Interview with e-MDs founder, Dr. David Winn

Dr. David Winn, founder of e-MDs

Interview with e-MDs founder, Dr. David Winn: Humanitarian, physician, EMR software developer, and gentleman rancher, Dr. Winn has created an EMR/PM system often praised for it's ability to generate medical notes with the "human touch". By Robert Gleeman Medical Journalist for EMR Update email me

I asked Dr. Winn of which accomplishment he is most proud: becoming an M.D., or founding and heading up one of the leading EMR/PM software firms, e-MDs (pronounced "EE-EM-DEES") in Austin, Texas. (See e-mds.com/about/management.html for Dr. Winn's biographical profile.)

He answered, "Actually, what I am most proud of is my volunteer service as a medical director and clinical physician for Hill Country Medical Ministries, and also, my national Sertoma (Service to Mankind) award. I feel good when I give, and I've always enjoyed giving to others. I met my wife in medical school, she was a nurse, and we have both been very active volunteers, helping those who could not afford medical care.


Dr. and Mrs. David Winn

In the EMR Update Forum, I talk a lot about honesty, commitment, and passion in the EMR industry because I see some pretty serious ethics problems in our industry. It's important to me that EMR users understand how my positions on EMR are consistent with the rest of my life, a life I have tried to dedicate to humanitarian service. My life of service is the basis of my credibility."

Why does Dr. Winn use a dog-human hybrid avatar in his forum posts?
"Obviously, he's the leader of the pack!"


As we all know, Dr. Winn doesn't stand for any "bull" in the EMR Update Forum, but he does raise some beautiful longhorn steers on his Texas ranch. (Is this the place to go for the next company barbeque, or what?)

He said, "I believe that the best source of information on EMR is EMR Update. Sure, there's a lot of hype and emotion, but if you read it all, the truth always emerges. E-MDs will always support EMR Update, because for one thing, it's the closest thing we have to a ‘Consumer Reports' for the EMR industry. The doctors know EMR Update needs to make money to stay in business, and I think the Forum needs to sell advertising to anyone who wants to buy it. Why not sell pharmaceutical or EMR display advertising? Just don't ever charge the members-that would not fly."

Do any examples come to mind where Dr. Winn has seen EMR Update "shake out" the truth about an EMR product to the benefit of physician members?

In the EMR Update thread Does I.T. Certification Favor the Big Boys Dr. Winn is quoted in the CCHIT news story, right along with another prominent EMR Update member, Dr. Al Borges — any comments on this "team effort"?

"I really like Al," he remarked, "and I understand what he is trying to do regarding some of the ‘predatory pricing' in the EMR industry, which ties into CCHIT. I have some misgivings about CCHIT, but overall, I think it's needed. One thing I hope CCHIT accomplishes is to eliminate the need for the survey that Mark Anderson's AC Group puts out, which doesn't evaluate the quality of an EMR, but rather, is just a checklist of features. Many of the vendors who fill out the AC Group survey check off ‘Yes' to everything, and there is no verification. We at e-MDs answer the A.C. Group vendor survey honestly, and we get penalized for our honesty. User satisfaction is the only accurate reflection of a good EMR."

I asked Dr. Winn to comment on how he views the relationship between EMR pricing and EMR quality.

"I used to sell e-MDs for a mere hundred dollars," he chuckled, "and people thought it couldn't be anything but junk because it was so cheap. I quickly learned that you have to charge a reasonable price for your product, or people just won't pay attention to it. So I raised the price to $2,500.00-for the same exact product-and people started buying it like crazy! They didn't take me seriously until I raised the price!"

Next, I asked Dr. Winn why he consistently criticizes consultants for lacking in the ethical standards he prizes so highly. Surely, they can't all be bad, can they?

With a laugh, he quipped, "There is a difference between a poor, honest consultant and a rich dishonest one. There are some consultants who do honest, valuable work that contributes greatly to the EMR industry."

Can Dr. Winn name a consultant he respects for being honest and hardworking?

"Any honest consultant, I do respect. For instance, a man named Vinson Hudson, who sells the POMIS Report (See: www.jewsonenterprises.com) sees many of the same ethical lapses in this industry that I see. Vinson said to me once, and I quote, ‘If you guys would lower your ethical standards, you would own this industry.' I'm very proud that e-MDs does well in the marketplace with 160 employees and 7,000 users without resorting to deception. I don't ever want to be ashamed of what I've done, so I'm careful about my approach. We've been profitable for the last three years, and we're growing at the rate of about 40% per year."

"There are some EMRs that are very highly rated by consultants," added Dr. Winn, "yet they put out 7, 8, or 9 pages of noise, and they are worthless. Physicians look at that and say, ‘This EMR-generated notation is junk.' When you have consultants demanding thousands of features in order to achieve a high functionality rating, it ‘bloats' the software, resulting in ‘padded' notes that can't be used for any purpose because they are so diluted."

