Want You To Know. Jonathan Bertman, MD, FAAFP. Alpert School of Medicine, Brown University. Amazing Charts. Physician Editor-In-Chief
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1 Secrets EHR Vendors Don t Want You To Know Jonathan Bertman, MD, FAAFP Clinical i l Assistant t Professor Family Medicine i Alpert School of Medicine, Brown University Founder & President Amazing Charts Physician Editor-In-Chief MDNG
2 Secrets EHR Vendors Don t Want You To Know Jonathan Bertman, MD, FAAFP Clinical i l Assistant t Professor Family Medicine i Alpert School of Medicine, Brown University Founder & President Amazing Charts Physician Editor-In-Chief MDNG I M COMPLETELY BIASED! (I own an EHR company and am an EHR vendor.)
3 A bit about me In 1999 I started working for some physicians who had an EHR.
4 A bit about me In 1999 I started working for some physicians who had an EHR. Like most EHRs it was designed for structured Like most EHRs, it was designed for structured data.
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6 Middle Ear Left effusion noted. Right no effusion noted.
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12 Middle Ear Left effusion noted.
13 Middle Ear Left effusion noted. Right no effusion noted.
14 A bit about me In 1999 I started working for some physicians who had an EHR. Like most EHRs, it was designed for structured data. Because of the many clicks and windows to Because of the many clicks and windows to navigate, the EHR was essentially unusable.
15 A bit about me In 1999 I started working for some physicians who had an EHR. Like most EHRs, it was designed for structured data. Because of the many clicks and windows to navigate, the EHR was essentially unusable. And every physician bypassed the technology and typed into a miscellaneous text field instead.
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17 A bit about me In 1999 I started working for some physicians who had an EHR. Like most EHRs, it was designed for structured data. Because of the many clicks and windows to navigate, the EHR was essentially unusable. And every physician bypassed the technology and typed into a miscellaneous text field instead. By 2001, I realized how much I disliked this EHR.
18 A bit about me In 1999 I started working for some physicians who had an EHR. Like most EHRs, it was designed for structured data. Because of the many clicks and windows to navigate, the EHR was essentially unusable. And every physician bypassed the technology and typed into a miscellaneous text field instead. By 2001, I realized how much I disliked this EHR. And how much I disliked working for other doctors.
19 A bit about me
20 A bit about me
21 A bit about me
22 A bit about me
23 A bit about me
24 How can it be better?
25 How can it be better? Get An EHR!
26
27 Bizarre approach to documenting visits!
28 Bizarre approach to documenting visits! Complex & confusing to navigate and use!
29 Bizarre approach to documenting visits! Complex & confusing to navigate and use! Ludicrously priced; can t try before buying!
30 Bizarre approach to documenting visits! Complex & confusing to navigate and use! Ludicrously priced; can t try before buying! Require long-term contracts (some with NDA)!
31 Bizarre approach to documenting visits! Complex & confusing to navigate and use! Ludicrously priced; can t try before buying! Requires long-term contracts (some with NDA)! Slick sales people! Software, Modules & Training = Big $$$$ Commission ROI
32 Bizarre approach to documenting visits! Complex & confusing to navigate and use! Ludicrously priced; can t try before buying! Requires long-term contracts (some with NDA)! Slick sales people! I just need something usable & affordable!
33 How can it be better? Get An EHR!
34 Anatomy of an EHR Computer Database
35 I can do this!
36
37 2001
38 2002
39 2002
40 Becoming an EHR vendor
41 Becoming an EHR vendor
42 Today
43 These industry secrets are my personal These industry secrets are my personal opinions based on years in the field as a frustrated doctor and an EHR vendor.
44 Who can you trust? What is the cost? Is it usable? These industry secrets are my personal These industry secrets are my personal opinions based on years in the field as a frustrated doctor and an EHR vendor.
45 Who can you trust?
46 Who can you trust? Experts/Lecturers? IT Consultants/RECs? Your Colleagues/Peers?
47 Who can you trust? Experts/Lecturers? IT Consultants/RECs? Your Colleagues/Peers? Experts may be bought! A significant number of the experts who lecture on EHRs earn money from the same vendors they recommend (as consultants) - but don t disclose the relationship.
48 Who can you trust? Experts/Lecturers? IT Consultants/RECs? Your Colleagues/Peers? IT Consultants think differently Most base their recommendations on anecdotes & theory rather than EBT. Tend to focus on security >> usability. (And some, like other experts, are compensated by vendors without disclosure.)
49 Who can you trust? Experts/Lecturers? IT Consultants/RECs? Your Colleagues/Peers? Most RECs are composed predominantly of IT Consultants.
50 Who can you trust? Experts/Lecturers? IT Consultants/RECs? Your Colleagues/Peers? Provider-Users may be compensated. Some EHRs pay or provide free / discounted d software to practices for referrals. Some EHRs pay or provide free / discounted software to practices that act as a reference site. Some EHRs pay, or provide free / discounted software to practices considered thought leaders.
