I’m completely fascinated by stats and metrics. I’m not sure what it is, but it’s like a drug for me. Looking at charts of what’s happening on my blog is like a little shot of adrenaline. Turns out that this isn’t just true for me. It’s true for many bloggers.

So, of course I was interested when I got an email talking about SOAPware EMR’s quality metrics. Ok, so I was a little misled by the title. At first, I thought I was going to see some really interesting metrics on how SOAPware EMR had improved the quality of patient care that was provided. I expected some really interesting initiatives and collaborations with doctors around improving patient care. Instead, it was a post about the quality of support that SOAPware offers their clients.

While not quite what I was hoping to see, it’s still really interesting to have a high level view of the type of support an EMR vendor offers. Finding an EMR company that provides top notch support is an essential part of selecting an EMR and I commend SOAPware for making what appears to be a sincere effort to measure and improve the support they offer.

Of course, they stopped short of publishing what would be the most interesting part of the survey results. Yes, I’m talking about the narrative answers to the question: “Any additional comments” That would likely be a pretty interesting read. They do address them generally when they say, “The negatives that we currently see in the comments are most often about appointments with support that were late, or return calls that had delayed response times. These are part of our growing pains, and we are taking actions to address these issues.”

I love seeing EMR companies taking a pro active role in providing great support for their EMR. Trust me. You don’t want to be using an EMR where you can’t get support from your EMR vendor.

I’ve heard this mentioned a few times, but in all my posts I don’t think I’d ever mentioned it myself. But it’s very true that EMR is the Physician equivalent of an ERP (Enterprise Resource Planning). Wikipedia describes an ERP as such:

Enterprise resource planning (ERP) is an integrated computer-based system used to manage internal and external resources including tangible assets, financial resources, materials, and human resources. It is a software architecture whose purpose is to facilitate the flow of information between all business functions inside the boundaries of the organization and manage the connections to outside stakeholders. Built on a centralized database and normally utilizing a common computing platform, ERP systems consolidate all business operations into a uniform and enterprise wide system environment.

Basically, it’s consolidating all of your IT software in one package. However, the real key is that by implementing this broad variety of packages you’re affecting almost every part of the organization. This is why I think the comparison of EMR software with an ERP is so interesting. An EMR has the same impact on the entire organization as the ERP does in a business.

As an aside, it is also interesting to note that ERP’s have been slow to be implemented in small business and have been most popular in very large companies. So, I think it’s interesting to see that we’ve seen a somewhat similar thing happen in healthcare. Most large hospital organizations have an EMR (at least in some state) and the smaller clinics have been more resistant to implementing an EMR.

The question then is what are the lessons we can learn from ERP implementations that we can apply to EMR implementations? Turns out that they’re things that I’ve talked about over and over.

1. Get Leadership Buy-In – An ERP is doomed to failure without a strong leadership that drives the ERP initiative. Since it affects every level of the organization it takes a strong leader to implement the changes and bring everyone together. The same is true for EMR.
2. Find Great Support – When you implement an ERP, you have to create a huge budget for customizations. In fact, one of your biggest expenses will be the consulting help you need to customize the ERP to meet your organization goals and policies. The consultants you bring to help you are critical to the quality of the implementation. EMR and IT consultants can have the same impact during an EMR implementation. Every EMR needs some level of customization for your clinic and a consultant well versed in your product can be a great boon.
3. Consider Implementation Phases – An ERP never goes live all at once. They ALWAYS do it in phases. This could be a great lesson for EMR implementations. Don’t bite off more than you can chew when you’re implementing. For example, in one implementation I did we just started with entering the diagnosis and charges into the EMR. Then, shortly after that we implemented the rest of the charting in the EMR. You can’t implement EVERY EMR feature from day one. So, phased EMR implementations are a good idea.
4. Include Staff in Selection Process – I was working at a large university and was asked to participate in a presentation by each of the ERP vendors. I felt very empowered to be part of the selection process. The challenge is that you can’t be fake about this. Don’t invite people to the meeting and then not listen to them. Otherwise, it will have the opposite impact from what you want. Really listen to people’s feedback and make sure they know you heard what they said and took it into serious consideration. Turns out that this involvement also helps with the buy-in mentioned above.

I’m sure there are many more. Feel free to add some in the comments. Much can be learned from other industries that can be applied nicely in healthcare. We’re not as unique as we’d like to think we are.

