Blog: The world's worst EHR vendor

By Mike Miliard
03:26 PM

When I was first forwarded a press release from Extormity, the Aspen-based EHR maker, I assumed it was a new vendor I hadn't heard of. In fact, it wasn't. The company doesn't exist. Its sleek and well-designed Web site is a parody – dreamed up and designed by an exec at a real-life personal health records company who remains anonymous (until a later date which, he says, is coming soon).

This relative newcomer to the health IT field is an ardent prosthelytizer about the value of electronic records. But he's also frustrated about several aspects of EHRs, many of which are "proprietary fortresses" instead of offering plug-and-play interoperability, and exist as expensive client/server solutions rather than affordable, Web-based apps. Moreover, many vendors offer inflexible software that's poorly implemented and leads to practice upheaval; a few, he says, are guilty of "blatant price gouging."

And so he dreamed up Extormity -- "at the confluence of extortion and conformity" -- as a funny jape at certain unnamed companies in the EHR space, who hawk subpar products, seeking to separate providers from their wallets and established workflows. He also established a Web site for SEEDIE, an ersatz standards and certification commission. (It stands, naturally, for the Society for Exorbitantly Expensive and Difficult to Implement EHRs.)

I chatted recently with Extormity's fictitious CEO, "Brantly Whittington," who replied to our e-mailed questions "between rounds of golf." Here's what he had to say about his entirely nonexistent company and its plans for complete and total domination of the healthcare IT industry.

So what is Extormity, and where are you based? I don't believe I saw your booth on the HIMSS10 show floor.

What is Extormity? This healthcare IT mega-corporation was started as a limited liability parody – a good natured attempt to shed satirical light on the underlying reasons for the ridiculously low adoption of electronic health records, personal health records, e-prescribing systems and other HCIT solutions. The overwhelming response from tens of thousands of visitors to and sister site, the thousands signed up for email alerts, and the hundreds of  fan comments have made it clear this exercise in fun resides amazingly close to the truth.

Our corporate headquarters is in Aspen, and can be described in three words: glass, wood and arrogance. We maintain a lean headquarters staff who can appreciate cultivated opulence, and we embrace virtual operations – with luxury outposts in Switzerland, the Caymans, Sardinia, Bahrain and Hong Kong. This enables our executives to work with clear heads, tan bodies, and easy access to abundant recreational opportunities. Our operating units, by contrast, are dispersed in hovel-like facilities around the globe where our developers and implementation staff daydream about one day working for a Chinese circuit board manufacturer.

As for HIMSS10, we were there but adhered to our “exhibits are for chumps” philosophy. We spent lavishly, sparing no expense to ensure that our clients and prospects realized the value of partnering with a powerful healthcare IT vendor. While we are reluctant to share the details of this successful relationship management strategy, suffice it to say the private hangars of Atlanta airports were busy servicing our jets, local spirit distributors had to replenish their depleted champagne inventories, and there were no luxury penthouse suites sitting empty while the little people attended an educational track focused on the trivial details of meaningful use.

You advertise your product with the pithy tagline "expensive, exasperating, exhausting." Describe some of the selling points of the Extormity EHR Software Suite.

You demean our corporate positioning statement when you describe it as a pithy tagline, and fail to recognize that we invested seven figures with a management consulting firm to identify and memorialize these Extormity Operating Pillars – an investment we pass along to our clients. These pillars are more than mere selling points, and they guide our corporate strategy.

Talk a little about your customer base: any notable implementations, lately?

Our clients generally prefer to keep a low profile, partly out of shame, and partly out of a desire to avoid regulatory scrutiny. Rest assured, there is an Extormity installation near you. New implementations are plentiful, and are fed by a never ending stream of “flavor of the week” innovations that permeate the healthcare landscape. Our current favorite is the so-called Accountable Care Organization. Thanks to a few peer-reviewed journal articles, a talk or two at HIMSS, and some government funded pilot projects, every health system is scrambling to become an ACO, whatever that means. We know that for Extormity, it means business, as we are promoting our expensive healthcare IT solution as the vehicle for ACO success. Now that we have convinced several large clients to cut P.O.’s, we intend to figure out what an ACO is and have some offshore programmers develop a module for our software suite.

