emr pricing
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501 Folsom Street.First Floor
.San Francisco
.California
.94105
ElectronicMedicalRecordsCompetitive
PricingandExperienceAnalysis
ARepresentativeExampleforKafkaClinic
a5-PhysicianFamilyPractice
JoshHarrington
HaasSchoolofBusiness
jwha4a@hotmail.com
Spring2010
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Believing in progress does not mean believing that any progress hasyet been made. Start with what is right rather than what is acceptable.
- Franz Kafka
Introduction:
DoctorsacrosstheUnitedStatesarebeingpushedtomaketheswitchtoElectronicMedicalRecords
(EMR).Thefederalgovernmenthassetaside$19billioninstimulusmoneytohelpseethatamassive
switchtakesplaceby2015.Yet,asthetimeforEMRadoptionfastapproaches,anincreasingnumberof
doctorsarenoticingalackofdependableinformation.Aninternetsearchforelectronicmedical
recordsturnsupoverthreemillionresultsandprobablyjustasmanyopinionsonwhichsystemisbest.
HealthcareprovidersneedunbiasedinformationsothattheycandecidewhichEMRtoimplement.
Giventhedifferencesbetweenindividualpracticeneeds,arelativelylengthyandconsultativesales
processhasdevelopedamongstvendors.Thismakesitadifficultandtime-consumingprocesstogather
andadequatelycomparepricinginformationandproductfeatures.
ThiswhitepaperwascommissionedbyPracticeFusionbutdesignedindependentlybytheauthorto
provideanobjectivequalitativeandquantitativeassessmentoftheexperienceandresultsofobtaining
initialpricequotesforastandaloneEMRsolutionandacombinedEMRandPracticeManagement(PM)
solutionfromsevenwell-knownvendors.Althoughanevaluationofproductfeaturesandusabilityis
beyondthescopeofthisreport,IhopetheinformationcontainedhereinprovesusefulinnarrowingtheoptionsforvendorselectionandhelpstosavetimeandeffortasapracticelookstoadoptanEMR.
Methodology:
ThisreportseekstoshedlightontheEMRpricingbyprovidingahead-to-headcomparisonoflicensing,
implementation/training,andongoingmaintenancecostsasquotedbysevenleadingproviders.The
studywasconductedoveraone-monthperiodinApril2010,beginningwithcallsandemailstothe
primarycontactslistedoneachcompanyswebsiteandfinalizeduponreceiptofanofficialpricequote
(withtheexceptionofPracticeFusionandeClinicalWorks).
ResultsarebasedonaquotegeneratedforKafkaClinic,ahypothetical5-physicianpracticewithonemid-levelmedicalassistant(MA),whichIwasassistingwiththedecisionprocessasaconsultant.The
pricingdatawasacquireddirectlyfromtheEMRvendors,throughtheirprimarysalescontacts.Where
available,quoteswereevaluatedforbothclient/serverandhostedsolutions.Requiredhardware
expenses(servers,PCs,laptops,tablets,andsupporting
equipment)wereexcludedfromtheresults,althoughitisimportanttonotetherearesubstantial
differencesinhardwarecostdependingonindividualpracticesetup.
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ItshouldalsobenotedthatAthenahealthdoesnotofferastandaloneEMRapplication,butmustbe
purchasedwithaPMandrevenuecyclemanagement(RCM)solution.GECentricitywouldnotprovidea
quoteforastandaloneEMRsolution,butmentioneditwasactuallymoreexpensivethananEMRplus
PMcombinedsolution.
SummaryResults:
EMRPriceComparisonOverview
Fullspreadsheetavailableonrequest.
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EMR+PMPriceComparisonOverview
Fullspreadsheetavailableonrequest.
