.jpg)
Win an iPod
Five Rules To Help Avoid Becoming an EMR Sucker
| Author: Jonathan Bertman, MD, FAAFP |
| Article Date: 5/31/2007 |
Five Rules To Help Avoid Becoming an EMR Sucker
By: Jonathan Bertman, MD, FAAFP
Dr. Bertman is the Editor-in-Chief of MDNetGuide.
Finding an Electronic Medical Record (EMR) doesn’t have to be a nightmare. Yet with well over 200 different EMR products on the market, most being sold by financially successful salespeople, finding the one that will make your life better while not decreasing your salary can be a daunting task. While I’ve heard first-hand many horror stories from folk who’ve had hellacious experiences, like the group who had to close their practice and declare bankruptcy just to get out of a bad EMR contract, I’ve also heard many terrific experiences from doctors on their EMR adoption. Below, I’ve put together five rules that will ensure you will find a terrific product at a reasonable price, and not end up as another anecdotal “poor bastard.”
My own experiences trying to find an affordable EMR for my Family Practice began at a medical convention in 2001 where many EMR vendors were showing their wares. The first worrisome sign that I might end up over-paying for something that actually was going to slow me down was that many of these companies refused to provide a straight answer on how much their system actually costs. The salespeople hemmed and hawed and wanted to set up an in-office demonstration at which time, they said, they could get a better sense of my needs and then give me a price. And while this seemed awfully sleazy, it soon became clear as to why they were avoiding giving me a quote: they charged a ridiculous amount of money for their product – and they knew that the sticker-shock would cause me to walk away before they could get to their sales pitch. Their goal was not to make the sale right then, but rather get a commitment to allow an in-office demonstration like a door-to-door vacuum salesman. Another sales technique they used was offering a “show special” to get a signature and deposit. Putting money down would essentially stop me from actively looking at other competition lest I lose my deposit. Not a great first impression of the EMR industry. Thus I decided I would develop my own “home-grown” solution, and if it worked for me, I’d sell it to other physicians the way I wished these vendors would have sold to me: free to try; cheap to buy.
Over the last six years of selling this product to other physicians I’ve experienced life “on the other side” as on of these slick vendors. And while being an EMR vendor is no easy task and we certainly get our fair share of abuse (deserved), I’ve also learned a number of common techniques to get somebody to spend a lot of money on something they might not really need. Alas, I’m a doctor first, and an EMR vendor second, so let me share five rules that will prevent you from getting suckered.
1. Ask colleagues and your academy.
There is no better way to find out if a system will help or hurt you than to learn from the experience of friends who have already been through the process. If an EMR vendor can’t keep their existing clients happy, than they are focused on the sale, and not the product. Ask doctors whose practice specialty and size match your own. If you don’t know people who are already using an EMR, ask the vendor you are considering for a list of local clients in the same specialty. Be sure to specify that you only want real users and not anybody affiliated with their company (e.g,. somebody who is also an investor in their company, or a doc that will be “reimbursed” for their time in speaking with you as a potential client - yes, a number of companies actually do this).
Another great place you may be able to get un-biased opinions from actual physician users is your specialty association. For example, the American Academy of Family Physician’s Center for Health Information Technology (www.centerforhealthit.org) offers AAFP members access to un-edited user reviews of many EMRs by their physician members. Their simple five star rating and price comparison makes narrowing down the EMR list fairly easy, and you can search by a number of criteria, such as practice size and price (at least for vendors who provide price data).
Table 1. The most highly rated systems that have been reviewed by more than 10 physicians.*
*This data is adapted from the AAFP’s Center for Health IT website as of 5/4/07. Ratings are based on a 1-5 scale in each of the following categories: Quality, Value, Usability, Productivity, Support. Scale for initial cost is: $ = less than $1000 per physician, $$ = 1,000 to $4,999 per physician, $$$ = 5,000 to 9,999 per physician, $$$$ = $10,000 to $15,000 per physician. Scale for annual cost is: $ = Less than $500 per physician, $$ = $500 – $1,999 per physician, $$$ = $2000 - $2499 per physician. NA means that data on cost from the vendor has not been provided.
2. Try before you buy.
One of the more astounding problems with today’s EMRs is that many of them are designed by programmers in a way that programmers think doctors should work. Using some of these modern-day products is more like taking an inventory at Wal-Mart than being a physician. So, while it may seem obvious, an alarming number of products don’t have any mechanism in place to allow you to really try their system risk-free. You wouldn’t buy a car without test driving it, so why would you commit to purchasing software without playing with it first? Many vendors say this is because their system needs a complex network and server on which to run. Unless you have a dedicated technical department, you want to purchase software that will be easy enough to install, learn, use, and trouble-shoot on your own. A complex server and network setup has complex problems that an office without a dedicated tech department just can’t deal with on Monday morning.
