Evan Steele

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Evan Steele, CEO of SRSsoft speaks with Eric Fishman, MD about the rapid expansion of SRSsoft.  Steele further discusses how SRS is different from other EMR solutions. For more information about SRSsoft, visit:http://srssoft.com/

Category: EHR Press, Featured
Date: December 15, 2009
Views:12,525 views

Video Title: Evan Steele

Length: 34:42

Description: Evan Steele, CEO SRSsoft, speaks with Eric Fishman, M.D. about the rapid expansion of SRSsoft. Steels also discusses how SRS is different from other solutions.

Eric Fishman, M.D.: Hello. This is Dr. Eric Fishman for EHRTV. Today, we’re speaking with Evan Steele, CEO and co-founder of SRSsoft. Evan is an MBA from the Wharton School of Business and has an extremely large amount of experience in the electronic health record industry, having founded SRS in 1997. So Evan, if you could start with how it is that you got interested in the electronic health record industry.

Evan Steele: Well first, Eric, thank you for having me here and for the time for this interview. The story starts back in the early 1990s when I was an investment banker on Wall Street. It was one of those jobs where you don’t have much of a life and I had young kids at the time. So I left the hustle and bustle of Wall Street and went to work with my brother who is a pediatric opthamologist at NYU Medical Center in New York City. We figured that I’d work with him and I’d help him grow his burgeoning practice at that time. Two, three years went by and we grew the practice. At one point, we had four offices, six doctors and a massive problem with paper charts.

Eric Fishman, M.D.: I have already mentioned your company name, SRS and your last name is Steele and I’m seeing a pattern here that might be the two S’s that sandwiched an R in the middle of SRS.

Evan Steele: Sandwiched in between the first programmer that we hired back in 1997 whose last name started with R. That’s how we got SRSsoft. So we had an intractable problem with paper charts and no matter how much time and effort and management skill you tried to put into taming the chart access problem, we couldn’t.

Eric Fishman, M.D.: Now opthamologists, as a habit, as a pattern, tend to draw pictures - frequently in colored pencils - on images in a chart. Were you trying to make arrangements to take care of those types of documents or all of the documents that came into the office?

Evan Steele: All the documents. Whether it’s referral forms from the pediatricians that would send patients over his way, patient registration forms, insurance forms, insurance cards, copies of the insurance cards – all paper from the office, including his consult letters and patient history sheets. There’s a lot of paper in a medical office. The biggest problem for him was his multiple offices and, as practices grow from one office to multiple offices, the paper chart problem expands expedentially. So one doctor practice will have 1x the paper problem. A ten-doctor practice with a few offices will have 100x the paper problem. So we looked at a number of EMR’s and they were all point and click; seemed to be a lot of data entry. We said, “We can do a better job.”

So we hired Mr. R and programmed the first version which was a data entry product and, it actually slowed my brother down. My brother could see upwards of 50, 60 patients a day, he’s a very high-volume physician. So we said okay, let’s go back to the drawing board, let’ just work on the chart access problem. So what we did is we wrote a package and our first version of SRS software strictly got rid of paper charts and made the office a completely paperless environment. It did wonders for his practice. His practice, whereas it was highly inefficient, became a very well-oiled efficient machine all because of the software. We were so excited about it that in the fall of 1999, we went to our first conference, the American Academy of Ophthalmology.

Eric Fishman, M.D.: And this is now two years after starting it approximately?

Evan Steele: Correct. So we went to our first conference, the American Academy of Opthalmology in the fall of 1999 in New Orleans, had a, what was then, a very cruddy 10 x 10 foot booth with a big 19 inch CRT monitor that we plopped down on a table that we lugged around and by some stroke of luck, people bought our software. We got orders from that conference and the rest is history. We sold some packages, grew a little bit, sold some more packages, need to hire more programmers, more people to install the software, more people to support the software. So you fast forward exactly 10 years. It’s almost exactly 10 years ago today that we went to that conference. We’re now at 100 employees, we have 498 medical practices that are on SRS and are completely paperless, we’ve eliminated over 30 million paper charts and digitized them completely. We have almost 5,000 providers of healthcare using our software in almost every state around the country.

