Costs and Limitations of Certified Health IT

Capability

Description of Capability

Costs or Fees

Types of costs or fees that a user may be required to pay to purchase, license, implement, maintain, upgrade, use, or otherwise enable and support the use of the implementation or use of the capability -OR- in connection with the data generated in the course using the capability

Contractual Limitations

Limitations of a contractual nature (including developer policies and other business practices) that a user may encounter in the implementation or use of the capability -OR- in the connection with the data generated in the course of using the capability

Technical or Practical Limitations

Limitations of a technical or practical nature that a user may encounter that could prevent or impair the successful implementation, configuration, maintenance, support or use of the capability -OR- prevent or limit the use, exchange or portability of any data generated in the course of using the capability

Drs® Enterprise Version 10

The Drs® Enterprise is a certified EHR that is available as either cloud hosted or local server hosted (client/server).

Client/Server:  There is a one-time fee for the software, setup, installation and training.  There are also one time and monthly fees that include support, maintenance, updates and upgrades.  This model is priced on a per workstation basis with additional fees for ePrescribe, patient portal and registries (see below).

Cloud Hosted:  There is a one-time fee for setup, installation and training.  There are also monthly fees for the hosting which includes support, maintenance, updates and upgrades.  The cloud hosting version is priced per provider per month with up to four named users.  Additional named users and registries would incur additional one time and/or monthly charges (see below).  On expiration of services there are data transfer fees (if that service is requested).

There are no known contractual limitations regarding Meaningful Use 2014 certification in the service contract, end user license agreement (EULA) or business associates agreement (BAA) for both the cloud and the client/server topologies.  There are limitations of liabilities provisions in the various contracts. Non-payment of fees results in limitation of user’s ability to access data.

There are hardware and system requirements for both the cloud and the client/server topologies.  There are no known technical or practical limitations regarding the Meaningful Use 2014 certification.

Patient Portal

This provides patients with the ability to view (or assign the right to their responsible party), their medical information on a secure electronic portal.  The patients also have the ability to download and transmit their medical record to other providers as well as communicate directly with their provider

This portal is provided through Updox and there is a one-time setup fee as well as monthly charges per provider for this service.  This is directly interfaced into Drs® Enterprise and therefore will need to be purchased through Keiser Computers.

The Updox portal is the only portal that we interface with and support.  There are no known contractual limitations associated with this capability.

The Updox portal is the only portal that we interface with and support.  There are no known additional technical or practical limitations associated with this capability.  An Internet connection is required for this functionality.

Direct Messaging

This provides physicians with the ability to securely send messages and/or documents to other healthcare professionals.

This ability is included with the cost of the patient portal mentioned above.  The physician will be given one free direct messaging address for sending and receiving direct messages and other documents.  Occasionally a practice may want an additional direct messaging mailbox for a staff member.  This would be at a small additional monthly charge.

The Updox Direct Messaging and HISP is the only direct messaging ability that we interface with and support. (A HISP is similar to a post office for direct messaging.) Each physician will need to be vetted to be able to participate in this direct trust program.  A separate contract with Updox is not required.

The UpDox Direct Messaging with HISP is the only direct messaging ability that we interface with and support. An Internet connection is required for this functionality. There are no known additional technical or practical limitations associated with this capability.

ePrescribe

This provides physicians with the ability to send prescriptions electronically.  It has the ability to provide feedback to the physician when writing the prescription as to contraindications for drug to drug, drug to allergy, formularies and more.  There is also the added optional ability to ePrescribe controlled substances (EPCS).

There is a one-time setup fee as well as recurring annual fees for the standard ePrescribe.  There are additional one-time and recurring annual fees for the optional electronic prescribing of controlled substances (EPCS). There may be additional fees for identity proofing (vetting). There are also potential additional one time fees (nominal) for lost EPCS tokens.

There are additional contractual obligations concerning the use of the ePrescribe ability.  Some of these are from the national Surescripts network that are required from all ePrescribers.  There is also the requirement that each physician be identity proofed (vetted) before they can ePrescribe.

The required browser for ePrescribe is Microsoft Internet Explorer.  For printing paper prescriptions from the ePrescribe module it is required to have the free Adobe PDF reader software.  An Internet connection is required for this functionality. There are no known additional technical or practical limitations associated with this capability.

General Registries

There are many different depositories of clinical data that are commonly referred to as clinical registries.  Some practices may be required to send clinical data to a registry in order to fulfill Meaningful Use requirements.

Registries often require complex schema for the data to be accepted.  This will usually require the outgoing data to be programmed thereby requiring some one-time costs to be borne by the practice.  Additional recurring monthly costs will be required to maintain the interface.  There might be other costs imposed by the particular registry.

