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Docs face frustrations in search for IT, article shows

February 01, 2010 | Mike Miliard, Managing Editor

WASHINGTON – Doctors who have shopped for healthcare software have sometimes come to regret their purchases, according to a new story reported by the Huffington Post Investigative Fund.

In her feature, Emma Schwartz finds that physicians are often frustrated with their switch from paper to electronic medical records – spending hundreds of thousands of dollars on software programs, only to find that the new systems are faulty or ineffective. Sometimes, the software vendors go out of business, leaving the doctors with no choice but to file suit in order to recoup their investment. One Florida surgeon called his experience with new IT "a disaster."

While Schwartz concedes that the doctor's dealing with a bankrupt software company is "an extreme example," she does highlight many of the pitfalls experienced by providers so far, as health policymakers push for a changeover to electronic records in the next five years.

Beyond faulty software, Schwartz finds that fast-evolving technologies often complicate things, especially for doctors who are unfamiliar with new and complex systems and who aren't well-versed in the proper questions to ask in order to ensure quality purchases.

"I’ve seen physicians buy EHRs where they’ve spent less time buying them than their house and car," she quotes one IT consultant.



That's a problem, the consultant continued, because in an emerging market with many vendors making big promises but having limited past performance to judge by, "there’s a lot of risk."



Meanwhile, with so many new players in the industry, it's expected that there will be considerable contraction in the coming years – and it's possible that providers might purchase expensive systems from a company that may go out of business.

In that case, as one lawyer for a provider who won a judgment against a bankrupt software vendor put it, "the doctors are left holding the bag."



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Reader Comments (9)Login to Post a Comment

1samadams says: Complexity \ Decision Making
February 22, 2010 | 8:18AM GMT

While it is important to recognize that proper time and research needs to go into selecting an EHR, equally it's important to realize that MOST EHR's (not all) are un-neccessarily complicated messes.

In attempting to automate a complex, fragmented process (HealthCare) we've ended up with solutions that reflect them - complex and fragmented. The first step should always be on ensuring your processes are capturable and cohesive, before embarking on any solution - or at least accept that you may have to change your process to match the solution.

I would say that while I feel the frustration, healthcare has no one to blame but itself, not computing in general. Far more industries with complicated proceses (manufacturing, finannce) have succesfully automated in part or in whole for a very good reason - they started witht the process FIRST, then the technology.

Until Healthcare leaders learn that lesson, the best solution in the world won't help.

probiller says: EMR Selection
February 10, 2010 | 2:43AM GMT

As others have expressed, EMR implementation is an extremely complex task. Successful outcomes depend on deliberate attention being given to each phase of the process, including system evaluation, selection, contracting, configuration, implementation, training and ongoing management & oversight. In almost all cases, those working inside the medical practice - providers, staff and management alike - lack both the time and the expertise to direct this process effectively. As a result, a common denominator of virtually all successful implementations is competent outside assistance.

In my opinion, choosing the right advisor is even more important than choosing the right system. The reason for this is simple. The best system, when improperly configured and deployed, will almost always fail. On the other hand, even a mediocre system, when implemented properly, will almost always succeed. Better people trumps better technology almost every time!

So where can you find a good, qualified, impartial advisor? One place not to look is with the EMR vendors themselves. As a general rule, they'll make the sale, plug you into their (not your) implementation schedule and then move on to the next deal.

My recommendation is to find someone with operational experience with the systems they install. Even better is to engage someone with a vested interest in a successful outcome. A good medical billing and practice management firm can be a great choice. Their business model is based on long-term relationships with their clients, and their core reason for existing is to help practices maintain optimal cash-flow. By working with a quality medical billing company to help select and deploy an EMR for your practice, you greatly increase the odds of a successful implementation and stable cash-flow during the process.

To find a medical billing and practice management firm with the resources you need, try contacting the Healthcare Billing and Management Association (www.hbma.org). They can help direct you to quality company in your area.

Scott Everson
Vice President, PracticeMax, Inc.
President, Healthcare Billing and Management Association (www.hbma.org)

mbebout says: This article highlights a
February 08, 2010 | 2:49PM GMT

This article highlights a major problem that we see a lot in the business of healthcare IT. That is that physicians are generally not very good at running the business of a practice, and yet they insist on doing it anyway.

Practice mismanagement is, in my experience, a major problem that physicians need to come to grips with. This article is a great example (yes, and a bit extreme as well) of that. As I clicked over and read the referenced story, I was not surprised that the subject of the story, Dr. Robert Cameron, is referred to as someone who is not much of a technology buff, and yet it appears by all accounts that he is the one making the decisions. I cannot think of any situation in any industry where spending $400,000 on an IT investment is a good idea without getting some guidance from an expert in the field. Yet in this case it seems that is exactly what has happened. It is hard to feel sympathy for a practice that pulls this kind of move. In many other types of small businesses, this kind of misstep would have run the company into bankruptcy.

