Getting physicians to use an Electronic Health Record (EHR) is not an easy task. Getting them to fork over thousands of dollars for one is even harder—and yet EHR companies have demonstrated an astounding ability to convince many physicians to spend ridiculous amounts of money for software that all too often actually decreases efficiency and increases frustration. How do they do it? Before I expose the secrets of how EHR companies get the unwary to sign on th dotted line, full disclosure is in order: I own an EHR company, and many of the issues discussed below could be construed as being self-serving (indeed, many are). Thus, keep in mind that these are my own opinions based on years in the field as both a vendor and a practicing physician, and may not reflect the opinions of the publisher of this magazine or anybody else.
In 2001, as a family physician wishing to use an EHR in my practice, I researched a number of solutions and found them to be overly complex and well outside my price range. Eventually, I gave up and decided to develop my own software, Amazing Charts. Since that time, in addition to running a private family practice, I’ve sold my EHR to more than 1,500 practices. Yet, I’m a Birkenstock-wearing family doctor first, and a salesman second, so I felt it was time to expose the seedy marketing and sales techniques that continue to fool so many physicians into adopting over-priced and overly complex EHRs.
Physicians tend to learn from the experience of others, either anecdotally or from peer-reviewed sources. We assume the information presented to us by reputable institutions, experts, and our colleagues is unbiased and that potential conflicts of interest are fully disclosed. When it comes to the EHR industry, this assumption is incorrect.Secret #1: (EHR awards have been bought!)
What first provoked me to explore the dirty secrets of the industry was discovering that most of the coveted awards prominently displayed by EHR companies are judged by people who are getting paid by them. Although this may be reasonable under some circumstances (eg, the expert judge is also providing legitimate consulting services to the EHR company), it is completely unethical if it isn’t openly disclosed—and in the case of EHR awards, the judges’ monetary relationships are not disclosed.
If one can’t trust an EHR award, perhaps it is safe to get advice from an expert lecturing at a conference or a consultant you pay to evaluate your practice and make recommendations?Secret #2: (That “non-biased” expert recommending an EHR to you may have been paid off too!)
A significant number of the leading “experts” and practice consultants also earn money from the same vendors they recommend. Again, this situation is not necessarily a bad thing, unless a prospective buyer isn’t clearly informed of the relationship. Whereas the FDA oversees drug company-sponsored meals and requires full disclosure of speakers’ affiliations and relationships, there is no similar protection from the unscrupulous EHR expert/consultant. I’ve attended many lectures by consultants who had been paid by one or more EHR companies without any sort of disclosure before, during, or after the lecture. Similarly, many consultants, in addition to charging you for their “objective” advice, also quietly collect money directly from some EHR vendors for their referrals. So, perhaps it is safe to get advice from another physician who uses one of the EHRs you’re considering?Secret #3: (Even that EHR-using physician you’ve been referred to may have been paid off!)
Clearly—and reasonably—an EHR company would try to avoid giving you the contact information of an unhappy client. But might the doctor to whom you are referred be getting compensated? Surprisingly, a number of EHR companies actually pay referring physicians to “compensate them for their time” in speaking with you. This can take the form of a direct cash payment or free/discounted software and services. Again, this is not necessarily unreasonable so long as the relationship is disclosed.Secret #4: (The respected physician leader of your local society may also be receiving compensation!)
Remarkably, I’ve even learned of physicians in leadership positions (such as your local medical society, IPA, etc) entering into financial relationships with EHR companies and not clearly informing the membership about the connection. Without clear disclosure, any of these examples at best is unethical, and at worst, is fraud. In the end, it is the EHR buyer who foots the bill for this insidious marketing. Determining the true cost of this deception is difficult. In fact, simply figuring out the real cost of an EHR can be surprisingly hard, since most vendors won’t provide this information.Secret #5: (Determining how much a specific EHR costs is going to be difficult, and you are going to be nickel-and-dimed every step of the way!)