Consistently earning top marks in KLAS’ small physician practice EMR category, Greenway Medical Technologies seems to prove the point that a limited focus equals increased quality. But will the Siren’s call to tackle larger quarry be succumbed to? And would such an expansion of focus lead to diminished results? To learn more about this quiet but capable vendor, HCI Editor-in-Chief recently caught up with President Tee Green to find out how HITECH is effecting small practice EMR providers.
GUERRA: I read that you’re doing a Webinar series about the Regional Extension Centers. Is that series targeted towards the people who will be running these centers or the physicians that may need the services they offer?
GREEN: More for the Regional Extension Center applicants regarding the processes they are going through and the information they need to be successful at that. Greenway has an interest in being part of any of the regional extension centers that are going to pick three or four vendors to work with, so we want to be seen by them as an educational source that says, “We have tools and resources that might make your applications more successful.”
GUERRA: I recently interviewed the leaders of Allscripts and NextGen. Everyone on the ambulatory side seems to understand that they’d better keep a close eye and get very friendly with these Regional Extension Centers because they are going to be recommending a lot of EHRs.
GREEN: Right, and you know it’s a mathematical equation that were all trying to solve. If we are truly going to succeed at this endeavor of electronifying the healthcare industry, we need a lot of feet on the street to help implement and train users. If we don’t have these extensions, mathematically, we won’t get there in 10 years.
GUERRA: But just because we create the extension centers doesn’t mean that the people exist to fill them. I mean, there’s supposed to be 50,000 fewer HIT professionals than are needed.
GREEN: You’re absolutely correct, and that’s why we have to go back into the universities. If we don’t focus on educating a couple hundred thousand new people into the healthcare workforce, if we don’t focus on universities like Northern Kentucky University and places like that, where they can educate these workforces, you’re right, there’s not going to be the human capital that we need to pull this off.
GUERRA: I’ve written a few edit memos and blog postings that are pretty critical of this legislation, especially the timelines involved. Just from our conversation here, it’s clear the cart has been put before the horse. We should have had these educational programs in place to create the workforce, because the timelines now don’t allow for it to be created in time.
GREEN: Right, right. It’s an audacious goal, but I think those are good. It’s good to have the loftiness of it because it forces the country to get ready and say, “Okay, we’ve got to make sure the technology is there, we have to make sure the service platform is there, and we have to make sure the human capital is there,” and there’s no reason to build one and wait on the other because there’s so much learning you can do simultaneously. I think that’s what we’re doing. So in some respects, I think it’s really positive, in others, I’d agree with you.
GUERRA: Do you think there’s a sentiment among those setting policy that we’ve got to break a few eggs to bake this cake?
GREEN: Well, yes. I mean, look at some of the stuff that’s been proposed already. Obviously, that’s, “Let’s throw some stuff against the wall and see what sticks and move on from there,” but we have to force change. I think that’s the biggest thing — we can’t wait for natural evolution to take place. We have to have stimulated evolution.
And I think that’s what we’re trying to accomplish, this stimulated evolution. If not, we still would electronify, we would be interoperable, we would have very advanced disease management capabilities, all of this would happen naturally, but it might take 20 years. I think we, as a country, are saying we’re better than that. We may have to pour some fuel into this evolutionary process to speed it up. At least that’s the way I view it, right or wrong.
GUERRA: You consistently do well in KLAS reports that cover the small physician practice EMR market. Tell me about that in terms of a philosophy behind the company, are you focused on only doing a few things but doing them really well?
GREEN: It starts with a simple question that is the DNA of the organization, “What is your experience?” We started out by saying there’s too much failure in this space, there’s too much blood spilt from physicians trying to adopt technology that didn’t work. So from the very beginning, we said if we constantly ask our customers what their experience is with Greenway, then it allows us, real time, to find out if we’re doing well or if we’re not. And so, culturally, that’s how it started. We said, “What is your experience with Greenway, the good, the bad, the ugly, we want to know, and we’ll focus on the bad and ugly and hopefully improve that.”
