HIStalk Practice Interviews Evan Steele, CEO, SRSsoft

Evan Steele is CEO of SRSsoft of Montvale, NJ.

Tell me about yourself and the company.

I grew up in Long Island and now live in New Jersey. I am 47 years old, have been married for 22 years, and have two children, one a freshman in college and the other a freshman in high school. I am obsessed with productivity, even in my personal life. Little things that waste time drive me crazy. For example, when my wife and I prepare dinner together, I can’t resist commenting as she slices carrots one at a time while I am lining up bunches of five and cutting them with one chop.

After earning an MBA from Wharton, I spent a few years on Wall Street as an investment banker. I left banking, didn’t like the lifestyle, and went to work with my brother, managing his high-volume, multi-site ophthalmology practice in New York City. Based on that experience, in 1997 I started SRS, an electronic medical records company with a commitment to physician productivity, a focus that to this day underlies all of our product development efforts.

The first version of SRS had a huge and positive impact on the productivity of my brother’s practice by simply replacing productivity-sapping paper charts with highly efficient digital ones. His practice quickly became the model of efficiency for a high-volume specialty practice, so we started marketing the product to other physicians. Today, the SRS EHR is used by 5,200 providers, mostly specialists, in 49 states. Vermont is the holdout.

Thoma Bravo just invested in SRS. Why was the timing good for SRS and how will it impact the company?

The investment from Thoma Bravo will accelerate SRS’s growth and prosperity and help us build on the success we have achieved over the past 15 years. I’m a big fan of getting help from those who have more experience than I do. As SRS grows from 5,000 to 10,000 to 20,000 providers, we will benefit from their help in scaling the company so that we can continue to provide the excellent products and service that our clients have come to expect.

Thoma Bravo invests over $4 billion in technology companies like SRS. Their operating partners have vast experience in technology, finance, operations, sales, and marketing. Several of these talented individuals are now on the SRS board.

Thoma Bravo will provide significant guidance and financial support for acquisitions that will expand the breadth of the SRS product suite. We have already begun the search for companies to acquire that will offer significant benefits to our physicians.

You have been outspoken in your criticism of the Meaningful Use program. What concerns you most about the program?

It is true. I have not been shy about expressing my concerns regarding Meaningful Use. But first let me tell you what I like about the program. The incentives have definitely encouraged EHR adoption and the program has pointed the industry in the right direction in terms of interoperability by establishing standards that allow a physician using any certified EHR to communicate critical clinical information with physicians using any other certified EHR.

What concerns me most about the government’s Meaningful Use program is that it has sapped innovation out of the EHR marketplace, and it will continue to do so for the foreseeable future if CMS continues churning out overly complex rules. The government has set the development roadmap for all EHR companies with its Meaningful Use certification requirements and the compressed timeframe for development and implementation. As vendors burn through their precious development resources meeting the ever-expanding government standards instead of improving their core products, they are failing to respond to the needs of physicians.

Large vendors, by their nature, find it difficult to innovate, and they are so busy meeting all of the requirements that they have no time to step back and increase the usability of their software. Small vendors may be more flexible, but they don’t have any spare resources to direct toward innovation. There are very few mid-sized vendors like SRS that have nimble data and interoperability platforms written in the latest Web technologies. These companies are still innovating, albeit within the constraints of Meaningful Use-stressed resources.

My other big concern relates to the negative impact that Meaningful Use has on physicians, which has led to rampant dissatisfaction. As Meaningful Use has piled on requirement after requirement, physicians are drowning in program-related minutiae. Not understanding the complex requirements has kept many from even attempting to participate, and many who are managing to muddle through are suffering tremendous losses in productivity. Dissatisfaction is even greater among specialists. They were included as an afterthought in what is basically a primary care program, and many resent reporting on requirements that are irrelevant to their practices.

What efforts is the company making in terms of product usability and how do you see market demand affecting that?

