InformationWeek's E-Health Record Buyer's Guide

Spurred by a more than $20 billion incentive from the federal government, under the American Recovery Reinvestment Act of 2009, there's nothing hotter than electronic health records.EHR systems are comprehensive end-to-end systems with significant infrastructure, integration and training requirements. Most of them are architecturally complex to deploy and maintain, and rely on proprietary software, systems and data models. However, without adequate training and education, usability can be an issue.

The latest buzzwords in health IT are meaningful use and usability. Usability, in particular, having been long overlooked, is getting a lot of attention.

Today, health services providers have multiple options to consider in how they deploy an EHR. The needs of small private practices are vastly different from those of larger integrated health systems. Providers must consider alternative software and informatics models before investing in systems. Although several prerequisites exist, planning is needed to implement an EHR in order to ensure that it can continue to provide high-quality and high-value healthcare services in an increasingly electronic and paperless world.

The timing couldn't be better. The next generation systems (EHR 2.0) are more flexible and use SOA concepts to make EHRs easier to use, integrate and customize. They're also more cost effective to deploy and manage. The end result for users should be an easier-to-use and more productive experience.

Last month, the Department of Health and Human Services announced the final rules on Meaningful Use and Standards and Certification for EHR systems. These are the rules providers must follow to qualify for federal funds aimed at encouraging the adoption of EHRs -- $44,000 in reimbursements over a five-year period for physician practices that demonstrate meaningful use of an EHR system. As a result of these incentives, the next 12 to 18 months will see a rapid acceleration in the implementation of EHRs across varying health service environments.

During this time, end users will have a slew of choices when it comes to vendors. The non-profit Certification Commission for Health Information Technology (CCHIT), points to over 100 certified products in its portfolio. American National Standards Institute-accredited Health Level Seven (HL7) International is also developing a set of standards by which to evaluate EHR systems.

For our part, InformationWeek is producing a buyer's guide for EHR systems that will help healthcare providers distinguish among the many systems. We'll provide vendors with a Request For Information that will be seeking specific information from qualified vendors about their existing EHR systems. The RFI will include a features chart outlining key capabilities and features of an EHR. Vendors submitting a response will be able to complete the features chart based on their current EHR system and which domain it supports (ambulatory, inpatient and emergency department). In order to provide a more focused and useful comparative analysis, the target audience for the buyer's guide will be small to mid-sized medical practices.

We're breaking down the market into these four areas.

1) Commercial-off-the-shelf (COTS) cloud and SaaS: These are EHR systems that are hosted and priced on a subscription or lease basis -- several hundred dollars per clinician per month, possibly with an initial set-up fee. These software-as-a-service systems have lower up-front software costs, fewer local hardware needs and more potential for clinical data sharing between subscribing physicians. However, they may be less flexible in terms of customization and some healthcare providers may take issue with not being able to hold data on premises.

2) Open source: These EHR products are licensed under the General Gnu Public License (General GPL). They come with free upgrades, free online support, electronic billing interfaces, document management; are Web-based with secure access via SSL certificates; and have built-in schedulers. They have a number of unique features, including customizable medical encounter forms, support for voice recognition software and electronic or scanned digital document management for records. These systems lack paid support and may require customization and expensive development to meet specific needs.

3) On-premises COTS: Hundreds of commercial EHR systems exist in the market. Some of them have limited functionality -- chart creation only, for example. Others are so feature-filled that they overwhelm and slowdown clinicians. CCHIT has put forward a set of features (functionality, security and interoperability) that has resulted in a many systems being CCHIT-certified. For example, there are 164 certified ambulatory EHR products. EHR software has been developed as client-server enterprise software -- meaning, you buy it from the vendor, install it on your machines and upgrade it as new versions are released. These systems can provide a lot of capabilities, but some practitioners may be concerned about the overall cost to buy and maintain them.

4) Government Off-The-Shelf (GOTS): The Department of Veterans Affairs offers healthcare providers an enterprise-wide health IT system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture. VistA is the largest single medical system in the United States, providing care to over four million veterans. It's in use at 163 hospitals, more than 800 clinics and 135 nursing homes. VistA is public domain software, available directly from the VA's Web site.

Our buyer's guide will help healthcare practitioners jumpstart their EHR selection process. In it, we'll share the results of the responses to our RFI, taking a look at what sorts of EHR systems and tools each of the participating vendors is offering. We'll examine features and functions and where vendors say their products work. We'll also explore what healthcare providers are looking for in EHR functionality by including the findings of interviews conducted with various medical providers across the country as well as insight from industry experts.

We'll release the RFI the week of August 23. Vendors interested in providing a response will have until September 6 to submit their information. The findings from the RFI responses and interviews with medical providers will form the foundation of the buyer's guide comparative analysis in October. More specific information on the submission process will be provided in the RFI invite letter that will accompany the RFI.

For more information on the InformationWeek's Buyer's Guide, contact Sean Claes at [email protected].

Farrah Jolly is an IT Health Portfolio Manager with Fusion PPT, a strategy and technology solution firm. Farrah supports the program management of IT health projects and has worked with electronic health records, IT Governance and public health throughout her career.