Open Letter: The EMR Challenge

Edition: September 2012 - Vol 20 Number 09
Article#: 4073
Author: Michael Paquin

Editor’s Note:the following is in response to an open letter to EMR vendors from the June 2012 issue of Repertoire.

Dear Anonymous,

Thank you for such a great and timely article: EMR Vendors, featured in June’s Repertoire.

With 35+ years in the EMR industry, I have spent the last six years as a consultant specializing in device connectivity and EMR. Additionally, I am a regularly featured speaker at Health Industry Distributors Association (HIDA) events and a contributor to Repertoire.

I wholeheartedly agree with everything in your letter and suggest, even further, that EMR vendors MUST listen and take notice if they hope to survive in today’s marketplace. Having experienced enormous success over these past few years, some EMR vendors have underestimated the need to support, service and be totally transparent with the provider community.

I began my career in health distribution, ultimately specializing in the cardiology space, where I developed the Brentwood Diagnostics product line. Brentwood Diagnostics products offered a significant software component, and as such, became one of the few organizations to introduce this technology to the industry. At that time, Brentwood interfaced its suite of diagnostic devices with over 75 different EMR vendors. I attribute much of the Brentwood success to an in-depth understanding of not only the physicians’ and nurses’ needs, but also those of the distributor representatives. Brentwood ensured that its software was intuitive and easy to use, and developed interfaces that integrated easily into the physicians’ workflow. In addition, Brentwood’s commitment to excellence in customer service was first and foremost in its approach. Brentwood even changed the in-service paradigm by offering telephone and WebEx® in-service programs to better support its providers. Brentwood knew and committed itself to supporting the sales process (making products simple to sell) and making products easy to use in the back-office setting. Brentwood clearly understood that the interface had to be easy to install and integrate seamlessly with the clients’ EMR. Brentwood was acquired in 2000 by Midmark.

With the impetus of ARRA dollars and healthcare reform, the sheer numbers of physicians ordering EMR software is off the charts. How does any vendor staff up sufficiently with knowledgeable people to train physicians across the country? I believe that most of the EMR vendors are now starting to understand that they must continue to develop and expand their product and service offerings and provide a high level of support and innovation to stay relevant in the future.

Being an EMR vendor is NOT easy. There is the constant need to upgrade, interface with hundreds of devices, and integrate with other vendors’ products for interoperability, lab connections, and connectivity with other solutions, such as hospital products. Not to mention the need to make sure their products are certified and meet the latest Meaningful Use Stage requirements. We see a lot of discussion around ARRA and Meaningful Use, which indicates that the bigger EMR vendors have at least three to four full-time people dedicated to staying abreast of healthcare reform and regulations.

We all must understand that some of the confusion is due to the continually changing rules governing evolving technologies. Imagine being an EMR vendor in today’s marketplace trying to develop to the latest Apple® or Microsoft® platforms, or trying to train practices with no IT experience or infrastructure on a new EMR and practice management solution. Better yet, think about the logistics of training a 50-provider practice with multiple locations. Compare that to training an office on a new ECG, Stress and Holter program.

I recall a conversation six years ago with an EMR vendor president whose company was enjoying significant sales growth. I suggested that his company start learning how to be more supportive of its clients and looking at flaws in its software. His response to me was “Michael you don’t understand, our product is great! Look at how our sales are skyrocketing and how many people are buying our product. We are great!”

I can also remember my first Distribution National Sales Meeting six years ago on “EMR, an Industry Need to Know Presentation” and advising the representatives to cautiously partner with an EMR vendor, as the industry was still too new. I was applauded and several representatives approached me afterward and shared that they had lost several significant accounts because they had endorsed an EMR vendor that had failed to perform.

Your letter said it all. For years I have promoted the importance of cultivating relationships with your physicians and helping them set realistic expectations for their practices. Be upfront with what they should expect and suggest that they engage a consultant. This is uncharted water for most providers and there are many complex issues to understand, plan for and negotiate when it comes to adopting and implementing an EMR. And we haven’t even factored in qualifying for Meaningful Use and ARRA reimbursement.

Another important consideration in selecting an EMR vendor is choosing a vendor that will prevail after all this confusion is over. There are in excess of 300 EMR vendors in the marketplace today. Get help understanding what to look for and understand the financial viability.

EMR vendors can ensure long-term success if they develop these four winning strategies:

1. Service. Make sure that everyone in the organization treats every customer like this is your “Best,” “First,” and “Last” customer. Make sure your software is easy to use, and that the sales person who won the account stays with the account. This is not a “wham, bam, thank you ma’am” relationship.

2. Support. Make sure that your customer understands the solution; make sure that they have someone in the organization to serve as their primary contact, even in a solo-physician practice. Make sure that your customer understands the issues (ARRA, Meaningful Use, ICD-10 codes). Make sure that when a client calls for assistance that they get a callback ASAP. And, make sure if you involve a distributor representative, that you engage them and keep them informed regarding issues and concerns. The distributor representative has a significant investment in this relationship beyond your finder’s fee!

3. Be Honest. No matter what! Set expectations that are realistic. The industry is growing rapidly and being an EMR vendor is riddled with challenges across the spectrum. Industry growth driven by ARRA and Meaningful Use means that there are still numerous providers looking to adopt an EMR that no one vendor can realistically implement, let alone train staff to use. Set expectations on all sides that preparing for Meaningful Use is not easy; that it will take time; and, it will temporarily slow down the practice. Let the customer know that certain interfaces and changes will take time. Example: Meaningful Use requirements and ICD code changes may demand development priorities and delay other projects.

4. Stay Relevant. Clients require superior, robust products and expertise to achieve MU Stages 2, 3, and beyond… and vendors will need to deliver solutions and services those clients need to provide superior patient care. Vendors also need to take significant steps in the near future to better position and broaden their solutions for the ACO market.

Michael Paquin, status

As of January 2012, I became a Vice President of Business Development at NextGen Healthcare Information Systems, LLC, Horsham, PA. Recently I was selected to be a member of the Healthcare Information Management Systems Society (HIMSS) Ambulatory Task Force. I am proud to say that in both roles it is my goal to address each and every point in your letter and to help make our industry better. I feel privileged that I have come from the distribution sector. That is why I felt compelled to respond to your excellent letter, not only as an EMR vendor representative, but as a fellow HIDA associate.


Michael D Paquin, Healthcare Information Management Systems Society