"My theory is," he continued, "if a doctor uses one part of the software 80% or 90% of the time, make that part of the software perfect. We haven't always done that. We have tried to ‘give in' to consultants such as the AC Group, adding feature after feature to increase our rating numbers, and we have seen this deteriorate the core product. So, we are going back to the basics. Where the physician spends most of his time in the EMR, those parts must be outstanding in order to maximize his productivity. Where CCHIT and other regulatory demands call for ‘deeper' features, they will be there, too. But our new version will break these out in a much improved way."


Dr. David Winn with his lovely family.
(The beautiful blond lady is already spoken for; fiancée of David's eldest son.)

Since Dr. Winn had supplied two questions for my interview with Mark Anderson, I asked Mark to return the favor. Mark's first question: "e-MDs does not use one of the national pharmacy databases for drug-to-drug, drug-to-allergy, or drug-to-diagnosis data, but rather, uses their own self-developed database. Why would e-MDs use a proprietary clinical database rather than one that is recognized by AMA, AHA, and every other medical society?"

In answer to Mr. Anderson's first question, Dr. Winn replied, "That's an easy one. When we first looked at First Databank back in 1998, e-MDs actually had an attached medical clinic with our own in-house pharmacy, so we had their drug database, and I was surprised at the number of errors I found in it. To me, it looked like they were using pharmacy students to compile it. I talked with other EMR vendors at the trade shows who said they had to ‘clean it up' in order to use it. Looking at the price we were quoted, I figured that if e-MDs could reach a ‘critical mass' of about 10,000 users, we would come out ahead by creating our own drug database. Plus, part of my model at the time was to put out an EMR that was very inexpensive. So I decided to build our own. We had spent about 3.5 million dollars in development, and we decided to make it available for free or at a nominal cost to the medical industry — provided it would not be resold with the intent to make a profit. We had all of the outpatient drugs and about 99% of the in-patient drugs. It's going to be part of our ‘expert database' which we have been working on for years, and for this, a third-party medication database just would not do. But in our next generation of software, a user can substitute the First Databank product instead of ours if he wants to pay for extra it, or he gets our at no extra cost. Our 7,000 users have had no problems with our drug database so far, although we don't have all the pictures that First Databank has. We just have pictures of the top 200 pills. In our market, which until recently, was almost exclusively is the 1 to 10 doctor space, First Databank is not a decision factor. When you get into the bigger groups, it is. So in our new product, which must be able to tie into Epic, you'll have a choice. Also, we are thinking of distributing a very low cost-or free-EMR, and we could not do that if we had to pay First Databank a $100.00 for every copy. It would restrict us. That said, First DataBank today is an impressive product that I have no qualms about whatsoever. "

"Yes," answered Dr, Winn, "we do intend to re-certify each year. It wouldn't do much good to do it only once, would it? It's not something I look forward to doing, but my marketing department had the last word on this one. They pointed out that the other vendors would ‘beat us up' if we let our CCHIT certification lapse. I was on the committee that specified the functionality requirements for CCHIT, so I have a pretty good idea of where this is going. It cost us about $200K in development costs last year just for CCHIT factors, and this year it will cost about $50K or $60K for certification development."

Dr. Winn, why do you believe that every doctor should use EMR?

He replied, "Current thinking is that medical mistakes cause about 98,000 deaths or injuries each year. Much of this involves medication errors. Often, medical tests are needlessly repeated because the documentation is weak. And we still see wrong-side-surgery. I believe EMRs have the promise and potential to save medicine. I really believe that our current system is terribly broken. Costs are out of control. Quality is terrible. The United States is ranked 37^th in the world in quality of care, yet our per capita medical costs are climbing out of sight. Our life expectancy is tied with that of Mexico."

I then asked Dr. Winn to tell us his vision of the future of EMR.

He commented, "Our government is moving toward a form of socialized medicine where the EMR will help determine how sick the patient is. Doctors will be compensated based on how much effort is required to treat a patient. EMR helps measure the degree of difficulty and the quality of care that doctors are delivering to patients. Outcomes will also help determine the doctor's compensation, again, best measured through the use of EMR. The challenge is to not penalize doctors who have really sick patients. Today, we pay doctors for doing things, such as surgery, and not so much for cognitive services, where the doctor tries to avoid doing things like surgery. If a doctor expends the effort to manage a diabetic and keep him out of the hospital, and keep him out from under the surgeon's knife, there's currently not a lot of reward for that."

Finally, I asked Dr. Winn what he hopes to accomplish by making himself so accessible to all of us here in the EMR Update Forum, where most EMR CEOs dare not venture.

He concluded by saying, "We need to improve our rate of EMR adoption.  Many doctors just don't see it yet. My greatest hope is to leave a legacy behind of increased EMR adoption, and not wait to see doctors forced into using EMR. I am a physician first and a businessman second. I will always conduct myself with the highest degree of integrity that I can, and if that means that I miss out on some opportunities, then so be it."