When eClinicalWorks settled the $155 million False Claims lawsuit with the U.S. Department of Justice, the agreement included stipulations that the EHR vendor must transfer customers’ data to a rival electronic health record platform if asked and that it fix software issues that caused the problem in the first place.
Almost a year since then an existential question has arisen: the government got its money and whistleblower Brendan Delaney collected approximately $30 million as he is entitled, but what about eClinicalWorks customers who either missed out on revenue because of non-compliant software or have to keep paying eClinicalWorks so they can collect on accounts receivable?
Smoke and mirrors
Two eClinicalWorks customers said the data transfer options and faulty software are still problematic today.
“They might be saying ‘okay we’re abiding by the DOJ’ but they don’t let you have a glide off path, they’re just making us pay full freight,” said Andrea Malik Roe, CFO of CRH Healthcare in Atlanta, Georgia. “I think they’ve just gotten away with it.”
Andrew Gordon, MD, of Northwest Neurology in Lake Barrington, Illinois, said he has been using eClinicalWorks since 2012 and while there have been small issues along the way, things really took a downturn in the last year.
[Timeline: eClinicalWorks DOJ settlement one year later]
“Crisis mode came in 2017. Every day there was something. We’d hit a button with a patient in the room and the history was lost or prescriptions didn’t go through,” Gordon said. “At some point in the future there could be someone who falls through the cracks. It’s a patient safety issue.”
Gordon said Northwest Neurology reported problems thinking eClinicalWorks would cooperate but what happened, instead, was “all smoke and mirrors,” that at times involved blaming other vendors, notably Microsoft or Comcast. “The error messages came from eClinicalWorks,” Gordon added. “It was not a connectivity problem.”
Roe and Gordon both said that insofar as they can tell eClinicalWorks has not complied with the DOJ False Claims case requirements.
“The settlement with eClinicalWorks is jaw-dropping. They are required to do root cause analysis, fix underlying problems, report to the Office of the Inspector General,” Gordon said. “None of that is happening in our experience.”
Specifically, the DOJ settlement corporate integrity agreement stated that eClinicalWorks must “allow customers to obtain updated versions of their software free of charge and to give customers the option to have eClinicalWorks transfer their data to another EHR software provider without penalties or service charges.”
eClinicalWorks says it’s compliant
eClinicalWorks spokesperson Bhakti Shah said that eClinicalWorks is in compliance with the settlement and retained an Independent Software Quality Oversight Organization, though she declined to name that company.
Shah sent Healthcare IT News the form outlining options customers have. Those include: CCDA export, which is free, a one-time unencrypted database backup including scanned documents that costs $500 because eCW provides an encrypted hard drive, cloud-read only access for $200 a month per provider, and the full-service data extraction option comprising patient demographics and appointments in CSV format, locked progress notes in read-only PDF format, patient documents in native format with index file, and interface results in PDF at $1,500 per provider plus $500 for the hard drive to house that data.
“Customers can have the forms. As per the CIA, we provide them free data transfer options,” Shah said. “The $1,500 is not a must. It’s something they want us to do.”
The ability to transfer data is a sticking point, Roe said, because of the matters of timing and accounts receivable. When Roe inquired about turning eClinicalWorks off and switching to Practice Velocity, which CRH runs in multiple facilities, she was told that it would take 4-5 weeks to get her data out of eClinicalWorks — which means CRH has to get close enough on its accounts receivable that Roe would be okay operating with a 4-5 week information gap.
Roe added that since CRH has approximately $500,000 gross in AR there’s little choice other than to pay the full price to keep eCW open for billing purposes.
“They’ve made me have to pay for the length of time to get the data, or we don’t have continuum of care,” Roe said. “That’s how they hold you hostage.”
CRH has worked with several other EHRs, including Allscripts, DocuTap, Medical Manager and AdvancedMD, and they all have a glide path so customers can keep their AR open while they finalize existing accounts receivable.
“Every other normal EMR vendor on the planet has a glide path that says ‘I will turn you into read-only and let you use the clearinghouse for a nominal fee until your AR is bled out,’” Roe said. “Not eCW. This is crazy.”
Should the government step back in?
Gordon said that because of glitchy eClinicalWorks software the Centers for Medicare and Medicaid Services denied Northwest Neurology’s PQRS.
Doctors went through the rigmarole of reporting only to have CMS say it never received that data and then subject Northwest Neurology to downward payment that Gordon estimated to be about $100,000 per year.
Gordon also said that the government should get involved again: It’s time for OIG to investigate, call out eClinicalWorks, bring executives back to the table and if they won’t comply the fine needs to be bigger, the remedies more comprehensive.
“There’s no way they’re complying,” Gordon added. “Our own government settled with eCW over software issues that didn’t get fixed and the government got $125 million out of this — but what about the users? What about us? The rest of us are out in the cold.”
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