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Getting Buy-in For Your Second (Or More) EMR Purchase

Posted on August 15, 2017 I Written By

The following is a guest blog post by Michael Shearer is VP of Marketing for SelectHub.

Remember when you rolled out your first EMR?  Many of your doctors were uncertain, frustrated or angry, insurers were rejecting claims left and right and revenue fell as providers struggled to use the new system. Ah, those were lovely days.

Thankfully, in time everyone finally adapted. Through a combination of one-on-one coaching, group training, peer-to-peer mentoring and daily practice, clinicians got used to the system. Your patient volumes returned to normal. Some, though probably not all, of them got comfortable with the EMR, and a few even developed an interest in the technology itself.

Unfortunately, over time you’ve realized that your existing EMR isn’t cutting it. Maybe you want a system with an integrated practice management system. Perhaps your vendor isn’t giving you enough support or plans to jack up prices for future upgrades.  It could be that after working with it for a year or two, your EMR still doesn’t do what you wanted it to do. Whatever your reasons, it’s time to move on and find a system that fits better.

Given how painful the previous rollout was, buying a new EMR could be pretty disruptive and could easily stir up resentments and fears that had previously been laid to rest. But if you handle the process well, you might find that getting EMR buy-in is easier the second (or more) time around. Below are some strategies for getting clinicians on board.

Learn from your mistakes

Before you begin searching for an EMR, make sure that you’ve learned from your past mistakes. Consider taking the following steps:

  • Conduct thorough research on how clinicians (and staff if relevant) see your existing system. This could include a survey posing questions such as:
    • How usable is the EMR?
    • What impact does the EMR have on patient care, and why?
    • Does the EMR meet the needs of their specialty?
    • What features does the existing EMR lack?
    • Are EMR templates helping with documentation?
    • What are the great features of your existing EHR?
  • Compile a list of technical problems you’ve experienced with the system
  • Evaluate your relationship with the EMR vendor, and make note of any problems you’ve experienced
  • Consider whether your purchasing model (perpetual license vs. online subscription) is a good fit

Put clinicians in charge

When you bought your first EMR, you may have been on uncharted ground. You weren’t sure what you wanted to buy or how much to spend, and clinicians were at a loss as well.  Perhaps in the absence of detailed clinical feedback, you moved ahead on your own in an effort to keep the buying process moving.

This time around, though, clinicians will have plenty to say, and you should take their input very seriously. If they’re like their peers, their critiques of the existing EMR may include that:

  • It made documentation harder and/or more time-consuming
  • It wasn’t intuitive to use
  • It got in the way of their relationship with patients
  • It forced them to change their workflow
  • It didn’t present information effectively

These are just a few examples of the problems clinicians have had with their first EMR – you’ll probably hear a lot more. Ignoring these concerns could doom your next EMR rollout.

To avoid such problems, put clinicians in charge of the EMR purchasing process. By this point, they probably know what features they want, how documentation should work, what breaks their workflow, what supports their process and how the system should present patient data.

This will only work if you take your hands off of the wheel and let them drive the EMR selection process. Giving them a chance for token input but buying whatever administrators choose can only breed hostility and distrust.

Look to the future

When EMRs first showed up in medical practice, no one was sure what impact they’d have on patient care. Administrators knew that digitizing medical records would help them produce cleaner claims and shoot down denials, but few if any could explain why that would help their providers offer better care. In some cases, these first-line systems did nothing whatsoever for clinicians while weighing them down with extra work.

Over time, however, providers have begun using pooled EMR data to make good things happen, such as improving the health of entire populations, identifying how genetics can dictate responses to medication and predicting whether a patient is likely to develop a specific health condition. These are goals that will inspire most clinicians. While they may not care what happens in the business office, they care what happens to patients.

These days, in fact, using EMR data to improve care has become almost mandatory. Even if they didn’t bother before, practices are now buying systems better designed to help providers deliver care and improve outcomes. If your clinicians are still unhappy about their first experience, they may have trouble believing this. But make sure that they do.

