Many of you might remember my recent post about EMR Performance Issues (ie. EMR Slowness). Turns out, the post had a pretty big impact on some readers of the site. In fact, it sounds like it was partially therapeutic for some to realize that they’re not alone.

I asked permission to share one of the responses with you so you could get some more first hand perspective on the issue of EMR slowness. I share it in the hopes that others can be aware and avoid it. Plus, I hope the EHR vendors that read this will take it to heart and be fanatically focused on EMR speed and customer support.

I’ve removed the name of the writer and the names of the vendors. Plus, realize that it was written originally in an email communication and not necessarily to be published.

OMG…you hit the nail on the head with this post. Our EMR is so slow. It often takes minutes between pages. My clinical and front office staffs so frustrated. We have had nothing but finger pointing going on ever since.

Part of the issue is the interface between our practice management system VENDOR A and our EMR VENDOR B It takes a minimum of 3-4 minutes for data entered into VENDOR A to roll into VENDOR B. My front office staff has taken to entering the data twice, once in each program in order to get our patients registered timely. When you see 80-100 patients in a day, a few minutes makes all the difference.

Additionally, certain criteria does not roll over, namely email addresses. This makes it impossible for us to send out patient visit summaries thus we are unable to meet meaningful use for that criteria. Referring physician is another part that does not roll over.

The most frustrating part is that no one will take any responsibility for the issue much less work on fixing it. These two vendors spend all day playing the blame game. Fortunately for our practice, we have a wonderful IT company that we work with. Our IT specialist has spend countless hours trying to mediate between these two vendors. Most times he just fixes what he can but we are paying for his services in addition to the tech support agreement with VENDOR A and VENDOR B.

A perfect example happened this week when the EMR went down in one of our exam rooms.. First we spend at least 10-20 minutes on hold waiting for a VENDOR B tech to pick up the call. In this particular case, they worked remotely for at least 4 hours on this one computer only to tell us they could not fix it.

I called my IT guy and he fixed it within 10 minutes. My staff spends countless hours on the phone most days trying to keep the system up and running. We are in the process of replacing all our PCs and I recently upgraded our Internet to a 10×10 fiber service however we still are not seeing any difference in speed.

It is at least comforting to know we are not alone. I plan to hang up your post for all my staff to see. It may not make our system work faster but hopefully it will give them some comfort knowing they are not alone.

Thanks for all the great information.

In response to my previous post about possibly creating an EMR pricing comparison website, I got a really interesting set of comments from a CPA who’s been assisting their clients in their EMR selection process. You might laugh at the idea of a CPA participating in the EMR selection process. Interestingly, the CPA that I use has also been asked by their clients about the EMR stimulus money and so they were grateful they could ask me some questions.

This aside, I found this person’s comments interesting. I think they also illustrate some of the challenges in EMR pricing and some of the thirst for EMR pricing also. I removed some identifying information and some other comments about EMR and HIPAA. Otherwise, the comments are in tact.

I have been pondering trying to do some sort of price comparison myself, and you’re right, they all differ so it’s tough to just do one basic comparison chart. I’ve seen already how some have things all bundled (ie.Athena, and others do it in separate modules can add on – ie. Greenway)

I have featured remote demo’s for clients to listen/view through our firm so they can avoid the vendor pressure… I thought I would try to get info on others for comparison purposes, but in keeping with the theme… it is just not that easy.

There are a few challenging items for comparison purposes, one of them being support and related costs.
The support/training is many times where the wheels fall off the well-intentioned EMR wagons.
You just don’t seem to get an answer or know the true support/training costs until you have already tied the knot with your new EMR system. If you could get more comparative info on that aspect, that would be very helpful – or better yet, come up with an EMR Pre-Nup.

Another toughy is the interfacing costs
From what I hear a [EMR Vendor] system may charge $30k to interface with another EMR vendor.
The vendors call that “not playing nicely”.
So tack on another layer of subjective complexity to your pricing project.

And yet another cost factor I’ve noticed is what EMR system an affiliated hospital is getting preferred pricing on. There is a hospital by us in an arrangement with [EMR Vendor], and of course advising the outside practice physicians to use the same. I am not to thrilled with this idea, I think there are better products that are not spread so thin in so many markets.

I mention the patient portal separately below as some of my clients don’t seem quite ready for that yet.
They view it as another task and feel could attack it once get the EMR running smoothly.
I know they need it for MU [Stage 1 doesn't require this, but future stages probably will], but they seem to want that a little later than sooner.

In any case, I think some possible approaches for a comparative pricing schematic would be to have different scenarios:
a) 1-5 Docs & Midlevel providers /Web Hosted/ EMR only/ PM Interface/ No Patient Portal
b) 1-5 Docs & Midlevel providers /Web Hosted/ EMR only/ PM Interface/ With Patient Portal
c) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ No Patient Portal
d) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ With Patient Portal
e) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ With Revenue Cycle Mgt/ With Patient Portal

Everyone seems to love talking about RHIO, HIE and all of the other various initiatives happening around sharing patient health information amongst doctors. This weekend, I want to open it up to you the readers to get an idea of what type of participation you’ve had in an RHIO, HIE or other clinical data exchange.

Are you participating in one now? Do you like it? Do you hate it? In fact, what do you like and what do you hate? Do you use an EMR to interface with the exchange? What’s the interface like? How much work is it to manage the interface?

I’d also be interested in hearing about people who are working through the process now. Where are you at in the process? What’s holding you up from making this happen?

Let’s help educate each other on what’s happening with something that I think we can all universally agree is important and INCREDIBLY challenging.