Eric Fishman, M.D.: Congratulations on quite an accomplishment because a lot of people in that 10 year interval, obviously, did not do anywhere near that well. I understand that you concentrate and specialize on making practices more efficient. Your brother you said was seeing 60 patients a day. That’s not an environment in which you can slow someone down a lot. I understand that a number of your physicians are cardiologists, orthopedic surgeons, obstetricians, people who by their nature – not like psychiatrists for instance - who may see 8 or 10 or 12 patients a day but rather offices that have a high volume. So explain to us, if you will, the studies that you’ve done. I understand you’ve even done some time motion studies to see what can be done to make a medical practice more efficient.

Evan Steele: Well, we have a very strong belief that medicine is a business. It’s a huge industry. It’s 16 %, approaching 17% and soon to be 20% of GDP.

Eric Fishman, M.D.: I hope not.

Evan Steele: Yeah, but it is a business and the only thing a doctor has to sell is his time. If a doctor takes a two week vacation, his revenues gets cut by two fifty-seconds of a year; two weeks out of 52. So with that view, that the only thing that a doctor has to sell is time, we really focused on the doctor, the staff and the business of the practice which is a little bit of a significant departure from some other EMR companies where they focus on generating an exam note in the exam room. We look at the whole business and try to make that process more efficient. So we now have 20 programmers and they’re primarily focused on, or solely focused on, coding the software to provide further efficiencies to very complex workflows in a medical office.

Eric Fishman, M.D.: Can you explain some of the work flows that are addressed in SRSsoft? What types of things can be done, using your software, more efficiently than without any software for instance?

Evan Steele: If you look at the patient visit and, again, if you look at it like a business, like an assembly line, patient makes an appointment. They come into the office, so a chart has to be created. That’s automated completely. We get a HL7 feed from the practice management software. No one has to create charts anymore. No one has to pull charts anymore because that comes over from the appointment scheduler. So no creating charts, no pulling charts, no dealing with label stickers, pouches, clasps, hole-punching, filing, retrieving - - that all goes away. Then a patient comes in and there’s papers generated. Every practice that you go to there’s Medicare waiver form, a HIPAA compliance form, a patient registration form, a history sheet. If it’s an opthamologist -- they like to hand write -- you have that exam sheet. Those papers are generated for all 60 patients for the day. Depending on the doctor being seen and the type of visit you would generate all those papers and they’re bar coded. So at the end of the day if you have four pages per patient and you have 60 patients a day, you’re going to have --

Eric Fishman, M.D.: So these 240 pages will be physically present in the office?

Evan Steele: Correct.

Eric Fishman, M.D.: While using your software?

Evan Steele: Correct. With any software. The patient’s going to write out their forms. What we’ve done is when the exam is over, the day is over, they take the 240 pages – and if you have five doctors that’s over 1,000 pages - so now we’re talking two reams of paper. You stick it on a high-speed scanner, click the button, walk away. When it’s through, you click “process” and the bar code that printed out -- when the forms came out of the printer there was a bar code on the form -- that’ll file each form away in the right chart or the right tab or right part of each chart.

And just an interesting fact, we do that at 10 pages a second. So if you have 1,000 documents, pieces of paper, it’s 100 seconds; less than two minutes to file 1,000 pieces of paper away.

Eric Fishman, M.D.: I was going to ask what does a scanner of that nature cost. You can buy a scanner for $100; you can buy a scanner for a million dollars. How much does a scanner cost for a 5 or 10 physician office to be efficient enough to do this properly?

Evan Steele: For a scanner that goes 50 pages a minute, you could spend anywhere from $750 to $2500 or $3000 dollars.

Eric Fishman, M.D.: And for an amount of money that small, you’ll have the bar coding and SRSsoft has the ability to place the paper where it belongs within the electronic chart.

