Consistently earning top marks in KLAS’ small physician practice EMR category, Greenway Medical Technologies seems to prove the point that a limited focus equals increased quality. But will the Siren’s call to tackle larger quarry be succumbed to? And would such an expansion of focus lead to diminished results? To learn more about this quiet but capable vendor, HCI Editor-in-Chief recently caught up with President Tee Green to find out how HITECH is effecting small practice EMR providers.

(Part I)

GUERRA: We were talking about how some vendors are operating on outdated technologies. Is that because you inevitably lose some customers during a major upgrade?

GREEN: Well, that can be a component of it, but it’s also very expensive to rewrite and retrain an R&D team. There are some of our competitors whose whole business has been built around buying a bunch of different products and trying to cobble them together. Well, now they have all these different R&D teams, they’ve got all the different domain experience, so to take all these people and say, “Stop what you’re doing. Rewrite this thing in Web architecture, but make sure it still has all the rich functionality and all the workflow,” is not practical. That’s a difficult process for a company to take on.

We were fortunate enough to come along at a time when we understood the technology platforms and the difference between the interior architecture systems versus a client/server system. I’m not saying we’re any smarter than anybody else, but we arrived at a different time.

GUERRA: When you re-wrote the app in .NET, was it painful?

GREEN: Well, the main thing for us is we spent the first four years in R&D. I didn’t have hundreds of customers whose workflow I had to disrupt. We were at a different time in our evolution than some of these other companies that have grown through purchases.

GUERRA: The one negative comment in the KLAS mid-year report was that you didn’t have the most timely enhancement releases.

GREEN: I’m not sure what the question was that got that response. We do three major releases a year, so maybe that’s not fast enough for some people. I don’t know. We’re pretty methodical on how we do it. Some of that can be how the question was asked.

GUERRA: How many employees do you have?

GREEN: I think we’re around 320 today and growing quite rapidly. We’re partnering with universities for a pretty neat incubator program. We have a pretty big consulting program that can help deliver these technologies, mainly from an implementation and training perspective. As our backlogs continued to grow, we recognized two years ago there’s no way we’re going to be able to hire and train this many people. That’s why you see these regional extension centers coming out. But we did start building a consulting program that has really almost increased our abilities by 100 percent. You’ve got to make sure you’re managing the quality and the training because they’re not your team, so you need to understand and manage that.

GUERRA: We’ve been talking about the HIT worker shortage, so how are you going to keep your people from being lured away?

GREEN: I think you have to create a work environment where people can thrive and be successful and provide for their families, and we’ve tried to create a long-term business plan here at Greenway. So we’ve passed the first 10-year mark in our history and now we’re preparing for the next 10 years. So our business model is if we can find the top talent in the United States and attract them, they can be a part of the organization, be part of extreme innovation in the healthcare industry, provide some really life-saving technologies to the industry. If that excites you, we’re going to reward you, we’re going to compensate you, and we’re going to allow you to be part of this very unique team. If you’re that type of person, you can probably build a career here. So we’ll have to be more attractive than our competition and compete with the regional extension centers.

There are also some people that don’t fit our model. Some people aren’t cut out to work in one business for the next 15 or 20 years. You know, they like to spend three years here, three years there. That’s not the person we look for.

GUERRA: How do you feel about competing against a center that’s gotten $8 million from the government?

GREEN: Some of those will be interesting challenges or hurdles. It will be interesting in communities where taxpayer dollars are going to compete against you, but hey, that happens in other business as well.

GUERRA: Essentially, your tax money is going to fund your competition.

GREEN: Right. Just imagine being Ford. [Laughing] I just think that’s bizarre.

GUERRA: A lot of bizarre things are happening these days.

GREEN: Yes, correct.

GUERRA: How do you engage hospital CIOs and make them aware of your product and make them understand that you should be on their Stark shortlist?

GREEN: First of all, it starts with our customers. Our customers are the number one lead generator for this organization, and our customers are the ones that bring us into the hospital systems in their communities.

I would imagine the worst thing you can do as a CIO is to recommend an EHR platform to your community physicians and see them struggle mightily during deployment because then it effects the whole relationship between the hospital and the physicians. And so one of the things that we bring to the table is a track record that our customers are more successful, typically, than our competitors because of our technology platform and our implementation processes. That way, you as a CIO can be assured that not only can you offer state-of-the-art technology, but you can offer a platform that your physicians are going to be successful using. And that means they’re more likely to electronify faster than the competition.

We think there’s a difference between electronifying information and liquefying information. There’s a lot of electronification taking place today in the country. There’s not much liquefying of information, and that means you’re going to have to be able to exchange information very efficiently and very securely in any format, in any security protocol.

So point-to-point interfaces don’t work, and that’s how we built our exchange portal. It allows us to take information from our customers, route it to any hospital, any lab, registry, clinical trial and do that automatically, managed by Greenway, rather than having to write point-to-point interfaces that create havoc in the industry.

GUERRA: Speaking of liquefication, what are your thoughts on CCHIT, the Drummond Group, and certification in general?

GREEN: It is a challenging environment for any of the vendors. The way I look at it, I have to have twice the amount of R&D budget that I normally would have, and I’m going to need X dollars to develop what Washington wants and X dollars available to develop what my customers need. So it’s whatever you would normally spend on R&D times two.

I’m going to make sure that I clear the hurdles of CCHIT and anything that comes from HHS, whether it’s interoperability or meaningful use. Those are the things that are requirements. Those aren’t optional things for us. So I have to be prepared for that, but I’ve also got a huge customer base that has needs in their business exchange, and they’re expecting innovation. So you’ve got to look at your project plans. I mean, half of it goes to Washington and half of it goes to customers. So you really got to have some resources to do that.

And then going back to the certification bodies themselves, it will be challenging for the industry if there’s multiple certification bodies. In my opinion, there needs to be one. It needs to be CCHIT; they’re the ones with experience. Believe me, just running test scripts is one thing, implementing these tests is highly complex. It takes a tremendous amount of intellectual property to actually conduct these tests. They have to be extremely smart. They must have done this a number of times to be any good at it. You can’t just hire some people off the street and say, “Go test some products.” So I would encourage us as a country to get behind one certifying body. Hopefully, CCHIT will continue to be the gold standard.