Physicians are pining for what they deem “usable” EHR solutions. In a recent survey, almost 2,000 physicians were asked “Do you take more time to enter exam data into your EHR, compared to paper charts?” A full 73 percent answered yes. In what other industry does technology replace paper and leave three quarters of its users with productivity reductions? Online bill payment is faster than paper checks, envelopes, and stamps. Googling an article is faster than wrestling with the microfiche in the library. Sending an e-mail is faster than snail mail. Yet most electronic health record systems are actually slower than inefficiency-laden paper charts.

At SRS, we define usability as meeting the data and quality measurement needs of physicians while increasing their productivity. Poorly designed EHRs that waste physicians’ time drive them nuts. At SRS, we have over 50 developers and a staff of business analysts who devote an inordinate amount of time analyzing how physicians think and work, all before the first line of code is written. We obsess about things like minimizing clicks, using screen real estate efficiently, limiting unnecessary pop-ups, and providing keyboard shortcuts for repetitive tasks, all of which improve physician productivity. This ensures that our software is the most intuitive, the most ergonomic, and the most efficient for the physicians.

How are specialists’ EHR needs different from those of primary-care physicians?

Specialists typically see higher volumes and generate more revenue per patient visit. They are more significantly affected by small changes in productivity. Consequently, a productivity-focused EHR is vital to serving the increasing demands of a growing patient base and to maintaining physicians’ incomes. Also, specialists largely provide episodic care, and therefore up to a third of their visits are with new patients. This means that a specialist EHR needs to be really efficient at new patient intake. Unfortunately, most EHRs in the marketplace were designed for primary care physicians. This makes it very challenging for specialists.

Which companies are your most direct competitors and why do you think your offerings are superior?

The competition in the high-performance specialist market is highly fragmented and there is no single competitor with which SRS competes regularly. The SRS offering is superior in terms of usability, speed, and focus on productivity, as evidenced by the testimonials on our website and the increase in sales of our EHR as a replacement for existing software. Using my carrot-cutting strategy as an analogy, SRS is the five-carrot EHR in a world of one-carrot technologies.

Another factor contributing to SRS’s success is that our clients are universally happy with their EHR and therefore promote SRS among their colleagues. We have been very successful at creating an amazing client experience by investing heavily in our eager-to-please support staff and our topnotch, on-site developers, both of which have earned us the highest ratings for customer service and satisfaction.

Our entire support team is located at our corporate headquarters. They are a highly certified technical team, holding 53 Microsoft certifications collectively, which means that when they get on the phone, they provide the technical expertise required to answer virtually any client question. They clearly provide a superior experience compared to many of our competitors that have overseas support reps who read from a script, often a very frustrating experience for the caller. We have an open checkbook policy in our support department to ensure that we deliver the highest level of client support in the industry.

Our entire development team is also located in our office. Because we are a stone’s throw from New York City, we draw software development talent from a vast metropolitan area and can attract some of the best and the brightest in the industry.

As more EHR vendors consolidate, how will your business be impacted?

Vendor consolidation will result in increased sales for SRS, as physicians will seek more appropriate alternatives when they are not satisfied with the EHR that is foisted upon them when their original vendor is acquired and their technology is phased out.

How much of your business is driven by product replacement and what factors cause the practices to seek new vendors?

Thirty-one percent of 2012 new license sales were replacements and 46 percent of our sales pipeline is replacements. We had always anticipated that this would occur, but we didn’t expect that it would happen so soon.

The primary factor causing practices to seek new vendors is the sharp loss of productivity stemming from their existing EHR systems. Accelerating the replacement trend is the fact that physicians rushed to purchase EHR systems so they could get their Meaningful Use incentives, and in their rush to purchase, they did not do the proper due diligence to find out whether their EHR was appropriate for their practices. Our sales pipeline is filled with large specialty practices that ran out and purchased popular, primary care-focused EHRs only to find out after suffering the pains of implementation that there is not a lot of success with those products among physicians in their particular specialty. These practices are desperate to get out from under the productivity-sapping effects of their EHRs.

Where do you see yourself and the company in five years?

I will still be In Montvale, NJ, serving as the CEO and chairman of the board of SRS. SRS will still be a key player in the HIT industry, one of the survivors of the inevitable shakeout that will occur. The winners will be the few EHR vendors that improve quality of care while increasing physician productivity.

