PODCAST: Laboratory Test Costs in EHRs and Physician Behavior


Johns Hopkins Hospital Listed the Cost of 61 Lab Tests on Doctors’ Computer Screens … While They Were Ordering Labs.



By Dr. Eric Bricker MD

Results:

–Just Seeing the Cost of the Lab Test DECREASED the Number of Labs Ordered Per Patient by 9%.

–Doctors Also SUBSTITUTED a Lower Cost Lab Test for a Higher Cost Lab Test 10,000 Times.

The Doctors Were NOT Clinically Directed to Change Their Behavior.

The Doctors’ Pay Was NOT Affected by Their Lab Ordering Either Way.

This Study Illustrates How Giving Doctors Cost Information in a Setting of Clinical and Financial Independence AUTOMATICALLY Decreases Healthcare Waste.

Doctors Can Be Much Better Stewards of Healthcare Dollars … and the Technological Innovation Needed is Minimal.

Disclosure: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.

YOUR COMMENTS ARE APPRECIATED.

Thank You

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EMR ‘versus’ EHR

What is the Difference – Know the Difference

By staff reporters

Both an EMR and EHR are digital records of patient health information. An EMR is best understood as a digital version of a patient’s chart. It contains the patient’s medical and treatment history from one practice. Usually, this digital record stays in the doctor’s office and does not get shared. If a patient switches doctors, his or her EMR is unlikely to follow.

By contrast, an EHR contains the patient’s records from multiple doctors and provides a more holistic, long-term view of a patient’s health. It includes their demographics, test results, medical history, history of present illness (HPI), and medications.

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Five [5] Reasons to Govern Medical Provider Data

The Heart of the Health Care Enterprise

By http://www.MCOL.com

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Doctors Call for EHR Overhaul

A New Research Study

By Stanford Medicine

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Conclusion

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The “Comprehensive Health Record”

About icucare

[Dr. David Edward Marcinko MBA]

http://www.CertifiedMedicalPlanner.org

There is much discussion today about the concept of a “Comprehensive Health Record”. This is an extension of the traditional terminology of “Electronic Health Records (EHR), Electronic Medical Records and Personal Health Records”, etc.

http://www.HealthDictionarySeries.org

From theory to practice

Etymology notwithstanding, the ISeeYouCare’s patient-centric healthcare platform is founded on the premise that the patient’s electronic health record must be accessible throughout the care continuum, no matter the venue, source or time of day. This level of integration and transparency drives clinical quality, positive provider and patient experience and lower costs in a value based world. The family of solutions impacts from the hospital to the home with an unmatched level of clinical collaboration for the payer to the provider, patient and family.

At ISeeYouCare, they support the concept of a Comprehensive Health Record (CHR). Furthermore, they  see it as true to the original concept of electronic health records.

 

Benefits of a Comprehensive Health Record

There are many reported reasons for a patient to manage and maintain their own comprehensive health record.

• Obtaining medical records from hospital systems and disparate providers can take a great deal of time. Often, patients need information in a timely manner, due to an emergency or a new diagnosis. The delay in getting information is frustrating and can be deadly in case of an emergency.

• Health care providers do not have to keep your records forever. The requirements vary from state-to-state, but in general, most do not have to maintain records beyond ten years.

• Maintaining a full longitudinal record of your health improves care coordination and promotes easier sharing of information with family and caregivers.

• Having full copies of your medical records with accurate information makes it easier to connect with other patients or conduct research online so you have a better understanding of any health concerns.

• You can save costs by providing doctors with results of tests and procedures performed by other organizations.

• It helps you make sure that your health information is accurate

Assessment: So, decide for yourself: EHR or CHR? https://icucare.com/

Conclusion

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Continued focus on improving EHRs (or is it CHRs?)

From EHR to CHR

By Dr. David Edward Marcinko MBA

http://www.CertifiedMedicalPlanner.org

I read this curated article and decided to send it right out to our ME-P readers for comment [EHR = CHR].

