• Big bang - Implementation happens in a single instance. All users move to the new system on a given date.
• Phased rollout - Changeover occurs in phases over an extended period of time. Users move onto new system in a series of steps.
• Parallel adoption - Both the legacy and new ERP system run at the same time. Users learn the new system while working on the old.

First, Take Our Survey
Have you been involved in an ERP implementation? Was it successful? We want to hear from you. We are hosting a survey to find out which implementation strategies are the most popular and most successful. We will collect results over the next two weeks and present our findings towards the end of the month. Select the link below to get started.



Big Bang
Just as the name implies, a big bang ERP implementation happens in a single, major event. All modules are installed across the entire organization all at once, more or less. Of course the changeover from the legacy system doesn’t happen without proper planning. There are many pre-implementation activities that need to be carried out prior to the big bang.

After the planning activities have been successfully executed, the old system will be turned off, and the new system will be launched. At this point there is no turning back. However, there should be fall-back scenarios prepared just in case the initial changeover is a failure.

The big bang implementation strategy has supporters on both sides of the fence. The most common criticism is the risk factor; there are a number of things that could go wrong in an instant changeover. However, the implementation is quick and less costly than a long, drawn-out phased approach. Here is a list of other benefits and drawbacks of big bang implementation:

Another downside of big bang implementations is Ken Eason’s “Initial Dip Phenomenon.” Eason, author of “Information Technology and Organisational Change” and one of the original authorities on implementation strategies, describes an “initial dip phenomenon” which happens shortly after an implementation. This catch-up period happens because users are struggling with the new system and organizational performance temporarily declines as a result.

Phased Rollout
In keeping with the theme of cosmological evolution, phased rollout would be analogous to the Steady State theory: instead of an implementation happening in a single instance, small changes occur over time. An organization moves off the legacy system and onto the new ERP system in a series of predetermined steps. This can be achieved in several different ways. Here are three well-known techniques:

• Phased rollout by module - This is the most common phased rollout strategy. ERP modules are implemented one at a time. Typically you begin with core business functions – those necessary for daily operations – then add in more modules and functionality with each phase. However, some experts suggest starting with easy modules like general ledger, or beginning with the less mission-critical modules. For a good explanation, read Insight Consulting Partner’s write-up.
• Phased rollout by business unit - Under this approach implementation is carried out in one or more business units or departments at a time. For example, you begin with implementing the new ERP system in human resources, then move to accounting. Some organizations may put together an implementation project team that travels between each department during implementation phases. As the team gains more experience with each implementation, subsequent phases become more efficient.
• Phased rollout by geography - For organizations with multiple locations, a phased rollout by geography is a frequent approach. The new ERP system is introduced at one or more company locations at a time. This is also referred to as the “pilot adoption method.” It’s common for large organizations that have multiple locations or independent departments.

Of course there are hundreds of options, including many variations and combinations of these three. Just like big bang, a phased rollout strategy has advantages and disadvantages. This table includes several common viewpoints:

Parallel Adoption
The third generic – though less talked about – ERP implementation plan is the “parallel adoption” approach. This has also been referred to as “parallel conversion,” “parallel running,” or “parallel cutover.”

Parallel adoption is thought to be the least risky implementation process. It includes running both the old and new ERP system at the same time. This way users can learn the new system while performing regular work activities on the old system. After requirements for the new system are met, then the legacy system is decommissioned.

Eason Strategy Matrix

Borrowing another illustration from Ken Eason, parallel adoption is presented as the “middle road” between big bang and phased adoption. For example, the pace of the changeover is slower than big bang, but faster than phased adoption. Similarly, user adaptation is easier than big bang, but more difficult than phased adoption.

The major trade-off – not illustrated in Eason’s matrix – is cost. Parallel adoption is the most expensive implementation method. Additionally, having employees enter data in both systems is not efficient. However, if the extra costs are less than costs incurred after a backfired big bang adoption, then it’s a reasonable plan. Still, organizations cannot predict cost overruns of big bang, so parallel adoption has become decreasingly popular because of perceived high costs.