It is likely that the clinical registry will require contracts including a Business Associates Agreement.

Occasionally the clinical registry will require data to be entered in a specific manner that may be different than the manner which the practice had previously been using.  This may require additional new workflows for the practice to meet the needs of the registry. An Internet connection is required for this functionality. There are no known additional technical or practical limitations associated with this capability.

Immunization Registries

This provides the ability for the practice to record immunizations.  There is also the optional ability to send these immunizations to state registries.

Many practices do not administer immunizations but would like to record the historical immunization data for their Meaningful Use compliance.  There is no charge for recording the immunizations into Drs® Enterprise. However, there are additional one-time and recurring monthly charges for the ability to send the immunizations to state registries.  Each state will have its own requirements and there may also be fees from the State Health Information Exchanges (HIE) to participate with their state registry.

There may be contracts required from the state registries or state HIEs where the immunizations are to be sent.

The immunizations are usually sent in a batch mode and can be defined by the practice.  An Internet connection is required for this functionality. There are no known additional technical or practical limitations associated with this capability.

Syndromic Surveillance

According to the World Health Organization (WHO), "the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice."  Many states have the ability to receive this information from the EHR. 

Though it is rare for the independent ambulatory private practice to be required by a state to submit the syndromic data, Drs® Enterprise has this ability.  Because this would need an interface, there would be one time and recurring monthly charges if this becomes required for the practice.

Contracts could be required from the state registries or state HIEs where the immunizations are to be sent.

Most states currently only require the syndromic data from hospitals and emergency clinics.  There are no known additional technical or practical limitations associated with this capability.

Interfaces

An interface is a software integration between disparate systems to allow sending and/or receiving clinical data electronically.  Usually these are automatic systems that work in the background to deliver/receive data.  Sometimes there will be the need for notifications in place to alert users to data that is received.  Examples of interfaces include pathway to/from practice management systems, labs, imaging systems, registries, portals, ePrescribe systems, medical devices and diagnostic equipment.

Some interfaces are at no charge and are included with the Drs® Enterprise system.  Certain practice management systems are examples of this.  The ePrescribe and Patient Portal interfaces are included in the pricing of these features.  Other interfaces are customized for the entity that will be interfaced.  Labs, imaging systems, registries and medical devices are examples that will require programming and quality assurance testing and therefore will incur additional one time and monthly costs.

Depending on the interface, third party vendors may require new contracts to be signed.  These will usually include a business associates agreement and other usage agreements.  Interfaces usually will have a one-time cost as well as recurring monthly maintenance costs.  Sometimes these costs will be borne by the entity that the practice is interfacing with - for example, labs and imaging companies.

The use of interfaces can streamline the workflow and reduce the workload.  Usually these interfaces will require a good Internet connection. There are no known additional technical or practical limitations associated with this capability.

Clinical Decision Support (CDS)

CDSs are notifications that can help the care provider become aware of important and relevant clinical information at the point of care.

CDSs for primary care and many other specialties, to be able to meet Meaningful Use, are included without cost.  However, some practices in some specialties may prefer additional CDSs to be available and there may be additional one time and/or recurring monthly charges for these CDSs. 

There are no known additional contractual requirements.

There are no known additional technical or practical limitations associated with this capability.

Clinical Quality Measures (CQM)

CQMs are measures required for Meaningful Use that provide clinical data for analysis by CMS and others.  Currently nine CQMs in three domains are required.  Drs® Enterprise offers many CQMs in the various domains.

CQMs for primary care and many other specialties, to be able to meet Meaningful Use, are included without cost.  However, some practices in some specialties may prefer additional CQMs to be available and there may be additional one time and/or recurring monthly charges for these CQMs.  There may also be additional one-time and/or monthly charges for assessment profiles if the CQM requires the use of special assessments.

There are no known additional contractual requirements.

Often the CQM will require additional procedures and/or diagnostic codes to meet the CQM measure.  Some CQMs may take considerable time to run because of the size of the database and/or the complexity of the CQM.  There are no known additional technical or practical limitations associated with this capability.

Computerized Physician Order entry (CPOE)

CPOE enables the physician to create clinical orders for labs, imaging, etc. It can also help to track compliance with the orders.

The CPOE ability in Drs® Enterprise does not require any additional costs.  However, Drs® Enterprise has the ability to provide customized workflows within the CPOE function.  This optional customization could incur additional one time and/or recurring monthly costs.

There are no known additional contractual requirements.

The CPOE functionality does not require additional customization to meet the Meaningful Use requirements.  Currently the CPOE does not transmit orders electronically to third parties. There are no known additional technical or practical limitations associated with this capability.