The truth is, there will always be someone who doesn’t like technology, or refuses to take part in the buying process, and it’s unlikely you’ll win them over. But if your EMR actually enhances their ability to provide care, most will be happy to use it, and even evangelize the system to their colleagues. That’s the kind of buy-in you can expect if you deliver a system that meets their needs.

Michael Shearer is VP of Marketing for SelectHub, which offers selection tools for EMRs and practice management systems.

 

#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Posted on February 26, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for Billian’s HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

interoppanel

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

“If You Could Tell Your CIO …”

Posted on March 7, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for Billian’s HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

In the first part of this blog series, I outlined the increasingly important role CMIOs are playing in the hospital ecosystem. They are bridging the gap between the world of clinical and IT, bringing a spirit of impartiality to HIT implementations that often makes the acceptance of impending workflow upsets a little bit easier to swallow.

This second part will focus on the specific challenges CMIO panelists at a recent Georgia HIMSS luncheon were particularly vocal about:

* Taking an EMR implementation from grumbles to growth;
* Data and its potential impact on establishing or refining best practices;
* Patient engagement; and
* “If You Could Tell a CIO.”

From Grumbles to Growth
All the panelists shared their “secret ingredients” for EMR implementation success. Roland Matthews, MD, physician champion at Grady, stressed that the hospital chose to implement an EMR not for the Meaningful Use incentives, but to ultimately improve quality over the long term. Despite recent EMR backlash, Matthews is a firm believer in the benefit they will ultimately bring to patient care.

That being said, he believes that simpler, easier-to-use systems are the best choice when it comes to gaining full adoption amongst clinicians. His statement echoes the increasingly loud call from clinicians for better user experience. Involving all departments in the selection and implementation process from the very beginning is also essential, according to Matthews, and serves as a testament to good leadership.

The best user experience won’t take physicians very far, however, if infrastructure is too unreliable to sport it. While he didn’t claim to speak from personal experience, Matthews also pointed out the latest and greatest EMR may never be used to its fullest potential if the platform on which it stands is down half the time.

Steve Luxenberg, MD, CMIO at Piedmont Healthcare, made sure to point out the full value of an EMR can only be realized if clinical and IT work together to maintain, optimize, and grow the product from within.

This takes us to conversation points about extracting data to create or refine best practices in an effort to drive quality initiatives.

Digging Out Data to Increase Quality
“It’s not an EMR for the sake of an EMR,” Luxenberg emphasized. “It’s about the data we can pull out, interpret and impact outcomes with.”

Daniel Wu, part-time CMIO at Grady, echoed Luxenberg’s comments: “The EMR has opened a door to allow us to collect data as we’ve never been able to do before.” The panelists all agreed on this point, and now it seems as if they are tackling the issue of interpreting the data to enable better outcomes and quality.

Matthews insisted that collecting the data is really all about quality, and suggested that the EMR should guide standards, which the panelists referred to in the same context as best practices.

Wu made the point that if providers don’t control what designates quality care, or best practices, then the government will come along and regulate it for them. (I’m fairly certain this echoes what Farzad Mostashari has tweeted about in the recent past.)

Luxenberg again emphasized the impartiality CMIOs must take when dealing with clinical and IT staff. He noted the CMIO’s role is to bring the two groups together for consensus on what best practices are and how to put those into the EMR, and added this becomes more challenging when working in a multi-facility healthcare system.

Patient Engagement
Patient portals were on the tips of all the panelists’ tongues when it came to patient engagement. Julie Hollberg, MD, CMIO at Emory, is in the middle of rolling out a portal right now. Her team is finding the most challenging part of that implementation to be educating Emory patients on what benefits the portal offers. Luxenberg was a bit lukewarm with regard to patient portals. He’s seen several come and go and has found that only a certain set of patients is apt to use them.

Wu, who has helped implement Epic’s MyChart at Grady, was firm when he said that patients have the responsibility in their court now. Patient kiosks are helping in that effort, too.

What Would You Like Your CIO to Know?
Wu’s big point was that if CMIOs and CIOs can’t communicate, each is doomed to fail. He said it with a smile, of course, as his CIO, moderator Debbie Cancilla from Grady, was standing right next to him.

