Does This Site Suck?

Al,

 I realize that your primary EMR concern is investment cost.  I have a issue with cost being a part of this proposal.  Price is just one aspect.  First of all, price is not fixed for all vendors and is often negotiable.   I have seen 30 physician groups catch a salesman at a large vendor when there numbers and job is on the line and get over 50% discounts on the product.  So really a simple price is not always available.

Moreover, this site should truly focus on feature and function and overall opinions of the reviewers.  Unfortunately, a qualified reviewer is going to be hard to find, I think really it would need to be a cooperative effort between two physicians from different environments.  For example, Lowel is in a small practice and Cyath is in a large group.  If both of these individuals review software they will consider many aspects differently in the software and architecture.

There is also the aspect of technical architecture.  You could use a highly technical third party IT person that posts here to get this information.  Obviously as a person that has implemented 10,000 users 500 plus server installations and been involved in Microsoft architecture and implementation for over 15 years I am qualified, but I would take my name out of the hat because I am a vendor, therefore, can be perceived as biased.  That leaves it to someone like Techguy to review the use of 2 tier or N-tier architecture, PC requirements, system design, and suitability to practice based on number of Physicians and Sites.  

For example, I just recently downloaded and reviewed a very popular EMR.  It is really cool on the front end.  It is also very low cost, under 2,000 dollars for a whole practice.  It also runs on a Jet Database but even worse makes no use of relational databases and has less then 20 tables.  The whole application from a architecture standpoint was obviously not written professionaly.  It is a great product but I cannot imagine it ever being easily changed and ever running in a environment of more then 10 physicians and never across a WAN efficiently.

I think all of this needs to be considered.  Price on the other hand is up to the consumer to decide if the price is right.  I believe firmly it would be a disservice to the end consumer if they don't review on feature/function.  After all price is negotiable and EMRUpdate does not and cannot do the due deligence to review cost reductions and promotions on behalf of the vendor or in a specific bid.

 Regards,
Brendon
 

 

What I paid for my EMR seemed reasonable to me and expensive to others. Plus, if one office is better at extracting an ROI, then the cost will subjectively be reported.

I think cost should be an objective part of a report and readers can draw their own subjective conclusions.

EMR's don't cost the same, often even though they are the same vendor/product.  This is not the case for all vendors, for example your eClinicalworks lists there price on the website for the software.  Even with this listed price if a large group is looking at this or any other product and they are in the buying stage they may negotiate a lower price as part of the final negotiation.

That being said I stick with my conclusion that it is impossible for the EMRUPDATE community to truly know the price of the software applications on a regular basis.  I think price should remain in the EMRUPDATE Naveen sponsored Spreadsheet and even there it varies greatly.

We recently totally changed our price structure and still have not updated this spreadsheet.  I would challenge anyone here to publish the current investment cost of eMedRec.

We can update the spreadsheet, but that does not mean we will not discount for large groups or even a single physician that is in a new state. Hell for marketing purposes we might even basicly give it away to get another state on our list of states.  Recently a 55 physician group got a quote from us for our software at $100K another group got a qoute for 12 physicians at 60K.  The first group was a 50+ doctor group so the purchase price of the software at discount would be under 2K with installation and for the other group it would be over $5K without installation and training.  Why the difference.  The fist group is in a state we have no business in, we are aggresively trying to get new states.  Plus we want to break into the very large group practices (NOT IPA OR RHIO) that have over 50 physicians in a single clinic or practice.  The second group is in our same neighborhood, literally 5 miles from our office in Boynton, one city over Delray where we are located.  Since we came from reference and we have no marketing capital to be gained in South Florida (over 30 installs) why discount for this group, plus they are not interested in price, they are 12 GI Docs looking for solutions.  The same logic could hold true for a specialty or company looking to offer some value in integration that will carry forward into the product.

How does this site account for vendor policies that vary  on price.  My example is not any different then others. 

Again, I reiterate I think price is best placed in a spreadsheet with a specific scenario as in Naveen's spreadsheet.

>>> What I paid for my EMR seemed reasonable to me and expensive to others.

I think that this is the crux of the argument- folks should get the best EMR for the price that they can afford.

I think that a lot of the negative aspects of price could be averted by vendors posting up front their fees. Why in the world they think that they are going to get a better sale is beyond me. In fact, I wish that somebody would do a double blind randomized study on this issue to once and for all prove that hiding costs can actually cause a loss of sales. When they don't they give the buyer the feeling that they are going through the anxiety that any buyer purchasing a used car has to go through. In Virginia they are considering forcing physicians to post prices, which I think is a good deal for the consumer. In the end it could make prices fairer overall.

>>> It also runs on a Jet Database but even worse makes no use of relational databases and has less then 20 tables

I could see a problem with working with what we used to call a "flat file" (non-relational) database, although in certain rare situations that could be all that is needed. The  use of 20 tables goes along with that process. Non-"normalized", non-relational databases are generally not a good design.

Now the use of a Jet backend by itself is not bad if their focus group is less than 20 consecutive users and they want to keep prices down, since the Jet backend is free and there is a lot to be said about it's size (smaller) and easy to maintain architecture. Most backend Jet EMRs should be priced accordingly at less than $1000 (s.a. is the case of Amazing Charts).

