eClinicalWorks’ CEO Girish Navani discusses the success his company has had with EHR development, the role EHRs play in population health management, and how the latest data-based technologies are opening up new possibilities for providers.
You don’t have to look far to find fault with EHR products these days. In fact, conduct a quick news search online and you’ll find that most of it isn’t too good. The sophisticated possibilities of EHR integration have given way to complex problems for providers, leaving many asking, where did EHRs go wrong?
For that answer, we turned to a company with a thought leader who seems to be getting it right. “Our success has been two fold,” said Girish Navani, the co-founder and CEO of eClinicalWorks, a provider of ambulatory HIT solutions, including EHRs and practice management solutions. “We have built an EHR that is more intuitive, but the fact that our EHR does more than the standard EHR out there is what has helped us really go further.”
It’s that very act of attempting to go further that seems to be snagging many providers’ plans as the move from the lighter criteria of Stage 1 of meaningful use (MU) and onto the more stringent criteria of MU, Stage 2, which includes patient engagement and sharing EHR data as its cornerstones. Organizations looking to satisfy the accountable care models, which rely on population health management (PHM) practices, are hitting the similar snares of interoperability and lack of engagement features with their EHR/EMR products.
As a result, many providers are looking to swap or supplement their technology to gain access to more sophisticated tools. While this has sent some technology vendors scrambling, eClinicalWorks is busy building upon its successful foundation; it’s one of the top two EHR developers in the market serving more than 85,000 providers in all 50 U.S states. The company has moved swiftly from EHR development to offering a variety of products, including its eClinicalWorks CCMR, the most used population health solution across all function ACO categories, according to KLAS.
We sat down with Navani, to find out how this company has captured the market, why its EHR has been so successful, and what role EHRs and supplemental technologies play in achieving a true population health management practice. This is what he had to say:
Q
Let’s start by talking a bit about your professional background; I know you have experience in semi-conductors and finance, but have been involved in HIT for more than 15 years now. Tell me how your experience in HIT led to the success of eClinicalWorks?
My background is technology, and it has been for about 25 years now. eClinicalWorks, the idea of it and HIT, came to life when I was in a conference in Europe and heard some presentations made around the future of Healthcare and technology. That vision appealed to me. I took a lot of my understanding of how to take digital systems that we were building at finance and other companies like Aspen and see what we could do to make it apply to a healthcare system, where we would connect the consumer’s healthcare to the suppliers healthcare and digitize the whole system. The last 15 years have been about putting one brick on top of the other, trying to make that vision become real.
Q
Right. And it seems like you had that vision far before the HITECH ACT. Does that vision attribute to the success of eClinicalWorks in any way? Do you think that you saw what was happening before some of these other vendors who later came out of the woodwork?
That is very true, HITC. If you look at our company inside, what we have been focused on, it’s been about digitizing the entire spectrum of healthcare, from the consumer down to the doctor. Electronic health records is one big piece of that, but so is the patient engagement side, and so is the analytics. It’s just been a matter of prioritizing which piece came before the other while we’ve been working architecturally and on a product vision that would indeed meet that entire supply chain.
Q
Right. And that plays in nicely to this question: There is a lot of ambiguity about the ROI in relation to EHRs as of late, especially for those providers now trying to attest to the more stringent criteria of MU, Stage 2. Some feel that they have nothing more than a sophisticated billing system. With that in mind, how has eClinicalWorks managed to have been different with its product? It seems that you have been able to capture engagement on both the provider and patient side. How have you done that? Has that attributed to your success?
Correct. I think you’re right. Provider engagement is one of the big compliments there. We have been listening to our customer base extensively, and understanding their work-flows, and understanding how they use technology, and make sure that we build software that meets those needs. The second part is how you deploy it. I think we’ve leveraged cloud computing very extensively since 2003, which has made a difference. At least in today’s day and age, deploying both product and content over the internet is important.
Making it available on different form factors like smart phones, iPads, PCs, tablets, has been the other benefit. The products support this different modality of being cloud-based, very mobile, which supports the notion of having intuitive design, which leads to a higher level of physician satisfaction, which I think is the first step to then go focusing on population and patient, because if a physician is not going to use technology in their office, then the second two steps really won’t have a meaning.
