As Records Go Digital, Cultures Clash - Part 2

At "As Records Go Digital, Cultures Clash, Bringing to Life Secrets the Health IT Companies Don't Want You to Know" I wrote of the used-car nature of the healthcare IT market, where lemon laws do not seem to exist and "physician buyer beware" seems a defining characteristic.

The Huffington Post Investigative Fund now has a report of their own on this phenomenon:

Shopping for Health Software, Some Doctors Get Buyer’s Remorse

By Emma Schwartz
Huffington Post Investigative Fund
Jan. 29, 2010

Computerizing American medical records within five years is a key goal of federal health policymakers, but disputes between some doctors and their technology vendors highlight the many challenges for individual medical practices making the conversion.

Bankrupt vendors leaving orphan software and inaccessible data, vendors misappropriating others' software for their own products, fights over source code, and "doctors left holding the bag" are just a few of the factors that clinicians have to face.

A nightmare scenario:

Robert Cameron wasn’t much of a technology buff, but the orthopedic surgeon knew he wanted to get rid of all the paper in his nine-physician practice in Pensacola, Fla. So he bought an electronic medical records system from a California-based company called Acermed.

Cameron’s group spent more than $400,000 on the software, but the system still never fully worked and even confused patients’ scheduled visits, according to a lawsuit the doctors filed against the technology company in 2006. Acermed filed for bankruptcy in September 2007, complicating the doctors’ attempts to recover their expenses.

The effort to go digital “was a disaster,” Cameron says now.

... Cameron’s Florida doctors group, Gulf Coast Orthopaedic Specialists, looked at half a dozen companies before signing with Acermed in April 2005. After installing the first part of the system, they alleged in their lawsuit, the scheduling software “malfunctioned causing patient appointment[s] to disappear.” Also, the billing system was not feeding claims back to insurers, which over the next six months nearly ran the practice into bankruptcy itself, the complaint alleged.

[Perhaps an ancient TRS-80 programmed by a medical student in Microsoft BASIC would have done better? - ed.]

Gulf Coast doctors continued to alert Acermed to the problems, but the company was unable to fix them, the lawsuit stated. They weren’t the only ones having trouble. Two other doctor groups—one in Florida, another in Tennessee—had also filed suit against Acermed, alleging similar problems. Gulf Coast filed its suit in October 2006. Acermed stated in court documents that the doctors had no basis for their claim.

[In other words, disappearing appointments and failed billing never happened and it was all in the doctors' imagination - ed.]

As it turned out, Acermed had been dealing with problems of its own. In July 2006, a federal judge ordered Acermed to pay more than $750,000 for using some of the source code from another vendor it had once worked with to develop its own electronic medical record software in 2004.

[In other words, the company misappropriated part of its computer program from elsewhere - ed.]

Gulf Coast’s lawsuit was still pending when, in September 2007, Acermed filed for bankruptcy. Company officials at the time said that the reason for their bankruptcy was the financial impact of legal bills, not problems with their software.

In January 2008, Ophthalmic Imaging Systems of Sacramento, Calif., bought Acermed and renamed it Abraxas Medical Solutions with Acermed’s former chief executive Michael Bina as president.

In an email, Bina said he does not “represent AcerMed any more and would not like to comment on its behalf.” He said that one of his conditions for joining Abraxas had been that it continued to service Acermed customers, and that “many clients” of AcerMed have stayed with the new company.

[A musical chairs question - who, then, does represent the old company if not the president of the company that now supports the old company's products? - ed.]

One of those clients, Tony Cattone, general manager of a 70-doctor medical practice in New Jersey, said in an interview, “they have lived up to their commitments and it’s working fine.”

[Until the new company does the same as the old, that is - ed.]

Several other doctors said they were left with loan payments for a system they never received.

And today, the Gulf Coast group still hasn’t entirely gotten rid of paper. In December 2008, the doctors settled their lawsuit with Acermed for an undisclosed amount. They invested in a different electronic system, but the doctors aren’t entirely happy with the new one either, said Alan Trest, the group’s technology manager. With the current system, doctors have to type rather than dictate notes. Some aren’t willing to make that transition because they say it takes them more time. So the group still pays for transcriptions.

“They haven’t really completely bought into the idea,” Trest said.

See the full story at the above link.

I note that "revolutionizing medicine" via IT still seems somewhat unlikely when the IT industry conducts itself more poorly than the used car industry.

-- SS

As Records Go Digital, Cultures Clash, Bringing to Life Secrets the Health IT Companies Don't Want You to Know

Yes, as records go digital, cultures clash: the culture of medicine, and the culture of the Barbary pirates.