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DetailedResultsAnalysis:
Allscripts
MyexperiencewithAllscriptsbeganwithacalltothecompanys1-800lineandworkingthrougha
phonetreetoreachthesalesdepartment.Afterleavingamessage,asolutionsconsultantresponded
fourbusinessdayslaterwithanintroductoryinformationpacket.Afollowupcallwiththesolutions
consultantresultedinnoadditionalinformationonproductfeatures,benefitsofclient/servervs.hosted
architecture,orpreliminarypricing.
Withintwohoursofthefollow-upcall,Iwas
contactedbyasalespersonabletoanswermore
detailedquestionsregardingtheproduct.When
askedabouttheprosandconsofclient/servervs.
hostedsolution,Iwastold95%ofAllscripts
customersusetheclient/serverconfigurationand
thatthebenefitisnotworryingaboutinternet
connectivityproblems.Ahostedsolutionsaves20-
30%upfront,butcostsanextra$100/mo/providerandonlymakessenseifonewasplanningto
abandontheEMRafterafewyears.IwastoldanASPsolutionisdefinitelynotrecommendedand
thatamajorityofclientswhopurchaseASPtendtoconverttoclient/serverwithintwoyears.
Withregardtoimplementation,theamountoftimerequireddependsonthepractice.
ImplementationisakeydifferentiatorforAllscripts,whichisthenumberoneproviderfordoctors
continuingtousetheproduct.ManydoctorsabandonEMRsolutionsgiventhedifficultyofthe
transition.Allscriptstechnicalstaffisdeployedon-siteforhardwareinstallationandwhenthepractice
goeslive.Trainerssitwithdoctorsandpatientstowalkthemthroughthesystem.The
implementationinvolvesoneweekofon-sitetrainingduringgo-live,thentwoweeksofftouncover
problems/issues,followedbyaweekofon-sitetrainingtoanswerquestionsandassistinthe
customizationofworkflowsandtemplates.IwastoldtrainingiswhereAllscriptsknocksitoutofthe
parkasmostoftheirtrainersareformermedicalassistantswhoknowhowpracticeswork.Iwastold
tocarefullyexaminecompetitorquotesforhiddentrainingchargesorlow-ballestimatesof
implementation.
Incrementalinformationabouttheproductincluded:softwareupdatesforclient/serverincludedin
maintenancecosts,e-prescribingincluded(thisisAllscriptsbreadandbutter),andaguaranteeof
meaningfulusetogetstimulusdollars.Supportcostsareincludedinmaintenance,withcoverage
24/7/365withanaverageresponsetimeof35minutes.
Iwastold95%ofAllscripts
customersusetheclient/server
configuration
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AninitialpricequotewasreceivedninedaysafterthelastcontactwithAllscripts.Afollow-upcall
revealedacurrentbacklogofthreemonthsforinstallationofthePMsolution,andfourmonthbacklog
forEMRinstallation.Asaclosingcomment,thesalespersonmentionedAllscriptsistheonlycompany
offeringAssureDisasterRecovery,backingupEMRandPMdataevery59minuteswhilecompetitorsonlydothisonceperday.
Athenahealth
MyinitialcalltoAthenahealths1-800lineledtoavoice-messagesystem.Ireceivedacall-backseveral
hourslaterfromthesalesdepartmentandwasinformedIwouldberequiredtositfora2030minute
productdemobeforeanypricinginformationcouldbeshared.Athenahealthssolutioniscompletely
differentthananyothersoftware/serviceprovideroutthere.IwastoldwithAthena,youretakingno
stimulusreimbursementriskinfactreimbursementisguaranteed.Anychangeswithmeaningfuluse
standardscanbeadaptedwiththepushofabutton.
AfewdayslateraconferencecallwithanAreaSalesSpecialistwassetup.Athenahealthssolutionis
web-hostedonlywith99.7%guaranteeduptime.Athenahealthsproductsprovidethepracticewithan
abilitytotailorworkflows,usetemplates,orcustomizetoindividualpracticeneeds.Mostpractices
cangenerallyexpecta57%increaseinnetcollectionsbyusingtheAthenahealthsolution.