Evan Steele: Correct. That’s 100 percent accurate. Unlike in the manual world, you’re paying somebody 8 to 12 dollars an hour to file paper that’s not always accurate. You might put a patient registration form in a different tab in the chart.

Eric Fishman, M.D.: Or in the wrong chart.

Evan Steele: Correct.

Eric Fishman, M.D.: So there’s a lot that’s been said about a hybrid EMR and I don’t know if you guys have coined that phrase, but I certainly see it associated with SRS more frequently than with anybody else. Explain the derivation, if you would, of a hybrid EMR and what it means to you.

Evan Steele: When we look at hybrid EMR, we look at and compare to a traditional point and click exam room data entry EMR. We look it as the differences, the DNA of the software, how the software was developed. You look at our software we developed and I remember my brother’s exam room. At the time, he had one exam room. Now he runs four at a time. But there was one exam room, a five-foot hallway and a little office storage area where me and the R in SRS would sit. The programming was done and we focused just on the work flows for a very busy, high-volume practice. We didn’t focus on the generation of the exam note like we originally did. We departed from that and we focused on office efficiency and work flow.

Eric Fishman, M.D.: It’s in a sense a practice management system but it does more than manage the appointment scheduling and the billing which is the classical practice management, but it manages the business processes of the practice.

Evan Steele: Correct. I think the mistake that some of the traditional EMR companies did is they started with practice management and they jumped right into the exam room. They never said, “Well, how do we take care of transcriptions and file them away when they come back from the transcription service?” Or, how do we take care of orders, or how do we take care of lab results that come back. They went right to the exam room and that’s the DNA difference. Where the traditional point and click EMR, when they developed their software, they looked at the exam room and the note. We have employees who worked at EMR companies and they say when they’re in the software development meetings at an EMR company, all they talk about is the note. The note, the note, the note. How do we generate the note, how do we template the note, how does the note look when it’s printed out or comes on the screen, how do we display it on the screen. It’s all about the note and getting in the doctor’s hair in the exam room. We’re about business process improvement.

Eric Fishman, M.D.: So now that we’re understanding what a hybrid EMR is, I guess it’s, in effect, utilizing the note portion as only a portion of the entire business process management and so in what other fashions does the word “hybrid” have any importance in this regard?

Evan Steele: Again, it’s the DNA. The software is built on a foundation of not encumbering the doctor, not forcing the doctor to change their own work flow or the way they practice medicine and document exams. Hybrid EMR - and hybrid connotes efficiency - hybrid EMR is an efficient product that provides business process improvement and efficiency for the medical office and the clinical areas.

Eric Fishman, M.D.: Many people who analyze this industry talk about a readiness assessment and they talk within the readiness assessment of trying to analyze the work flow that an office has at this point and time and then trying to visualize what the work flow will be after a period of time has elapsed and they’re using a new software product. Is it your belief that physicians who utilize SRSsoft tend not to have a major disruption, a major change in their work flow? So that in fact the software allows for a disparate number of work flows and doesn’t force a specific work flow on the practice?

Evan Steele: That’s correct. When you go live with SRS the first day, we do not curtail the doctor’s schedule at all.

Eric Fishman, M.D.: That’s unusual.

Evan Steele: It is unusual. We have something that we introduced this year. It’s called the No Cost Pilot Program where we’ll pick a practice, we’ll put our software into the practice, at our cost. No money exchanges hands. We put in the hardware, the software, we train, we assist them with implementation and then doctors go live and use the software for a 30-day period. After 30 days, there’s a board meeting and they vote and they see if the want the software.

Eric Fishman, M.D.: Am I allowed to ask how many people give it back?

Evan Steele: The first one we did, we didn’t get a no, but we haven’t gotten a yes yet. And we learned a lot from that. Everyone we’ve done since, we have had 100 percent success. No other vendor will offer that because typically it’s very difficult to train the doctors and we invest a lot of time and money in that. If a doctor’s work flow is encumbered and they can just give back the software if they had the opportunity, I think that would occur too many times for other vendors. But for us, since we don’t interfere with the doctor and we actually make them more efficient by making the whole office more efficient and the whole business more efficient, we’re able to offer that and we’ve had a huge amount of success and we’ve signed on hundreds of providers with that No Cost Pilot Progam.

