Why Superior EHR Customer Service is Critical to Your Practice’s Success

In today’s increasingly complex environment, superior service and support from your EHR vendor are critical to long-term practice viability. Reliable customer service can no longer be viewed as just a box to be checked on the EHR scorecard during the selection process—it is vital to success.

Why Superior EHR Customer Service is Critical to Your Practice's SuccessThe EHR industry is characterized by fairly poor customer satisfaction—the average KLAS score for service sits at a low 73% (Ambulatory EMRs for 11–75 Physicians). Physicians who cannot rely on their EHR company for excellent support will find their productivity and success jeopardized. No longer is the impact of an EHR limited to its use in managing charts—the increasing demands of government and other payer programs have extended the reach of an EHR beyond the four walls of the practice, and success or failure now has increasingly significant financial implications. Physicians must be able to successfully share information, connect to HIEs, and report on clinical data. In the future, they will need to respond to new reimbursement models such as ACOs. All of these communications are complicated and fraught with potential technical challenges—even with the best EHR solutions—making access to the highest quality customer support vital.

Meaningful use incentives are foremost on the minds of most physicians right now, and the program’s requirements are complex, confusing, and challenging. Physicians rely on their EHR vendors not only for the technical support necessary to achieve meaningful use, but also for the educational resources required to successfully navigate the program. Unfortunately, this kind of support is not universally available within the industry. The findings of a recent survey presented to the HIT Policy Committee revealed that physicians cite vendors—in particular, the lack of adequate support and training and unresolved technical problems—as a major obstacle to achieving meaningful use.

Physicians want to know that their EHR company will be in business for the long term. In a recent post, “The EHR Bubble Will Pop—To the Victor Go the Spoils,” I maintained that significant market consolidation is inevitable, and that many, if not most, of the 472 EHR companies currently offering certified EHRs will not survive the shakeout. Customer service is a distinguishing feature among EHR companies that will be important in ensuring a vendor’s future viability.

So, what constitutes excellence in EHR customer service and support, and how do you see through the promises made by vendors during the sales process to ensure that you will receive the level of support that you need? The highest quality customer support requires a sufficiently large team of highly skilled, well-trained, eager-to-please employees, who are easily reachable and accountable for responding within a defined and appropriate amount of time. Where possible, they should be proactive, not just reactive. Such a team requires oversight by senior management, which is really only possible if the support department is not outsourced or sent overseas. You should rely on the real experience of colleagues—review the KLAS ratings and then validate them by doing your own due diligence.

The EHR Bubble Will Pop – To the Victor Go the Spoils

Like the dot-com bubble, the EHR bubble—nurtured by the government incentives—will not last. As I look at what’s happening in the market, it becomes apparent that at some point in the not-too-distant future, the EHR bubble will pop and many vendors will face financial challenges that will lead to their demise.

Several market factors will come into play, including:

  • Physician dissatisfaction with their choice of EHR, which likely was selected in haste to meet the government’s incentive timetable and was delivered by an overwhelmed vendor;
  • Physician disenchantment with the EHR Incentives Program, as financial rewards decrease while requirements intensify;
  • An overabundance of EHR vendors  competing in a market dominated by a small number of major players. (Currently there are 472 EHR vendors offering certified “Complete EHRs”)

To understand how these factors will affect EHR vendors, it is important to understand how such companies typically raise money and what kind of “hockey-stick” growth projections they made to attract investors.

EHR Revenue

Missed growth projections; continued expenses for implementation, support, and ongoing upgrades; and diminishing government incentives will leave many companies unable to find investors willing to fund their future growth.

There will be market consolidation, and financially strong companies will acquire distressed companies for pennies on the dollar.

…To read the full story, see HIStalk Readers Write.

Are EHRs Being Oversold?

I am a firm believer in the tremendous value that the right EHR can deliver to physicians, so the historic dissatisfaction with the EHR industry—as reported in studies and anecdotal conversations—has long disturbed me. The alarming intensity of this dissatisfaction was brought home by visitors to my company’s booth during the recent AAO (American Academy of Ophthalmology) meeting.

I was truly appalled by the abject frustration and anger expressed by numerous physicians about their EHRs. One visitor described his experience by saying, “It has taken the joy out of practicing medicine.” Another said that he felt like he should put a picture of his face on the back of his head so that his patients could see him—because he was forced to focus on the computer and enter data while the patient provided information. Physicians universally complained about the “productivity-killing” impact.

From AAO - Are EHRs Being Oversold?Why is this so? I know there are good EHR products in the market that physicians enjoy using and that enhance, rather than reduce, their productivity. Why are physicians not more successful in finding these?