And so, over time, that has developed into this culture that says, “Who has a bigger interest in our customers success than Greenway?” Because, if you think about it, if a physician implements our technology or our service and they’re unsuccessful and their business deteriorates, who has more to lose – us or the physician? That physician can wind their practice down and go work for the hospital. We have to ensure that our customers are successful because we have more at stake than they do. I know they wouldn’t think that, but that’s how we approach it, and that’s how we culturally approach everything we do at Greenway.
GUERRA: I understand what you’re saying but, beyond that, does having a limited focus help you stay successful? Or are you expanding your focus?
GREEN: Two years ago, we started focusing on the enterprise, and today we have 33 hospital accounts. They’re buying the technology, whether it’s under Stark or some other arrangement. They’re deploying our services into the communities; a place where competitors such as NextGen and Allscripts play well, an area where two years ago we built a business plan and said, “We will address this.” So my bet is, within the next 12 months, you’re going to see us rise into the large enterprise market, and my bet will be that we’ll perform equally well.
GUERRA: So you are expanding into the larger practices?
GUERRA: So you said you’ve got 33 hospital organizations that have put you on their Stark shortlist, or would you describe it another way?
GREEN: I would say it’s a combination. We’re either on their Stark shortlist or they have bought our technology on behalf of their physicians. That would mean that they actually pre-buy it up to 85 percent and the doctors pay the remaining fees.
GUERRA: I haven’t heard of Greenway making many hospital shortlists. Is that because you didn’t have an offering for the 100+ physician practices until now?
GREEN: Yes and that’s why, you see, when we built the business plan two years ago, we built specific technology for the enterprise. So it’s just rolling out and it’s rolling out slowly, controlled. We’re going to do it right and we think that will win in the end. And if you look at it, if you really go follow some of the Stark transactions where a hospital system or a big IPA said, “We’re going to buy XYZ vendor,” look at that deal after 24 months and see how many physicians have it rolled out, how many of those have truly lived up to the expectations that the original contract set out? That’s an interesting question.
GUERRA: So just because they signed on for the licenses, doesn’t mean you have successful rollouts.
GREEN: Absolutely, and that is something that we are not going to do. As an organization, we don’t want to be part of a deal where a hospital buys 1,000 licenses and three years later, 10 percent of them are deployed. Who wins in that model? Nobody.
GUERRA: You’ve been doing this for a long time, you’re very successful. How much of it is the technology, the actual application and the ease of use, versus your implementation methodology?
GREEN: Well, I’d have to say it’s 50/50. There are so many systems that I would consider legacy systems, technology-wise. They’re built on old server platforms, and they’ve been cobbled or Frankenstein-ed together over the years. We designed our software on a .NET platform, a Web platform, that gives us a tremendous, rich user experience. So we can present information to a user based on who the user is, not based on what the system is. So that’s a huge part of it, being able to deliver rich user experiences.
And then the second part of it is equally important. It’s the process and the tools that you use to train somebody how to do it. I’ll use an example. You know if you take a fighter jet or a Boeing 777, those are magnificent pieces of technology, but without a very robust training and implementation processes to fly the system, it’s really not worth much to anybody. So I think the implementation process is equally as important as the technology itself.
GUERRA: Would you say a vendor’s implementation methodology is its ‘secret sauce’?
GREEN: I would say it is part of it, sure. But the reason it’s part of it is because the technology allows it to be. I couldn’t take our implementation process and use it on a clunky closed server app and do the same thing with it. Our technology enables our processes to be good.
GUERRA: Did you create your platform in .NET or was it rewritten at some point?
GREEN: Well, we started actually writing the code in ’98. So .NET hadn’t officially been labeled .NET. We started out recognizing that the client/server world was not going to be efficient enough to run this industry, and it was not going to move fast enough. You were not going to be able to manage your source code, your version control security. So that’s why we said you have to separate your application layer and your data layer, you’ve got to be able to separate those two things so they’re not so dependent upon each other, so that we can continue to develop the app without having to send upgrades or CD’s out to every customer. That model is just not going to work. That was our opinion, and that evolved into what is now called the .NET platform.