Back on December 4, we posted a bit on the inexpensive and small EHR that are opting for CCHIT certification. Recently, we received a request to post a comment that was being held for moderation. Long and the short, the comment never got through so I asked the commentor, Dr. Alberto Borges, to send it along directly to me so that I could ensure it posted. Rather than tuck it back in the comments section, where few are likely to see it we decided to give Dr. Borges his own post. Here's what he had to say in response to our original post.
YOU STATED>>> "among the list of eleven newly certified EHR "[m]ost.
. . are inexpensive products from small vendors. Health IT experts say
that this undercuts claims by CCHIT critics that certification is a
plot by big vendors to drive small ones out of the market."
The
fact is that none these EMRs are anything from "inexpensive" or
"low-cost", terms usually applied to those EMRs that have up-front
costs less than $5000.00 (or less) in the first 2 years. These vendors
are also not "small" by any means, unless of course you're comparing
them to GE.
The process of finding out an
actual price of an EMR is like asking the mafia to price out one of
their illicit products. Some even claim that their price quotes are
even "copyright"! If you call them they offer sale price incentives
that can lower a "regular" price, but then they can add additional
optional packages that can significantly increase the base price. It is
like throwing a dart onto a moving target! On top of these
difficulties, they also will have their nag salesmen call back several
times, and one once even called me on my emergency cell phone. The EMRs
that post the true cost of ownership up front are usually the true
"inexpensive" EMRs.
Here
are some facts that I have been able to obtain from these so-called
"small" and "inexpensive" group of newly CCHIT certified products:
- (from
http://www.emrupdate.com/forums/post/3656.aspx) "The quote from
Acermed for the above is 58K for all training and conversion of my data
now (Medisoft) into there software PMS." - Redneckdoc at emrupdate.com
- (from http://www.emrupdate.com/forums/thread/58695.aspx) "Medinotes=ChartingPlus and the price comparison table puts it at $7610."
- (from
http://www.emrupdate.com/forums/post/35376.aspx) "Hal's EMR costs for
Medinotes+PMS, one physician "Primary Bundle" plus "installation" and
"training bundle" and "NDCMedisoft bundle"... ~$18600" [in 2005]
- AcerMed
is 127% of the cost of e-MDs (which puts it at slightly over $19000.00
for a 2 doc, 2 year use)
(http://www.emrupdate.com/forums/thread/35301.aspx , and calculation
using price matrix)
- Bond Technologies, 2 docs, 2 years comes out to about $27600 (http://www.emrupdate.com/forums/thread/26506.aspx)
- Medplexus-
one poster at http://emrupdate.com stated that in 2005: "they wanted to
charge for each computer I had it on. If I recall, the software was in
the 20k range [for one physician, one license]."
- CPSI- could
not get a per-office or per-license cost, but found this out about this
vendor: "Cash collections of $20.1 million for the quarter (1st
quarter, 2004) on sales of $18.2 million... Total revenues for the
first quarter ended March 31, 2004, decreased 9.3% to $18.2 million
compared with total revenues of $20.1 million for the prior year."
(http://www.cpsinet.com/news/article.php?newskey=125) Of interest,
Yahoo has its 5 year stock performance as FLAT, in the $32/$33 range.
(http://finance.yahoo.com/q/bc?s=CPSI&t=1d)
- Abelsoft* is priced up-front at just under $10000.00 for a one physician base license (private communication from vendor).
- NetSmart*- From their own website:
"Netsmart provides comprehensive financial, clinical and management
solutions for more than 1,300 organizations, including more than 30
state systems, to help them improve the quality of life for millions of
consumers. On 11/22/2006, Iowa Department of Human Services Selected
Netsmart Technologies for a $2.5 Million Statewide Software
Implementation."
I
hope that this clarifies the untrue hype that is being posted by
HIMSS/CCHIT. There is no way that a true low cost EMR vendor can afford
to pay the costs of this certification process.
Sincerely,
Dr. Borges
Alberto A. Borges, MD
I've asked Dr. Borges to also elaborate on what products are out there that he does consider a value. We're very interested to learn more about the expectations of doctors who are unhappy with the status quo. We don't necessarily disagree with Dr. Borges and his compatriots that there is something wrong with the current state of the industry but we do very much embrace the old saw "you get what you pay for." If you're paying nothing, in our opinion, that's what you're likely to get.
One last note on the subject of "small vendors can't afford the costs of CCHIT." Assuming the (wildly speculative) cost estimates of $200,000 over two years (including R&D, programming costs, and CCHIT fees) are accurate and assuming a vendor had a base of 1000 users, the cost to defray over that user community would be $100 per user per year. We're still waiting for someone to explain exactly why that's too much. We understand that reimbursements have taken a hit in recent years but considering the value afforded doctors (over the long term, it is true), one would think that $100 a year would be an acceptable expenditure. Let's hope this debate continues - it's fun and educational!!
