While there is no doubt health system CIOs are working 18-hour days just to keep their heads above water, major inpatient and outpatient EMR vendors have significant to-do lists as well. From HITECH guarantees to reading the tea leaves on certification to staffing up for the oncoming sales tsunami, vendors know one bad implementation can spoil a bunch of good will, and tarnish a stellar reputation. One company that has come on very strong over the last few years is ambulatory EMR vendor eClinicalWorks. With some impressive signings under its belt, Co-Founder and CEO Girish Kumar Navani is working to maintain quality while riding a fast moving train of increasing sales, and expectations. Recently, healthsystemCIO.com editor Anthony Guerra talked with Navani about how he’s handling today’s HITECH-fueled HIT industry.
BOLD STATEMENTS
… at the end of the day, the customer also has to adopt the technology and make sure the guidelines are met.
We’re not tying ourselves to 25 criteria and then measuring that to be a success. That’s like a registration sticker on a car. I don’t think I’ve ever bought a car because I knew it could get past inspection.
I would say there are people about to enter the market because there’s money on the table who might not have bought before. That is a scary thing because you really want their total commitment.
GUERRA: How would you describe the market right now?
NAVANI: I think, from a business standpoint, we finished a pretty good year in 2009, both in terms of revenues and new customers picking up eClinicalWorks as their solution. I would say it was crazy busy in Q4 as well.
I would not attribute that increased revenue or physician adoption to HITECH yet. We’re not seeing that as being caused by the stimulus. I think people are buying more around the premise that we’ve had for a while — that if you build good technology and if it solves a customer’s problem or creates an opportunity, they probably will buy it in the first place. So I think we’re seeing the market continue to do well, and we’ve seen that for our company and our products for awhile. I would say there is more talk around meaningful use and all the regulations among the HIT vendors, consultants, and legislators; and it will trickle down to the physician base over time.
As far as what’s different between January of 2010 and January of 2009, now people are asking the question, “Are you going to guarantee that your product is going to meet meaningful use?” That’s probably a question that might come up in the sales process, and we say yes to it.
I’d say the market is doing as well as it has year to year. There is no significant change in the reason why customers are buying or adopting as of today. I do expect that might change a bit by the end of this year.
GUERRA: So you guarantee that your product will be certified, not that customers will receive the stimulus money, correct?
NAVANI: Yes, there are two aspects to this. One is the part that a vendor has to play, which is to have a product that is intuitive in design and easy to use and meets the basic criteria that is established by whatever deadline — 2011, 2013 or 2015. But at the end of the day, the customer also has to adopt the technology and make sure the guidelines are met. You can’t guarantee that, but you can obviously work towards making sure your customers get there. We have lived through some projects like that where our payment was contingent on us getting doctors to a certain level of usage.
New York City is an example of that. That’s where we’ve implemented 2,000 doctors under strict guidelines of making sure that the quality data is recordable and reportable, which means that the doctors were using the EMR at the level you need for structured reporting.
It is not a guarantee in terms of the letter of the law, but it is definitely a guarantee in terms of our understanding inside our company. So we need to provide that type of service, and we need to provide that type of product. At the end of the day, the market will determine which vendors have an easier product to use, a product that can get them not only to meaningful use, as per the CMS/ONC requirement, but make them overall a meaningful user of technology as they go from a paper to electronic world.
So it definitely is a little bit broader. We’re not tying ourselves to 25 criteria and then measuring that to be a success. That’s like a registration sticker on a car. I don’t think I’ve ever bought a car because I knew it could get past inspection. I bought a car because at the end of the day I thought it was something that I might prefer to use as a consumer, with the understanding that it will definitely pass through inspection anyways.
GUERRA: How do you ensure you’re staffed up to handle the coming volumes?
NAVANI: First off, we have the necessary staffing as a company. More than two-thirds of eClinicalWorks is either in project management, training, or support. Rightfully so, not in areas of trying to sell and market, but in areas that you need to be strong to implement. So we’ve got the staffing in the company. Secondly, the product was designed for an easier implementation cycle. We believe you need to be able to implement eClinicalWorks within weeks. It shouldn’t take years and it shouldn’t take months, and it shouldn’t take IT people having to come and build the product for you.
GUERRA: Have you had any difficulty finding the right people?
NAVANI: I have not. The reason is we’re not necessarily looking for people with HIT backgrounds to hire. Now, if we did that, I would agree that it is going to be tough because everyone’s going to be looking for that same person. We, on the other hand, are looking for individuals that are analytical in their thinking, good communicators, and have a desire to succeed. We bring them into our environment and get them into the HIT framework. The result of that approach is that the talent pool is actually very large.
But there is segmentation of the market that we are referring to. If you look at the CIO in a hospital implementing their physician groups, obviously we give them talent that has already been in HIT for month or years because you need that experience to work in that context. When you go into a private physician group, you need a different level of talent because you can’t really go in with a very regimented approach. They will not follow it anyway; they’re going to change it on you at the last minute.
So you must keep both equations in mind. We tend to staff both on an “enterprise deployment model” and a “retail deployment model,” and I think we’ve been able to manage our growth by internally sourcing talent. We work with a few partners but, by and large, 95 percent of our implementations are done by eClinicalWorks.
GUERRA: What is the major roadblock to implementation success — possibly a lack of commitment, no ownership, a lack of buy-in, or a lack of allocating the necessary funds?
NAVANI: I would say there are people about to enter the market because there’s money on the table who might not have bought before. That is a scary thing because you really want their total commitment. So I would say that commitment to implement and go through change is probably the number one factor that a customer needs to accept for success. The only reason to implement EMRs is not the $44,000. That, I think, is not reason enough to do it. The reason must be that it will make my life more efficient, I will probably end up with a better quality of care at the patient level, and then, more importantly, it will save me some time by offering me flexibility. I will no longer be tied to my office because I can get the information wherever I am. I think there have to be more reasons than the stimulus. So commitment is probably number one in terms of my viewpoint.
Having said that, the answer I give you applies more to the private physician groups, small, medium, and large. If you go into the hospital side of it, it comes down to money. You will see cost as a main factor because the cost structure of inpatient and outpatient departments tends to be one of the other deterrents in the process. So between the commitment and the cost, I would put those as the number one or two reasons for trouble, based on the customer and their profile.
GUERRA: Has HITECH changed the cost equation, or is the $44,000 not enough to really alter that?
NAVANI: The $44,000 is a significant investment in terms of dollars to nullify the cost concern. As a result of it, the commitment concern is going to probably become the number one de facto question to ask. If you’re not ready to go through the change — even if it’s a matter of weeks and not months — it might not be worth the $44,000.
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