3. Get a written quote, including the “hidden” charges.
Despite recent trends toward a lower price, the average EMR remains markedly overpriced. Worse still, many companies insist on demonstrating their product before providing their pricing. Demand a straight answer on the price (or even just a ball-park range) before you agree to learn anything about a product. A beautiful product will be useless if its cost is prohibitive or causes you to have to take out a loan to afford it. Another vendor trick is to give a price and then later spring hidden and extra charges such as on-site training and extra “modules”. Be sure to get a price list for any modules you might want, any hardware they require, any updates, support, and maintenance they offer, and the cost for any training and support they recommend. These items can double the cost you end up paying, so if it is not clearly stated on their marketing material – get it in writing.
4. Don’t take out a loan to buy an EMR.
Perhaps this is reasonable for a large practice with a dedicated IT staff, but for a solo or small practice, taking out a loan or leasing software to use software is ludicrous. EMR software should be designed to make your life easier by automating repetitive tasks and providing analysis of your practice to improve care and reimbursement. It’s that simple. The value of EMR software should be obvious based on its price and what it can do. If a salesperson has to justify their price with “business” lingo of ROI (Return On Investment) or offer an “easy monthly payment plan,” than you are looking at the wrong software.
5. Be skeptical of vendors and consultants.
Of course we’ve learned to take medication information from our drug reps with a grain of salt, and what these folks tell us is tightly regulated by the FDA. EMR vendors and consultants, on the other hand, are a completely unregulated group. And what is said in attempting to sell you a product should always be confirmed. A good salesperson can do a demonstration that will make you say “wow.” But their presentations are tightly rehearsed, and if you ask them to demonstrate something you define on the spot, you may be surprised at how many clicks and steps needed to do what you want.
Similarly, with the growing EMR market, many third-party groups have seen dollar signs and want a piece of it. Local medical associations and groups, often run by highly respected and usually ethical physicians have a surprising propensity to make undisclosed deals which result in your money going into their pockets. Be especially critical of a group that recommends a single EMR product as they are most certainly getting something in return for their recommendation. Be sure you are aware of any financial ties before accepting their recommendation. In addition, I’ve learned of a number of nationally recognized consultants who lecture frequently on EMRs who are also hired by the same companies they recommend. It’s not that this is necessarily bad, it is just biased – and if not clearly disclosed, you are likely getting an opinion suited to their benefit, not yours.
In summary, finding the right EMR that can help improve patient care, efficiency, and your personal/financial well-being can be a treacherous process. Keeping these 5 basic rules in mind can mean the difference between being thrilled with your selection, and being just another EMR sucker.
____
Dr. Bertman is Clinical Professor of Family Medicine at Brown University and a fellow of the American Academy of Family Practice. He is the founder and president of the EMR company, AmazingCharts.com and the consumer information website, AfraidToAsk.com. Dr. Bertman also has a private practice in Hope Valley, Rhode Island. He can be reached via email at Jonathan_Bertman@brown.edu.
By: Jonathan Bertman, MD, FAAFP
Dr. Bertman is the Editor-in-Chief of MDNetGuide.
Finding an Electronic Medical Record (EMR) doesn’t have to be a nightmare. Yet with well over 200 different EMR products on the market, most being sold by financially successful salespeople, finding the one that will make your life better while not decreasing your salary can be a daunting task. While I’ve heard first-hand many horror stories from folk who’ve had hellacious experiences, like the group who had to close their practice and declare bankruptcy just to get out of a bad EMR contract, I’ve also heard many terrific experiences from doctors on their EMR adoption. Below, I’ve put together five rules that will ensure you will find a terrific product at a reasonable price, and not end up as another anecdotal “poor bastard.”
My own experiences trying to find an affordable EMR for my Family Practice began at a medical convention in 2001 where many EMR vendors were showing their wares. The first worrisome sign that I might end up over-paying for something that actually was going to slow me down was that many of these companies refused to provide a straight answer on how much their system actually costs. The salespeople hemmed and hawed and wanted to set up an in-office demonstration at which time, they said, they could get a better sense of my needs and then give me a price. And while this seemed awfully sleazy, it soon became clear as to why they were avoiding giving me a quote: they charged a ridiculous amount of money for their product – and they knew that the sticker-shock would cause me to walk away before they could get to their sales pitch. Their goal was not to make the sale right then, but rather get a commitment to allow an in-office demonstration like a door-to-door vacuum salesman. Another sales technique they used was offering a “show special” to get a signature and deposit. Putting money down would essentially stop me from actively looking at other competition lest I lose my deposit. Not a great first impression of the EMR industry. Thus I decided I would develop my own “home-grown” solution, and if it worked for me, I’d sell it to other physicians the way I wished these vendors would have sold to me: free to try; cheap to buy.
Over the last six years of selling this product to other physicians I’ve experienced life “on the other side” as on of these slick vendors. And while being an EMR vendor is no easy task and we certainly get our fair share of abuse (deserved), I’ve also learned a number of common techniques to get somebody to spend a lot of money on something they might not really need. Alas, I’m a doctor first, and an EMR vendor second, so let me share five rules that will prevent you from getting suckered.
