1. From the St. Louis Business Journal
: http://www.bizjournals.com/stlouis/stories/2010/07/19/focus4.html
Health care and its partners
EHR providers continue to wait onstimulus boost
Medical Office Online founder Dr. John Costello (left) and CEO Vim Anand expect business to double or triple in the next
few years.
Rebecca Boyle
The field of medicine, as technologically advanced and future-driven as it is, has been slow to adopt the
modern convenience of electronic record-keeping.
Using stimulus funds, the federal government hopes to speed things up.
Last year s American Recovery and Reinvestment Act included $36 billion for doctors and hospitals to
purchase and network electronic health records (EHR) programs. And that could mean big business for
several local firms that specialize in providing EHR software and consulting services to physicians.
Doctors who treat patients on Medicare and Medicaid will be eligible for $40,000 to $65,000 in purchase
incentives, which will come in the form of Medicare and Medicaid reimbursements. The incentives phase
out over five years, and starting in 2015, doctors who don t use EHR will face penalties.
Physicians in private practice provide 80 percent of the health care in the U.S., but only 20 percent use
electronic health records, according to a study last year by the Massachusetts Institute of Technology.
That s a huge potential market, but for now, it s a market waiting in the wings.
Before they can receive payment, physicians must meet government standards showing the new
software is certified and being effectively used. But those standards aren t completed yet, and the
government did not finalize its software certification process until June 24.
Physicians are shopping around, but many remain hesitant to make commitments to an approach until
the rules are in place, said Mike Barnell, CEO of Creve Coeur-based Precision Practice Management Inc.
With the Cash for Clunkers program, they talked about it for a long time but the rules were not finished,
so no one was going into auto showrooms, he said. It s not quite like that we do have install meetings
every so often but there s still a lot to be determined. We re already busy, but we re expecting to get
even busier.
Vim Anand, CEO of Medical Office Online, based in Des Peres, said he expects lots and lots and lots of
new customers once the government rules are complete.
We re certainly expecting to double or triple over the next few years, Anand said.

2. Medical Office Online s target market is small practitioners, and Anand said there are about 450,000 of
them in the U.S. The majority have Medicare or Medicaid patients, meaning they d be eligible for the
federal refund. Currently, the firm serves 900 users across the country.
Uncle Sam is going to put somewhere between $44,000 and $65,000 in their pockets, spread over four
years, and their subscription to us is only $3,800 a year. So why wouldn t they do it? Anand said.
Anand has seen steady interest from physicians starting new practices. But now with the stimulus
available, he s seeing inquiries from established physicians, as well.
Electronic health record software comes in various forms, but all involve digitizing patient records. Some
also include digital practice management elements, like electronic appointment calendars; dictation
software that transcribes doctors clinical notes; and e-prescription programs, which negate the problem
of sloppy handwriting.
Charles James Jr., president and CEO of Shrewsbury-based North American Healthcare Management
Services, said a one-size-fits-all solution can be hard to find, however.
For instance, some physicians already use electronic billing, and those programs may not always mesh
with a new practice management system. James firm provides both types of systems.
In the mad dash to implement something, I think many practices totally fail to understand that this is not
something where you can make a decision and cram into your office in the space of three months, he
said. It s a fundamental shift in the way physicians operate.
For James, it means a shift in business model. In the past, North American Healthcare might just install
billing software for physicians who use the firm s services.
Now, physicians might have other programs, too, and it s up to North American Healthcare programmers
to make sure it all works together.
It s a change in process for us. Ultimately, it s not that big a deal; we typically go in and get training on
whatever that piece of software is, he said. The bigger issue is internally for the physician or the medical
practice. If they are on a paper chart, they are totally reinventing their business processes, top to bottom,
and I think it s a much bigger disruption than people understand at this state.
It was disruptive for Dr. Paul Rottler, but he said in hindsight, he wishes he had changed sooner.
The Kirkwood-area cosmetic surgeon wouldn t have been able to use the stimulus incentives because he
doesn t have enough Medicare or Medicaid patients. If he hadn t been forced out of the former SSM St.
Joseph Hospital in Kirkwood when it closed and chosen to build his own facility in St. Louis County, he
might have taken much longer to make the leap, he said.
Believe you me, it was a leap of faith, he said. All my records had to be scanned and eventually they
shredded them, and that was really scary. I was parting with charts I had from the first day of my
practice.
He started using Encite software from Precision Practice Management about a year and a half ago. After
a three-month learning curve, Rottler was sold.
Now instead of rummaging through paper files, he and the nurses carry tablet computers with patients
records. Encite is even available on the iPad.
Rottler and his staff can take notes during a consultation, order an X-ray, order a prescription and even
schedule a future appointment, all from one device. After a patient visit, Rottler uses a dictation program
to transcribe his notes, and everything is connected to the patient s record.
This is so much easier, so much better. There are fewer steps, fewer screw-ups, fewer everything, he
said. Like any new software program, it takes a while to learn it. But once you see all it can do, you
wonder, Why didn t I do this a long time ago?
Other physicians are apparently catching on, because business was growing before the stimulus, Barnell
said. Precision serves 85 physician practices throughout the Midwest, and more are on the way: Barnell
said the calendar is booked with implementation meetings through the end of August.
Barnell said Precision brought in $8.2 million in revenue last year, and he expects that figure to hit $10
million by 2011.
In addition to Encite, Precision is adding three additional software platforms to accommodate physicians
needs, Barnell said. The new programs NextGen, Greenway Medical Technologies and eClinicalWorks
each have strengths that appeal to practices of different size and specialty, he said.
The trigger for sales will be the government finalizing all its standards, Barnell said. As that occurs,
what we ll see is practices begin to finalize their decision on what software they want to go to.

3. Barnell said he s not counting on that alone, however.
What we focus on is that they should try to get a good EHR that will pay for itself through internal
efficiencies and effectiveness, and better clinical care, he said. If the government comes in later and
also pays the practice to have done that, then the practice wins twice.
Rebecca Boyle is a St. Louis freelance writer.