It doesn’t matter how long you’ve been involved in the healthcare IT industry. Whether you’re in your first year just learning the ropes or an industry veteran, you can appreciate its complex nature. Of all it’s complexities, integrating with a new Practice Management (PM) system can be one of the most challenging tasks.
Between making sure the system provides everything you need while ensuring your employees know how to use it is extremely difficult.
We interviewed Rylan Arnold, Vice President and General Manager of Open Practice Solutions, about joining the healthcare IT industry, PM system integration, and EHR user-interfaces.
Interviewer
Matt Moneypenny
Marketing and Sales Analyst
Matt: Thanks for sitting down with me today, Rylan. Before we get started with the interview, I’d like to introduce you to our audience.
Rylan Arnold is the Vice President and General Manager of Open Practice Solutions, a fast-growing healthcare technology company whose mission is to develop web-based practice management and medical billing applications based on open standards.
Rylan has over 25 years of experience with practice management and EHR technologies and just celebrated his 10th year with OPS two months ago. Rylan started in the industry with VERSYSS, one of the pioneers of billing software, and later was a regional sales manager for the publicly traded healthcare IT company Allscripts Healthcare Solutions. He was at Allscripts for 10 years prior to joining OPS.
Welcome, Rylan.
Rylan: Thank you. Good to be here, Matt.
Matt: Rylan, as I’m sure you know the healthcare IT industry has a massive learning curve associated with it.
What are your recommendations for someone who is just now entering the healthcare IT industry?
Rylan: Welcome to healthcare IT, first and foremost to someone that’s new. It’s a great place to be, it’s recession-proof, and growing every year. Whether that’s good for us as a country or not is another conversation, but from an employment standpoint, it’s an amazing place to be.
The advice I give to new people entering the business is to spend time learning what your segment of the industry is all about, and who the customers are that you serve. Sometimes those are internal customers or external customers outside the healthcare delivery. Whoever your customer is, I think the most important thing is to spend time learning what it means to be them, what they do day-to-day, and what their concerns, problems, and challenges are.
From our standpoint at Open Practice Solutions, we mostly try to hire experienced people in the industry that bring that knowledge to the table, but we’ve also hired newer folks that are entering the industry. Once we get them up to speed about who we are and what we do, our routine is to send them out to spend time with our customers. The most important thing when trying to serve your customers is to understand who they are and what their needs are.
Matt: Right, that makes a lot of sense. Something from our perspective, here at Etactics, is that we’ve hired people before that don’t even know what a copay is, but they’re some of our best-performing employees. So there is hope for people who have no experience in healthcare IT.
You certainly had some time to adjust to the industry as you spent 10 years working at the publicly traded and multi-billion dollar healthcare IT company Allscripts.
What was it like working for such a massive company? What were the positive aspects of your experience and what were the pitfalls?
Rylan: For clarity, it technically wasn’t just 10 years at Allscripts because I came to be at Allscripts through acquisition. I was with a smaller company, we were acquired by a medium-sized company, and we were subsequently acquired by Allscripts.
I was able to experience the small private sector, the medium private sector, and the very large publicly traded organization. I got to experience all the pluses and minuses of those different sized organizations over those 10 years.
Most of my time was spent in the sales, marketing, and revenue-producing side of the organization. As you grow into a large company like Allscripts, it’s nice that you no longer have to introduce who you are because everyone knows your company. Brand recognition and everything that comes with that is certainly a nice thing to experience when working for a company of that size.
As far as pitfalls, when you get into the public space you start to deal a lot with the cycle of quarterly reporting. It seems like life centers around the next quarter-end, trying to get business wrapped up, and making decisions surrounding having to announce your revenues and achievements, or your shortfalls. It tends to put you in a crazy, quarterly cycle that can be distracting at times for the bigger picture.
Matt: That can certainly be tedious. There are always drawbacks when working for massive companies, regardless of the industry they serve.
Large publicly-traded companies place huge budgets towards research and development so they’ll offer products and services that have all of the bells and whistles attached to them. However, their products are usually offered at a premium price because everything is about dividends and appeasing to shareholders.
Their billion-dollar revenues obviously come from a huge pool of clients, which is great. But this usually leads to poor customer service and inauthentic relationships.
What are the benefits of working with a smaller, privately-owned healthcare IT company? With your current venture, Open Practice Solutions, what are your biggest goals when working with new clients?
Rylan: You definitely covered it. There’s certainly the resource pool with large companies.
You go to a conference and you have the multi-story massive booth, which is always an impressive and fun experience, giving out free lattes. But those conference experiences are indicative of the entire experience. You walk into a three-acre booth trying to find the person that knows the answer to a specific question, but you could spend the next hour going up and down stairs trying to figure out who knows the piece of information you need.
That was my experience, as well, moving from small to large. In theory, you may have more resources at your fingertips, but trying to make decisions and get things done can be extremely challenging because it’s hard to figure out who is responsible for any given area. There’s a lot of finger-pointing and chasing around to get things done.
