Who is your EMR Vendor?
We are at another critical juncture in the EMR evolution. Meaningful Use Stage 1 is coming to an end and developers at your EMR company are madly coding for Stage 2, or so you hope! We are starting to see the expected migration of the EMR birds that can’t fly the Stage 2 path.
I recently asked a state REC why they chose the vendors on their suggested list. They told me because those are the biggest EMR companies in the country. Is bigger really better? If you have not already chosen an EMR or are in the process, or are looking to change products, there are some key points you want to consider when selecting a vendor.
- As a percentage of total business, how much does the vendor spend on R&D of the specific product you are looking at? If it is a vendor with multiple products, touting the amount spent on R&D is not significant to you if your product is the red headed stepchild of their offerings.
- What percentages of their installed providers have successfully attested for Meaningful Use Stage 1 of the product you are looking at, not their entire client base of all products?
- Does the product allow you to meet all the incentive programs now? (PQRS EHR reporting, e-prescribing incentive, MU Stage 1 and soon to be Stage 2, and so on)
- Does the product itself keep you from being penalized now and in the future for e-prescribing and PQRS EHR reporting?
- If the vendor has multiple products, do all of them have the same level of certifications? Some vendors with multiple products have their premier product CCHIT certified and ONC-ATB certified through CCHIT. The rest of their offerings are not CCHIT certified and their ONC-ATB certification is through another certifying body. This is a red flag. More R&D money is being spent on certain products in their line. Is yours one of them?
It is short sighted for any provider who is looking to purchase an EMR to not know how these programs are being addressed by their vendor. It doesn’t matter if you don’t care about attesting to MU now for the incentive money, you will be penalized in the future. And if you don’t participate in Medicare, understand that this is going to be pay-for-performance for your commercial payers at some point, so don’t blow it off.
I often hear from small practices that they are going with Vendor X because they are a big company and less likely to be sold or go out of business. If you are a 1-5 doctor group, do you really think the biggest companies even have you on their radar? Does being a big company mean that they will never be sold? We have all seen that this is not the security blanket many believe it to be. Even if the company is not sold, underperforming products are sunset all the time when a company has more than one product in their offerings.
If you are dealing with a small company that only focuses on one product, you still have some important questions to ask besides the ones listed above.
- Is yours a specialty specific product? If so, what is your install base? Specialty-specific products traditionally have fewer clients, which can mean fewer dollars for R&D. How do you plan to fund ongoing R&D?
- How do you plan to address ongoing regulatory changes? Can you guarantee that you will meet all regulatory deadlines so the practice can take advantage of incentives and not be penalized? When a sales person says, “Of course we will meet the deadlines,” get it in writing. Get a guarantee that if they can’t meet the regulatory deadlines that they will reimburse you what incentives you’ll lose due to their lack of functionality, or pay for the penalties incurred. If they can’t give that to you in writing, move on — that means they don’t have absolute faith in their own abilities to meet your needs.
- How many people do they have providing implementation and support services? I have a few clients who recently purchased a specialty-specific product. Their training and implementation was done on the Internet — nobody came on site to assist. In my experience, that is not conducive to a successful go-live and ongoing proficiency in the product. We are on the West Coast. This vendor is on the East Coast. Their support becomes “on call” after 2:00 p.m. West Coast time. Doctors who are stuck charting a note or trying to send an electronic prescription are truly stuck waiting for an on-call person to call back within their after-hours guaranteed window of 90 minutes. I wish I could get away with telling my supported clients to wait 90 minutes for me to call them back when they are stuck in the middle of their work day.
If your vendor has multiple products and they decide to sunset one, what does that mean for you? It’s nice to hear that they’ll give you licenses to one of their other offerings, but if their other offerings were a good fit for you to begin with, wouldn’t you have purchased that product instead? A one-for-one license swap may seem like a sweet deal, but what is the ongoing total cost of ownership of this other product? How much additional training and infrastructure will you need? If you are going to have to change products, you should consider this like a new purchase and start your process anew, comparing all your options.
Julie McGovern is CEO of Practice Wise, LLC.