MGMA 2010 – Randy Schiff (Aprima)

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Ann Fishman and Richard Jonas of EHRTV speaking with Randy Schiff, Vice President of Aprima Medical Software

Category: Featured, MGMA 2010, Tradeshows
Date: November 16, 2010
Views:5,201 views

Ann Fishman: I am Ann Fishman with Richard Jonas of EHRTV. We are with Randy Schiff, Vice President of Aprima Medical Software. Randy, thank you so much for joining us.

Randy Schiff: Thank you very much for having me.

Ann Fishman: We would like to talk about the very important topic of "meaningful use". Would you speak to the final rules that just came out this summer?

Randy Schiff: So, the Interim Final Rules were published earlier in the year and there is an open comment period of 60 days where anybody can make suggestions on their perspectives of what the final rule ought to be. The government received over 2000 comments during that period of time and then they went through those and in the middle of July, they published the final rule. The interesting thing that came out is that while the criteria that were published in the Interim Final Rule remained the same, some of the requirements were changed, they were lessened. For example, originally some of the physicians were going to have to submit, I think, 70% of their prescriptions electronically and in the final rule that number was reduced. There were some exceptions that were made for specialties that don't do prescriptions at all, for example. The other thing that was changed in the final rule was that the criteria that were in the list of 25, and I am speaking only for ambulatory EHR, I am not speaking at all about hospital EHR software; but for ambulatory EHR software, they broke their criteria into two sets – a set of core items and a menu set items. So, in that group of 25, there were 15 core items and everybody has to deal with all 15 of those; and then in the menu set, there were 10 items there and the physician can choose 5 out of 10, they have to report 5 out of 10 of those. So, again from the Interim Final Rule stage, a physician would have had to have done all 25; after the comment period and the final rule, they only have to deal with 15 core and then 5 of the 10 in the menu set.

Ann Fishman: One of the components of "meaningful use" is to be using a certified EHR. So, would you speak to the certification process in general?

Randy Schiff: Sure. I think one of the things to keep in mind is what the government originally did and where we ended up now. Originally, the government said there were going to be businesses or organizations that would be testing body and then there would be another organization that would be a certification body. So, an EHR vendor like Aprima would take our software to the first vendor, they would be tested against the standards, and the results of the test would passed to another organization which would certify those results and then we as a vendor we get the result of that certification. The government realize they are very interested in being able to have vendors certified by October and they realized that for companies to apply to become a testing body and a certification body that was going to be very difficult for EHR vendors to ultimately again certified by October so that there would be certified products in the market by January of 2011 which is really what they were trying to achieve. So, the government said “You know, we are going to have a temporary process where a single organization can be both a testing organization and a certifying body” and so anybody could apply to do that and if they met the government criteria, then they were announced as an ATCB – an Authorized Testing and Certification Body. Today, there are three organizations that have achieved that; the first one was CCHIT which is the Certification Commission on Healthcare Information Technology, a long-term player in the industry from an EHR vendor standpoint for assessing the quality of EHR products. The second one was the Drummond Group and then the third one is a company called InfoGuard. So, today an EHR vendor can take their software to any of those three organizations and have their software tested and certified to hopefully ultimately become a certified product. The interesting thing is that all three of those organizations, remember, they had to apply to the government, and in order for them to be chosen by the government, they had to prove that they could follow the government's procedures exactly so that any vendor's product that ultimately receives certification would have gone through exactly the same process as any other vendor and the standards that government used for the certification where established by NIST – the National Institutes of Standard and Technology. So, all three of those groups – CCHIT, Drummond and InfoGuard – would have taken NIST standards and run a product like a Aprima software through that ultimately to get the certification.

Ann Fishman: How onerous do you think the "meaningful use" standards are for physicians to comply with?

Randy Schiff: Perhaps in a couple of specialty situations, there may be some challenges, but for the most part I would say it's not difficult. The software today does so much of what the physician would need to have done on paper in the past and kind of an interesting analogy is that if you are familiar with PQRI – the Physician Quality Reporting Initiative – there was a 2% or so <<inaudible>> that was available to physicians, and if you weren't on Electronic Health Record software, it really wasn't worth the extra paperwork that would have taken to qualify for that; but if were on Electronic Health Record software that allowed you to do that, then it just kind of came out of your workload. In Aprima, for example, when a physician is documenting a patient's visit, they can see when they have done the things that are required for PQRI which just shows up on the screen, they don't have to do anything differently, and then they submit that and they receive the certification; but with a certified EHR as far as "meaningful use", then the software is really going to step them through everything that they need to do and the vendors are going to let them know which of the menu set – there was the core set of 15 items in the menu set of 5 out of the 10 – the vendors are going to recommend which of the 5 are going to be the ones that they ought to be able to do. For the most part, I don't think it's going to add very much of a burden at all.