Implementationtypicallytakesaboutfourmonths,andAthenamakesnomoneyonimplementation,onlyrecoversitscosts.ThepracticecandoEMRplusPMimplementationconcurrently,butmost
choosetodoaphased-inimplementationtoavoidbeing
overwhelmed.Oncescheduled,aprojectmanageris
assignedforimplementationwhowillusuallymake56
sitevisits,identifysuper-users,andprovidethreedays
ofeight-hourtrainingsessions.Theprojectmanager
canbringbestpracticesfromotherclientstobearon
yourset-up.
TheSalesSpecialistmadeparticularemphasisonstimulusreimbursement,notingthekeybenefitof
Athenahealthisitsfocusoftoolsandmanpowerontrackingfederalstimuluseligibilityandensuringit
isreceived.Iwastold80%ofwhatthepracticeneedstotracktoqualifyformeaningfuluseistracked
bythefrontdesktheintakenursetakesonmostoftheinput,soitdoesntslowthedoctordown.I
receivedapreliminaryquoteeightworkingdaysafterinitialcontact.
Aprojectmanagerisassigned
forimplementationwhowill
usuallymake56sitevisits
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GECentricityInitialcontactwithCentricitysaleswasmadeviaemail.Ireceivedaresponseonedaylaterfroma
salespersonabletospeakatlengthaboutthedifferencebetweenclient/serverandhostedsolutions,of
whichCentricityoffersbothanddidnotappeartobepushingoneoptionovertheother.His
perspectivewasthatthekeybenefitofahostedsolutionwasnotworryingaboutbackups/upgradesof
theon-premiseserversandhardware.Howeveritseasytooutgrowtheinternetsolution.Thekey
benefitofclient/serverwastheabilityofapracticetoownyourowndataandnothavetorelyon
internetconnectivity.Conversionfromhostedtoclient/serversolutionwashighlightedasakey
differentiatorforCentricityonceyouownthelicenseitseasytotransitionforaminimalcostof$95
perhourforapproximately810hours($800$1,000total).Centricityalsoprovidesaccesstothe
medicalqualityimprovementconsortium(mQic),allowingphysicianstocomparepracticemetricsand
patientoutcomesacrosstheUSinordertoidentifydiscrepanciesandbest-methods.
Withregardtoimplementation,athree-phasedapproachwasrecommended.Theoveralltimeline
wouldberelativetothecommitmentlevelofthepracticeandphysicians,butaroughschedulewould
be1)ConvertthePMsystem,whichshouldtakeapproximately4560days2)usetheEMRsystemfor
3060daysfornewpatients,allowingdoctorstogetcomfortablewiththesystemand3)converttheold
patientstotheEMRsystem,likelytotake36months.Duringimplementation,theyuseagoal-based
system,workingone-on-onewiththepracticetoattackanyissuesoneatatime.Thepracticereceives
accesstoadedicatedsupportteam.
Iwastoldmostcompetitorsaregenerallyaroundthe
sameprice;itboilsdowntowhoyouwanttoworkwith
andgivenarecommendationtotalktootherusersto
gaugetheirimpressionsofthesystem.Youdbe
surprisedbyhowmanyclinicsabandonanEMRandgo
backtotheiroldways.Centricitywasthequickesttorespondwithaquote,fivedaysafterinitial
contact.
eClinicalWorks
IncontactingeClinicalWorks,theSalesCoordinatorIreachedwasabletoanswerbasicquestionsabout
theproductandwasquicktoemailproductinformationmaterials.Whenaskedaboutapreliminary
quote,Iwastoldthateachmemberofthepracticeandthedecision-makingdoctorwouldberequired
toparticipateinaproductdemonstration.AbasicpricelistfortheirvariousEMRandEMRplusbilling
Youdbesurprisedbyhow
manyclinicsabandonanEMR
andgobacktotheiroldways.
