Business

Desk-side assistance: Hiring an IT consultant

Small group practices are slowly discovering what many large groups already know: There is value in retaining independent companies for tech support. Companies are responding and adjusting their target audiences.

By Tyler Chin — Posted Aug. 14, 2006

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Stasia Kahn, MD, and her two partners knew they wanted their internal medicine group to be a paperless practice right out of the chute. So, much like a big hospital system, they hired a health care technology services company to help them evaluate electronic medical records software systems.

The Winfield, Ill.-based practice bought a system from NextGen Healthcare Information Systems Inc., on the advice of E-Medapps, Schaumburg, Ill. Then, without hesitation, the three physician partners agreed to pay $1,900 a month to E-Medapps for tech support.

"If you really want to make [an EMR] work, be totally paperless and have the whole practice using it, you have to commit that you're going to be able to fix problems immediately," Dr. Kahn said. "The cost of doing business and being completely electronic requires [hiring] an information technology consultant, because otherwise your practice processes are interrupted every time there's a glitch."

Plenty of other practices have reached the same conclusion. Most of these, however, tend to be large groups that can afford to hire in-house staff or contract with vendors to support their systems. That's why health care technology consulting and services companies usually market to large groups, rather than smaller ones that often are reluctant to spend money on information technology.

"In the small-office market, there's often a doctor who has a little bit of technical knowledge, and he's the guy who kind of put the network together and he keeps on saying, 'Well, if I can do it, why should I pay someone?' " said Rosemarie Nelson, a senior consultant for the Medical Group Management Assn.

"But as physicians in small practices increasingly adopt EMRs, they start to realize, 'Holy cow! The network is going to be too big. If I have a second location or satellite office I will have to get connected,' " Nelson said. At that point, some realize they need help, she said.

Some tech support services companies already are targeting small practice offices. "We focus on the one-to-five doctor [practice] market ... because we feel that the doctors in that segment are underserved," said Kurt Dykema, CEO of Final Support Inc., of North Richland Hills, Texas.

Companies providing tech support services to doctors tend to be regional or local, although modems and the Internet allow wide coverage areas. Some firms support EMRs and other software from multiple vendors. Others resell and support software products from single or preferred vendors.

Typically, tech support companies grow from physician referrals. When one customer in a medical building signs up, the company will cold-call other doctors in that same building. They also buy direct-market lists.

Charges for tech support services vary widely and can be structured on a retainer or an hourly basis. For example, E-Medapps, which targets small groups in Illinois, Wisconsin, Michigan and Indiana, charges a practice a monthly fee ranging from $1,500 to $2,500, depending on the group's size, its software and hardware, and the number of office locations, said Joe Cernik, vice president of business development. Doctors can opt for a $125-per-hour fee instead, but don't receive a service guarantee and may have to wait until a technician is available, Cernik said.

Final Support charges $2,400 for software support for the first physician and $400 for each additional physician. The company -- which scored a deal to become the exclusive reseller of GE Healthcare's Centricity practice management and EMR to groups of five or fewer doctors in Texas, Oklahoma, New Mexico, Colorado and Wyoming -- offers hardware support only to practices that buy hardware from it. Those costs depend on the practice's equipment configuration, Dykema said.

At the low end, a group could pay $500 to $750 annually to support one server and $2,000 at the midrange, based on $20,000 of equipment. At the high end, a five-doctor group that invested $40,000 in hardware, including servers, tablets and printers, could pay $3,800 to $4,000 annually for support, Dykema said.

For technical help, most practices pay a percentage of the list price of their EMR software for support and upgrades from their EMR vendors. But that annual fee covers only support for problems specific to the vendor's EMR product. So when problems occur, someone in your office has to sort out if it's an EMR issue, or a glitch in another piece of software, hardware, interface or somewhere else.

Avoiding that time-consuming detecting is one key reason why Fox Prairie Medical Group is paying $5,508 annually to NextGen and another $22,800 annually to E-Medapps, Dr. Kahn said.

