HIStalk Practice Winners Circle: Baqar Naqvi, Practice Manager, Progressive Medical Care

Editor’s Note: This is the first installment of the HIStalk Practice Winners Circle, an interview series featuring physician practice professionals that have been recognized for their health IT-related expertise.

Baqar Naqvi is the practice manager for Progressive Medical Care in Montgomery Village, MD. EHR vendor MTBC named him Office Manager of the Year for 2016.

Tell me about yourself and the practice.

I am, by training, a pharmacist. I have 30 years of experience at different director-level positions within the DoD, VA, and other healthcare systems. I have worked for Progressive as practice manager since 2011. I work part-time to help out my wife, Tesheen Naqvi, MD who is one of three physicians at the practice. It seems like it is going very well.

Given that you’ve been with Progressive since 2011, how have you seen healthcare technology impact the staff’s ability to care for patients?

I have very positive feedback as far as technology is concerned, because I think the healthcare industry was way behind and now they are catching up. We can now capture things like immunizations, patient physicals, or other follow-up issues – even making appointments has become easier. We now have a clearer picture than we did before. There’s no longer a need to have so many personnel attached to administrative tasks like filing and retrieving charts. We can now get that information in just a couple of keystrokes. Healthcare technology has saved us a lot of time.

Our patients are very happy because, when they sign up for the patient portal, they can easily see all their health information – their prescriptions, balances, appointments – and even update their own contact information. It prevents headaches all around.

Why did you receive the Office Manager of the Year Award? How have you used the practice’s healthcare technology to benefit staff and patients?

For two reasons. The first being that I educated my staff – physicians, front desk, medical assistants – on why health IT is important. It is human nature to resist change, after all. We still have challenges. At the highest level, my job is to convince my staff that this can help patients, save us time, make us more efficient. Though it has definitely resonated with staff and patients, I find that it is a continuous battle. I have to help them understand that there are consequences to not using this technology appropriately. If we don’t update patient information and we need to get in touch during an emergency, what is going to happen? If we don’t sign up patients for the portal, guess what? We’ll get more phone calls.

This is the way I approach explaining the value to them, which brings me to my second reason. I make the front desk staff sign up every new patient for the portal before he or she leaves. There’s a certain amount of education involved. You have to walk them through it; there are no if, ands, or buts allowed. We are trying to strongly encourage our patients to sign up. That effort is the reason our practice has high portal enrollment numbers.

Is the practice looking at implementing any new healthcare technologies in 2017?

We’re thinking about doing telemedicine. I’m working on it – looking at different vendors, and at the related legal issues. I’m investigating that at this point.

What is your number-one consideration when vetting telemedicine vendors?

There are three factors involved – safety, what legal challenges I have to deal with, and cost.

I understand that several of your physicians have attested for Meaningful Use. Now that it seems to be winding down, what consideration are you giving to MACRA?

This is going to be a moving target, to be very honest. I don’t expect MACRA is going to be the last step. In two years we’ll be using some other term as we learn more and things continue change. We do plan on participating. The only thing I’m worried about is that the changes will penalize us. It’s really difficult to break even. Cost is one of our major concerns, and so anytime I look at those changes or rules coming from CMS, I worry. I have not done a deep dive on it yet.

Do you think you’ll need to adopt new technologies or use what you have in different ways as you transition to value-based payment programs? Or, will things stay the same?

I hope I don’t have to look for another vendor. MTBC has been very good at implementing my suggested changes. If telemedicine factored into MTBC, I’m confident that would be the easiest way for us to transition. Going to other vendors for just one component – telemedicine – is going to be expensive and cumbersome for us. We may have to upgrade our computers. If we have to do it, we have to do it.

What are your goals for 2017 when it comes to helping the practice use healthcare technology more efficiently and effectively?

I think I will stay on the course that I am on to educate our patients. The biggest concern patients have is security. They want to know “Is my information safe?” We have some information about HIPAA, and we are educating patients on the the safest way to communicate with us which is through messaging. Don’t send us emails, don’t call us. The best way is to send us messages. Our challenge is to educate patients so they feel comfortable communicating with us using technology.

