Want to acquire an EMR Vendor: Look out for these points:

Considering the Electronic Medical Records space is heating up across the globe, and in India too in the coming 5 years there should be some Big Groups like Reliance entering it, lets look at what a Corporate Biggie looking at entering the EMR space via an acquisition should look for in an EMR Product.

The guys at Software Advice linked me to this very interesting article on their site by Austin on Intuit and a possible acquisition by them in the Health IT segment and requested a few added opinions on the same. http://www.softwareadvice.com/articles/medical/intuit-health-1042511/

Since Austin has done a fantastic job at listing the qualities Intuit should be looking at in an EMR Product for acquisition, lets list them out before going further:

• Low price point product -
• Dead-simple UI -
• Friendliness for cash-based practices -
• Web-based deployment -
• Large market share / brand name -

In case the strategy is to go after Physicians and 1-3 Member clinics as mentioned in the article, most of these points are a given. The price point being low should not be an important factor in case there is a substantial subscriber base of Physicians - the eventual target market.

I'll look more at things to cover which if not looked at can and will lead to issues in the future:

1. Is it just an EMR or does it also help a physician do his job better? 

There must be enough reason for a Phsyician to use this EMR as against pure digitization of records. Here is a list of a few features that help Doctors run their practice more efficiently:

• What Patient Safety features are provided?
• Are there Medico Legal Safety features to protect doctors against suits?
• Does it allow operation for patients as an EHR ?
• Does it allow Physcians to export Clinical Statistics and Trends which can be used in Presentations, Research papers or simply better planning.
• Does it offer Administrative advice like a Hospital Information System does?
• Can it generate Email and Text Messages alerts, Birthday and Anniversary Reminders, have some CRM functionality.
• Can the doctors, nurses and staff have Intra-Team chats via the product.

(This list is compiled from requests by doctors who have been using an EMR for a minimum of 2 years)
One point which I'd also like to add is Does it interface with 3rd party PHR's or Patient Portals?
 

2. How does the EMR vendor provide training and after sales support? This is an important factor which directly influences the percentage of Physicians which will stay on with an EMR vendor in the long term. 

• Does the EMR vendor have a ticketing system?
• Does the EMR vendor allow issues to be reported via the Phone to a person?
• Does the EMR vendor provide Live and Online Support?
• Can the EMR user simply email the issue with possibility of attaching a screen shot?
• Does the EMR vendor have a Dedicated Training and Help portal with html and audio visual Training Aids?
  
• Does the EMR vendor provide a DVD with audio visual aids for Training?

3. How does the EMR vendor collect feedback and feature requests. Health Care IT is still a nascent idea irrespective of the billions being pumped into it. As the user base grows, the improvements and feature ideas that this increasing mass of users provide will change how EMRs are built and function over time. If the EMR vendor you pick does not do it, some one else will.

P.S. Plus91 runs a Pain Point Analysis program for Physicians in India and we get almost half a dozen ideas each month. Every 6 months we go through that list of ideas to evaluate which of them should be the next feature to put in. This program lets us "Help Doctors Help Us Help Them". Look for an EMR vendor who has been listening to the users and has a dedicated process to solicit and collect feature feedback and requests.

4. How consistent is the EMR firm with regards their Business Model?
Different EMR firms have different Business Models. Comparing Practice Fusion vs AdvancedMD on a parameter like Subscriber Base doesn't make sense. Some have short terms models directed at Sales, other look at Recurring Revenue via SaaS and Value Added Offerings, while others look at real long term offerings based on Data Mining and Trend Analysis. Whatever be the model, consistency is important.

5. How future proof is it: The EMR and the Vendor? 
Its important to look for an EMR company which is thinking ahead and is building its products influenced by the future. Look for mobile friendliness and features for a smart phone offered by the EMR, Does it have a smart way of integrating Social Media while following privacy norms.

6. Flexibility ???:  Flexibility may mean ability to modify the UI, enhance the product features, add newer modules. Physicians and small practices usually don't have their requirements clear and these do end up varying over time. A flexible EMR permits additions and modifications to be made quickly in the future. Look for an EMR product which is flexible, modular and offers the scope for improvement. Note, that this is a very tough ask in spite of how simple it sounds. Too much focus on flexibility can easily lead to a non-product.

Useful Links:

Technology For Doctors

Physician barriers to EMR Acceptance 

A Blog on EMR and EHR

Prayers for Japan and Learnings for everyone on the benefits of National Health IT Policies

The past few days have involved almost all of us praying for Japan which was ravaged by a severe earthquake and tsunami. Japan's most powerful earthquake in 140 years struck the north-east coast on March 11^th 2011, triggering a massive tsunami leaving behind many homeless and stranded. (Information and Situation Report from WHO)

As we continue praying for hope in Japan, we are also learning all we can about how disasters can impact the way we live and seek to improve. Sadly, Japan now faces severe logistical problems and with the latest news on the mishap at a nuclear reactor, the situation only seems to be getting worse. While Japanese officials have more pressing issues on their hands, a problem that will arise as time progresses will be that those left alive may find themselves without their medical records. Natural disasters wipe out everything — including paper medical records as well as computer and communication networks.You can setup the network again, but you can't bring back the paper.

In this time of national crisis, it would have certainly been helpful for Japan to have a robust Healthcare IT network in place. A collaborative one where it is easy to share data, which is securely backed up redundantly in multiple locations that would leverage geographical diversity as a means of countering nature’s unpredictability: Geographical Division Multiplexing if you please;

While Japan does have a Healthcare IT strategy setup, with benefits and stimulus funds, it is relatively new and yet to mature. Health data digitization and Electronic Record Keeping is still in its infancy. Japan does not boast of large scale Electronic Medical Record coverage.

Wouldn’t any country ride out disasters better with health data sharing in place? This should be taken as a wakeup call as well as a learning lesson by all nations which haven’t yet devoted time and money to setting up Nationwide Health IT Infrastructures.

India for one must be looking at learning from this.  Having a Nationwide Health IT Strategy should be treated as important as a Tsunami Alerting System (TAS).  Purists will argue that a Nationwide Health IT System is not intended for alerting and helping contain situations like the TAS. And they are not completely wrong. 

In many cases it has been observed that long term benefits are eventually forgotten. Instead, this concept of “Long Term benefits” must be replaced with Pre-planned Goals which must be “Sought” on maturity of a model.  Now, any system can provide a set of benefits directly on implementation, and an additional set when it has matured.

Similarly, the use case of using a Nationwide Health IT System for predicting and alerting requires a certain amount of usage at first.  A sophisticated and mature Nationwide Healthcare Network built using technology can identify the emergence of possible pandemics. Trends in symptoms can help identify risk areas, and collaborative diagnosis can help is sharing treatment plans and improving them.

One must understand that if maturity of a network is required for additional goals and since that takes time, one must seek to implement early. 

Links of Interest

WHO Page on Environmental Health in Emergencies

WHO page on Myths and Realities in Disaster Situations