EMRBIG BOX DISSATISFACTION

Pushes Demand for Specialty Specifi c Systems

ONE SIZE DOES NOT FIT ALL

WHITE PAPER

ONE SIZE DOES NOT FIT ALL

Due to the unique needs of specialty practices, the

majority of these providers are dissatisfied with their

general practice electronic medical record (EMR)

software. In fact, according to a recent IDC Health Insights

report, 58 percent of providers are disappointed with their

system’s usability, and 66 percent stated that because of

increased documentation and lost productivity, they are

seeing fewer patients. Because of this discontent, specialty

providers are seeking out customizable, specialty-specific

EMR solutions that meet the unique workflow needs of

their practice and of each individual within the practice.

Similar sentiments were expressed in a 2013 Black Book

survey, where managing partner Doug Brown is quoted as

saying, “Some popular one-size-fits-all EMR products

have not met the needs of several specialists and

cannot continue to satisfy their client base with a lack

of customizable or bespoke tools.” This Black Book survey

asked the question, “Are you seeking a vendor who has

demonstrated capabilities and success with practices in

your specialty as a replacement EMR?” The response to the

question was staggering—92 percent answered yes, one

percent said no and seven percent were unsure. The results

of this survey clearly show the demand for customizable,

practice-specific solutions.

General Practice EMR Dissatisfaction Pushes

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TARGETED FEATURES FOR UNIQUE

SPECIALTY PROVIDER NEEDS

The reasons for dissatisfaction are as diverse as the users’

expectations. Depending on the specialty, size of the

practice, organizational structure, business processes and

the technological knowledge of the staff, each provider

expects different functionalities. However, with many

general practice EMRs, providers are forced to adapt to

the systems’ predesigned structures, rather than have the

solution meet their unique workflow.

While this varies by practice, there is a range of features and

capabilities that specialty providers find extremely valuable.

In the aforementioned IDC Health Insight report, the top

reasons for implementing an EMR were:

• 82%: to achieve a reduction in the number of lost or missing charts.

• 75%: the ability to access medical records remotely.

• 56%: to earn incentive payments.

However, after implementing general practice EMRs, many

practices’ needs are not met, and as a result, providers tend

to abandon their systems.

TARGETED FEATURES FOR

Demand for Specialty Specific Systems

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85%Spending more time

on documentation2

66%Seeing fewer patients3

58%Specialty physicians said they

were dissatisfied with their

system’s usability

SPEED of Documentation

and PATIENT VOLUME

TOP REASONS SPECIALTY PHYSICIANS

WERE DISSATISFIED WITH THEIR EHR:

34%were very dissatisfied

with the ability of their

EHR to decrease workload

32%of respondents had not

“returned to normal

productivity” compared

to 20% in 2010

37% in 2012 were dissatisfied

with the EHR’s ease of use

OTHER RESULTS

FROM THE SURVEY INCLUDE:

82%Reduction in the number

of lost or missing charts

75%The ability to access medical

records and work remotely

56%Incentive payments

TOP REASONS SPECIALTY PHYSICIANS

WERE SATISFIED WITH THEIR EHR:

Accessing Patient

Information

Documenting Care

ePrescribing

Viewing Labs and

Diagnostic Tests Results

Entering Orders

1

2

3

4

5

DOES YOUR SYSTEM WORK

WITHIN YOUR WORKFLOW?

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CUSTOMER RELATIONSHIP MANAGEMENT

One key feature that many specialty practices look for

in an EMR vendor is an integrated software solution for

marketing that allows the practice to utilize its EMR as a

customer relationship management (CRM) system. This

is especially important to specialists that deliver elective

procedures, so that they can reach out to their customers

and market their practice. This type of software module

provides the ability to evaluate business development

activities, such as calculating the return on investment

(ROI) from marketing efforts and tracking patient referrals.

This system also includes tools to calculate business ratios

that help practices make decisions on advertising budgets

based on consult-to-patient conversion rates and revenue-

to-expense graphs for different referral sources, which can

become a significant revenue driver.

