An Exclusive Interview with Andy Ury, President and CEO of Practice Partner

I mentioned recently that Practice Partner did very well in TEPR's recent physician office EMR judging. I thought I hadn't heard of them, but it turns out I had forgotten about their recent name change from PMSI (Physician Micro Systems.) Practice Partner is a big, established player in the practice management and ambulatory EMR market. I was happy when Dr. Eric Rose, the company's EHR manager, offered to line up Dr. Andy Ury for an HIStalk interview. Not only did Andy found Practice Partner and run it, he's also the vice-chair of EHRVA and a CCHIT commissioner. I found the interview informative and I hope you do, too. Thanks to Andy for taking the time to speak with me.


Tell me about yourself and Practice Partner.

I’m a family practice physician and founder of Practice Partner. We recently rebranded the company, which had been called Physician Micro Systems for a long time, to Practice Partner, which is the name of our product. I went to Stanford Medical School and trained at the University of Washington. I’ve been involved with the company for 23 years. I’m also a commissioner of the Certification Commission for Healthcare Information Technology and vice-chair of the Electronic Health Record Vendors’ Association, of which Practice Partner was a founding member.

We’re probably the oldest vendor of electronic medical records products, certainly of those running on PCs. Our first commercial sites were in 1987 and over 1500 practices use our software. We offer a fully integrated system: EMR, billing, and scheduling, but it’s modular, so you can buy what you want. Our target market is 1-200 physician practices, but we have larger sites.

Practice Partner’s recent TEPR success seems to be at odds with its performance as measured by KLAS. What do you tell prospects about how your product competes with others?

Practice Partner has won TEPR’s best EHR three years in a row, either in the small or medium-to-large category, and has been a finalist in the other category. We’ve done well in other surveys. VHA recently picked us as one of the products they’re recommending to their members.

We are doing much better than the KLAS ratings suggest, partly because we hadn’t focused specifically on the KLAS ratings until recently and also because it’s a lagging indicator. About 1 1/2 years ago, we realized we needed to make a major investment in service and support. Our metrics have improved dramatically in the past year. The KLAS ratings don’t yet reflect those changes.

We survey our own customers monthly, about 300 of them, so we know how we’re doing. For example, we’ve decreased open support cases by half, cut response time by 50%, resolution times are now 75% better than they were a year ago, and individual call satisfaction is now at 95%.

Let’s say a four-physician practice is looking at eClinicalWorks, eMDs, Practice Partner, and Allscripts for an EMR and practice management solution. How should they make their selection and what would the strengths and weaknesses of each vendor be?

For the one-to-five doctor practice, physicians should be looking for a product that is going to do two things: improve their quality of care and the productivity of their practice. What’s different about Practice Partner is that we’re provably able to do both. We improve FTE ratios per doctor as well as income and the number of patients seen per day. We have a research network that works with 120 practices that monitors their quality in 80 measures and we’re having great success in improving their quality.

One thing that really differentiates us is a progress note centric approach. You’re always in the note and can create it using a wide variety of input means, such as voice recognition, templates, transcription, handwriting recognition, and pointing and clicking. Or, you can type directly, of course. When the note is saved, it updates the rest of the chart no matter how you entered the information. You get a structured chart from that note.

We don’t sell by criticizing our competitors. That’s not true of some of those competitors, but that’s not how we do business. That said, eClinicalWorks, eMDs, and Allscripts all take a different approach to data entry than we do. It involves a lot more menus and dialogs as you go through the note. The disadvantage is that it’s harder to go back and correct things or deal with multiple patient problems in the visit.

We’ve been around longer and we have a richer feature set than those products.

Would you buy Emdeon’s practice management system division?

Emdeon’s a public company, so I don’t want to speculate whether we’d buy it or not. Emdeon has a really large installed base on the PM side, but unfortunately it’s not a division that’s growing. It’s something that would be attractive to someone who wants to capture an installed base rather than a growing and profitable division. Whoever buys their practice division has to have strong financial backing. But I can’t speculate on what we’re planning to do.

Are ambulatory EMR and practice management systems becoming a commodity?

No, I don’t think so. There’s quite a bit of market differentiation at this point. We’ve been in the market a long time and we’ve seen a large number of companies both enter and exit the EMR space. There will always be a room for a top tier, but there will always be consolidation and exits by companies not in the top tier. It’s always been amazing to me that the US, if not the world, is perfectly happy with having three word processing systems, but we apparently need a lot more electronic medical record systems than that.

There are two kinds of market entrants. New entrants will build products from scratch, which is a risky business. And existing practice management companies will add EMR products. The failure rate of new entrants in the EMR market is very high.

Once you have well established and mature products, the new functionality you need to enter the market is high, as well as the comfort level that physicians have with a company that has an installed base. Medical records  and doctors’ times are very precious and it’s hard to enter the market.

Will CCHIT certification really increase EMR adoption by reducing customer risk?

I think certification is intended to increase EMR adoption, but reducing customer risk is just one of the ways it will achieve that. By ensuring baseline functionality, it does reduce customer risk. It also increases the chance that payors will provide incentives to physicians who use EMRs.