1. Ask colleagues and your academy.
There is no better way to find out if a system will help or hurt you than to learn from the experience of friends who have already been through the process. If an EMR vendor can’t keep their existing clients happy, than they are focused on the sale, and not the product. Ask doctors whose practice specialty and size match your own. If you don’t know people who are already using an EMR, ask the vendor you are considering for a list of local clients in the same specialty. Be sure to specify that you only want real users and not anybody affiliated with their company (e.g,. somebody who is also an investor in their company, or a doc that will be “reimbursed” for their time in speaking with you as a potential client - yes, a number of companies actually do this).
Another great place you may be able to get un-biased opinions from actual physician users is your specialty association. For example, the American Academy of Family Physician’s Center for Health Information Technology (www.centerforhealthit.org) offers AAFP members access to un-edited user reviews of many EMRs by their physician members. Their simple five star rating and price comparison makes narrowing down the EMR list fairly easy, and you can search by a number of criteria, such as practice size and price (at least for vendors who provide price data).
Table 1. The most highly rated systems that have been reviewed by more than 10 physicians.*
*This data is adapted from the AAFP’s Center for Health IT website as of 5/4/07. Ratings are based on a 1-5 scale in each of the following categories: Quality, Value, Usability, Productivity, Support. Scale for initial cost is: $ = less than $1000 per physician, $$ = 1,000 to $4,999 per physician, $$$ = 5,000 to 9,999 per physician, $$$$ = $10,000 to $15,000 per physician. Scale for annual cost is: $ = Less than $500 per physician, $$ = $500 – $1,999 per physician, $$$ = $2000 - $2499 per physician. NA means that data on cost from the vendor has not been provided.
2. Try before you buy.
One of the more astounding problems with today’s EMRs is that many of them are designed by programmers in a way that programmers think doctors should work. Using some of these modern-day products is more like taking an inventory at Wal-Mart than being a physician. So, while it may seem obvious, an alarming number of products don’t have any mechanism in place to allow you to really try their system risk-free. You wouldn’t buy a car without test driving it, so why would you commit to purchasing software without playing with it first? Many vendors say this is because their system needs a complex network and server on which to run. Unless you have a dedicated technical department, you want to purchase software that will be easy enough to install, learn, use, and trouble-shoot on your own. A complex server and network setup has complex problems that an office without a dedicated tech department just can’t deal with on Monday morning.
3. Get a written quote, including the “hidden” charges.
Despite recent trends toward a lower price, the average EMR remains markedly overpriced. Worse still, many companies insist on demonstrating their product before providing their pricing. Demand a straight answer on the price (or even just a ball-park range) before you agree to learn anything about a product. A beautiful product will be useless if its cost is prohibitive or causes you to have to take out a loan to afford it. Another vendor trick is to give a price and then later spring hidden and extra charges such as on-site training and extra “modules”. Be sure to get a price list for any modules you might want, any hardware they require, any updates, support, and maintenance they offer, and the cost for any training and support they recommend. These items can double the cost you end up paying, so if it is not clearly stated on their marketing material – get it in writing.
4. Don’t take out a loan to buy an EMR.
Perhaps this is reasonable for a large practice with a dedicated IT staff, but for a solo or small practice, taking out a loan or leasing software to use software is ludicrous. EMR software should be designed to make your life easier by automating repetitive tasks and providing analysis of your practice to improve care and reimbursement. It’s that simple. The value of EMR software should be obvious based on its price and what it can do. If a salesperson has to justify their price with “business” lingo of ROI (Return On Investment) or offer an “easy monthly payment plan,” than you are looking at the wrong software.
5. Be skeptical of vendors and consultants.
Of course we’ve learned to take medication information from our drug reps with a grain of salt, and what these folks tell us is tightly regulated by the FDA. EMR vendors and consultants, on the other hand, are a completely unregulated group. And what is said in attempting to sell you a product should always be confirmed. A good salesperson can do a demonstration that will make you say “wow.” But their presentations are tightly rehearsed, and if you ask them to demonstrate something you define on the spot, you may be surprised at how many clicks and steps needed to do what you want.
Similarly, with the growing EMR market, many third-party groups have seen dollar signs and want a piece of it. Local medical associations and groups, often run by highly respected and usually ethical physicians have a surprising propensity to make undisclosed deals which result in your money going into their pockets. Be especially critical of a group that recommends a single EMR product as they are most certainly getting something in return for their recommendation. Be sure you are aware of any financial ties before accepting their recommendation. In addition, I’ve learned of a number of nationally recognized consultants who lecture frequently on EMRs who are also hired by the same companies they recommend. It’s not that this is necessarily bad, it is just biased – and if not clearly disclosed, you are likely getting an opinion suited to their benefit, not yours.
In summary, finding the right EMR that can help improve patient care, efficiency, and your personal/financial well-being can be a treacherous process. Keeping these 5 basic rules in mind can mean the difference between being thrilled with your selection, and being just another EMR sucker.
____
Dr. Bertman is Clinical Professor of Family Medicine at Brown University and a fellow of the American Academy of Family Practice. He is the founder and president of the EMR company, AmazingCharts.com and the consumer information website, AfraidToAsk.com. Dr. Bertman also has a private practice in Hope Valley, Rhode Island. He can be reached via email at Jonathan_Bertman@brown.edu.