The Hybrid, the Stimulus & You

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Physicians who have adopted hybrid EMR systems are quite enthusiastic about them, but industry observers are doubtful such systems will meet stimulus funding criteria.

Hybrid electronic medical record users are extremely loyal to their product. Give them an excuse to talk about the part-manual, part-digital EMR, and you're likely to be subject to a barrage of exuberant exclamations about how easy it is to learn, how inexpensive it is to implement, and how it has simplified even the most harried physician's life.

It's only when the topics of meeting government incentive goals and gaining certification are brought up that the shiny veneer of optimism begins to crack and even the hybrid's staunchest supporters admit they don't know what the future holds for their beloved EMR.

Much like the traditional EMR, the hybrid EMR has a somewhat vague definition that varies depending on the product and applications it offers. The one constant, and some say the most appealing aspect of the hybrid EMR, is that providers can go digital without having to change how they see their patients.

"Physicians can document patient visits however they are comfortable, whether it's handwriting, voice dictation, or something like Dragon [voice recognition], and they still get the benefit of having a completely digital office," says Nick Benoit, director of health information management at Cardiovascular Institute of the South, a 40-physician cardiology practice with 10 locations in Louisiana.

Benoit has a unique perspective regarding a hybrid EMR because CIS had implemented a traditional EMR in 2001. Over time Benoit says CIS found it to be so cumbersome and such a time-drain, it transitioned to a hybrid EMR about 18 months ago. "We realized that due to our high volume, our doctors were simply not going to be able to keep up with the data entry required by the traditional EMR system," says Benoit.

After evaluating a number of products, Benoit says CIS settled on a scan-based document system from SRSsoft because providers can still make use of all of the electronic functions and functionality of a traditional EMR, such as e-prescribing, computerized physician order entry, and the Centers for Medicare & Medicaid Services' Physician Quality Reporting Initiative alerts, without slowing down their doctors.

"We see a very high volume of patients, over 190,000 visits a year. We embarked on the traditional EMR and it was really going to be difficult to get our doctors to adhere to it. Things evolved, and now with this hybrid EMR we can focus on workflow and bring more efficiency with an electronic process that doesn't slow down our physicians."

While hybrid EMR systems like the one Benoit uses have the ability to meet some government pay-for-performance standards, such as e-prescribing and PQRI, the general consensus among industry experts, including hybrid vendors themselves, is that the hybrid EMR probably won't meet the meaningful use and certification standards required for physicians to cash in on the $19.2 billion being channeled into HIT as part of the $787 billion stimulus bill signed into law in February by President Barack Obama.

Part of the appeal of a hybrid EMR is its flexibility. Practices select and assemble the modules they need, when they need them. That flexibility is also what will probably keep it from being certified because the government is going to identify one set of standard features that every EMR will need to qualify.

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