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What I Wish I’d Known Before … Going to my First HIMSS Conference as an Exhibitor

I knew HIMSS was a big conference, but I didn’t realize that the impact would be that it is just hard to move around and accomplish a lot. You never really get to see the whole exhibit floor or do a lot of things because it just take so long to get there. Food lines are long, there’s no place to sit. It’s a complete workout. The startup pavilion has some of the more interesting companies and the big vendor booths are very impersonal. Then, when it is all over, you wonder what you really accomplished or learned and if it was worth all the trouble.

Wear really, truly comfortable shoes.

That my exhibitor badge gets me into educational sessions as well. Someone more experienced at these events helped guide me in finding helpful sessions for my area of expertise.

Very long hours on your feet. I have a pair of super supportive shoes I call “my HIMSS shoes” and I am never without them.

HIMSS is all about making and strengthening business relationships. But on the floor, you literally have about 30 seconds to get someone’s attention and earn the right to have a meaningful conversation.

As an exhibitor, it can devolve into a party atmosphere, quickly. Pace yourself.

Wear comfortable, not necessarily stylish, shoes.

Wear comfortable shoes!

The exhibit hall is like the Caribbean, full of ports (booths) and buyers are like cruise ship passengers. The enthusiasm doesn’t always stick once they get home and visitors will confuse ports/vendors. Give them something memorable (in good way) and be prepared to present again after HIMSS if you want them to truly remember anything you showed them.

Be careful about scheduling meetings first thing in the morning after the first day. Last day first or last are the worst times for any real business to happen.

Stop at two drinks. Period. It’s possible, even likely, that key people in the industry are around you at all times, even 1 a.m. in the hotel bar. Remember that this is your career and you’re making an impression even after exhibit hours are done.

Make reservations for every anticipated meal, even if for two people, as everything will be packed. And, if invited to a meal by a vendor, verify that that vendor has a reservation inclusive of all invited attendees. I attended a breakfast at a previous HIMSS with a vendor where the rep from the vendor did not make reservations for an intolerably crowded joint and eight executives huddled around a bar-height bistro table for two in the hallway of the casino discussing the strategic direction of our partnership.

How your message gets lost in the noise and the value proposition is questionable, unless you are one of the larger vendors.

The amount of time you will be on your feet. I have HIMSS shoes, comfortable, dressy shoes half a size too big with the most cushioning insoles I could find and hiking socks.

Establish scheduled meetings before or during HIMSS if you are looking to sell (vs. touch current customers, develop business development relationships, or perpetuate your brand). It is not worth pulling anyone off the floor to learn about your product anymore since, unlike in the early days, most of the folks walking the floor are fellow vendors.

HIMSS is in a conference that companies in the healthcare information technology industry must attend even, if the value for doing so is minimal. Pulling out is a public red flag that there is a problem or at least a big change in the company. So we go and represent with minimal expectation of value, but it can be fun for the team selected to the representing.

What I Wish I’d Known Before … Taking a Job Selling Software to Hospitals or Practices

I wish I would have known that the company had a policy of customizing the application to whatever they thought the prospect needed. Functionally what we wound up doing was demoing vaporware, and there was no way the clients would ever get that content without customizing. It’s entirely unethical. I was gone within a few months.

As someone who has started two small HIT software companies (both acquired by larger HIT companies) and was responsible for designing, selling, and implementing the systems and overall customer satisfaction, a couple things I would want to know:

What is the main value that customers get from the system?

What percent of the customers get that value? (Software companies love to highlight their reference sites, but what is more important is what benefit do the majority of the customers derive from the software. Reference sites are nice, but even a blind squirrel finds a nut once in a while.

Can you quantify the value?

How does the value stack up against the investment?

How long does it take to get the software installed and how long before the customer starts receiving the value?

How much work is it going to take by the customer to get the software running and keep it up and running and is that amount of work and cost part of the return on investment analysis?

Why would a prospect buy the competitors’ products rather than the product we are selling?

What is the customer retention rate, and don’t include the customers that have to renew because they are in a multi-year agreement. I would want to know what percent of customers renewed the last 2-3 years that had the option to turn off the system.

Do Epic and Cerner have a similar offering?

What is my quota and how have the current sales team done with respect to that quota over the last two years?

What is the retention rate of the sale staff over the last 2-3 years?

How long has the sales leader been in the role?

Can I live in San Diego?

Do I have to wear a tie to client meetings?

Most of the people you talk to or not meaningfully involved in the decision-making process.

The people who are using your software are often not at all involved in the decision process, which injects hostility once purchase and deployment happens.

