Picking the right software is like selecting a mate. First, you look out. Next, you check out. Then, you make the move. Sometimes, you live together happily ever after.
For healthcare providers, this process is more complicated since software selection is not exactly a doctor’s area of expertise. The dizzying array of choices in electronic medical records (EMR) solutions makes it all the more confusing.
“Connecticut is split between Allscripts in the north and Epic in the south, with other companies like eClinicalWorks, Sage and NextGen capturing the rest of the market,” said healthcare IT consultant Alexis Cort, CEO of Hamden-based Clinical Insights LLC.
EMR software, which can range from free to over $800,000, promises to do just about everything, expect cook the doctor’s dinner and pick up patients’ laundry.
Some, like GE Healthcare’s Centricity Advance, deliver a web-based Saas model solution, integrating both practice management and EMR systems, accessible by providers and patients.
Epic’s applications are built on a single database that supports patient care by working together with hospitals, clinics, and physician offices. The software speaks multiple languages to enable global healthcare providers to work as a team.
Allscripts — the market leader — has an open architecture platform that facilitates native integration with third-party electronic health records and other systems to enable an exchange of actionable patient data across disparate systems.
NLP International offers a natural-language software, which can extract and encode clinical information from EMR.
Some, like chronic disease management-focused eClinicalWorks, are super-specialized. By contrast, NextGen caters to almost any need, providing a single solution for connecting inpatient, ambulatory, and patient portal systems.
And then doctors must wade through an alphabet soup of quality standards: NCQA, PQRI, NQF, etc.
Equally important is to know what one wants from IT investments.
The main return on investment is lower costs associated with decreased manual labor. Increased patient safety due to fewer errors is next. Better disease management and higher operational efficiency through integration and optimization are key outcomes.
The American Recovery and Reinvestment Act, passed in February of 2009, is a driving factor for physicians to computerize. The $19.2 billion Health Information Technology for Economic and Clinical Health Care Act, provides federal incentives to qualifying providers who show certain benefits from EMR.
Starting in January of this year, providers who are ‘meaningful use’ certified will be eligible for incentives up to $44,000 paid over a five-year period. The application process will begin in April and requires a practice to have used a certified system as a significant part of its business for a 90-day period.
Medicine is what 70-year-old Gary R. Wanerka, founding partner of Branford Pediatrics and Allergy, has known and excelled at for much of his life.
Three years ago, his practice, consisting of 11 doctors and 12,000 patients, embraced IT across various administrative functions.
“We made a premature decision in selecting our provider,” said Dr. Wanerka, whose office is now entirely computerized.
He picked NextGen, which has over 2,500 clients and 50,000 individual users nationwide. In Connecticut, NextGen has 31, including the University of Connecticut (UConn) Health Center.
“Unfortunately, their sales people weren’t forthright and the cost was far more than indicated to us; we’ve spent around $700,000 so far. Nobody tells you about the number of hours required to train people. The software is not user-friendly to pediatric practice,” he said. “Plus after we signed the contract, the economy went into a recession and that made everything more difficult.”
Adding to his woes, four months ago, he installed EMR software. “We went with NextGen because we already had their practice management software. It’s been wrenchingly difficult. We see fewer patients each day and our income is falling,” he said.
The practice is associated with the Yale-New Haven Hospital healthcare system, which does not subsidize IT costs incurred by physicians at private practices nor provide free IT support, Wanerka said.
Kristy DelMuto, a NextGen spokeswoman, said: “We’ll take a direct look at his account to identify where we can help. We’re disappointed when any of our users have a bad perception of our company.”
At his wit’s end, Wanerka eventually hired IT consultant Alexis Cort of Clinical Insights to help clean up the mess. “We were so naïve; we didn’t even realize that we needed an IT expert at our end,” he said.
However physicians affiliated to UConn have had a smoother experience with Next Gen, given the guidance they’ve received from the hospital.
“We chose NextGen for our physician practices because it’s one of the top EMRs available, has sophisticated decision support and alerts, is intuitive and user-friendly and offers customized templates for both our primary and specialty practices,” said Sandra Armstrong, CIO at UConn Health Center in Farmington.
“We’re eliminating 100 percent of dictation costs in each of the four offices as physicians move to electronic templates and notes. But the numbers won’t look impressive until we have more offices implemented,” she said.
Over the last seven years, Hartford Hospital has invested more than $40 million to implement EMR systems in the hospital, homecare services, and at its affiliated primary care physicians offices.
“Next year, we expect to implement EMR systems for our behavioral health and rehabilitative services as well,” said Stephan O’Neill, vice president of Information Services at Hartford Hospital.
The organization picked Allscripts — among the most expensive healthcare software nationwide — for its physician offices. Allscripts has more than 1,700 clients in Connecticut including St. Raphael Healthcare System, St. Francis Hospital and Medical Center, and St. Mary’s Hospital.
Dr. Varalakshmi Venkatachalam, partner at a two-doctor internal medicine practice in West Hartford, is poised to convert to EMR shortly.
She chose Allscripts because it’s used by St. Francis, where she is affiliated. Plus she requires a platform that integrates patient information across multiple external providers.
The driving factor was that St. Francis subsidized the lion’s share of the cost, and is guiding her through the process.
“My upfront cost is $2,500 per physician plus a recurring monthly fee of around $500 per user,” she said.
She hopes that once the EMR software is installed, she’ll be able to see more patients and spend less time doing paperwork.
Around four years ago, Venkatachalam realized that in order to effectively run a medical practice, a doctor had to understand the corporate side. This led her to obtain an MBA in healthcare management from the University of Massachusetts (Amherst).
“My goal is to provide better patient care by managing my business better,” she said.