Other insights included:

* Keep IT simple for the clinicians.
* Just because you can do it doesn’t mean you should.
* Always keep in mind what’s best for the patient, and what’s the simplest way to get that done.
* It’s always a good idea to have IT folks shadow clinicians and vice versa. The CMIO’s job is to help facilitate this type of partnership.

How have CMIOs brought your clinical and IT teams together? Please share anecdotes and more best practices in the comments below.

Breaking up with Your EMR is Hard to Do

Posted on February 13, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for Billian’s HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

In light of this week’s “holiday,” I thought I’d take a look at the current love/hate relationship the healthcare industry seems to have with electronic medical records and Meaningful Use.

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Thanks are due to @mdrache and @EHRworkflow for their inspiration for the title of this week’s post: EMRtweet1

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The nay sayers seem to have become especially vocal lately, which may be due in large part to the passing of time. Those that have implementations under their belt now feel qualified to talk about the efficacy of the solutions they selected. Negative EMR press may also have bubbled up to the service in light of the recent RAND report, which backpedaled on previous predictions of cost-savings associated with healthcare IT adoption. That study broke the ice, so to speak, and perhaps made providers more comfortable with voicing their discontent.

In any case, if current healthcare IT press is any indication, EMR technology currently on the market has often left providers dissatisfied for a number of reasons. No doubt this dissatisfaction will be a subject of many show-floor conversations at HIMSS in a few weeks. I wonder how EMR vendors are preparing their responses. What will be their top three talking points when it comes to EMR benefits? It seems Meaningful Use incentives have lost their luster, and in fact have left many providers disenchanted with healthcare IT in general.

John Lynn posted a very telling reader comment over at EMRandHIPAA.com from a provider who used his Meaningful Use malaise to create a new independent practice business model. Is this an indication that more providers may “revolt” against Meaningful Use and the trend towards hospital employment? If so, what will the private practice landscape look like in three to five years?

Just how easy is it for providers to truly “break up” with their EMRs? We’ve all read the multi-million-dollar rip-and-replace horror stories – talk about a bad breakup. And then there are the providers that stay in dysfunctional relationships with their EMRs because they can’t afford a new one, instead developing copious amounts of workarounds potentially at the expense of clinical care and accurate reimbursement.

As of last summer, KLAS reported that a whopping 50% of providers were looking to replace their ambulatory EMRs, compared to 30% in 2011. A recent Health Data Management webinar noted more than 30% of ALL new EMR purchases are made to replace an existing EMR.

To me, these numbers beg a number of questions. Were first- and perhaps even second-generation EMRs just not mature enough for providers’ needs? Did providers simply not do enough due diligence before making their purchases? Will these impending replacement EMR purchases stick? If you have updated EMR breakup statistics or a crystal ball, please send them my way.

10 Tips for Selecting the Right EHR

Posted on November 30, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently stumbled upon the Insight Data Group website. I don’t know much about the organization, but they had an interesting page on their site listing 10 tips for selecting the right EHR. Here are there 10 tips.

  • Make sure the EHR is easy to use and customize
  • Get training and more training
  • Buy the ‘right sized’ solution for your practice
  • Know who’s filing your insurance claims
  • Get and check references
  • Get mobility / portability access
  • Use the government’s money to pay for your EHR
  • Compare total cost of ownership not monthly payments
  • Know the financial stability and reputation of your EHR vendor
  • Make sure your vendor’s meaningful use guarantee is meaningful

They have a full explanation of each tip at the link above, but I thought it was an interesting list to share. I have a little bias for the e-Book I wrote on EHR selection, but this is a good quick list to consider if you’re in the EHR selection and EHR implementation process. I would be careful with the government money recommendation. I’d probably have said, “Consider using the government’s money to pay for your EHR.”

Of course, many of you are likely already past this process. However, I know that many of you will need this list in a year or two when your current EHR software doesn’t deliver what you expected it to deliver. We’re already seeing this now, but the replacement EHR market is going to be huge over the next few years.