News 2/7/13

Forbes recognizes Kareo as the 58th most promising privately held, high-growth company in the country.

CAQH launches a universal electronic funds transfer (EFT) enrollment tool for allows providers to enroll with multiple payers through a single online process.

AHRQ and CMS announce a new EHR format for children’s health that includes recommendations for child-specific data elements such as vaccines, prenatal and newborn screening tests, growth data, and child abuse reporting. The format is designed for EHR developers and providers who wish to augment existing systems with additional features or to build new EHR systems for the care of children.

United Health Centers of the San Joaquin Valley (CA), an FQHC, selects WellFx’s online social platform for its patients and employees.

EClinicalWorks will invest $25 million over the next year to enhance and expand its patient engagement tools under its Health & Online Wellness (healow) business unit. The first product is a soon-to-be-available free mobile app for patients.

The Boston Globe, by the way, profiles eClinicalWorks and the launch of its patient engagement initiative.

Navicure extends its partnership with the MGMA AdminiServe Partner Network through 2015, which gives association member preferred pricing for Navicure’s claims management technology.

An AHIP survey finds that the percentage of medical claims filed electronically has increased from 44 percent in 2002 to 94 percent in 2011. In 2011, 93 percent of electronic claims and 79 percent of paper claims were processed within two weeks.

The Charlotte Observer looks at the shared medical appointment model that allows a single provider to treat a group of patients with similar medical conditions. Proponents say the model allows more patients to see a physician on shorter notice and gives patients the opportunity to learn from one another. Zeev Neuwirth, MD, CMO for Carolinas HealthCare’s physician services group, likes the shared appointment model, saying,

“Our research shows that patient satisfaction was as good as, if not better than, if patients are seen individually. And the outcomes are the same.”

E-mail Inga.

From the Consultant’s Corner 2/6/13

There’s No Time Like the Present: Shifting to a Core Vendor Before ICD-10 Implementation
By Brad Boyd

Is your organization thinking about transitioning your patient access, EHR and/or revenue applications to a single core vendor? If you are, you are not alone. This has been a strong industry trend over the past three years, and many IT vendors have made this a development priority.

With healthcare reform ushering in initiatives like Meaningful Use, accountable care organizations, and value-based reimbursement models, technology systems that smoothly integrate clinical and business data are essential. In most cases, a core vendor that provides tight integration across these applications is better positioned to meet a healthcare organization’s business intelligence requirements.

I recommend that organizations evaluate the benefits of a core vendor from feature, functionality, total cost of ownership, and reporting perspectives. Truly integrated systems provide a variety of benefits which often include decreased operating expenses, reduced lost charges, improved reporting, and a rich functionality which can enhance the overall patient experience. However, with the benefits of a core vendor often come trade-offs from a best-of-breed perspective, particularly gaps in workflow capabilities.

Given the delay in ICD-10 implementation, now is an opportune time to engage in a focused assessment on long-term vendor strategy. While a system conversion is not an insignificant undertaking, there are efficiencies and cost advantages to make this switch in tandem with other changes required by ICD-10.

While switching to one core vendor may not be appropriate for your organization — or resource availability may not permit tackling both ICD-10 and a system conversion concurrently — examining the benefits, cost impact, and operational readiness is a valuable exercise. The delay in ICD-10 provides you with an opportunity for this analysis.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

News 2/5/13

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Cerner will integrate Gateway EDI’s claims and remit systems within Cerner PM solutions.

Medicare administrative contractor Palmetto GBA posts the results of a prepayment review for CPT code 99214 (established office visit), which included denial rates between 44 and 65 percent. Documentation inadequacy and coding too high an intensity were the most frequent reasons for denials.

More than half of cardiology practices have sold or leased their practices to hospitals compared to 32 percent in 2011. The primary driver was business expenses.

Five practices within Stellaris Health Network deploy PatientKeeper Charge Capture to send charge information from Meditech to their NextGen billing system.