Richard Jonas: So, as a vendor in a certification processes, I assume you have to pass all 25 criteria – the 15 mandatory, the 10 where the physician picks 5 – but as a vendor again, correct me if I am wrong, you have to pass all 25 to meet the "meaningful use"?

Randy Schiff: Right.

Richard Jonas: As a vendor?

Randy Schiff: Yes. So, as vendor our software has to pass all 25 of those and the reason is that in that menu set where the physicians choose 5 out of 10, some specialties, some of those menu set items may not apply. Of course, we want to be able to sell our software to anybody and so it needed to handle all 25 of the criteria. You actually bring up another good point too in there. There are two ways that an EHR product could be certified in these process – one is as a complete EHR and one is as a modular EHR. Aprima was certified as a complete EHR which means a physician can buy Aprima and any of those 25 criteria they will be able to satisfy. There are other products that may not have that breadth but they could be certified as a modular EHR and perhaps with the recommendation of that EHR vendor, the physician could cobble together all of the components so that ultimately they would have a complete EHR. So, there were two levels of certification.

Ann Fishman: We are in phase one of the paradigm. When phase two kicks in, what new requirements will likely be in place?

Richard Jonas: Let's couple that with a second question – not only what paradigms but do you think these paradigms are being driven, is technology driving what ONC is looking at or are physicians driving it because there is a clear differentiator between what a physician needs to practice versus a set of requirements that says “you have to do 1, 2 and 3.” How do those melt together?

Randy Schiff: Right. So, the way I look at it, there were the three stages. The stage 1 was announced earlier this summer and that's what we are going to place in January of 2011. The stage 2 criteria are forecasted to be ready by 2013 and then the stage 3 criteria by 2015. So, one of the things that we know is that as you go from stage 1 to 2 to 3, the criteria that are in there are going to be increasingly onerous. So, the key takeaway there is that it’s better to start now; and when you start to look what the reimbursement models are, the government has really frontloaded the whole process. So, there's more money available in the first few years; and if don't start till several years out, there is potentially less money that's available for you, and the stages that you have to attest to are easier the sooner that you start. So, the physician that starts now in January of 2011, they can meet the stage one requirement which can be the easiest of the three stages twice, they meet the stage two requirements twice, and they only have to meet the stage three requirements once. If you delay for just a year and don't start to use the software until 2012, you meet the stage one requirements once, the stage two I think is twice and then the stage three is twice, if I have that right. So, one of the things then is start now.

As far as the components and the criteria, the second stage, as we talked about the first stage having the 15 core items and the 10 menu set items and the physician can choose from that menu set, everything that we have read that we believe is that in stage 2, all 25 of those will be core requirements. So, that's an example of one of the differences between stage 1 and stage 2.

Stage 1 was really about enabling the physician to be able to gather the data and to provide some educational materials for the patient to make transactions easier. The second stage and the third stage ultimately are designed to enable higher quality of care for the patients and to make that care more readily available across the nation and then also to increase the reporting of disease states and disease outbreaks so that the government can kind of better track those things. So, the second and third stages are going to go deeper into what the delivery of care is all about.

Richard Jonas: So, what's Aprima’s position – maybe ‘position’ is the wrong word – but the movement towards the personal health record and both the security of that data and you mentioned just now about the patient's moving or health record being available; so the patient's health record should play a large piece. Do you see that as a major focal point in the future for making sure that patient's are educated?

Randy Schiff: Well, the education piece is actually part of the "meaningful use" requirement. So, for example, a physician is expected to be able to hand a patient their continuum of care record or documents that talk about smoking cessation or diabetes management or whatever. And as far as the personal health record though, it's not an area that Aprima plays in today. There are certainly very large organizations and very large insurance companies that have taken a position there, but it's not an area where Aprima's involved in.

Ann Fishman: Well, it has been a very interesting interview. We thank you so much, Randy Schiff.

Richard Jonas: Thank you.

Randy Schiff: Thank you.

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