Which ERP Implementation Strategy is Best for Your Business?
There certainly is no one-size-fits-all when it comes to implementing an ERP system. Every company has unique goals, and an implementation requires careful planning and analysis. Some companies may choose a combination of strategies, like a mini big bang mixed with phased rollouts (i.e. “big bang” the important modules, then add in the peripheral modules later). Others may choose to implement a mid-market ERP system (e.g. Microsoft Dynamics, Epicor) at the plant-level, while keeping a major ERP system (e.g. SAP, Oracle running at headquarters). And at times, the best implementation strategy will be obvious (as illustrated in this case study).

At a minimum, we hope this guide gets your organization off on the right foot. By choosing one of the above or developing an entirely custom strategy, you should be well on your way to success.

Joel says to Rebecca, “We’ve got a match from our real estate company. It’s only four blocks away. Let’s go see what the house looks like.”

Within minutes, the couple is outside the 714 Longview Rd. home. It happens to be exactly the type of home they wanted, in the exact neighborhood they wanted to live in. They call their real estate agent to set up a viewing.

How did this happen? How was the couple instantly notified of the opportunity, perfectly merging buyer requirements, location and timing? The answer involves a combination of “geo-fencing,” mobile phones and GPS technology.

If you’re a tech savvy real estate agent or property manager, this powerful combination of technology represents a great opportunity to gain new clientele. Many real estate buyers do not have the time to review new listings online, travel to viewings or patrol their desired neighborhoods for opportunities. But the vast majority of real estate buyers do have mobile phones they carry with them nearly all the time.

This technology would help real estate and property management companies capitalize on business that may otherwise slip through the cracks. Software Advice would like to see this type of mobile marketing become a permanent feature in today’s property management software systems to help advertise real estate and rental properties.

Let’s see how that could be done.

Geo-Fencing + Mobile Phones = Powerful Real Estate Marketing
What if a buyer looking for a place to live didn’t have to do anything beyond choosing what features they wanted in a home? What if a buyer was automatically alerted to nearby properties that matched their needs?

This is what we’re talking about with the next generation of mobile real estate marketing.

The use of “geo-fences” surrounding properties really drives the location-based marketing engine. A geo-fence is a virtual boundary surrounding a geographic region. When a person with a mobile phone crosses a geo-fence boundary, a notification is automatically issued to that mobile phone. Traditionally, geo-fencing has been used to send alerts when users exit a certain area, instead of entering one.

Geo-fencing has been used in conjunction with GPS technology for a while now and for a variety of uses:

• Tracking senior citizens with Alzheimer’s;
• Ensuring mobile employees don’t travel outside of certain areas; and,
• Monitoring hazardous cargo, to name a few examples.

We’re confident that someday, we’ll be able to add “Market real estate” to that list. Here’s how we see this new form of mobile marketing working in the real estate industry:

Create geo-fences. Before real estate and property management companies set up their online portals, they’ll need to create geo-fences around all of their properties. This will ensure that if a qualified user crosses the geo-fence with their mobile phone, that user will be notified about that property.

We’d like to see geo-fencing modules built into today’s property management software, allowing companies to quickly create geo-fences around their properties by drawing them on a digital map.

Collect buyer needs online. Real estate and property management companies can create online portals on their web sites, where prospective tenants and buyers set up notifications tailored to what they want in a property.

For example, a user could create an alert based on square footage, number of bedrooms, pet friendliness, special amenities, and zip code, to name just a few of the myriad of options available. Once they’ve entered their cell phone number and submitted those housing preferences, all they have to do is carry their phone with them to receive notifications.

We’d also like to see today’s property management software vendors integrate these online portals into their systems. Many property management software vendors offer web site design and hosting packages to their customers. A geo-fencing module could be another module that’s presented as an option to a management company when they purchase the software.

Let the notifications begin. The notifications are where this entire concept of location-based mobile marketing comes together. The geo-fences have been set up. Users have entered their housing preferences online to receive notifications. All that is left is for the users to go about their normal lives, with their GPS-enabled mobile phones, of course.

When they get close to a property that matches their wants, they’ll be automatically notified on their mobile phone. Property management software can then integrate all of these contact points with customers into their CRM system, to track the effectiveness of the messages and review properties with clients.

House hunting couldn’t get much easier than that, could it?

The Benefits
Hopefully by now, the benefits of this unique marketing method are clear.

First, since the user opts in to receive these marketing notifications, there is no feeling of intrusiveness or annoyance as with unsolicited messages. This type of marketing is perceived as a service, not an intrusion.

