Since it’s Friday and I know that many of you stop reading the site cause you’ve already headed off for the weekend, I decided I’d keep it short and sweet this Friday. Plus, hopefully this joke will give you a great laugh to start the weekend.

Whats the difference between a EHR salesman and a used car salesman? The used car salesman KNOWS when he is lying!

Now you know why I have a category on this blog called EMR sales miscommunications.

Thanks to Mark Wright from Aquarius Imaging for giving me the joke.

I previously wrote about the reasons EHR companies use to get you to buy an EHR Now. Today I came across a post that’s really similar to my idea. The post is by Evan Steele, CEO SRSsoft and it’s entitled “From EMR Vendors: Fact or Fiction?” I think that Evan does a really good job covering some of the misconceptions/lies that are being spread by overzealous EHR salespeople in regards to the HITECH act’s EHR stimulus money. My favorite one was this:

“You must act now—buy an EHR now because in order to get the money from the government, you must be using the EMR by 2011.” As with used-car salesmen, “buy now” is always popular, but you actually have until 2013 to implement and potentially qualify for the lion’s share of the incentives.

Even if you do not implement until 2014 (5 years from now), you would still be eligible for almost 80% of the money.

A feature of every EMR vendor is a whole multitude of sales lines. If you’ve ever talked to a EMR sales person, you know what I’m talking about. This isn’t really unique to EMR sales. The same can be said of most software that’s trying to solve complex problems.

Well, there’s one EMR vendor sales line that gets on my nerves more than any other line. Let’s take a demo of an EMR vendor’s templates. Now here’s the line that I absolutely abhor:

“You can make it do whatever you want.”

Hearing this is like hearing fingernails on a chalkboard for me. Certainly, the intent of their comment is that the EMR template creation is really flexible (and it very well might be). However, the superlative “whatever” is just wrong. Every software system has limitations and I can guarantee you that if you really start using an EMR system you’re going to bump into those limitations.

I guess my problem is using superlatives like whatever, any, all, always, etc. is just misleading and leads to what I call EMR sales miscommunication. Anytime you hear one of those things during an EMR demo (or even during an EMR training) you better start asking lots of questions.

Of course, these superlatives do a lot better job selling EMR software. I guess that’s why I’ll never be an EMR salesperson. Maybe it’s also why people seem to like reading my EMR blog posts.

Time to call out another myth that EMR salespeople love to use to sell their EMR system. Here’s the question and answer that will be familiar to many:

Doctor: Do you have templates for my specialty?
EMR Salesperson: Of course, we have tons of templates for your specialty.

Available templates is one of those myths that is perpetuated by many EMR companies. The problem with the question being asked is that “EMR salespeople” wouldn’t know the difference between a good and bad EMR template if they tried. Add in the idea of specialty specific templates and it’s no wonder they don’t know how to give a doctor a real answer to that question. They are also so far removed from the EMR template development that they can’t reasonably answer that question. So, stop asking the salesperson.

Instead, ask to see all of the specialty specific templates. At least then you’ll know up front the quality (or lack therof) of the EMR templates offered for your specialty.

I’d personally even take it one step further. Ask the EMR vendor to make a change to one of the templates you like. The harsh reality of templates is that almost every (and possibly EVERY) template you get from an EMR vendor is going to need at least some modification to make it look the way you want it to look. You might want to reorder the data, brand the note, add in missing options in drop down lists, or some other edit. Regardless of how big or small, you’re going to be editing the templates you’re given. Better to know up front the process for editing the template. If the person showing you the template baulks at your request to modify the template, that’s a really bad sign.

I’m not hammering on templates either. They can be very effective if created correctly. Just don’t expect a set of practice changing templates right out of the box.

A while back I wrote something about why having an EMR or EHR consultant could be beneficial to a doctor looking to implement an EHR. Here’s the first part of a five part series on reasons why I think a well qualified, experienced EMR or EHR consultant is valuable. The first part is how an EMR or EHR consultant helps with the selection process.

EHR Selection Process

By first evaluating a doctor’s needs and preferences EHR consultants are able to eliminate a majority of the EHR companies and provide doctors with a short list of high quality EHR vendors to evaluate. By providing a smaller pool of EHR vendors, doctors are more comfortable with the selection process and don’t get discouraged seeing hundreds of EHR vendors that don’t meet their needs. EHR consultants also help doctors through the evaluation process. EHR consultants often provide a list of questions that can be used to evaluate EHR vendors. These questions have been designed to tease out information which will better enable doctors to select the right software. EHR consultants also assist doctors that need help negotiating with EHR vendors. These services include requesting enhancements to meet doctor specific needs or even ensuring that EHR vendor pricing is comparable to other EHR implementations.

