Commercial EMR

[KingofTown]

I'm in a 7 doc primary care internal medicine private practice. We are at the point where even the ludites in the group see the advantage of migrating to an EMR (despite the short term pain and $$$$). Unlike the solo programmers making their own EMR we need a commercial solution. Anybody have any experience in this area. Success and horror stories appreciated.

KoT

[mel]

We had tried to start a thread when we launched but traffic was still quite low, 'll keep an eye out, and please keep us posted on your research

[Scroggie]

Look into Springcharts (www.springcharts.com). They are going to release a new version soon.
Its cross platform (Mac, PC Linux, whatever) and seems to be easy to configure/maintain. A good friend of mine uses it in his FP/IM office and raves about it.

Also they'll let you download a free copy. Talk to Ms Merck (like the manual) she was helpful.

[Kursk]

I'm in a 7 doc primary care internal medicine private practice. We are at the point where even the ludites in the group see the advantage of migrating to an EMR (despite the short term pain and $$$$).
KoT
Fill us in on what you want the EMR to do for you - it may help focus your search and direct you to the correct market segment. Are you expecting financial improvement (the dreaded ROI argument), office efficiency (chart management, filing, scanning, FTE arguments), document management, patient communication, prescription writing? Do you want to dictate, type, check box, do VR, handwriting recognition? Are you trying to be paperless (and why)?Are you going to replace your practice management system at the same time? What arguments are you using to convince the Ludites?

[Scroggie]

There are wide varieties in cost and quality. For the medium market (5-15K) you could also look at Praxis (kinda of cult/EMR/way of life); e-clinical works, e-Meds, Springcharts, SOAPware (a little cheaper) et al.
At the old POL, the CEO's of SOAPware (Randall Oates, MD) and E-meds (David Winn, MD) seemed willing to talk/help educate you on their product.
Try to find similar size practices using the system that you can visit and see it in action, not just watch a salesman demo it.

You may want to look at the yahoo group, digitaldocs http://health.groups.yahoo.com/group/digitaldocs/

[Kursk]

Again, knowing why you want an EMR is key. As for ROI here is an interesting thread:
http://www.emrupdate.com/forum/topic.asp?TOPIC_ID=1260 that brings up some issues to think about.

[BigDoc]

I went to ACP this past week, and the EMR discussions were quite interesting, one thing I took away, KoT please note, all the manufacturers should be able to give you a working demo before you decide to buy, nothing like trying software before you buy, especially if you are looking to spend the kind of money they ask.
Out of curiousity, has anyone ever compared the price of EMR with software used in other industries, I know it is to some extent apples & oranges, but on one level I feel we pay a premuim; is it because for the most part it is cottage industry?
Bigdoc

[Scroggie]

Al will be able to expound on this.
The developers say that the cost of developing, licencing and marketing the EMR, combined with ongoing upgrades is high and they aren't really making very much.

Yet they have very high margins according to some studies. The truth is probably somewhere in the middle.

It depends on the philosophy of the company: make a lot a a few sales or make a little on a bunch of sales.

None of them give a real breakdown or reasoning of how the come up with their costs.

So in the end, I don't know.

Al we say the reason they charge so much is because they can. And because we pay it. If nobody was willing to pay 12K a year, they wouldn't be able to charge that much.

[Kursk]

Efficient market theory would figure in the RISK of the investment in the EMR company arguing that the return on the investment should be equal to the return on another investment of similar risk. Since capitalizing a company to create, market and sell an EMR in the current market is a very risky proposition (I dunno, maybe like junk grade bonds), the RETURN must be proportionately high. Otherwise an efficient market would ignore this investment in favor of a better risk/return curve. Look at it as an investor - are you going to put your retirement fund money in shares of Praxis, PowerMed or E-mds? Why or why not? Aren't there better investments? What rate of return would I have to offer you to invest? How stable would the market and the company have to be? What profits do you want to see?

Until the vendor space settles, standards are set and EMR actually cracks 20% of physician's practices I don't see the prices coming down much, at least with a company that has a chance of a decade of survival.

