Fulfilling the Promise of Technology Through Service

Rich came to PracticeIT from a career delivering innovative software solutions for health care and social services organizations and has found that whether working in the large enterprise or small venture development arenas, the challenges are consistent: commit to truly knowing your customer; tackle only their key business priorities; evolve the software to a point that it ultimately fades from view and their business remains the focus.

Based on his experience, Rich has some definitive ideas about how technology in general, and specifically electronic medical records (EMR), should impact the medical workplace …

Rich, when you look across the EMR playing field what do you see?

I see great opportunity – for physicians to be well served by a partner that will deliver on the longstanding promise of EMR.

I see real advances in connectivity, both in terms of geographical and data integration that will serve the physician’s need to deal with an increasingly transient patient population, seeking increasingly specialized care.

I see advances in web technology that can put physicians in the driver’s seat, letting their practice of medicine drive innovation and implementation.

Sadly, the legacy EMR industry has been full of promise yet has failed physicians with a history of low adoption rates, high failure rates and poor service. In fact, EMR adoption represents a long string of broken promises from vendors to physicians, namely that EMR would: help a practice save time and make money; increase productivity ; r educe headcount; and promote higher quality medicine.

Despite the decades-long feature race for the best software package, EMR adoption has been an unrewarded leap of faith for early adopters. Rather than fulfill promises, legacy EMR technology has: added time to the physician's workload (up to several hours per day); reduced patient visits – the key driver of practice revenue; added headcount or outsourced resources to manage new information technology; introduced exorbitant upfront and ongoing support and maintenance costs ; and h ad little to no impact on quality of care.

I see great opportunity for PracticeIT to lead the way in our commitment to knowing and serving physicians who can now demand a partner that is committed to their unique needs.

We have dedicated ourselves to making EMR simple, efficient and affordable. We believe every physician should have the opportunity to have one, and that if we deliver well, the technology should become ubiquitous and nearly invisible – fading into the background as physicians simply return to the practice of medicine.

What is the current state of the industry?

The industry sits at a critical crossroad, where a growing mandate and acquiescence to physician office technology coexists with significant trepidation and reluctance on the part of physicians. Physicians remain unconvinced of the benefits of adopting technology to automate their practices.

In fact, physicians are openly holding out on the purchase and adoption of EMR. Despite a 20-year industry history, The New England Journal of Medicine reports that only 4% of US physicians have a fully functional electronic records system and only 13% have a basic one.

Nevertheless, almost to a person, physicians acknowledge that this movement is coming quickly and will soon be here for good.

The many physicians that I regularly meet and speak with simply want to believe that there exists an EMR that doesn’t have to completely disrupt their practice, or wreak havoc on their tenuous finances. They are pressured by patient loads, declining reimbursements and shifting legislation. They simply can’t add to that risk pile the adoption of an invasive technology.

PracticeIT’s sole mission is to be that partner for physicians – to deliver the simplest most affordable EMR solution available, non-invasive to their practice and easy on their wallet.

What are the main barriers to adoption (or reasons for their reluctance)?

Many times we refer to the traditional barriers as the “Killer C’s” of Adoption – Change, Complexity and Cost. While there are many independent studies on this topic and each physician’s concerns are unique, we find that reluctance ultimately boils down to some combination of these key elements.

Cost and Complexity are fairly easy for physicians to articulate – they either have these pain points or they do not. Many physicians simply cannot justify the large capital outlays required for the historically typical EMR. Some have put the decision to adopt off indefinitely out of frustration over the overwhelming complexity of many offerings – the downside of the software vendors’ feature race.

The harder element to pin down is Change – although this represents the bulk of all adoption reluctance. Concerns over change include all the fears regarding practice disruption, staff turnover or retraining, role shifting, workflow modification, new skill development, threats of government mandate, etc.

At PracticeIT we believe, and physicians are confirming, that most are simply waiting for a partner that will stand with them and focus on their needs. A partner that won’t disrupt their practice with a technology install. A partner that won’t interrupt practice operations and revenue generation with training that overwhelms and confuses. A partner that won’t train them once and then leave the practice to customer support calls that vary in responsiveness. Ultimately, a partner that will finally fulfill the promises of automation with an EMR that is simple, affordable and efficient.

