Med groups link up with IT vendors

The American Medical Association has a solution for physicians put off by the quickly evolving, high-stakes marketplace for health information technology.

Specifically, it has a doorway to other people's solutions, and it plans to sell tickets for entry.

Over the past several months, the organization has announced partnerships with a few technology companies that have signed on as participants in this new online platform, including NextGen Healthcare Information Systems and CareTracker, which offer integrated electronic health-record and practice management applications.

The AMA and other national physician groups generally have steered clear of endorsing any particular product or vendor, choosing instead to be counselors and resource libraries to members attempting to understand a complex and quickly evolving marketplace before investing tens of thousands of dollars and untold hours into a product.

Some organizations, however, are taking tentative steps into business relationships with vendors. The American Academy of Family Physicians and the American College of Physicians, for example, are adopting models that charge vendors for a presence in Web resources available for practices exploring their IT options.

The AMA is going much further with a new project called Amagine that is expected to launch in 2011. It's already up and running in Michigan as a pilot project coordinated with the Michigan State Medical Society.

The state association had been planning a similar project. Both were working with Covisint Corp., a division of Detroit-based Compuware Corp., working out the technology to create a cloud of online applications and allow physicians to log in once and get access to their entire array of tools, including registries, health records, e-prescribing and lab orders.

In addition to agreements with Ingenix for its CareTracker product and with NextGen, the Amagine project has inked deals with DrFirst for e-prescribing; Quest Diagnostics' Care360, a suite that includes lab ordering, e-prescribing and other tools; WellCentive's patient registry; and Dell, which will offer e-mail and data-storage services, as well as discounts for Amagine customers who want to upgrade their hardware.

The AMA isn't endorsing those products; nor is it entering licensing deals that would give the organization a cut of the business. The association instead is striking deals with a variety of vendors and will enter into contracts directly with physician practices.

The AMA will provide technical support and, in some cases, implementation services. The details depend on the particular product and service level chosen in the contract.

"Occasionally, if the product doesn't work, we'll go back and put the pressure on the vendor—we have to work with them," says Robert Musacchio, AMA senior vice president of business products and services. "But the relationship is between the physicians and us, and us and the vendors. We're the ones who are holding the responsibility here."

Amagine is expected to generate revenue for the AMA. "Yes, it will be a business line for the American Medical Association," Musacchio says. "However, the reason why we got into this is really about engagement and wanting to provide physicians with some help."

The AMA began bringing vendors into the Amagine marketplace by evaluating the business needs of its potential users and then pursuing business deals with vendors that met a few criteria: they'd been around for a while; their products were market leaders; the price points were accessible for small and midsize physician groups; and the technology could conform to the AMA's platform.

Although the AMA endorses no particular option among the ones that become available through the portal, the association necessarily is deciding which products can be a part of the market created by its cloud of applications.

Now that vendors know what the AMA is up to, they're clamoring to be a part of it—though not all will pass muster. "What I don't want is a solution that's been developed by the famous two guys in a garage that may not be here tomorrow," Musacchio says.

Several regional extension centers also have entered group purchasing contracts with lineups of vendors for products vetted for their likelihood of allowing users to meet the federal government's criteria for putting the technology to meaningful use, a regulatory regime that doesn't necessarily fit neatly with the marketing.

In September, the Massachusetts eHealth Institute promoted 10 EHR vendors as offering products that met criteria that help determine buyers' eligibility for federal health IT subsidies under the American Recovery and Reinvestment Act of 2009—even though no EHR system at that time had been certified by any of the entities authorized to do so. MeHi later clarified that the vendors were offering guarantees their products would be deemed compliant. Certifications of products have since started rolling out.

Some state medical associations are forming partnerships that lend visibility and credibility to health IT vendors while offering member physicians discounted rates on the products. The Indiana State Medical Association, for example, entered into an agreement in August with Indianapolis-based iSalus Healthcare that brings members discounts on the company's Web-based EHR and practice-management software.

The Michigan State Medical Society, meanwhile, launched a portal in January 2009 that is identical in concept to what the AMA is pursuing. A partnership was struck with the AMA later that year, and the MSMS switched to the similar platform that Covisint developed for the AMA, allowing Michigan to become the association's testing grounds.