That’s ultimately what made this venture at Open Practice Solutions very attractive. When I started here 10 years ago, it was a very small organization. I was able to experience all sized worlds and self-reflect on the fact that what’s really fun is being in that nimble small company environment.
Privately-held is also a bonus because you’re able to take the long view of what you want to deliver to your clients, and you’re not focused on the next quarter. You can focus on the next five years, which ultimately is going to be better for the company, employees, and customers because quarterly-decision routines generally don’t have a good long-term impact.
I find the nimble, close-to-the-customer aspect of a small company really exciting about where we’re at today. The customer doesn’t need to go through 20 different layers of bureaucracy to get a good idea heard by someone who can actually do something about it.
Matt: You brought up a good point. I didn’t even bring up trade shows. They’re a huge part of those big companies. They’re all about having the flashiest booth, but it’s all nonsense to a certain extent.
Rylan: The row of cheerleaders can be exciting at the conference, but at the end of the day it’s not adding value to the customer.
Matt: When a doctor’s office or medical practice determines that it’s time to start looking for a new practice management system, they have their work ahead of them.
What factors do you recommend companies should keep in mind while on the quest to find the Practice Management system that’s perfect for them?
Rylan: Great question, probably one of my favorites. The industry is at a funny clinical-focused place, where the vast majority of decisions are made based on clinical software and electronic medical record software for the practice. They’re the product of a healthcare practice. Very often it’s a physician-led decision, and there’s nothing wrong with that. The physicians need to get what they need in order to practice great medicine, but it’s often at the neglect of practice management and billing.
A lot of the vendors that offer software in the clinical space offer what we do, practice management and billing, but it’s an afterthought. I think a lot of practices make the mistake of not even looking at the billing side of the equation. If the physician’s happy, they just take whatever comes with the system. The vendors know that the way they can sell systems is by making the physicians happy. The physicians are focused on what happens in the exam room.
The net effect from this is that our side of the business has been generally neglected. The clinical side keeps evolving, while the practice management software has been relatively stagnant.
The first point is to evaluate the system. It’s key to know what it is you’re looking for. Analyze your organization and take an audit of what is and isn’t working well, and have a clear understanding of both when you head into the search. Every vendor is trying to sell, and it becomes very tempting to just fall under the spell of the salesperson. My strong recommendation is don’t be sold.
Spend the time to become an evaluator and look at the systems from the standpoint of your priority list. There’s usually some aspect of every system that’s working well for your organization. Sometimes people take those things for granted, then put in a new system and realize they lost some of the functionality. They assumed because this was the new system, it must do the things that their old system did.
But because the focus isn’t on billing and practice management, the equality of the systems that we compete with today is a lower level of competition than what I was seeing 15 years ago.
So, evaluate the PM, and don’t make the evaluation into a sales process.
Matt: That’s an interesting point. You can’t get lazy when you’re evaluating a new practice management system and you can’t fall for the marketing. You have to go for what you know has always worked for your system, and then see what else is available for it. That was a great answer.
Rylan: No matter how good the systems are or aren’t, every system out there has something good about them. If you let the process drive it, then you’re going to spend all your time looking at some nifty widget or dashboard, that isn’t relevant to what your practice needs.
Matt: Right it’s all about staying focused.
After finding their ideal Practice Management system, its time to move into the implementation phase which is totally different than the initial evaluations.
When you’re onboarding new clients at Open Practice Solutions, what steps do you take to ease the implementation process?
Rylan: Yeah, that is a whole different process. It’s never easy or fun. People are creatures of habit, and when you try to change everybody’s day, it can be a painful process. We deal with change regularly in technology. The “Who Moved My Cheese?” book is one that I wish I could get everybody to read before implementing their new system.
Over the years we’ve moved into a process which I refer to as “Just In Time” training. When you’re implementing a system, there’s a mountain of information to absorb and processes you have to incorporate and change within your organization. You can’t do it all at once.
In the early years, we had gone down a path of trying to overshare. We’ve moved instead to understanding that when you’re getting ready to go live with your system, there’s a certain amount of things you need to be good at.
You have to be able to do some basics such as register a patient and schedule an appointment. While they’re basics and fairly straight forward processes, in the old system you were doing them without thinking about it because you had done it thousands of times. But now with the new system, you can’t do anything without thinking about it. Every little thing requires some thought and some methodical process.
We break up the implementation into easily digestible, bite-sized pieces where you learn the minimum amount needed to successfully go live. We don’t overwhelm people. As they mature in their utilization of the system, we continue to provide training.
Day one they might be collecting copays, but later they get their first insurance payments back on the new system. That’s a great time to learn how to deal with insurance payments. If we teach this prior to go live, by the time they need the knowledge, they’ve completely forgotten it, they’re frustrated, and we’re actually training them extra two or three times.
Our approach of breaking the training up into small pieces as they need it has proven to be much more successful.
Matt: That’s an interesting form of training. You could have all of the features in the world to offer to doctors but if their employees don’t know how to take full advantage of their new PM system, the practice will run into the same issues they experienced prior to switching vendors.
