By: Anne Zieger

At first glance, you wouldn’t expect much frivolity from a company with a sober name like Medical Informatics Engineering. As it happens, though, MIE – and subsidiary NoMoreClipboard.com – are the powers behind the most pointed satire to target the EHR industry in, well, forever. For years, MIE secretly maintained the fictional corporate site for a bloated, arrogant EHR vendor dubbed “Extormity” (the EHR “at the confluence of extortion and conformity”). The parody was a hit, so much so that when MIE announced that it was behind the site, the disclosure was covered by the Wall Street Journal! CEO Bruce Lisanti says the project, which is still online, has serious points to make. In the Q&A below, he discussed the ideas behind Extormity, the EHR market and how physicians should size up vendors.

 

What provoked the Extormity project?

It’s a parody, but it’s also a reality. You could talk about 10 different companies that charge a fortune for their products -- take Epic, which basically says “Give us $40 million and five years and we’ll see if you’re good enough for us.”

This big-vendor mindset is gradually hitting doctors. A lot of clinics are being acquired by hospitals, and then doctors are being forced to use whatever system the hospitals have. Then all of a sudden doctors are installing Epic or GE or McKesson, and they can only see half as many patients for six months. More and more physicians are going to face this.

We wanted [IT administrators and doctors] to understand that they didn’t have to be in a tethered, siloed system. You ought to be able to share info with other entities, and it shouldn’t have to be a custom environment every time you share.

The concept behind Extormity is thinking about where we want to go and should go – an open, connected environment. As an industry there’s no reason we can’t do it technically – it’s about turf wars and silos and people protecting their mega-products. We wanted people to think “It doesn’t have to be the way.”

So doctors shouldn’t fall for walled-in products. What should they think about when shopping for an EHR?

One of the marks against EHRs over the years is that they’ve been very inflexible and very inefficient. People have spent hours on keyboards entering vitals, say, and then they can’t spend it on their patient.

Many, many EHR vendors are going to say, “Here’s our templates for your specialty” but that doesn’t give you choices. If you’re going to implement an EHR, you should realize that you can keep practice workflow as is, if you’re happy with it.

The truth is, a lot of doctors don’t want to point and click – maybe they want to dictate, or scan in notes. If they want to have an assistant use a keyboard, great. The system should work the way the doctor wants it to work. The EHR should complement the practice. They shouldn’t be forced to go something that upsets their practice.

Ultimately, if you can’t both capture information and improve patient care, there’s no point in it. You want to improve patient care and reduce cost. If an EHR costs more and takes away from ability to see patients, that takes away from what you want to achieve.

What features would you be looking for if you wanted to buy an EHR?

For starters, I’d look for an EHR that’s easy to install, flexible and doesn’t require any IT support. They should make sure they can get as little or as much service and installation support they want.

Ask: Is it Web-based? You don’t need local servers or IT support. Can you access it with an iPad or smart phone or other things?

Doctors should find out whether it will easy for them to develop a template or use their own forms. They’ll find that most companies out there are “take it or leave it.”

I’d also look for references. And a guarantee – that they don’t have to pay a cent until they get their first Meaningful Use check.

 

Don’t only look at cost—that’s a mistake – as the cheapest solution mat may not be the best solution for a practice.  In the EHR world, you’ll see systems that are free, some $1K per month plus installation expenses. I’d look for vendor that offered me a guarantee if I didn’t like it. 

 

Remember cost quotes on the front end can be misleading. Don’t look at just advertised monthly cost – find out what the total cost will be to get MU reimbursement. Even a system that doesn’t cost anything per month, are you going to need to bring in a consultant? What does it cost to connect to LabCorp or Quest?

Make sure the system you put in is more than paid for by reimbursement. One of the ways practices get caught is that they think they’re getting a real cheap system up front, but then as they add up integration costs, integration with labs, e-prescribing and so on, they didn’t get a good sense of total cost.

 

The bottom line is that if I’m a single doc, I can’t afford a $20K mistake.  I would look for a company that offered me the flexibility I wanted, so I could retain the integrity of my practice and I wouldn’t have to go through major upheaval.

So, once the Meaningful Use dust settles, what's next for EHRs?

We have a huge opportunity to improve healthcare by simplifying the flow of information.  If you’re a patient you ought to have access to your records; you shouldn’t have to fill out forms on that clipboard. Filling it out twice is too many.

We ought to be able to make information more accessible and take a lot of duplication out. If we do that we’ll be able to take a lot of the cost out.