Customer satisfaction is generally high, I presume? Any complaints?

We focus not on customer satisfaction, but retention. Without revealing the details of our strategy, the approach is straightforward: after spending ridiculous sums on our software and support, and realizing few if any benefits, no hospital CIO would dare complain or admit to making a multi-million dollar mistake. We soften the lack of value with over-the-top entertainment, travel to resort locations to attend customer advisory council meetings, and plenty of golf. In our experience, customers are reluctant to bite the well-manicured hand that feeds them.

You're competitively priced, I hear.

You heard wrong. Extormity is expensive. Pay through the nose expensive. We make no apologies for our pricing, and ensure that the only sorry party is on the receiving end of our products, services and invoices.

Will you help my hospital meet meaningful use?

If your hospital refers to its IT budget as a war chest, then Extormity is ideally suited to help you achieve meaningful use. Our EHR can help your hospital meet the requirements, especially those that only require self-attestation. The Extormity consulting team includes an acting coach who will teach your CIO to say “Yes, we can do that with our EHR system” with enough mock sincerity that even the most hardened auditor will walk away convinced.

We have also added new modules to meet those pesky patient and family engagement requirements. The Extormity My-I-Your-Their-Health-E-PHR takes the oft-maligned tethered model to a new level, in the form of a shackled patient portal. When patients create a portal account, they are prompted to enter their credit card information for “identity verification purposes.” While patients can use the account for free to view carefully selected and highly sanitized health information in the Extormity EHR, if they attempt to print or share their information with another provider, their credit card is charged a $1000 convenience fee. Next time these patients log into their portal account, a mild electrical current is fed through the computer keyboard while a message warning against visiting non-Extormity physicians is displayed. Your patients quickly become loyal captives. While some question the ethics of replacing customer satisfaction with fear and intimidation, this approach fosters repeat business and inadvertently improves continuity of care.

I've heard that some EHR makers offer "money-back guarantees" to their customers. Does Extormity do anything like that?

We leave money-back guarantees to the late-night TV marketers of ginsu knives. Extormity does offer a “money-spent guarantee” which ensures that every cent of stimulus funding earned by an eligible physician or hospital is promptly signed over to pay for Extormity goods and services.

What sort of service and support do you offer?
We recently launched the “Extormity Underwire Service Plan” modeled after a well-known approach to bra construction. Like its namesake, our new service plan offers barely adequate but often painful support. At the end of the day, we enable our clients to function, but not without red welts and significant strain.

What are some of the major opportunities ahead for EHR adoption? Obstacles?

The latest refrain in healthcare circles is the oft-repeated “is $44,000 enough?” The answer is no, but it’s certainly enough to get going! An EHR system is like crystal meth – once you get started it’s hard to stop, and soon it pervades the community. Once everyone in the neighborhood has an EHR system, good things are bound to happen.

For Extormity, the major near-term opportunity lies in helping physicians and hospitals qualify for and hand over their stimulus checks. Once we get them using our applications and attending our receptions, spending for Extormity will become an evergreen budgetary requirement.

Our primary obstacle is all these emerging goody two-shoes, Software as a Service vendors offering high quality EHR solutions at affordable prices. These short-sighted challenger brands have the temerity to leave money on the table, telling clients they will actually have stimulus funds left over to spend on other pursuits.

We are also disturbed by patient portal companies offering portable PHR products designed to be interoperable with any EHR application using industry standard integration protocols. This flies in the face of the proven tethered approach designed to keep walls around our bountiful cash-crop gardens. Thank goodness for SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHRs. Working closely with SEEDIE and other like-minded vendors, we aim to ensure the preservation of proprietary, high-cost, server-based solutions.

I can probably guess your answer, but do you believe the switch to electronic records is better served by dozens of smaller EHR makers, or one or two big IT behemoths?

Clearly, the EHR category must submit to the will of a few gargantuan players. The little companies exist to give the impression of competition and prevent anti-trust investigations. Please do not misunderstand, we value all the small players – it gives us something interesting to step on when we get bored. We keep these EHR ants under our magnifying glass, and when one begins to attract too much attention or amass more than a negligible market share, we focus the sunlight through our competitive lens and create a crispy carcass where an aspiring upstart used to be.