For doctors and staff, I think we are doing a pretty good job and we will keep doing it so everybody starts using technology more and more. My goal is to have almost 50 percent of my patients signed up to the portal by the end of this year. We are close to 30 percent. It is a stretch, but achievable.

Contacts

Jenn, Mr. H, Lorre

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HIStalk Practice Interviews Caraline Coats, Vice President, Provider Engagement, Humana

Caraline Coats is vice president of provider engagement at Humana.

Tell me about yourself and the company.

I am the vice president of Humana’s Development Center of Excellence department. We are largely a team that supports Humana’s enterprise goals around our value-based journey, supporting our physicians and their overall experience as they move from volume to value. My team supports our network and our market leaders on choosing the right physicians – those who make good partners. We want to develop a long-term understanding of what their needs and capabilities are and meet them along the way on our continuum. Humana doesn’t really have a one-size-fits-all. We have different options to meet physician needs depending on their infrastructure, capabilities, and appetite to launch from volume to value. My team serves as the internal operations support for our value-based goals.

My background is historically more of what you call your traditional managed-care contracting and more transactional oriented. I’ve worked both with physicians and in the hospital space in doing contracting and negotiations, and have also served in leadership roles with Humana in our network organization. It’s been within the last four to five years that I’ve transitioned myself from what I’d call the volume to the value world. I feel like I’ve been making that journey in parallel with our physician community. As the industry is evolving that way, Humana is growing its own capability to support physicians in that space.

When did Humana launch its provider quality rewards program? How have you seen provider interest in that grow?

Humana has actually been in the value-based space for over 20 years. We have had what I call a more standard physician rewards program for the last five or six years, and it’s really progressed as the industry has progressed. Outside of the markets that have been more mature in it, the program is offered to engage and support physicians early on around certain quality metrics. It provides financial and clinical data to manage that core, founding population. We work with them along the journey to determine if and when they’re ready to move beyond just upside only and take some element of risk.

We start with physicians early on, looking at opportunities and ensuring that they’re provided with adequate data that is actionable around their population. We help them grow critical mass with them, mitigating any volatility in the numbers to help move them farther along that continuum where, eventually, they can share in some of the upside and downside risk.

How does Humana recruit physicians for the program?

We don’t have a formal recruiting program. We have a lot of local resources on the ground through our market and our leadership team through building relationships with physicians and understanding what their needs are – what programs we can offer to meet them along the way. We have over 900 value-based relationships and that continues to grow. We have increasing goals each year to put more and more physicians in our value-based programs, but I emphasize it’s not just around the number. It’s around really finding the right partnership and the right place on the continuum. I think with that it’s not so much a recruitment as it is just building deeper relationships with our physicians and finding out how we can support them.

How has technology impacted the ability of practices to succeed in your value-based programs?

Technology is critical to a physician’s ability to effectively manage population in the value-based space. Humana does provide some population health capabilities that provide financial and clinical data to the physicians around the population that they’re managing. We now have an increasing utilization of this capability from the physician’s self-service perspective. Historically, we have provided the data and the reports directly to them, which we continue to do but are now allowing functionality where they can access it themselves and use that data to turn it into actionable information to manage their population.

How does the quality rewards program fit into physician plans to participate in MACRA and its quality-improvement programs?

We’re all learning about MACRA. At a high level, it’s value-based, so MACRA is CMS’ way of moving physicians from just volume to value, and rewarding them for improvement in quality around certain metrics. I would say the fundamental feature of our value-based program does that. It has quality metrics built in and we work with the physicians on measuring, improving on, and rewarding for those metrics. Fundamentally, the concept is the same. How our program evolves to align with MACRA is in progress. We’re determining what will make the most sense for physicians to mitigate a lot of disruption, but continue an improved experience where ultimately their patients are getting the most high-quality care.

Aside from the quality rewards program, how is Humana helping physician practices implement population health management programs? You alluded to data earlier. Are there any other ways you’d like to highlight?