On my favorite EMR forum, EMR Update, Matt Chase from Medtuity suggested the following pattern for how IT is involved in the EMR implementations he’s been involved in. Here’s what he said (emphasis added):

The characteristic pattern on a new server install is the IT guy comes in, puts the infrastructure in place, comes back in a couple of times over the ensuing 2 weeks and then disappears into the ether for a few years. Once a network is setup properly, it needs surprising little tuning. For example, a facility running Medtuity ~7 years is just now replacing their Windows 200/SQL Server 2000 box (a busy place too. They’ve had their IT people out no more than once per year, I’ll bet, over the last 7 years. Another group with 7 facilities does not even have an IT person on their payroll despite a server at each facility. The important point is to set a server up correctly at the outset.

I’ve seen this pattern first hand with the small clinic implementations I’ve been apart of. Although, I’d say that it’s probably more like 1-2 calls per year and the Merry Christmas phone call in December too. The key really is to make sure the server is setup properly at the outset.

However, what Matt doesn’t highlight is the importance of having the right IT people available for those 1-2 calls per year. It happens so rarely that the clinic goes into a partial state of panic. Having an IT person that can assist you quickly and effectively in that moment of panic is very important.

One thing that I’m sure very few doctors consider when they’re selecting an EMR software is the method that the EMR vendor uses to handle support calls. Certainly, it wouldn’t be that hard to figure out.

First, you can ask the EMR vendor at the end of the demo, “How do you track problems that I call you about?” There answer should be very telling. If they say that you call the 800 number and we try and help you. That’s not so good. If they say that you call, email, IM, etc us with your support request. We take all the information we need and create a ticket (or some other word like ticket) that will track the request you made until completion. You’ll be emailed the information that was added to the ticket with a number in it for your reference. Then, if they’re really great you’ll hear them say, we handle [insert number] requests a day. Our average resolution time for support requests is 3 hours. Our customer rating after a support request is 4.5 out of 5 stars and our goal is to make that 4.8 next year. Yes, we send out a survey where customers can rate the support they received for that ticket. If they’re unsatisfied with the resolution, it’s elevated to a supervisor who follows up with the client directly.

All of the above is possible and really not that hard to implement. Sadly, not many EMR vendors go to this extent. However, I’m guessing that as EMR adoption increases they’re going to have to reach this level of sophistication in order to compete.

Second, when you do a site visit or phone call with someone who uses that EMR (and yes, you better do this), ask the person what type of response they get from the EMR vendors support. You’ll learn a lot about an EMR vendor by asking the client how their supported.

The real question you want to ask yourself is, “how much thought and effort has the EMR vendor given to how they support their customers?” If they haven’t given much thought to this process, then it’s likely that they haven’t given much thought to other key areas of their EMR and associated processes.

Today, CNET posted an article that talked about a Dell EMR. Yes, we’re talking about the Dell that makes computers (and sells everything else under the sun).

We’ve known for a while about Dell’s partnership with eCW and Walmart-Sam’s Club to sell EHR, but the thing that’s interesting about the CNET article is that it calls it “Dell’s EMR software.” I’m certain that Dell didn’t create it’s own EMR software package. I assume it has to just be eCW’s EMR right?

To add to the fun, I even found the page http://www.dell.com/emr which talks about Dell’s foray into the EMR world. However, on that page it links to the Sam’s Club/Walmart/eCW EHR partnership as well.

I have a feeling that the CNET article is just an extension of Dell’s partnership with eCW and Walmart. I’m sure eCW wants to market their EHR as much as possible and Dell is a respected brand on which to market your product.

UPDATE: The following is an excerpt from Healthcare IT News about the Dell EMR:

The Round Rock, Texas-based computer maker on Thursday introduced an electronic medical record system for hospital-affiliated physician practices. The intent, said Dell executives, is to accelerate the sharing and meaningful use of digital patient information among hospitals and physician practices.

Dell executives say their EMR solution is sponsored by hospitals for their affiliated physicians and designed to make it affordable and practical for physician practices to transition from paper to electronic records.

So, it looks like it’s hospitals that will choose to partner with Dell in order to get doctors to buy an EMR from Dell? It still doesn’t say where Dell got this EMR. I think we can rule out them developing their own. So, the question remains: Is this an extension of the partnership with eCW or did Dell purchase another EMR software company?

In summary, a doctor will be buying an EMR sponsored by their hospital association who has an associate with Dell who has an association with some EMR software? Sounds like the perfect recipe for finger pointing.