When it comes down to it, a good EHR consultant can save a doctor large amounts of time and money that would have been wasted looking amongst the hundreds of EHR companies. It’s not hard to say that doctor’s most precious commodity is time.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant – Selection Process
Benefits of Using an EMR/EHR Consultant – EMR Training
Benefits of Using an EMR/EHR Consultant – Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant – Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant – Improved Clinical Buy-in

The day is fast approaching for me to present at the Pacific Coast College Health Association conference in Hawaii. In fact, I have less than a month to finish my preparations. I feel pretty good about my ability to present and also my knowledge of EMR, but presenting something always gets my nerves going. I think once I get started talking about EMR, then I won’t be able to stop. My real hope is that the people that attend my session will be interested in what I have to say, find it useful and ask good questions. Honestly, a part of me really wishes that I was a member of a panel where I just answered questions about EMR. I think that would be a lot of fun.

Since it’s not a panel, then I’d love to hear any feedback from people on things I should include in my presentation about “Lessons Learned from EMR Implementation.” I have a ton of things already planned about EMR implementation, but I’m sure there are some important things that I’ve missed. Time has a way of doing that to you.

Either way, I’ll be happy if one person in my session on EMR goes away saying they were better prepared to implement an EMR system, then I’ll be happy.

In my recent post about EMR site visits, I got a comment from prakash about what questions a doctor should ask an EMR vendor. He gave me the following list of preliminary questions:

What is the cost per physician license?
Do you have any existing clients in our specialty?
Does your system come pre-loaded with templates for my specialty?
Is your company the developers of the software or is it re-branded from another vendor?
Is your system client/server based or ASP based?
Does your system include practice management software?
How many clients does your company have?
Is your system HL7 compliant?
How long has your company been in business?
Is your development done overseas?
Is support done overseas?
Is your software CCHIT certified? If not, why?
How often is the software updated?

I don’t think this is nearly a comprehensive list of questions. In fact, I think it just is the tip of the iceberg. I also would consider changing some of the way the questions are phrased. However, I thought it was a good starting point that could be built out over time. In fact, I think I’m going to make a static page on this website for these type of questions.

Hopefully, my valuable readers will continue to point me to other good resources that might have a nice list of questions that I can continue to compile into a valuable resource for those searching for an EMR. Just post a comment if you have other questions you think should be asked or know of other resources and I’ll continue to compile questions for EMR vendors.

Thanks Prakash.

It was very nice to see a well written article that documented 5 cases of users implementing an EMR system. I think there are hundreds of more stories that need to be told. They laid out the stories into 5 phases as follows:
Phase 1: The Spark
Phase 2: The Vendor Search
Phase 3: The Installation
Phase 4: The Payoff
Phase 5: The Future

I love the idea of the 5 phases, but some of the stories didn’t seem to fit the phases described above. Looking at the phases above it does seem like they left out a nice gap between installation until payoff. Thankfully the stories didn’t leave the hard work of implementing an EMR out. Therefore I loved the article from Health Leaders Media. Here’s a little play by play of the 5 stories:

Phase 1: The Spark
This woman is courageous. Running a solo practice by herself with one part time medical assistant. Talk about thinking outside the box and managing costs. I was super impressed by this ladies thought process. I imagine this type of gyn practice allows her a lot of freedom. More importantly for this site was that she sunk $70,000 into an EMR system. I hope those reading this will know that you don’t need to spend that much money. EMR programs shouldn’t cost nearly that much money. Espescially for a solo practice. She does point out an important point to remember with an EMR program. Buy the upgrade package. You don’t want your EMR stagnant. Stay with the latest and greatest in EMR development. Don’t get left behind on an old EMR system where a few years down the road you’ll have to upgrade again.

Phase 2: The Vendor Search
Excellent story of EMR vendor selection failure but eventual EMR implementation success. It really makes me sad that an EMR vendor the size of NextGen couldn’t deliver in this story. I guess kudos go out to Companion�s EMR software (which I’ve never heard of) for helping them be a success. I still think the story needs more detail on what happened with the second EMR vendor. It’s only fair to compare the differences between the EMR failure and EMR success.

