The practice of charging for interfaces is ubiquitous in the healthcare IT industry, said Mark Christensen, a co-founder of WebChartMD, a Johnson City, Tenn., technology services provider to multiple medical transcription firms. Christensen said he's heard many complaints from his customers.
What with electronic prescribing, labs and other services, “the interface racket is pretty significant,” said Jason Mitchell, director of the Center for Health Information Technology at the American Academy of Family Physicians. “I asked a vendor last year, 'Why are you charging our members $3,000 to $4,000 for interfaces, and the ongoing cost of maintenance?' ” The answer is “because they can.”
With all the criteria imposed on developers to qualify their systems for the federal EHR incentive payment program, “the cost of the EHR should include all these interfaces,” Mitchell said. “Hopefully, we'll see some change coming, but I'm not holding my breath.”
Not surprisingly, vendors see things differently. Dr. Jon Bertman, founder and president of Amazing Charts, an EHR developer in North Kingstown, R.I., said his firm charges $5,500 for a high-level, HL7 interface to a lab and “for additional connections, we charge $500 for every practice thereafter. The $5,000 is for building the software, the $500 for testing and debugging.”
But typically those charges are paid by the labs, which want to use the IT interfaces to bind themselves to their customers, according to Bertman. Health information exchanges have also been useful in spreading out the costs of lab interfaces, he said.
“We never charge the doctor a fee,” said Girish Kumar Navani, CEO and co-founder of eClinicalWorks, a Westborough, Mass.-based developer of EHRs for office-based physicians. Lab or dictation companies pay for it because they know they'll make a lot of money from the physician practice down the line, Navani said.
“Why do interfaces cost money?” Navani said. “I have a team of at least 135 support people only supporting ancillary systems like labs, so it's not inexpensive. I don't think we run the interface end on a for-profit basis. We just see that there are enough resources to keep it going.”
In its latest round of rulemaking governing the EHR incentive payment program, the Office of the National Coordinator for Health Information Technology at HHS stopped short of requiring vendors to provide all possible interfaces to qualify their systems for participation.
An earlier ONC proposed rule on the testing and certification of EHRs would have compelled vendors to include “clear pricing” on their websites and marketing materials revealing the full cost to purchasers of their products in a single price. But EHR developers opposed the plan, saying it would hinder innovation and flexibility in product development.
In its September 2012 final rule, the ONC retained price transparency as a guiding principle, but said EHR vendors would only be required to “disclose the types of additional costs, and not the actual dollar amounts of such costs.”
“We suggest providers, when shopping for an EHR product, ask the vendor or salesperson to detail all of the other add-on fees for which the provider will be liable,” said ONC spokesman Peter Ashkenaz. “If the vendor is not upfront with those costs or fees, please report the vendor either to ONC or the (certification body) and we will open an investigation.”
Some physicians are more sanguine about the interface fees. “We have a couple of interfaces that are up and running that are very useful to us and a couple more on the way,” said Dr. Eric Weidmann, the HIT “champion” at the South Austin (Texas) Medical Clinic, a group of nine family practitioners that's been live on an EHR since 2002.
Three of their interfaces are to lab services providers, all with the more complex HL7 interfaces. They are “well worth it,” he said. Two more are with in-office devices, an EKG and a spirometer, and Weidmann doesn't begrudge that expense, either. “For a few thousand dollars, it's worth it having a more sophisticated, clean, timely system.”
But Weidmann said they've declined offers to connect directly with a local radiology group for a few thousand dollars. The radiology reports are still faxed over and scanned into the record, he said. To Weidmann, an interface must be “highly useful” to warrant the expense of the inevitable glitch repairs and upgrades down the road.
He has an idea of why vendors charge for interfaces. “They're doing their best to compete on upfront costs, because doctors are notoriously cheap when it comes to this stuff,” he said.