[ozzie]

As June Allison would say depends..
Whatever the market will bear comes to mind also ..
software has few variants
high volume low price low support limited upgrade and expansion ex = winzip $30
high volume medium price some support limited upgrade but yearly patch support expansion any ex = anti virus $30 - $ 50
medium volume medium price good support yearly upgrade ex = vmware $300
low volume high price good support yearly upgrade ex = most emr $1500 to 150,000

To sustain you need residual income, thats where the yearly patch support comes in..
the low volume models cost much more to support, 24 And 7 call centers. Sales reps drooling at your feet, flash animantions and pretty websites 4 color brochures etc..
All the crap to make $300 pice of software a $3000 piece of software..
Same reason drugs cost a lot its all about the sale once the product is made. Note never see a new improved version of a drug..
There is a mentality out there thats says a $5.00 pair of socks is worse quality that a $50 pair of socks. Sure sock for sock there is difference but from TCO picture 5 pair of $10 socks would be the better bargain.

One issue I see in my small foray into emr software is most packages try to do too much. The it's like herding cats trying to get all the facets playing nice. A lot of mission creep . Maybe some of the high end deals are just a few smaller apps all hacked together. then you have the WEBMD factor which buys out the competition and kills a few players to narrow the mark space. And generally the better software is the baby thats gets flung with the bathwater..

The winner in the end is the software that has total focus on support and needs based updates rather than profit based updates. Cisco kills the market becuse they have the best support game in town and you don't mind paying for it because you get the support and it works.

And even when 15K is at stake the sizzle may close the deal.. Which may be a good purchase int the eyes of the buyer but a poor purchase in the hands of the end user..

[Kursk]

>Whatever the market will bear comes to mind also <
Couldn't agree more. Sounds like an efficient market where consumers in their infinite wisdom have decided the value of a product.

[alborg]

Hi guys:

Just my 2 cents worth...

Scroggie>>> There are wide varieties in cost and quality. For the medium market (5-15K) you could also look at Praxis (kinda of cult/EMR/way of life);

"Kinda of cult..."? I'm surprised that the USA hasn't found some of these guys saying their morning prayers in Falluja, Iraq with a Sadr EMR-loving cousin! {G} Overall, they are a nice group of folks, but they do love their software in a kinda-weird sort of way.

Sroggie>>> e-clinical works, e-Meds, Springcharts, SOAPware (a little cheaper)

eCW isn't all that cheap, though. It can cost up to $450.00 per month, which is more than a basic SOAPware cost. My associate who signed up with eCW still hasn't really used his copy much with patient care, thus making the eCW box a very expensive door stop. The rental fee really is another way to dress up the high initial cost. It does take away the sting, but if you have to sign up for a 1-2 year contract, the overall effect is the same: an emptier bank account for the buyer.

Bigdoc>>> ...I feel we pay a premuim; is it because for the most part it is cottage industry?

I would consider it more of a "Trump Towers" rather than a "cottage" industry! Last year the gross income of many of these EMR software companies was massive. Just like on TV we've seen advertisements equating cable TV vendors to pigs, then EMR companies would be equated to hippos. Just check out the "Top 100" update posted last year at http://www.healthcare-informatics.com/issues/2003/06_03/jun03.htm. As you can see in these documents, companies have increased their multi-million dollar gross revenues by up to 7-8 fold over the past 10 years.
Just like the gold mines of California dried up in the 1880's, so will physicians one day smarten up and realize they are being taken for a ride by many of these vendors!

Regards,
Al

[alborg]

Hi guys: (part II)

Scroggie>>> Yet they have very high margins according to some studies. The truth is probably somewhere in the middle.

As long as there are vendors willing to sell their wares for less (with over 90% of the functionality of their $$$ counterparts), then I will continue to feel that physicians are NOT getting their healthcare consumer money's worth of goods with the more expensive softwares. (Of course, I'm a little radical when it comes to this issue... )

>>> Al we say the reason they charge so much is because they can. And because we pay it. If nobody was willing to pay 12K a year, they wouldn't be able to charge that much.

