The Marketplace: Tech Shopping 101

Business is booming, and operations have never run more efficiently at Regional Women’s Health Management in Voorhees, N.J. The 30 clinics and 100 providers that make up this group enjoy access to a new EMR, an electronic system that tracks physician orders, and an automated billing system that together have considerably streamlined office work flow, resulting in enhanced patient care and a fatter bottom line.

This is the work of Tony Cottone, the group’s director of systems operations. And he did it all in six months.

Billing has been simplified, giving clinics access to much better data when claims leave the office and slashing the number of days claims linger in A/R. And quality of care has improved. When physicians order tests such as mammograms or ultrasounds, they can now check to ensure that those tests were actually performed; test results are sent to patients’ electronic records, where they are appropriately reviewed. The clinic has been able to use its new ability to electronically track physician orders to persuade its payers to raise reimbursements and its malpractice carriers to cut premiums.

Cottone says the group’s EMR - soon to go wireless - will further enhance physicians’ quality of life at Regional Women’s. “With a tablet PC and a broadband card, physicians can stop and take a call on the turnpike and document the call right there at a rest stop,” he explains. “We have fertility practices in four offices, and the guys had these little wheelie suitcases they used to carry charts from one office to the other. If someone calls while the chart is in transit, you can’t help. … And in fertility, timing is everything. Having the data in real time is going to be critical to their effectiveness.”

The secret to Cottone’s success? Turning technology decisions into business decisions.

Selecting expensive technologies can be risky even for the most knowledgeable consumers. But basing your choices on your practice’s business objectives keeps your focus where it should be. That sounds obvious, but too often physicians - like most consumers - get sidetracked by peripheral concerns.

Look beyond the price tag

Physicians have a bad rep when it comes to tech know-how.

“People who think physicians make uninformed [technology] decisions don’t understand,” says Girish Kumar Navani, president and founder of eClinicalWorks. He’s walked plenty physicians through the EMR selection process. “Compared to other industries, these are sophisticated buyers.”

But even the most urbane shoppers can get sidetracked and buy for the wrong reasons. For example, in these days of dwindling reimbursement, many practices that feel pressured into pricey tech purchases begin shopping by looking only at price tags.

“I’ve heard of people excluding systems because of price from the beginning,” says Cottone. “You’ve got to look at the features first. You want a base idea of what they charge … but if you’re big enough to have some market clout, you can move that.”

Sometimes the extras that accompany a more expensive purchase can more than pay for its higher price tag. For example, the billing system Cottone chose is a good deal more expensive than the one the group previously used. “But the effect on turnaround time and days in A/R was significant enough that it made sense to do it,” he says.

Bill Presler, senior business development manager at Panasonic, says some of his company’s best customers are those who bought the cheapest hardware they could find when first implementing new software.

Say you’re a small practice that has just put out $35,000 for a new EMR. Many such groups will try to save on additional expenses by running their new software on inexpensive laptops. But when those laptops fail - and, Presler says, industry-wide, one out of every four machines will - and repair times stretch into weeks and months, cheaper machines can actually end up costing your practice more than higher-quality hardware that is more expensive on the front end.

Presler isn’t the only one who advises against using price as your only guide. Rosemarie Nelson, who consults with medical practices on technology-related issues for the Medical Group Management Association, says that when faced with the hypothetical situation of having to choose between an EMR that is expensive and complex and another that is cheaper and simpler, you have to weigh the pros and cons of each. Which system would best fit your needs? “The more robust system usually has more complexity to the implementation,” Nelson says. “Are you willing to put in the effort to get the most out of the product?” If you are, she adds, you also need to factor in your time investment.

When shopping for expensive technology such as EMRs, Nelson advises visiting practices that are using the systems you are considering. Take along a nurse and a doctor so they can see how they would need to modify their processes if you purchase a system that is more difficult to customize. If you are leaning toward a system that offers a high level of customization, Nelson recommends talking to individuals who have built their own templates from that system. How many versions did they go through, and how much time did it take before they got it right? Did their investment pay off? Do you have the resources to do the same?

And forget about brand names. Nelson advises asking yourself: “Are we worried about the outside world more or about inside operations?” A vendor’s glossy brochures and big name mean nothing if you don’t use all those extra features you paid for.

Resist peer pressure

Nelson says she often gets called in to clean up messes created by another common mistake practices make when purchasing pricey new technologies - slavishly following the demands of “the geek with a stethoscope,” that is, a physician in the group who simply must have every new gadget the second it hits the market.