Second, from a marketing standpoint, notifying the right person, at the right place, at the right time about your product is powerful.

It’s the holy grail of marketing:

• You have a desirable product;
• You have identified the person that wants your product; and,
• You can automatically tell that person that your product is nearby.

Finally, this marketing method is scalable. A real estate or property management company could theoretically have dozens (or more) of users taking advantage of this service at any given time. Beyond taking calls to schedule viewings, it wouldn’t require any extra labor on the part of the management company.

Conclusion
We don’t expect this spin on mobile marketing to be installed in every real estate and property management office tomorrow. But whether through geo-fence triggers or other GPS-centric methods, the real estate industry will undoubtedly continue to make a huge effort over the next few years to connect with buyers and renters through their mobile phones.

The technology is too compelling to ignore.

What are your thoughts on geo-fencing’s affects on real estate marketing? Too far-fetched? The holy grail of marketing? Share them in the comments.

We see this as a coming renaissance in electrical contracting. There has been a revival of interest in the electrical trade as home owners and corporations adopt alternative methods (e.g. solar, wind, etc) to power buildings. What’s driving this? Federal incentives, lower material costs and savings from reduced energy spending.


A study by the American Solar Energy Society projects renewable energy jobs for electricians to grow approximately 900% by 2030, just in the state of Colorado.

To take advantage of upcoming opportunities, electricians will need to “green” their skill-set and re-brand themselves. We’ll share more on this later. First, let’s take a look at the trends driving this change.

Green Construction is on the Rise
According to a 2009 Booz Allen Hamilton study, green construction will skyrocket over the next five years. The report projects green construction to generate $554 billion dollars in GDP, provide $396 billion in labor earnings and support or create over 7.9 million jobs from 2009 to 2013. These figures are way up from the previous 8-year period. From 2000-2008, GDP from green construction was just $173 billion, labor earnings was $123 billion and number of jobs created was 2.4 million.




This growth comes directly from increased demand for green buildings, which is largely driven by cost savings from reduced property operating expenses, and by new regulations from federal legislation (e.g. American Clean Energy and Security Act).

Clearly, environmentally friendly construction affects the architecture engineering construction (AEC) industry collectively. But how will this impact electricians?

Electricians are in High Demand
The growing green construction market will create new demand for electricians. And to keep up with demand, electricians will need to diversify their skill-set. We obviously expect to see electricians working on solar photovoltaic and wind turbine installations, but that’s just the beginning. They’ll work on building retrofits, mass transit and light rail projects, “smart” electrical grid transmission systems and more. Here are a few examples of the unique places we expect electricians to find work:

• Lighting system upgrades – There are an estimated 2.2 million commercial buildings in the U.S. that have antiquated lighting systems (old fixtures, ballasts, lamps and controls). Additionally, all federal buildings are required to switch to Energy Star lighting products by the end of 2013 (in accordance with the Energy Independence and Security Act of 2007). Some of these upgrades can be handled by the local maintenance guy, but others will require the expertise and skill of electrical contractors.

• Parking lot electrical outlets – A state bill in Minnesota will require half of new parking facilities to include outlets to charge electric vehicles. Who will install these docking stations? Electricians of course. Members of the Minnesota Electrical Workers (IBEW) Local 292 are already preparing to provide labor for these projects. If successful, we expect other states and cities to follow Minnesota’s example.

• Wind turbine manufacturing – According to a report from the American Solar Energy Society (ASES), a typical 250-person wind turbine manufacturing company has two electricians as employees. This isn’t a large number, but it’s an example of the variety of job opportunities available.

• Electric vehicle electricians – Jobs for electricians will also emerge in adjacent industries. For example, electricians will need to be trained in auto mechanics – or auto mechanics will need to be trained in electrical contracting – in order to meet demand for electric vehicle maintenance. And the career outlook is good: electric vehicle electricians make an average of $39-$59 thousand a year.

For additional information on green job opportunities for electricians, check out this article from the National Electrical Contractors Association (NECA).

LEED Creates New Opportunities
Projects applying for Leadership in Energy and Environmental Design (LEED) status are growing just as fast as the rest of the green construction market. With many LEED credits being electric- and energy-related, electricians will have an opportunity to win work on these projects. However, they’ll need to get versed on credit requirements, and should even consider becoming a LEED accredited professional (AP). LEED projects get an extra point for having an AP on the job, which could be a selling-point when bidding on jobs.