Don’t sell your software without the client having a strong change management plan in place. The sale is usually worth less money than having your name dragged through the mud later if adoption is poor.

You should aim to sell one client multiple things over the course of a long relationship more than trying to get clients.

Take your estimate of the sales cycle and double it.

Old-fashioned networking and being able to discuss specific use cases that resulted in success are the best methods for selling. Healthcare is not very impressionable by social media, content marketing, email campaigns, or other more modern marketing tactics.

How lonely the job can be.

For five years in my career, I sold an EMR to physician practices. Looking back, I wish I had understood better the degree to which physicians lacked the appreciation of the overall efficiency and throughput of their practices (which they usually owned) versus their role within the practice. Most thought only in terms of themselves and their own time, and these were the ones that struggled or refused to modernize their practices (also usually the ones with full waiting rooms of frustrated patients). Those I worked with that recognized that they were a part of a larger system embraced changes to their practices supported by EMR, they flourished, and tended to have happier patients with shorter waits for appointments.

How difficult it was going to be to accurately forecast when the sales would close.

My job is a hybrid, or at least it’s supposed to be. I have a half dozen clients that I am responsible for their satisfaction as well as a quota for each client. However much our company likes to say “It all comes down to satisfaction! Keep your clients happy!” and even with tying a portion of our compensation to client satisfaction surveys, it’s obviously all about selling. Leadership would rather you sell whatever you can, however you can, even if you piss off everyone in the process. It’s a very short-sighted model, but with how the direction this company is moving, I’m not very surprised. If you have any ounce of empathy, or like to forge client relationships that focus on more than dollars and cents, selling may not be for you. (If there are companies we can work for that actually give a hoot about clients beyond what they buy quarter to quarter, please share!)

That some of the “function and features” are pure vaporware. They haven’t been tested or met compliance in any setting other than the developer’s environment. This obviously causes major concerns from the client at go-live. I end up selling future versions that a user will not experience until 12-24 months later.

In no particular order or rank, here are a few of the things I wish I’d known before getting into the HIT sales field.

The training for salespeople is very limited and you’ll hear, “We don’t want you to train them, just sell it.” My product training for my first job included watching two demos of the application by my manager, one of which was provided while we waited for our plane at the airport. EHR software is complicated enough that vendors should either sufficiently train sales reps or use product specialists for all demos.

You’ll want to ask a lot of questions about your territory (how often does it change, how successful were previous sales reps, what is the turnover in this territory, are there any/many happy customers in my territory, etc.) to try and figure out if you really can make your numbers. Sales managers like to pretend that all sales territories are created equal, but they are not.

To truly provide a demo that shows a provider how your software works for their workflow, you will need to do a discovery with the provider or someone who truly understands the workflow. In the ambulatory physician space, it can be very difficult to get face time with the doctor and critical staff, so you know this beforehand and be able to prepare sufficiently to show them what they want/need to see. This discovery isn’t or shouldn’t be done to use smoke and mirrors and trick the staff. It’s no different than a doctor not being able to accurately diagnose a patient unless they’ve had sufficient time to do an assessment and evaluation before they prescribe the correct treatment. Salespeople should really refuse to do demos if they don’t get this time, but as long as they have quotas, they will do it.

Many physicians and their practice staff won’t bother to complete the requisite pre-work before their implementation, which further compromises their ability to optimize the expensive software they just bought. It is time-consuming, but it’s usually a question of “pay me now or pay me later.”

Not sales, but working in HIT for 16 years for companies that sell commercial software to doctors and nurses. I wish I’d known about the stress of being morally compromised on a daily basis as keeping my job (and thus my ability to pay my rent and buy food) requires either doing things I know are the wrong thing to do, or not doing things that are the right thing to do (way more of the latter than the former, fortunately). I’ve seen some very dark instincts on the business and technology “leadership” side of the house. If you ask why I stay, the only answer I have is: if I leave, that’s one less person banging the drum for what is right.

How often solutions aren’t fully baked before companies try to package them as GA.

Does the product actually work? Can the company actually implement and deliver it? Can they support it? Do they have any idea who will actually buy it? And who pays for it? Too many healthcare software companies I’ve worked for/with think that “if it treats patients better” or “makes the organization better” or “makes clinicians better” or “makes patients safer” (etc.) their product will fly off the shelves. All you, Mr. Salesperson, have to is bust your hump, get in front of the right people, and do your sales magic. Healthcare sales today is ALL about compliance or cash. C-Levels are only buying that which they HAVE to have, will save them money, or make them money (hard ROI).

Who are the competitors who are investing in the same product line?

While software is 100 percent margin, software companies in healthcare don’t want to pay as much as other technologies and their products are usually late.