MOBILITY

Furthermore, as stated in a recent article by Medical

Practice Insider, specialty practices, especially surgeons,

also have much higher patient volumes compared to their

generalist counterparts, which makes it even more crucial

that they are able to improve efficiency. Because of this,

many specialty practices require an EMR system that allows

them to chart and document anywhere and in real time,

using mobile devices like an iPad. In addition to being able

to walk from room to room without having to log in to a PC,

the iPad camera allows specialists, such as dermatologists

and ophthalmologists, to capture, store and retrieve images

for clinical documentation. This mobile capability based on

tablet technology allows physicians to chart almost as if

they were using paper, which is an important feature for

some specialty providers. The wireless connectivity of a

tablet also gives physicians anywhere, anytime access to

patient data and scheduling information.

INVENTORY

Ophthalmologists, plastic surgeons, dermatologists and

several other specialty practices also have a critical need

for an inventory management solution. For example,

ophthalmologists need to send and order directly from

their EMR to their optical shop software. With this capability,

when a patient walks into the optical shop to pick up their

prescription, the order has already been placed and the

practice has essentially “captured” that person in their own

optical store. This is a huge convenience for patients and

a major source of revenue for the provider; in fact, optical

dispensaries account for about 45 percent of the total

revenue in a dispensing ophthalmology practice, according

to a recent Review of Optometric Business report. Without

this integrated capability, ophthalmologists can lose a

significant portion of their optical shop revenue to discount

chains or stores.

Because of these unique needs, having an EMR and practice

management system that is optimized to each specialty’s

workflow, meets their unique practice requirements, and

allows them more time to see patients is highly desirable.

Integrated Software Solution

An EMR and practice

management system

that is optimized

to each specialty’s

workflow, meets

their unique practice

requirements, and

allows them more

time to see patients

is highly desirable.

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Anytime, Anywhere Access

CUSTOMERRELATIONSHIPMANAGMENT

patient engagement

practicemanagement

emr

inventory

revenuecycle

managementanalytics

marketing

In addition to improving workflows and efficiency,

increasing coding requirements and additional

practice management needs have added an extra layer

of responsibility to providers’ job functions. Indeed,

it represents their chief complaint with regard to general

practice EMRs or hospital EMR solutions, which were never

designed for specialty providers and were made to be all

encompassing, rather than customizable. These general

practice EMRs, commonly referred to as “big box” EMRs,

were designed to meet the lowest common denominator

and work for everyone, but in reality, these EMRS cannot be

all things to all people.

With general practice EMRs, providers have to develop

“workarounds,” which typically involve a great deal of typing,

dictation or even transcription of charting information and

data. With practice-specific solutions, time-consuming

workarounds are unnecessary, and providers can finish

their charts as they complete their patient encounters, sign

off and create a bill or order simultaneously.

Another issue for specialty providers is that there are

uncertainties around how to improve patient care in their

particular setting if they don’t have an EMR solution that

is customized to their practice. From their perspective,

many of the big box solutions they struggle with often

generate a disjointed patient record. One of the key

drivers in improving patient care for a specialist is having a

practice-specific solution that can store, track and manage

a complete record of their patient’s medical history. With

the growth of specialty practice solutions, finding the right

EMR and practice management system is becoming an

ever more critical business decision.

Every Minute Counts: Solutions Made

For most specialty

practices, every

minute spent on

documentation,

placing orders,

billing and other

tasks means less

time with patients,

so speed and ease

of use are crucial.

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When selecting an EMR, providers should carefully

consider the following questions and issues, such as:

• How will the software help the practice run more efficiently?

• Is the EMR fully integrated with the practice management system and additional modules, or is it composed of multiple systems?

From a technology perspective, “fully integrated” means

that the entire system is running on a single database.

Solutions that are not single-source may have much of

the specialized functionality that might be required for the

practice, but it won’t be particularly helpful if physicians

and staff have to log out of one module in order to log in

to and access another. For most specialty practices, every

minute spent on documentation, placing orders, billing

and other tasks means less time with patients, so speed and

ease of use are crucial.

The software modules such as inventory control,

marketing, mobility and imaging should all work

together seamlessly with the practice management

component. During a demo of the software, the solution

provider should be able to clearly show how this works.

