Interview with Mark Anderson:
CEO of AC Group, single father of three daughters, and avid Texas horseman, Mark Anderson rides shotgun with M.D.s on the trail of their most wanted EMR.
Mark Anderson is a single father of three beautiful daughters. Although Mark is called a "futurist" by his clients, he is also an avid horseman, and he raises them – the kids and the horses – on his Texas ranch.
In a recent EMR Update Forum discussion located here, it became apparent that, along with Dr. Murdoch, the originator of the thread, many of our members were interested in having me interview Mark Anderson, founder and CEO of the AC Group, the premier EMR consulting firm, based in Montgomery, Texas (www.acgroup.org).
In an exclusive phone interview, I asked Mark Anderson what his title, "Healthcare IT Futurist" really means – are we talking about the "Future", as in Isaac Asimov or Arthur C. Clarke?
"No," Mark chuckled, "one of the challenges of being a futurist is that I am looking at what you're going to need two, three, five years out. What you need right now, today, is different from what you are going to need three, or four, or five years out. I don't want someone going out and buying an EMR application, and then realizing two or three years from now they have the wrong application based on new things that are occurring in the future."
In Mark's experience, I asked, how difficult is the problem facing a doctor who wants to switch from one EMR application to another?
"It's very difficult!" he exclaimed. "Now, with practice management software, there are ways of switching. But with EMR, especially since we've not had very good standards in the past, it's very hard to switch from one EMR vendor to another EMR vendor, because the data doesn't transfer over as well as would practice management demographics and monetary balances. So, if someone is going to make an EMR selection – or EHR, whatever you want to call it-then they need to make a selection for the future, not just what they need right now."
By the way, EMR Update readers, if you don't believe that Mark Anderson's favorite word is "future", I suggest that you call him up and talk with him for five minutes. His cell phone number is 1–(281) 413–5572, and of course, he gave me permission to give you his number.
To better understand how a futurist operates, I asked Mark to give me an example. In past years, were there any EMR features that the A.C. Group predicted as future requirements which would be needed by the doctors who use EMR applications today?
| He replied, "I was saying back in 2001 that formularies were gong to be very important because the healthcare plans pay off of them. So, in order to reduce the phone calls going back and forth regarding the drug-to-drug interactions, and other types of drug comparisons – I was stating that formularies need to be built-in. People thought I was ‘nuts' back then. The vendors complained to me, ‘Doctors are not asking for that today! Doctors are not saying they need that today!' | Every time I work with another physician group, they come up with 30 or 40 new questions… |
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"And I was saying that doctors want to know what the healthcare plans are going to be paying for, or, what are the new pay-for-performance standards which will be coming out. Most of my clients are larger groups, usually more than 30 or 40 doctors, {Note: AC Group clients listed here: www.acgroup.org/clients.html} and granted, they are looking for more features than most solo practice doctors would. So, we're always out there looking for the requirements of the future. What is going to be needed? How about the new CCHIT standards of the future? Many of us may know which EMR vendors will pass CCHIT this year, because we're tracking that. But who's going to pass CCHIT in 2008? That is the big question. Each year, each EMR vender has to renew their product's CCHIT stamp of approval."
Where is the pressure coming from in regard to CCHIT? Who is pushing hardest for CCHIT, according to Mark Anderson?
"Right now," he answered, "there seems to be a big push from the government, healthcare plans, and malpractice insurance companies who want doctors using some kind of certified EMR, government-certified if possible. So, if there are 30 EMR vendors who have already passed CCHIT certification, this means the doctors need more detail than just a list of which EMRs have passed. That's where the A.C. Group comes in-we ‘drill down' into a lot more detail."
Maybe too much detail? What does Mark say in response to vendors who object to the A.C. Group's huge EMR vendor questionnaire which asks as many as 5,000 questions?
"OK," he acquiesced, "maybe too much detail. I agree there are too many questions. But every time I work with another physician group, they come up with 30 or 40 new questions to be added to the vendor survey. I hear the voices of critics who say the survey is far too long, but it's very hard to go back and eliminate some of those questions, although, we did eliminate 750 of those questions from the survey last year."
Having read the informative A.C. Group home page, I asked Mark Anderson to describe, in his own words, the process by which he helps doctors select an EMR for their practice.
| "First, you have to determine your requirements. Every medical specialty and size of practice obviously has different requirements. We must consider the combined future demands of healthcare organizations, plus the ongoing needs of Medicare and other government agencies, and we create a ‘baseline requirement'. The most difficult part is comparing that ‘baseline requirement' to what the vendors actually have. Believe it or not, the vendors sometimes say all kinds of things that aren't actually true. | The most difficult aspect of our evaluation is company viability… |
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"We take our general requirements and match them up in 48 categories with vendors who have responded to our survey. We also match them up to good vendors we know about who have never responded to our survey. Probably, about 20 percent of the time, there's a vendor included in our final recommendation who does not want to fill out our survey, and we don't have a problem with that. Obviously, though, we know a whole lot more about the vendors who have filled out our survey.
