Electronic Health Records HIT Greenway

What is your history with Greenway?

I have been with Greenway for over seven years as the Vice President of Marketing, Corporate Development and Government Affairs. My other major title is Chairmen Emeritus of the EHR Association.

When I graduated, I went to work for HBO & Company.  They merged in 1999 with McKesson.   After working at HBO & Co., four associates and I left to form Healinx.  McKesson later acquired Healinx and renamed it RelayHealth. I was not active in the organization at that time, but I was a shareholder.  McKesson RelayHealth is much larger today.

That brings me up to my present position.  Greenway has grown fairly substantially while I have been present, so it has been a wonderful opportunity.

What are the key reasons for such substantial growth, and why has Greenway been able to emerge as a top Electronic Health Record software vendor?

Why I decided to join Greenway and its success are synonymous issues.  Primarily, when I saw the progress in late 2002, it became clear that the fully integrated solution was the silver bullet.  I knew from my previous experience how aspects of a complete EHR solution should come together; in a fully integrated platform.   Back then, it was about interfaces.  The idea of a complete EHR solution was at its infancy and interoperability wasn’t even spoken about.

It was great to be involved with a strategy that initiated the eventual goal of encompassing all clinical and financial aspects of practice needs.  With these foundational objectives in place, the addition of an integration engine became the capstone of the PrimeSUITE framework. We had created an outline to work towards the future with.

From there, we filled in interoperability and Interfacing.  Greenway manages all of the interoperability, in-house, at one central location.  Thus we take burden upon ourselves and don’t place it on site at the practice.  Four and eight doctor practices shouldn’t be managing interfaces.  They are there to operate practices, see patients and deliver their highest quality of care.

Greenway even had a clinical research strategy well before a majority of other firms.  Research is one of the main reasons why we are doing all of this—to report outcomes and deliver higher quality of care.  I saw all of this coming back in 2002 and Greenway already had the model.  There were no companies that had that foresight at that time.  Everyone else was working on different pieces of the puzzle. Greenway pulled it all together.

These are the reasons I joined Greenway and why we are a top rated KLAS vendor and continue to grow exponentially.  Greenway and I have a match in values and vision; I see where our country needs to go, and how we are helping each other get there.

What makes PrimeSUITE trump other leading complete EHR solutions?

We have allowed our customers to achieve true usability at the point of care.  This means our customers have all the features they need, in addition to intuitive usability.  The provider can document the care using highly customized templates, per their desired workflow.

Most systems don’t offer a flexible technology framework like PrimeSUITE.  In those cases, customers bend to what our competitors’ systems can perform.   PrimeSUITE meets customers in middle; allowing them to have the workflow they are accustomed to on paper, in electronic form.  With PrimeSUITE there are no workflow changes for interoperability; everything is already inherently built into the system.  We have a happy customer base because they don’t have to modify their existing workflows to meet Meaningful Use.

Then there is claims payment.  Usually Accounts Receivable are out some 40, 60, 90, days.  Not to mention poorly designed Revenue Cycle Management (RCM) systems that can go down or break etc.

Our customers receivables are in around 20-25 days and paid quickly.  PrimeSUITE’s RCM layer allows practice managers to pay bills and outstanding claims faster and more efficiently.  Their physicians can even increase patient loads, without fear of an unmanageable claims volume. We put them in more control over their workload.

EHR HIT Greenway HIMMS EHRA Justin Barnes

Meaningful Use Stage 3 and PrimeRESEARCH…

PrimeRESEARCH really helps our customers.  They can participate in clinical trials, outcomes reporting, quality reporting, public health etc.  Practices will also gain access to the best analytics and strategies—sort out how they want to use their data.

Only 4% of practices in America currently participate in clinical trials to improve medicine and Healthcare.  We want tens of thousands more to participate in clinical trials and research.  Experts suggest that we may have the cure to cancer locked up in these paper records.  So we are enabling data on an opt-in basis for research studies.  It is these integrated research options will allow physicians to improve Healthcare as a whole.

A goal of Greenway’s and a personal mission of mine is creating smarter, more sustainable health systems in America; one customer at a time and one practice at a time.

And incentivizing those activities…

Exactly.

What are some of the more specific ROI savings from implementation of EHRs?

Our average practice receives between $20-80k ROI per physician.    For specialties, $80k is a very real number.  One recent example is an OBGYN practice that had an $80k increase in ROI for its first two years; post implementation of PrimeSUITE.  The bulk of the return was from simply running cleaner claims.  If you are a specialist and you can hit those numbers, you have paid for the system in one year.  Everyone knows the insurance companies make money from floating bad debt claims.  This turnover is probably the most heavily weighted variable in these ROI calculations.


