EMR Getting Started

More "must haves" in your EMR Contract

Nick Harrington — Thu, 05 Nov 2009 14:20:00 GMT

This is a Getting Started resource contributed by Michael Uretz of The EHR Group.

Michael Uretz, Executive Director
The EHR Group
700 NW Gilman Blvd. Suite E293
Issaquah, WA 98027
Tel: +1 (425) 434-7102

Here's a couple of quick notes from Mike Uretz about things you must consider as part of your EMR vendor contract.

1. Data Schema : You need to know what your data looks like.

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2. Vendor Warranties : Ensure your vendor offers service guarantees.

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Michael Uretz is considered one of the top U.S. authorities on EMR and Health IT Selection and Contract Negotiation. Michael’s specialty is representing healthcare organizations in EMR and Health It Vendor Selection, Contract Negotiation, and Project Implementation.He can be reached at mikeu@ehrgroup.com or direct 425-434-7102. Website: www.ehrgroup.com

Download our Free White Paper:
7 Costly Mistakes Made When Purchasing EMR & Health IT
http://www.ehrgroup.com/special-report.htm

Electronic Health Records Contracts : Software Escrow

Nick Harrington — Wed, 14 Oct 2009 11:07:00 GMT

This is a Getting Started resource contributed by Michael Uretz of The EHR Group.

Michael Uretz, Executive Director
The EHR Group
700 NW Gilman Blvd. Suite E293
Issaquah, WA 98027
Tel: +1 (425) 434-7102

Software Escrow

Mike Uretz talks about the importance of having a Software Escrow Agreement with your EMR provider.

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You might be interested in these other Getting Started articles contributed by Mike Uretz:

Download our Free White Paper:
7 Costly Mistakes Made When Purchasing EMR & Health IT
http://www.ehrgroup.com/special-report.htm

Making your IT Services Provider “Walk the Walk”

Nick Harrington — Fri, 27 Mar 2009 15:10:00 GMT

This is a Getting Started resource contributed by Michael Uretz of The EHR Group.

Michael Uretz, Executive Director
The EHR Group
700 NW Gilman Blvd. Suite E293
Issaquah, WA 98027
Tel: +1 (425) 434-7102

Making your IT Services Provider “Walk the Walk”

Some call them geeks, propeller heads, or computer nerds. Saturday Night Live had Nick Burns, The Computer Guy, who made his way through life abusing and taking advantage of his computer users, mainly because he could. And there have been countless parodies of the non-communicative techie who holds the technical future of an organization in their hands. However, whether you like it or not, at some point you will need to sign a contract with an IT services company or individual to install your software, set up your network and computer hardware, provide ongoing technical support or provide other IT services. This relationship with your IT services provider is becoming increasingly important as more and more technology is being integrated into your practice with no end in sight.

And the question is “who will control the rules of this relationship – you or your IT services provider?” I will tell you that after over 30 years of IT experience as both a provider and purchaser of IT services, it is in your best interest to level the playing field when it comes to contracting with IT service providers. I’m sure you’ve heard all the IT implementation horror stories...

That’s why I wanted to share a couple of tips on how to level the playing field when it comes to contracting with IT services companies. These come from years of negotiating with these firms as well questions that have come up from practice managers and providers attending my workshops and seminars.

How do I make sure my IT services provider lives up to commitments made?

This is why negotiating and structuring protective and all inclusive contracts and agreements is so important when dealing with IT service providers. It's unfortunate that we need these instruments to hold our partners accountable, but you need to be certain about their commitments. And that's why you want to make sure you have very, very strong contracts with these folks.

One of the most important areas to focus on is really the level of service and commitment of service. This is typically spelled out in a Service Level Agreement (SLA). This spells out the Rules of the Road regarding how your IT services provider is going to take care of you. And one of the components of an SLA is the area of issue response and resolution

During the honeymoon period, when IT services providers are trying to sell you their services, sales people are quick to assure you of great support. But can your provider “walk the walk” as well as “talk the talk” once they start your project or if they are providing post implementation support? If you do run into problems, how long will the vendor have to address these problems? What are the penalties if the vendor doesn’t meet stated commitments? Sales people will commit to taking care of you, but unless there are real consequences for the vendor, you might not be the “squeaky wheel” you thought you’d be
Are they going to guarantee that they are going to respond to your phone calls in 1 hours or 24 hours? How long does it take them to actually show up? What are they going to do? How are they going to do it? How are they going to escalate things? What are they willing to guarantee? You want to get these in writing.
But some SLA’s don't go far enough. If they say they are going to come in an hour and they don't come in an hour, or don't call you in an hour, or whatever time period is agreed to, then there have to be financial penalties. Typically these penalties take place in the form of monthly credits. The actual dollar amount of the credit isn’t necessarily as important as the fact that they are now held accountable for not living up to their commitments.

Finally, there might just come a day when you’ve had enough and you want to get out of the deal completely. IT services providers like to put in a termination clause that outlines their rights. But what if it’s just not working out for you? What are your rights? Spell this out in the termination clause. If they don't come up with the goods, if they don't give you good service, well, they should be out. For example if they don’t perform their implementation projects per the project plan you agreed to you should be able to part ways. If they consistently don’t follow the Service Level Agreement for support and it’s affecting your practice you should be able to say “enough”.
And to prepare adequately for the possibility of moving on to a different services provider with the least amount of downtime, you need to make sure that all the work they do for you is documented and spelled out. They have to give you documentation of what they're doing and the processes they’ve put in place. So if you need to basically pull the plug and transition to another company, you don’t have to reinvent the wheel.

How do I prepare for managing my own IT down the line?

I'm actually doing this right now. I'm working with a practice that is large enough to have its own IT staff, but they want to start out with an outside IT service provider with the thought that down the line they might have their own staff.
So what we're doing is making sure that from day one any work that contractor does for us is documented.. Whatever the system architecture is, whatever the processes are; how they do backups, when they do things; what the system looks like; is all documented. At some point in time the practice will hire its own IT person and that individual will step in and say, "OK, how does this work?"
And, fast forwarding, if they have the documentation regarding all the work the IT contractor had been doing for the past one, two, three years, than it's much, much easier to make that transition - and that's very important for you to have. In addition you can request that your present IT Services provider works with whoever is taking over that role for you. You can spell this out in a Transition Services clause. At the end of the day you don’t want to be totally dependent on your IT Services Provider.