"So, we match the needs of our medical group with the information in our vendor survey database, and then we give our client a report which lists the top ten EMR vendors, those whose EMRs best match the medical group's requirements, based our percentage scoring system. If someone doesn't like the A.C. Group's top ten list for a particular client medical group, he or she can blame me, because it is my determination who those top ten vendors will be for any given client. Specialty EMR programs are always recommended to matching specialty medical groups, even though many have not filled out our survey."
I asked Mark to describe, in general terms, what he is really looking at in his EMR evaluations. How are points scored in favor of a particular vendor's EMR?
"We look at functionality," he answered, "which receives 30% of our evaluation point value system. Then, we look at user satisfaction, which also gets 30%, in which we look at KLAS and other satisfaction surveys out there, as well as our own research calls. 30% goes to company viability, which is really the tough one; because most EMR vendors are privately held companies, and they won't release financial information. Some vendors say they are selling EMR systems and earning millions of dollars, yet, two months later, they have no money. It's hard, but we track the vendors' growth as best we can.
| "The most difficult aspect of our evaluation is company viability. For instance, we knew that MD Anywhere was going to close their doors; we knew that All-Scripts was going to have to buy a PM system. This all has to figure into the viability point score. Sometimes a vendor staff member will tell us straight out that there are problems in the company, which is how Dr. Winn and I first had a problem. Two years ago, one of his staff members told me that the company was in trouble, and Dr. Winn still hasn't forgotten that." | I don't want the vendors to like me. I just want them to respect me… |
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I told Mark that I personally have a lot of respect for Dr. Winn.
Mark replied, "So do I. Actually, I think Dr. Winn is one of the true visionaries in this whole marketplace. Did you know that Dr. Winn invented the first integrated product, EMR with PM? His idea was so perfect, that everyone else in the industry was forced to catch up with him, and of course, some passed him. That's the definition of a visionary."
I commented to Mark that many EMR vendors might eventually develop "harsh feelings" toward him, because ten times out of ten, his report will disappointment nine EMR vendors.
"Yes," he replied, "but that's OK. I don't want the vendors to like me. I just want them to respect me, and, I want them to be honest when they complete the vendor survey. The most frequent complaint I get from my client physician groups is that I am too hard on the vendors."
This covers 90% of the A.C. Group's point scoring system. How about the remaining 10%?
Mark explained, "The remaining 10% of our point value system is based on existing customer base, such as how many clinics of the same size, the same specialty, and same general geographic locality are using that particular EMR. So, we score 30% for functionality, 30% for user satisfaction, 30% for EMR vendor company viability-admittedly our weakest area of evaluation-and 10% for having customers of the same size and medical specialty in the same geographic area."
I asked Mark if EMR pricing is included in his top ten lists.
He answered, "Yes it is. I get quotes from probably 100 different vendors each year. Part of our EMR vendor survey asks about pricing. Also, because we help medical groups negotiate better prices from vendors such as NextGen, we are familiar with their discount structure, and we try to get them down to what we feel is their rock bottom price. Actually, many of the ‘big name' vendors get eliminated because of price. And, even though Dr. Winn hates me, his company e-MDs(http://www.e-mds.com/) has agreed to give my clients a discount."
Borrowing a question from a recent forum post, I asked Mark Anderson if the A.C. Group had ever recommended Dr.Notes.
"No," he answered, "we have never recommended Dr.Notes to anyone. Dr.Notes claimed to have many happy customers, but I talked to some of those customers, and they weren't very happy. As I mentioned, I sometimes receive confidential information about company viability which, although I can't release it to the public, I still have to consider the information in my recommendations to clients."
How much do doctors pay for Mark Anderson's service?
| Mark replied, "The price always varies with the size of the practice, which may not be the best way of doing it, but it's the way we've come up with. We have five different options, or levels of service, so it can cost as little as a thousand dollars for one to three doctors, where we just do a side-by-side comparison. | Just like EMR Update, I'm trying to help doctors make sense of EMR. |
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"The highest price we charge would be for groups over 100. They want us to come on site, so we sit down with them and go over the top ten, the goal being to further refine that list to the top three to five vendors that best meet their requirements. Then, we invite the vendors in, and we actually create with the client a documentation script. We don't allow the vendors to do a demonstration, because all they're going to do is demonstrate how great their product is. We actually write out a script for all the vendors to follow, so the doctors can do a side-by-side comparison of all the vendors. In that script, we force the documentation to create errors, such as two medications which contradict each other. We want to see the system popping up errors. Then, while we're on site, we make the vendors go test their EMR using our script."
I asked Mark how much an average-sized client group of 30 doctors would normally be charged for his complete evaluation service.
"A 30 doctor group," he answered, "would be charged about $15K for everything. And we will guarantee in writing that we will actually save our client more than that in our contract negotiations. But we actually work with almost as many 1-5 doctor practices as we do large groups. Our maximum charge is $40K, which would cover a group of 100 doctors, or even 500 doctors.
Can the A.C. Group speed up the search for an EMR?
