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Janury 22, 2007

Independent EMR Consultants: Is There a Need?
By Selena Chavis
For The Record
Vol. 19 No. 2 P. 34

Physicians can’t help but hear the clamor to adopt EMR technology. Perhaps if they had an expert shoulder to lean on, they would be more apt to make a commitment. Then again, maybe not.

There are two old adages that many HIM professionals agree ring true for electronic medical record (EMR) adoption: “Time is of the essence” and “Time is money.” In an era of tighter healthcare budgets, higher costs, and staff shortages, many healthcare providers are left without many resources or options for effectively transitioning to EMRs.

Faced with the daunting task of reengineering the way business is done, experts say that some healthcare providers are treading cautiously for fear of making costly mistakes, which leads to the question: Why aren’t there more independent EMR consultants?

In an industry where it seems there are consultants for nearly everything, technology vendors and professionals suggest there are currently only a smattering of people who have made it their full-time profession to provide guidance for EMR adoption.

“There are some … I know four or five who do it for a living,” says John Lynn, creator of an EMR and HIPAA blog and student wellness technical specialist at the University of Nevada, Las Vegas, adding that while the need may appear great, he doesn’t see many professionals moving their careers in that direction. Noting that he has done some consulting with a few physician practices, Lynn believes it would be difficult to obtain enough business from physicians to make it a full-time endeavor.

“Most [healthcare providers] just get their IT implementation people to consult,” he says, further adding that when he implemented an EMR at the University of Nevada’s student health and counseling center, “they called their implementation people consultants.”

William Bryson, a partner with Ohio-based IT solution company Calyx, concurs, noting that in his experience, the consulting role often falls in with a healthcare provider’s IT vendor. “There’s a need for guidance, and we do provide that as an option,” he says.

Would More Consultants Speed Adoption?
Bryson believes the need for independent EMR consultation exists, especially in the case of physician practices. “We started to focus on physicians because it’s incredibly important to get doctors on [EMRs],” he emphasizes, adding that most physicians don’t have the time or knowledge to sort through the 400 to 600 available products that address EMRs. “With some of these things, it doesn’t make sense for you to do it on your own. Do you see the value in having a team of experts on your side?”

Lynn agrees, adding that “you need someone who is going to be a champion of that product. Everyone buys in because everyone can look at the consultant and say, ‘This person knows what [he or she is] doing.’”

Many believe expert consultants could hasten EMR adoption by alleviating the time and resources required to select appropriate technology and map out new clinical record processes. While most professionals agree that there could be efficiencies achieved through the use of EMR consultants, they are also quick to point out that numerous obstacles exist to the use of consultants, especially within physician practices.

Steven Waldren, MD, MS, director of the Center for Health Information Technology with the American Academy of Family Physicians (AAFP), believes independent physicians and physician groups currently face the greatest obstacles to EMR implementation and the use of consultants. “In all of our surveys, well over 80% have made the decision [to implement an EMR] but don’t have the financial resources or are afraid of making the wrong decision,” he says.

Unlike a hospital or medical-surgical setting, justifying the use of consultants in a physician practice is more difficult because the cost per unit is so much higher, says Waldren. “There’s more potential for value there [in a hospital setting],” he notes. “It’s easier for a consultant to go into a hospital because there is so much more that needs to be done.”

Bryson acknowledges that he has witnessed a reluctance on the part of physicians to pay for outside consulting services. “Everything [in the EMR process] is so cost-prohibitive right now. I hear physicians say, ‘I don’t really want to pay these guys $10,000 to do this—I’ll do it myself,’” he says, adding a warning that without knowledge of the inner workings of the technology field, expensive errors can be made. “For them to make the right decision is paramount. There are monies to be saved by having professionals in your corner.” Bryson adds that the most significant errors in the implementation process often come from not investing the right amount of money in infrastructure and training.

Waldren says it often becomes a quandary for physicians because they don’t have the financial resources or desire to pay for expert advice, but they are reluctant to start the process of EMR adoption due to fears that the wrong decisions will be made. “You need to show value, and you need to build trust. Those are the two things consultants have to answer for,” Waldren emphasizes. “I do see some uptake [with EMR consultants], but I also see that they have a difficult marketing challenge ahead of them [with physicians].”

Waldren notes that the AAFP has a listserv of consultants for EMR implementation that has been somewhat successful because the doctors are well-known and trusted in the industry.

The uncertainties associated with legislative decisions and issues surrounding EMR adoption also slow down the process for physicians, Bryson adds, naming topics such as privacy, product certification, and lowering the financial burden. “They are extremely reluctant right now, but I understand why they are reluctant,” he remarks. “They don’t want to move forward because they don’t know what is going to happen. Ultimately, the doctors have to want to take the next step before they are going to approach a consultant.”