So, as you can surmise, to get into a relationship with an IT services company without adequate control of the situation can prove to be a big mistake. The future of your practice can partially rest on how well you integrate this growing flood of technology. Your expertise is taking care of patients, not managing IT. And, some IT services companies can take advantage of this. The tips in this article are just a few tools you can use to fight back and be in a little more control of your IT destiny.

Download our Free White Paper:
7 Costly Mistakes Made When Purchasing EMR & Health IT
http://www.ehrgroup.com/special-report.htm

Geek IT image + T-Shirt available here.

7 Costly Mistakes Made when Purchasing EMR and Health IT

Nick Harrington — Mon, 23 Feb 2009 12:28:00 GMT

Mike Uretz of The EHR Group is the author of an important paper detailing the 7 costly mistakes made when purchasing EMR and Health IT.

The following is an excerpt from the report outlining how to proactively protect yourself should your vendor go out of business or be acquired, or if you make a decision to migrate your data to another system.

Mistake #5 – Not Planning for Worst Case Scenarios

Have you ever thought about what could happen if you purchased an EMR system and your vendor went out of business, changed direction, or dropped adequate support for your product? In my EMR seminars and workshops, this is a concern and worry that comes up time and time again.

How to prepare for worse case scenarios

You have the right to request that your vendor put their software and documentation in escrow for a rainy day should the vendor not be there at some point in the future. With the vendor’s intellectual property at your side, you have a better chance of taking care of problems should the vendor go out of business.

It’s also important that you have access to the vendor’s database schema in case you have to transfer to another vendor. “Database schema” is a technical term that describes the roadmap of how your data looks inside the system. In short, the schema is the formal structure of the database, including the tables, forms, and fields, and their relationship to each other. Not having this schema could prove very costly should your vendor go out of business as you’ll have to pay an IT consulting firm to reconstruct for you.

When negotiating a contract, ask that the database schema, including all associated documentation, be included as an exhibit to the contract. Technically, you own your clinical and billing data, but if you need to transfer it to another system for whatever reason, it can be a very expensive endeavor if you don’t have the “roadmap.”

Finally, make sure that the vendor agrees to help you with a transition to another system should you decide to go this route later on. With this understanding and agreement, you can save considerable time, money, and hassle and assure smooth functioning of your practice should you need to part ways at some point with your vendor.

Click the following link to download the complete report “7 Costly Mistakes Made When Purchasing EMR and Health IT”. (Registration required)

How to Select and Electronic Health Record System (link)

Nick Harrington — Thu, 19 Feb 2009 08:54:00 GMT

A resource contributed by one of our readers, Randy P of UXAlliance about How to Select an Electronic Health Record System that Healthcare Professionals Can Use. This is a white-paper by User Centric (UXAlliance). This is their introduction copied from the above introduction:

In recent years, Electronic Health Records (EHRs) have been promoted by industry and government as a means of improving patient care and controlling costs. However, actual adoption of EHRs has been lower than expected due to general resistance related to implementation costs, security, privacy, and systems integration. Recent studies have shown, however, that many of these adoption barriers pale in comparison to basic usability and productivity concerns. Simply put, healthcare professionals have found many EHRs too difficult to use.

Why has EHR usability remained an issue even as more organizations deploy these systems? To explore this topic, User Centric inspected dozens of publicly available Requests for Proposal and procurement guidelines for EHRs to learn how usability was addressed. This inspection revealed that EHR usability was overlooked or only marginally mentioned in nearly all of the documents. Only three documents discussed usability or user experience in any substantive way. Thus, there was a gap between the need for improved usability in EHRs and a lack of usability criteria in the EHR procurement cycle.

To bridge this gap, User Centric proposes an approach for specifying usability requirements and assessing EHR systems relative to these requirements. The User Centric white paper, "How to Select an Electronic Health Record System the Healthcare Professionals Can Use," identifies a five-step process for specifying and measuring the usability of EHR systems. These steps are intended to help guide selection of an EHR that meets the criteria for high levels of effectiveness, efficiency, and subjective satisfaction among healthcare providers. User Centric believes that EHR systems selected in this manner are more likely to be adopted, meet the needs of their users, and reduce the chance of usability-related abandonment.

Click here to find the download link for this report.

The report is provided in Adobe PDF format. You can download the free Adobe PDF Reader here.

Integrated Community EHR

Nick Harrington — Wed, 03 Sep 2008 05:20:00 GMT

This is a Getting Started resources discussing Community Electronic Health Records.

This discussion between Robert Gleeman and Mark Anderson, CEO of the AC Group, Inc. discussing Integrated Community Exchange or an Integrated Community EHR. This interview is also provided as a written transcription below. Click the arrow to play:

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Robert Gleeman: This is Robert Gleeman at EMR Update. I'm talking today on Casual Friday with Mark Anderson from the AC Group. Welcome again, Mark.

Mark Anderson: Thanks again, Rob, for having me on today.

Robert: Mark, as you recall, last conversation we had you were in a cab going to JFK and we talked about the community EHR, the ECR. And now, you say there is another development that you'd like to talk further on that subject about ICE. What is ICE?

Mark: Oh, we're coming up with another, of course, three‑letter description of what an Integrated Community Exchange would be or an Integrated Community EHR. And when you're talking about IHEs, the Integrated Health Exchange and we talk about EHR.

But now we're saying, with the change in the Stark Law, a lot of times hospitals, MSOs or IPAs are trying to roll our EHRs to multiple physician practices in a community. And many of the EHR vendors really don't meet those requirements.

Robert: What is the goal and what is the problem?

Mark: Well, one of the, the goals is to obviously connect to the community physicians in one community setting so that we can share demographics information about the patient, their insurance information. And then, hopefully share some of the social history, medical history, family history, and then through the CDA requirements be able to share allergies, medications, labs, and other things.

The problem has been that most of the vendors will offer an EMR for the whole community that they can share. but it all has to be set up as one database. And that they can share data because they're in one setting. But most community physicians want their own database. They want to be separate. They don't want everybody getting into all of their records. They'd like to have a separate database but be able to share data through some kind of community hub or community portal.