There have been some major mergers and acquisitions.  More recently Allscripts-Eclipsys, INGENIX-Axolotl and you even mentioned your involvement with McKesson.  What should we be ready for when selecting an EHR in this dynamic environment?

It’s about making the most sound business decisions, in every step of your life.  Physicians and practices need to be very aware of this. When you look for an EHR, the decision goes well beyond bells and whistles.  Make sure product works for you, your specialty and your workflow.  When you are analyzing an EHR, it is very important that you get the right information.

Let’s talk about reference lists.  When you ask for one, make sure that it comes from within your specialty. From there, confirm that greater than 50% of caretakers in the practices referenced actually use the software.  If it’s a 20 doctor site, at least 10 of those physicians should use those EHRs to even be considered “implemented.”  Physicians are not aware that implementations are evaluated through a minimum standard of 50% user adoption at an individual site.  Therefore, if the practice down the street is of the same specialty, size and over half of the doctors are using the EHR, it probably works for you.

Beyond reference sites, looking at the company’s past success is crucial.  What was the growth over the last four years?  Is it consistently growing?  It is important to ensure the company has been able to navigate these new waters.  Just because an EHR vendor was marginally successful two years ago does not mean they are today.  Even if it is a privately held EHR company, you should still be able to get financial data in this regard.  If you aren’t seeing 15% annual growth, if not up to 30%-40% annual, then there should be cause for alarm.  It’s not the best EHR for your specialization.

Meaningful Use and Accountable Care are all about usability, discrete data capture, interoperability and quality reporting.  Outcomes reporting and outcomes management are the future.  This was not the case two years ago.

Electronic workspace security:  What discussions are occurring in Congress?

I just spent the last few days on the Hill testifying and security was one of the topics.  We are trying to create some better discussion points and not let the absurdity of worst case scenarios manage these conversations.  We must collectively ask—”what can we do as a united country to move this discussion forward?”

Well, we should ensure that we are using the highest levels of encryption available and the best security protocols. Let us also make sure we are not creating information silos because of fear, thereby putting the country at risk.  Congress is dealing with these issues and they understand the tradeoffs involved.

We should enforce laws we already have and prevent fear-based decisions. The bad actors need to know that they will be fined and they will be held accountable to the fullest extent of the law.  We need to create a smarter more sustainable Healthcare system in America as soon as possible.  Don’t let that goal be forgotten as we move through the next steps.

There is a great deal of discussion looking towards Healthcare Reform in Congress.  What could be done to the HITECH Act, and what could be done to Healthcare Reform efforts given the change of tides after the election?

I am going to start by separating HITECH and Reform as they are fundamentally different.

Leading up to the election, candidates were making broad stump speeches about stopping ARRA stimulus funds.  Although there are some unspent stimulus funds that might be accessible, attempts wouldn’t make it through the Senate, let alone the veto pen.

Funding in ARRA, specifically HITECH, is relatively finalized and passed.  This means HITECH is now part of the Medicare trust.  ARRA funding for ONC Meaningful Use is not subject to the appropriations process.  There is nothing that either party can do to modify these funds given the new standing in Congress.  Now if we want to really drill down, there is some appropriable money that would choke implementation.  At this stage of ARRA, these efforts would only hurt individual states and the overall quality of CMS funding.  These actions would not affect 98% of the funds.  Don’t get me wrong, they could still pass a bill, but it doesn’t matter because it’s not going anywhere.

I did not have to go into this detail last year, but I will now because of the confusion.  Which is fine, but we just have to make everyone understand that ARRA is passed.  No one can significantly change EHR implementation via appropriations.

In contrast, Healthcare Reform is very different. It is not part of the Medicare trust fund and there are certainly ways of choking these funds in the appropriations process.  For example, they could disable HHS from working on aspects of reform issues across the country.

One of the larger issues from the Affordable Care Act is the formation of Accountable Care Organizations (ACOs).  There is some confusion as to how these will take shape.  So let us start with the very basic questions. What are they?  What are they most likely to be?

We should see interim final rules shortly—so I can’t answer as to “What they are” directly yet.

What they are most likely to be is an institution or series of institutions, networked in a community.  Some communities will have one ACO or a few ACOs and larger cities will have multiple ACOs.  I am working on this at the Capitol as well.  There are going to be care providers that want to participate in multiple ACOs in their community.  We have to really think about this moving forward.