Eric Fishman, M.D.: How much training is involved per physician when a physician who doesn’t have any experience with any previous EHR starts using your software?

Evan Steele: It depends on the module. Day one, 20 minutes just to get them live and never looking at a paper chart again. And then they’ll go into lab management and order management and messaging and e-prescribing and each of those will be another 20 minutes or half hour as they’re ready to go to different modules. But the first day, we like to get them on a dry run the night before or even a half hour before they start seeing patients just to get them comfortable with the software and then they’re off and running for that first day and they never look at paper charts again.

Eric Fishman, M.D.: Now you spoke a few minutes earlier about clicking in order to produce the chart. So obviously, there’s a variety of ways of producing a chart. You can hand write it, you can type it, you can click through it. One of my favorite ways is speech recognition, there’s hand writing recognition. Do you have preferences as far as the physicians are concerned as to how they would produce it? Do you still have any patients, the old family physicians who hand write a note? Is that compatible with your software?

Evan Steele: We have doctors that hand write and that’s more popular in primary care, family physicians and Ophthalmology. Orthopedics – I’m sure when you were a practicing orthopedic surgeon you dictated.

Eric Fishman, M.D.: Yes.

Evan Steele: Orthopedics dictate, cardiologists for the most part dictate, so we allow for handwriting onto the bar coded forms, dictation, a hybrid. Not why we’re called a hybrid EMR but where you have a form that comes up on the screen and they could do some drop-downs for some very basic type of exams and integrate every tightly with Dragon Medical Version 10 to save them on transcription costs and just have immediate results to be able to dictate and have a complete note. So we’ll support many different ways. Like my brother, he does a consult letter for 95 percent of his patients. He’ll template 50 or 60 percent, depending on the day of his exams because simple exams are easy to template the letter. It’s when you get that high pathology patient that walks in. That’s where a templated system breaks down. And that’s where an EMR that’s reliant on point and click data entry and structured entry for every note breaks down. So we take an approach where if it’s simple and templatable – let’s say that someone comes in with rotator cuff tendonitis and it’s just a basic, couple little orders and it’s kind of a basic exam template - we have a lot of doctors that will use that template. If someone comes in from a car wreck and they have multiple problems, broken bones, you can’t template that exam. So that’s where they’ll revert back to dictating.

Eric Fishman: And if I understand, a physician can dictate – as you know I’m involved in Dragon Medical – they can use Dragon Medical to get the document completed at that moment or they could also use a digital recorder or telephone and have a transcriptionist type it and put the transcribed note back into the proper place in the chart?

Evan Steele: Actually we have a lot of practices where they have a centric server form and the transcriptionists are offsite and they dial or connect right in to a centric server or terminal server, right into the chart and type in the note, click a button and it sends it to the doctor’s inbox for approval. So there’s no filing and that’s part of the automation we were talking about. Or, we interface with a myriad of transcription services where the doctor will dictate a slate of patients for the day and then those 50, 60 exam notes for the day will automatically be filed away and routed to the correct inbox for digital sign-off. Or, just dictated, not read, filed away.

Eric Fishman, M.D.: Now what happens if the physician wants to dictate the history for instance and then use some of the templates for some of the easier template parts of the chart, then they get to the assessment, the plan and they want to talk again. Is the transcriptionist able to put portions of the note into the various components of the SOAP note if you will?

Evan Steele: Absolutely.

Eric Fishman, M.D.: How does that work?

Evan Steele: When they pull up the template, the parts of the note that have been dictated, either you do Dragon and you go right to the spot that’s bookmarked or you go right to the field and you dictate. Or, the transcriptionist will just type in those sections on the document and then it’s saved in the chart automatically.