Robert: And this community hub or interchange, do you see it as a separate server or a separate entity that the different databases would communicate through?

Mark: It depends on the community. And we've come up with five different descriptions of the community. An example would be, well, Level One would be if all of the doctors are employed by the hospital. That would be like a Level One product, a Level One community. And therefore you really don't need to have a separate product because they're all employed;that there's a way of setting that up.

But then you start looking at what we call a Level Five community where there are some employed physicians. There's a whole bunch of community physicians that do not want to have one database. They all want to have separate databases. Then you do have to have some type of extra product that can either be offered by the same EMR vendor. Or sometimes. they're offered by a third‑party neutral vendor that can actually provide the links to tile the separate products together.

Robert: So are you saying that this idea of ICE, an Integrated Community electronic record would actually consist of separate databases that would communicate through a third‑party software product?

Mark: Correct. It could be the same vendor software product. For instance, Noteworthy Medical has a product that allows the community to connect together with separate databases. Nexion has their CHR product that allows the same thing. E‑Clinic Works has their community product that's out there. There are separate products.

There's also vendors, third‑party vendors, that offer products like Axilato Healthvision, Well Logic, Orion Healthcare, that allow multiple EMRs to actually connect in through a community setting. One of the advantages of the community setting though is that doctors that don't have the EMR or the Emergency Room that may not be using it, can still access and view summary information about the patient which makes a great value to them especially if they're not on an EMR or EHR today.

Robert: Now you've mentioned some of the heavy‑hitter names in EHR. Is there anybody actually implementing this or is it still in the planning stages?

Mark: No, if you go back and look at the EHR vendors, I know that, I just got off of the phone with MySys. And they talked about a number of their community settings that they have set up with their MySys Connect product. Nexion has a number of locations with their Community Health Record community product. Two of my clients are actually using the E‑Clinical Works they call their EHRS product which sets up the community. So there are a number of community projects out there that these vendors are using.

Then the third‑party software vendors, there's a few, a number of those that are out there. I happen to be involved in a number of them that Axilato was using. And that Health Vision which was creating these community portals. Probably the most well‑known is the Taconic IPA up in New York that's using Health Vision as their connectivity community portal. And then they're connecting in EMR vendors from Next Gen, All Scripts, E‑Clinical Works and GE Healthcare.

Robert: You know one of the, one of the most frequent problems that we discuss on EMR Update is the doctor who has joined the so‑called community healthcare project through the hospital and now he wants to back out. He wants his data to be separated and given to him so he can have his own EMR, his own set‑up. How does that fit in to what we're talking about with ICE?

Mark: Yeah. An ICE‑type of product, and again that's just a new three‑letter name we came up with, is designed around allowing a physician to basically sell his practice to somebody else, back out of the community network, move someplace else, because they have their own separate database.

Robert: Ah.

Mark: A lot of times it's on a separate, small server that they can all exchange information on. And sometimes what, depending on the, the companies, like I‑Medical allows that with their product where your data can actually be stored locally on your, in your office, on a small server. But you're still accessing all of the information off of the centralized server that can be housed by the hospital, the IP, the MSO.

Or sometimes the actual software vendor will do the housing of the, kind of an ASP offering of the product. But you still have your data backed up in your office. So once of the requirements is that you have to have separate databases that can easily be taken apart if a physician or a physician practice wants to move out of the community.

Robert: How much standardization needs to be done before this type of system can be widely implemented and shared?

Mark: There are a couple parts of the standardization. You have to have a community master patient index for identifying who the patient is. There are some great products out there today that do that. All of the EMR vendors actually have that built in.

So practices can have different numbering systems, but when a patient shows up in my office for the very first time, I can look at my database and say, "This patient has not been here." Then I can look in the community database, find the patient, and have it automatically brought in from an interface so I don't have to ask the patient for all the demographic information and the insurance information.

Then if the patient moves and somebody knows about the move, everybody in the community has that new address automatically updated into their system. Or if the patient's no longer eligible, everybody gets that same update no matter where they are.

But the part I like the best is, having the patient fill out the social history, the medical history, and the family history once and having that go to all the doctors.

That's not quite as standard yet today. But through the CDA standard we are able to exchange clinical data, especially the medications and labs and certain other kinds of things. That's a good standard that's already been established vendors participated with [audio interference].

Robert: Is there still activity in the CCR?

Mark: I think that a lot of the vendors are still saying CCR, but the reality is that we've moved now to the CDA standard which is the HL7 version of CCR.

The problem, again, is always that a lot of the vendors say they can do it which is nice, but we need to see it at live sites. We need to see exchanging data between multiple EHR products. Not just exchanging between the same EHR, but at different practices. You've got to start with that, but I want to see more live sites where we're actually exchanging data.

That's where the ICE type of communities make more sense. They have multiple databases and will have multiple EMR products like we did up at the [indecipherable] with four different EMR vendors.

Robert: How far away are we time‑wise from EHR‑implementations, would you say?

Mark: I think they are being implemented today. Again, there are probably about 50 of these installed and operational. They're not called ICE. They're basically called Integrated Healthe .NETwork or a C Community Health Record.

The problem is that we really needed to define that. Because if it's only one vendor providing EMRs to an employed physician community, that's different from a truly integrated community separate database type of environment.

So we're trying to better define a community setting with multiple community positions, community databases, and trying to call it something. ICE just seemed to be another three‑letter acronym that we could use to help make a difference between the typical 500 doctor owned and employed physician community and a traditional multi‑specialty, multiple practice community that needs separate databases. We needed a new word for that, so we just came up with ICE.

Robert: And ICE again stands for what?

Mark: Integrated Community EHR.

Robert: OK.

Mark: Think of it as an iceberg with a little bit on top and a lot underneath that we have to actually have to make this work.

Robert: What makes it interesting is that we're talking about multiple databases somehow communicating. It seems like we're talking about real concrete standards to get that to work, aren't we?

Mark: Yeah. Again, through a mass community patient index, which are pretty well standard because most of that's driven off the HL7 standard, and the CDA standard for the sharing of clinical data: Those standards are already set for both of of those.

All we have to get now is software vendors that are providing that in live environments. They can start with exchanging just between one EMR, but then again for these community settings where you've got multiple community practices with separate databases, and they may have different requirements.