The EHR Has Clothes … At Least Some of Them

Posted on July 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been really falling in love with some of the content that the Health Affairs blog has been putting out there lately. A recent post titled “The EHR Has No Clothes” was no exception. In this incredibly thoughtful post by Barry Saver, he’s not afraid to start a discussion about points that many are afraid to talk about. I like that a lot. Although, I think the post also represents a couple ongoing trends I see in EHR perceptions.

Common EHR Problem 1 – I can’t tell you how many times I ask a doctor how they like their EHR and then they provide me some small facet of the EHR which annoys them. In Barry’s case it’s “Most screens do not show age, date of birth, or medical record number.” While we could delve into the particular feature that Barry mentions, that’s really not the point. The point is that far too often I see users of EMR systems fixating on one particular issue and ignoring the dozens of other items that are better than the paper world. It’s the proverbial throwing out the baby with the bath water.

No doubt I have a little Pollyanna in me. Although, I should be clear that I’m not suggesting that EHR problems shouldn’t be addressed. Please do hold EHR vendors accountable if their software needs changes. I am saying that I see far too many doctors and clinics that get so fixated on one problem that they ignore all the other good things that are possible. There are deal breaking EHR features and their are EHR annoyances that can be fixed. Make sure you know which one you are really dealing with when you see it.

As an interesting sidebar, this same fixation often happens in the EHR selection process. Although, in this case the person selecting the EHR often fixates on some particular feature (valuable or not). For example, they’ll say that they really love the login screen or background color. It’s amazing what little things can have such an influence on our decision making when they shouldn’t matter at all.

Common EHR Problem 2 – I’ll call this problem the mature feature problem. It turns out it’s a fallacy to assume that a mature EHR (ie. one that’s been around for a long time) has had time to fix all the problems. Here’s a short paragraph from the above linked post:

Approving 12 months of refills when I receive an electronic refill request typically takes a combination of 14 mouse movements, clicks, and keystrokes – as opposed to four if it were implemented efficiently. The list of items needlessly making it more difficult to provide efficient and effective care would cover many pages. These might seem like issues that could be present in version 1 of a system and then promptly fixed, but we currently have version 5.6.

I’ll save the discussion of mouse clicks and keystrokes for another post since it’s an important one. Instead, let’s focus on the idea that a mature EHR will have worked out all the issues with certain features. While this can definitely be true in the early development of EHR software, the opposite often comes into play as EHR software matures.

When an EHR begins its development life cycle it’s usually only saddled with a very specific task. In fact, you don’t have time to build all the features so you often have to make it really simple because of time constraints. Assuming this meets your workflow, it’s a great thing and you enjoy a wonderfully simple interface. Over time, features continue to be added to the interface. Plus, they have to start supporting all 50+ medical specialties that all have their own specific needs. Quickly, the beautiful EHR interface gets bloated to the point that it can do everything imaginable, but it does nothing really well.

Certainly, the best EHR software vendors know this and battle against it. Although, it really takes a battle to overcome this challenge.

What I find even more ironic is that Barry suggests Vista as the solution to his issues with EHR. At least he admits to never having used it other than the demo client on the web. Certainly Vista has its place in the EHR world and I love that it’s open source and benefiting from that innovation. Although, I think it’s crazy to think that a small doctor’s office is going to implement Vista. I’d love to see Barry do a write up after he adopts Vista.

Does the EHR have no clothes?
I think many EHR companies do have clothes on. I think the real problem is that we need to just stop shopping at the high end stores by the nude beach.

Mayo Clinic Social Media Residency, EMR Selection, & EMR License Transfers

Posted on July 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While the Twittersphere is flooded with tweets about the #HIT100, I still was able to take a look through all the volume of tweets and find a few good topics that are well worth discussing on this site.

There are some real doozies in this EMR and Health IT Twitter round up. I’d love to hear your thoughts on each of the topics.

Let’s start with this announcement from the Mayo Clinic:

That’s pretty amazing news to consider. I imagine that most doctors won’t like the use of the name “residency” when it comes to this program. It kind of diminishes how much work, effort and learning happens in their residency. In this case I have to agree with those doctors. Use of the word residency for this short “social media residency” is in poor taste. Although, I do like that the Mayo Clinic is placing such value on the use of social media in healthcare.