"We need someone to be accountable whenever we have a [technical] problem in our practice," Dr. Kahn said.

E-Medapps was recommended by a urology practice that used the firm, she said. "We respected their opinion, and I guess it was very important to us that other physicians whom we knew and trusted felt that this organization was worthwhile and trustworthy."

The clincher, though, was that E-Medapps helped save Fox Prairie $25,000 to $30,000 on its initial EMR purchase. "I mean, the bottom line is still there," Dr. Khan said, noting that most of the savings came from the practice using trainers provided by E-Medapps.

The practice physicians and staff also received some training from NextGen trainers, but the locally based E-Medapps was able to offer trainers at lower cost. E-Medapps also negotiated discounts on the EMR software and hardware on behalf of the group, which bought those products directly from the vendors.

Fox Prairie's annual tech-support fee is considerably less than the cost of having a technology professional on staff, Dr. Kahn said. And beyond the salary and benefits, it's not likely one tech professional would have the diverse technical skills to meet all the practice's needs, including hardware support, database programming and Web site support, she said.

For example, last year when ASTM International approved the Continuity of Care Record which enables physicians to exchange key patient data electronically with each other, regardless of EMR software, Dr. Kahn wanted the CCR to be built into the group's EMR because "I thought that I could improve my patient care right away [with it]."

E-Medapps assigned the task to an employee who knew XML, a programming language on which the CCR is based.

"I think that in the long run we're better off using a group like that because then we have the expertise of the whole group versus the expertise of one person," Dr. Kahn said. "They are a consulting group and they are part of our overhead."

Sue Landrum, manager of a two-doctor neurology practice in Middletown, Ohio, that has paid a monthly retainer to triPRACTIX LLC for EMR software support since 2004, agreed. "It's definitely overhead," she said. "I don't think any practice is too small to farm [tech support] out because of the [complexity] of the EMR system. With the EMR system everything is on our computer. If it's not running, we're not seeing patients and we're not making money anyway. So, it's very important that we keep things running and maintained."

Providing a comfort zone

Another benefit of paying a monthly retainer to a tech support company is the "sense of security that your system is being [taken care of]. We know if something is not working properly, we make a phone call and it's fixed immediately," she said.

While some physicians contract for both software and hardware support, Boyd Jenkins, MD, a family physician in Frisco, Texas, has farmed out software support to a third party, but handles hardware support for his three-doctor group himself.

"I'm pretty technically savvy, and I tend to be a do-it-yourself type," Dr. Jenkins said. He recognizes that there are limits to his skills, though, and pays $12,000 a year to Final Support and GE Healthcare.

"I'm seeing patients and I don't really have the time [or expertise] to take care of everything that comes up," he said. "So, it's nice to have someone I can go to and have these things figured out. If something were to go down and I weren't able to immediately fix it, we'd be in trouble, whereas they have the ability to get things done much more quickly and reliably than I."

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ADDITIONAL INFORMATION

Vetting the help

If you're considering contracting with a company to manage all or part of your information technology, here are some questions experts recommend asking first:

  • How long have you been in business?
  • What experience do you have supporting physician practices?
  • Can you provide references from physician clients with similar practice size and specialty?
  • How far are you from my practice?
  • How much do you charge for technology support, and what does that fee cover?
  • How many clients do you support? (This reflects how quickly questions and problems might get answered.)
  • How many support employees do you have, and what are their qualifications?

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Soup-to-nuts tech support

The services that health care technology services companies provide to small practices may include:

  • Evaluating and negotiating prices of electronic medical records and practice management software. Note, though that some health care technology services companies have agreements to resell software from a single vendor.
  • Implementing and training staff to use EMR and other software systems.
  • Helping practices select and evaluate hardware.
  • Supporting information technologies, including hardware, software and Internet connectivity. Some companies that resell hardware provide hardware support only to clients who buy equipment from them.
  • Configuring and implementing a network.
  • Providing a help desk, disaster recovery and custom software programming.
  • Selling add-on proprietary software applications for your EMR.
  • Offering business processes such as billing and collections.

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