We need to be able to share data from multiple EMRs, and that's where we are trying to separate those from the traditional community projects that we hear about that are one large multi‑specialty database. Or, in the case of certain communities, one large [inaudible 11:48] where everybody [inaudible 11:50] everything about every single patient.

And then through some kind of security rules, we may be able to protect certain things. The average pediatric practice does not want a competitive pediatric practice looking at their information. We've got to keep it separate. A type of product like ICE, by definition, will help keep those totally separate because they're separate databases.

Robert: Very interesting. Any question that the doctors should be asking? If they are approached with this idea of a community integrated EHR with separated databases, what is the main thing the doctor should ask and what does he need to know?

Mark: I think you start with, "Do I have my own separate database? Because I have a separate tax ID."

Can we share information between the multiple practices that are out there with separate databases?

And then again, if I decide I don't want to be part of the community, can I just leave and take my data with me seamlessly, using the same software product?

And if I decide to leave and I want to use a different software product, can I automatically convert all the data I've entered in about my patient to another product?

Robert: Looking again into the future with ICE.

We're talking to Mark Anderson from the AEC group.

Thank you once again, Mark. Great to have you on casual Friday.

Mark: Thanks again.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX 77316
(c) 281-413-5572
(f) 832-550-2338
email: mra@acgroup.org
web: www.acgroup.org

Slow Adoption Rate of EMR

Nick Harrington — Sat, 23 Aug 2008 02:36:00 GMT

This is a Getting Started resources discussing the Slow Adoption Rate of EMR.

This discussion between Robert Gleeman and Mark Anderson, CEO of the AC Group, Inc. discusses the slow adoption rate of EMR and delves into some of the reasons behind why Doctors are not using EMR as actively as they could. This interview is also provided as a written transcription below. Click the arrow to play:

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Robert Gleeman: This is Bob Gleeman with Mark Anderson from the AC group on Casual Friday. Mark, we had talked a little bit about why more people haven't adopted EMR. You had a study that you mentioned that said something like 4% of doctors are using EMR?

Mark: Correct, there was a study that just came out of the "New England Journal of Medicine" that actually went out and surveyed a number of physicians to find out what their EMR usage was.

They determined that about 17% of the doctors have purchased an EMR but only 4% of them were actually using the EMR in the full capacity, for actually recording, review systems, HPI, their evaluation, and actually generating a chart note out of it. 13% were using parts of the product.

After 20 years, we only got 4% of the doctors using an EMR, there's a big question out there about how valuable these systems are.

Robert: Well first of all, do you agree with that figure, does that jive with what you've been seeing in the field as a consultant?

Mark: Actually it does, we thought the number was closer to 7% of the doctors are actually using the full EMR. We do a lot of surveys and talk to a lot of reference sites when we're looking for vendors. A lot of references sites said: yes we had the EMR, we really like it, and our doctors are still dictating.

They classified that as a full EMR implementation. Which is OK, but the goal of all of this is to have a full EMR where the EMR generates the note, does the E &M coding. We're actually creating discrete data out of everything. We're finding reality is a lot of doctors not using all of that and not using the full capabilities of this EMRs. Now the question why are they not doing it?

Robert: Why do you think that is?

Mark: I think when you sit down with the physicians, we finished a new survey that shows that the average doctor spends 38 seconds charting on a returned patient. About two minutes on a new patient. The question always is, can the EMR product allow the physician to chart the complete note in 38 seconds?

The answer traditionally is "no." It's going to take a lot longer than that. The doctor are saying, if it takes me any longer, I don't want to use it. That 38 seconds goes by pretty fast when you're trying to click 500 different buttons on those EMR products today.

Robert: Yes, yes. Now how about as far as the quality of the documentation. I've had doctors whose medical records about me were completely worthless. They didn't know what I was taking, what was wrong with me. Barely remembered ever seeing me and the notes did not help.

I know was not a one to one comparison, but what do you think is the solution to this dilemma? What is the cause and what is the solution?

Mark: I think part of the cause still is that we have not tied financial incentives back to using the EMRs. I know Medicare CMS has a program where they're providing a little incentive for doctors using prescribing.

There's no incentive for doing all of the charting yet. I think if we can get a system... Like an EMR light product, where the doctor can at least know with what's wrong with you. They have your problem list, they have your diagnostic codes, your allergies, your lab results.

In other words, all of that important stuff about you in the chart, and they can review that. Then maybe still dictate or hand write out their note, or place all their orders on‑line. We're going to get 60% to 70% of all the business benefits that a physician needs, with a much simpler system to use today.

Therefore, allow the doctor to not become the data entry clerk for everything, maybe start walking before you run. Until someone mandates full EMRs or starts paying the Doctors for the full EMRs, then we got to come up with something that's going to work for them. Again, CMS has it, but they're only paying for e‑prescribing right now, not for the full EMR.

Robert: What can we do at EMRUpdate to spread the word? I know what we're doing with these interviews helps a lot of people and they're discussed for years afterwards. Is there anything else EMR Update can do to further the cause of EMR?

Mark: I think we have to get doctors and the vendors really communicating on the same level. Doctors have got to really tell people what do they really want today, versus what they may want some time in the future.

The EMR vendors have to find a way to start showing them how they can use the product today. Today may be as I need to do the whole review of systems, the HPI and everything else. Today I'd like to have information about the patient, review that information, and then have the dictated report, or the handwritten report available to me electronically. I don't have to put all of that data in.

That's got to be an option out there, and literally rarely do I ever see any vendors showing that. They spend 20 minutes show a physician can spend the next 10 minutes charting of all this information, which is nice to have. Do the doctors really want to spend the time charting all that, do they need all of that data as discrete data? Are they getting paid to do all that data entry work? Those are questions [inaudible 6:03].

Robert: So you really see that as the major problem that the entry of the data is being done by the doctor.

Mark: Correct.

Robert: Would it be better if the doctor had a person like a scribe to work with them and enter into the EMR?

Mark: Yes, if the doctor had a scribe, then they could spend more time one on one with the patient. People can enter the information in. The difference is that we're entering a lot of data in there, primarily so we can make sure that we have the right E&M code put together.

But some [inaudible 6:44] review of systems, it's kind of like everything is normal, except I have a cough, so we're going to listen to the heart.