51 Who can you trust? Experts/Lecturers? IT Consultants/RECs? Your Colleagues/Peers? The Solution: Make them disclose. It s as simple as asking if they have any potential conflict-of-interest that you should know about.
52 What is the cost?
53 What is the cost? Buying an EHR is just like buying a car.
54 What is the cost? Buying an EHR is just like buying a car. EHR reps work on commission: the more you pay, the more they get paid.
55 What is the cost? Buying an EHR is just like buying a car. EHR reps work on commission: the more you pay, the more they get paid. Reps will want to sit down to go through their cool features before discussing price.
56 What is the cost? Buying an EHR is just like buying a car. EHR reps work on commission: the more you pay, the more they get paid. Reps will want to sit down to go through their cool features before discussing price. Reps will use ROI arguments.
57 What is the cost? Buying an EHR is just like buying a car. EHR reps work on commission: the more you pay, the more they get paid. Reps will want to sit down to go through their cool features before discussing price. Reps will use ROI arguments. Reps will offer payment plans including monthly leasing options.
58 What is the cost? Buying an EHR is just like buying a car. EHR reps work on commission: the more you pay, the more they get paid. Reps will want to sit down to go through their cool features before discussing price. Reps will use ROI arguments. Reps will offer payment plans including monthly leasing options. After discussing price, you ll be nickel & dimed d for extras.
59 What is the cost? Buying an EHR is just like buying a car. EHR reps work on commission: the more you pay, the more they get paid. Reps will want to sit down to go through their cool features before discussing price. Reps will use ROI arguments. Reps will offer payment plans including monthly leasing options. After discussing price, you ll be nickel & dimed d for extras. The Solution: Understanding this game is the first step in not becoming an EHR sucker.
60 What is the cost? Ask for clear and transparent pricing (in writing).
61 What is the cost? Ask for clear and transparent pricing (in writing). If that t isn t possible, do an MMSE.
62 What is the cost? Ask for clear and transparent pricing (in writing). If that t isn t possible, do an MMSE. Max/Min Scruple Exam
63 What is the cost? The MMSE (Max/Min Scruple Exam) 1. Ask the vendor what the Maximum, or highest price a practice of your size and specialty could expect to pay.
64 What is the cost? The MMSE (Max/Min Scruple Exam) 1. Ask the vendor what the Maximum, or highest price a practice of your size and specialty could expect to pay. 2. Now ask about the Minimum specific needs for your practice (e.g., license charge, maintenance, eprescribing, interaction-checking, E&M coding, spell- checker, automated t backup).
65 What is the cost? The MMSE (Max/Min Scruple Exam) 1. Ask the vendor what the Maximum, or highest price a practice of your size and specialty could expect to pay. 2. Now ask about the Minimum specific needs for your practice (e.g., license charge, maintenance, eprescribing, interaction-checking, E&M coding, spell- checker, automated t backup). 3. To pass the MMSE, their original estimate in #1 should be close to the results of #2.
66 What is the cost? The MMSE (Max/Min Scruple Exam) 1. Ask the vendor what the Maximum, or highest price a practice of your size and specialty could expect to pay. 2. Now ask about the Minimum specific needs for your practice (e.g., license charge, maintenance, eprescribing, interaction-checking, E&M coding, spell- checker, automated t backup). 3. To pass the MMSE, their original estimate in #1 should be close to the results of #2. If not, the vendor will now be explaining why they didn t include eprescribing and other extras in the original estimate.
67 What is the cost? The MMSE (Max/Min Scruple Exam) 1. Ask the vendor what the Maximum, or highest price a practice of your size and specialty could expect to pay. 2. Now ask about the Minimum specific needs for your practice (e.g., license charge, maintenance, eprescribing, interaction-checking, E&M coding, spell- checker, automated t backup). 3. To pass the MMSE, their original estimate in #1 should be close to the results of #2. If not, the vendor will now be explaining why they didn t include eprescribing and other extras in the original estimate. This is failing the MMSE.
68 Is it usable?
69 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks.
70 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?)
71 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?) Middle Ear Left effusion noted. Right no effusion noted.
72 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?) Middle Ear Left effusion noted. Right no effusion noted.
73 Is it usable? EHR demonstrations are pre-scripted and have been pre-configured to appear simple and easy to use.
74 Is it usable? EHR demonstrations are pre-scripted and have been pre-configured to appear simple and easy to use.
75 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?)
76 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?)
77 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?)