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solutionswasprovided,althoughtherewaslimiteddisclosureaboutimplementationcosts.Thehosted
solutionwasrecommendedasbeingeasierasopposedtotheclient/serveroffering.Afternumerous
contactswiththisSalesCoordinator,Ilearnedthataprimaryfieldsalescontactwouldonlybeassigned
afterademonstration.
Whenaskedaboutimplementation,apreliminaryverbalestimatewasprovidedas810daysofonsite
workandtrainingat$1,000perday,travelexpensesforthetrainer(estimatedatapproximately
$2,600),and34daysofdatamigrationat$750perday.AftersigningacontractwitheCW,akickoff
callwouldbeheldseveraldayslater,withago-livedatenormallyscheduledwithineightweeks.
NextGen MyinitialcontactwithNextGenwasviaemail,withaphonecallbacktwodayslater.Iwasinformed
thatsupporthourswerefrom8:30pm-5:30pmlocaltime(guaranteed2-hourresponsetime),andthat
additionalchargesapplyforoff-hourssupport.Iwasprovidedcontactinformationforasales
representative.
Afteremailingthesalesrep,Ireceivedacall-backthesamedayandhadalongconversationaboutthe
companysproducts,itscompetitors,andtheindustry.WithNextGenyoupayforthesoftware
licensingfees,extraforhostingservices.IwastoldNextGenskeydifferentiationisonthePMside,
wherewecanmateriallyimproveprocessesandcollections.Whenaskedabouttheprosandconsofhostedversusclient/serverarchitectures,Iwastoldtheonlybenefitofhostedwaslessneedto
purchaseupfronthardwareandthatmostpracticeshaveanITpersononcall,butdontneed
someoneon-sitetomanageaclient/serversetup.Withregardtosoftwareupdatesforclient/server
setups,Iwastoldupdatesgenerallyonlyhappen1or2timesperyearnotthatoftenandmost
clientssimplyskipoutontheupgrades.
TheNextGenrepresentativewouldnttalkbadaboutcompetitors,buttherearelotsofreasons
peoplearentchoosingotherbigEMRproviders.OneofthosereasonsisthatNextGenisabig
company,with50,000users,ispubliclytraded,andhasnodebt.Inaddition,NextGenwouldnever
outsourcesupportfunctions.Althoughtherearemany
EMRcompetitors,theresnostability,theycouldget
boughtoutatanytime.Thekeyadvantageoflarge
providersistheirabilitytohavesystemsinplaceto
ensuresuccessforthephysiciansandclinic.Youdont
skimponEMRsoreyesurgery.
therearelotsofreasons
peoplearentchoosingother
bigEMRproviders.
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WithregardstotimeframeofafullNextGenimplementation,Iwastoldtoexpect46months,andto
bewaryofanycompetitorpromisinglessthana4monthimplementation.Aftersigningacontract,a
projectmanagerisassignedtothepractice,followedbyonlinetutorialsforthepracticemanagerand
threedaysofonsitetrainingforsuperusers.HerecommendedaphasedimplementationPMfirst,thenEMRasopposedtoabigbang(bothatonce).IwastoldtheentireEMRbuyingprocessis
verymuchaconsultativesalewithaneedtofindagoodfitandestablishsolidchemistry,followed
upbyarequesttomeetinpersonbeforeprovidinganypricinginformation.
Afterseveralfollow-upcalls,IreceivedaNextGenquote12workingdaysafterinitialcontact.Iwastold
NextGenoutsourcesitshostingservicestoDell,andwasgivenarecommendationforaproviderof
hostingservicesatlowercost.IwasremindedofthebiggestscareofotherEMRsystemsiswhat
happenswhentheygetacquired.Thequoteincludedanestimateforon-sitetraining,whichhasan
optionofbeingprovidedoff-sitetoreducecosts.
