Find your tech tutor: What doctors need in a systems consultant

As soon as the physicians in her 16-doctor group gave her the green light to implement an electronic medical records system, Patricia A. Brown knew immediately which technology consultant she wanted to help guide the practice through the EMR planning and vendor evaluation process.

She had listened to the consultant speak several times at Medical Group Management Assn. meetings, and "I knew from observing and hearing her that she's top-notch," said Brown, administrator of Summit Medical Associates, Hermitage, Tenn.

Finding and hiring a health care technology consultant unconnected to an EMR vendor isn't easy. There aren't many around, given the fact that fewer than 20% of physicians have EMRs. Also, consultants aren't listed in a single directory and don't have an industry group certifying their expertise.

As a result, doctors typically find consultants through word of mouth from peers, or through exposure consultants gain from speaking at industry conferences, publishing articles or writing books. Some state medical societies, including North Carolina's and Virginia's, can help refer consultants to members, but the associations don't endorse them.

"There's plenty of information about technology consultants and consulting companies that can do the basic foundational hardware and things like that," said Mark Fotheringham, vice president of communications and membership at the Utah Medical Assn. "But to find those that have that expertise, and also understand how a physician's office runs and how a physician's office works, so that doctors can get the right stuff in there, may be harder."

Still, at the request of members, the UMA is attempting to develop a list of local health care technology consultants, Fotheringham said.

Physicians who are technologically savvy and have the time and inclination to research and evaluate information systems might not need to hire a consultant, said Steven E. Waldren, MD, director of the American Academy of Family Physicians' Center for Health Information Technology. But if "you have made the decision that, yeah, you want to move forward, and these are the things you want to do and are not sure you can change your practice to get to those ends, then it's time to get a consultant," Dr. Waldren said. Conversely, you should not hire a consultant, much less implement an EMR, if you're not willing to invest money and resources to change how you practice, he said.

Hiring a consultant also makes sense if a practice needs a neutral third-party to develop consensus, said Jeffery Daigrepont, a principal at The Coker Group, an Alpharetta. Ga., health care consulting company.

Technology consultants come with different skill sets. Some will analyze and redesign health care business processes, determine what issues doctors must address to re-engineer those processes successfully and what technologies can support those processes, said Steve Lazarus, PhD, president of Boundary Information Group, whose services fall in this category.

Others implement or support practice management and EMR software products, Dr. Lazarus said. This type of consultant typically works with companies that sell practice management and EMR software. A third type, who might not necessarily have health care expertise, sets up wired or wireless networks, databases and security technologies, and provides network and personal computer support, he said.

In deciding who to hire, there are several questions physicians should ask, observers said. These include:

What is your experience? There is no formal national accreditation for health care technology consultants. But in 2004 Dr. Lazarus co-founded Health IT Certification. The Seattle-based for-profit company trains and certifies health care professionals responsible for planning, selecting, implementing and managing electronic medical records and other health information technologies. Although the program targets doctors, nurses and hospital administrators, a handful of consultants have obtained certification, Dr. Lazarus said.

To determine if consultants are qualified, you must ask if they have provided the specific service you're seeking to practices the same size and specialty as yours.

Next, ask for and check several references, said John Osberg, president of Informed Partners LLC, a Marietta, Ga., health care technology consultancy.

The Coker Group's Daigrepont recommends that a physician ask consultants to provide a complete roster of their clients so the doctor can pick who to talk to.

How much do you charge? How consultants are paid varies. But observers recommend that you ask for a flat fee based on an hourly rate for your project and set up a payment schedule. You could make an initial payment up front, additional payments as different goals or milestones are met and the remainder after the project is successfully completed.

Depending on their level of experience, hourly fees range from $100 to $300. "Consultants who are senior technology consultants specific to health care get from $1,400 to $1,600 a day, and the most senior ones can command daily rates of more than $2,000," Osberg said.

MGMA charged Summit Medical Associates a total of $6,600 for the senior consultant the group hired, Brown said. Of that, $800 was paid up front, and the remainder was paid when the work was completed. The fee included prework, a three-day EMR weekend retreat the group held for its 11 non-hospitalist physicians and the consultant, and post-work that will occur after the practice goes live on its EMR in June, Brown said.

The consultant's knowledge and experience made the process go more smoothly, Brown said. It also solidified and enhanced doctors' buy-in and understanding about EMRs, she said.

Although Summit paid several thousand dollars for a consultant, others could pay much less, depending on how much work they want to do themselves. For example, Gregg M. Alexander, DO, a solo pediatrician in London, Ohio, didn't need to hire a consultant to help him plan for and evaluate EMRs because he spent two years researching those issues. But he spent $1,000 for a consultant to negotiate the purchase of an EMR.

"I know if I get someone who truly is an expert and get them on my side, the odds of my ending up with what I want in the long term are much higher," Dr. Alexander said.

Do you have financial agreements with recommended vendors? To make sure you're getting unbiased recommendations, you want to work with consultants who don't have ties to vendors whose products they are recommending. At the least, you will want the consultant to be up front about any relationships he or she might have with vendors. "You want to see a consultant who has a list of diversified vendors they work with and recommend," Daigrepont said. "If you notice that one consultant is giving you only one or two options to look at, that might be a red flag. ... That might be an indication that they don't have a good breadth of knowledge of all the options, or that the vendor is paying them off to just recommend them."

Who will do the work? Consultants can be either a person or a firm. If you're hiring a firm, particularly if it's large, ask how the company will determine who the lead consultant for your project will be, "because to a large degree the success of the engagement is based on who the consultant is individually, not who the firm is," Dr. Lazarus said. Doctors who hire companies should make sure that the contract they sign gives them the right to interview and select the consultant, and, if necessary, the right to replace that person if the relationship isn't working out.

Whoever is assigned to your project, you must keep in mind that you are in control of the relationship, not the consultant, Dr. Waldren said. "You don't want a consultant necessarily to come in and just say, 'Oh, you should pick this EMR, this is how we're going to implement it, this is where we're going to go.' Really, you want a consultant to work with you to come to those decisions," he said.

Daigrepont also said it's extremely important that doctors communicate openly before and during a project. "Don't be scared to tell your consultant what's wrong with your practice. Be honest with them. Tell them things that may even be embarrassing for you to admit about your practice, because they will be able to help you a lot better when they know those things," he said. "Always be very up front and honest when you're not happy ... or [when you're] confused."

What happens if something goes wrong after you complete the job? That's something you have to work out in your consultant's contract. "I think that any consultant should be willing to provide you with some level of follow-up just as a courtesy and good customer service," Daigrepont said. "The physician just needs to ask up front, 'Can I call you if I have additional questions after the engagement, and if so, is there a charge?' "