Yes, continuing evolution of the data and actionable information that we can provide to them. I don’t want to underestimate the local resources that we have on the ground. We have regular joint operating committees with our value-based physicians to review data, understand obstacles and barriers, and understand what they need to continue successful evolution in their value-based programs. That face to face relationship with the physician I think is instrumental to continuing success.

Outside of that local market level, we now have value-based executive care forums that are led by our office of the CMO. We call in value-based physicians from around the country and have a day-and-a-half session – an open forum – so they can learn from each other, we can hear directly from them and understand how we can support them in population health.

Given the direct feedback you’ve received, what are the biggest barriers practices face when it comes to implementing population health management or value-based programs, and how is Humana working to help practices overcome those barriers?

One of the biggest things we hear, and it’s not unique to Humana, is that we need to do something different for everyone. Even looking at MACRA coming up, what does that mean? To report different data when you have traditional Medicare, plus a handful of health plans … it’s the different offices and the different programs. Payers including Humana can look at how we can provide a physical solution to them to improve the administrative burden, if you will, of all those different programs so that they can focus on patient care and adhering to one program that ultimately meets the quality of their patients and improves their experience.

Do you have any final thoughts?

No, other than Humana recognizes the world of value-based care is evolving and every physician’s need is different, every practice’s need is unique. We continue to learn from each market and each physician, and strive to evolve our programs, options, and capabilities to best meet them where they are so they can successfully grow in this space.

Contacts

Jenn, Mr. H, Lorre

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HIStalk Practice Interviews Linda Fischer, EMR Manager, Boulder Community Hospital Physician Clinics

Linda Fischer is EMR Manager of Boulder Community Hospital Physician Clinics, Boulder, CO.

Tell me about yourself and your practice.

I have been with the hospital for almost 15 years. We’re part of Boulder Community Hospital. We have a subset that owns our practices, Boulder Community Hospital Physician Clinics. We have 17 clinics that are owned by the hospital that are multi-specialty, ranging from family practice, internal medicine, infectious disease, travel clinic, an endocrinology clinic, and we just added a trauma clinic and a neurology clinic. We also have sports medicine and occupation medicine and pain. The clinics are located within a 30 to 40 mile radius around the hospital and serve the local patients of the community.

What type of healthcare technology software do you have in place right now, and how long have they been in place?

We’re currently using Greenway for both practice management and EMR. We’ve been on it for almost four years. We converted in April of 2010. Just a couple of those clinics are not on Greenway currently. They are still using paper because they are recent acquisitions and we have not brought them up yet on Greenway. But they are in process. The hospital uses Meditech, and we do have some interfaces that run between Meditech into Greenway.

Were you involved with the selection of the Greenway system?

Yes. In fact, I implemented the legacy system that we had. And then I was part of the selection committee to bring on Greenway including the review process and then of the orientation to Greenway.

Tell me a little bit about the more recent selection process.

We had a legacy system at the existing clinics that we were on for five years. The providers did not have a choice in that system, and it interfaced directly with our hospital system. When we got a new CIO, she gave them the opportunity to stay with what we had or to do a selection process. They opted to do a selection process. So, we went through a two-year selection process where we had a number of stake holders all on the team, including IT, providers, medical assistants, front desk, and billing staff. All were on the team as stakeholders.

The main direction from IT was that the system had to be CCHIT-approved. We went through the list and people had some things that they had already researched and really wanted to look at. We grabbed about 35 of them to look at initially. We also created a list of must-haves, and then things that we would like to have. Every stakeholder put in things that the new system absolutely had to have, based on what our legacy system could already do. The dream things were things that we wished that our legacy system could do, but it doesn’t. We traded those lists, then we started to review those 35.

We looked at KLAS reviews and narrowed the list down to about ten. Did more intensive KLAS reviews and narrowed that list down to four. Then we had a vendor site fair for those four. The vendors came onsite and we had all the stakeholders as well anybody else that wanted to participate, come look at the systems that were being demonstrated, as well as maybe do a little hands-on play. We kept our legacy system as one of the four that made it that far in the selection.