Here’s a sample of credits that require the knowledge and skill of electricians.

Electricians Must Act Now
With so many opportunities on the horizon, contractors need to make sure they’re ready to win jobs. To get started, they must gain the skills and knowledge to take on green projects. Both the International Brotherhood of Electrical Workers (IBEW) and National Electrical Contractors Association (NECA) offer education programs for green electrical work.

Next, contractors should market and promote their new green credentials. Update your website and other marketing materials, syndicate a press release to trade magazines and local media, and get more exposure online by joining directories (e.g. CalFinder.com) or advertising in search engines.

Finally, update your bidding process to make sure you win those green electrical jobs. You’ll need to bid accurately to ensure job profitability, but competitively to make sure you win the job. This means having up-to-date pricing information on materials and labor. Good electrical estimating software will have specific capabilities to estimate solar panel installations and other types of renewable energy jobs.

Our goal with this survey: Find out what healthcare professionals want in a tablet and how well Apple’s iPad fulfills those wants.

Let’s see what we found out from our survey results:

Majority of Healthcare Professionals Are Likely to Buy a Tablet

This chart shows how likely respondents are to purchase a tablet for healthcare use in the next year.

When nearly a dozen new tablet devices were shown at the Consumer Electronics Show earlier this year, it looked like 2010 was going to be the year of the tablet’s emergence as a consumer gadget.

Judging by the survey data above, 2010 also may be the year of the tablet’s emergence in healthcare. Of the respondents to the survey, 54% said they were either very likely or somewhat likely to purchase a tablet for healthcare use over the next year. That’s good news for tablet makers.

Tablet Tasks

This chart shows what percentage of respondents want to use a tablet for a particular task.

Healthcare workers want to use tablets for a wide variety of tasks. A majority of our respondents said they wanted to use a tablet for all of the above tasks except for billing, coding and claims.

Ease of Use and Software Selection are Top Reasons for Tablet Selection

This chart shows what criteria is most important to survey respondents when purchasing a tablet.

According to survey results, ease of use is the major purchase reason for a majority of healthcare professionals. That may fare well for the iPad. Why? The iPad runs on the popular iPhone operating system. Thousands of doctors are already using iPhones in clinical settings.

In addition, the iPad has a finger touchscreen. Of our healthcare respondents, 63% said they preferred a finger touchscreen over styluses and voice dictation when asked about their data input preference. Many of those same people said that the speed of the data entry was the determining factor when noting a preference for the finger touchscreen.

How important is quick data entry in healthcare? Here’s what one respondent had to say:

As an MD in the ER, I am the most ‘expensive’ employee … doing data entry. The available software for data entry for my physicians is rudimentary at best. Speed is the key. I need to be able to see 30 patients in 8 hours and FULLY document the visit in a time-efficient fashion.

In the case of healthcare workers, ease of use could appears to at least partially equate to speed of use. The iPad’s operating system and touchscreen would appear to have both criteria.

In terms of medical software selection, the iPad lags far behind virtually every other tablet on the market. Despite having over 5,000 medical apps immediately available for download through Apple’s App Store, none of those apps are a functional EMR system or even remotely close to one. The vast majority of EMR software on the market today will not run on a Mac OSX operating system. Most require a Windows-based operating system to function.

The iPad may have an easy to use operating system helped by a finger touchscreen but those pros are nullified by that system’s inability to run the vast majority of medical software on the market today.

What Healthcare Wants, the iPad Doesn’t Have

After reviewing dozens of tablets on the market, both consumer focused and healthcare focused, we came up with the above list of “must-have” features for healthcare tablets. We asked our survey respondents to check all of the features they felt were “must-have” features in a healthcare tablet device.

This chart shows what percentage of respondents thought a feature was a “must-have” in a tablet.

Unfortunately for the iPad, as we found out last Wednesday when Steve Jobs unveiled the tablet’s features, it only has a few of the top “must-have” features for healthcare use.

The iPad has Wi-Fi access; lightweight hardware (1.5 pounds); and arguably an ergonomic design. That’s it from this list.

It lacks a large number of features that healthcare professionals deemed important, such as resistance to dust and hospital fluids and disinfectants (the iPad does not have sealed ports); fingerprint access to the system (HIPAA compliance); barcode scanning (patient safety); and an integrated camera (documenting diagnosis). In fact, you could argue that the iPad’s difficulty in being disinfected or kept clean of hospital fluids is a deal breaker for healthcare workers.

