EMR of their own
When Dr. David Schall went shopping a few years ago for the right electronic medical record system for his six-site primary care practice in southern Maine, he was taken aback by how complex and how expensive they were. So Schall, chief executive officer of Bowdoin Medical Group, developed his own.
Today, all the doctors in the group use the EMR and more than 80 percent of paper records have been scanned into the new system – more than 1.75 million pages so far.
"I can train a doctor in an hour, and they can be fully electronic when they walk out the room, " Schall said.
"The docs really love it," he said. "They really love it."
Schall has spun off a subsidiary company and expects to put the new technology on the market by fall.
Across the country in Phoenix, Ariz., Dr. Roy Frieband, a family practitioner, is way ahead of Schall. Back in the mid-1990s, Frieband, who had been dappling in programming, left Pennsylvania for Arizona, where started work on his master's degree in medical informatics. He also practiced medicine part-time at a community center in Casa Grande, where he started working on an EMR system, using the center as a beta site.
The 18 doctors and four physicians' assistants eagerly adopted it, he said.
"They were very progressive, very forward thinking, very much into improving processes," he said.
Today Frieband sees patients three days a week and heads Mindware Medical LLC, a small software company with four employees. His system, Patient Minder, is geared specifically for solo or small group practices of no more than 20 doctors. Mindware also recently launched RXMinder, an electronic prescription writer for small practices.
Dr. Caroline Samuels, who has developed Ambulatory EMR Selector, a Web-based product to help doctors find EMR systems that match their practice, is skeptical of homegrown products."I don't see much future in it," she said, "as CMS (Centers for Medicare & Medicaid Services) is raising the bar. These homegrowns are unlikely to have the functionality to make the grade."
Schall and Frieband aren't worried.
Everyone is in the same boat when it comes to meeting changing standards, said Frieband. "When you start doing this, you have to realize, it's always changing. It doesn't matter whether you have an EMR system that's very expensive from a very large vendor, or a homegrown one. The question is can you respond to the changes?"
Many systems Schall reviewed before he developed his own cost in the neighborhood of $40,000 per doctor to set up and $13,000 a year for service and maintenance, he said, "and you can only anticipate a three-year life span.
"We're a third or a fourth that price," Schall said.
Schall has not figured out payback time yet, but he estimates it at nine months.
Schall's system, called Instant Minuteman Medical Record, is fundamentally a scanning technology with database overlay.
Frieband's pricing is $3,500 for the initial provider and $1,500 for each additional provider. Both doctors say the cost of marketing usually drives up the cost of software.
"Marketing is unbelievably expensive," said Schall. "Fifty percent is marketing." Schall plans to do no marketing except by word of mouth.