The following story perhaps brings to life much of the advice from a candid HIT vendor (who happens to also be a physician) in my post "10 Secrets the EHR Companies Don't Want You to Know":

As Records Go Digital, Cultures Clash
By Sammy Mack, Health News Florida

Jan 22, 2010

A group of Broward County doctors looking to switch to electronic medical records say the result has been a massive headache: surprise charges, inadequate training and even blocked access to patient files.

... Experts say a culture clash between mid-career physicians and tech-savvy software vendors can translate into mismatched expectations. They tell the buyer to beware.

And with federal incentives now in play, they say there is bound to be further conflict.

“I get upset just talking about it,” said Dr. Arleen Richards, a Plantation physician and one of the doctors who signed a contract with Castranova. [An IT supplier - ed.] "When you look back in retrospect, you’re like, ‘how did this happen?’"

Physicians are too trusting of IT salespeople, that's how. I recommend considering an IT purchase as you would consider purchasing a used car.

Richards says Castranova promised a cheap, easy piece of software that would increase efficiency in filing insurance claims. The price tag: $10,000 plus the cost of some new computers.

... After signing up, Richards learned she would have to pay a $2,500 licensing fee for each provider in her office, to qualify for the stimulus funds. In addition, she said Castranova hit her with almost $15,000 in charges to install new computers--charges she didn't authorize. [cf. Secret #5: Determining how much a specific EHR costs is going to be difficult, and you are going to be nickel-and-dimed every step of the way! - ed.]

$10,000 for the software, plus previously undisclosed per-user licensing fees and $15,000 to install what are probably commodity computers available at Newegg for a few hundred dollars? If true, the term for this "gotcha" is: ripoff.

Castranova said he doesn’t understand how she could think the computer charges were unauthorized. After all, he said, someone had to let him into her office to install the machines.

A contract that clearly specifies such "materials and labor costs" is the standard when, say, a plumber fixes your toilet.

This is especially true when those costs exceed the cost of the product itself, the software. These IT added costs should always be presented to clients up-front, above board, in writing and in a manner that could not cause misconceptions or buyer's remorse. If this did not occur here, then that is a problem.

Another of the doctors in a tiff with Castranova, Fort Lauderdale internist Paul Preste claims Castranova didn't provide adequate training after installing the electronic records system.

Preste's office manager, Donna Golden, said there was a day-long training and that Castranova’s employees came to the office on a number of occasions, but she noted some practitioners had to start from scratch after decades of paper records.

One day of training on a complex information system? That is a joke.

In another complaint against Castranova, Dr. Linda Kaplan said she too was surprised by charges on her invoice. When they first met, Castranova recognized her as a former medical editor at the local NBC television affiliate. She said he offered to waive her software and training fees if she would endorse the product [cf. Secret #3: Even that EHR-using physician you've been referred to may have been paid off! -ed.]

Kaplan agreed, but she said she was unimpressed with the system once it was installed in her Hallandale Beach office. She was reluctant to drum up business when she wasn't a satisfied customer.

Kaplan said Castranova was displeased with her lackluster endorsement and locked her out of some 600 patient records on his server. He billed for the software system anyway. [cf. Secret #6: Your patient data will be a bargaining chip to prevent you from leaving an EHR company! - ed.]

"We are holding your patient information hostage. Pay up."

I sincerely hope for this vendor's sake that none of those 600 patients suffers an adverse outcome during the "records blackout." This information is not exactly chopped liver.

Here is perhaps the most concerning statement in the article:

No agency tracks electronic medical records disputes, but experts said feuds like these are not uncommon ... Linda McMullen of the Florida Medical Association said she's starting to hear similar stories of spats between doctors and software vendors.

As the government pushes health IT on to unwary physicians, physicians need to educate themselves on the wiles of the IT profession ... fast.

(HC Renewal and my academic site on HIT dysfunction are two examples of where to start.)

Advice in the article:

Maxwell, the software consultant, said doctors can avoid some of the grief by thoroughly researching their options before buying an electronic records system. She encouraged medical offices to shop around and set a five-year budget that includes the cost of scrapping a system if it doesn't work out.

Draw up an exit strategy for retrieving data if something goes wrong, she counseled. And get expert help reviewing contracts. [I note that data migration is never cheap, and never easy - ed.]

"The people that have had problems just went out and bought one (electronic medical records system)," she said, as opposed to researching the software and the company behind it.

Fine advice. However, this reality belays the arguments about health IT being a deterministic convenience, saving money and improving efficiency. IT is often a headache and a money pit in and of itself.

Physician buyer beware, indeed.

-- SS

Addendum Jan. 31:

Also see my comments on a Huffington Post Investigative Fund story about physician HIT buyer's remorse.