Print
Solutions May 2006
Feature
Article
Health
Care
A
Call for Electronic Medical Records
Distributors
change their sales strategy in
preparation for health care’s
nationwide shift to digital.
By
LaShell Stratton
In
April 2004 President George W.
Bush delivered a speech before
the American Association of Community
Colleges in Minneapolis, announcing
that within 10 years most hospitals
and physician practices throughout
the country would be expected
to adopt electronic health records,
also known as electronic medical
records (EMRs).
IN
BRIEF
A
mandate from the Bush Administration
may force many hospitals and medical
facilities throughout the U.S.
to switch to electronic medical
records in 10 years, making several
distributors in the health care
market rethink their sales strategies.
Bush
said nearly $100 million in funding
would go toward local and regional
grants that would create IT systems
that share health care information.
He also announced that a new position
would be created within the U.S.
Department of Health and Human
Services to help coordinate this
dynamic shift from paper to digital
that would make all patient records
electronically accessible to health-care
providers, labs, insurers and
pharmacies throughout the country.
The new National Coordinator for
Health Information Technology
will have until 2014 to organize
partnerships between the federal
government and private entities
to adopt this new technology.
(The person appointed to that
position in 2004, David J. Brailer,
M.D., Ph.D., submitted his resignation
in April of this year, effective
May 19.)
Distributors
who focus solely on the health
care market or see a large percentage
of their sales coming from health
care reacted to the news differently.
Under the Bush Administration’s
directive, traditional unit sets,
continuous forms and paper charts
for health care facilities will
become a thing of the past.
Some
distributors saw it as a challenge
to diversify their product lines.
“Part of what we’re
trying to do is realize that with
every new regulation there is
opportunity,” says Larry
Noethlich, vice president of sales
and marketing at RBF Inc., Lansing,
Mich. Nearly 60 percent of RBF
Inc.’s sales come from the
health care sector. “What
we’re doing to replace the
volume lost in forms is selling
more commercial and marketing
materials for hospitals. We see
fewer sales of unit sets and continuous
forms, but we are replacing them
with commercial print, bar codes,
hospital wristbands, etc.”
 |
“Part
of what we’re trying
to do is realize that
with every new regulation
there is opportunity.”
Larry
Noethlich, vice president
of sales and marketing
RBF
Inc.
Lansing,
Mich.
|
Others
saw it as a chance to create new
partnerships. George Smith, CDC,
vice president of sales at Tully-Wihr
Company in Colfax, Calif., says
his distributorship is considering
approaching software companies
that create EMR systems and explaining
that they don’t have to
go through the cumbersome process
of scanning in paper documents
that would later be converted
into digital form. “We have
the PDF capability,” Smith
says. “They don’t
need to scan it in. We’re
willing to work with them. I’m
going through the process to do
this. But it has to be reciprocal.
There needs to be an equal exchange.
If we work with them, they have
to help us to get through the
door with the customers they’re
working with.”
But
whatever path distributors decide
to take, many have concluded that
they will have to adapt with the
times and follow the current of
change to stay competitive or
in some cases, to keep their companies
afloat. “Anyone who focuses
on health care is going to lose
a lot of business if they don’t
adapt,” says David Bouvier,
owner of Doctor Stuff, Hamden,
Conn. “There will be a lot
fewer pre-printed forms. If you’re
heavily into patient’s charts
and index tabs you’re going
to lose that business. Some of
this may mean that you’ll
have to start looking into other
industries if you only do health
care. I feel that I have to start
offering technology or change
the focus of what my business
does.”
A
Nationwide Mandate With Starts
and Stumbles
Distributors
say they are noticing a shift
to EMRs but it varies from region
to region, and hospital to hospital.
They also acknowledge that some
hospitals and physician practices
are moving to digital more slowly
than others.
Smith
says he definitely sees the shift
in his regional market of Northern
California. “In California,
they’re going about it systematically,”
Smith says. “They’re
going from ER to admission. They
are doing it in modules. They’re
doing it that way so they can
gradually incorporate it into
their systems.”
Smith
says the incentives to make the
change are definitely there. “The
health care industry understands
that electronic charting is less
costly and more efficient in the
long run. They don’t have
to do dictation and transcription,
and they can get the information
spread through the system much
more efficiently. You have the
younger, more computer-savvy,
computer-literate generation that
can just key in this information.
Plus, the gradual cost of the
change has become less and less,
and you can actually do it. Costs
have come down across the board,
from the cost of computers to
the servers.”
 |
“There
will be a lot fewer pre-printed
forms. If you’re
heavily into patient’s
charts and index tabs,
you’re going to
lose that business. Some
of this may mean that
you’ll have to start
looking into other industries
if you only do health
care.”
David
Bouvier, owner
Doctor
Stuff
Hamden,
Conn.
|
Bouvier
says he has also seen the desire
to shift from paper to EMRs among
his customer base in the Connecticut
and Massachusetts area “but
right now customers are in a holding
pattern from switching over because
the government is setting standards.
A lot of people are hesitant to
move forward. There’s also
a little bit of paralysis by analysis.
They just aren’t sure which
way to go.”
When
switching to an EMR system, physicians
must choose between EMRs that
are “born digital”
and those that are scanned into
the system. “Born digital”
records can be entered into the
system through a database or transcribed
through a touchscreen tablet or
laptop computer before they are
stored on a server. In the second
version of EMR, hard copy documents
like medical forms and X-rays
are scanned in as images that
are then converted to digital
format. Information cannot be
modified with the exception of
overlay notations inserted by
third-party software. “Imaging
was thought to be the better solution
at first but not now, from the
way things are going,” Bouvier
says.
