How do I know know my PAS/EMR/EHR vendor is a good choice?
One of the key areas where projects fail, is the mismatch between what a vendor’s business pressures are, vs the operational nature of clinical care.
Everything is in alignment, up to the point of go live and the following weeks. Often, short term compromises are made – do we really need X, or can it wait for phase 2? – in the interests of a launch.
What then inevitably happens is a period of walking back previous assumptions, discovering missteps between both parties and the real world radically challenging all of the best laid plans.
Typically, key staff learn of the shortcomings or areas deferred until later, frictions increase and ultimately the idea of investing further in a platform begins to seem daunting. Will it just bring more of the same experience to your organisation?
From the vendor’s perspective; often there is a strong desire to improve their core product offering in your speciality, but it is difficult to justify a full project team on operational support levels of funding – they can’t afford to both be cost competitive and continually hire enough experts to support their entire client base; so familiar faces disappear from weekly check ins, contact slows, relationships risk souring.
Is the project actually done? Are the benefits originally promised actually delivered and realised? Often no – both parties then end up slightly at odds with their motivation and ultimately, innovation pauses.
Clinicians and administrative staff, rightly so, begin to feel that being becalmed with no respite or rescue is not a desirable situation.
How could this be done differently?
When choosing a vendor, look at offerings that align more closely to your funding and success models.
For example, if your revenue is aligned to consultation volume and minimisation of cancellations; is a vendor charging a platform of $1/appointment or $20,000 up front for three years a better deal?
You might do some back of the envelope math – 3 years, 255 working days, you currently do 40x consultations a day across your clinician workforce, obviously the lump sum is a better deal.
But have you priced in the risks or uncertainty of the future? More importantly, in which situation is the vendor more likely to stick around to make platform improvements?
The one where they have the the substantial amount upfront; or the one where they have continual revenue?
Hint: It’s not the lump sum. Your vendor has already booked your upfront fees and has a reduced incentive to retain you. If they do well or they do badly, its about the same to them. They can coast for the next few years, until renewals start to be discussed; and have perhaps fallen so far short they expect you to simply churn – so why bother changing the status quo? Simply move on to new opportunities.
Compare that to a vendor with a performance incentive as tied to your volume. They learn and adapt their system to your practice, knowing the better they solve for X; the higher your throughput will be and the higher their resulting revenue is. Even better; if your clinic faces an unexpected interruption; your costs also scale right down.
It will never be a case of an organisation in perfect lockstep with your own; but the more you can align contractual and financial incentives of a vendor to your business model; the better your outcomes will likely be.
What are the risks?
You may be paying a premium for the vendor deviating from their established model. In some ways, this is good – the participants in the digital health space who are not aligned to this will naturely
Excessive use of a product offering, where a price per unit is agreed but a ceiling exists – where your organisation grows beyond the limits, you may find you are suddenly at an inflection point for cost.
Vendors slowly incrementing costs above CPI; relying on lock in – once you are hooked on their add-ons or unique offerings; they have far more negotiating power if you have become reliant on their staff or tech; and there are not easy “plug and play” alternatives.