Warning –you may be activated when you finish this article. I encourage you to channel your activity using a new platform to tell me that I am stupider than a dwarf seahorse* and/or tell the practice management software vendors you would like to see a change in the status quo. Here goes:
First – an analogy:
What if you purchased a car and when you got home, you realized that the port to your gas tank only accepted a gas pump from a single gas station in town.
You decide to make the best of things. Some of you would fill up little red one gallon jugs of gas and pour yourself, some might rig up some kind of funnel adaptor you could use at other gas stations, but most would opt for the efficiency and ease of pulling into a gas station. You would likely even travel extra miles to that single gas station and probably even pay a few extra bucks per tank for the luxury of filling up your car.
In most cases you would be cheezed off and complain a little but you would make the situation work. Now a few what if’s for you:
- What if you found out that as a disincentive to using a “standard” gas tank port the car manufacturer gets a few bucks per tank from the gas station as a “revenue sharing” scheme?
- What if a crack house opened next door to the only gas station in town that you could use to fill your tank and the crack addicts scared your kids on the way to soccer practice?
- What if that single gas station was always out of gas?'
- What if their gas was double the cost of the station next door?
My bet is that you would be pretty upset and the car would wind up on Craigs List or donated to NPR for the next sucker.
So what does this have to do with my practice management software vendor?
To make a long story short, some practice management software vendors are utilizing the same closed systems, exclusive deals, and “revenue sharing” practices as car dealer in the previous analogy.
For example, this month AVIMARK is advertising an association with a 3rd party teleradiology company where reports from this company are easily integrated into AVIMARK. As a representative for nearly 100 radiologists and readers using the DVMinsight platform to conduct their teleradiology business, I contacted AVIMARK to see if the thousands of reports distributed by the DVMinsight radiologists could find their way into AVIMARK. I was informed that this was not possible because they have an “exclusive” agreement with their selected teleradiology company and that this arrangement included a “revenue sharing” arrangement.
The implications are enormous
AVIMARK is effectively deciding for it’s users that if they want efficient teleradiology in their practice they are limited to this particular teleradiology company. Well, what happens if the reports are no good or the service is terrible? What happens if you prefer a radiologist that is not associated with this company? What happens if the prices are higher than you could get elsewhere? The answer is that if you want integrated teleradiology at your practice you are hosed or you can change your practice management software.
It cannot be overstated that this situation is not limited to teleradiology. What if AVIMARK or other practice management vendor sold access to their system to the highest bidder for digital radiography, lab service, lab machines, inventory management systems, distributors, etc?
If this situation is allowed to continue, veterinarians must understand that they will be effectively shopping for their digital radiography system, distributor, outside lab service, etc. at the time they purchase their practice management software. No longer can you purchase a “best of breed” practice management solution for your practice because you will also need to consider what other associations and deals are available to you by your practice management vendor.
A praise sandwich for AVIMARK and other PMS vendors
In defense of AVIMARK and other practice management vendors, it is absolutely a positive development that they are finally putting resources into developing integrated veterinary practice management solutions.
The possibilities that increased connectivity between practice management and the outside worlds are limitless. Integrated solutions could include, automated billing between PIMS and outside lab services, automated integration between PIMS and digital radiography, automated teleradiology and other referral applications etc. These applications all have the potential to create efficiency and improve productivity for the veterinary practice.
It should also be remembered that practice management software vendors have a business to run and support calls are expensive and time consuming. Stated another way, integration is not and never will be free. Someone will ultimately have to pay for this development and neither veterinarians nor 3rd party provides should expect integration to be a free ride.
Developing integrated platforms (in the absence of standards..see below) is an expensive affaire and they must recoup their development costs and create a model where the added costs incurred by integrated platforms concurrently generate additional sources of revenue.
As such, the “revenue sharing” arrangements described above should not be entirely unexpected by veterinarians. These arrangements, however, should be disclosed
Veterinarians must also, therefore, realize that the practice management software package with the least expensive purchase price may actually turn out to be the costliest because of “hidden” long term costs and/or risk of limited access to integration avenues in the future.
There is a better way
Developing an open standard that teleradiology companies and other third party services can use to seamlessly and effortlessly transfer information in and out of practice management is essential. Going back to our gas analogy, this is the equivalent of using a standard gas port on your car that allows you to use any gas station to fill up.
It is outside the scope of this article to discuss the different standards that are available or how tough that would be to pull off (and because this article is about 42 lines too long already) but we should not underestimate how difficult this process will be. This is a process that will require the cooperation of all practice management software vendors.
Unfortunately, it is my experience that practice management vendors are like hungry male bteta fish in a 2 inch bowl and it is unlikely that without prodding, pushing, and arm twisting from the veterinary community that they will work together with one another.
I firmly believe, however, that the practice management vendors will do whatever the veterinary community asks of them. If we stop buying software that does not support open standards they will adopt them. If vets switch vendors because they do not like being controlled, vendors will let go of the control and open their systems. We saw this with digital radiography. I believe that we can see it with practice management.
*if you have ever seen a dwarf seahorse fight a turf battle – it is fairly entertaining as are the battles ocurring at http://www.sidetaker.com/