Amazing counsel!! Read it again and post it on your wall if you’re going through an EHR selection. The other way to deal with this is to not buy until the requested features is implemented. Although, if you go that route, you might be sitting around forever since they may never implement your requested feature.


I’m glad to see Jim Tate tweeting again. I think he was on hiatus for a while. Or maybe I just hadn’t seen him for a while. In the above tweet he links to an article by William O’Toole that does a great job looking at the issues associated with EMR licenses. Well worth a read if you’re purchasing an EHR or if you plan to one day sell or transfer your practice to someone else.

EHR Selection Services

Posted on June 12, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Those of you who’ve read my Free e-Book on EMR selection know that one of the things I suggest you do is to narrow down your list of EHR vendors to a small group of ~5 EHR vendors to start your EHR selection process. The book has the full rationale, but the challenge is that with 600 EHR companies out there you can’t review them all.

Of course the next question I’m asked is how you narrow down the companies to start your EHR selection review process. One thing that’s really developed over the 6 years I’ve been blogging is the EHR selection services. They’re still all far from perfect, but I suggest you take a look at a couple of them to start getting a list of EMR companies that you might want to consider. Then, take those lists and ask around to your colleagues. I call this approach triangulating the EHR data points to get you down to a smaller group of EHR companies.

One challenge is that there are a lot of EHR selection website out there. Here are just a few for you to consider. If you’re just looking for a really simple way to get access to price quotes and demos of EHR software, then go check out Software Advice or EHR Scope.

If you want a deeper, more custom EMR / EHR matching system then you’ll want to take a look at EMR Consultant, EHR Selector, and Hielix Apps. All 3 of these websites have made significant investments to try and help doctors match their needs with the EHR software.

I’ll admit that I’m probably a little bias towards EMR consultant since they’ve been around ever since I first started blogging about EMR. Plus, I love that it’s free. Although, a little birdie told me that EHR selector is considering a Free EHR selection option as well. There’s something I really love about the free EHR selection model. Basically, physicians that use it to help with their EHR selection have very little to lose.

Hielix on the other hand costs a few hundred dollars to use. They did send me a promo code for those that want $25 off their service. Just enter: “EMRANDEHR” Hielix is definitely taking a much more hands on approach to the EHR selection process so it makes some sense that they’d charge for the service. In one email exchange with them they talked about their CEO meeting with one of their customers to discuss their report. I’m sure many doctors will like this type of high touch service.

Always trying to get some good info for my readers, I got permission to publish a PDF file of a sample report that Hielix produces. I think the really good stuff in this report starts about page 7.

As I said previously, none of the EHR selection services are perfect. Although, I think using a couple of them isn’t a bad idea to start narrowing down the long list of EHR companies. I see it as an extra data point that can be used to narrow your list. Unfortunately, none of these services make it so you don’t have to do a thorough evaluation of multiple EHR vendor before you buy. I’d love it if someone figured out how to solve that problem. Until then, an EHR selection service isn’t a bad place to start.

How To Grill An EMR Vendor

Posted on June 4, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I found a nice blog piece on how providers — largely medical practices, the blog’s core audience — can grill EMR vendors effectively prior to sinking their money into a product. I say “grill” because the questions will force vendors to put up or shut up on several levels, something a lot of non-techy doctors wouldn’t know how to do.

Here’s the five questions, courtesy of the EMR and EMR Insights blog (with a few comments on each):

When did your company start operations, and can I have 2 references from each year you have been in business?

I don’t know about you, folks, but assuming older companies will produce better results involves some significant risks too.  Sure, a high-flying venture-funded partner might go out of biz next week, and that would be pretty terrible. On the other hand, many companies grow less creative and less flexible over time, and take their customers for  granted — even if it’s not part of a doofus big vendor’s lineup.  What about: “Can I have five references for clients in my specialty?” and “Please sign this contract addendum which addresses how you’ll handle it if your product is discontinued or you close you doors.”

* How many developers are assigned to work on your core EHR product? Where do the developers reside?

