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As anticipated, the release of the proposed rules of “meaningful use” has created a lot of conversation with physicians and practice executives. As they move forward, it is most likely one of the most expensive and onerous business decisions they will make in their career.

The importance of their decision regarding who to partner with will be as important as the selection of the EHR itself. While sitting with various committees and groups with MGMA members and leadership, I have been a part of lively conversations and engagement concerning EHR, their cost and effectiveness.

Here is a brief summation of the HITECH Goals of EHR:

1. Push Provider Adoption/Use of Approved (certified) EHR Technology
2. Capture Data
3. Move Data – Interoperability
4. Report Data

$27B in “CARROT” incentives:

- Up to $48,400 through Medicare
- Up to $63,750 through Medicaid


Objectives are broad spanning goals/activities. Meeting the objectives for stage one meaningful use includes 15 core measurements required by all eligible providers and 10 “Menu” measurements from which eligible providers choose five. (To get a broad outline more comprehensive than this article, email a request to bappling@wucpas.com). There will also be a joint webinar co-sponsored by Memphis Medical News and Watkins Uiberall Healthcare Consulting Group in the near future.

I have not changed my strong opinion of the importance of knowing the history of the company you are going to be doing business with or the importance of doing business locally. Choosing an EHR is complicated, expensive and resource intensive; thus the strong opinion for working with local companies and talent. I am not too impressed with some of the following track records of EHR endeavors.



In the last five years, I have seen:

* A four physician practice ‘junk’ their EHR after a substantial financial outlay
* A solo physician spend $15,000 for an EHR only to have to ‘junk’ it for lack of support for interoperability with hospital computer records
* A thirty plus physician group re-evaluate their current EHR and their vendor relationship and open talks with another vendor
* A Physician Hospital Organization exit the EHR business after a number of physician installations

And these are just a few instances of well-intentioned decisions.

PCS Medical Solutions is a company which fits a rigorous profile of experience and an excellent product. Located here in Memphis, PCS has been in business for 25 years and has supported medical practices with over 500 providers in the Mid-South. They started their EHR evaluation over seven years ago to assist their physician groups in moving forward with this technology. They provide the hardware, software, training, implementation and support locally. They have partnered with Sage, a national provider of physician practice management and electronic health record solutions company. Sage is also a Gold Affiliate of the Medical Group Management Association. (MGMA Buyer’s Guide 2011).

With the Medical Group Management Association cost survey database as its source, the Electronic Health Record Impact on Revenue, Costs and Staffing: 2010 Report Based on 2009 Data describes the performance of Medical Groups with paper medical records and those with Electronic Health Records. Data from this report shows that groups with EHRs have higher median total medical revenue, total operating cost and total medical revenue after operating cost per full-time equivalent physician ( excuse the physician FTE component of this article, I dislike the term, but it is used in discussing costs, etc.) than similar practices with paper medical records. Most practices say the pain and difficulty of converting to EHRs is something they wish never to repeat; they agree that physicians and staff would never return to using paper medical records.

There is much to consider when selecting and partnering with a company, hospital, insurance company or other entity with such an expensive decision. Hopefully, this article has helped in looking at some of the variables (with the realization that there are more) in making a decision such as EHR.

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