Yet many observers said EHR buyers shouldn't expect the experience to be much different from buying a car. A bank doesn't modify its automotive loan terms just because the car itself may not have met the buyer's expectations.
“One of the things we've struggled with in the past is to make sure that financing is still tied to the vendor,” said Steven Waldren, director of the American Academy of Family Physicians' Center for Health Information Technology. “Once the vendor got paid, the incentive to find a solution was less. They had no obligation to make sure the software really worked.”
A crucial difference in an EHR loan compared with a car loan is what's at stake: a doctor's ability to freely access patient data. Even in cases where the data is guaranteed to be returned if the deal goes south, the doctor needs to make sure the contract says exactly how that would happen.
A partner with physicians
Kim LaFontana, a vice president with Ingenix, agreed that the issue could pose a concern for physicians. She said her company tries to position itself as a partner with the physician, instead of just a vendor, and would always make arrangements to transfer patient data back to the provider, in whatever form they request it. “There's no case in which we would hold patient data hostage. That's not what a partner should do,” she said.
Lawsuits filed against one EHR vendor in South Florida alleged the vendor declined to give physicians passwords to access their patient data until they paid increased maintenance fees, and the company eventually filed for bankruptcy protection, according to court records and published reports.
Meanwhile in Wisconsin, the Milwaukee-based Independent Physicians Network in November 2008 sued its EHR provider, MedcomSoft, for failing to deliver a master index of clinical information for data-mining, court records say. The lawsuit was dropped four months later after MedcomSoft's law firm, Foley & Lardner, reported to the court that the company was not only in bankruptcy, but also it did not appear to have any employees or directors following a sale of its assets to a Pennsylvania-based limited liability holding corporation.
“I think we're going to see more of those kinds of horror stories,” said Nancy Nankivil, the senior vice president of quality and efficiency for the Wisconsin Medical Society. “There are some double-edged swords to all of this. Physicians are trained to provide patient care, and they now have to become IT experts, finance experts, legal experts, compliance experts.”
One of the ways recommended to avoid problems is to do business with companies that have a track record and a stable presence in the market. Few in the industry doubt that some of the vendors operating today will not exist in five years. Although mergers and acquisitions in healthcare are nothing new, observers say it's particularly an issue in the EHR world because the federal grants have become a “pot of gold” attracting vendors with little prior experience.
But Steven Grant will tell you that even picking a long-standing vendor is no guarantee.
Grant, a physician, is president and CEO of United Physicians, a 1,700-member independent practice association in Michigan. About five years ago the organization subsidized the adoption of an EHR offered by Misys Healthcare Systems in the offices of more than 170 of its physicians, after doing extensive research on the various functionalities of the software, as well as the histories of the companies backing them.
But in 2008, Misys was bought out in a $330 million deal to form Chicago-based Allscripts-Misys Healthcare Solutions. Grant said the merged company has begun informing United Physicians' members that it will no longer support some of its Misys systems, which his IPA helped underwrite, and that some doctors' offices must pay thousands in fees for installation of new software.
An Allscripts spokesman responded that practices such as the ones in Grant's IPA are in fact not required to make the switch from their Misys software, which the company will continue to support and maintain. Physicians will need the switch, however, in order to have an EHR that gets certified for stimulus incentives, and Allscripts has presented the cost to Misys customers as a return of $10 from the government for every $1 spent on the upgrade and associated hardware.
But Grant isn't happy. “We did a deal with Misys. They're not there anymore. They're AllScripts,” he said. “At the time, Misys was considered one of the top EMRs in the country. … We thought they were going to be around for a long time. Well, guess what.”
A version of this story initially appeared in this week's edition of Modern Healthcare magazine.
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