What was your legacy system?

It was called LSS and it interfaced with our Meditech system that the hospital has. It was the outpatient division for Meditech and we kept that as one of the top four. Then after the vendor fair we narrowed it down to two, which did not include the legacy system.

We sent teams out to do site visits with those two systems to see how actual clinics used the systems. And, we did an RFP for both of those systems. Those come back in and then we compared and contrasted those. After we had done all that, the site visit, and the RFP, we came to a consensus as a team with all the stakeholders and we selected Greenway.

Tell me a bit about the implementation process for both the practice management and EHR.

Since we had so many clinics already up on the legacy system, we felt like the best way to do it was more of a big bang approach. When we brought on the legacy systems I was able to stage it because they were all on paper, so I did one clinic every six weeks. I brought them up on the PM first and then I did the same process and brought up each clinic on the EMR.

But, because they were already all on an electronic medical record, we felt like we needed to do it big bang, so we did all the PM first for two weeks. We created all the schedules, migrated all the patients, and did double entry for about two weeks, scheduling patients in both systems. Then we went cold turkey and everything was in Greenway. Then two weeks after that was done, we did the EMR.

Again, we had migrated as much data as we could. There was very little structured data that could fill in to the same fields, so we did have to re-enter a lot of data. But that happened over time. We obviously weren’t able to do that initially. We migrated all the chart notes and then as the patients came in, we started putting in the new structured data in the new fields in Greenway. Because we had so many sites and doing the big bang, we did bring in contract work from Greenway so that we were able to have support at every site, when we went live.

So you electronically migrated of some of the EMR data?

Yes, as much of it as we could. We were able to get in the progress notes, allergies, and medications. Those were things that we felt like we absolutely had to have, as well as the registration data for the PM side. They weren’t able to migrate any of the scheduling, so we had to rebuild all the schedules.

What about scanned documents on the medical records side?

Well, we never scanned in all the paper record on the legacy system because at that time, we did not have the storage for that. So, we still have paper charts, but since we were on the legacy system for five years all those progress notes converted electronically. Now that we’ve been on Greenway for three and a half years, there’s very little that needs to be done in the paper chart, at least for the existing clinics that we brought up at the time. We do have more scanning to do with the brand new clinics that we have since purchased and with clinics that we had but didn’t bring up at the time. With those they have more scanning to do because they were on paper initially and went from paper to Greenway.

Tell me how you get physician buy-in in terms of you changing the workflow from the old system to the new system and just using the computer in general?

Well initially, they were all on the legacy system before we went to Greenway. But to get a buy-in on the legacy system, it was a lot of one-on-one attention and training with them, and support to help them through all that. On Greenway it’s the same thing: we give them a lot of individual training. We do additional training as Meaningful Use changes have come out. We’ve needed them to step up and do a few more things that maybe they didn’t use to, like check a box, or we will help them with workflow changes so that we can get the reimbursement that we need.

I understand that several of your practices are participating in the CMS comprehensive primary care initiative project for Colorado. Tell me about the decision to participate in the program and what that entails.

The decision was made by our COO. She wanted to see if our family medicine and internal medicine practices could participate in that program. She felt like it would help us in our move towards a patient-centered medical home, which is another direction that we are going. We do have some narrow level contracts that are also geared toward patient-centered medical home and we are moving all of our family practice and internal medicine clinics to patient-centered medical home.

When we did the application to be part of the CPCI initiative, we had to apply for each clinic individually. They did select five of our eleven. We do have some different things that we need to do for those CPCI clinics that’s a little above and beyond what we do for the regular patient-centered medical home clinics. But we are trying to keep things standard across the board. The differences that we do are more for initiatives that are being looked at and tracked on the CPCI level that we are not necessarily tracking on the rest of the patient-centered medical home clinics.

What kind of results are you seeing in terms of the quality of the care that’s being provided, both for the clinics that are part of the CPCI and the regular medical homes?