Right now we spend maybe 30, 40, 50 seconds charting all the stuff about review of system, where it could be done in about five seconds. You can't go and say that everything is normal unless you actually looked at everything.

Again these EMRs are designed to record thousands of data elements, which is nice but most of the doctors are saying: I don't need all 12,000 of those data elements recorded. Because I don't used any of that afterwards. I'm not getting paid to do all that data entry work.

So if we can get people using I think EMR lights today. Then in 2009, 2010, 2012 progress more into full EMR capability. We got to move the number of doctors that are buying these systems from 17%, which is the estimate today, to 40, 50, 60% relatively quick. If we're going to have full EMR adoption by 2012 or 2014, we're not getting anywhere if we only 4% using it today and 17% that is bought.

Let's come up with a new model that really takes care of 80% of what the doctors need today. A product then that could meet those other 20% of the requirements sometime in the future. We all agree we need to have all this information, but right now it's not working because the doctors are not using it.

Robert: You say they're not using it because they are the ones burdened with the entry of the data primarily.

Mark: Well, there's a couple things that always come up. One is it's too costly, that's why I didn't purchase it. But all of the references we called that are using these vendors' products come back and say: Well yes, we liked the product but we realized the full charting took too long, so we're not using that anymore.

The interesting part is when you talk to the vendors they all say: Oh, all of our clients are using the product or 90% of our clients are fully using the product. If that was true then why are we only at 4%, based on "The New England Journal of Medicine" that are actually using it?

The reference checks we do, we find only about 7% of the total doctors are really using these systems. Especially during that first year, it takes a long time to get your templates built and do all these kind of things.

I think we need to step back now and yes, I agree we need to have the C chit stuff to determine what we're going to need in the future. But can we buy a very strong maybe C chit application that we know is going to meet the requirements of the future? Then use parts of that, in the beginning, to get physician adoption.

Let's don't give them everything. You know, make them use everything in the beginning; let's have them use certain things. Incremental approach to the EMR I think works.

Robert: The incremental approach you have mentioned before. I think this is appealing to a lot of doctors, to start small and work your way up to make a gradual transition. As medicine always says: do things gradually, don't shock the system.

As we talk in the EMR Update, this is one of the things that comes up quite often. As you know we are primarily pro EMR, but we have a few people that are very resistant to EMR. They claim they are pro doctor and they resist.

Mark: Right.

Robert: Do you think that these three or four people that we have, very vocal on EMR Update, have any influence at all on the adoption rates of EMR?

Mark: Well, I think that they are very vocal, like you say, and things. But I agree with them a lot of times, because is this really benefiting the physician themselves? We have to go back to this. This whole EMR is about the doctors using it are they getting the benefits out of it?

Most of the benefits people talk about are going to benefit the insurance companies, it may benefit the patients. In theory it's going to improve quality. But for this specific physician, is this EMR that's going to take longer for me to use, really going to benefit me enough.

I think they do, if you start with an incremental approach. Get messaging. Maybe have orders going through. But if you're going to sit there and spend five minutes recording review of systems, HPI, your full evaluation and you never use any of that data later on, does it really benefit the physician?

Or are we all doing all this data recording just so we can get the correct ENM coding, which is a financial reimbursement system. Are we really using all this data for any purpose except to just recording for some day we may need it.

I agree, orders, problem lists, basically the data that's in the CCR and now the CDA format is the biggest value. That's why I agree with a lot of the government agencies that are looking at: let's come up with a minimum data set of information that everybody can share. Why don't we just start with that?

Why don't we just start with a minimum data set that the government has set and record all of that information? But do we really need the other 98% of the data that we need to record today? We'll need it sometime in the future, but we need to get that implementation rates got to go from 17% to 50% in a short amount of time, if we're ever going to get to a full adoption rate.

At the rate we're going right now, I think we've, what, increased what 2% in the last three years? We're never going to get there growing at that rate of increase. People are selling, but not necessarily using it a lot.

Robert: One of the topics that this seems to relate to is granularity versus text. In other words, if you take the time to check off many different points of data and increase what they call granularity, then you can use this data later and call it back. Is this what is lengthening the data entry more so than a text note?

Mark: Yes, the text note, again a text note you can dictate a lot quicker than clicking all the buttons. Clicking all the buttons gives all this granule information. The question is what is anybody doing with all of this granule information?

Is anybody actually using that to determine anything? I think it's great to have a database with all that in, it but if you're never going to use it, what's the purpose?

Robert: Well Mark I think you've stimulated some more heated discussion that will occur around this talk so I thank you very much for being with us again on Casual Friday. Mark Anderson, AC Group, thanks again, Mark.

Mark: Thank you, bye, bye.

Robert: Bye, bye.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Insider Tips for Getting Quality EMR Vendor Support

Nick Harrington — Tue, 19 Aug 2008 00:31:00 GMT

by Michael Uretz, Executive Director EHR Group

As I thought about my experience over the past few years negotiating contracts with Electronic Health Records and Electronic Medical Records vendors, I kept coming back to one of the top questions posed by frustrated providers and administrators attending my seminars and workshops... "How can we guarantee we'll get timely vendor support when we need it?" For some reason, Murphy's Law ("Anything that can go wrong, will go wrong"), seems to always kick in after the system is installed, the final payment is tendered, and the practice is now dependent on the new technology. After all, you're paying a substantial percentage of your license fee every year for your support and maintenance "rights". But still, in most cases, the onus is on you to protect your own interests. I have infrequently run across a vendor that voluntarily offers to penalize themselves for poor support or that guarantees and commits to exactly how you will be taken care of. You need to become the "squeaky wheel" when you need support and a "squeaky wheel" gets better traction if you have contractual "teeth" backing you up. Thus, the concept of support clauses in your contracts or separate Service Level Agreements (SLA's)...

These agreements outline various areas of vendor accountability in which the vendor is willing to make a commitment to service and support with associated penalties. I've worked with IT contracts for almost 30 years and for some reason many EHR and EMR vendor contracts have had very "lightweight" or weak contractual clauses when it comes to customer support assurances and guarantees. Some important areas to be aware of include the following.

Hours of support.

