You could forgive your average specialist for not paying too much attention to their patient management system (PMS) in the past.
Though a critical component of their day-to-day operations, the market has been slow and steady, the products have been relatively straightforward and basic, and their have been just a few dominant and trustworthy players. And depending on your specialisation, rheumatology for instance, your PMS will likely then have been dictated by the specialised modules that some providers concentrate on.
But that reasonably steady and staid world is undergoing significant and rapid transformation. Generally, a practice will upgrade or change its PMS every three to six years.
A PMS done traditionally is a big upfront investment in technology, services and ongoing support. Depending on the size of your practice and spread, things can get decidedly complex and expensive, so generally all this investment in servers, data migration, networking, and hooking your PMS to all the things it should hook too – appointments, kiosks, accounting, even some forms of billing – is capitalised in your accounts over the life of your hardware. That makes it all feel a bit better.
But if you’re coming to the end of your current PMS financial life cycle, and your practice manager and IT head (if you’re big enough for one) or IT support company, are starting to niggle you on some new options, you’re going to need to stop and think very carefully.
Within the next five to 10 years, it is almost inevitable that most systems whether specialist, or GP based, will move into the cloud and offer your practice the ability to be far more connected (read: interoperable) over time, far less to run, and entirely mobile.
Such changes synchronise neatly with what many believe are systemic changes starting to occur in the relationship between the healthcare system and patients.
Patients, whether doctors like it or not, are becoming more powerful in an information ecosystem which, until now, has been largely asymmetric in favour of the doctors.
Regulation around risk will continue to make healthcare a market where consumers are less powerful than other markets such as travel and technology, but not so much that you won’t notice big changes as a doctor. These new cloud-based mobile systems are likely going to enable you, as a doctor, to meet some of these challenges head on.
If you feel the desire or need, you will be able to significantly re-arrange how you engage with your patient population. Things should be at once far more intimate, and efficient. Things should, by rights, get better for both sides.
But your journey to this potentially improved future via new technology is not likely to be easy, especially if you’re the type to want to leap to the front. Your decision will be whether to wait and follow, and potentially lose some ground on your practice patient population or brand, or move in the next couple of years and build your practice into what some think will be a new era of patient centric and highly connected multi-disciplinary care.
What are your likely hurdles in this journey?
Firstly, what am I even talking about here? What’s the difference between cloud and mobile systems and traditional systems? Who has them? How good are they really? How would I even begin to think this through? Can’t I just leave this to my practice manager like I have in the past? You are making me anxious!
The good news here is that some of the major traditional players are moving on cloud-based systems so you may already have a system, such as Genie, which has a cloud version on offer and in rapid development. In the case of Genie, this system is Gentu. So you may have an existing vendor who you already trust who can take you on this journey to some extent.
In the case of Genie Solutions, this group was acquired by the private equity arm of a huge investment fund in early 2017, but even by that time the group had decided to double down on its investment in a cloud version of its system. Under IFM, it then declared its hand on the future by employing a new chairman who came from possibly the most stark example of transformation via cloud-based professional services technology outside of banking. That is, accounting.
James Scollay, was general manager of the business division of Australia’s largest accounting software firm, MYOB. Scollay’s five years at MYOB probably could not have prepared him better for a role at Genie.
Those five years saw a massive transformation in the accounting industry which was sparked by the entry and rapid growth of a cloud-only competitor to the traditional MYOB business, Xero.
In the last five years, MYOB had to react and then re-react and start again and build its own functional cloud offering to keep afloat in this market. And in that time accounting has undergone a massive transformation in small business, where now the businesses themselves do much of the day to day simple accounting via their cloud systems and only leave the complex stuff such as BAS, treasury and tax to their traditional accountant.
The Xero MYOB story might be apocryphal for the medical practice management market. Scollay says that while Genie’s desktop product will continue to be developed and supported throughout the next decade, Gentu, the company’s cloud product, will ultimately be the major system used by all specialists, and perhaps even more broadly.
Initially Genie started on its cloud product development under the founding Carr brothers, and the story goes that the initial product build was an insurance scheme – just in case their desktop product got isolated by stories of the future. But over time the company realised that cloud-based architectures for PMSs had so many advantages and talked so much better to the evolving potential of mobile to create insights through data and engagement with patients that the company became a true believer in the cloud.
Like the accounting market, Genie potentially would not have got its act together, if it hadn’t been prompted by a potentially disruptive upstart, start-up. In the case of MYOB it was Xero, a cloud only play, that initially MYOB dismissed as non viable. It’s unlikely Genie ever dismissed Clinic-to-Cloud as non viable. Its huge investment over the past two years in the Gentu product suggests it learned the lessons of MYOB.