Peripherals, such as an RFID reader and barcode scanner, may be available in the future. But because they’re not native to the iPad, they’re just more cables and cords a busy healthcare worker has to lug around. That’s another negative mark for the iPad.

Also, as we mentioned before, the iPad does not have a wide selection of medical software because of interoperability issues with it’s operating system. A wide selection of medical software was voted as a must-have feature by 70% of our respondents. Most medical software on the market, EMR software especially, will only operate in a Windows-based environment. This presents a huge problem for the iPad in healthcare.

The Verdict

Healthcare wants a tablet. Healthcare likes the iPhone. That does not translate into healthcare liking the iPad.

Simply put, the iPad lacks many fundamental features necessary to function in the healthcare field. From the difficulty disinfecting the device to its lack of interoperability with the majority of Windows-based healthcare systems and software, the iPad in its current state suffers from many of the same problems that previous, failed healthcare tablet PCs have suffered from.

The iPad may be sleek and simple to use. But that doesn’t translate into widespread adoption by the healthcare industry. In fairness, it doesn’t appear that Apple was targeting the healthcare vertical; their bread and butter market remains the consumer.

Survey Comments

In our final survey question, we asked the respondents, “Why haven’t tablets become mainstream devices in healthcare?” Here are a few of the more interesting responses we received. They touch on a few topics we didn’t address here today. They are sure to spark more discussion.

• “Shoehorning a desktop OS into a tablet does NOT work. This has been the approach of Microsoft and hence no uptake. A modal interface like the iPhone is more suitable to touchscreen use and makes more sense in this setting.”
• “Why use a new product when old ones are properly doing their jobs?”
• “Lack of a streamlined, polished UI for task specific functions inclusive of each practitioner’s duties.”
• “I have worked in ERs that have them and they never seem to work.  Low battery life? Unstable software? Limited functionality, too (not integrated with imaging).”

Demographic breakdown:

• Health IT Professional: 29% (52)
• Physician: 28% (50)
• Nurse: 16% (29)
• Other: 14% (23)
• Student: 12% (22)
• Admin support: 1%  (2)

• Make tenants’ lives easier and more convenient;
• Improve collaboration and communication with building owners; and,
• Make the property manager more efficient in their operations.

How does it work?

The TSPM certification considers a management company’s technology capabilities across the following fifteen qualification criteria, in three major areas:

Certified by: Property Management Software Advice

Property management companies that apply for the TSPM certification are scored on their adoption of each of these capabilities on a binary basis. That is, they have either implemented that capability or they have not. The TSPM certification is vendor-agnostic, meaning that a property manager can deploy any technology to fulfill the qualification criteria. It is not tied to any specific technology vendor. Building owners that are evaluating new property managers can look for the TSPM certification badge on the property manager’s website. An example is shown at right (Alternate versions are available). Property managers that qualify to display the TSPM badge will benefit from the third-party validation provided by the Software Advice TSPM certification.

How can a company qualify?

The TSPM qualification process consists of a brief questionnaire that will determine the extent to which a management company is taking advantage of important property management technology. Upon completion of the application, a Software Advice researcher contacts the applicant to verify the answers and explain the certification results. If the manager is accepted, the company receives a badge that they can display on their web site to show off their “tech savvy” credentials. Software Advice will regularly verify technology use and implementation to maintain the credibility of the TSPM certification.

Why Software Advice

As a third-party organization – not a property manager or a property management software vendor – Software Advice is uniquely qualified to manage the TSPM certification. Our team of experts have researched the property management software market in-depth to determine which capabilities are most important to clients and tenants, as well as how those capabilities correlate to effectiveness and efficiency.

Software Advice has solicited feedback on the fifteen qualification criteria from a range of property management software vendors and property managers. We will continue to update the TSPM certification to include new criteria as technologies and market demands evolve.

How do I get started?

Click the link below to get started. After completing the application, our team will contact you to let you know your status. If you have any questions, please contact Chris Thorman at (512) 364-0118 or by e-mail at chris@softwareadvice.com.