Many of you may remember my rather detailed coverage of the impact of Walmart offering an EMR through Sam’s Club and in partnership with eClinicalWorks and Dell. For those that missed my comments, I wrote about the details of the Walmart EMR offering, and then A Doctor’s Perspective on Walmart EMR and eCW and Dell’s perspective on Walmart EMR.

I saw the Walmart EMR listing on the Sam’s Club website a while back, but didn’t have a chance to post it. It’s really interesting to see an EMR listed at Sam’s Club. I also find it interesting to see that they chose to market it as an EMR and not an EHR. I think this actually is a pretty smart move since I think most doctors still call it an electronic medical record or EMR. Those of us in the industry sometimes get caught up in the difference between EMR and EHR, but I think doctors don’t really care about the difference.

I still don’t think that this is much more than the opportunity for eCW and Dell to market their products. However, it is really interesting to see an attempt to commoditize the price of an EMR. As I look through the prices, I think that anyone that tries to buy this package through Sam’s Club is going to be hit by a bunch of hidden costs. Everything from the cost of travel for the eCW trainers to the upgraded hardware support from Dell. At the end of the day, I don’t think it will save doctors anything.

Turns out that the website states: “Availability of this offering is currently limited to Virginia, Illinois, and Georgia with anticipated nationwide coverage by the end of the year” I’d love to hear from someone who has taken the bait and purchased the Walmart EMR from Sam’s Club.

I previously posted a summary of the Walmart EHR package with eCW and Dell.  Then, I followed it up with a doctor’s persctive on Walmart EHR.  At the end, I promised to follow up with a post on the Walmart EHR deal from Walmart, eCW and Dell’s perspective.

I think this was a great move by eCW, Dell and Walmart.  Honestly, what do they lose by trying this out?

Let’s not go overboard here.  I don’t see this offering completely changing the landscape of EHR.  Walmart has done that in a lot of areas, but EHR is not going to be one of them.

However, Walmart could be a good lead generator for eCW and Dell.  Dell certainly has reached a point where they have a strong brand established and scale is their friend.  They want to distribute their product through as many low cost channels as possible.  If this is successful, Dell tablets (a new offering for Dell – second generation just came out for those keeping track) will be in a lot more doctors’ offices.  If it fails, then Dell still will have gotten some PR in front of doctors saying that Dell offers tablets for doctors.  Don’t believe this is happening?  Do a quick search on google news and see all the stories about Walmart EHR.  This blog post is another example of the free PR Dell is getting from this deal.

eCW isn’t quite the brand that Dell has become, but they do have a substantial install base.  Scale really is their friend.  The more EHR software they can sale, the better for them as a company.  EHR sales is a numbers game and the more doctors they have viewing their product the more doctors they’ll have buying it.  Plus, if someone is thinking about EHR at Walmart, then that’s a high quality lead.  The leads won’t be as high quality as say advertising on EMR and HIPAA (excuse the plug), but a lead’s a lead.

Walmart really seems to have nothing to lose in this.  I guess they’re giving up floor space for the product.  I wonder what this will look like at Sam’s Club.  If anyone sees it, take a picture and send it to me so I can post it.  I’m not sure Walmart’s internal projections, but they threw out the number of 200k health care providers are members of Sam’s Club.  I’m a member of Sam’s Club as well, but I can’t remember the last time I was there.  My wife usually takes care of it.  I’m pretty sure many of these doctors are the same as me.

I do think this is a really interesting news item for Walmart.  Walmart has been doing a ton of things in regards to health care lately and so offering an EHR didn’t suprise me that much.  We have Walmart Clinics.  Free or cheap Walmart drugs.  Now we have a Walmart EHR.  Once they offer the Walmart PHR to compete with Google Health and Microsoft HealthVault, then we can really start to wonder if Walmart just has so much money they don’t know what to do with it.

As promised, I wanted to share a few thoughts about the newly announced Walmart EHR package. I previously posted a nice summary of how the Walmart, eCW and Dell EHR will work. If you’ve never heard about the Walmart EHR, then go read that post and come back.

Offhand it would be really easy to criticize this move by Walmart (really Sam’s Club). I can just imagine doctors going down the aisle of Sam’s Club: toilet paper, candy bars, EHR software, oh yeah, I almost forgot the salsa. Honestly, does that sound right to anyone?

However, I’m certain that many people said the same thing about getting TVs, vacation packages and tires at Sam’s Club when they first started offering those items as well. Toilet paper, candy bars and disney vacation doesn’t sound much better.