Don't just accept such terms as support during "standard business hours". You need to have a specified range of hours. And make sure the hours are satisfactory based on local time. I've seen support clauses where an East Coast Vendor specifies 8-6 EST and the client is on the West coast. That would put the ending of a normal support day at 3pm PST. Remember, any issues that are resolved outside of normal business hours typically have an additional charge.

Problem Escalation

Whether it be your phone company or bank, have you ever gotten frustrated by the lack of knowledge or problem resolution by the immediate support person, and have asked to speak to the "manager". This is what I'm talking about. In the case of your EHR contract make sure it's the levels of escalation are specified ahead of time. These are your rights. This can also include asking that the vendor's support person come on site if the issue can't be resolved by the normal means in a reasonable timeframe.

Response and Resolution Times

How long does it take a vendor to respond to you when you have a problem? How long will it take to actually fix the problem? If your system is completely down or if this is an issue that affects patient care, will you be expected to wait 24 hours or will you get taken care of immediately. Be aware that different functions of the system might warrant different response times. For example, clinical documentation problems might need immediate attention, while a problem with a patient education module might not be as urgent. Get a commitment as to how long the vendor will guarantee a response to you. This includes associated financial penalties if they fail to meet their commitments. That's a powerful "squeaky wheel"!

Upgrading to New Versions

What about new releases of your software as time goes on? By paying your support and maintenance fee you certainly have the right to receive new releases free of charge. But, I've seen contracts where a vendor has the right to expect you to upgrade in a short timeframe or support will be reduced or even dropped until you are compliant with the new system. From a vendor's perspective, this is great because they would only need to support the newest version. However, you might not want to install the newest version right away, as the time to test and install a new version is not trivial and can possibly impact your internal resources and the operation of your practice. Also, many times, new releases can have some initial kinks. You should always expect that, at the very least, a vendor will support the previous version(s) for a reasonable amount of time.

There are more items to address in an acceptable Support clause or Service level Agreement, but hopefully the above tips will help get you thinking and pave the way to greater comfort in this area. Remember, you can choose the right vendor and get a great deal, but the key to your ultimate success is in holding your vendor accountable for the service and support you expect and deserve.

For more information about the subjects discussed here you can contact Michael Uretz by email mikeu@ehrgroup.com or 1-888 5 GET EHR

See our other Getting Started resources here.

Contact information for Mike:

Michael Uretz, Executive Director
The EHR Group
700 NW Gilman Blvd. Suite E293
Issaquah, WA 98027
Tel: +1 (425) 434-7103

E-mail: sales@ehrgroup.com
Website: www.ehrgroup.com

The Community EHR of the Future

Nick Harrington — Fri, 15 Aug 2008 11:45:00 GMT

This is a Getting Started resources discussing the The Community EHR of the Future.

The speakers are Mark Anderson CEO, AC Group, Inc. and our roving reporter Robert "Bob" Gleeman.
Click the play button below to play this interview.

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These are my brief notes from Mark's interview in a Yellow Cab travelling from downtown Manhatten to JFK.

Challenges is that the patient in the hospital -- Doc has to use the Hospital System which he is completely unfamiliar with. CPOE Products. Every Hospital that the Doctor goes to, he has to learn a new product - none are similar to their office EMR.

What is the Community Health Record? A new approach. Have a system where the Doc uses their usual EMR system but when they go to the Hospotal their using the same system. The Doctor doesn't have to use different systems -- all the data goes into the same system. Create one system for the Physician and easier for the ER technician, the Nurse, the Health Worker using the same data.

Timescales? Working with a think-group asking how we can roll this out to small communities. A place where they're looking to trial this is a hospital, 32 Docs, which doesn't have an existing system. Try to establish a EHR for the whole community. A Patient centric EMR for the whole community.

Are there vendors already looking at doing this? There are vendors that talk about it. There's a company called EPIC but they're not really scaleable down to the smaller hospital.

In the past we've talked about the Hospital offering the Doctor the EMR software. Is this along the same lines? Yes. The hospitals are offering a stand-alone EMR product to their employed physicians and community physicians. This goes to the next level where instead of offering an Inpatient and an Ambulatory EMR and offering one community EHR.

Who pays? Today the person that pays is the hospital -- they pick up 85% of the costs. Why? For every 20,000 ER visits we can save 1/2 million dollars per year. If the ER doctor gets all the information in a familar format, this saves the uncompensated care in the Emergency Room. A great fit.

Reimbursement. EMRupdate has quite a few posts about Medicare Reimbursement. Will this have an impact on Medicare? It is all about improvement in the Health of the Patient.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Add-ons for EHR and EMR

Nick Harrington — Thu, 31 Jul 2008 06:00:00 GMT

This is a Getting Started resources discussing the Add-ons for EHRs and EMRs; what Add-ons do you need, should you be paying for them and do you need every add-on? What should we know about Add-ons?

The speakers are Mark Anderson CEO, AC Group, Inc. and our roving reporter Robert "Bob" Gleeman.
Click the play button below to play this interview.

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These are my notes from the interview:

