Providers get discounts by signing up with Arkansas HIT Preferred EHR Vendors

There are several hundred vendors of electronic health records (EHR) in the U.S. Choosing the right company to trust with such vitally important records could be a difficult challenge.

The Arkansas Foundation for Medical Care’s Health Information Technology (HIT) Regional Extension Center (REC) has made that task easier by doing a comprehensive evaluation of vendors, selecting 11 for Arkansas that meet the requirements for Preferred EHR Vendor status.

“We heard from the Arkansas Medical Society concerns about the financial viability of some of the EHR vendors, concerns about ownership of medical records, and concern some providers had when vendors were not fulfilling their obligations,” said Arkansas Foundation for Medical Care Chief Operating Officer Jonathan Fuchs. “Providers were left out in the cold. There are some 300 odd vendors out there, perhaps more. We felt it was important to evaluate those vendors and provide advice about which vendors have certified systems and are able to meet the various meaningful use criteria to allow providers to obtain stimulus dollars from Medicaid and Medicare.”

The REC went through a Request For Proposals (RFP) to choose the HIT Select Vendors. While 42 companies responded to the RFP in July 2010, only 28 had complete applications. Eighteen of those were interviewed, and 11 chosen as Select Vendors after an extensive interview and onsite review process.

Fuchs said of first importance was addressing the issue of data ownership to make sure the physician or clinic owner owns the data and that it can’t be used without the express permission of the owner. Other issues evaluated include the ability to meet meaningful use criteria, a provision for recovery of the records in case of a disaster, an escrow for source code if a vendor becomes insolvent for any reason, the ability to upgrade, and a clause that the provider is held harmless if the vendor becomes insolvent.

Vendors had to agree to specific terms and provisions that added protections for Arkansas providers. And they had to agree to provide a set REC price.

“Providers who use HIT Select Vendors not only get a set REC price, but they also get free technical services if they join up with the REC,” Fuchs said. “Providers don’t have to negotiate price and terms. That is the real advantage of joining REC and using one of our vendors. REC is required to assist up to 1,280 providers in Arkansas, which is not a lot compared to RECs in some larger states. But we are getting the same price as other larger RECs in the country.”

Currently 780 providers in the state are signed up with the REC. Fuchs hopes that number climbs close to the total number of providers as more people get on board with EHR.

REC will provide technical assistance even if a provider prefers a vendor that is not on the list, as long as the company is certified with the Office of National Coordinator (ONC) for HIT. In that case, providers are on their own when negotiating contracts. But the REC will assist with implementation and technical services.

“We will tell them what questions to ask, but they will have to negotiate the master service agreement with vendors themselves,” Fuchs said.

While the REC is not focused on assisting the state’s largest hospitals, it does provide assistance to 35 rural hospitals with fewer than 50 beds through the REC’s cooperating agreement with the ONC.

“Right now we have about 10 signed up, but we want to be working with all of them,” Fuchs said. “What we do for them is two things: We help them with an upfront readiness assessment, and then go in to help them understand how to meet meaningful use criteria.”

It can take a year or longer for a hospital to adopt EHRs. For a medical practice, it can take 60 days to three months or more.

Regarding what to look for when choosing a vendor, a lot depends on size of practice and its comfort level of practice with EHRs.

“Do you want your own self-contained system and server on site?” Fuchs asks. “Do you have the technical staff to support that kind of activity? Or do you want to use software as a service that is Internet based. Does the clinic have broadband access? What are the clinic’s needs? And what is the clinic budget?”

Fuchs said the stimulus money available to providers is up to $44,000 per provider for Medicare and up to $63,750 for Medicaid. The vendor selection will depend on the clinic’s budget and potential for stimulus payments.

“The price range for these vendors is all over the block,” Fuchs said. “Website\software as services are generally less expensive versus the server type with extra hardware. Prices can range from a couple thousand a month to a Lamborghini-type system. The key point is each one of the vendors on our approved list have met requirements of the national coordinator so that they will meet the meaningful use criteria if the provider meets the requirements of the program.”

Some physicians nearing retirement age may be reluctant to change over to EHR. Fuchs said that physicians should consider that this is going to become the standard of care. Failure to keep up with the technology changes could make it more difficult to recruit younger doctors, or to sell a medical practice upon retirement.

“You should consider the value of the practice when making these decisions,” Fuchs said. “And, at the end of the day, this is an improvement in the way information is utilized so we can reduce errors, eliminate paperwork, improve personnel utilization, and reduce excess testing and services. At the beginning, it will not be a cost savings. It will take a lot of hard work and perseverance. But providers need to do this because this is a journey to a superior way of recording and taking care of patients.”

HIT Arkansas has been holding a series of ehealth summits that include hands-on vendor demonstrations and education. There are ongoing regional meetings where providers will have an opportunity to meet other physicians using these systems. For more information, see the website www.hitarkansas.com.

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