All of this said, I still think the idea is crazy. I’m not talking about Walmart, eCW and Dell being crazy. I’m saying that any doctor’s office that chooses to buy this package at Sam’s Club is crazy. Let me explain.

I’ve often talked about your EHR becoming the life blood of your practice. Once you’ve implemented an EHR it becomes apart of almost everything you do in a clinic. I can’t think of any part of a clinical practice that isn’t affected by the implementation of an EHR. Doctors spend as much time on their EHR as they do helping patients.

Yes, I know it’s a sad reality, but it’s the reality. Other people might tell you different, but I don’t think they’re being very honest with you. Is this reason for concern? No, because you could have just as easily said that Doctors spend as much time in paper charts as they do helping patients. Why this is the case is the topic for another post. The point is that the EHR becomes the center of a practice. Still don’t believe me? Watch for a future post on the topic which will include more compelling reasons EHR’s the core of a practice.

Since EHR is the core of your practice, do you really want to get your EHR package at Walmart?

Seriously, think about that. You’re trusting your livelihood and happiness (yes, EHR affects both of those things) to a $25k package you bought at Walmart?

I’m not saying that eCW, Dell and Walmart aren’t great companies. eCW has an EMR product that’s been very successful and is an EMR that many should and would consider for their clinic. I love Dell products and recommend them to anyone. I just don’t see why you’d purchase it at Walmart instead of going directly to Dell and eCW.

Let’s just think this through. First, I’d expect that if I’m buying this EHR package through Walmart, then I’m getting a better deal than if I bought each of the items separately. This means less revenue for eCW and Dell from the start. Next, you take out whatever Walmart’s getting paid to make the sale. The question then remains, how can these companies sell their products cheaper than normal AND share the revenue with Walmart? The answer is easy. They’re going to find other ways to lower their costs.

Let’s think about ways that they can lower your costs:

First, they should have saved money trying to sale you the product.  In theory this is great.  Walmart’s taking care of the marketing and sales of the product, so that’s why the product is cheaper.  Of course, the doctors should be asking themselves if they want Walmart to be the one showing them how the Walmart EHR will work for them.  Ahh, but certainly Walmart won’t be the ones demoing the product to the doctors.  eCW will be taking care of all the demoing and “sales” of the product.  Well, there goes the money eCW was saving by using Walmart.   That basically relegates Walmart to a lead generated for eCW.

Second, eCW could enjoy economies of scale as they support more istances of EHR.  Let me translate what this means for you as a doctor: POOR Support.  Try supporting 25k physicians (number using eCW per NYTimes) spread across the country in every specialty imaginable.  It’s pretty much impossible to expect that eCW could provide personal and quality service to such a large user base.  Just think about how many people eCW would need to hire and train to be able to provide the type of support you’d like to receive if you’re a doctor implementing an EHR (eCW is hiring for those searching).  I’m pretty sure that calling them and telling them that you bought your EHR at Walmart is going to put you at the front of the support line.

EHR vendor support is so important to having a successful EHR implementation.  I’m familiar with a large eCW implementation that was having troubles getting the support they needed.  It seemed that this was probably due to the popularity of eCW.  Credit the eCW sales team for doing a good job selling the product, but if I’m a doctor I’m not throwing my ring into an EHR vendor that can’t support me because they’ve oversold.  Considering you’re buying a cheap (isn’t that Walmart’s motto?) Walmart EHR, don’t expect World Class support when you’re paying Walmart prices.

I could keep going with thoughts about this announcement.  Suffice it to say that from a doctor’s perspective I think you’d be crazy to take it.  Now, if separately you’ve made a decision to choose eCW and the Dell computers they offer and you can get it cheaper at Walmart, great.  However, what are the chances of that happening?

There’s so much more that should be said about this topic.  I’ll be following up with another post tomorrow about the Walmart EHR from an eCW and Dell perspective.  I think you’ll enjoy that post.

I probably should have also mentioned that eCW does have a strong community of users that can be leveraged for support as well.  The point of this post isn’t to lower eCW or Dell in particular.  This could have been any EHR software vendor and hardware vendor and I’d have said the same things.  And yes, I’m still very excited to try out the 2 new Dell dual touch tablets I ordered yesterday.

One final parting thought: if you buy the EHR package at Sam’s Club, does the Sam’s Club return policy apply?  Now that’s something that could change my mind.