EHR Vendors and HITECH Guarantees

HITECH, the $19 billion Federal program designed to accelerate the wiring of America’s health system, has EHR vendors scrambling like chickens in a barn fire.

The anticipated burst of spending on EHRs is enough to explain the flurry of vendor activity, but the chaotic nature of this activity is the result of other realities. These include:

  • A mandate that providers use an HHS-certified EHR in order to cash in,
  • the Feds have yet to decide what they mean by an “HHS-certified EHR,”and
  • if you go by their working definition, few if any EHR vendors have a machine that would qualify right now.

Among the more amusing side-shows to have emerged from the chaos has been the Guarantee War, in which no less than 12 vendors have claimed their dog will hunt when the time comes to go get the bone.

Guarantee War participants include Allscripts, AthenaHealth, ChartLogic, eClinicalWorks, e-MDs, GE Healthcare, Ingenix, Medsphere Systems, NextGen, Noteworthy Medical, Practice Fusion and SourceMedical. Let’s look at some EHR vendor guarantees and see what they tell us about the companies themselves.

Note: To prepare this post, I used information from company Web sites and articles found during a routine Web search. Some vendors may have additional documentation that would influence this analysis.

The Allscripts Guarantee
Allscripts guarantees physicians “that the Allscripts EHR they select will meet the EHR certification criteria provided by (HHS)…under the Allscripts Guarantee, the Company will waive up to 12 months of a client’s monthly support fees if their Allscripts EHR fails to meet the HHS certification criteria.”

The guarantee apparently does not cover support costs after 12 months, if the EHR remains non-certified. It presumably does not cover fees for licensing, software updates, integration, customization and so on.

In addition, the guarantee appears to apply only to newly purchased EHRs, not to existing users. If so, then the latter group might want to ask how Allscripts plans to support their efforts to qualify for HITECH incentives.

Of note, Allscripts also offers a financing program that is “designed to help physicians who want to qualify for the (HITECH) incentives but are concerned about the initial capital outlay.” The financing program means physicians “can elect to make no payments on software for up to six months, followed by monthly payments over the time period that works best for them. At the end of the term, they own the software.”

This appears to be a loan offer in which interest rates and other key terms are not specified. It isn’t a price cut. Industry insiders know that providers who spend 6 months coming up to speed on an EHR are unlikely to trash it, whether they like it or not.

The NextGen Guarantee
NextGen appears to have appended HITECH guarantee language to a previously-existing money back guarantee program. The relevant new language is as follows:

“The (NextGen) Software will …allow you and/or your providers, as applicable, to participate in federal health incentive programs.” This “means that through our Software Maintenance Services we are, and will continue to be, diligent in providing features that enable the Software to capture and report clinical data in support of the efforts that you and/or your providers, as applicable, make to participate in federal pay-for-performance and ‘pay for meaningful use’ incentive programs.”

Unlike the previous clauses in this document (which govern proper use, training and support), this one does not make it absolutely clear that users can get their money back if the system falls short, although my best guess is this is the case.

Regardless, the guarantee’s reference to “clinical data” but not the other 25 activities required for Meaningful Use raises questions. It isn’t clear from this document what happens if the EHR falls short in any other area.

The AthenaHealth Guarantee
In a video on its Web site, company executives say, “Our clients will get paid their HITECH bonuses. Everything involved with that is part of the deal. What we’re guaranteeing is that they’re going to receive their 2011 bonus check that shows they have demonstrated meaningful use of their EHR.”

“What we are prepared to do is put 6 months of our own revenue at risk. If the client doesn’t get their bonus check, we’re not going to get 6 months worth of payment for use of AthenaClinicals.”

The following text appears below the video: “As a service-based EHR, our monthly fee is the only payment we receive from our clients for our EHR. If you do not receive the Federal Stimulus reimbursement dollars when they are available, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to the HITECH Act reimbursement payments only. Additional terms, conditions and limitations apply.”

Pending explanation of that last clause, Athena appears to be guaranteeing Meaningful Use of their EHR by physicians, not just that their EHR will be HHS certified. Thus if a physician fails to submit 80% of her orders using CPOE and thus doesn’t qualify for the bonus, Athena’s guarantee still applies. Publicly traded companies rarely assume this degree of risk.

The Practice Fusion Guarantee
“Practice Fusion guarantees that its EHR will be certified and available to all physicians who want to qualify for 2011 HITECH payments.”

We value reader input on our guarantee, especially in relation to those offered by our competitors.

Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs Practice Fusion