We feel like we’ve really been able to step up the quality of care that we’ve been able to provide. The CPCI has given us some initial start-up money that we wouldn’t have had if we had stayed with trying to implement patients that are in a medical home on our own. We have used that start-up money to create care coordinator positions that we never had before. They aid the physician by working with high- risk patients and getting the high-risk patients more outside care and better coordinated care that we just didn’t have time to do in the past. Things like follow-up for mental health or abuse, as well as additional follow-up for our patients that have been hospitalized. We just didn’t have the bandwidth beforehand to be able to follow up with all of those patients.

Now we can contact those patients that have been hospitalized and find out how they’re doing.  If they need to see the physician we get them in to see that provider in a more timely basis. We have done a better job at trying to make sure we have same day appointments to get our patients in. That’s especially been helpful in our internal medicine clinics because often there had been quite a wait to get in to see some of our providers.

And, we are implementing another analytics system that’s due to come online very soon. All the data’s in and we’re just working on the finishing touches which will allow us to really work with registries and more of our high-risk patients preemptively and be able to call on those patients again. Before we didn’t have the bandwidth to do these things or have some of the analytics capability to find those patients. Now we’ll be able to find them much more easily and then work with them preemptively, before their visit, to make sure that they’ve had the labs that they need, that we’re calling them, that they’re doing their blood pressure checks or their sugars checks for diabetes, or those types of things.

What is the analytics program and does it interface with Greenway?

It’s Wellcentive and it does interface with Greenway. All that data has been loaded in from Greenway. I call it kind of an EMR light, but we will not be documenting with Wellcentive. We are using it for the analytic and the registry portion.

What are some of the things that have made participating in quality initiatives easier because you have an EMR and practice management system in place?

The ability to create structured data and then capture that so that we can track trending issues, follow conditions better, create payment models with the payers, and know beforehand when we’re negotiating those contracts, and knowing that we can meet their requests for the different payment models that are coming.

Are you currently using a patient portal?

We’re going to roll it out and start in two weeks. It is from another third party that interfaces through Greenway called Intuit. It is actually live now; we just have not rolled it out to the patients yet. We’re finishing up the legal and the risk assessment on it before we do that.

What is your plan for getting patients to actually use it?

We’re first going to pilot it at two sites, and work with just some specific providers and their care teams. We will, one on one, really try to engage the patient when they’re in there for their visit and see what kind of patient engagement we can have. We’ll let them know that they are part of a pilot so that we can get feedback from them on how we could do it better and determine things that we could improve upon before we roll it out again. Because we have so many clinics, we want to make sure that we do a good job and really make it useful for our patients.

Well, I just want to throw in here, quell some of our provider fears around the portal as well. Our providers are very anxious that it will increase their workload, as opposed to just changing their workload and the way that they’re seeing some things.

Tell me about the innovation award you recently won from Greenway. What specifically was the practice being recognized for?

I think for the way that we are using Wellcentive to meet the needs around patients at our medical home and CPCI. And, from a Greenway standpoint, we’ve also done some work to help them create a GL utility that they never had before, because being part of a hospital system, we have a much more in-depth need for GL than they had ever run into before. As well as our recent implementation of our occupational health clinic and Boulder Center for Sports Medicine using Greenway. Again, therapies that they had not used in the past on their system. And we’ve done it quite successfully; they’re doing really well.

Anything else that you’d like to add or advice that you’d like to give other practices looking to increase their use of technology?

Some of our lessons learned were related to working with a vendor that had not been used to something quite our size. We did have some early growing pains with the way we were scoped from a server size. We didn’t have an adequate number of servers and so we experienced some system slowness that could have been prevented had that been done better. As well as load balancing – just more some technical things that maybe we didn’t scope or communicate as effectively with the vendor as we needed to.

