor promises to the contrary, local payers will get into their systems, see how much they are charging, and will want to renegotiate contracts.
Rishel believes, as do I, that like it or not EHRs are going into the cloud. There will be setbacks, but there is no choice -- unless every doctor wants to become an expert in IT or hire one.In the first few years, there will be dozens of SaaS providers, but over time, there will be industry consolidation. In the meantime, I would say get your health care IT surfboard waxed and ride the wave.
Next week's post will discuss the dangers of putting EHRs in the cloud.