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Part IX: Wrong Technology, Wrong Software Company, Unproductive Interaction with Vendors

Here is the ninth installment of WRS Health’s 10-part series dedicated to Dr. Lawrence Gordon’s recent white paper, “10 Implementation Mistakes to Avoid: Why Practices Fail.” Each segment of the series examines one of the 10 most common implementation mistakes by medical practices when implementing electronic health record (EHR) systems.

MISTAKE #9: WRONG TECHNOLOGY, WRONG SOFTWARE COMPANY, UNPRODUCTIVE INTERACTION WITH VENDORS

There are countless stories of practice implementation failures due to being romanced by the wrong EHR company and being wed to the wrong software. Unproductive interaction with vendors is also a red flag for disaster.

Dr. Ash and colleagues offer excellent advice from a “Consensus Statement on Considerations for a Successful CPOE Implementation,” which advises that before embarking on the serious undertaking of CPOE, the following conditions should be met: The stability and product quality of the vendor are at least good, if not excellent and that there is deep understanding that CPOE projects are a vendor “marriage,” not a purchase.”

The experience of Denton Combs, CNP, owner of a solo ENT and allergy practice in Sioux Falls, SD provides evidence that choosing the wrong EHR company can have disastrous results on a practice’s efficiency. Having initially used a free EHR for the first seven months, Combs reports, “We were having major trouble with billing and getting everything through. I hated that the business side and patient control side were not on the same side as the EHR. All of your billing was separate. Nothing was tied together. You were waiting to make an error and then you had to redo that error.”

Prior to finding his current EHR, Jeffrey Kunkes, M.D. of Kunkes Ear, Nose and Throat in Georgia was using separate modules from separate companies. “Before we were using a different module and we had to hire a billing company. We were spending $4,000 a month between billing, collections and medical records. We switched to an EHR where we paid a flat monthly fee. The former company said we were going to lose collections. We’ve maintained our collection rate, or increased it. We’ve saved $2,000 to $3,000 a month. Because everything is under one company we have saved the hidden costs of billing and collecting, going from one screen to another and printing things. We’ve been able to cut our printing and copying costs significantly. Because we are doing everything under one roof with different modules from one company we are pleased. We have saved a significant amount of money on billing and collection without missing a step,” states Dr. Kunkes.

Keys to selecting the right technology and software company

  • Know the strengths and weaknesses of the platforms that are available. Know the difference between server-based and web-based systems.
  • If you want to avail yourself of a robust platform, web-based EHRs offer vast opportunities for instant access and convenience anytime and from anywhere there is an Internet connection. Physicians who travel to more than one practice location and those who need to access patient records while at the hospital, at home or on vacation can get quick access to patients’ records from a web-based EHR.
  • Web-based systems are much more affordable than server-based systems. Web-based EHRs do not require the purchase of expensive hardware or the hiring of expensive IT professionals. There are usually no fees for update.
  • Ask about customer service and how problems and issues are handled before you sign on the dotted line. Know the way in which the company has chosen to do business. Ask colleagues for references. Conduct an Internet search on reputable EHR review sites and search for client testimonials. Many satisfied EHR customers aren’t shy about informing their colleagues about the problems they encountered with their previous EHR companies. If the company has garnered a reputation for telling customers “Don’t come to us” when there is a problem, you have chosen the wrong firm. A company with a reputation for partnering with physicians and providing excellent customer services, including rapid responses to any size queries or problems is a safe bet.
  • Perform a thorough evaluation of the different vendors of EHR systems. Igor Huzicka, M.D. of Colorado-based First Internal Medicine wanted a fully integrated, web-based system with a speech recognition capability and an Internal Medicine patient portal. He turned to the Colorado Medical Society for advice and also found an instructional DVD about how to select an EHR software system. “I also went through an EHR Matrix site which allows you to input what you want from an electronic health records system and the EHR I chose emerged as one of the better systems,” says Dr. Huzicka.
  • Ask colleagues with similar size practices and specialties about their EHR system. Visit their practice to see how they are using their EHR.
  • Visit the software company for a demo.
  • Search for unbiased articles about different EHR companies.
  • Contact The Office of the National Coordinator for Health Information Technology which has a published list of electronic health record vendors.
  • Check reputable EHR Review Sites such as softwareadvice.com, as well as the American Academy of Family Physicians (AAFP) for vendor satisfaction rankings.

Lack of productive interaction with vendors

Physician and health information technology vendor relationships are crucial for a successful implementation. Problems will inevitably crop up. How your software handles and resolves issues is the key to success.

Gail Wyatt, Office Manager of Trilogy Women’s Health in Grapevine, TX explains the mutual benefits of having an excellent practice/software relationship. “We get great service. We keep in contact via phone and email. If they have a concern about a claim they send me an email and we address it. It’s really a good team. I sleep better. Knowing the software company Team is there is such a relief. I couldn’t do this on my own. Knowing people are there to answer our questions and take care of billing for us, is worth every penny. Our relationship with our software company’s representative is very, very good.”

In contrast, in an article in Medical Economics, pediatrician Dr. Joseph Cramer reveals the havoc wreaked upon his Utah-based practice when the vendor relationship goes sour. “We were fooled by the sales job into the thinking we were the only clinic on earth for this company to support and that its personnel would do everything to make our transition as streamlined as possible. Now the story is just the opposite. We ask for changes and are ignored. The underlying corruption of design is undisturbed. The regular upgrades haven’t appeared and promised connectivity is still not working. If we weren’t lied to, we were, at the least, misled.”

Physicians also need to be vigilant about finding out whether a software company’s products are certified to meet each stage of MU objectives, as well as additional factors such as timing of HITECH-compliant software versions and infrastructure changes that will need more interdependency.

“More vigilance is urged on the part of physicians who are purchasing EHRs in order to achieve their goals. Bazzoli points out, “While providers need to buy certified systems to qualify for incentive funding, they will also need more open communication with vendors about what it really means to implement a HITECH-compliant solution. They will also need contractual assurances that products will integrate with necessary systems and data exchanges, and that vendors will maintain applications to future MU objectives which will likely be more challenging in future stages of the program.”