"One nice thing," Mark replied, "is that when a medical group is ready to look at EMR, we already have the results on 117 EMR vendors, so we don't have to go out and do original research, we're ready to go. Also, a lot of the vendors will update their survey numbers every month and our report comes out twice a year at TEPR and MGMA, so the vendor data is constantly updated.
Does the A.C. Group physically test EMR software, or is all information "self-disclosed"?
Mark said, "If an EMR vendor gets above an 85% on our scoring, we bring in the EMR software in for testing, which is ‘scenario testing' that walks the product through a whole bunch of different situations. Some vendors complain that they have never been tested. The reason for that is that if the vendor ‘self-rates' that his EMR product can't do all the functions on the survey, we believe them, and the product winds up with a 62% rating. If you give yourself an 85% self-rating, then you've got to be tested by us. In our report, we show which vendors have and have not been tested."
Mark Anderson had mentioned that he works with malpractice insurance firms. I asked him why they have an interest in which EMR a doctor selects for his practice.
"We are working with seven malpractice insurance agencies right now," he answered, "who are willing to give premium discounts to doctors who use an EMR that meets certain requirements, to reduce the risk of malpractice claims. Everybody knows that if you document better, you're going to reduce the risk, because a lot of the risk is based on what the doctor did or didn't document. So we have to look at what doctors want as well as what everyone who interfaces with doctors might want from them three years from now".
Backtracking just a bit to pricing matters, I wanted to ask Mark a question posed by Dr. Graham Chiu of SynapseDirect, who wants to know if A.C. Group considers any EMR under $10K.
"The answer is yes," Mark said, "about 80% of the EMRs we recommend are under $10,000. Even NextGen (www.nextgen.com) has a lower-priced version under that cost. We also have a section in our report that deals with value, the best software for the money. Here we list products like Soapware (www.docs.com). We actually feel that some EMR products under $2K offer the best functionality for the money. As long as there is basic interoperability, we think a doctor can start with a ‘value EMR' and upgrade in four or five years."
How did Mark Anderson become a healthcare IT futurist?
"For the first 25 years," he explained, "I worked in hospitals as a CIO. But I was always coming back to the issue of how to help the hospital survive, and I came to the realization that it's all about the physician. We live off of the physician. It was clear to me that if I could not help the physician create a wonderful future for himself at this hospital, then the hospital has no future. No doctors, no patients. I am giving over 100 speeches a year, and my audience calls me a "futurist" because I am always looking at and talking about the future needs which must be anticipated by the present workforce."
Dr. Winn suggested two questions for this interview, the first being "Mr. Anderson, have you ever told a vendor that their ratings with you would be more favorable if they paid your consulting fee?"
Mark Anderson answered, "No. We don't charge vendors or anyone else for phone time, or for submitting a survey, but if a vendor wants me to fly to his location and consult with his development team about the marketplace, or speak to his user groups, or any other detailed consulting work, yes, I will charge my normal consultation fee plus travel and expenses. But this has nothing to do with their point score rating. In fact, it can have the opposite effect. If I have visited a vendor's business, I might actually know more of the negative facts about that vendor. I make it very clear to EMR vendors that hiring me as a consultant will have no positive effect on their rating, and might possibly raise negative questions. A vendor recently hired me for a day for $1K. I looked at their marketing plan which offered absolutely nothing new, and I told them so. How does that help their rating? It doesn't.
"There is very little going on in the industry about which we do not hear. For instance, we know about a lot of issues regarding E-Clinical Works (www.eclinicalworks.com) to the point where we now warn our clients tremendously about e-CW installation, training , and configuration issues that are out there. We go into detail of what those issues are, and what our clients have to watch out for. Our clients may still buy from them, no matter what we say, so we tell them they have to do these ten things or they are not going to be happy, and every time, the client says we were right. They like the product, but there is a big issue about configuration. They do not configure the product. They install it, but they do not configure the product the way the practice wants it. The EMR makes or breaks the practice. It needs to be usable by the doctors, or it can cost a practice $50K a year."
Finally, I asked Dr. Winn's second question: "Mr. Anderson, what was the reason that MS-HUG (www.mshug.com) and TEPR (www.medrecinst.com/conference/tepr/index.asp) decided not to allow you to speak or judge any longer in their respective awards presentations?"
Mark's answer: "TEPR created a new rule that you can't earn over $1K from any vendor if you wish to be a judge. I actually was the person who started the TEPR awards, but I stepped down as a TEPR judge because I make 4% of my income from vendors. In the case of MS-HUG, two vendors complained about my being a judge because I was giving a speech in the NextGen booth, as well as three other booths, so again, I voluntarily stepped down as a judge."
In conclusion, I asked Mark Anderson what he thinks of EMR Update.
"Continue to challenge everything I do, but please, at least read the reports I produce. Or give me a call. I love EMR Update, but I get such personal attacks. I'm out to save money for doctors by sorting out a great deal of EMR information. Just like EMR Update, I'm trying to help doctors make sense of EMR."
Posted
Nov 07 2006, 03:19 AM
by
Robert Gleeman