I like the Q regarding the size of the development team, which can be  make-or-break factor in keeping your product updated and bug-patched.  But as for where the developers reside, again, that’s a toss-up.  You could hire a vendor with a large but poorly-managed development team, or a small vendor whose team is overseas — but well-managed and effective nonetheless.

* How was your product and company ranked in the Best in KLAS Awards — Software & Services Report – December 2011, and the KLAS Ambulatory EMR Specialty Report 2012?

Interesting. In theory asking about rankings is a good idea, unless you don’t respect the people doing the ranking. (I know my colleague John Lynn isn’t a raving KLAS fan.)  I suppose rankings like these can be a touchstone, but they probably shouldn’t be a primary factor in EMR investment decisions.

* Do you have a whitepaper that explains your interoperability platform?

Definitely a good question, but the answer is probably over the heads of many clinicians and office managers making the EMR call. If a medical practice has someone on staff who’s geeky, or an IT consultant is on your selection team, sure, get the whitepaper. Otherwise, I believe medical practices would do better simply studying the literature and asking for a thorough, plain-language presentation explaining these features.

* What are your specific plans for meeting all the Meaningful Use requirements of Stages 2 and 3?

What can I say but yes, yes and more yes. A company that can’t answer this question should be toast.

One final note.  How about throwing in “If I can’t get to Meaningful Use within x days, do I get my money back?”  Seeing how your vendor reacts should be, um, educational.

Are Large EHR Vendors More Likely to Shut Down an EHR Than Small EHR?

Posted on May 9, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most people who have read this blog for a while, you know that I try to bring you raw perspectives on things that a lot of people don’t want to talk about. Plus, I don’t mind arguing the other side of topics in order to provide a more well rounded view of an important topic. One of my main goals is to provide the information necessary for doctors to make great decisions.

I recently got into a lengthy discussion with someone about EHR vendor selection. They suggested that doctors should look to the 5 EHR market leaders in their EHR selection process (I believe he sold one of those EHR market leaders). He made some very good points about the market leaders ability to support all stages of meaningful use, that they have a solid business model that will support doctors for the long term, and that they have the resources to support an EHR software for the long run. He also provided some reasonable cautions around small EHR vendors with skeptical business models that might not be around a few years from now.

Certainly the points he makes have merit and are worthy of consideration. Although, unlike this person, I’m not so ready to throw the rest of the non-top 5 EHR vendors out and I think it’s a mistake for a doctor or practice manager to do so as well.

As I considered on this discussion, I realized that over the past 5-7 years, it’s many of the big EHR vendors that have closed up their EHR software. Possibly even more than the various startup EHR companies. Here are just a few examples of large companies shuttering their EHR: Misys (billion dollar company if I remember right), Epocrates and GE Centricity Advance (one of GE’s suite of EHR). Of course, Misys merged with Allscripts (if you call it a merger since they were going bankrupt), but I know a lot of unhappy Misys users that don’t know what to do now. GE has many other Centricity products as well and seems to have made a smoother transition for their Centricity Advance users. At least that’s within the same company. Epocrates is a large company, but didn’t have many EHR users.

My point of course is that even EHR software from large EHR vendors aren’t safe from possible future issues. In fact, I could make a reasonable case for why a smaller EHR vendor that’s grown in a sustainable way over a long period of time is in a better financial position than a HUGE company with a lot of overhead. Plus, I know personally A LOT of these small EHR vendor CEOs. They love what they’re doing and they’re in this for the long haul.

Now with 600+ EHR vendors out there, I’m certainly not saying that all of them have great business models. I was blown away when I met one at MGMA who had 1 doctor using their system. I hope whoever they sign up second is aware of the situation and is going in with both eyes open. There are certainly risks associated with being the second doctor on an EHR software, but there are also plenty of benefits as well. When you suggest something be changed, there’s a good chance you’ll get that change.

Conclusion
There are good small EHR companies.
There are good large EHR companies.
There are bad small EHR companies.
There are bad large EHR companies.

I guess what I’m saying is that size doesn’t matter in EHR selection. There are much more important factors to consider.