There are a number of additional things you might want to add on. For example, have a scanner to scan in the Insurance Card. That can be really useful.
Some of the typical EMR Add-ons are:
Clinical knoweldege base
Zinks knowledge base.
Health & Maintenance alerts.
Clinical Protocols and National Requirements; Doctor doesn't need to research and enter all that data. It's already uploaded
Probably 30 categories of add-ons.
Would the vendor raise with the Doctor?
Talk to the Vendor -- each Vendor will bring up certain things. e-Prescribing. raise a drug-to-drug database and it's worth asking what is the source for that. Who is the company -- which database. Did they build or use from a Nationaly renowned company.
What shoujld the doc have in mind to ask about an add-on.
When the Vendor raises an Add-on, the Doctor has to ask "Is this part of the Product, or is this an add-on with an additional cost?"
A lot of vendors are charging maybe $25.00 a month for access to SureScripts or Rx Hubs. They may not mention that, but it is an added costs.
Some of the products can provide for the scanning of documents; is it their product or third-party -- and if third-party what is the cost for that.
InstantMedicalHistory -- an add-on that probably 30 of the top vendors have today which allows the patient to go on-line using a computeror through a kiosk to answer the Review of Systems, HPI, Social 7 family Hiostory -- but allows the patient to enter all of this data. Sometimes comes in as discrete data. Allows patient to be part of the data-entry form. Why not give the patient the Social Medical History and how you feel today.
Direct Link to Medical Test -- either a one-way of bi-directional interface. Any time you need data from an external source. I'm want those results back to the EMR. It could be a free or add-on costs. But the biggest issue is that I want the Lab Test to go to the correct Lab Company. Remember the HealthCare plans dictate where those labs can go. I want them to come back as discrete data. And is that a one-way or a two-way, bidirectional. What's the additional cost to get that data in.
Any add-on product should be part of the cost proposal. And you need to include within your contract how they are going to work today and in the future. The contract must state who will provide the two-way interface and if it doesn't work who is going to get it fixed. Is the Doctor going to call the Lab company or will the EMR vendor get it fixed.
So the EMR Vendor will support the EMR product, but you buy all these Add-ons and the EMR Vendor can say "not my problem", but you bought the Add-on from them. That's where the Contract needs to be looked at.
You need some experience as to What works with what. Unless you know and the vendor can prove that they've integrated a specific add-on, then you want pretty specific language in your contract to make sure they're going to follow through.
Would you recommend that a Doctor visit a reference site which has that EHR and that Add-On? We're always talking about the EMR product, we're not asking about the complete solution, if you like "The Digital Medical Office of the Future".
When does your Drug database get updated, it it online. Series of additional questions that need to be asked. Very rare today that you see an EMR being sold without Add-Ons because the EMR vendor will just not have that knowledge or expertise like the ones mentioned above.
One example; I want to have a card-scan so that when I scan in the Driving License, it automatically places the picture into the EMR or PM system but also takes off the address, date of birth, sex of the patient. Have they actually done this, not that they could build an interface in the future, because a lot of times the future never actually gets here.

Is that a real product -- MediCard allows the drivers licenses to be scanned in and to pull off whatever information is on the Driving License.
IntelliFinger - TEPR conference award. Also do the credit card to pay for your co-pay. So the patient arrives and scans their finger themself with the biometric device and they're already checked into for their appointment - including a request for payment collection now or later. All these things can be done in a kiosk like format.
There are some great little products out there that are really nice add-ons that help improve the customer-satisfaction and the efficiency of a practice.

... and Mickey says hello to everybody.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Side by Side Comparison of EMR Costs and Price Matrix

Nick Harrington — Wed, 16 Jul 2008 12:11:00 GMT

This is a Getting Started resources discussing the Side-by-Side Comparison of EMR Costs; how to really compare EMR pricing from different vendors.

We're running this interview in parallel with our call to EMR vendors to participate with our Price Comparison Matrix - we're trying to give Doctors researching EMR solutions a good starting point to compare the price of different EMR products. We reason that everyone saves time and effort if they know what an EMR Vendor's ballpark prices are. This allows the Doctor to select EMR vendors that are likely to feature on their investigation list.

Price Comparison Matrix (Excel template)

Download this Vendor Price Matrix template; fill in pricing for 1, 2 and 5 doctors; and send it back to Nick or contact Robert for any assistance adding your content; Help us build and maintain a comprehensive pricing resource for Doctors who visit this site.

You can get a sneak preview of the (draft, subject to change, didn't say it was finished) Price Comparison Matrix here. Each Vendor's Product Price includes a Blog Post entry detailing additional notes and information about that line's items. The Price Comparison Matrix can be used to compare on-screen prices from any checked price-line. A useful tool for getting a good feel and ballpark for an EMR Vendors prices. He's a demo snapshot:

On with the interview! The speakers are Mark Anderson CEO, AC Group, Inc. and our roving reporter Robert "Bob" Gleeman.
Click the play button below to play this interview.

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These are my notes from the interview:

All EMR Vendors have different pricing structures & methodologies.
Pricing can be different; by Physician, by part time Physician; some include or exclude third-party software (or not even tell you that you need that component).
How widespread are prices across EMR vendors? Working with a 3-doctor practice in Georgia, two quotations came within $1,000 of each other. However when adding support, implementation, training, over a 3 year period, there was a $60k difference per physician.
You have to try and get down to an apples-to-apples comparison.
Get everything you think you need included on your quotations and then start negotiating.
Are there some Price landmark features; such as bi-directional Lap Reports? There are major differences in interface costs with different philosophies; some hospitals may charge $10-$15k, some vendors only charge a $1k.
EMR Vendors might include things such as Personal Health Record, CPT or IC9 Codes, connection to AllScripts or Rx might be included. But if you don't need these things you're paying for things you don't need.
Document Imaging can be another big difference. With some vendors this is a completely separate third-party product not included in their quotation.
Some EMR Vendors may include or exclude things -- and sometimes your EMR salesman doesn't even know what's included.
The SQL relational database can also be anoother big issue; some vendors might only require the low-cost MySQL and we've seen some Vendors asking for an unlimited SQL Server License at $6,300.
emrupdate.com are providing a Price Matrix to give a good starting position on EMR prices.
The Doctor has to know exactly what is included in the core software price. List all the options and understand what these are. Let the Doctors check-off what they want and what is not needed.
GET A CONTRACT. DO NOT BUY an EMR without one. This is really is a case of buyer-beware. You should be changing the contract and/or adding clauses to guarantee your on-going support.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Who should enter the data (into the EHR)

Nick Harrington — Fri, 04 Jul 2008 08:48:00 GMT

This is a Getting Started resources discussing Who should enter the data into the EHR. The speakers are Mark Anderson (with the suntan) CEO, AC Group, Inc. and our Robert Gleeman (without tan). Click the play button below to play this interview.

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I noted the following points from the discussion which might give you a feel for what the discussion gets into:

With EHR we're able to move some work to the patient, the MA or the nurse. Patient can enter their own data -- previously they would usually do this on a clipboard. These days they do this on the web, or use a kiosk like a tablet machine, or bubble-sheet (OMR).
Some are using web-based Insant Medical History, almost an HPI.
The advantage of using a portal or kiosk web-based application is that new questions can be asked depending upon how some questions are answered.
Some are allowing the nurse to do RoS and HPI. When Doctor walks in a lot of data is already ready. This can cut out about 60% of the data-entry. Setup a division of labor in the recording of patient data while still keeping your existing processes. Doctor should be reviewing the data and letting someone else do the majority of the data-entry.
This works really well with templates - and they need protocols established. The adoption of EHR really does touch everyone in the clinic. The Doctors that are doing all the data-entry work are sometimes giving up if they're being asked to do too much. The successful practices have moved a lot of the work down to the MA or the nurse.
Here at emrupdate.com we have a lot of discussion about what equipment or techniques the Doctor uses in adding their part of the data. We've talked about a tablet and pen-based data-entry.
It's really down to how they want to interact with the patient.
Goal has to be that we can collect the data the Doc needs (by the patient or the nurse). Doctors can then record just the data that they require; only the data that they can enter.

