Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Practice Wise 11/25/12
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.
Julie:
This is a good conversation – but you are putting too much weight on CCHIT certification. The fact that a vendor does (or does not) choose to certify their products with CCHIT bears no correlation with their likely success or failure. The CCHIT “stand-alone” certification program has been grasping for relevance for several years and has no sustainable business model. I predict that it will die withing another year or two. It’s a solution that is now looking for a problem. The only certification that an REC or a provider should care about is ONC ACB certification. CCHIT is (as you say) just one of many. Does it really matter if I get my car inspected by Shell or Mobil or Bob’s Auto? No. Of course not. So long as I have my car inspected by an approved inspection station – it’s inspected. And so is the EHR certified.
As small companies are getting consumed by larger companies – and business models are changing, many of your points above are appropriate and necessary.
But you’re missing a few others:
* As the EHR market shifts from one in which companies make their money on new sales to one in which companies make their money from services – how are you planning to change the way that your company operates?
* What plans do you have to (or not to) migrate toward a cloud infrastructure?
* Do you sell data or analytics to life sciences companies? If so – how do you protect patient privacy?
* How will your products anticipate changing payment models toward accountable care, and better compensation for better outcomes rather than more volume?
* How are your systems assisting providers in documenting what’s most appropriate for care and collaboration – rather than as tools to collect too much data solely for the purpose of increased billing?
“asked a state REC why they chose the vendors on their suggested list. They told me because those are the biggest EMR companies” Seriously? Politics doesn’t enter into it?
Our EHR company focuses exclusively on eye care. In our domain we determined that internet training works best as a supplemental tool. We require our customers to go through our eLearning curriculum prior to on-site training sessions. The eLearning system allows us to evaluate learning progress at key stages throughout the training program. We have been training clinics to transition from paper charts to our EHR for thirteen years and we are constantly tweaking the process. The eLearning system is also available to our clients after implementation. This is useful for them when they hire new employees. It is also very helpful for introducing advances feature after the basics of the initial implementation period are mastered.
“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.”
Although no longer working for our state REC, we had a somewhat arbitrary, but relatively fair method for selecting vendors and it did consider those with the largest footprint in our state as ONE factor. Not a foolproof parameter, but at least some measure of stability, we thought. But mostly I recall the short time frame and pressure we were under from ONC to come up with our “short list” of preferred vendors. It wasn’t fair to the vendors or us to make such a hasty decision, but that’s what happened. I doubt they’ll own that though!
More importantly, I would love to see the metrics on how many PPCPs working with RECs actually were already on an EHR when they signed an agreement with a REC. That would preclude any need for a vendor selection in most cases, and provide 2 milestone payments to the REC for each PPCP who signed up! Not a bad bounty! But wasn’t the idea to get providers who weren’t using an EHR to start using one….in a meaningful way?