PracticeFusionIcontactedthesalesdepartmentontwoseparateoccasions-oneanaccountmanagerandonea
businessdevelopmentcontactleavingavoicemailforeach.Onathirdattempt,however,Ireacheda
livesalespersonandfoundthemtobewell-trainedandknowledgeableabouttheproductofferingand
industrytrends.ThesalesexperiencewithPracticeFusionwasnotablydifferentthancompetitors,most
likelybecausetheirEMRserviceofferingisfree.Withregardtoimplementation,Iwasinformedthereisnowaitingtime,nodelay.
Trainingisprovidedon-line,withnoon-sitetrainingofferedbythecompany.Whilethismaybeanissue
forsome,Iwasinformedtherearenumerousapprovedthird-partyconsultantsavailableforon-site
trainingifdesired.
Supporthoursare6a.m.6p.m.withnoadditionalcosts,thoughthereisafeeforhavingasupport
personon-call.e-Prescribing,recordsconversion,anddemographicsconversionareallfree.Although
basicschedulingandbillingfunctionalityisincludedintheEMR,IwastoldthatafullyintegratedPM
solutionwasavailablewithpartnerKareo.ThesalespersonalsoinformedmePracticeFusionwould
guaranteecertificationundermeaningfulusetoensurefederalstimulusreimbursement.
updatesgenerallyonlyhappen1or2timesperyear
notthatoften
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QuestCare360ContactwithanappropriateQuestsalespersonwasdifficult,asIwastransferredbetweenmultiple
contactsbeforefindingthecorrectone.SeveralofthoseIreachedhadnoideaQuestofferedanEMR
product.Ittook10businessdaystofinallyhaveaphoneconversationwiththeappropriatesales
representative.
IwastoldQuestsEMRsolutionisonlyprovidedasanASP/hostedservice,withsupportavailable24/7
andguaranteedresponsetimesdependingontheSLAandseverityoftheissue.AkeybenefitofQuest
EMRisitsinterfacewithQuestLabs,althoughthepracticedoesnthavetouseQuestexclusively.e-
Prescribingisincludedintheoffering,andcanbeimplementedbeforeusingtheEMRoronastandalone
basisaswell.Apracticemanagementsolutionisnotbuilt-intotheEMR.Questhaspartneredwith
anothercompanytoprovidethisfunctionalityavendorhasbeenselectedbuthasnotyetbeen
announced.
Implementationtimewasestimatedat26weeks,dependingonthecommitmentofthepractice,
mostofwhichistrainingtime.Iwastoldthereisnotypicalcontractlengthsomepracticesgo
month-to-month,someuptothreeyears.IwasunabletosecureaformalpricequotefromQuest,but
receivedabasicpricelistforservices17workingdaysfrominitialcontact.
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Conclusion:
ThepricequotesforEMRlicensingfees,implementation,andannualmaintenanceasgatheredforKafka
Clinicvariedfromfreeto$100,000ormore.Pricepointsatthehigher-endsuggestanEMRindustry
focusedontheneedsoflargebusinesses,leavingthe80%ofUSphysicianspracticingingroupson9or
lessinadifficultpositiontoweighthelureofgovernmentstimuluswiththecostandbenefitofEMR
adoption.Despitebeingasoftwareproduct,thegreatestsalesemphasisisplacedontheservice
componentsofimplementation,support,andmaintenance.
AphysicianpracticelookingintoEMRadoptionshouldbepreparedforalengthy,relationship-based
salesprocess.Gatheringpriceinformationisdifficultandtime-consuming,whileapples-to-apples
comparisonofproductfeaturesposesanevengreaterchallenge.Afteramonthofinvestigatingvendors
IhaveabetterideaofthecostofEMRadoptionbutstillunabletodifferentiatebetweentherelative
valuedelivered.IhopethisreportprovidesausefulstartingpointforEMRvendorevaluationand
insightintowhattoexpectfromthesalesprocess.
Bestofluck!
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