Another very critical issue to inquire about is how much

specialty-specific content the software company is able to

provide with their solution.

AN INFORMED INVESTMENT: Ask the right

questions to select the best solution for your practice.

In a 2013 Black Book report, providers overwhelmingly

noted that their current EMR did not meet their needs and

79 percent of respondents attributed this discontent to the

fact that they did not adequately assess their own needs

before choosing a vendor. In this same report, 92 percent

of specialists now say that they want clear proof of success

before signing a new contract.

As such, it is important that physicians are fully prepared

to ask the right questions during a vendor demonstration.

For example, physicians should provide their own clinical

case studies and ask to see them incorporated into the

software demo. Another aspect of preparing for a software

demonstration is to ask a software vendor to show how

they can create a template for the most frequently used

CPT codes used by a practice. Many specialty practices

use a relatively small number of codes in the course of an

average day. In addition, providers should ensure that the

EMR is able to customize various templates to meet their

workflow and that the staff can be trained to quickly and

easily create their own templates.

with Specialists’ Time in Mind

Big Box v. Practice-Specific THE BIG PICTURE

SPECIALTY SPECIFIC

Customizable to the practice and providers needs.

With practice-specific solutions, time-consuming

workarounds are unnecessary, and providers can finish

their charts as they complete their patient encounters,

sign off and create a bill or order simultaneously.

Practice-specific solutions can store, track and manage a

complete record of their patient’s medical history

BIG BOX

Designed to meet the lowest common denominator

and work for everyone.

Providers have to develop “workarounds,” which

typically involve a great deal of typing, dictation or even

transcription of charting information and data.

Generates a disjointed patient record.

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NO TWO PHYSICIANS

CHART THE SAME WAY

Every provider has slightly different documentation

and charting methods, and the ability of the software to

map to their personal preferences greatly enhances their

satisfaction with the solution. As mentioned in a Health

Affairs article, for example, most clinicians need to chart

the same information within a practice, but physicians

vary greatly in how they document progress notes. Some

doctors prefer to dictate their notes directly into the EMR,

while other users prefer to type data to templates and

electronic forms.

A truly customizable solution should utilize flexible

templates to customize charting and workflow to meet the

needs of every user within a specialty practice. A system

that is not properly customized could lead to fatigue and

can cause physicians to use the system improperly, in turn,

making it difficult to qualify for meaningful use incentives.

THE IMPORTANCE OF PERSONAL,

INTERACTIVE TRAINING

As cited in a 2013 report published in HealthLeaders, EMR

implementation alone was not enough to improve patient

care. Researchers reported that it took physician practices,

a minimum of nine months of EMR exposure, combined

with eight or more site visits to demonstrate any significant

statistical improvements in key quality measures.

This highlights the need for personalized, interactive

training that allows staff to learn how to customize a

template so that it precisely meets their charting needs

and workflow preferences. This training methodology not

only creates the templates that each person needs, but it

teaches them to quickly and easily customize or modify a

template that they might want in the future.

The ability of the

software to map to

physician’s personal

preferences greatly

enhances their

satisfaction of

the solution.

Preparing for Success with Customized

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As a part of this training, EMR specialists should work with

all of the staff members to implement the workflows that

each person in the practice wants. This allows each user

to see and learn exactly how each template is modified

according to what they have requested.

SUPPORTING EMR GO-LIVE

WITH A PARTNERSHIP APPROACH

The go-live phase of an implementation is arguably the

most important time period in the process. If there are

any software problems, the practice may be at risk of not

being able to see or treat patients until the technology

issues are resolved. Additionally, if there are “blind-spots”

during rollout, many organizations will have to go back

and resolve problems later down the road, resulting in an

even longer time period of decreased productivity. Having

highly experienced support experts present during the

implementation ensures that software problems can be

fixed immediately without disrupting daily operations.

