AMA Is Reseller of Cloud-Based Medical Software

May 18, 2011 — The American Medical Association (AMA) has gone into the business of helping physicians go paperless, and qualify for federal cash in the process.

At a Web portal operated by an AMA subsidiary called Amagine, physicians can access software for electronic health records (EHRs), e-prescribing, patient registries, and more, all with a single sign-on, as opposed to a separate user ID and password for each program. As part of the deal, consultants will help customers select and implement the programs. The AMA calls it a 1-stop shop for gearing up to earn as much as $44,000 under Medicare, and almost $64,000 under Medicaid, for "meaningful use" of an EHR.

The Amagine Web portal, built with the help of a company called Covisint, debuted nationally last month after a pilot program among Michigan physicians. It epitomizes "cloud computing," or reliance on Internet-based programs that spare users the hassle and cost of hosting the software on an office-based computer, and keeping the programs updated to boot.

As with other examples of cloud medical software, programs available at Amagine come with no big upfront cost. Instead, physicians can essentially lease them from Amagine, which functions as a reseller. Customers sign up for a minimum 12-month contract and pay a monthly subscription fee, with AMA members receiving a discount ranging from 7.5% to 10%, depending on the product. Amagine advertises that a $300 monthly payment will put someone behind the wheel of an EHR.

Several healthcare information technology (IT) consultants interviewed by Medscape Medical News give Amagine mixed reviews. Although 1 consultant said Amagine may simplify a physician's transition to digital medicine, 2 others questioned the choice of some of the 20 programs on its menu of options.

"Dashboard" Composite of Patient Data

Physicians can choose a mix of programs 1 from 5 categories:

• EHR: Three programs are available, from NextGen Healthcare, Quest Diagnostics, and Ingenix, a business owned by UnitedHealth Group that is changing its name to OptumInsight.


• E-prescribing: The offerings here are Rcopia from Dr. First, CareLab360 Labs and Meds from Quest Diagnostics, and Amagine ePrescribing, said to be "powered" by Allscripts, an electronic prescribing and EHR vendor.


• Revenue cycle management: Infinedi, NaviNet, and AMA PATH provide tools allowing physicians to conduct online insurance verification, transmit claims electronically, estimate a patient's financial responsibility at the point of service, and automate other billing functions.


• Quality reporting and patient registries: Physicians who want to earn "meaningful use" bonuses must report to the Centers for Medicare and Medicaid Services how they manage preventive and chronic illness care for various patient subgroups. Three patient registries called DocSite, WellCentive, and Rcopia-MU help physicians do this.


• Lab ordering and results: The single program in this category — Care360 Labs — allows physicians to submit lab orders and review results online.


• Clinical support: Using the 7 programs in this category, physicians can look up drug interactions, journal articles, and evidence-based diagnostic and treatment advice; order medication samples online; and communicate online with patients.

The Amagine Web portal aggregates a particular patient's data from a chosen suite of these products into a single "dashboard" view. Certain bundles of programs are designed to be interoperable, meaning they can exchange patient information, said Robert Musacchio, PhD, senior vice president of business product solutions at Amagine. Dr. Musacchio told Medscape Medical News that if a physician selects products that lack this kind of data interface, Amagine will create one free of charge, as long as it is a "standard integration."

AMA Receives Commission as Reseller

Amagine states that it gives physicians — confronted with hundreds of medical software products — a pared-down list of carefully vetted vendors that meet its standards for integrity, reliability, security, and user satisfaction. Among other things, the vendors must demonstrate financial stability and focus on office-based medicine, as opposed to inpatient care.

The line-up of vendors, especially those in the EHR category, does not impress healthcare IT consultant Mark Anderson in Montgomery, Texas. "The medical associations I work with don't recommend any of these products," Anderson told Medscape Medical News.

Prominent EHRs that do not appear in the Amagine stable include some that regularly earn number 1 rankings in customer satisfaction surveys conducted by a research firm called KLAS. The latest KLAS ranking by practice size puts the following products in the top spot:

• 2 to 5 physicians: e-MDs Chart from e-MDs;


• 6 to 25 physicians: Greenway Medical PrimeSUITE Chart from Greenway;


• 26 to 100 physicians: eClinicalWorks EMR from eClinicalWorks; and


• more than 100 physicians: EpicCare EMR from Epic.

Anderson said the EHRs offered through Amagine have their good points but suggested that financial considerations may have weighed heavily in their selection. He noted that some organizations have endorsed EHR products because vendors were willing to "pay to play" — that is, simply buy an endorsement. Healthcare IT consultant Barb Drury in Larkspur, Colorado, voices similar concerns. "There has to be a business reason [for both sides]," Drury said.

Dr. Musacchio said Amagine is not a pay-for-play marketing venture. "[Vendors] don't pay us to be on the site," he said. One financial consideration that does affect vendor selection, he noted, is the commission that Amagine earns for reselling subscriptions to online programs. If a company proposed too low of a commission, "it wouldn't be economical for us to sell its product on the portal," he said.

Dr. Musacchio said Amagine would be adding more products to its line-up. He noted that some prominent EHR vendors initially did not meet the technological criteria set by his company. "Since then, things have evolved," he said. "Now that some of the technological issues have been worked out, you'll see more products come aboard in the future."

At the same time, said Dr. Musacchio, Amagine cannot do business with everyone, nor should it attempt to. "We want to give physicians a choice, but we're not aiming for an infinite number of choices," he said. "Otherwise, that would paralyze a physician's decision-making."

"Trusted Source" vs Typical Vendor

Rosemarie Nelson, a healthcare IT consultant in Jamestown, New York, who is affiliated with the Medical Group Management Association, also sees a benefit in a limited field of products.

"What Amagine is saying is, 'We're going to simplify the deal,' " Nelson told Medscape Medical News. "It would appeal to a lot of practices that are overwhelmed with the decision points."

Nelson said that practices unsure about selecting and implementing the technology could benefit from Amagine's consulting services as well. Those consultants, according to Dr. Musacchio, represent a combination of Amagine staff and third-party companies that provide a regional presence.

Amagine's consulting arm reinforces the company's role as a technology reseller. Customers do not have a direct relationship with any of the software vendors whose products are on the Amagine platform. "They have a relationship with us," said Dr. Musacchio. As a consequence, if they experience a problem with their software, they would turn to Amagine for assistance.

Nelson said Amagine may win customers as a "trusted source," because of its AMA roots. However, Barb Drury advises physicians to keep up their guard and treat Amagine as they would any other vendor. She recommends that they study the terms of use and related business documents at the company Web site, found by clicking on the "Legal" link at the bottom of the page.