To:

From: Emily Prumers

Date: June 27th, 2021
Subject: PHR AND EHR SEMANTIC INTEROPERABILITY RECOMMENDATION MEMO

Purpose
Contained in this memo are the results and recommendations resulting from the tasks laid out in
the previously sent, and subsequently approved, PHR and EHR Semantic Interoperability
Recommendation Research Proposal, dated June 20 th, 2021.
Summary
Steps and results from the three tasks (1) Health Care Provider Census, (2) Government Funded
EHR Implementation Proposal or Tax Credit and (3) Request for Quotes are provided here
within. Additionally, conclusions and recommendations are listed. Next step is to select a vendor
and begin work on the PHR system.
Introduction
Patients lack easy access to their own medical records and an efficient way to share their medical
records between health care providers. The offices of health care providers transfer medical
records between themselves, a process that can take days and can be somewhat incomplete. A
database/application (PHR system) that patients can receive and send their medical records to
and from is needed. Patients would have 24/7 immediate access to their health records and be
able to share and receive them from their smart devices. Communication between the solution
(PHR) and the individual systems that health care providers use (EHR) needs to be researched
and developed to accommodate Health Care Portability and Accountability (HIPAA) laws. Both
patients and health care providers will benefit from this solution. Patients can easily access their
records and test results and share those documents with health care providers as needed. The
general public and medical professionals are the primary audience. Caretakers and retirement
homes are also a focus, as is anyone with a smart device. Security surrounding the PHR is the
primary concern, and how the data would be transferred between the PHR and EHR systems.
Furthermore, on the heels of the COVID-19 global pandemic “telemedicine”, meeting with a
health care provider via a live video connection, was vital during the pandemic and has
continued to increase in popularity. Medical records are an essential part of health care. The
importance of health care providers to be able to share medical records electronically, both
amongst themselves and with patients, has increased alongside telemedicine and is arguably
more important now than has been in the past.
Research Methods
Task #1 – Health Care Provider Census
The census was successfully mailed. 96.2% of the results had been returned and tallied two
weeks earlier than anticipated. Tallying consisted of running the ballots through a Scantron
system to easily, quickly, and accurately aggregate results. Original mailing list was used to
mark-off returned ballots as they were received, and the detail data list * saved under each
mailed ballot name. Given the large success of ballot return rate we proceeded with publishing
results, enabling the team to roll onto Task #2 two weeks earlier than originally proposed.
* Data set available upon request in .xslx, .csv or .xlm format

Task #2 – Government Funded EHR Implementation Proposal or Tax Credit

Basis the results of the census we decided to lobby for a tax credit. Lobbyists focused on the
Senate Finance Committee to propose and promote the bill. We were ultimately successful,
although we ran two months past the proposed time frame and thus ran over budget.
Task #3 – Request for Quotes
Quotes were sent out and all responses were received one week earlier than originally
anticipated.
RFQ Sent To Time Frame Response Total Estimated Cost
Syberry 12-14 Months $ 165,236
ClearSummit 9-11 Months $ 254,897
iTransition 16-18 Months $ 175,896
SideBench 13-19 Months $ 245,189
MojoTech 14-17 Months $ 219,856

Additionally, the Final Budget Summary is listed below.

PHR and EHR Semantic Interoperability Research Proposal Budget
Task Time Cost Actual
Health Care Provider Census 8 Months - 7 Months, 2 Weeks
Form Printing $ 250,000 $ 239,514
Postage $ 549,000 $ 550,000
Tally Results $ 158,000 $ 152,357
Rebate Proposal 1 Year - 1 Year, 2 Months
Lobbyist Salary $ 615,000 $ 621,548
Travel Expenses $ 357,000 $ 352,450
Request for Quotes (RFQ) 3 Months - 2 Months, 3 Weeks
Office Assistant Salary $ 42,000 $ 42,000
$ 1,971,000 $ 1,957,869
BUDGET VS. ACTUAL DIFFERENCE $ 13,131
Results
The results from the Health Care Provider EHR Census of 2021 are listed in the table below.
High level summary: the majority of providers have an EHR system in place. All systems listed
on the census are compatible with the software being developed, leaving a potential 3.15% of
respondents that will need to change from their current EHR system to a compatible system.
Hospitals and Clinic/Medical Offices were the bulk of respondents, and most facilities see
between 1500 to 6000 patients a year. The majority favored a tax credit over a cash rebate, with a
small percentage preferring an unlisted method.

Health Care Provider EHR Census 2021 - Results

(1) Are you currently using an EHR System?
Yes: 62.41%
No: 37.59%
If Yes, What EHR System are you currently using?
Allscripts: 36.20% Epic: 12.36%
Cerner: 24.52% NextGen: 6.52%
eClinicalWorks: 17.25% Other: 3.15%
(2) How do you define your health care instituion?
Ambulatory Surgical Center: 12.65% Hospital: 26.20%
Birth Center: 2.56% Imaging/Radiology Center: 1.30%
Blood Bank: 1.18% Mental Health/Addiction Treatment Center: 1.02%
Clinic/Medical Office: 36.52% Nursing Home: 2.52%
Diabetes Education Center: 0.09% Orthopedic/Rehabilitation Center: 1.09%
Dialysis Center: 1.20% Urgent Care: 3.91%
Hospice Home: 9.75% Telehealth: 0.01%
(3) Approximately how many patients do you see a year?
Under 500: 0.20% 3000-6000: 49.59%
500-1500: 1.56% Over 6000: 2.44%
1500-3000: 46.21%
(4) What is your prefered incentive for installing/upgrading to an EHR System?
Cash Rebate: 37.68%
Tax Credit: 45.96%
Other: 16.36%

Conclusions
With the results of the census showing the majority of respondents preferred a tax credit, we
instructed the lobbyist firm to proceed to convince legislators to enact the EHR Tax Credit bill of
2022.
It was observed that, the larger the health care institution, the more likely the facility was to
favor a tax credit over a cash rebate.
Recommendations
#1. Engage with MojoTech. Their budget and timeline were reasonable, and they have
significant experience with software in the medical field.
#2. Once software has been completed, approach Apple and discuss adding the application to
‘The App Store’.
#3. The tax credit amount should be based solely on the amount spent by the health care
provider.
 Annotated Bibliography
INVID. “How Much Does Custom Software Cost?”. Invid Group. https://invidgroup.com/how-
much-does-custom-software-cost/ 16 Dec. 2020
- This website was used to estimate reasonable quote responses, as I did not actually send
out quotes to companies for a software that I am (in the real world) unable to fund the
creation of.
Newman, Dave. “Top EHR Vendors 2021 – Epic, Cerner, Meditech, Allscripts, Athenahealth”
Healthcare IT Skills, Health Information Technology Career Advice, Healthcare IT
Certifications, Project Management, Job Tips, HealthcareITSkills.com
https://healthcareitskills.com/top-ehr-vendors-allscripts-athenahealth-cerner-epic-
meditech/ 21 Mar. 2021
- Used this site to derive reasonable results from the ‘census’.
The Manifest. “Top 100 Software Development Companies” https://themanifest.com/software-
development/companies 12 Jan. 2021
- This website was used to determine what software companies I likely would have sent
quotes to. Again, I didn’t actually send quotes out – doing so would be unethical (request
a quote for something I have no intention, or means, of actually funding).