Apparently, that concept may soon be a reality. In early January, Venture Beat reported a rumor that Apple reps have been spotted at Los Angeles’ Cedar-Sinai hospital, probing physicians about how a tablet (Apple’s iPad) could be used in a hospital setting. Meanwhile, tablets were all the rage earlier this year at the 2010 Consumer Electronics Show with product announcements from Hewlett-Packard, Lenovo and Dell.

2010 is shaping up to be the year of the tablet. We want to know which device is best positioned to rule the halls of healthcare.

Survey has closed. Results will be posted Tuesday, February 2nd.

Here are 4 other ways we think Apple’s 3D head-tracking could be used in healthcare:

• MRI scans and X-rays – Gone are the days of the light box. Doctors will view MRI scans and x-rays in 3D from their tablet or smart phone. Fractures that were once difficult to find will now be easy to identify by looking behind the bone.
• Graphics & drawing – Some EHRs allow physicians to draw on anatomical diagrams or digital pictures and include them in the patient record. Using Apple’s technology, physicians could “draw with their hands,” like in this demonstration of Pranav Mistry’s “Sixth Sense.”
• Ultrasound – Soon-to-be mothers will appreciate this. Not only will you be able to view an ultrasound in 3D, Apple’s technology would allow you to view a fetus from all angles.
• Medical education – Some of the best selling iPhone apps are 3D human anatomy apps designed for med students. If head-tracking doesn’t become widely adopted by practicing physicians, at least it will be a cool way for students to memorize bones of the body.

For all you Rhinoceros (Rhino) 3D fans, here’s a clip that demonstrates Rhino 5.0 WIPs new two-point perspective feature (by default, Rhino Perspective Viewpoint uses a 3-point perspective).

Of course the technology could be extended to other manufacturing software applications like product lifecycle management (PLM) software. This would be especially useful when manufacturing a complex product with multiple assemblies. Project members could better visualize the product and avoid costly engineer changes later on.

It may be years before Apple takes this technology to market, or until enterprise software vendors integrate it with their existing systems. In the meantime, feel free to leave us a comment and share your ideas on other ways this technology could work in manufacturing design.

These documents give us the clearest picture yet on what features physicians and hospitals need to look for in their EHR technology. They also tell us how that technology needs to be used to meet the definition of meaningful use during the Stage 1 (2011) EHR adoption period.

Among other things, these documents show us:

• How physicians and hospitals can achieve meaningful use in Stage 1;
• What software features your EHR technology needs to become certified; and,
• What the final rulings mean for CCHIT certification.

We’ll also look at a few points that the rulings didn’t address.

How to Achieve Meaningful Use in Stage 1

In the table below, we’ve combined the meaningful use objectives for both eligible professionals (physicians) and hospitals for the Stage 1 adoption year, the required EHR technology criteria to accomplish those objectives and what criteria the government will use to measure meaningful use.

CMS defines “meaningful use” as using an EHR for the objectives listed in the first column. The objectives fall under these general topics:

• Improving quality, safety, efficiency, care coordination, population and public health;
• Reducing health disparities;
• Engaging patients and their families; and,
• Ensuring adequate privacy and security protections for personal health information

For the first time, CMS has also outlined specific measurements for how the government will determine if an EHR is being used in a meaningful manner for the Stage 1 (2011) adoption year. Updated definitions of meaningful use for Stage 2 (2013) and Stage 3 (2015) EHR adoption periods will be released in the year before those periods begin.

This table outlines what Stage 1 objectives define meaningful use, what software features are necessary to accomplish those objectives and what criteria the government will use to measure meaningful use. EP refers to eligible professional.

How long does EHR software have to be used in a meaningful manner to qualify for incentive payments? In the first year of adoption, CMS states that a physician or hospital must be using an EHR in a meaningful manner for a minimum of 90 days in order to qualify for incentives. In subsequent years, the EHR must be used in a meaningful manner for the entire year.

The ONC’s interim final ruling details what software features EHR technology must have to become certified. Those criteria are listed in the second column. These criteria form the basis for the definition of “certified EHR technology,” which we discuss next.

To summarize, the government now has told physicians and hospitals what tasks they should be using their EHR for (meaningful use); what EHR software features are needed to accomplish those tasks (certified EHR technology); and how the government is going to measure those tasks to determine whether or not they are being performed to their satisfaction.

What EHR Technology Will be Certified?