Potential Benefits
Overwhelmingly, EMR experts agree that one of the greatest benefits to seeking expert advice for EMR implementation is the guidance that can be provided in the selection of appropriate technology. “There’s so many of them [vendors] out there,” Lynn says. “Knowledgeable consultants can weed the top tier they know have been successful.”

Currently, there are a number of Web-based services such as www.emrconsultant.com and www.centerforhit.org that offer advice about EMR technology, but Lynn says healthcare providers and physicians often don’t have enough background to ask the right questions. “Vendor miscommunication is a common problem,” he says, suggesting that it is wise to use the negotiating skills of someone who “speaks the language” of technology vendors. “A good consultant will look through your processes and apply them to the electronic medical record,” he says.

Offering an example, Lynn notes that one of his evaluating clinicians asked a vendor, “Can your EMR handle a walk-in only system?” Acknowledging that the vendor had some great features to handle walk-ins and intermix them into a clinician’s schedule, he recalled that the word only was missed in a sales communication. “It would have been much better to ask the EMR vendor, ‘How can your EMR handle a walk-in only system?’” Lynn says, advising to stay away from yes/no questions with vendors.

Bryson says he has seen healthcare providers make the mistake of signing on with vendors that don’t have an established track record. “There are lots of small companies putting stuff out. There are applications out there with only one or two doctors signed on,” he says, adding that if a small company puts out a good product, it will often get bought out by a larger company.

He also cautions that he has seen start-up companies approach physicians with an offer for them to get in on the ground level of a business opportunity. “If I were consulting with a physician, he would adopt an [EMR] system from a small company like that over my dead body,” Bryson remarks.

In mid-sized to large physician practices or healthcare settings, Waldren suggests that a consultant can help with consensus building. “Likely, there will be a few champion physicians, but the whole practice has not said, ‘Yeah, we think EMR is important, and we’re ready to move forward,’” he notes.

Lynn concurs, adding that if it is a person everyone trusts, a consultant will often add a certain comfort level to the process as well as keep the process on schedule or accelerate initiatives if needed.

Experts emphasize that the consultant’s role is not to make choices for healthcare providers but to help them make their own informed decisions. “You play devil’s advocate,” Lynn says regarding the need for an independent consultant to present all sides of an issue.

Bryson agrees, adding that anytime a consultant is engaged with a client, the primary duty is to help them make a decision that is in their best interest. “Lowest price and best value are not necessarily the same thing,” he emphasizes.

A Business Plan for EMR Consulting
Intrigued by the identified need for more EMR consulting, Lynn says he had given the concept considerable thought and currently has plans to write a business plan for an EMR consulting company.

Lynn views EMR consulting as a feeder into a number of other “commodity” services. Waldren concludes a similar conceptual understanding of consulting duties, saying he could see an EMR consultant offering a basic implementation service with “a la carte” features such as contingency planning, privacy, security, and HIPAA requirements.

Lynn says the central functions of an EMR consultant involves the selection, design, and implementation of EMR technology. After implementing an EMR, he believes a physician’s office or clinic could benefit from computer maintenance such as completing Windows updates; antivirus, adware, and spyware scans; and backup checks. “These are the type of commodity services that I think many doctors would find useful to have someone else do monthly,” he notes. “In fact, doing these things is pretty much required by HIPAA.”

Another potential service that Lynn believes would be beneficial for physician practices are HIPAA security audits and reviews.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.

Advice at No Charge
While many healthcare providers may not have the resources or desire to hire a consultant for implementing electronic medical records (EMR), Steven Waldren, MD, director of the Center for Health Information Technology (CHiT) with the American Academy of Family Physicians (AAFP), notes that most are open to free advice. A number of services and blogs are available on the Web that offer the latest information on EMR technology and issues.

Self-described as a physician’s guide to EMR solutions, the service was founded by Eric Fishman, MD. Doctors and practice managers fill out a Web-based questionnaire, which is followed up by representatives asking more detailed questions. Recommendations for technology are narrowed down to three to five systems out of approximately 300.

AAFP’s CHiT (www.centerforhit.org)
The CHiT is the focal point of the AAFP’s technical expertise, advocacy, research, and member services associated with medical office automation and computerization. Available through the organization’s Web site, the step-by-step EHR adoption guide includes a readiness assessment, product reviews, and an e-mail discussion list.

Marketed as an independent, unbiased, and unfunded forum, emrupdate.com currently has more than 5,000 members who can take advantage of advice and testimonials offered through blogs, interviews, and forums.

EMR and HIPAA (www.emrandhipaa.com)
Founded by John Lynn, a student wellness technical specialist at the University of Nevada, Las Vegas and a former consultant for EMR projects, EMR and HIPAA is an open forum offering advice from experts and information on technology.

— SC