So a lot of systems don’t meet that criterion. They are sophisticated billing systems that really don’t lend themselves to mobility. They don’t lend themselves to different form factors of use. Their user interface is not designed with the physician in mind. So if the end user feels that they’re not justifying the ROI, and then to top it off, these companies do not have the other solutions for managing population and patients, you really don’t get the full value for what you’re putting your money into.
Q
Absolutely. And I want to get to that whole aspect of managing the population. But before we get there: you just brought up being intuitive to physicians. I understand that to connect with physicians, eClinicalWorks really took the time to understand the way not just one physician but multiple clinical workers operate by producing multiple interfaces. Can you tell me how you arrived at that solution?
We hopelessly hone in on every single customer request. We actually have two online forums of user communities where our users can voice an opinion of what they’d like to see in the product, and then others get to vote on what they feel is important. We take the ideas that get commonly voted on and we develop them. That’s one. Second, we’re open to critique. We don’t mind being told what we don’t do, even if that information is available to a competitor, which lends ourselves to be more agile in meeting needs and requirements. Even to date, I still get told every single day, “You don’t understand what a physician really wants.” I still take that as a compliment.
So different ways, different modalities of listening every day, watching them use, develop it, and don’t get too nervous about critique. Try and incorporate that in the next iteration of your product.
Q
Right. So what do you say to those who don’t think that EMR/EHR technology is up to snuff, especially for accountable care organizations (ACOS), which are really something that you have had success with, especially when it comes to patient outcomes? We’ve been talking about this whole idea of not only just recording billing, but having a solution that not only works for the intercommunication of an ACO, but does by and large, manage the population and help you practice population health management. Talk to me a little bit about how your technology is achieving that and overcoming the speculation that it isn’t sophisticated enough for that purpose?
Well, in 2007, we did a very large community project in the city of New York. The goals were extensive: improve the healthcare for six million patients in the city by deploying technology to 3,200 primary care doctors. That as a goal is very large. We looked at the learning we’ve gotten from that over the last seven years, and I think that’s made us understand population health better than many other companies and many other products. It starts with the deployment of an intuitive electronic health records system, but it does not stop at the deployment of electronic health records systems.
You have to build technology that sits on top of an electronic health records system. For example, analytics: being able to take data from many different practices and collate it in such a way that you can make better decisions. We have a very strong analytics layer now that we developed as part of our population health management.
From thereon, you need to go ahead and identify patients that need interventions and that need some form of coordinated care, which then allows you to have a layer of technology that can be used by, I call them “intermediary layers of care,” like nurse managers, coordinators, dieticians, nutritionists, so that you can counsel the patient. If the patient does not do well, then you get the PCP engaged even more. That learning is now a part of solution. It sits on top of our EHR.
I might actually be the one to tell you that our EHR alone will not improve population health, but our EHR combined with our care management capabilities and product line will help improve population health. We have demonstrated that across the country. We have a number of ACOs, as you now know, that leverage both our pieces; they leverage our EHR, they leverage our population health management product. The two together improve quality of care in a big way.
Q
With that in mind, if you’re working with an organization, is the adoption of the technology a tiered process, or would you install both products at once?
You know, we would like to do both at once, but it is not easy to do both. You’ve first got to get a physician to a level of understanding how to use an electronic health records system, so they can do the prescription writing, ordering of the labs, understanding their vital signs, and focus simple alerts and simple interventions. Population health should come right after that so that you can then start focusing on telling them what they need to focus on more: where are the areas of concern in terms of their population, what interventions might work. So I’d put it as a two-tiered product.
Now, if you are converting a customer from one EHR to eClinicalWorks and they’re already familiar with the use of an EHR, than that might be a much shorter cycle. You could go “bang bang,” and do it back to back, while if you’re coming from a paper world, you might take a little bit longer. You might first do the EHR, pause a little, and then do population health management.
Q
Right. So what do you say to the people that feel like their current product isn’t up to snuff then? I think some providers feel it’s discouraging to think that the upfront investment and training isn’t paying off and it’s really not being successful. Do they have to, in a sense, start from scratch?
No. In a number of ACOs in the country, we have physicians on disparate EHRs. We are still succeeding with population health management for them. Now, I’m not saying it’s as easy as having an EHR from eClinicalWorks on the other endpoint, because there we do integration as well, which is because we put the data right into the physician’s inbox. But, you do not need to abandon your EMR just to use eClinicalWorks population health tools. You get an added benefit if you are using both, but we have many ACOs today that don’t. In fact, we have some that don’t use our EHR at all. They still use our population health management tools.