Another lesson learned that we picked up is because we did the big bang and we brought in all the outside contractors that they didn’t necessarily buy into our processes and our workflows. So, there was some subterfuge there when they would be in the clinic and we’d ask them to do things ABC; as they’re rolling them out, the staff would ask questions and they’d go, oh, well, you can just do it CBA. You can reverse the order and it’ll work fine in Greenway. Which is true, but that’s not our workflow, to make sure that things aren’t forgotten and that we’re following all the processes that we need to mitigate patient risk or things like that. So that’s again another lesson learned: to have those people for support on the same page.

HIStalk Practice Talks with Greenway’s Tee Green and Vitera’s Matthew J. Hawkins

We spoke with Greenway Medical Technologies CEO and President Tee Green and Vitera Healthcare Solutions CEO Matthew J. Hawkins shortly after the announcement that the two companies would combine. Because Greenway is publicly traded, the leaders were unable to comment on specific aspects of the pending transaction, but shared a few insights:

Hawkins: From a Vitera perspective we are just thrilled with this combination, this transaction that was announced today. We feel it is absolutely a continuation of our commitment to create an incredible business, a platform of healthcare that can take care of our customers’ needs not just today but for years to come.

We mentioned in a note we sent out to our employees that we have had a chance to get to know the Greenway team and know their culture, and the values that they have and their tremendous focus on product innovation and support and service, and felt there is a real alignment with what we are working to build at Vitera as well. So we are really excited about that as well.

We also noted that both Vitera and Greenway solutions are all certified for Meaningful Use 2014 edition and both have achieved patient-centered medical home pre-validation status, and all are ICD-10 ready by the end for this calendar year. So there is a real alignment in taking care of our customers. And that got us excited.

We think that this transaction with Greenway is really a testament to our partner Vista Equity Partners and their vision for what this combination can accomplish in the healthcare space. It’s really a testament to our hard and intense focus on growth and our commitment to take care of our customers today and in the future.

I can’t make too many forward-looking statements other than to say we think that with this transaction and working together to put in place a plan that will allow for a smooth integration at the right time, if and when the transaction occurs. We are very excited about it. Our staff is upbeat, we are upbeat, and we think it is a continuation of our long term goal: to be great partners with our customers in the market.

Green:  As Matt said, this is huge for the industry and certainly huge for our customers and Vitera’s customers –  being able to continue the Greenway brand, the strategy that we developed around electronification and consumerism that is really starting to take hold in this country. We believe there is a going to be a real thirst to improve health and with an innovation platform like this and a customer base like this we think it creates unparalleled opportunities for our teams, our customers, and our business partners.

The leaders could not comment on who would lead the company going forward but noted that plans were being developed for combining the two entities:

Green: A lot of is being worked out right now as far as how as how the synergies are going to roll. Obviously we have some great innovation within these companies and we are putting together that strategic plan over the next 45 to 60 days leading up to closing, and then at that closing we will have the opportunity to share that strategic roadmap with everyone.

The acquisition discussions apparently began fairly recently:

Hawkins: We have been friendly for a while but never had any serious discussion until far more recently. We had a chance to take a friendship in the industry, knowing each other as acquaintances, and feel there is tremendous value to be had by potentially combining these two entities in a transaction like this. Those conversations have been much more recent.

Long term plans for product platforms are still evolving:

Green: If you look at the press release and you look at the brand, obviously as the company continues to evolve, maintaining multiple platforms probably isn’t going to be the long term strategy because that doesn’t create value for your customers or your team. You will see some of that evolution over time.

Hawkins: I will also say the Vitera business has several product platforms today and we expect to continue to support and maintain and provide updates to those product platforms. I will also note that all of our product platforms are set for ICD-10 compliance and we have a clear pathway for our flagship platform Intergy, which is Meaningful Use 2014 edition-compliant, one of very few vendors that have reached that status, so we are pleased by that. We will also continue to support, maintain, and invest appropriately in those products. We need to be emphatic about that.

We are thrilled and excited about the PrimeSUITE of solutions that the Greenway business has. While we don’t have any clear plans as of yet, we like the PrimeSUITE product platform and we also have high regard for the revenue cycle management business that Greenway has put in place. We feel like there are opportunities for the combined entity to be able to take advantage of these RCM solutions while continuing to use the product platforms of their choice.