The answer is that EHRs are being oversold. There are many EHRs that are marvels of software, capable of doing incredible things, but the selection process that physicians typically employ is flawed, and the sales process capitalizes on this shortcoming. The salesperson dazzles them with a demo, or they take prospective purchasers to see a physician—typically just one or two—who adeptly uses the software. This creates a false sense of ease-of-use, and the physician prospect leaves the site visit expecting that he or she will be able to use the EHR just as successfully. But not all physicians are alike—they may all be very intelligent and have tremendous medical expertise, but they are not all equal in technological inclination or skills. Their success—or lack thereof—with a particular EHR will vary significantly.

This brings us back to the importance of doing due diligence—something I have talked about before. Call and/or visit a variety of physicians who represent a wide spectrum of proficiency. Go to the reference practice’s website and select physicians on your own—don’t rely on the vendor’s selection. Ask the kind of questions listed in the last EMR Straight Talk. This is the only way to increase the odds of a successful EHR experience, and to avoid making a painful and costly mistake.

HIEs and Information Sharing: Physicians Feel the Pressure

The exchange of clinical data is one of the three pillars of the EHR incentives program, and the legislation was intended to serve as a stimulus (pun intended!) for the creation of health information exchanges (HIEs) by including significant funding earmarked for their establishment. The stage 1 meaningful use requirements provide further support by requiring physicians to take a first step towards information sharing. EHR adoption was expected to be the impetus for the development and flourishing of HIEs.

HIE and Information Sharing - Physicians Feel the Pressure

It appears that it may be just the opposite—interest in HIEs may be driving adoption of EHRs, rather than the other way around. Growth in the HIE arena is coming from private HIEs—those sponsored by health care systems to connect their own providers and facilitate the effective sharing of clinical information about their mutual patients. The growth in private HIEs is far outstripping the growth in community HIEs, according to KLAS, and physicians are facing new and stepped-up pressures to participate.

It is no longer just the carrot of the meaningful use incentives at play. The following are just two examples that have recently been brought to my attention where sticks are being used to “encourage” physician participation in information sharing. The University Physicians Network (UPN) at NYU is making participation in its information-sharing network a requirement for membership in the UPN, without which physicians do not have access to the group’s favorably negotiated reimbursement rates. A similar physician group in Massachusetts is making membership in its network a prerequisite for patient referrals.

I’m interested in hearing from readers about the development of HIEs and other information-sharing networks in your markets, and the carrots and/or sticks associated with participation.

Stage 2 Meaningful Use: What Do You Think?

At this week’s HIT Policy Committee meeting, the Meaningful Use Workgroup presented its Stage 2 thinking to date, based on the 422 comments they received on their initial proposal. As discussed in a previous EMR Straight Talk post, the issue at the forefront is timing—with providers and vendors expressing significant practical concerns, and consumer groups pushing for rapid advancement.

The workgroup presented the following options for consideration by the Policy Committee. (I invite you to voice your opinion by responding to the poll below.)

  1. Maintain current timeline. Stage 2 would begin in 2013 for providers who demonstrate meaningful use in 2011. Providers who first demonstrate meaningful use in 2012 would have until 2014 to meet the Stage 2 requirements.
  2. Maintain the current timeline (as above), but allow a 90-day reporting period, instead of a full year, when providers are first governed by Stage 2 requirements. This would give providers until October 1 to begin their first year at Stage 2, instead of January 1—a nine-month delay.
  3. Delay Stage 2 by one year, allowing providers 3 years instead of 2 years at Stage 1. This means that the earliest any provider would have to meet Stage 2 expectations would be 2014.
  4. Phased-in approach separating existing from new functionalities:
    – Stage 2a (2013) would increase thresholds for measures for which the functionality already exists, (required to meet Stage 1), adding only new clinical quality measures.
    – Stage 2b (2014) would add new measures that require new EHR functionalities .

The responses from various HIT Policy Committee members covered the gamut.

  • Some were in favor of moving aggressively at all costs, presenting various arguments such as: (a) If we don’t pressure providers now, we will face the exact same issues at the next stage; (b) More extensive data capture does nothing to move us towards Stage 3 goals; and (c) We cannot just address the physicians’ workflow problems and ignore the challenges patients face in dealing with the current, difficult-to-navigate healthcare system.
  • Other Committee members, like Gayle Harrell, cautioned against trying to do too much too quickly—as she has from the outset—and stressed the long-term value to the program of setting providers up for success. Pushing them too hard could cause them to drop out after they earn the bulk of the incentives associated with Stage 1.
  • The phased-in approach was perceived as creative, but I was surprised that there was not much discussion about the administrative complexities this plan creates—to say nothing of the challenge of conveying it to providers.