Phase 3: The Installation
This story seemed quite off target. Why would they use a home grown EMR system to Illustrate the installation phase of an EMR? Programming and implementing your own EMR system, besides being a crazy idea, is not a good example for those implementing an EMR package. I’ll push that aside and say that there were some good points in the story.
-Katrina proved that EMR’s are essential
-Continuing testing and reworking your EMR processes
-Have physician champions
I loved that they actually payed an IT salary to a few of the doctors who helped test their EMR system. That’s thinking outside the box.

Phase 4: The Payoff
Be careful comparing financial rewards of one clinic with another. They are too hard to compare. I think it is important to see the clinical outcomes he is able to show because of an EMR. If your EMR breaks you even and provides your patients better care then I call that a Win. This should be the hope and expectation when starting an EMR implementation. Isn’t healthier patients payoff enough?

Phase 5: The Future
The Quote of the article:
�For six months, I lived EMR.�
This pretty much describes most implementation and the reason I got the job I did. They needed me to live EMR. Now you see why I call it the EMR experience. I think a lot more could be said about what EMR will allow a doctor to do in the future. This fifth EMR story doesn’t even do the future justice. It does point out one great monetary key to EMR implementation. Transcription cost savings can be a key driver for purchasing an EMR program.

I’ve been reading quite a bit of discussion about a new CCHIT certification that is being created for EMR companies. I really think these medical certifications are interesting since you really have no requirement to be certified and certification really doesn’t mean you are necessarily better. However, with the number of EMR companies out there a consumer certainly will be looking at certification as some means of proof that an EMR has features that they will need or want. Too bad this isn’t necessarily the case. Either way, the CCHIT certification is coming whether you like it or not. Here’s a link to the CCHIT certification requirements. You have until March 31st for public comments.

Many of the smaller/free EMR companies out there are really frustrated with the certification process proposed by CCHIT and they’ve been making their frustration clear in an EMR forum called EMRUpdate. Theit frustration from my point of view lies mainly in the enormous cost to be CCHIT certified including a large yearly royalty fee and the requirement to code a bunch of useless enhancements just for certifications sake. I can’t say I disagree with these 2 items.

I also think the certification process is wrong because it is an all or nothing certification. That means if you are missing one feature then you would not be certified. This really doesn’t make sense. An EMR company should receive a grade instead of a certification. This would allow each EMR vendor the ability to justify why they got the grade that they did. Not only would this be fairer, but it would also give more information to doctors evaluatin an EMR.

A group at EMRUpdate have put together a letter that they are sending to CCHIT about flaws found in the CCHIT certification process. Any of those interested in participating in these recommendations can sign their name at EMRUpdate Draft Letter to Dr. Mark Leavitt, MD, Ph.D. You can see the thread that created this letter here.

Depending on the response to this letter, many of the people who participated in creating the content for this letter have talked about creating a new Certification sponsored by EMRUpdate.com. They’ve termed it SHOVEL – Software for Healthcare Organizations EMR Voluntary Ligitamacy and I better give some props to AlBorg who has done a significant amount of work on this idea. I like the idea, but as stated in the thread creating the idea, I think it will probably take 30-40 EMR vendors coming on board to make it work.

I guess we’ll see how much power an online group of vendors, consultants, doctors and EMR lovers are able to do. Let me know what you think of the certification process and SHOVEL.

No one really likes dealing with sales people. There is just a general feeling of mistrust that usually exists around salespeople. However, it is important that you create a good relationship of trust with that person so you can ask good questions. During an EMR demo you will see a lot of great features on the ideal system. Unfortunately, it is often the ideal system for a specific office for which it was designed. If your office is ideal then there isn’t a problem.

Since you are still reading I assume that you don’t have the ideal office(not to mention it doesn’t exist). This means that your office is going to have to adapt to the EMR software. Don’t expect the EMR software to adapt to you. Even with the most reactive customer service friendly EMR(which I consider mine to be at the top in this area), it just takes time to make changes to software, test them and then deliver them to the customer. So, the ease or difficulty in implementing a software depends on how close the software mimics your method of doing business.

Let me give an example for those visual learners. One of my evaluating clinicians asked, “Can your EMR handle a walk in ONLY system?” The EMR vendor had some great features to handle walk ins and intermix them into a clinicians schedule. However, somehow the ONLY was missed in a sales communication. It would have been much better to ask the EMR vendor, “How can your EMR handle a walk in ONLY system?” Then, follow it up with the question, “Can I see it?” Now you can actually envision what this EMR vendor would be like in your “ideal office” and what you would need to adapt to use that EMR in your environment.