(stage-left a cleaning operative malfunctions)
The Tablet as the state of the art. Do you see people leaning towards the tablet? Most are using a desktop or notebook. Most practices are not entering data in the consultation but actually back in the office. Going forward you will see a lot more tablet use.
Do you see a reduction coming in the price of tablets? You always see hardware going down in price; not much reduction in tablets, but this will eventually happen.
What is the nurse going to use? And what happens when they drop it. Do you have a number of spares available in the office. The device you use to enter the data does make a big difference. In a Doctor office last week I saw a PC mounted on the wall, a monitor on a swivel arm with a printer combined into the setup. The Doctor could print the patient chart or educational material right there in the consultation.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Does CCHIT really matter for a Specialty Practice?

Nick Harrington — Thu, 26 Jun 2008 11:35:00 GMT

This is a Getting Started resources discussing the relevance of CCHIT to a Specialty Practice today and in the future. The speakers are Mark Anderson (left in baseball-cap) CEO, AC Group, Inc. and our Robert Gleeman (sporting his new weekend look). Click the play button below to play this interview.

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I noted the following points from the discussion which might give you a feel for what the discussion gets into:

Mark Anderson describes (current) CCHIT as a general foundation or a minimum standard for what should be in an EMR. CCHIT doesn't yet get into the specifics that a speciality practice does on a day-to-day basis.
CCHIT have acknowledged that they need to start looking at specialities and have already identified the following Specialties: Child Health, Behavior Health, Personal Health Records, Cardiology and OBGYN.
CCHIT will start to identift the minimum requirments for these Specialities. Mark states that its good that a there will be a mimumum standard but will the Doctors pay that increased price for that CCHIT certified specialty product.
Robert asked how many CCHIT certs in 2008. Mark Anderson answered 45-50 for 2007. 18 in 2008. With interoperability built into the 2008 standard, maybe that answers why the reduced numbers planning certification.
Robert credits Dr. Al Borges as the "world leader" of the anti-CCHIT movement. Does Mark Anderson agree with Al? Lot of Doctors don't need CCHIT today -- but what about 2011, 2012? (This is the second mention for Al Borges MD in our Getting Started resources!)
What vision or forecast can Mark Anderson give for CCHIT in the next 5 years? Vendors are now adopting CCHIT -- not because their customers are requesting it -- because they are losing sales if they don't have it.
Mark touches on vendor demos - adding that he sees some 100-150 a year and many are not great.
Price cannot be the only factor. If the hospital is offering a product which doesn't meet your way of work, it may be better to walk-away and start with a lite-EMR and build up to an EHR over time.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Company Viability

Nick Harrington — Tue, 03 Jun 2008 14:17:00 GMT

Today's Casual Friday discussion is talking about Company Viability.

Will the company and the product survive?
For how long should you need a product to be around?
Is one of our regulars Al Borges, MD right to check company Stock Prices?
How strong is the company? But what about Misys? Big Company?

Thanks to Mark Anderson and Robert Gleeman for a excellent thought provoking discussion.

(Please visit the site to view this media)

Folks -- "The Hawain look". I'm just about keeping up with the last minute wardrobe changes; unable to find a suitable summer shirt I had to fall back on the 10-gallon Texas Hat*. As always I'm in trepidation at what next I have to introduce.

* Canadian; Calgary Convention & Visitor bureau actually!

Nick

How to conduct EMR Vendor Demos

Nick Harrington — Fri, 30 May 2008 06:18:00 GMT

We're unable to brush over the delay in posting this interview as we're looking at a tanned Mark Anderson fresh from the TEPR conference which completed last week May 22, 2008 in Fort Lauderdale, FL. An upgrade delayed our concentration on content.

The subject for today's Casual Friday discussion is How to conduct a vendor demo.

We're hoping for some feedback from any EMR Vendor sales representatives about the issues they have with Physician demonstrations. Be of interest to get their perspective.

Click the Play button below to watch our discussion.

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What tips can Mark Anderson offer.

Talk to the vendors -- they always want to present what they're used to presenting.
Mark recommends that the Doctors create some kind of documentation script around their workflow and have each of the vendors present that using the same workflow methodology

The sound of an in-bound Skype Chat Bubble at 1m 25s ... is probably me calling Bob. Oops.
Just looking for an EMR? Start with the Patient Check-in. How does the nurse know which patient to bring back to the office, then how the nurses would enter in vital signs, present illness, etc.
This also depends on the Physician Specialty. If orthodpedic, you would do x-rays first before having the patient back to the office.
Propose that you use some Sample Patients? Look at your types of workflow then pick a few patients. An existing Patient on their 2nd or 3rd repeat visit, and a New Patient and one with multiple complications.
Process is the same across all the demonstrations -- That is the Check-in / Check-out process should be the same. Have each vendor demonstrate that.
It is then easier for the practice to do side-by-side comparison between products if using the same scripted workflow.
Often a sales person may not be trained to do that sort of demonstration or they say "It doesn't help us to show how great our product is, if we follow your type of demo, because our product does more".
How many demos? One for each of their top-five? For PM and EMR. You may do separate demonstrations for each.
Get down to the top #2. Come back for a second or third demo with the same product.
Like watching a movie. You see different things the second or third time you watch the film.
How long should the demo be? Webcast should be 45 + questions. If the vendor is on site. 1 hour for demo, 1 hour on PM, 1 hour on EMR and 1/2 hour on viability and implementation.
What advice can offer the EMR vendor salesman? Know who your audience is. Know the size of the practice, know the Doctors Workflow. Does the product meet the physicians requirements, not that your is the best product. This is not about functionality or bells and whitles. The physician should have done all basic check before they get the vendor in for a serious demonstration.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.