Mississippi House members approve legislation that would allow insurance companies to pay physicians who consult with rural doctors via telemedicine.

SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.

A study finds that HIT adoption by FQHCs is associated with significant improvements in care quality. FQHCs with higher HIT capacity were found to be more likely to use discharge summaries, notify patients for preventive services and follow-up, and create timely appointments for specialty care.

Greenway Medical announces that is compliant with 37 ONC 2014 Edition criteria and is certified as an EHR Module by CCHIT.

eClinicalWorks announces the availability of billing services charged as 2.9 percent of monthly collected revenue.

E-mail Inga.

DOCtalk by Dr. Gregg 2/3/13

Is Meaningful Use Becoming “Lost In Translation”?

From dear Dr. Jayne in her “Curbside Consult” on HIStalk to enigmatic SRSsoft CEO Evan Steele on EMR Straight Talk and more, the phrase “runaway train” keeps popping up in descriptors of the current state of Meaningful Use. I’m on record as a fan of Meaningful Use, but I’ve been seeing some signs, both external and internal, that have me concerned.

First, the external.

As mentioned above, the increasing clamor in the HIT blogosphere seems to be congealing around a core concept that MU has gone (or is going) off track. Not only are smart folks like Jayne and Evan questioning MU’s current trajectory, we’ve even got some of the original stalwarts for HIT who helped craft our technological rail lines making increasing queries about our train’s timetable and rail network design.

The New York Times article, “In Second Look, Few Savings From Digital Health Records” from January 11, 2013, states , “While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. [David] Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.”

Later in that same piece, David J. Brailer, MD, PhD is on record as saying, “The vast sum of stimulus money flowing into health information technology created a ‘race to adopt’ mentality — buy the systems today to get government handouts, but figure out how to make them work tomorrow."

How many vendors are spending all of their developmental resources solely addressing MU? I know that every vendor with whom I’ve spoken this past year or two is spending the majority of their dev teams’ time on this. Some are spending all of their dev time on it. If everyone’s development is focused upon MU, that sure doesn’t leave much room for creativity and new “meaningfulness” that may not yet have been considered.

Now, the internal.

More by happenstance than plan, I was the first provider in the State of Ohio to receive payment for Stage 1 Meaningful Use via Medicaid. (I was ready for it, for sure, but I just happened to be looking at e-mail when the sign up announcement came through.) I was grateful to receive it, believe me, because margins in small town pediatrics are about as skinny as a heroin-addicted runway model, i.e., deathly thin.

However, since my lovely EHR was sunsetted, I’ve declined to pay for server software upgrades needed to upgrade to the last version my EHR will ever have. That version would allow for Stage 2 achievement. But this expense just doesn’t make sense to me at this point. That money would basically turn the Stage 2 incentive monies into a pass-through, more for a software vendor’s benefit than my practice’s. (And, it makes even less sense if my next EHR is cloud-based!)

I’d prefer to just find my next system upon which to grow, so that any the Stage 2 incentive dollars that pass through to someone else are at least supporting a system with which I’ll be moving forward. (Finding that next system, the one that’s right for me and mine, is a whole other story!)

But, since being on hold, I’ve also noticed that the lower dollars incentivizing Stage 2 seem less motivating. As I spend more time looking at systems, I spend more time thinking about MU hoops. The more I think about Stage 2, then Stage 3 (and Farzad’s talking Stage 4 stuff), the less incentivized I feel.

Don’t get me wrong. I love the potentials and all of the truly meaningful stuff that connected EHRs will allow, once we’re all connected. The problem is, I’m starting to doubt that a federally-legislated definition of “meaningful” will actually play out as was once hoped by all the brains that crafted MU and all of us who have supported it or who even just went along.

I still support the overall idea of Meaningful Use. I’m just wondering if the meaningfulness part has started to get lost in translation.

There’s a part of me that envisions Bill Murray and Scarlett Johansson, standing somewhere off in the wings of an imagined HIT train station, snickering.

From the trenches…

“But the good news is, the whiskey works.” – Bill Murray as “Bob” in Lost in Translation

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).