Problems arise with current electronic records system

During their years-long struggle to get the $2 million NextGen electronic medical record system to work correctly, Powell Valley Healthcare leaders considered ditching the system and looking for something better.

However, the cost to do that was prohibitive, and the organization persevered. While still not perfect, the NextGen system is operating more satisfactorily now.

But, in an ironic twist, it looks like the opposite may happen: The NextGen system eventually might ditch Powell Valley Hospital — well, sort of.

In September, NextGen’s Hospital Solutions Division was purchased by Harris Computer Corporation, which owns QuadraMed, another health information system. NextGen retained the ambulatory division, which is used in Powell Valley Clinic, with a stated purpose of focusing on health information services for clinics.

The PVHC Board of Directors has been waiting since then for word on what effect the acquisition of the NextGen Hospital Solutions Division by Harris QuadraMed might have on Powell Valley Healthcare. Until Monday, that was still unclear.

That changed on June 27 when Josh Baxter, PVHC information technology director, gave the board the bad news: QuadraMed will not develop NextGen to meet Stage 3 of federal Meaningful Use requirements for electronic health information systems.

The hospital already has met Stage 1 of federal Meaningful Use standards and is halfway through the time period, which ends Dec. 31, for attesting to Stage 2. Powell Valley Healthcare received federal incentive money for meeting Stage 1 requirements. Attesting to Meaningful Use standards also qualifies the hospital for higher percentage reimbursement rates for Medicare and Medicaid.

Now, it looks as if Powell Valley Hospital could be unable to meet Stage 3 of the Meaningful Use requirements unless it changes to a new health information system.

The good news is that Harris has offered to install QuadraMed for hospitals now using NextGen, with the only cost being the installation. But that installation would cost $800,000, topped by an annual cost of  $225,000 for software maintenance, updates and support.

Baxter said a PVHC team tasked several years ago with choosing a health information system had considered QuadraMed during its information-gathering process, but eventually selected the NextGen system. The team quickly ruled out QuadraMed because of the $5 million-plus cost to purchase that system. With that price put into context, the $800,000 installation-only cost is a considerable savings, he said.

While Powell Valley Clinic could continue to use the NextGen health information system, the two different systems — QuadraMed in the hospital and NextGen in the clinic — may not communicate with each other. If that were the case, Powell Valley Healthcare would be looking at replacing that system as well, adding to the cost — and the institutional pain.

“Either way, it’s not going to be fun,” Baxter said. “Converting from one system to another system is painful. And to know that we’re going to have to do it again ...”

Neil Todhunter, president and chief executive officer of HealthTech Management Services, said, “When we get ready to look at a different system, I think you also want to look at something that will support the clinic as well. You’ve got to get that interface.”

Todhunter said both hospitals in Billings have the capability of bringing other medical organizations into their medical records systems. Billings Clinic uses Cerner, while St. Vincent Healthcare uses Epic, he said.

“The cost would probably be significantly less,” he said. 

Baxter and Todhunter both reminded the board that no health information system is perfect, and frustrations exist with them all.

Complicating the issue further is the fact that requirements for attesting to Stage 3 of federal Meaningful Use regulations haven’t even been set yet by federal regulators, and the deadline for meeting those as-yet-undetermined requirements has been pushed back repeatedly. So, hospital administrators don’t know what the regulations will be, or when they will be required to meet them.

PVHC Interim Chief Executive Officer Terry Odom said that’s still all undecided. Some federal officials say Meaningful Use stage 3 won’t happen, while others still say it will.

Board member Dr. Mike Tracy asked if going back to paper medical records was an option.

“I don’t think so,” Baxter replied. He said the hospital already has attested to previous stages of Meaningful Use, and he didn’t know what the penalty would be for backing out.

Todhunter said, “Probably about $2 million. They’ll penalize you going forward and will probably come back and ask for that incentive money back.”

John Freeman, associate vice president of HealthTech, said the upcoming election could result in changes in federal expectations for health information systems.

“I wouldn’t want to make any systems decisions in the next few months,” he said.

“I’m not sure we could right now, anyway,” said Board President R. J. Kost.

Harris QuadraMed response

Harris QuadraMed will continue to support its NextGen hospital clients as long as they wish to remain with that system, said Kent Hargrave, Harris QuadraMed’s executive vice president for revenue cycle management.

“We are not going to discontinue to support on a day-to-day break/fix issue,” Hargrave said during a telephone interview Wednesday. “We’ve told our hospitals ... if you find a bug, we’ll fix it.”

Hargrave confirmed that QuadraMed will not develop NextGen to meet Stage 3 of federal Meaningful Use regulations. But he said company representatives have advised their small, critical-access hospital clients that they can file for a five-year hardship extension through the federal Centers for Medicare and Medicaid Services to delay the deadline for meeting Stage 3 requirements.

“That allows these hospitals breathing room to do a slow, methodical migration” to a new electronic medical records system, he said.

Harris QuadraMed purchased NextGen for two reasons, Hargrave said.

“One was that NextGen announced that they were going to close that part of their business,” he said. “We saw an opportunity where there were 50 hospitals that were going to be left out to dry, with no support, no anything. We knew, as a strong health-care vendor, that at least we could support the product they were on for the foreseeable future, but could also give them a more economically viable way” to update their electronic medical records systems.

If they choose to remain with QuadraMed, that allows them to upgrade to a newer product without additional license fees, through a program known as “Software for Life,” Hargrave said.

“By grabbing this piece of NextGen, we helped ourselves — we got 50 more clients — and we helped our clients, because they weren’t left out in the cold. We rescued them when NextGen closed their doors,” he said.

“Our support is better than the support they got from NextGen,” he added. “NextGen didn’t deliver what they promised.”

Hargrave said QuadraMed’s parent company, Harris Computer, has been around for 30 years.

During that time, “we have probably acquired 60 companies, and we have never sold one of them. We are not venture capitalists here for a quick purchase, only to turn around and sell ... These NextGen clients will be Harris clients for as long as they want to stay. We’re not going to buy it and rip it apart and sell you off again.”

Hargrave said QuadraMed was sold three times in a short time before Harris purchased that company, but Harris now plans to keep, update and maintain it permanently.

Computers facilitate a very big part of health care services these days.

According to Josh Baxter, Powell Valley Healthcare’s information technology director, PVHC as of June 27 had and/or used:

“We emphasize having a good storage structure and keeping ahead of it so we don’t run out of space,” and ensuring that documents can be accessed quickly, Baxter told the PVHC Board of Directors.