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.
… whatever we want to do with certification needs to be done on a firm, open basis with a clear timeline so every customer and company can go about lining up internal resources to meet them. This uncertainty doesn’t help any one of us in this industry, so we need to get it out.
So I’m not a critic of the criteria that you might institute for vendors to qualify against. I am critical when people don’t make it very transparent, regarding the timelines and the timeframes that are expected.
… there needs to be criteria. If there isn’t, you will find people selling notepads and calling them HIT and someone will pay $44,000 for it.
GUERRA: Regarding your KLAS scores, in physician practices with between two and five doctors, most of the EMR vendors were fairly close in score. One of the things that stood out to me was that 53 percent of your customers said eClinicalWorks had all the functionality needed. That means 47 percent were looking for something more. Is there anything you’re hearing about consistently that you plan on adding to a future release?
NAVANI: No. I am on the user forum every night, so I know every detail that a customer wants, and there are probably thousands of features that we’ll keep adding as customers ask. But if you really compare the use of eClinicalWorks as a product, the reason we are doing extremely well is because when people visit our customers in that market segment, they tend to see a more comprehensive use of the product. Once you cross the basic threshold of documenting with it, writing electronic prescriptions, ordering labs, getting results, quality measures, order sets, you start striving for patient portals, mobile use, more interoperability. I think it’s that type of feature and functionality that they would like to deploy. It’s not that the product functionality doesn’t exist, but it takes a lot of effort for small practices to put in place. Sometimes I don’t know if you can actually compare two vendors on a score matrix of what they require, because we don’t know what level of usage they’ve already achieved.
I fully buy into the notion that a company cannot stop innovating and should continue to deliver more and make it easier for its end consumers to adopt the system. So we are relentless in that, and I think we listen to our user forums and customers. We have virtual roundtables, we have physical roundtables, and I think that tells us what we need to do next.
GUERRA: What are your thoughts on certification?
NAVANI: I, generally speaking, like certainty because it allows me, and the leaders in the company, to execute on timelines and deliverables. When timelines shift, it creates uncertainty around release cycles and your overall go-to-market strategy. So I think it’s important that whatever we want to do with certification needs to be done on a firm, open basis with a clear timeline so every customer and company can go about lining up internal resources to meet them. This uncertainty doesn’t help any one of us in this industry, so we need to get it out.
Is it one company that does certification, is it 10? At the end of the day, eClinicalWorks is only going to go get certified by any one of those 10. So I’m assuming that we’ll come up with common standards, and the different bodies will do the inspection, no different than how they do it on the emissions testing of cars.
So we expect to go through that, and we treat it as part of doing business in this industry. I don’t complain about it because there is no use barking. If you’re making cars, you better expect them to have emissions tests and, if you make HIT, you need to expect that you’ll be measured against certain criteria, whether it is interoperability, decision support, whether it is some form of data capture that will yield transferable information between systems. This also happened in every other industry where institutions eventually found ways to transfer information in an interoperable fashion.
So I’m not a critic of the criteria that you might institute for vendors to qualify against. I am critical when people don’t make it very transparent, regarding the timelines and the timeframes that are expected. What happens is two or three vendors go through preliminary certification, and they are in limbo now waiting for their final certifications. We have certain timelines where we were expecting our people to go get certified, but we can’t go ahead and get them done. So these resources are now getting redeployed into something else because it’s not just product development that gets effected, it’s also the whole preparation that goes into making sure those test patients are in there, making sure that somebody has read the scenario and the script, has practiced it enough to make sure they don’t waste the time of the judging bodies.
Regarding the money spent around certification, we do spend a considerable amount of money on R&D, so it does take effort. It’s not inconsequential, but this year, for example, we’ll spend less than the first year when it was all new. I’m sure there was more to be done because we were getting used to understanding what certification might look like, and then the next year came along and it was smaller in terms of the work you had to do. Then 2008 came along and the bar, in terms of product features, was not as much. 2009 falls more into the bucket of maybe six, eight, 10-man months work. It is not 10-man years of work.
So I’m critical of the process in terms of making it transparent. I am not critical of going through a certification if I need to, because if somebody wants to hold people accountable for the money they’re going to spend — whether it was Stark, stimulus, or whatever — there needs to be criteria. If there isn’t, you will find people selling notepads and calling them HIT and someone will pay $44,000 for it.