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Making It Work

March 1, 2006
by Pedro Rivera
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Are vendors from Mars, clients from Venus?

The vendor-client relationship is often compared to a marriage. There are compromises, and sometimes things are done to keep the status quo. At any given time, either party might feel they are not getting enough attention. Sometimes they are asked to do something that costs money, and they are not sure if they should just take the other's word for it.

If the above rings true, then it's time to assess your relationship — your vendor relationship that is. I have heard many clients lament the fact that their practice management system is too customized. Over the years, they have incorporated certain changes to the application to get it to do what they needed or thought was necessary at the time. Changes in staffing and leadership produce fresh eyes that look at the system and they wonder: what were they thinking?

The need for change is often raised when your vendor wants a new upgrade or operating system and you feel that you are not given a choice in the matter. There are sound reasons to upgrade your application. Most software vendors take common custom coding requests and client user group input and package them as new software versions.

As the consumer, you need to decide if the new features are worth the upgrade and what impact it will have on existing customization and internal workflow. The vendor does not understand your internal workflow, they simply provide software tools to tweak the revenue process. However, do you understand your workflow and the impact on new software tools?

Workflow mapping and procedure development is a painful process. It is one of those action items that gets left behind because you are too busy putting out the daily fires. The sad truth is that it is the key process in determining revenue bleed and sets a foundation to help you decide if you're using the right tools for the job. The axiom of the right tool for the right job can apply to the software tools used to collect, process, report, generate and apply financial data.

First things first

A good place to start is a systems review. How are you using your current systems and what features are you lacking? What processes are not being captured and what are your project wish lists? If you're getting ready to make system changes, upgrades, purchase multiple modules or maybe even take the electronic health record leap, then you owe it to yourself to exercise some due diligence and seek RFPs from other vendors. You might be surprised at how competitive some vendors can be when you have a full system approach, including an EHR.

Knowledge is Power

It's important for organizations to take a step back and reanalyze their current practice management system before hitting the market. First off, do a Google search on "practice management systems" and you will be overwhelmed by the choices. Then, ask a series of questions:

  • Why is your current system the right one?

  • When was it purchased?

  • What were the key features and financial challenges facing your organization when the system was purchased?

  • How much growth have you experienced since the system was first installed?

  • What organizational changes have been made since the system was first installed?

  • Is it meeting your strategic goals?

If you're not sure or you feel that your software tools have not kept pace with your organizational changes, it is time to do a comprehensive assessment. — P.R.

A clean slate gives you an opportunity to match organizational requirements, policies and procedures to a new set of tools. It also enables you to get to that paperless environment that's been promised for the last 20 years. It will enable you to merge automated clinical tools to financial capture. Your staff will be working with 21st century Web browser-based applications, decreasing training time and increasing productivity. Processes that were done because "that's the way we have always done it," will be uncovered and improved with new tools.

So now for the downside, your staff will fear and will not entertain process changes because they are good at what they do. The recognition of solid skills and expert knowledge comes from many years of working with the software system. Look at any heads-down charge-entry clerk or a finance (billing and accounts receivable) super user and they can run circles around software vendor trainers because they use it in the real world.

However, bring up the possibility of a new system and watch the stress level go up. Will they be able to understand the new system? Will they still be the "go to" person when things don't work right? Will they be able to rattle off new dictionary and financial classification numbers in their sleep? These are real questions and concerns that have to be addressed as part of any system change. Remember the marriage analogy? Well in this case you need to be prepared to provide employee/staff counseling and workshops for your vendor divorce. You also need to be able to filter their input with the understanding that they may not want to change because of personal reasons, which may be contrary to organizational financial goals.

Keeping score

After you send out RFPs and collect responses, be prepared to score them and assign weighted averages based on key features critical to your revenue flow. Look at integration with EHRs, external labs, PACS and electronic prescription clearinghouses. These are critical for future growth.

If you like what you see, make sure that you get some solid ROI data and case studies that you can verify. If you're not versed in the latest bits and bytes terminology, make sure your technology team reviews proposed hardware and interface solutions for standardized platforms and supportability.

Put a group together empowered to make key decisions and review your goals and preferred outcome. Schedule some calls with the vendor's clients and have some prepared questions and scoring sheets. If evaluating EHRs is part of the solution, make sure your physician champion is involved every step of the way.

Get the list down to two or three vendors. Schedule the demos and give the vendors prepared scenarios that fit your organizational workflow challenges. Have both practice management and clinical scenarios to simplify the process of comparing the products. Have scorecards ready for the evaluators, but keep it simple enough to tally and collect data. At the end of the demos, you will have verified ROI data, hardware requirements and costs and evaluated scoring of the application features. And, best of all, you will have achieved a much better understanding of current software capabilities in the market.

You will also be able to determine if enough excitement over improved revenue and productivity has been generated in your organization, or if it's time to talk to your current vendor about improving their application and service offerings. You will be better educated about features and capabilities that you know will improve your cash flow. They will know you were looking and will be more eager to offer improvement solutions. So whether the result is divorce or marriage counseling, either way you're bound to come out much better in the end.

Author Information:

Pedro Rivera is a senior healthcare consultant with Hayes Management Consulting, Newton Centre, Mass.

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