You seem to have a real concern for physicians.

We do! I’ve been asked that question before in an interview and honestly it was somewhat surprising to me. The notion that genuine concern for our customers and their unique needs was notable and distinct was troubling, but also what I’m most proud of about PracticeIT.

It’s true; we’ve built PracticeIT with physicians and for physicians. Our goal is to be their partner, their EMR, that’s it. And we’ll be that when our services meet their needs. A seemingly simple formula, but one that has escaped the broader market and one that we passionately pursue.

So what should a physician be looking for?

There are certain basic features that must be in place to make an EMR helpful to the physician’s practice, the “table stakes,” if you will. A physician needs to chart, code and bill, prescribe, and archive documents. The office may want to communicate with labs or the local hospital system.

Your EMR should help you do these things in the simplest, least invasive way possible. At PracticeIT, simple means you don’t learn complex new software programs. Non-invasive means your practice should run pretty much the way it always has unless there is some workflow streamlining we can help you with.

Beyond the software features, I believe that the difference lies with the vendor in their desire and capacity to provide implementation support, comprehensive training and customer service as an imperative that continues long after “implementation” has begun. Training and service must be ongoing… so physicians and their staff can focus on giving care, not maintaining technology. You simply have to have a partner that’s there with you for the long haul. Time and this industry’s track record have proved it. And that’s why we built PracticeIT.

We believe that is important to put our own skin in the game. Everyone asks me how we’ll be profitable providing unlimited service and training without charging extra for it. My answer never wavers: We’ll provide simple tools and train you skillfully so that adoption is quick AND lasting or we won’t be successful.

We’ve tied our success to yours. If I have to come back time and again and constantly re-train, then I haven’t made it easy enough, I’m not serving physicians and I haven’t brought lasting change. We’re doing it now, and I believe it can be done on a large scale to serve physicians that have never even considered EMR.

This leads me to ask, what does a successful implementation look like? How long does it take? How quick should a practice expect benefits? How much disruption should they expect while they are getting up to speed?

When I took this job, I challenged the staff to build a product and associated services that would let me say that our physicians could expect to be implemented in an hour and trained in an afternoon. While the shock is still wearing off at the office, here’s what I mean when I say that.

Implementation really can be that fast. We’re a hosted solution. If you have a browser and bandwidth, we can truly have you implemented in an hour. We work with a physician’s staff to obtain the necessary personnel data so they can be logged in and adding patients within the hour.

Now, the counter argument is always: “Well that’s not fully implemented. You haven’t taught all of my staff how to do everything.” What they’re really doing is echoing the industry standard approach that has been taught for so long. They’re saying - because it’s what they’ve heard: “You haven’t shut my practice down, made me stop seeing patients and had a mass training session (which minimizes time and expense for vendors).”

I say, why does that have to define implementation? You start with something that will bring you immediate value. Maybe that is e-prescribing, maybe it simply means scanning in your current t-sheets and other practice documents so you don’t have to keep paper files. Maybe you start on the front end with the practice management function and enter your contract information and charge master so your billing can be streamlined. Some of these things could return value within hours or days. Some may take a little longer. The physician should be able to work with their vendor to choose what’s best for their individual practice and receive value right away.

The point is we train you the way you work, so that you can keep working. If that sounds like it might take longer than a mass training event, I would point to the importance of lasting learning.

The AC Group shared the following statistic in it’s Fall 2007 Industry Report: 73% of installations fail as defined by the answer to the question posed one year after purchase, “Are you using your EMR for >80% of your patient visits?”

Successful implementations are implementations that stick – where you continue to find value from the product and your vendor’s services – where you can continue practicing medicine with as little disruption as possible.

Finally, much of this interview has focused on service. What do you have to say about the technology the service supports?

The technology is critical, there is no doubt. You’re offering to automate and streamline a complex process. You have to be really good to do that successfully. But technology doesn’t have to be hard from a user perspective, and it doesn’t have to be complex. I challenge our technologists to use all of their considerable skill to bury the complexity from the user. Use the elegance of technology to make the user experience blindingly simple. Then you’ve done something.

At PracticeIT, we believe that technology, when done right, simply fades from view and all that’s left is the streamlined practice of medicine.