I was in a sales support position, demonstrating application software. I suppose I was naïve to think that I would have to stretch the truth about the functionality of said software. Salespeople would provide me with what my response should be to certain questions. To which I stated, “That’s when I turn to you, because I won’t lie.” Ultimately, I transferred to another department within the vendor company to training so that the end user would find out how the system really worked. I would hear, “But they said [that being the salesperson] the system could do that.” To which I replied, “I know what they said, but I’m here to tell you the truth.”

What I Wish I’d Known Before … Bringing an Ambulatory EHR Live

That technical dress rehearsal issues would get ignored or not addressed before the go-live. Wasn’t that the point of the TDR?

I wish I knew ahead of time that the EHR vendor outsourced their support to a third party. This arrangement created speed bumps to getting real support answers relayed from the EHR vendor through the support vendor.

I wish I knew how effective running a mock clinic was for training providers, especially physicians. An EHR analysts plays the role of a mock patient and gets checked in, roomed by the MA or nurse, seen by the doctor, and checks out. Ideally, the provider completes common orders, does a note, and charges. Any system problems can be caught by the analyst and a trainer can be at the elbow of each users. It is a little labor intense, but the clinics come back up to full speed much sooner. We had one ophthalmologist seeing 87 patients a day within one week of go live. His partners that didn’t do the mock clinic took weeks to get back up to full speed.

To what degree provider productivity would be negatively impacted and how that would impact the productivity-based comp plans of physicians and administrators. There’s a reason CIOs have a hard time surviving an EHR implementation, first among them messing with peoples’ pay checks.

How to generate sincere engagement for the implementation with the clinicians and staff as beneficial to their patients and care delivery. And helping all to make the project not just about the billing.

We learned after the CIOs and people allowed in the room had chosen Epic just because, that all non-Epic apps that were to integrate into the EMR had to have a test environment, or else integration was denied. Even apps with fewer than five users. Go-live was pushed back months, there no budget for this, and rebuilding non-Epic apps took time away from learning and building the actual future EMR and getting certified.

Focusing on optimizing physician workflows and making them as efficient as possible is absolutely important, but the same amount of effort must be made for the other roles on the ambulatory clinical care team: nurses (especially nurse triage), medical assistants, in-house laboratory and radiology, as well as all other ancillary services provided by the practice. Ensuring that the physicians are happy should not come at the expense of everyone else in the practice.

What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based System

You still have to work at the application’s care and feeding – you can’t just “dump it in the cloud” and expect all the problems to go away. Some of them will, but not as many as you think.

The Internet gets slow and breaks more often than you think, especially when vital services are at the other end. Downtime procedures are even more important.

Do the research to figure out what all the pieces you will or might need are. Once you’ve done the big deal, you have very little pricing leverage until you have big money to commit again. Example: a full-copy test environment. With one well-known CRM vendor, those environments are priced as a percentage of total licensed product. That makes sense in a way, because a full copy is just that — a full copy. However, that also means that the cost of the environment goes up when you add more products or add-ons to your list of licensed things.

They seem to track their application only up to the point where it leaves their data center or Cloud Source. Anything else between their address and my user location is left up to me to figure out if there is a problem with the application and my users. We have had to go to other third-party products to get the health of the Internet between the SaaS source and our end users. Yet they (the SaaS source) blame our internal network setup for any end response issues at play. Very tired of hearing “none of our other users are having that problem” when the problem lies in the health of the general Internet and not our last mile.

Was the solution architecture design for the Web and cloud, or was it client-server front-ended by Citrix?

If it’s your first time down this path, your internal HIPAA team or legal may end up having no idea what to do with it based on their standard vetting process. You might have to take additional time in the implementation for back and forth with the vendor to while they jump through whatever hoops are placed in the way to get a green light to implement or even sign a contract.

I’ll have to pay to get my data back.

The importance of not just a DR plan, but a business continuity plan. You are not in control of when down applications will be available, but you still have patients to care for and business functions that must continue. Always have a plan and have it readily available for staff.

You won’t necessarily have full access to the database or software maintenance tools. Ask in advance and put a plan in place on how when data will be accessed / software changes will be completed.

You will spend a lot of time explaining your business operations. Analysts go from those making configuration changes to someone who needs to partner and fully understand business processes and operations. Vendors will not successfully function as your systems analysts.

This was 15 years ago. I wish we had known the true cost of going to the cloud. Verizon charged us a ton to install a redundant pathway to the Internet after questioning why we wanted to do such a silly thing.