Certification won’t be a differentiator if either everyone or no one obtains it. Will CCHIT consider releasing specific details instead of pass-or-fail results so that physicians can make their own decisions based on the needs of their practices?

The certification scripts are public. At this point, certification is 100% pass-fail, so I’m not sure what there is to release. Certification is done using an anonymous jury, so there’s no record to look at for most of the certification process. The bulk of it is a juried pass-fail test. Certainly certification and the criteria will evolve over time. While it provides a baseline for the market, there’s plenty of room for product differentiation that certification doesn’t cover.

It’s still important for physicians to pick according to their needs. If they’re looking at five certified EMRs, they’ll need to look at awards, medical society recommendations, VHA, demonstrations, etc. There are plenty of other ways to differentiate product.

Not everyone will be certified. But let’s assume that most major EMR vendors will get certified sooner or later. The benefit of certification is a comfort level for the purchaser, but there’s still the possibility of payors providing incentives.

I think there’s no question that vendors have to work to pass certification. It is a multi-year process and the criteria change year by year. The 2006 criteria cover widely available features, but most vendors will have to make some software changes to achieve certification. In 2007 and 2008, vendors will have to continue to change their software to become certified.

Certification is year-dependent, so each certification is measured separately and is good for three years. Vendors can choose whether to be recertified every year on the stricter criteria. Customers will be able to ask if vendors if they’re certified under each year’s standards.

Certification also involves interoperability, which is  important to many customers. It also includes security and reliability, which are harder for practices to judge and may be a source of comfort.

Will personal health records succeed or are they a passing fad?

I would say that PHRs are here to stay, but like most things, they’ll have slower adoption than most people think. They’ll be important to patients and payors. Practices need to be able to exchange information with PHRs.

Do we need standards for that PHR-to-EMR exchange?

Yes. Competing standards are being developed and I hope we have a single standard within a couple of years. Last week, a consortium of 26 organizations came together under Continua to do that. Also, CCR from ASTM and CDA from HL7 are the obvious competing standards for PHR data interchange.

What is Practice Partner’s strategy with regard to PHRs?

Our strategy is threefold. First, we offer a patient portal, so that our sites can provide much of their patient chart online, as much of it as the practice and patient are comfortable with in a secure manner. Second, we believe in interoperability with PHRs, so we’re supporting several of the interchange standards. Third, we are negotiating an alliance and will be recommending one or more PHRs for our clients and their patients.

Would you develop your own PHR product?

At the current time, we are not developing our own PHR. However, our patient portal does serve many of the purposes of a PHR and we’re planning to offer both the portal and interoperability with PHRs.

Who do you see emerging in the PHR market? Do you think that patient concerns about Internet security will make acceptance of portable device PHRs more widespread?
 
There are a lot of PHR players. I’m not aware yet that Quicken has a big impact, but they may well do so. It’s not clear whether the dominant PHR’s  will be Web based or on a flash drive. I see both models competing with multiple companies in each space.

The problem with the USB drive is that it’s small and you can lose it, even though it may be password protected. There are concerns about web security, but more and more people are banking on the web, so people must be relatively comfortable with that technology.

What’s the biggest challenge in running Practice Partner?

The biggest challenge we face is preparing for the rapid growth in the EMR market and making sure we scale with it, making sure all aspects of the company function well and provide great service. We’ve learned a lot in the last two years and we know as much as anyone how to handle the growth and provide great service, but we have to be very careful.

I believe that the market for EMRs, having been in it for a long time, is moving from the early adopter to the middle adopter. Middle adopters like products that involve less effort to implement and adopt. While they have many specific needs, they need ease of implementation and ease of use. That’s a strength of Practice Partner.

Doctors are very conscious of their time when practicing. Just one minute is a very long time, since that extra minute per patient makes you 20 or 30 minutes late at the end of the day. The goal is to save them time, not to take that extra minute. Many products do not save physicians time. If that’s important, and I think it is, doctors need to choose carefully. We believe that Practice Partner, for the majority of our customers, will save them substantial time.

Most of the ambulatory EMR market is made up of first-time buyers. Will that cause a lot of dissatisfied customers and churning, or will they just stick with whatever they buy now rather than going through another implementation?

Most of our customers are first-time implementers, although we do some EMR replacement. Like practice management systems, it’s a lot of work to switch to another product, learn it, and convert data. People will hesitate before changing, but early adopters do change. One of our customers said Practice Partner was their third and last EMR product.

The EMR market has been slow to develop because early adopters bought products that didn’t work well. For those of us with solid products, it slowed down the entire market.

What would you like to see as the end result for Practice Partner?

When 90% of physicians are using EMRs, I’d like Practice Partner to be in the top two. The vendors we compete against change every five years, so I don’t know who we’ll be competing with then.

Who do you admire in the industry?

Because I’m vice chair of EHRVA, I’d like to say I admire a lot of people in the industry, but I’d rather not name names [laughs].

Do you read HIStalk?

I have begun reading it. I only recently became aware of it.