Nothing more needs to be said, on my part. Is this mere definitional obfuscation for flawed technology? http://www.HealthDictionarySeries.org

So, what do you think?

http://www.healthcareitnews.com/news/epic-ceo-judy-faulkner-standing-behind-switch-ehrs-chrs

Assessment

A rose by any other name still smells sweet. But, does not an onion stink?

Conclusion

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3 Steps to Take Before Buying Healthcare E-Signature Solutions

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More on Paperless Healthcare Records

[By Patrick McTosh]

The movement towards paperless healthcare is growing. Every year, more and more health professionals are beginning to implement EMRs and EHRs as a way to turn their file cabinets into data on a hard drive. While EHRs help the problems of storing paper, they do not create documents that can be legally, securely and efficiently shared with third parties and patients during day to day activities.

These issues can be addressed by implementing an electronic signature solution. These types of solutions allow professions to create documents for physician orders, prescriptions, patient admissions, consent forms and other important medical documents in a timely and relatively paper free manner.

Verify EHR or EMR Integration

It’s important to ensure that whatever electronic signature software is compatible with your current EHR and EMR software. While most e-signature solution providers claim they have specialized services for healthcare organization, it’s best to confirm with a phone call or email that they have experience integrating their services with the EMR that is currently in use.

Verify Local Legislation & Signature Guidelines

Hospital accreditors have already recognized e-signatures as equivalent to paper signatures. However, it’s always important to verify federal and state regulations regarding e-prescriptions and electronic signatures.

For example, the latest DEA regulations on electronic prescriptions require digital signatures to have at least a biometric authentication. In addition, some states have not adopted the Uniform Electronic Transactions Act and therefore have difference laws pertaining to the legality of e-signatures.

Most e-signature providers specializing in healthcare tend to be on top of these things because better legal compliance is one of the benefits of e-signatures as a whole, but it’s always better do double check.

eHRs

Ensure It’s Human Error Proof

Many e-signature solutions attempt to reduce the risk of human error due to lost, damage or incorrectly completed forms which can cause significant delays. As most e-signature software will actually guide the signer through the complete process ensuring that the document meets necessary requirements before sealing the document with a tamper-evident digital seal.

Assessment

However, not all providers have such precautions against human errors, but it is definitely a must in the healthcare industry.

Conclusion

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Did the NSA End Obamacare?

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Did ambitious NSA officials unintentionally end Obamacare years ago?

[By D. Kellus Pruitt DDS]

1-darrellpruittIf loss of trust in encryption ends Obamacare, can whistleblower Edward Snowden be blamed for that as well? Yep.

What’s even more ominous, the former National Security Agency contractor’s news that encrypted medical records are no longer secure reached Alaska on a weekend.

“Risky electronic health records: Alaska should make information exchange system safer – Imagine: The National Security Agency slips into your doctor’s office and peeks at your medical records,”

by Alaska ACLU executive director Joshua Decker was posted hours ago on Newsminer.com, out of Fairbanks.

http://www.newsminer.com/opinion/community_perspectives/risky-electronic-health-records-alaska-should-make-information-exchange-system/article_a9947eb0-1863-11e3-8153-001a4bcf6878.html

Decker questions the security of the state’s Health Information Exchange (HIE), and offers common sense but costly steps which arguably lessen the danger of privacy breaches – including giving patients the choice of “opting-in” to permit their encrypted, but increasingly vulnerable identities to be shared online via Obamacare’s exchanges.

My POV 

In my opinion, if informed Americans are given the choice of volunteering to risk identity theft, HIEs won’t be around a year from now, and neither will Obamacare. If informed Americans are not given a choice, the costs are even greater. Americans deserve honesty.

National Obamacare Hangs in the Balance

In a related, slow-burning game-changer, Obamacare hangs in the balance, not just for Alaska, but for the nation.