HIStalk Practice Interviews Michael Lovett, SVP and Ambulatory Division Manager, NextGen Healthcare

Michael Lovett is SVP and Ambulatory Division Manager of NextGen Healthcare of Horsham, PA.

Tell me about yourself and the company.

I am the senior vice president and ambulatory division manager for NextGen Healthcare and a member of the QSI Executive Committee. In my role, I am responsible for developing and implementing the ambulatory division’s strategic plan and ensuring that this plan is aligned with the company’s strategic direction. I also oversee day-to-day operational functions within the division and coordinate efforts across departments to promote operational efficiencies and achieve company goals. I am also responsible for shared operational policies and procedures to improve tools and solutions for client-facing organizations companywide.

NextGen Healthcare Information Systems is a  wholly owned subsidiary of Quality Systems and provides integrated clinical, financial, and connectivity solutions for ambulatory, inpatient, and dental provider organizations.

Everybody talks about product usability and ONC seems interested in transparency in that area. What efforts does the company make in terms of usability and how do you see market demand affecting that?

Those are two great questions. Recently, we launched NextGen Ambulatory EHR 8 Series. It is our most advanced, easy-to-use, and transparent system ever. It has a new user-friendly interface, standardized framework for all templates, and streamlined navigation that is faster and reduces training requirements. It helps providers set the stage for patient-centered, collaborative, accountable care – key drivers in today’s changing healthcare landscape.

In addition, the 8 Series gives providers the tools they need to meet healthcare reform initiatives like Meaningful Use Stage 2 and ICD-10. Our new EHR system features automated outcomes reporting, enhanced disease management workflows, and precise content for over 25 medical specialties. At our most recent user’s group meeting, we received extremely positive feedback. We already have existing and new clients seeing its benefits. In fact, we have reports from clients who have reduced training time by about 50 percent and workflow from days to hours. Others have been able to see more patients.

With the complexity of today’s reforms, the market is hungry for solutions that are fast and easy to use while addressing the demands of compliance, quality, measurement, and reporting. In addition, the recent ONC 2014 certification of our ambulatory EHR includes requirements for and validation of user-centric design principles. To me, this provides another strong, positive answer to your question about our product usability and transparency.

A number of vendors are selling ambulatory systems through hospitals that either encourage or force their owned and affiliated practices to use the selected product. Does that trend worry you?

Not at all. Because of the success we have across so many specialties and up and down the size scale of practices, we have run into this a lot. The depth of our content and the ability to deliver appropriate workflows for the physicians give us an advantage over the hospital vendors who are trying to work their way into the ambulatory footprint. If hospitals are to have successful deployments, the physicians must see the positive benefits, which means it must fit their workflows. In many cases, “encourage” is just a euphemism for “force” and that never works out well in the long run.

Connectivity and interoperability are also key benefits to our solutions. We already have ambulatory practice clients who became part of a hospital system and who work seamlessly across the existing hospital’s platform. And, we offer both hospital and ambulatory HIT and EHR solutions so our company strategies align perfectly with this trend.

Athenahealth and Greenway did particularly well in the recent KLAS report. How are your offerings superior to theirs?

Now you’re trying to get me in trouble with my friend Tee. Jonathan will surely disagree with me, but we are superior to Greenway and athena in a number of ways, from the number of providers and leading edge practices we have as clients, to the content, ease of use, and functionality of our products and services.

While we understand a few of our 80,000 providers are not fully satisfied, we have made and continue to make great strides in increased satisfaction. The response at the user group meeting was great. Our internal satisfaction polling there showed very positive results.

A key point to note is that within the KLAS report, over 90 percent of our clients consider us as long-term partners. They see us as experts who can help them more easily connect with colleagues, hospitals, and payers; attest for MU2 and beyond; transition to ICD-10, and thrive in a pay-for-performance reimbursement model. All while improving care.