78 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?) Online (Ongoing) Studies AAFP s Center for Health IT ACP s (et al.) AmericanEHR KLAS Research* *Industry sponsored
79 Is it usable? By far the most common mistake is not understanding the specific steps needed to do basic daily tasks. Will this make my practice-life easier? (aka Is this EHR usable?) Published Studies (2011, 2009, 2007) Family Practice Management s biennial EHR User Satisfaction Study
80 The EHR-sucker? Jdaslkfl;aksjdfl;aksjdf;lasdkjf;alskfkj dfajfjfaodfasfjadfaposdfapdfj;kdjralsij Jdaslkfl;aksjdfl;aksjdf;lasdkjf;alskfkj flasjdfl;adjkdjfkdakdajfakd;akdfakjlk dfajfjfaodfasfjadfaposdfapdfj;kdjrals sjdasf;spoiaerogpandovnaweofmaso ijflasjdfl;adjkdjfkdakdajfakd;akdfakjl mdfaemflaisjfoiasjdfoaismdfasmdf;as ksjdasf;spoiaerogpandovnaweofmas j mdf;lkasmdf;lkasndf;lasjdfiajg;sdgoj omdfaemflaisjfoiasjdfoaismdfasmdf; gasjdgojdaslkfl;aksjdfl;aksjdf;lasdkjf asmdf;lkasmdf;lkasndf;lasjdfiajg;sd ;alskfkjdfajfjfaodfasfjadfaposdfapdfj; gojgasjdgojdaslkfl;aksjdfl;aksjdf;las kdjralsijflasjdfl;adjkdjfkdakdajfakd;a dkjf;alskfkjdfajfjfaodfasfjadfaposdfa kdfakjlksjdasf;spoiaerogpandovnawe pdfj;kdjralsijflasjdfl;adjkdjfkdakdajf ofmasomdfaemflaisjfoiasjdfoaismdfas akd;akdfakjlksjdasf;spoiaerogpando mdf;asmdf;lkasmdf;lkasndf;lasjdfiaj vnaweofmasomdfaemflaisjfoiasjdfoa g;sdgojgasjdgolkjasdk;ljdsjkladslkjfd ismdfasmdf;asmdf;lkasmdf;lkasndf; g j g j ; j j j kjl;kjlasdjkdaklj;jkjkljk;klj lasjdfiajg;sdgojgasjdgolkjasdk;ljdsjk Jdaslkfl;aksjdfl;aksjdf;lasdkjf;alskfkj ladslkjfdkjl;kjlasdjkdaklj;jkjkljk;klj dfajfjfaodfasfjadfaposdfapdfj;kdjralsij Jdaslkfl;aksjdfl;aksjdf;lasdkjf;alskfkj flasjdfl;adjkdjfkdakdajfakd;akdfakjlk dfajfjfaodfasfjadfaposdfapdfj;kdjrals sjdasf;spoiaerogpandovnaweofmaso ijflasjdfl;adjkdjfkdakdajfakd;akdfakjl mdfaemflaisjfoiasjdfoaismdfasmdf;as ksjdasf;spoiaerogpandovnaweofmas mdf;lkasmdf;lkasndf;lasjdfiajg;sdgoj omdfaemflaisjfoiasjdfoaismdfasmdf; skfkwkkwlkkdkkklskkkslkkd asmdf;lkasmdf;lkasndf;lasjdfiajg;sd wkk Jdaslkfl;aksjdfl;aksjdf;lasdkjf;alskfkj gojskfkwkkwlkkdkkklskkkslkkd wkk dfajfjfaodfasfjadfaposdfapdfj;kdjralsij Jdaslkfl;aksjdfl;aksjdf;lasdkjf;alskfkj flasjdfl;adjkdjfkdakdajfakd;akdfakjlk dfajfjfaodfasfjadfaposdfapdfj;kdjrals sjdasf;spoiaerogpandovnaweofmaso ijflasjdfl;adjkdjfkdakdajfakd;akdfakjl mdfaemflaisjfoiasjdfoaismdfasmdf;as ksjdasf;spoiaerogpandovnaweofmas mdf;lkasmdf;lkasndf;lasjdfiajg;sdgoj omdfaemflaisjfoiasjdfoaismdfasmdf; gasjdgosjsdkjfksdjfkjjkkskksjjqjjjjsdf asmdf;lkasmdf;lkasndf;lasjdfiajg;sd kjsdflkjsdflkjsdflkjhjwoehrw9esfoivm gojgasjdgosjsdkjfksdjfkjjkkskksjjqjjj j j j j sinvisdfksldjfoiwsgnosnofdmfksmffos jsdfkjsdflkjsdflkjsdflkjhjwoehrw9esf dflk dflk dflk h f nfoisnfgosgfoisjmfgomsgpfksfd oivmsinvisdfksldjfoiwsgnosnofdmfks mffosnfoisnfgosgfoisjmfgomsgpfksfd Published Studies (2011, 2009) The 2011 EHR User Satisfaction Survey: Responses From 2,719 Family Physicians Edsall R., Adler K.,Fam Pract Manag Jul-Aug;18(4):23-30.
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82 Summary: 1. Make them disclose. 2. Make them give you transparent pricing (or administer the MMSE). 3. Make sure it s usable in your practice - or your money back.
Fall in love with your EHR.
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