It was September 5th when the Guardian Weekly posted: “Revealed: how US and UK spy agencies defeat internet privacy and security,” written by James Ball, Julian Borger and Glenn Greenwald, and based on top secret NSA information Snowden stole.

http://www.theguardian.com/world/2013/sep/05/nsa-gchq-encryption-codes-security

Snowden told the Guardian that years ago, the NSA joined with the UK’s spy agency GCHQ (Government Communications Headquarters) to successfully make encryption obsolete – including for medical records.

Naturally, if properly informed Americans fear that secrets they tell their doctors might be breached, incorrect EHRs become less than worthless. They become dangerous.

More on Health Information Exchanges

What’s more, even before the added expense of waiting for Americans to opt-in to the exchanges – instead of discouraging them from opting-out – the very funding for the increasingly-battered Obamacare is based on a rumor of savings.

Starting years ago, health IT lobbyists, including former Speaker of the House Newt Gingrich, told lawmakers to expect annual savings of $77 billion and 100,000 lives – quoting the results of a once popular, EHR-friendly 2005 RAND study which was funded by General Electric and Cerner Corporation.

Obamacare

As you can see, while we were not paying attention, we were had!

The RAND Study

Predictably, both GE and Cerner profited immensely from the development and sales of EHR systems before the RAND study was widely discredited months ago – even by RAND.

According to a NY Times article from January, “Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.”

(See: “In Second Look, Few Savings From Digital Health Records by Reed Abelson and Julie Creswell, January 10, 2013).

http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html?_r=0

Assessment

Last weekend’s bad news for Obamacare is still under the radar, but I predict within days it will become apparent that the mounting obstacle between President Obama and healthcare reform will be in regaining trust his administration squandered while helping GE and Cerner profits at the expense of soon-to-be pissed off American patients.

Conclusion

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Our Healthcare Referral System is Broken

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About the Management Process

[By Staff Reporters]

Our healthcare referral system is broken, according to Referral MD. The firm reviews some of the key factors that contribute to this system.

The Paper Trail

The following infographic highlights a key pain point in the healthcare referral system management process that despite healthcare providers adopting an EMR system, they are still utilizing paper.

A large percentage of processes in healthcare involve documents and forms that must be scanned and stored outside their existing EMR system such as records from referring physicians, patient consent forms, patient instructions, insurance authorization, etc.

Assessment

With so much paper still floating around, opportunities for HIPAA violations increase with as high as 86% of mistakes made in the healthcare industry stem from administrative activities.

Conclusion

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A Physician Query on “Used” eMR Billing System Value?

Understanding Residual Worth

“Ask an Advisor”

Submitted by an Anonymous, MD

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Greetings!

I am in a three man Neurology practice. Five years ago we invested in an all inclusive EMR / billing system with A4 Health Systems and Allscripts. The system cost close to $60,000 and has been constantly upgraded (for “free”). There are also yearly “maintenance” fees of about $7,000. Each physician also had to get a license at a cost of $7,000 each. A license now per physician is $13,000!  

Buy-Out Value

I am going to be leaving the practice in one year and would like to know how I go about getting the EMR appraised for my buy-out. I am not about to turn this very valuable system over to my partners as a “going away gift”. The system has been upgraded several times a year and the practice obviously could not run without it (i.e.: it is a tangible asset and has continued value in use). 

Assessment

PCs, printers, etc. may have depreciated in value but the system has not especially since it has been upgraded on a regular basis. Can you refer me to someone who is familiar with appraising EMR systems?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. How do you appraise a “used or second-hand” eMR system? Does it have any residual value at all! Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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On Hospital CPOE Systems [Part Two]

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Computerized Physician Order Entry Systems

By Brent Metfessel; MD, MIS

A significant initial cost outlay for an organization-wide CPOE system is necessary, which for a large hospital may run into the tens of millions of dollars.  Understandably, the majority of the hospitals that have installed a CPOE system are large urban hospitals.  The up-front cost outlay may be prohibitive for smaller or rural hospitals unless there is an increase in outside revenue or third-party subsidies.

