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.
… if you’re going to cut your patient load in the week of training — and we require that you give us 12 hours of your time during that week, while we recommend you do it as well the following week — you need to factor that revenue loss into the $44,000.
I don’t run a $100 million company on a survey, but I also acknowledge that sometimes it is good to look at what information is coming from sources that you’re not necessarily paying a lot of attention to.
It’s not going to be plug and play, but it definitely can be made a lot easier by using some level of standardization in how you approach every project, what technology you use, making sure it’s not being done one-off, that it’s repeatable.
GUERRA: Even if, as you say, eCW has a smoother implementation process than many, physicians will still feel a slowdown in their productivity. It’s important to be honest with them about that, correct?
NAVANI: Oh, yes. We actually tell them that during the sales process itself. The other thing to note, before I get into the question, is that more than 90 percent of our business is referral based, so we’re getting people who have already spoken to somebody who has been through it, whether it’s a private physician group or a hospital doing it under Stark. As a result of it, some of the expectations are set before we get into the sales process. We actually don’t do the outbound sales methodology of trying to call a practice using the yellow pages. We don’t go down that sales approach. It’s been mostly all reference based or inbound.
So in that type of customer profile, we tend to find that you don’t have to go and convince them why they need to implement an EMR. They’re now trying to answer the question of which EMR might be better suited for them. And I think when we look at $44,000, we don’t believe all that money should be spent on software and hardware. That money needs to factor into what you refer to, which is if you’re going to cut your patient load in the week of training — and we require that you give us 12 hours of your time during that week, while we recommend you do it as well the following week — you need to factor that revenue loss into the $44,000.
So our pitch is not, “Here is some software and hardware for $44,000.” What we say, on the other hand, is you get software, hardware implementation services, plus what you hopefully take away from the two weeks of training — it should all add up to less than $44,000. And that’s worked for us.
GUERRA: Let’s go through some of the KLAS scores a little bit, and you can give me some color around these. First of all, what is your view of KLAS?
NAVANI: I respect KLAS for what they do as an organization, but I don’t run eClinicalWorks based on any other feedback than us talking to our customers. So I think, on a broader spectrum, you will find me on my online forum with our consumers on a daily basis talking to real doctors that are using our system first hand. We’ll talk to our support managers that we have in the company who do surveys and polls of our customers, in terms of their satisfaction. We track turnaround times on call volumes and many other metrics and analytics. I don’t run a $100 million company on a survey, but I also acknowledge that sometimes it is good to look at what information is coming from sources that you’re not necessarily paying a lot of attention to.
We, for example, follow the KLAS rule very closely, which is we do not ever tell our customers to fill out a KLAS survey. It doesn’t matter how happy they are because, two years ago, KLAS told us that’s not what they expect. We don’t push it. If they do it, that’s great. If they don’t do it, so be it. So we respect them for what they do and, at the end of the day, it’s probably one of the companies that does take the time to go in and investigate or go into the details of when customers call them, but at eClinicalWorks I think I’ve tried to keep a much broader perspective of what it means to be successful in healthcare IT.
GUERRA: Speaking about the “2009 Top 20 Best in KLAS Awards” Report, in the category that looks at EMR use at physician practices with more than 200 doctors, you rank third, with a score of 70.9. You were in the general pack, but that whole pack was quite a bit behind Epic (89.34). Do you have any thoughts on why that might be?
NAVANI: Well, first of all, it’s a very good company, so let’s not take away something from Epic. They have high ethics in terms of how they treat their customers, and maybe that’s what reflects in their scores too. They do have a good product. They do have a good methodology of going after customers who adopt their full solution most of the time, so they do create value from inpatient to outpatient systems, and a lot of the larger groups fall into that market segment.
I think they rightfully deserve the recognition they get, especially because they automate the entire workflow, and that’s always been our mission statement, too. The problem or challenge that we would have in a hospital system is we don’t do inpatient. We do outpatient and we do ambulatory. So in that market, where they do the whole thing, they do end up getting credit for a bigger automation piece, and they deserve to. I think they are best in that market for the type of customer they sell to.
GUERRA: By my count, there are about seven major inpatient vendors and I’m sure you could rattle off the list, have you integrated with all of them? Are you at the point where it’s plug and play?
NAVANI: Plug and play is not the right word but, practically, interoperable is the right answer. We simply have significant traction in both the community model around Stark and around the employed “outpatient department.” So we have integrations with Meditech, Cerner, McKesson, and Eclipsys. I don’t think we actually have integration with Epic because usually their outpatient departments are also using their inpatient software. That, again, speaks well for them because they offer a unified solution. We’ve done labs with Epic at a client in Texas but it’s not anything beyond that, while with some of the other vendors I mentioned we actually can do meds and allergies, too. So there are differences as to the degree of interoperability with each vendor.
We have a generic framework for interoperability using EHX which is our platform for interoperability with external sources. It is capable of handling most the industry standard formats. It’s not going to be plug and play, but it definitely can be made a lot easier by using some level of standardization in how you approach every project, what technology you use, making sure it’s not being done one-off, that it’s repeatable. We have staffed our implementation to almost five times the size of most companies in our market segment because we believe that is one of the critical parts of ambulatory care.
GUERRA: Did you mention GE or Siemens?
NAVANI: GE IDX, yes. We’ve done quite a few on the IDX side of it. Siemens’s Lifespan, yes.
GUERRA: So essentially, you’ve done integrations with all the major inpatient vendors except Epic?
NAVANI: Epic on a small scale, yes, but only labs at this point.
GUERRA: One of the things that I’ve heard from a number of different vendors is that Epic can be difficult to work with and to integrate with. You haven’t found that?
NAVANI: I can’t comment on either the good side or the bad side of it. That’s all I can say. I don’t have enough data to comment on that.
GUERRA: Let’s go back to the KLAS report and look at EMR use among the 26 to 100 doctor physician groups. Your rank is #1, but you had what they call “low konfidence,” which means they didn’t have a record of a lot of installs. You scored a 91 percent in terms of whether customers would buy your product again, and that was far above the next vendor at 69 percent. So you see, I’m not picking on all the negative here (laughing).
NAVANI: I think we should get that kind of score across every market segment. That’s the first thing I would say, and I’m still disappointed 9 percent would choose not to buy our product again. Our track record is really good in terms of successful implementations. Our internal renewal ratio is around 98.6 percent. So on both “fast models” of implementation, you can cancel and walk away without penalty. So we, generally speaking, do extremely well.
It comes down, at the end of the day, to the number of KLAS questionnaires that get filled out. Though I appreciate you mentioning that number, I would not take that to be a tremendous compliment in either the positive or negative direction. It’s just too subjective.
Part III Coming Soon