Based on training recommendations from the Washington

and Idaho Regional Extension Center (REC), practices

should look for a vendor whose standard implementation

process includes sending an expert team to provide hands-

on, technical and clinical expertise to ensure there are no

software roadblocks or workflow problems that might

prevent the practice from operating at peak efficiency as

soon as they go live. Before the team leaves the practice,

their commitment should be to ensure everyone is able

to effectively use the charts and templates they helped

create, that the practice is operating smoothly with the

new system and that everyone’s questions have been

thoroughly addressed. The ability to provide this level of

personalized support and on-site technical troubleshooting

is a key component that Nextech customers often mention

as standing in stark contrast to their experience with big

box vendors.

Solutions and Personalized Training

A truly customizable solution

should utilize flexible templates to

customize charting and workflow

to meet the needs of every user

within a specialty practice.

Having highly experienced

support experts present during

the implementation ensures that

software problems can be fixed

immediately without disrupting

daily operations.

The ability to provide this level

of personalized support and on-

site technical troubleshooting is

a key component that Nextech

customers often mention as

standing in stark contrast to their

experience with big box vendors.

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FINAL TAKE-AWAYS

FOR SELECTING AN EMR VENDOR

Selecting an EMR is more than choosing a list of

functionalities. Providers need to ensure that the system

fits in with their workflow and day-to-day operations. When

a system is personalized and tailored to fit the unique

demands of a specialty practice, it can become a powerful

tool that not only drives improved care and efficiency, but

also supports business goals through marketing modules,

inventory control, imaging capabilities and mobility,

to name a few. It is imperative that providers take time

selecting the EMR that is right for them and that they make

sure their vendor is committed to supporting them not

only during implementation, but for the long term success

of their practice.

Choosing the Right EMR

FULLY INTEGRATED

MOBILITY

Mobility and efficiency are even more

critical with the higher patient volumes

compared to generalist counterparts. DON’T BE BOXED IN!

Don’t Settle for the rigidity of a

Generic Big Box EMR!

DON T BE BOXED IN!

One Size Only

One Way Only

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1. New IDC Health Insights Survey of Ambulatory Providers Reveals Dissatisfaction with Ambulatory EHR . Retrieved from http://www.meddatagroup.com/idc-health-insights-report-ehr/

2. http://www.healthcare-informatics.com/news-item/ambulatory-providers-dissatisfi ed- ehr-systems-survey-reveals#.UuAa2xAMexw.email

3. http://www.meddatagroup.com/idc-health-insights-report-ehr/

4. EHR divorce: What’s driving dissatisfaction? Retrieved from http://medicaleconomics.modernmedicine.com/medical-economics/news/ehr-divorce-whats-driving- dissatisfaction-0?page=full

5. http://medicaleconomics.modernmedicine.com/medical-economics/news/ehr- divorce-whats-driving-dissatisfaction-0?page=full#sthash.ifQXCMCU.dpuf

6. http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_ RR439.pdf

Provider for your Practice

“Use this as an

opportunity to

think very carefully

about what your current

workflow is and how

information technology

can be optimized to

leverage your work

processes.”6

Before jumping full-force into the search for an EMR, make sure

you have put together a thorough synopsis of what your practice

needs from the system of choice. Create a list of these key items

and use it as your scorecard to qualify potential vendors. By doing

so, you are defining a standard for your practice and will be able

to methodically approach the task of finding the most suitable

solution to help your practice thrive and grow.

What do you need?

Marketing

Patient Portal

Patient Engagement

ONC Certified

ICD-10 Compliant

Mobility

Practice Management

Electronic Medical Records

Billing

Inventory

Revenue Cycle Management

Analytics

SPECIAL PRACTICES = SPECIALIZED NEEDS

KNOW YOUR NEEDS

Nextech deploys specialty-focused healthcare technology

for physician practices. As a trusted advisor to thousands of

specialty providers since 1997, Nextech delivers consultative

guidance, professional services and innovative tools that

enable clients to increase efficiencies while meeting their

long-term business goals. The company’s robust solutions

integrate seamlessly with value-added modules to create

a single, intuitive platform that streamlines clinical,

administrative, financial and marketing workflows.

To learn how Nextech’s advanced offerings help

specialty providers succeed in a fast-changing

healthcare environment, visit www.nextech.com.

5550 West Executive Drive, Suite 350 || Tampa, Florida 33609 || p: 866.857.8557 || f: 813.425.9292 || Nextech.com