Before you buy, evaluate the vendor's responsiveness
■ A practical look at information technology issues and usage
Three years ago, Michael Lynch, MD, an internist from Fresno, Calif., took the plunge and invested in an electronic medical record system.
After several months of using his new system, he identified some glitches that soon became major problems. Adding to the frustration was the lack of sympathy he said he got from his vendor when he called for help.
That included unreturned calls and "completely unacceptable" answers when he did succeed at tracking someone down.
"We don't have time to deal with things like this, and it's so frustrating, it's like someone in your house is working against you," said Dr. Lynch.
Many practices have found out the hard way that when problems are discovered, the vendor that once promised the sun, moon and stars sometimes can become suddenly silent and unresponsive. In some cases it's because the vendor has gone out of business or has been acquired by another company.
Whatever the scenario, the physician usually is the one left to clean up the mess.
Experts say there are steps physicians can take to wake up an unresponsive vendor. But they say the best move comes before buying a system -- making sure your vendor contract is very clear about what a vendor is expected to do, and when.
If you have a problem, experts say one of the first steps to take is to make sure you talk to the right person.
Sicely Donaldson, who oversees the health care portfolio for the Portland, Ore., office of the consultancy firm Point B, said it's a good strategy to work your way up to the person who has the authority to make things happen in the organization. Walt Zywiak, principal researcher for Falls Church, Va.-based Computer Sciences Corp., a technology services company, said ideally a point person will be identified prior to a problem arising.
Shahid N. Shah, CEO of Netspective, a consultancy based in Lanham, Md., said there are always options for dealing with an unresponsive vendor. But sometimes those options aren't cheap, or easy to deal with.
Unless there is a direct contract violation, in which case your attorney would need to get involved, your only recourse is to force the issue yourself -- but "be ready to jump off," Shah said. Meaning, be ready to dump your system.
"If you are not ready to jump off, they likely will not give you much support."
Shah said that even if you're ready, some vendors believe it's easier to let you go rather than try to resolve your problems. And sometimes it's better to change systems, learn from your mistakes, and make a better choice the next time around.
But Shah said switching systems may not be as nightmarish as it seems, if it comes down to that. He said there are services available that make transferring data between systems easier than printing everything out and re-entering it manually.
But experts agree that the best course of action is to prevent this kind of situation from the start.
Zywiak said it basically comes down to due diligence and finding references familiar with each vendor you are considering.
The best reference, according to Zywiak, is going to be a practice that is as close to your practice as it can be. Not only is same specialty, practice size and scope important, but it's helpful to talk to people with a similar technology background, as well.
If you talk to someone who is much more technically savvy while you know very little, that person would likely require far less technical support from a vendor, and therefore would not be the best source, he said.
Donaldson said it's also important to establish your standing with the vendor ahead of the contract being signed. She said that vendors with large hospitals for clients will likely place small practices at the bottom of their priority lists.
Practices also can lose leverage by signing long-term service contracts, Shah said.
"Say you went into a three-year contract for $15,000 a year for support. The vendor knows you signed a contract for [a total of] $45,000, and they will get that money no matter what," he said. A year-by-year contract will force the vendor to prove annually that the practice is getting what it pays for.
But Donaldson said some vendors will allow financial remediation to be built into the contracts, in order to ensure timely service. This feature means that the vendor will pay you when your system is down. (See Clarification)
"Financial clauses will give a practice a better leg to stand on when things go awry," Donaldson said.
Contracts also should include contingency clauses for cases of companies that are bought out or closed. Companies are bought either for their technology or their customer base, Shah said.
When they are bought for their technology, that means the new owner will likely continue to support the systems it is acquiring. If the company is bought for the customer base, legacy systems are generally discontinued, but comparable systems are usually offered at a reduced or complimentary rate, he said.
"Customers have an enormous amount of leverage before they sign and almost none after they sign," Shah said. It's best to spend time up front designing a favorable contract, he said.
Barbara Cardova, Dr. Lynch's office manager, said the company told her that the practice's system didn't need "fixes," as defined in the contract. What it needed were software "updates," which would come later in the year. The practice said it has found ways to work around its system problems.