Meaningful Use, ePrescribing, and PQRS: Need for Harmonization

While physicians are working feverishly to understand the complexities of meaningful use, their efforts are complicated by the demands of other government incentive programs that have similar goals but different rules. Two of the three cornerstones of ARRA are ePrescribing and reporting on quality measures, yet it is still necessary to comply separately with the regulations of EHR incentives (ARRA’s meaningful use), ePrescribing (MIPPA), and PQRS if physicians wish to maximize—or, in the near future, preserve—practice revenue.

EHR Incentive PaymentsThe chart to the right is taken from a 6-page CMS document that addresses the complicated interrelationships among EHR incentives, ePrescribing, and PQRS. For physicians, the challenge goes beyond understanding the potential payments; of greater significance is the administrative burden created by the discrepancies in reporting metrics and reporting periods among the three disparate programs. The following represent just a few of the inconsistencies inherent in the programs:

  • Under Medicare, physicians cannot receive both an EHR incentive and an ePrescribing (MIPPA) incentive in the same year. They can, however, receive both an EHR incentive and a PQRS incentive in the same year.
  • Future penalties for failure to demonstrate both meaningful use and PQRS will be additive. Whether cumulative penalties will apply for physicians who are not meaningful users and do not ePrescribe is not addressed in the CMS chart, but the prevailing understanding is that, instead, the harsher of the two penalties will prevail.
  • Because ePrescribing benchmarks differ, a physician could be deemed a successful ePrescriber under ARRA but not under MIPPA, and vice-versa.
  • Regardless of whether or not a physician receives incentives under ARRA, he/she must continue to comply with the MIPPA ePrescribing requirements (i.e., G-Coding) to avoid future MIPPA penalties. (Ironically, a physician could demonstrate meaningful use in 2011, receive an EHR incentive, but be penalized 1% under MIPPA in 2012 for failure to report G-Codes—a MIPPA, but not a meaningful use, requirement.)
  • Although many of the quality measures are common to both meaningful use and PQRS, separate reporting is required. Differences exist in the applicability of thresholds and in the reporting periods.

I am glad to see that the lack of program harmonization is being recognized—and I hope it will be successfully addressed in the next round of rule-making. Recently, the AMA distributed a survey “seeking physicians’ input on rules and regulations that increase their administrative costs and paperwork burden, or that interfere with patient care without a significant benefit to patients and/or the government.” Last week, the Government Accounting Office issued a recommendation to CMS that they eliminate overlapping ePrescribing requirements. Harmonizing the rules will go a long way toward encouraging widespread and successful participation in government programs that are aimed at increasing quality of patient care.

Blumenthal’s Departure: Odd Timing

Yesterday morning, in a podcast interview with Neil Versel, a respected HIT journalist, I was asked to compare the mood at last year’s HIMSS meeting with my expectations for this year’s assembly. In 2010, I listened as David Blumenthal, head of ONC, spoke to a standing-room-only crowd, whipping up a frenzy of excitement about ARRA and its EHR incentives in what I can only describe as a pep rally. I told Neil that I anticipate a more subdued and somewhat anxious atmosphere at this year’s meeting, since the practical realities and challenges associated with the complexities of meaningful use have set in. A recent survey of hospital CIOs, for example, revealed reduced confidence in the ability of their respective institutions to successfully meet the requirements within the allotted timeframes, and a resulting skepticism about whether they would earn the incentives. Similarly, at the recent 2-day hearings conducted by the Adoption and Certification Workgroup, the generally positive sentiment was tempered by concerns about operational issues, timing, IT workforce challenges, and the multitude of government programs on the plates of practices.

Then, yesterday afternoon, the news broke that David Blumenthal is stepping down from his post as the national leader of the EHR adoption and incentives program. Although we all know that no single individual is ever indispensible, the timing of his departure struck me as quite odd. The program is at the precipice—its launch is just underway and the first attestations of meaningful use are expected in April. Initial success or failure will be evidenced imminently. One would think that this would be the time to demonstrate stability and unwavering commitment from the top down—a time to rally all of the forces to ensure the program’s success.

I cannot help wondering the following:

  • Why is Blumenthal stepping down now, when the program is at such a critical juncture?
  • Why is HHS Secretary Sebelius just now “conducting a national search for the right successor” even though she reports that it was always the plan that Dr. Blumenthal would end his term at this point?
  • What are the implications for the EHR incentives program?
  • Will his departure affect the likelihood of its success?
  • How will provider confidence in the program be impacted?
  • Should we expect changes in the program? What kind of changes?

Please share your thoughts on David Blumenthal’s departure by commenting below.