As a group, we physicians are very poor consumers. We don't look for the best deals because generally we're so busy, because we don't realize the true value of our dollars, and because we generally are computer naive, thinking that the software peddlers are selling something "special" that can't be put together for less. As our payments dry up under the current Titanic-like Medicare situation and our overhead increases with the malpractice crisis, I'm sure eventually most of us will come around to a hard reality check.

Kursk>>> Look at it as an investor - are you going to put your retirement fund money in shares of Praxis, PowerMed or E-mds?

If you go to the URL noted above concerning the "Top 100" healthcare IT companies, you would immediately begin to invest in these companies without any hesitation, especially now that President Bush has promised to make all docs EMR owners by the year 2010. Although even the authors of that list admit that companies slide in and out of the list.

ozzie>>> There is a mentality out there thats says a $5.00 pair of socks is worse quality that a $50 pair of socks.

YES!!! The problem which totally computer-naive docs have is that some may need that extra hand-holding. One way to get around having to rely on a very expensive vendors is to hire your own IT guy.

>>> Cisco kills the market becuse they have the best support game in town and you don't mind paying for it because you get the support and it works.

I don't know about not minding to pay for it... {G} I'd rather get it free one way or another...

Regards,
Al

[ozzie]

ozzie>>> There is a mentality out there thats says a $5.00 pair of socks is worse quality that a $50 pair of socks.

YES!!! The problem which totally computer-naive docs have is that some may need that extra hand-holding. One way to get around having to rely on a very expensive vendors is to hire your own IT guy.
Now Now Al be nice you snipped the important part of 5 pair of $10 socks. me being the IT guy i am the $10 pair of socks LOL..


Cisco kills the market becuse they have the best support game in town and you don't mind paying for it because you get the support and it works.

I don't know about not minding to pay for it... {G} I'd rather get it free one way or another...
Regards,
Al
The point here is that the type of support and warranty cisco provide will never be free unless you plan on stealing stuff. But GOOD service which has value has a price.. I doubt you would want your patients to bargain shop, but rather base their choice on YOUR skills and service ..
It's easy to say Oh every MD can build an EMR system , but to get every MD to do it is another matter .. Anyone can do anything granted, but the reality is that many other chores take precedence..

Geo Bush says all will have EMR systems byt whenever, sure but I bet he aint buying but if you want medicare/medicaid money you will need an emr system. maybe thats what he is really saying..

But if the boobs in washington decide for you lookout.. The SEC EDGAR program which allows corps to upload SEC filings is just a mess and they ahve been workingat it for a few years. If you do a bunch of filings you need to buy aftermarket software a $3000 per user to do it.. Unless you want to get 15 uploads rejected then miss a filing deadline. Then maybe get hammered by the SEC..
For every A$$ there is a seat to fit it.. Trust me it is no different in other industries.. I know printers who spend $800 plus for a postscript editor ??get this $25K for RIP (Raster Image Processing) software for ripping images before printing.. When you can buy 1 of 50 RIP apps for maybe $500 price range..

Look at photoshop 700 gimp for free or paint sho pro for $70 ??
But try to get the mouse from MAC users hand using photoshop.. good luck..
And still the same colors and the sames image types . Who is kidding who here.
So in the end it balance is the answer.. and in time the market will sort itself out and oin the end you will still have low medium high and are you out of your mind pricing. Then service will factor into the pricing..

Oz

[alborg]

ozzie>>> The point here is that the type of support and warranty cisco provide will never be free unless you plan on stealing stuff.

I wonder if they offer it on eBay? ROFL!!!

Hell, if Medicare and the HMOs don't pay me, why would I want to pay Cisco? I say let's make the pain go all around...

Al

[ozzie]

Speaking of socks I guess once your DB selling pair of socks is worn then my Cisco argumentwould be far more analgesic huh heh

oz


ozzie>>> The point here is that the type of support and warranty cisco provide will never be free unless you plan on stealing stuff.

I wonder if they offer it on eBay? ROFL!!!

Hell, if Medicare and the HMOs don't pay me, why would I want to pay Cisco? I say let's make the pain go all around...

Al