He
says this change in opinion has
led to a reduction in the number
of those shifting toward EMRs.
“I have not had many customers
switch within the past year. It’s
weird because several years ago,
I lost a lot of customers. But
it’s definitely started
to slow down.”
Noethlich
says he also sees the same hestitancy
among some of RBF Inc.’s
customers in the Upper-Midwest.
“In the center it’s
not moving as fast as we thought
it would,” he says. “We
work with the forms committees
and standards committees of several
hospitals. And we see that they
are still trying to decide exactly
how their documents are going
to be converted.”
Feeling
the Sticker Shock
The
capability to convert is definitely
available. Popular EMR software
companies include Medical Information
Technology Inc. (MEDITECH), Westwood,
Mass., and Cerner Corporation,
based in Kansas City, Mo. But
it is often the price tag of the
conversion to EMR that keeps many
hospitals and practices from taking
action.
“It
can be a very costly affair,”
Noethlich says. “This isn’t
just the cost of software. Internally
it requires a lot of resources
to do the conversion. It requires
a lot of people.”
Bouvier,
who networks with EMR software
reps at Medical Group Management
Association (MGMA) meetings, gave
a breakdown estimate for the typical
price for a physician practice
to covert to EMR. “It can
mean $7,500 to $15,000 per doctor
plus the hardware cost, plus the
support contract which is about
20 percent of the total. In the
end I would say for a practice
of 10 doctors, EMR could cost
about $200,000. Of course, this
doesn’t include the money
lost in the transition. This is
the money lost when a physician
is taking time to learn this new
software rather than seeing patients
or conducting surgery.”
Bouvier
says the decision to switch is
largely dependent on the type
of practice. “The groups
that don’t have a lot of
money will hold off on it as long
as they can,” he says. This
includes doctors who specialize
in pediatrics, small physician
practices of two or three doctors,
non-specialists, and primary care
physicians. But the practices
that can afford it are definitely
illustrating that point. “For
some of the doctors switching
over, it’s a status thing,”
Bouvier says. “I’ve
even seen a billboard where someone
advertised that they now have
EMR at their practice.”
The
federal government is trying to
offset the high costs of EMR by
including in its 10-year plan
incentives to health care providers
to switch. According to American
Medical News, so far most EMR
adoption incentives are pay-for-performance
programs in which health plans
and self-insured employers offer
bonuses to physicians who meet
clinical, patient satisfaction,
administrative efficiency and
information technology guidelines.
“Doctors
on EMR will get reimbursed by
the government at a higher rate
than doctors who still use paper,”
Bouvier says. “Insurance
companies are bound to follow.”
Seeing
Change on the Horizon
Less
than one-quarter of hospitals
in the United States currently
have operational electronic health
records, according to results
of a survey conducted by the Healthcare
Information and Management Systems
Society earlier this year. This
means that the nationwide transition
to EMR is moving at a snail’s
pace in many places, but from
some distributors’ perspective,
the final transition is inevitable
and they are preparing for the
change.
“We
have developed a software program,
Total Document Management Technology,
that would allow these hospitals
to print out EMRs on demand,”
Noethlich says.
 |
“The
Health care industry understands
that electronic charting
is less costly and more
efficient in the long
run. They don’t
have to do dictation and
transcription and they
can get the information
spread through the system
much more efficiently.”
George
Smith, vice president
of sales
Tully-Wihr
Company
Colfax,
Calif.
|
Smith
says in addition to selling more
commercial printing to hospitals,
Tully-Wihr currently has a partnership
with the software developer, FormFast
Inc., St. Louis, which sells EMR
modules: self-contained components
of EMR systems that can interface
to the other parts of the system.
“FormFast has two customers
where they’re working on
a module for admission and we’re
taking care of the consumables,”
he says. “In the past, the
majors would go in and try to
sell the whole system but now
you have people like FormFast
who just sell modules.”
Bouvier
says he has also shifted to selling
more consumables like laser printer
toner, has considered offering
scanning capability for conversion
to EMR, and is working with software
companies in other ways. “If
I have a customer who’s
actively looking for EMR products,
I will tell them about the software
company. I want customers to know
the pluses and the minuses. I
want to let them know that I’m
not hard selling them,”
he says. For recommending the
software company to his customers,
Bouvier gets a finder’s
fee or a portion of the commission.
He said it’s to his advantage
to work with these companies.
“For my business, I want
to know when I’m going to
lose my printing business….
The health care industry is changing.
There’s no doubt that it’s
happening, but the reality is
just how quick it is going to
change.”
LaShell
Stratton is an assistant editor
at Print Solutions magazine. Email
your comments to lstratton@PSDA.org.
Top
5 Reasons Why Health Care Providers
Chose to Switch to EMRs:
•
The need to improve clinical processes
or workflow efficiency
•
The need to improve quality of
care
•
The need to share patient record
information among health care
practitioners and professionals
•
The need to reduce medical errors
and improve patient safety
•
The need to provide access to
patient records at remove locations
Source:
Medical Records Institute
Top
5 Reasons Why Health Care Providers
Aren’t Quickly Adopting
EMRs:
•
Cost
•
Complexity of the system
•
Difficulty choosing an EMR system
•
Lack of staff to maintain information
systems
•
Lack of system interoperability
Source:
American Medical Association
