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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!