In the comments of a post by Dr. Gregg, someone made a really interesting case for going with an EMR VAR instead of the EMR vendor itself. Of course, this commenter was named “EMRVAR” which probably means they come from a VAR. So, you have to take these comments with a grain of salt, but their comments are worth considering. Here’s the case they made for VARs.
My Advice: Seek out a VAR – Value Added Reseller that cares more about you and your practice then any BIG NAME EMR CORPORATION that only cares about its stock valuation on any given day.
VARS
A VAR is an advocate for your practice – a Var’s many installs weigh more heavily than any one customer that the BIG EMR Corp has.
A VAR deploys technology from several vendors and adapts these products and services to its customer specific needs
A VAR partners with several product manufacturers and service providers. Though partnerships are formed, it is important to realize that a VAR is an independently owned and operated business that is not bound by any one corporation products, services and policies.
A VAR is often located locally to the communities it serves
The VAR model is important in healthcare and the above comments state a pretty good case for the EMR VAR. I find it interesting that in many respects this is the case that small EHR vendors make as well.
What has been your experience with EMR VARs?
Wonder how much risk there is that a VAR gets an agency fee (i.e. kick back) from the vendors it takes to the market?
Going with a VAR rather than direct from the vendor is a matter of choice after weighing the pros and cons of each. I bought my iPhone from Best Buy rather than directly from Apple or a telco because I enjoy the benefits of their almost limitless (but expensive) warranty.
Two things the commenter failed to mention that always stand out to me when it comes to an EHR VAR are:
1. A VAR is bound to whatever products, services, and policies it agrees to be bound to when signing contracts with their partners.
2. Beware the support fee’s of a VAR. Where many vendors build an annual or monthly support fee into the purchase contract where a VAR often bills for support by the hour so if you didn’t purchase vendor support through the VAR prepare to wait long hours for the VAR to call you back or come out to your office and then pay large fees for the time and effort.
Don,
They certainly get paid for the referral. I don’t have a problem with this as long as they weren’t the ones consulting you on the EHR selection.
Andrew Cox,
Really great addition to the conversation. Some really important points to consider.
John … Only way a middle man whether a REC or a VAR adds value is if it provides consultancy support to the practice helping it define need and best fit option from the of EMR providers.
If the government-backed REC is doing its job … helping the practice define its need and best fit EMR options … then addition of a VAR on top is superfluos since the practice could simply execute a contract direct with the specified vendor.
If the REC isn’t doing its job … then the VAR better be helping its client practice define its needs and steer it to the best solution options.
The utility of a REC versus private sector management consultancy was the basis for the debate between Bobby G and me.
If VARs are emerging as a key component in effective EMR deployment … this validates for my original view that RECs were potentially detrimental to the overall objective if they didn’t add value by providing a practice with management consultant services, steering practices to the EMR options, and then brokering the best buy for its client with the vendors.
If you are a middle man … whether REC or VAR … you better be adding quantifyable value or you are just parasitic drag.
A REC is a VAR. Only RECs were funded to support EHR adoption in primary care. Some RECs have initiatives to assist specialty providers in their state, but that gets away from their core purpose.
If a REC isn’t doing its job in providing effective consultancy and implementation support, then a different VAR should be considered. VARs are popping up in the shapes of RCM (billing) companies, consultant firms, and IT firms, who all specialize in EHR implementation and have expertise and (should have) certification in one or more EHR softwares.
VARs are great because as the article says, they deploy technologies from different vendors and they adapt those technologies to the specific needs of individual health systems, allow them to stay nimble. Some VARs, like RCM firms in particular, have an inherent incentive to ensure successful implementation of an EHR.
If your VAR isn’t doing its job and helping you succeed, switch. If your REC isn’t doing its job and helping you succeed, then yes, they could be potentially detrimental to the overall objective and are just another entity perpetuating the cycle of inefficiency in our healthcare system.
@Don – really? Of course they get a fee, plus any additional support fees
@Andrew – good points, another thing to note when paying an ongoing MX fee is whether upgrades, or at least the upgrade process, is part of the MX fee.
