Overcoming Healthcare's Resistance To Change

At Health IT Outcomes, we’ve made it our mission to provide the healthcare industry with expert guidance on technology system selection, integration, project management, and change management. To help achieve this goal, we speak with industry leaders on everything from EHRs to HIEs to HIM, and then share these conversations with you. We recently travelled to Chicago to attend HIMSS15 where we had the privilege to speak with Michael Lovett, EVP and GM of NextGen. Lovett discussed what types of initiatives are currently underway to help both patients and doctors with problems regarding population health, EHR, and interoperability.

Health IT Voices: How does NextGen serve the healthcare market?

Lovett: QSI-NextGen was founded about 40 years ago by Shelly Razin, who is now our chairman of the board. It started off as a dental solutions company then, about 20 years in, Shelly and the board decided to add some additional services and guide into the ambulatory physician market for practice management and medical records through two acquisitions on the East Coast. That’s what formed NextGen.

We develop and support over 30 solutions and services mainly focused on the ambulatory world, but we also have a small hospital division that focuses on community access. Obviously, we still have the dental division, and we also have a revenue cycle management division.

We believe a lot of people are starting to outsource services, and probably less than 10 years ago we made another acquisition in that space to bring those services into our portfolio. We service about 85,000 providers nationwide spanning about 4,400 practices. We’re also pretty excited to take focus and aim on population health.

Health IT Voices: It’s fair to say healthcare is resistant to change and physicians have been leery of EHRs. They think the increase data entry demands, interrupt work flows, and reduce time with patients. What is NextGen doing to overcome some of these challenges?

Lovett: You used the word “leery,” right? I’ve read some polls found 70 percent of physicians hate their EHR and I like to joke that the other 30 percent are simply lying. It really becomes incumbent upon us to double down and really focus more on physician experience and not just the physician. When I say physician, I really mean that physician-patient experience, because what we are doing now is putting a technology in probably the most-intimate setting there is, when you are sitting in front of your doctor talking about something that is going on.

Our efforts right now are to move that needle. We don’t want people to hate the solution, so we are really motivated to make that experience better. Twenty years ago, we gave providers a tool and a blank slate and said, “Build whatever you want.” That was the power of NextGen and the differentiator. Those early adopters thought it was great, because they could do whatever they were doing in the office, and they recreated it.

Crystal Run Healthcare is one of our early clients and they just took off with that concept. That next evolution of providers that we’re starting to move into in EHR, they didn’t want to create it from scratch. They wanted a kind of quick-start mechanism, so the power of having so many practices and providers out there doing stuff is we were able to bring in and start to aggregate some of that content that they were creating, and create essentially a starter kit. We could offer those providers that needed a jumpstart a great content solution along with a great EHR, and that carried the day forward for a while.

This latest generation of adopters is really looking for something that just makes their life easier. The new folks, they just want to get through their day. They want to capture what they need to do and they want to do it seamlessly and that’s where we really have to take our development efforts. I think — two or three years ago, maybe a little further back — if you looked at our solution, you would have said, “Yeah, that’s probably a little too informaticist-heavy for us.”

When we released version eight of our software two years ago, that focus was on ease-of-use and the user experience, so we have been carrying that forward for the past two years in working with those providers out there, garnering great feedback.

We’ve got that big pool, we do focus groups, and we do online surveys. We have a user group meeting that’s attended by almost 5,000 people. We break them into sessions and they give us great feedback, so we leverage that power of the NextGen nation, as we call it, to help us continue to move forward. That’s not to say we get it right all the time. We’ve stumbled along the way, but we are just really committed to bringing it home as we talk about that physician-clinician-patient experience and making life easier for them.

Health IT Voices: Where do you think healthcare is in terms of interoperability?

Lovett: Interoperability is still an evolving process. In our case, the biggest acquisition we did was Mirth. They, in our humble opinion, were the kings, the gold standard, of interoperability engines. We could throw a rock in this room and hit one of our competitors that is using some of the Mirth stack for some of their interoperability engine. We did that because we have to move from just talking about being able to exchange data or going to the interoperability showcase and showing some transfer and move it more towards where it’s just engrained in what happens.

The key is, “Yeah, great, I can change a CCDA” or “I have an ADT with a hospital, but if I can’t start to move the data that I need at the time I need it,” speaking from the frame of a clinician, “while the patient is there and I can create action that has a positive outcome, then the exchange of data is just the exchange of data.” That’s where this entire industry — all 45,000 people at HIMSS — understand that’s where we have to go and it’s going to take the effort of the commercial side really doubling our efforts on what we are doing in working together with some of our competitors.

I think regulations maybe takes a step back and lets some creativity step into some of those gaps, but it is key to where we are going, ultimately. So, it’s a great question. It’s something, if we can get it done right, we can move ourselves forward or closer to the Triple Aim.

Health IT Voices: We are moving into Stage 3 meaningful use. What plans does NextGen have to help healthcare make this transition?

Lovett: I would say there’s no doubt that this program moved the needle forward. It started to generate adoption and that’s good for healthcare. However, when we look at that, if you are doing things based on a criteria of a program that providers have to do, does that make them use it more meaningfully? Not always, and I think the program forced vendors, even the ONC, to start really getting fixated on, “You need to grab this data. You need to put it in this way. You need to get certified,” and all of those hoops that we had to go through.

During that process, we did all of that, which is great. We wanted to be one of the first vendors every year or every term to certify, but the entire time, as we are going out to market and talking to people that are coming in as prospects, what we are asking them is, “What else?” You don’t want to buy a solution, you don’t want to adopt a solution that the only reason you are doing it is because you want to get an MU check or you want to avoid a penalty. There are plenty of vendors out there — hundreds and hundreds of them — that could get you that check or move it, but what you needed to do is make sure that it was going to do something else for you and move you forward.

As this program winds down, I think that it gives us the ability to focus more on the “What else?” and really drive that home. I know when we think about our development efforts, our product management, and our innovation, that’s what drives us. What else can our solutions do?

We haven’t been about just checking the right boxes and letting them get their check or avoid a penalty. We’ve been all about creating robust content, creating the right solutions, and the tools that they need, such as Pop Health and Portal, and you talked about interoperability. I think that when this program ends, it will have moved healthcare forward. We have gone to solutions, gotten the right frame of mind, but I think the folks that can answer that “What next?” question or that “What else?” question, those vendors will fall away through natural competitiveness, and providers will be left with solutions that can actually answer that question effectively for us and move us closer to the Triple Aim.