However, although it may take a few years before a positive ROI becomes manifest, there can be a significant financial return from such systems.

www.CPOE.org

Potential Benefits

The potential benefits of a CPOE system go beyond quality. Significant decreases in resource utilization can occur. In one study, inpatient costs were 12% lower and average Length of Stay (LOS) was 0.89 day shorter for patients residing on general medicine wards that used a CPOE system with decision support. Rather simple decision support tools can reap cost benefits as well. When a computerized antibiotic advisor was integrated with the ordering process, one institution realized a reduction in costs per patient ($26,325 vs. $35,283) and average LOS (10.0 days vs. 12.9 days), with all differences statistically significant.

Studies have shown that CPOE systems can significantly reduce medication error rates, including rates of serious errors.

For example, one large east coast hospital saw a 55% reduction in serious adverse medication errors after the system was installed. However, on occasion errors can actually be introduced due to the computing process; in particular, errors can be introduced if the provider accidentally selects the wrong medication from the list or drop-down menu.

Accordingly, a CPOE system should not be viewed as a replacement for the pharmacist in terms of checking for medication errors. In addition, proper user interface design such as highlighting every other line on the medication screen for better visibility and having the provider give a final check to the orders before sending are some ways of reducing this kind of error. Overall, error rates from incorrect order entry on the computer are much smaller than other medication errors prior to introduction of the system.

Appropriate use of a CPOE system helps prevent errors and quality of care deficiencies due to problems with the initiation of orders.  However, errors can also occur in the execution of orders, particularly with the administration of medications to patients.  Bar coding of medications, discussed previously, is a simple way to close the loop in medication error prevention as well as further increase the efficiency of workflow.

Despite its advantages, a CPOE system has been implemented on an organization-wide basis in only about 45% of all US hospitals and growth in implementations has been relatively slow, although about 67% plan to add a CPOE system in the next few years.  Implementing a CPOE system is not an easy task, and there is a significant risk of failure.  Most hospitals utilize vendors for implementation rather than attempting to develop the system in-house given the difficulty of hiring full-time IT talent that specializes in CPOE systems.

One critical feature of any CPOE system is to obtain physician buy-in to the technology, since they will be doing most of the ordering.  Actually, unless the system is of the highest sophistication, physicians may claim it takes more time to write orders using a CPOE system than using the paper chart, as there may be a number of drop-down menus to negotiate prior to arriving at the appropriate drug.  Real-time retrieval of information and electronic documentation, provision of on-line alerts, and the ability to use standard order sets (prepackaged sets of orders pertaining to a particular clinical condition or time period in an episode of care), when relevant, can make the net time spent on writing orders similar to using paper charts.

Doctor Acceptance

It is also important, for physician acceptance, to not overwhelm them with on-line alerts.  Clearly, the system needs to point out the more serious errors, but if the physician’s process is frequently interrupted by alerts, they may increasingly resist the system.

For example, medication allergy alerts may warn physicians not only of potential problems with medications that have an exact match to the allergen, but also, as a defensive maneuver (“better safe than sorry”), to other medications that have a related molecular structure,, even though the patient may already be taking such medication and tolerating it well.  Furthermore, allergies to medications that may result in life-threatening anaphylactic shock may not be distinguished from “sensitivities” that consist of side effects that are not true allergies and are usually much less serious.

Thus, the potential exists for frequent alert generation that would interrupt the work flow and require time spent to override the alerts, making the system difficult to use and leading to user resistance.  One suggested solution is to have a hierarchy of importance, with alerts for potentially life-threatening situations being allowed to interrupt the work flow and requiring specific override or acknowledgment, and alerts for less serious problems being “noninterruptive,” allowing easy visibility of the alert without requiring stoppage of the work flow.