@Don – not true. Example: Centricity. This EHR is geared toward larger practices. GE will directly support large practices, but if you are a smaller practice, you’ll get lost in the shuffle, hence a VAR generally makes since in this case. A VAR typically is NOT an EHR consutancy, they are a value added RESELLER of a system. RECs shouldn’t exist in my opinion, they are “just” another expense to the entire healthcare program and their performance varies wildly. And to your last sentence value added, but it is up to you the buyer to ensure they are actually adding value.
@Sidney – maybe a REC is a VAR…I didn’t think it was supposed to work that way. If RECs are acting as VARs, how are “they”, the government, choosing your EHR for you??
REC – our local REC is in financial trouble. They were supporting a local doc on the tech support side of things, but had to drop that for a variety of reasons.
As one who does IT support for medical offices, I’m completely against a pseudo government agency showing up with “my” tax money and taking my clients. It is wrong…and it appears, at least for ours, they weren’t any good at it.
VAR – a VAR lives on fees for selling/ implementing/supporting the software. Just make sure you understand the fees. There are good VARs & bad, along with vetting the EHR software, you need to vet the VAR. I’m not a VAR for any EHR for a few reasons – I haven’t seen an EHR that I would confidently sell, plus that just isn’t the business I really want to be in.
Wow long post, but to summarize:
Like selecting an EHR, you must carefully select a VAR IF that is how your EHR is implemented.
I also think the concept of a REC isn’t one size fits all. Since government funding for these entities ends in 2014, they will need the ability to generate revenues to stay afloat. Some RECs will make it past 2014 and some won’t. Revenues could be generated from consultancy fees, vendor referrals, etc. I know that some RECs intend on sustainability prior to 2014, so I’d be interested to see exactly how they are making or planning to make money. Also, John B, RECs don’t choose the EHR for you, rather they exist to provide EHR evaluation and implementation assistance, helping primary care practices work with EHRs that works best for them.
Great discussion. Many RECs have a lot of similarities to VARs and plenty of bias in the assistance they provide. I wonder if many RECs will become essentially VARs once their govt money runs out.
@Sidney – “RECs exist to provide EHR evaluation and implementation assistance”
While this may be why they were created and in their mission statement…I see those I’ve come in contact with dealing with 1 EHR.
There is an assumed neutrality in a REC, wouldn’t you say?
Though I repeat – I’m bothered that my tax dollar is being used to create competition against myself.
@John Brewer …
My initial post was to prompt a response. I am on board with you. Have never seen the true value of a REC when compared to a private management consultant. Yes, of course they should get a management fee from the provider for the consultancy work and based on the quantity and quality of programs they bring the vendor ought to be able to pass discounted ‘box price’ on to the practice.
So in effect a consultancy helps a practice top line and bottom line through process and program improvements … and then can play in the implementation of an EMR option it offered the client.
Theoretically RECs should be neutral … but then you have ones like CalHIPSO who were picking EMR winners even before ONC selected its first ATCB.
I also don’t like tax dollars being used to prop up semi government entities that pick winners without the up front means to provide the practice with consultancy services … or broker it out. Far more effective overall to improving health care would be private consultants in my opinion whose value can be evaluated directly by the client.
RECs are stimulus program entities built to create jobs for middle men to push one of the 600 approved boxes on EPs.
Our EHR is through a VAR. They are great at “pass the buck”. They’d really like to be able to improve system functionality, but it has to go on the long list at the EHR company. 4 yrs later still waiting for changes
OB GYN Doc,
You’re so right that a VAR makes finger pointing easy. It’s much better to have “one neck to ring.” The finger pointing can be really painful to a practice. It’s why many want an integrated PM and EHR system as well. Same principles apply in many regards.
Although, if you have the right VAR, they might also carry more weight with the Big EHR vendor. So, if you get them to ask something, they might have more influence than just one doctor asking. If you’re working with those VARs with that power though, you still have to convince them to convince the EHR vendor to do your request.