Al, I have to say that I agree with you on this. As much as I can understand why they don't post the prices (as illustrated above) I do have to say that it bugs me. I really like an EMR site that has a good quick demo and a nice pricelist for all to see so that you don't necessarily have to give contact info for a a callback. I think MediNotes was like this if memory serves.

As I recall, there was strong condemnation when some agent provocateur used the "sucks" as a tag for one of the EMRs.

Why use it in the subject header?   

Price of the EMR and overall costs may not be concerns to physicians in large orthopedic groups, each of which takes home $600,000 a year or more, but it is a great concern, possibly even the primary concern, to family practitioners that average $138,000 a year in income.  It is flippant to blythely state price should not be the primary concern when purchasing an EMR, I actually agree. Price of the EMR is not the greatest factor but cost is, including all the hidden costs of extra hardware, links programs, not-included necessary parts of an office practice such as a scheduler our output to a billing company, training, and absurdly expensive recurring fees for who knows WTF.  Cost matters most.

If you check the website of mortgage companies,  they also tons of options and still they provide all the interest rates.  The maximum they differ may be $500+ in charges and rest of it is the same.

But if all follow an interoperability protocol so prices would be like email - FREE.  without it, this trend will not change. 

However, as I mentioned in another thread,  we moved tangentially away from the actual topic.

-Sankar

This site has changed alot.  Whereas the discussion used to be significantly more focused on vendors, prices, features, and experiences.  While I hope this is not rose colored retro, I think that if we could examine, we would find a much higher % of posts that are not along these specific lines. 

 I like some of your ideas.  I really need to find the time to go back and start doing some product demos again. 

Nick

algos:

Price of the EMR and overall costs may not be concerns to physicians in large orthopedic groups, each of which takes home $600,000 a year or more, but it is a great concern, possibly even the primary concern, to family practitioners that average $138,000 a year in income.  It is flippant to blythely state price should not be the primary concern when purchasing an EMR, I actually agree. Price of the EMR is not the greatest factor but cost is, including all the hidden costs of extra hardware, links programs, not-included necessary parts of an office practice such as a scheduler our output to a billing company, training, and absurdly expensive recurring fees for who knows WTF.  Cost matters most.

Algos, I don't know that I'd go so far as to say price matters most, because a piece of junk unusable EMR is gonna cost you a whole lot more in the long run than one that's reasonably priced but works better. I would say that functionality matters most, because what sense does it make on spend a dime on software that doesn't work for you and only serves to give you heartburn?

As doctors here on emrupdate, along with our vendor and IT peers, we can help steer doctors in the right direction when it comes to EMR software. Although we can encourage and recommend to vendors to make their pricing more competitive, we really have little influence on what they choose to charge for their services. After all, since many (most) are private firms, we don't really know what thier cost for R&D was, or what they need to charge in order to turn a profit and in turn do more R&D.

Bottom line, just like any other capital purchase, if you can't afford a particular EMR, you're not going to spend a ton of time looking at it. You can tell from the posts over the years that docs will kind of self-identify their price point based on the companies they are asking about. Dr. X looking at SOAPware, Amazing Charts has a different threshold than Dr. Y who wants to know the differences between eMD's, eCW and NextGen. Now, don't get me wrong, that's usually just a starting point, and education about a particular EMR might make them choose to spend a bit more. The point is, they have a choice.

I mean, you might decide that you have a budget for Amazing Charts, but if you fall in love with eCW, you might choose to stretch a bit to make it work, and that's something we've seem a lot of here in the past. Likewise, you may think that eMD's is out of your price range, but then you might somehow manage to sweet-talk David Winn into giving you this like totally killer deal and bada-bing! now you have a great EMR and you don't have to live on TopRamen for the next 5 years. Just sayin'.

>>> On any given moment, I've seen up to 90 148 (update- tonight!) simultaneous lurkers on the site.

Correction- 162 tonight (Friday night).

Choosing an EMR is like getting married:

Unless you make a really lousy choice, you will be happier than before.. It can take as long to find an EMR as a spouse, and it's a huge deal to divorce your EMR and wed another.  I'm still waiting to see if I have a midlife crisis with my EMR.

I think someone posted here about having EMR brand-specific discussion boards. That would interest me more, obviously, to chat with people using the same software I do. I keep hoping my EMR parent company will have their own bulletin board someday.  I'm not sure how they would react to seeing one for their product on someone else's web site (kind of like naked pictures of your wife being posted). As it is right now, I don't have much to offer for the types of posting going on this web site at present.

>>> As I recall, there was strong condemnation when some agent provocateur used the  "sucks" as a tag for one of the EMRs.

Yeah, we gotta get Arnold to finish this thread off...

I agree with whichever genius changed the title. I think this site it great, but suggest the title of the thread "S U C K S".

 

However -- anyone and everyone can offer suggestions for how to improve the site. Everyone has a perspective or comment that should be heard and appraised... Would have been a little nicer -- or less controversial -- to have titled the thread "How can we improve this site".

Really I'm a sort of "Glass is Half-Full" kind of guy NOT "Glass is Half-Empty".
Why can't we stress the positive, improve what we do well, and stop doing the stuff that don't work?

 

 Maybe we should all lighten-up, celebrate the good-stuff and move-on.

 

Can anyone guess that I'm just back from a vacation in Antigua?