In the end, prospective buyers must realize that the survey firms are only talking to a small subset of the client base — in the case of KLAS, just 200 clients out of over 3,500 — and surveys should be used as one of many parts in the buying decision. In turn, it is our responsibility to stay close to the pulse of our clients through direct interactions and be responsive to their needs. The new account management programs we are implementing will help us make great strides with that. In fact, in the Black Book Rankings, announced on March 16, 2013, our NextGen Ambulatory EHR came in first place for highest client experience and customer satisfaction for several categories, including independent physicians associations with less than 150 physicians and physician group practices with over 250 physicians.

The company’s stock has fallen about 60 percent since April 2012, a time that has been quite favorable for some EHR vendors. How has this impacted company priorities?

Over the last year, many EHR venders have had their ups and downs. Our strategies and priorities, however, have remained on target. Our company is focused on the future delivery of healthcare including pay-for-performance accountable, collaborative care. We continue to develop our broad range of innovative and integrated ambulatory and hospital products and services. As a result, our award-winning solutions rank us as one of the top four EHR vendors in Meaningful Use attestations.

From the Wall Street perspective, we have seen many new investors buy into long positions with our stock. That means that they believe in the vision and the strategic plan that was introduced by our board at the last annual meeting. That gives us additional confidence that we are focused on the correct initiatives and as we deliver on those our stock performance will reflect that.

Do you see your inpatient and ambulatory offerings as two distinct lines of business or are there plans to integrate the offerings?

They are elements of a complete, comprehensive, and integrated HIT and EHR offering. For example, our EHR and practice management solutions are fully integrated and connected to our hospital and dental solutions. Moreover, our development team is unified under one organization for all of our divisions, thereby ensuring alignment of and innovations across all product and business lines.

Some are calling for EHRs that are open and that allow the use of third-party apps to add or change functionality. How would you summarize the state of openness of the EHR market and NextGen Healthcare’s interest in incorporating that capability?

Charlie Jarvis, our VP of health reform, and I sit in numerous meetings in DC where the subject inevitably turns to interoperability, connectivity, and data sharing. There are some vendors that simply can’t do that very well at the discrete level. We have always been and continue to be willing to work with other vendors where appropriate. We also have many interfaces for a variety of devices.

Interoperability is not new to us. We have been exchanging discrete data through our exchange with numerous vendors for some time. Our HIE and EDI solutions have been providing access to all available relevant patient data to help providers improve care quality and patient safety. With NextGen HIE, providers can collect, store, and securely share patient information, regardless of what EHR platform it may be stored within, bridging the gap between hospitals and physician practices while providing a channel for communication between communities.

What’s your opinion on HITECH and how do you predict it will impact physician systems in the future?

The HITECH act stimulated an incredible amount of EHR adoption across the ambulatory physician market.  As a result, most medical providers — 70 percent — have now adopted or are in the process of installing EHR systems in their practices.

With high EHR adoption, the biggest challenge now facing providers is how to configure their EHR system to produce the outcome data needed to demonstrate their value-based care performance against objective medical criteria. Just as important is the interoperability between systems needed to compare these objective data points among healthcare providers. Without connectivity and interoperability, providers will find collaborative and accountable care more difficult to achieve.

As a result, the EHR industry is now vigorously supporting movement to standards that will create information highways that make health data readily available and easily interchangeable. Until these standards are fully in place, the challenges of data sharing will continue to be experienced across the entire industry.

In addition there are a large number of providers who purchased a solution that could only offer them a tool to enable the first stage of Meaningful Use. Many of those vendors don’t have the operational, technological, or financial resources to enable their clients to advance to the next stage. Because of this, the replacement market will continue to heat up. For providers in that situation, they will look for vendors that can offer them solutions that deliver more than just stimulus payments, but real function that transforms their practice. NextGen Healthcare is a vendor to help them be transformative. In fact, our NextGen Ambulatory EHR version 5.8 is now ONC 2014 Certified as a complete EHR to get our clients to Meaningful Use Stage 2. We are one of only three vendors to achieve that distinction at this time.