I’ve been in situations where someone will teach me something, I’ll write it down, but then I look at my notes and it’s complete jibberish. I’ll have no idea what we talked about so I have to re-talk to them, and it’s embarrassing.
Rylan: Being human can be tough. That’s a great point because when people implement new systems they tend to stagnate at some point. They might have purchased it for cool features that were exciting in the sales process, but then fall into the rut of using the basics, and the temptation is to never get to that next stage. Even if the staff does, we tend to be a high turnover industry meaning the front desk, schedulers, or billing team that were initially trained aren’t there five years later.
We’ve worked to incorporate and build the intelligence into the system so that when we see customers coming to a screen for the first time, we can give them a tour of the function.
When you look at your notes from a year ago, they won’t mean anything to you today. If we can present the information at the time the customers are trying to do a function, we find it’s much more successful to get them to utilize the fancier functionalities.
Matt: That’s an awesome feature! Let’s bring in EHRs a bit.
In almost all cases EHR and PM systems integrate with each other since their services complement one another. Recently, there’s been a push for better user interfaces and experiences within the EHR space.
I read an article published by ComputerWorld that said 50-70% of physicians are experiencing burnout symptoms due to EHR-related workloads.
Have you noticed this call for better user experiences within practice management? What is Open Practice Solutions’ process for evaluating new functionalities or workflows within your applications?
Rylan: That EHR issue is getting a lot of press. The last I heard it was in the 70-80% adoption range within the clinical side of EHRs. Our side of the healthcare practice goes back 25 to 30 years, so that push for the user experience that you’re describing started much earlier. We’re routinely implementing practices that deal with people who tend to be very experienced in knowing what they like or don’t like.
But that universal push for better experiences is certainly applicable in our world. It goes back to the focus on the client and end-user. Being a small company, we have a policy for getting to the customer and the why. Why are they trying to do what they’re asking for?
If we can understand what they’re trying to accomplish, we can continue to evolve the platform to better meet their needs. It’s about listening to and staying close to the customer, which we can do more readily since we aren’t a multi-billion dollar organization.
Matt: A lot of times when a customer brings in an inquiry and needs support help, there’s a reason why. It might not be very obvious, but if you dig deep and collaborate with your team, you can determine it.
Rylan: It’s analogous to what physicians deal with. When a patient walks in the door, they’ve already self-diagnosed themselves. We deal with the same thing.
When customers call, they tend to tell us what it is they need, as opposed to the problem that they’re trying to solve. We continue to train our team on not just listening to what the customer is asking, but also making sure they understand what it is the client is trying to accomplish. In some cases, the client is trying to do something in the wrong spot. Rather than add another checkbox somewhere else, we can actually point them in a different direction and give them a much better answer and experience.
Matt: One of the aspects that OPS actively promotes, as mentioned in your introduction, is that your applications are developed on “open” standards.
Could you elaborate on what you mean by that? What makes the Open Practice Solution experience different than other practice management software?
Rylan: I think it ties together some of the earlier points in the conversation. The term “open” doesn’t mean “open-source platform.” It’s more of a philosophy than a technology because technology continues to evolve. “Open” speaks to our focus on providing our clients the absolute best billing and practice management workflow and functionality that is out there.
There are clinical systems that are going to best meet the physicians’ needs that must work hand-in-hand with OpenPM, our application. Rather than trying to be everything to our clients, “open” means that we are looking to tie together all of the technologies that the practice or service wants to employ and making sure they work together seamlessly.
Years ago it was an HL7 interface-type conversation. Today it’s more of an open API integration. As the standard evolves, and technology evolves, we’re highly attuned to that because of our “open” philosophy
We’ve adopted the latest healthcare standard API to allow our customers to plug into OpenPM with whatever software they’re utilizing.
Matt: I think that plays to customer feedback and always being willing to learn from customers, and change the UI as necessary.
Matt: Rylan, thank you again for taking the time for today’s interview. Before we leave, I always like to open up the floor to our guests.
Is there anything else you’d like to share about Open Practice Solutions before we close?
Rylan: I think the conversation has been around technology, the evolution of technology, and the various aspects of that which are certainly important being in the healthcare IT business for some years.
Clients have come to expect generally sub-standard client service across the industry. Although we take great pride in our solution, I think the actual customer support and service after implementation is just as important as buying software that takes care of your needs.
The healthcare industry has kind of come to terms with bad support and it’s almost become a punchline. I think it’s really about the service after the sale. A practice would be better off with a mediocre system and excellent support than having the opposite. If you have amazing software but don’t know how to use it and can’t get answers to your questions, then there’s nothing “amazing” about it.
I would encourage anybody going down this path to not only do the evaluation that we discussed but also take the time to truly talk to customers because it’s worth the investment. Online reviews are great, but there’s nothing like talking to users and hearing the pros and cons from them.
Matt: That was a great wrap up, Rylan. Thank you for your time today, and like I said I appreciate it. Until next time!
