Never before has the ambulatory EHR landscape been of such importance to the acute-care CIO. With the relaxation of Stark a few years ago, some savvy health systems began underwriting EMRs to independent practice in their areas. While HITECH threw the market a curve ball that temporarily slowed down the Stark snowball, it has recently picked up apace. Most now realize that integrating with local physicians, and the guaranteed patient flow they constitute, is all-important to maintaining a robust market presence in the coming decades. To learn more about how HITECH and Stark are effecting ambulatory EHR vendors, HCI Editor-in-Chief Anthony Guerra caught up with NextGen President Pat Cline.
GUERRA: Let’s talk a little bit about your KLAS scores. Both your scores and your primary competitors scores seem to be trending downward. What do you make of that, and what, overall, do you think of KLAS scores?
CLINE: We pay attention to our KLAS scores but, frankly, we pay far more attention to our own internal studies. We have a dedicated department of people within NextGen Healthcare that survey every customer – not with a written survey so that they only get so many back – but a department of people whose jobs it is to get every customer on the telephone during the implementation, after the implementation, and then periodically thereafter, and we poll our customers on all kinds of different quality and customer satisfaction metrics. We do that because we’re very serious about quality and serious about customer satisfaction, but again, we do pay attention to the KLAS scores.
I think there are some nuances to reports or third-party surveys like the KLAS report that people need to understand. For example, if one system has hypothetically 500 features and another system has hypothetically 20 features, you may find that the customers are purchasing that 500-feature system would have slower implementations, so there would be more difficulty implementing that type of system than a very simplistic system.
So for example, if NextGen Healthcare’s system comes with interoperability to community data exchanges, and provides PQRI reporting through registries, and supports Patient Centered Medical Home, and interfaces to Quest and Labcorp and other hospital labs; and another system that might get delivered to the same size practice doesn’t support any of those things or has very, very limited support, it may be that that system – the less feature-rich system – is far easier to implement, and would probably fair better in the KLAS survey or ranking than a system that’s extremely feature rich.
That’s not an indictment of KLAS but more to point out the nuance and the reason we feel it’s critical for us to maintain that department of people who poll our customers with all the metrics that we feel are important.
GUERRA: Do you speak to KLAS about your scores?
CLINE: We do.
GUERRA: So they’re willing to have those conversations.
CLINE: Yes, they’re very open to having conversations. They’re doing the best job they can and it’s impossible for them to cover all of those nuances and to adjust for them.
GUERRA: You’ve singed a number of big deals lately. With the healthcare IT worker shortage in mind, do you have to make sure you don’t take on too much? Do you ever get to the point that you shouldn’t take on another big deal?
CLINE: Yes, we do get to that point and I think we have, in fact, throughout our history turned deals away when we feel we’re not in a position to do a good job, a good quality job. I do see the potential for an increase in the number of deals we turn away. If we can’t do a good job or if we sold too many to where we can’t render training and implementation services on a quality basis, nor can we lean on some of the third-party consultants that you talked about earlier, it’s far better for us to turn the business away than it would be to execute an agreement and do a lousy job. It costs us far more with respect to our reputation, and in many other areas, than we would make on a given deal or sale.
In order to combat what may in the future (and frankly, a lot of our competitors are hoping) will be a tremendous shortage of available personnel, we are doing a lot of things that I mentioned previously. We’re working very hard to make our software easy to use and, in fact, the easiest. We invest a lot in our computer-based training. We do certify third parties. We have opened training centers across the country that help us leverage, for example, one trainer across multiple practices being trained at a time.
GUERRA: How do you protect the good people you have from being poached, and how do you find the people you’re going to need?
CLINE: Well, no one knows how bad it’s going to get, but certainly there’ll be a lot of poaching going on. I think those companies that treat their employees very well in many respects, financially and with respect to recognition and incentives, will fare better. We’re proud that we’re consistently voted in our respective regions as one of the top 10 places to work, and those awards and accolades are based on independent blind employee surveys.
We’re a company that treats our employees well. We try to do the very best we can in listening to them and empowering them and training them, paying them at or better than market, and we’re also a company that believes in incentive pay and paying based on performance, so that the best people in the industry find they be far better working for NextGen than elsewhere.
GUERRA: Regarding the regional extension centers, how can you compete with 70 new organizations for talent when they are funded by the government?
CLINE: I think in the same way, I think we pay based on performance and provide solid incentives and treat our people well and they’ll stay with us. We have probably what we think is the lowest turnover in our business, not just with implementation people, but with software developers as well. In our turnover report – the internal company turnover report that I read – with approximately 100 implementation and training people the turnover in that department for the period I looked at was 0, and that’s unheard of in our space.
Certainly, the issue that you raised where if regional extension centers are essentially engaging in predatory practices and, in fact, abusing the position they occupy with government funds, if they want to pay people twice market or those kinds of things, it would be very difficult for NextGen and our competitors to compete against them for talent. We view it more as how can we most effectively work with the regional extension centers to bring them up to speed, train them, train their new people, in fact, help them to find people the same way we find people; if we can.
GUERRA: It’s going to be critically important for you to make sure that the people running these centers are well enough versed in your product that they feel comfortable essentially, selling it, recommending it. There’s going to be a lot of software purchases that are directed through these centers, right?
CLINE: No question about it. It’s very important to us that we help them to do their very best job.
GUERRA: And will you keep your eye on some trending, in terms of which products are being recommended out of which centers?
CLINE: No question about it. I think everyone in our market will be looking at those things.
GUERRA: Finally, tell me your thoughts on the Grassley letter in which he asked a number of vendors for “complaints and/or concerns from health care providers/professionals and other clients with the HIT/CPOE systems,” among other things.
CLINE: Well, I think the motivation behind the letter and similar letters has come out over time in other industries like pharma, from what we understand. Essentially, I think there are folks in the government who think that, “Gee, maybe we shouldn’t spend this many billions of dollars without having some accountability.” But I think, over time, it could be that some folks in government have gathered or received certain complaint letters from users of electronic health record or CPOE systems, and it maybe that the list (of those who received the letter) came from a complaint list or a complaint log that’s kept in some place. It may be the vendors that did not receive the letter just hadn’t had complaints or had not had complaints yet. There aren’t any such things as bug free systems.
So I think vendors need to do a good job of quality assuring, have quality assurance processes and departments in place, and vendors need to have solid internal policies and procedures having to do with when customers report a bug, identifying whether that bug could potentially represent a patient safety issue, and have formal warning systems and escalation processes and client notification system so that all clients who have that product or that version of the product get notified on a timely basis. My personal view is that the industry needs to come together and create some type of body, either through, or connected to, the EHR Vendors Association or something else. If the industry doesn’t implement all of those policies and procedures and police itself, then the government will.
GUERRA: I was at the CHIME conference last week and a lot of people were guessing that this was all about getting EHRs under the medical device category so they could be taxed.
CLINE: I have no idea.
GUERRA: It’s not the craziest thing I’ve ever heard.
CLINE: I’ve heard a lot of things, it’s not the craziest.