Not withstanding, Clinic-to-Cloud, a ground-up built cloud system start-up which first came to market in July 2015, is boasting that they have taken quite a bit of market share in the specialist market. And although they deny it was their intention, the biggest market sector they were targeting was procedural specialists – the core market of Genie.
In terms of cloud and specialists, there is only one other player that has come to market in the last couple of years – a system called MediRecords. MediRecords has only a very minor share of the specialist cloud market compared to what Clinic-to-Cloud and Genie are claiming. But it is a fully operational cloud suite which includes its own kiosk, appointment system, and fully functional patient app, something the others haven’t yet achieved. It also recently won a contract to be installed across the entire hospital network of Queensland for visiting specialists to use. The contract will eventually see the system serving thousands of users, essentially on one system across the cloud.
This contract was hard fought between a lot of software vendors, but ultimately, when the contract was awarded, it was because MediRecords was the only fully operational cloud solution in the tender.
That has given MediRecords a fair bit of street credibility in both the GP and Specialist markets. I am a non-executive board member of the MediRecords business, so read into that what you will as you assess this article.
I will try to make some assessment for you of the various pros and cons of each of the cloud systems on the market, but assessing these new systems isn’t that easy because you really have to be a user for a while to understand the real utility and to become a user is a hassle that starts with you making a commitment to cloud, and then migrating all your data.
Once you’ve done that, it’s hard to go back, not just because cloud really does offer a different future, but usually because you’ve spent a lot of time, money and emotion in making the change, especially around data migration.
But before we even start there are some non-cloud based vendors which still warrant a mention.
In rheumatology and dermatology, Audit-4 stands out as the major one, because it offers something that no other vendor offers, either in their cloud version or desktop – the ability to capture and analyse patient data in a manner that can be audited for research, and for risk assessment. It also has several modules specifically designed for rheumatologists and several other non procedural specialities.
In the case of Audit 4, it does not feel likely that any of the major vendors will reproduce this specialised functionality in the near term – they have too many other things on their plate just getting their cloud versions working correctly. So if you’re a specialist with needs in the direction of understanding your data better for research, even internal research around risk, Audit 4 might be the exception to the rule here that most specialists examining their next PMS should be giving serious consideration to a cloud system.
The other system which might be interesting is Blue Chip from MedicalDirector. I mention this system because they have a reasonable chunk of the specialist market, and although this is a desktop system, MedicalDirector has spent a lot of time and money developing a cloud system for the GP market called Helix.
Only Helix and MediRecords have cloud functionality for GPs. I mention Blue Chip because it seems inevitable that if you are a customer, they will take what they’ve learnt on Helix and bring it to the specialist market. There is no indication from them yet however that they are moving on that.
Other desktop systems you might be familiar with are Shexie and MedTech. Both offer a “hosted server” solution for mobile specialists and multi-practice groups. Shexie is a long standing and reasonably well respected brand but they aren’t signalling the development of a cloud version yet.
In the accounting market, and in the medical software market, when faced with true cloud competitors, vendors reacted with what is known as hosted-server solutions and attempted to convince their clients that they were cloud as well. This is technically not a lie because essentially they are serving their system over the internet. However, these are not cloud solutions, and they can’t compete with properly architected cloud solutions in any way, because the latter are built ground up with purpose built software and databases to optimise speed, utility and interoperability.
There is a huge difference in both cost, performance and utility between these old systems which are simply “slaved” and served in their clunky old format over the web, and a purpose built cloud solution.
In the accounting market MYOB nearly lost its way by making this solution their first reaction to the arrival of Xero.
The first step in deciding whether you want to move yourself to a cloud system is natural – homework. I’ve tried to provide a bit of a cheat sheet below on most of the PMS specialist systems (cloud and desktop) , but in the end you’re going to have to listen to the pitches of the various vendors individually. The list below might help you form an order of calling.
Possibly the least painful part of the process is the actual decision to move your system over to cloud. The only advice here is be very sure of your decision because any PMS changeover is painful – data migration is always an issue – and cloud is particularly so if you haven’t done your homework and aren’t actually that committed.
The key to cloud is to understand what you are doing is introducing a whole lot of new ways for your practice to work. To feel good about cloud once you have it up and running you will need to have pre-thought how you might implement the new utility it is going to provide you. The most obvious utility is any device anywhere, relatively seamlessly. The next is far more ability to have intimate but controlled patient engagement. After that things spread out quickly.
The other thing about cloud is a thing we in the management game like to call “who has the D”. That is who is actually the decision maker in this process. My advice is that it is the practice owner and/or founder, not your head of IT.