It is not very difficult to find very well qualified EHR consultants who could have come into this practice and led this major undertaking. Bringing in an outside expert in EHR's helps to eliminate a lot of the problems that practices have in the evaluation, selection and implementation process and could save practices a lot of time and money by avoiding mistakes like this one.

The front-end process of converting to an EHR is something that does not receive a lot of attention, but it is arguably the most important part of the entire effort. Until more physician-owners begin to understand that they are most likely not a good fit to lead the evaluation, selection and implementation process, we will continue to see more stories like we see here.

sandypik says: its not easy...
February 08, 2010 | 9:39AM GMT

As a consultant that has worked on a number of EMR projects, I can tell you that I am not surprised that folks are frustrated. Vendors make promises they cannot keep; MD's don't ask the hard questions they need to ask, often because they don’t know what those questions are.
In addition, it seems like there are so many vendors out there now, since EMR looks like the 'next big thing' and everyone wants a part. They are hard to distinguish from one another. As a result the EMR business has become very competitive, and many vendors are falling by the wayside.
As consultants, we have had very little success in attempting to work with EMR companies who don’t respond to requests for more detailed information. They appear to be very reluctant to partner with anyone outside their own organizations to sell or install their products. We have had better success working within the practice to negotiate with vendors on behalf of our clients.
My best advice to those who haven't taken the plunge: contact some of your peers who are using an EMR. Speak to their IT staff as well as line staff. Find out what the like and don’t like about their systems. You'll learn from their mistakes.

DonaldK says: empty promises & high expectations
February 08, 2010 | 7:56AM GMT

We are beset with empty promises & high expectations that cannot be fulfilled; there will be weeping and gnashing of teeth for a decade or more. The IT and health care industries have insufficient mutual understanding. The languages, the world views contrast too sharply, and harmonization is a distant hope, at best. Physicians cannot construct good requirement specifications; and developers cannot understand the physician language when specs are attempted. Consider, for example, the essential element of narrative & story in medicine, and its defacto absence in computer science. The pen waves a lonely and prolonged goodbye .

EMR Vet says: Getting Gouged by your EMR Investment
February 05, 2010 | 12:43PM GMT

One way to avoid getting gouged by your EMR Investment is to not pay everything upfront. There are a myraid of newer, faster companies with better technology than the legacy vendors that charge one predictable monthly fee instead of "license" fees. All your support, updates, and success tools are built into one monthly price which is lower than a lease payment, doesn't require putting yourself or your practice in debt, and holds the vendor to the responsibility of supporting you - or you can walk. Check this kind of vendor our first. Technology costs go DOWN over time, not up. Its the same with development. Purchasing technology is unique in that paying more, doesn't get you more. Most medical technology in the market today is at least 10 years old and requires third party products and extra labor to plug security holes.

Let's say your sales person walks off with a $100k check and you start making payments to the bank. You're always going to owe the bank that money whether the software works or not. What leverage do you have to get the vendor back in the door if something isn't going right? Their honor? Its a noble thought but protect yourself by having an agreement where your mutual success is tied together. Don't be an easy mark and PAY AS YOU GO!!!

methington@simplifyMD.com

Allan Week says: Importance Of The IT Contract
February 03, 2010 | 11:05AM GMT

I can say with a high degree of confidence that many (perhaps, most) of the problems experienced by physicans who have purchased EHR or other HIT systems could have been avoided if more time and attention had been devoted to the review/negotiation of the contract for the IT system. The IT contract should be accorded a priority and importance in the transaction that is equal to the selection of the system itself. That is because if properly written, the IT contract is a blueprint for the project, addressing the expected system performance, delivery timelines, installation, acceptance testing, payment schedule and post-delivery support services. Since IT contracts are more in the nature of a construction contract rather than a typical business transaction, if a lawyer is brought in (and often one is not) that person should have experience with IT contacts and the computer industry if the buyer is to maximize protection. And if remote (Internet) access is part of the EHR system, the issues to be addressed are complicated by the presence of a third party provider.

FPiragibe says: EHR Software
February 02, 2010 | 4:29AM GMT

EHR are valuable resources. So, besides being formally sound and robust, they must be in an easily interchangeable format. For those of you who are consultants looking for a product born from a strong commitment, conceived by physicians and supported by a neutral international standards organisation, I would recommend taking a look at openEHR based products, specially those by Ocean Informatics, which has some of its board members taking part in the standard's board, too. OpenEHR is a neutral international standard, backed by European and Australian organisations, and can really deliver robust, complete and interchangeable electronic health record support.

GLRCPAVA says: Frustration
February 01, 2010 | 4:48PM GMT

Not only doctors are frustrated. I am a CPA who specialized in software implimtation. I want to add an EHR software to the list of products I support. Problem is, I can not get anyone at the several EHR companies I contacted to talk to me. How can I find out about their products and if they use outside consultants if I can not get a representitive on the phone. Any ideas? I believe consultants such as myself can save doctors many thousands of dollars and assure their systems are setup properly.

Thanks,

Gary L. Roberson, CPA
gary@glrcpava.com