Here is the ONC’s latest definition of certified EHR technology:

“A Complete EHR or a combination of EHR Modules, each of which (1) meets the requirements included in the definition of a Qualified EHR; and (2) has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the [ONC].”

In a nutshell, as long as the EHR software meets the software certification criteria laid out in the table above, an integrated EHR software suite or combination of best of breed EHR modules is going to fall under the ONC’s definition of “certified EHR technology.”

CCHIT Certification

Within the available EHR universe are a number of EHRs certified by the Certification Commission for Health Information Technology (CCHIT). The ONC feels that 90% of the EHRs that are CCHIT-certified (~80) will become certified under their proposed certification criteria. The ONC also feels that a significant number of the remaining EHRs will require only minor upgrades to comply.

As we’ve noted before on the Software Advice blog, CCHIT-certified systems are a good bet if you want to qualify for incentive payments. If you want to find out more about these systems, take a look at our list of CCHIT-certified EHRs.

What was left out of the final rulings?

What body will be doing the certifying? This wasn’t made clear and is already a point of contention between the ONC and many healthcare organizations.

Who will enforce the meaningful use measures? Again, this is not clear in the documents released. The measures are clearly defined. What body will enforce them is not.

By now you’ve heard about the $850 billion American Recovery and Reinvestment act of 2009 – the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending.

What’s in it for you?

Well if you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs).

How does the subsidy work?
Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 – $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums.

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

What is a “meaningful user”?
To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” The bill defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.

HSS will be working throughout 2009 to set the necessary criteria for certifying systems, and is expected to have a final report by January of 2010. Many expect CCHIT certification to play a major role in setting standards of interoperability. (See “Should CCHIT Influence Your EHR Selection” for more information). After all, HHS funded the creation of CCHIT to start certifying EHRs a few years ago.

View a list of CCHIT Certified EMRs/EHRs

How do I qualify for the maximum payment?
In order to receive the maximum payment, physicians must qualify as a meaningful user in 2011. Eligible physicians will receive a first year bonus of $18,000 (up from $15,000) and will max out the payment schedule over the next five years.

The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

No payments will be offered to physicians who first become eligible after 2014.

Practices with multiple physicians will be eligible to receive incentive payments for each provider. Remember that payments will be based on 75% of the correlating year’s Medicare and Medicaid charges. Therefore, in order to qualify for the maximum payment of $18,000 in the first year, each provider must bill Medicare or Medicaid a minimum of $24,000.

Should I purchase an EHR now or wait until 2010?
An obvious concern is whether an EHR implemented in 2009 will meet the standards set by HHS in 2010. Although a legitimate concern, waiting until 2010 to implement a system may be a mistake. Researching and selecting the right EMR can be a lengthy process, and many providers who wait may find it difficult to have a system in place in time.

Practices would be well-served to begin the research process now, allowing ample time to create a short-list of systems, perform demos with several vendors, check references, meet with vendors in person, negotiate terms, and complete the implementation and training process. To alleviate buyers’ concerns, vendors may provide binding agreements, guaranteeing their system will comply with all emerging standards.

Furthermore, buyers’ should consider CCHIT an important Certification relative to the requirement for “qualified EHRs.” While we have discussed the many opinions for and against CCHIT, we expect it to play a critical role in the EHR subsidy qualification.

What if I choose not to purchase an EHR?
Unfortunately, for physicians who choose not to implement an EHR, the stimulus bill is a double-edged sword. Not only will they forego thousands in incentive payments, but starting in 2015, they will be penalized by way of decreased Medicare and Medicaid payments. Physicians who fail to qualify as meaningful users will face decreases of 1% in 2015, 2% in 2016, and 3% in 2017, with a maximum reduction of 5% by 2020.

Bottom Line
Although each physician’s individual situation will dictate whether or not they choose to implement an EHR, the unique opportunity offered within the stimulus bill should not be overlooked.

Practices understand that up to $45 billion is allocated to provide incentive for physicians to adopt EHRs. However, many questions remain about how and when providers will receive stimulus funds.

We teamed up with Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and Vice President of Greenway Medical Technologies, to help answer these questions. The original presentation was delivered last week, however you can view the entire webinar above. In this hour webinar, you’ll learn:

• How the stimulus money will be paid out
• What it takes to qualify for funding
• Which specialties qualify for funding
• How “meaningful use” is defined
• What constitutes a “qualified EHR”