Virginia Gibson, director of subsidiary services for MSMS Physician Services, says the organization envisioned its project as simply another resource for members who would continue to contract individually with their chosen vendors, with the MSMS Connect portal providing physicians with streamlined access to those applications.

“We want to simplify as much as possible for the physician, but we still want them to be given the opportunity to choose what works for them in their individual practice and situation,” Gibson says.

More than 500 users, about half of whom are physicians and half of whom are practice managers, are using the platform in Michigan. Some are now using the AMA-branded version.

Interest has been growing, Gibson says, as practices become intent on qualifying for subsidies under the stimulus law. "The hurdle is how to explain the concept," she says.

The AAFP has no plans to follow the AMA's lead—be a party to its members' IT contracts or directly tailor the technology to its members' needs. The AAFP Center for Health IT instead intends to move the marketplace in its own way. While the organization will maintain its neutrality, the strategy will align the organization more closely with vendors than before.

The AAFP previously established what it called the "ACID" test, inviting vendors to certify that their offerings abide by the principles of affordability, compatibility, interoperability and data stewardship. They essentially pledged "that they supported family medicine," says Steven Waldren, M.D., the AAFP center's director. The companies paid a small one-time fee for legal work, and their products and services were listed on the AAFP's website—along with a lengthy boldface disclaimer of AAFP liability—and physicians were invited to share their experiences using them.

But the center now is plotting to revise its strategy to encourage technology developers to build features into their products that support the changing needs of family practices, many of them striving to remake themselves as patient-centered medical homes, Waldren says. For example, he says, “Can it tell me who all my diabetics are, or the diabetic patients that haven't come to my office in six months even though I've told them to do so?”

The AAFP is developing a new set of principles, and companies will be invited to pay a more-substantial (as yet undetermined) sum to be part of the program.

The money raised from vendors would support educational resources for practices and will stay within the program, he says. "That money comes out of the pockets of the customers, which are going to be our members." The program is not, he says, going to create "a windfall for the academy."

The American College of Physicians, meanwhile, has rolled out a somewhat similar idea. In July, the ACP unveiled AmericanEHR Partners, a partnership with Cientis Technologies, a firm based in Vancouver, British Columbia, that previously developed online tools to help Canadian physicians with their health IT shopping.

AmericanEHR Partners charges vendors an annual fee of $7,200 to be included on its website, which now has 4,100 registered users representing more than 45,000 physicians, according to Michael Barr, a physician who is the ACP's senior vice president in the division of medical practice, professionalism and quality.

Information the vendors provide allows their products to come up as possibilities when users submit a description of their needs. Users also may choose to have their needs relayed directly to vendors. The site also generates revenue from advertising, though Barr says the advertising policy does not allow advertisers to pay for preferential placement in search results.

Several medical specialty groups, including the Infectious Diseases Society of America and the Renal Physicians Association, have signed on as partner organizations. They are able to query participating companies to customize the website's search filter to their members' needs.

"This is a business model we hope will be self-sustaining and generate revenue," Barr says. "We know that the success of this site is going to be significantly dependent upon the credibility with physicians. It's not going to abuse their trust," he adds. "The whole goal is to put as much information in as usable and accessible a format as possible."

Other physician groups, including the American Medical Group Association and the Medical Group Management Association, say they intend to remain free of business relationships with IT vendors.

Surveys have indicated that most AMGA members already have made their technology vendor choices—90% of them have implemented or are in the process of implementing an EHR system, AMGA spokesman Ryan O'Connor says.

Cynthia Dunn, a principal in MGMA Health Care Consulting Group, says she's often asked for the association's preferred products and has to demur. "We get that question a lot: What's the best one? Just tell us the best one," she says. "I think where practices are going to get into trouble and the reason I have a job is some are in a hurry. People in a hurry think you can just plug and play."

However, the MGMA is putting together a directory of IT vendors that offer practice-management systems that are up-to-date and compliant with the upcoming 5010 HIPAA transaction standards and ICD-10 diagnostic codes. The transaction standards take effect Jan. 1, 2012. The diagnostic codes take effect Oct. 1, 2013.