Wish I’d required more detail in how my data will be turned over to me at contract termination. Our outgoing ambulatory EMR vendor refuses to hand over our contractually mandated export until the day *after* our account is turned off, giving us zero opportunity for smooth migration to the new vendor.

I wish we better understood and negotiated standard maintenance windows and patch load times for production issues. We sometimes have to wait weeks for patches and get a nine-hour window, any time during which the system could be brought down to install the patch. I also wish we had better prepared ourselves for the challenges of offshore support. They only want to talk via the ticket system and you have to try hard to get them on the phone or a WebEx. It really exposed now poor our internal support was since every issue required going through this painful process with the vendor support.

What I Wish I’d Known Before … Replacing My Hospital’s Time and Attendance System

That our hospital’s Time and Attendance policies were not being applied throughout the organization equitably in all departments.  We found a lot of departments that were providing extra incentive pay to nurses in order to boost their salaries. Other departments were making up their own on-call pay programs for their personnel.

That employees were getting around showing up late by not punching in and then later stating that the system must not have worked when they “clocked in.”

Anything that directly or indirectly to do with payroll is EXTREMELY sensitive. Expect people to freak about any test results that don’t match the result of the existing system in payroll, down to the penny.

If your facility is non-union, and has been working to stay that way despite onslaughts by SEIU and others, expect to deal with lots of very complex pay premiums. Don’t be surprised if disgruntled employees and/or organizers try to make something sinister out of the system change.

Place time clocks in areas with enough room to hold all the employees standing around waiting to clock in in the morning and clock out in the afternoon.

If your internal sponsor is the HR director, make sure that you reassure that person early and often that the system change won’t accidentally result in pay changes.

Hospital pay rules are more complex than any other industry, sometimes exceeding the capability of non-healthcare specific payroll systems to handle them. It was shocking to find how many departments were running their own unapproved overtime, call time, and bonus programs in direct contradiction to hospital policy. It takes a lot of time and finesse to find these exceptions and then some HR backbone to bring those departments into compliance instead of building rules just for them.

If your implementation involves installation of hardware, allow lots of time to make it happen. Hospital construction can be very tricky from a permitting standpoint.

Plan to run tests through month end and end-to-end with payroll to make sure everything is perfect before you agree to a cutover plan.

Don’t let Procurement sunset the contract with your existing vendor until you are absolutely confident in your cutover dates.

Policy over technology. Users run in the door and swipe at 8:14:59, then get ready for work, and out the door at 4:45:01.

Pay attention to the choice of letting employees clock in by telephone and limit that to in-house phones.

Expect managers to express shock and indignation that it’s their job to review time clock reports against reality. And to look the other way if they’re worried the offending employee might quit over being paid accurately rather than generously.

I wish we had understood the complexities of overtime, the number of salaried employees that are required to clock-in/clock-out even though their pay doesn’t change (and the frequency with which they forget or delay their swipe), and I wish it was understood exactly how much manual overriding would be needed over the first four payroll cycles to make sure employees were appropriately paid. I also wished we had budgeted for all of the overtime required for staff that were perpetually on call to handle these and other issues during the transition period. In short, I wish we knew everything since what we actually knew was nothing, and our vendor was complicit in helping us fail pretty spectacularly during the process.

Will employees be able to access accrued PTO in their current paycheck (leaving a zero PTO balance) or will their pay be docked even though they have PTO remaining? This “feature” has to be manually overridden by our HR personnel with management approval.

How difficult is it for employees to enter multiple days off in a row. Do they have to do every single day as a separate entry or is the multiple-entry feature seamless and user-friendly?

That a focus on staffing workflow impact is equally or more important than the specific technology. That includes integration with upstream and downstream systems.

Don’t underestimate the creative nature of employees clocking in and out. Before we got wise and changed it, some would stop and clock in and or out at our remote locations (30-45 minutes away) and then drive in to the hospital. We noticed a spike in overtime. Also we noticed an incredible number of time sheet edits by non-management folks who had the authority previously. Their role went away and the authority moved to managers (some of whom argued it wasn’t their job?) Every management level now had to sign off for their areas. The number of edits decreased but it took a long time and a lot of oversight.

A story about a payroll system. I don’t recall the name but it was a Mom & Pop vendor (Mom was the CEO and Pop was the techie) selected by the HR division. On January 31 with no other option, we had to mask out the SSNs on a couple hundred (or more) printed W-2s, then run them through the printer as blank sheets with a correctly placed SSN cell from Excel. We moved on to a new vendor and the company was gone the next year.

They were in negotiations to be acquired by a competitor and there equipment would be sunset within the year.

It’s not the system that causes issues. It’s the clock in/out & OT calculation policies & procedures.

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