“The mistake is following that physician zealot - the guy who just says, ‘If we don’t do it we’ll be dead in the water,’” Nelson explains. “You feel like you have to do something because he seems to know enough about it.” Never mind that it’s not the right tool for your processes or that it doesn’t interface with what you already have. “You go and you spend a lot of money, and two years later you’re calling for help, saying, ‘We’ve got an EMR, and we can’t make it work.’” It’s OK to listen to your geek’s advice, says Nelson, “but become an informed buyer. Understand what your goals are. You can’t measure a return on investment unless you understand what you are measuring it against.”

Also resist the siren songs of your existing vendors. It can get pretty high-pressure when you are looking into EMRs and your existing practice management software vendor happens to sell one. Navani says he’s seen vendors “camp out” at practices until they seal a deal. And Nelson says that sometimes practices feel as if they have to choose an EMR from the same company that supplies their current software because they don’t want to get into the mess of integrating two incompatible systems. She reminds physicians that even when both management software and EMR software come from the same vendor, they may not be truly integrated. Some practice management software vendors bought EMR companies when they became the hot new thing and patched the new software to their existing offering. It’ll work, says Nelson, but it’s not integrated, just interfaced.

“It’s not always a bad decision [to use the EMR solution from your practice management vendor], but it’s not always a great decision either,” says Nelson. “Just don’t feel like you need to settle for second best - for not having functionality you want.”

And just as price shouldn’t be the only factor in your decision-making process, neither should the desire for specific features. This is about business, not bytes. “The industry has moved heavily to a features/ function orientation, a technology orientation as opposed to … looking at how a solution fits the needs of your practice,” says Dan Pollard, director of product management at Misys Healthcare. “It’s a complex buying decision, and people are looking for a shortcut.”

The Certification Commission for Healthcare Information Technology (CCHIT), which has been accrediting EMRs since July 2006, emphasizes the functionality-based approach when evaluating products. That’s not all bad, but there’s no sense having a bunch of functions you’ll never use or that don’t address the business problems specific to your practice.

Stay on track

So how do you keep your eye on the business at hand when vendors, geeks, and the technology itself provide such convenient distractions?

Nelson advises kicking off every technology selection process by asking three questions that focus everyone on the most important issues at hand. Here they are, written specifically for an EMR decision:

• What objective(s) do you wish to achieve by implementing an EMR? What problem(s) are you trying to solve? This answer should be the key driver in your selection and implementation process.

• What is your preferred solution to automating your medical record-keeping process?

• What must an EMR do/provide for you to be willing to use it?

Nelson says a red flag should go up if physician partners can’t agree on the answer to the first question - or worse, if only a handful of physicians in a group bother to respond at all. “If I send out my three questions to a group of eight physicians and I only get two responses, I go back to the group and say, ‘You have a problem here,’” she says.

Achieving active participation and gaining near consensus on these core questions are crucial to making a good purchasing decision and following through with an effective implementation plan. And that requires understanding your own business. “Identify the processes that are costing you too much money now,” Nelson suggests, rather than first looking at what processes a vendor promises to fix. Is reissuing prescriptions a nightmare in your office, or is locating charts the real problem?

“Groups seldom know their existing process costs,” Nelson says. She encourages shoppers to do a quick time-motion study of the work their practice does each day or to at least spell out each step in their more painful processes (i.e., billing), and estimate the costs incurred there.

When Cottone set out to ease the processes of following through with clinical orders at Regional Women’s, he began by mapping an ideal work flow - not by looking at what vendors promised him was achievable with their products. “We talked about … what our expectations are,” recalls Cottone. “We have a board of managers comprised of an owners’ group of physicians. … We worked with them to develop the specifications, what we wanted it to do. … What are the possible results for a Pap smear, and, based on that, what happens? We created a work flow and laid it out for the programmers.”

To select an appropriate EMR for the group, he created a checklist - a list of attributes any system the group selected had to have. When the physician board reviewed any product, Cottone kept the board members focused on the checklist.

“I wanted them to understand how to objectively look at a system,” he explains. “It’s hard to look at something in an hour demo and see how it would really work.” Cottone admits it’s “difficult to get physicians to use the matrix [checklist] as a tool and to stay focused on it to make sure you are getting what you want and what you need,” but the effort gets groups closer than a less-structured process would.

And staying on point is the key to using technology to optimize any individual practice’s specific processes.

Pamela L. Moore, PhD, is senior editor, practice management, of Physicians Practice. She can be reached at pmoore@physicianspractice.com.

The checklist (titled “Decisions, Decisions”) created by Tony Cottone for the Regional Women’s Health Group can serve as a handy tool that can help your practice compare different products when shopping for an EMR or other new technology. It’s been adapted by Physicians Practice to help practices large and small and of all specialties make the best purchasing decisions for their IT needs.