Now as I spend more time on the side of the equation where technology is infrastructure, I also understand that some communities do not have equal access to this technology.  If we are going to create the most robust return for this country, we have to accept that a community organization built on technology creates the most successful ACO solution.  If legislation allows our Healthcare system to stay on paper, we will have similar issues as we had in the eighties.  And everyone has seen that movie.

So let’s make this blockbuster using new technology and put it in 3-D.  If we do that, we can get everyone out to the theater this time.  If you are going to have a successful ACO and make it any different from in the past, you have to build it on a foundation of technology and interoperability.  If we do that, we have a greater chance of long-term success than the colossal failures of the past via paper record.

If you can get past the scale of these issues, realizing we are all here for quality patient outcomes, operations will be more profitable.  It is an issue based around who has the chance to be successful out of the gate, who is going to let their personal efficacy come forth.  Those with the ability to do so may have some early struggles, but they will also secure their position as one of the market leaders.

These early entrant’s specialists will be health technology leaders moving the community forward in that direction. Those catalyzing organizations will come from a community that is well on its way to adoption of health IT and we are helping along these discussions.

Further regarding ACOs, let’s talk about incentivizing the role of physicians in these terms.  There have been reports of grads preferring to work for larger organizations that may be part of ACO networks.  There are also talks of gain-sharing and other ways to incent the ACO outcomes and performance.  What future do you see for new physicians, residents and Healthcare professionals graduating into this economy?

I will validate the trend as it is another thing we just discussed on the Hill.  So we have two things:

First, the graduates are leaning heavily towards working for large institutions.  Arguably, they can make the same, if not more money than in the past.  Before, one would take a pay cut working for a larger institution, but would have a consistent work-schedule.  Today, arguably, there is such high demand that they are making the same, if not more, money.

Another, equally important trend is how these same graduates only want to work with institutions using the best HIT solutions.  They can’t imagine going from using industry leading EHRs and HIT, at our nation’s top schools, back to paper.  We have had several individuals actually testify in this manner.

My point is—the practices who are not adopting technology are putting themselves in a position not to attract new talent, not to participate in the future of Healthcare and they are putting themselves in a position not to be competitive when it comes to the new ACO structures.  That’s dangerous.  We would never put our corporations in that position and I would never put Greenway in that position.  If I were hiring sub-par talent, not hiring on technological competency and thereby not for the future of this company, I would be fired immediately.

Having said that, I’m not insinuating that everyone should go out and buy EHRs either.  You need to buy the right EHR, the right Health IT for your specialty.  Don’t just go buy any technology, but buy the right technology for your practice workflow solutions.  You need to build the future of your practice and your facility.  The right technology affords you to be attractive to the new communities forming around you.  It will be very difficult to participate and compete successfully on paper.

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For more information about Justin Barnes and Greenway Medical Technologies, Inc. Visit: http://www.greenwaymedical.com/

EHR Scope would like to thank Justin Barnes and Lindsey Berryhill for making this possible.

About Justin Barnes

As a Healthcare software executive and public policy expert, Justin Barnes is a Vice President with Greenway Medical Technologies and manages Greenway’s Strategy, Marketing, Corporate Development and Government Affairs. In addition, Justin is Chairman Emeritus of the HIMSS Electronic Health Record (EHR) Association where he is responsible for executing the EHR Association’s industry strategy and leadership.  Justin resides on several Public Policy, EHR and Health IT industry governance boards, bringing the essential continuum of corporate experience from Silicon Valley start-up’s to Industry-leading Fortune 20 conglomerates.

Justin is a national public speaker on the state of Healthcare in America, Healthcare Transformation, Health Reform and specifically, the Stimulus Package/ HITECH Act and its relation to Healthcare, health IT, interoperability, health information exchange, EHR meaningful use, EHR certification and electronic health record adoption.  Justin also is a leading speaker on Accountable Care, ACOs and Health Information Exchanges (HIEs).

About Greenway Medical Technologies, Inc.

Greenway Medical Technologies provides innovative EHR, ambulatory healthcare and clinical research business solutions and services to more than 23,000 Healthcare providers nationwide, in 31 specialties and subspecialties, by enhancing the delivery of patient care through advanced health IT software and on-demand services that allow physician practices to function at their highest level of efficiency in group practice, IDN, REC, HIE, IPA, Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) settings. Established in 1998, Carrollton, Ga.-based Greenway is a privately held company with more than 400 employees.

About EHR Scope, LLC

EHR Scope is a leading provider of EHR and EMR software consulting services.  They offer a variety of valuable EMR education resources to help physicians and practices navigate their way through the EHR implementation process.  In addition to the educational resources are media coverage of the Healthcare Information Technology industries and current Healthcare Reform issues.