This is a decision that involves the whole operational utility of your practice and has significant implications for how your workflow of doctors and associated allied services work together, and with patients. It’s a doctor-led decision.
Before you get to your most painful hurdles, which usually involve your people, you should probably do a quick check that the cloud system you are thinking of has sufficient mid term functionality, and if it doesn’t, if it is likely to have in time.
I say the latter because some of the vendors, like Genie’s Gentu, have limited functionality compared to their desktop versions still, but they are madly working to get a reasonable base of functionality in the near term so it might be worth changing over still.
Functionality comparisons for cloud systems versus desktop systems as things stand today aren’t entirely fair. Some of the desktop systems have been in development waterfall style for up to 25 years, so getting that functionality into a cloud system in a short space of time is impossible.
So decide what you need as the basics, and whether sacrificing some functionality of the old desktop system for the cloud is offset by the mobile, cost and connectivity advantages of your cloud system in how you intend your practice to work into the future.
As a starting point, if you are a proceduralist you are likely to have very specific modules. Given this market is possibly the largest, both Gentu and CTC have some form of those modules at least.
As a rheumatologist, a non-proceduralist, you also have a few good purpose built modules, which may not yet be available in the cloud systems. Genie, for instance, has modules, but their cloud version doesn’t yet. You’ll need to check when they might have it and on what timetable they intend to develop it.
After specific specialist modules, your decisions come down to quite similar decisions you may have had for changing your desktop PMS module. Quality and history of provider, quality of support, security, and last but no longer least, cost.
No longer least because in the past, unlike GP PMS acquisition, cost never really seemed to play a big role in PMS specification in the specialist world. But the change in cost profile can be so dramatic in the case of cloud, that we think it might be play now.
After these basics, then look at the utility you are getting with cloud – mobility, connectivity and cost and a chance to develop a more meaningful engagement with your patient community.
Finally, take into account where everything is heading in this world – to mobile and the cloud. Unfortunately at this time, getting onto the cloud is still hard, and when you are there one of the issues you will have is that in medicine, most of the connecting systems – other than your patients – are on old technology, so the cloud vendor spends a lot of time writing code to talk to outdated government and private pathology billing systems. But as we move forward this situation is going to reverse. Old desktop systems will inevitably be odd man out, and have to start writing to the cloud services for financial providers and the like.
We are never going to tell you that at this time this is an easy decision to make.
That and you will soon find out that a significant number of IT professionals, whether they are employed by you internally, or contracted as a service provider, are significantly conflicted by your decision to move to a cloud system.
Cloud systems get rid of your need for servers, hosting, updates, patches, downtime maintenance, and so on. Essentially your only starting requirements are decent internet bandwidth and capable devices – any device between a mobile phone, ipad, laptop or desktop.
It’s little wonder your IT friends will be anxious about your decision.In large part, everything they’ve been doing in the past, or charging you for, will not be required in a cloud system.
Not withstanding, a good software service contractor, or internal IT person, will still be of enormous value to you moving forward. There are lot of things to do “upstream” that optimise your practice on the cloud. It’s just that some IT providers aren’t over both technologies.
If they aren’t multi-skilled in cloud and older technologies, the reaction of many internally employed IT managers and software contractors is very negative. They will give you a thousand reasons why you shouldn’t move.
Some of the reasons given are an immediate red flag for an IT employee or software contractor who is simply threatened by the cloud and is attempting to confuse you. Beware if you get the following objections:
- Cloud systems aren’t secure – your data is on the cloud where anyone can get it. Your data is imminently more secure on the right cloud system than on your local server where the protection from increasingly sophisticated ransomware practitioners and hackers is far less sophisticated.
- Cloud systems go down and that’s it – you can’t do a thing. This is actually true if they do go down, but you’ll find these days they don’t.
- The data migration to a cloud system is a nightmare – it’s actually easier than moving desktop vendors
- Cloud systems have hidden costs and they will cost you more: properly installed systems will save you a bomb over time.
- The internet isn’t good enough to handle all the data and it will slow you down: this is rarely true these days, especially in urban areas, but can be easily checked before you embark on the process
Cloud systems aren’t perfect. But most of these excuses do not apply if your using the right people to help to get you to a cloud system.
The other administration issue you might have is with your accountant or book keeper. When you move to a cloud system your costs move from what is known as accrual accounting – where your finance person amortises the costs of your hardware and system over three to five years, to operational accounting, which simply means all the costs of the system are taken up at the time of the cost – which is usually a subscription.
This can cause internal discomfort sometimes as it messes with your P&L for a year or so. But in the end, you will be dispensing with a lot of overall cost and hassle.
Certainly every three to five years when in the past you had to upgrade all your hardware including networking, will, in theory never happen again.