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CPOE Pitfalls

Other pitfalls with respect to CPOE systems include the following:

  • crowded menus making it easy to select the wrong patient or wrong drug with the mouse;
  • fragmented information necessitating navigation through numerous screens to find the relevant information;
  • computer downtime (scheduled or unscheduled); and
  • location of terminals in busy places, which can lead to distractions and resulting incomplete or incorrect entries.

Intelligent, well-thought-out system designs can serve to mitigate many of these problems.  It is important that such difficulties appear on the systems designers’ “radar screen” and are explicitly considered in the implementation.

Pharmacists

As for pharmacists, a CPOE system will not take them out of the process. Although a CPOE system has the capability to capture many drug errors and remove the need for manual order entry, there will always be a need for pharmacists to not only give a second look at possible errors, but to take a more active role in patient care, including going on ward rounds for complex cases, defining optimal treatment, and giving consultative advice.

www.MedicalBusinessAdvisors.com

Assessment

A CPOE system has the potential to give physicians ready access to patient data anywhere in the hospital as well as at home or on the road, especially with Internet-based connections. This is significant given the difficulty in obtaining patient charts for mobile providers.

In today’s environment of high expectations for care quality and pay-for-performance initiatives, enhanced quality of care can translate into financial gain. Although there is a significant up-front allocation of funds for CPOE systems, given present trends the time may arrive where there is no longer a choice but to implement such a system.

Conclusion

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Improving Patient Control of eHRs

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Traditional Command-Control Option Dying Out … Slowly!

[By Staff Reporters]Hospital Access Management

NewYork-Presbyterian Hospital recently introduced a new personal electronic health record [eHR] enabling patients to access medical information wherever and whenever they need it. Called myNYP.org, the system uses Microsoft’s HealthVault and Amalga technologies to offer patients the ability to select and store personal medical information generated during visits to NewYork-Presbyterian.

About NewYork-Presbyterian

NewYork-Presbyterian Hospital is one of the most comprehensive university hospitals in the world, with leading specialists in every field of medicine. The hospital is composed of two renowned medical centers, NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center, It is affiliated with two Ivy League medical institutions, Columbia University College of Physicians and Surgeons and Weill Cornell Medical College.

Assessment

MyNYP.org uses a “pull model” in which patients proactively opt to copy their medical data into their own personal health record and access that information using a secure username and password with any Web-enabled device. And yes, online bill pay features are available.

Conclusion

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Understanding the PHI “Minimum Necessary” Rule

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Protected Health Information and HIPAA

By Richard J. Mata; MD, MIS, CMP™ [Hon]

Dr. Mata

One important concept of the Health Insurance Portability and Accountability Act [HIPAA] is the “minimum necessary” rule, which states the minimum use of Protected Health Information [PHI] to identify a person, such as a social security number, home address, or phone number.

Only the essential elements are to be used in transferring information from the patient record to anyone else that needs this information.

Financial Information Included

This is especially important when financial information is being addressed. Only the minimum codes necessary to determine the cost should be provided to the financial department. No other information should be accessed by that department. Many institutions have systems where a registration or accounting clerk can pull up as much information as a doctor or nurse, but this is now against HIPAA policy and subject to penalties. The “minimum necessary” rule is also changing the way software is set up and vendor access is provided.

Human Resources

Another challenging task is keeping up with the number of people who access PHI, because the privacy regulations allow a patient to receive an accounting of anyone who has accessed their information, both internally (within your hospital, Emerging Healthcare Organization, or medical entity) and externally (such as through your business associates).  The patient has the right to know who in the lengthy data chain has seen their PHI.  This sets up an audit challenge for the medical organization, especially if the accountability is programmed internally.  When other business associates use this PHI without documenting access to a specific patient’s PHI, no one would be accountable for a breach in privacy.

http://www.findbookprices.com/author/Hope_Hetico

One way to track access is through a designated record set, which contains medical or mixed billing records, and any other information that a physician and/or medical practice utilizes for making decisions about a patient.  It is up to the hospital, EHO, or healthcare organization to define which set of information comprises “protected health information” and which does not, though logically this should not differ from locale to locale.

Assessment

Overlaps from the privacy regulations that are also addressed in the security regulations are access controls, audit trails, policies on e-mail and fax transmissions, contingency planning, configuration management, entity and personal authentication, and network controls. For more information about the Security Standards final rule; reference the Federal Register.

Conclusion

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The Health Dictionary Series

dhimc-book13Meet a ME-P Sponsor

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The “Dictionary of Health Information Technology and Security” was recently released.

It was edited by our own Dr. David Edward Marcinko and Professor Hope Rachel Hetico, as a collaborative and wiki-enabled, peer-reviewed, print publication.

Link: Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Terms and Definitions

It contains over 10,000 entries, including 5000+ definitions, 3000+ abbreviations and acronyms, and 2000+ resources and readings. The book provides a comprehensive, handy, and up-to-date guide to this rapidly expanding area of the health care industry. The dictionary covers the language of every healthcare IT industry sector:

1. Software, codes, and operating languages–hardware, PDFs and peripherals, legislation and policies.

2. PCs; LANs, WANs, Internet/intranet, T1, Ethernet and cable lines, and notable HIT industry icons.

3. Security, WiFi, WiMax, tele-medicine, tele-radiology, tele-surgery and HIT security and risk management concerns

Assessment

It also highlights new terminology and current definitions, and explains confusing acronyms and abbreviations. It is global in coverage addressing international tech standards as well as those used in the US, and is arranged in a simple A-Z format.

www.HealthDictionarySeries.com

Conclusion

Two other dictionaries in the series are also available:

1. Dictionary of Health Insurance and Managed Care

2. Dictionary of Health Economics and Finance

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

LINK: Health Dictionary Series: http://www.springerpub.com/Search/marcinko

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Wal-Mart’s Health Information Technolgy Game Plan

CCHIT Meet Sam Walton

By Darrell K. Pruitt; DDSpruitt3

Dana Blankenhorn posted an article recently on zdnet titled “Wal-Mart Selling Windows Health Records.”

Link: http://healthcare.zdnet.com/?p=1966

After reading it, I opened a good, cost-effective fortified breakfast wine and began hammering out my comment that I copied below, long before the sun came up.  Hope you enjoy it.  I’m going to get some sleep. 

Looks Like Rein

Coach Glen Tullman’s traditionally favored and tough Allscripts-Misys team originating in CCHIT meets Walton’s consumer-supported, nimble team from Arkansas in front of Sam’s home town crowd. As a sports fan and occasional off-color commentator standing on the sidelines, Dana, I think this ball game could get exciting. The weather is perfect for sloppy, poor conditions and heaven knows that these two ideologies share history.

Wal-Mart HIT 

Some odds-makers say Wal-mart’s success in selling healthcare IT at Sam’s Club prices and quality is likely to take off in their patented free-market style in the next few months. 

The big question is; could this threaten federally-favored Allscripts’ early advantage? 

For example; if things get competitive, and the value of MDRX starts to falter under natural pressure, will Trustee Tullman call on the reserve strength of his exclusive Club CCHIT to out-flank the quick and slippery Sam’s Club wide-ended attorneys?  Some say that if CCHIT suddenly selects surprising, deceptive and occasionally lame applications for certification requirements – that happen to already reflect Allscripts pre-determined game plan – it is a cinch to give Tullman’s team a head start around their strong side with a pulling guard or three from the right (weak side) to lead interference.

Assessment 

Will Sam protest such a rule? You bet. It could get messy. Snot could fly. 

Here is the question on this reporter’s mind. If close calls are occasionally ruled in the home team’s favor, will Tullman move on down the road? I like to watch the cheerleaders.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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