Eric Fishman, M.D.: Will the transcriptionists be looking at the completed note including the drop-down click and --

Evan Steele: Correct. They’ll be looking at that shell.

Eric Fishman, M.D.: And just putting in their portion?

Evan Steele: Correct.

Eric Fishman, M.D.: That’s interesting. I understand that you have been very vocal and maybe even more literate on the subject of certification meaningful use, the Hitech Act. And certainly for many physicians, the carrot and stick, the $44,000 is a very meaningful incentive to utilize a certified – whatever that means – electronic health record and use it in a meaningful fashion, which hopefully in the near future we’ll understand what that means. But then, of course there are some physicians for whom that’s not particularly important. Can you discuss for a few minutes your position on that issue? And I guess medical economics to some extent that’s the same question as the difference between electronic health records for family physicians as opposed to for specialists.

Evan Steele: Right. The meaningful use requirements if you read it – and I’m not using this term in a bad way – it reeks of primary care. All but one of the primary care quality measures, the CCHIT certification document -- if you read the 2009 one before they pulled it -- was almost 500 items. It’s like reading a primary care specification sheet. Perhaps the government program will be worthwhile for a primary care physician although it depends on their volume and how much revenue is at stake. But for the specialist -- and that’s who we focus on, the high volume, high-performing specialist -- don’t want EMR's that have been developed for primary care. They want a solution that’s going to get them efficient, make their offices efficient and help them run their business more profitably. I think the meaningful use and what the government is trying to do does not focus on the needs, the very important needs or the special needs of specialists.

Eric Fishman, M.D.: And I would tend to agree with that to a large extent. One of the subjects I’ve been addressing recently is readiness assessment, trying to figure out if an individual practice is ready even to start looking for an electronic health record. Is there a class of physicians for whom you would say SRSsoft is not an appropriate solution, that they should for sure use a different type of product?

Evan Steele: We’ve had 100 percent success in 498 practices around the country.

Eric Fishman, M.D.: And do they include family physicians and internal medicine?

Evan Steele: We’re in 40 different medical specialties. Our largest client in terms of physicians is a 100 doctor primary care group. And then we have a 131 provider orthopedic group and we have one-doctor family practitioners, one-doctor pediatricians and 15 doctor ophthalmology groups. So every time we install the software, it works because it’s work-flow focused, it’s efficiency focused and it’s a lot better than the paper chart.

Eric Fishman, M.D.: And if you’ve got a physician in multiple offices and they see a patient in one office one day and then they’re going to see that same patient in another office a different day for whatever reason, the information is accessible from one office to another?

Evan Steele: Its as if it’s all virtually in one place.

Eric Fishman, M.D.: Now what if you have two different offices, two different practices in the same community using SRSsoft but they’re different practices? Will they have any sharing of information capable between those two practices?

Evan Steele: If they want.

Eric Fishman, M.D.: And how would that work?

Evan Steele: Well, for example, out in Colorado there’s a REO called QHN. And what we do with one of our practices is when the doctor signs off on his dictated exam note, once it’s signed, we scrape out the exam narrative from the transcription. We put it in an HL7 file and send it securely to the REO so that the primary care physicians in the community can have access to that exam.

Eric Fishman, M.D.: What are you using, your software or others?

Evan Steele: Ostensibly, they could be on any software.

Eric Fishman, M.D.: Obviously, the federal government is putting not only pressure on physicians to adopt an electronic health record, but also on patients to utilize a personal health record. Where do you see SRS fitting into this methodology in the future?

Evan Steele: The way I look at the PHR market today, it’s highly fractured. There’s a lot of different vendors out there. Whether it’s through insurance companies or Goggle or Microsoft, I think that the government should be in the PHR business. They should have one PHR - lab results, medications from Shore Scripts, radiological reports, images and a simple list of problems that should be posted on the government PHR. Then any EMR in the country can pull from that centralized PHR.

Eric Fishman, M.D.: Interesting. Do you hear anybody making noise about something like that actually happening?

Evan Steele: I haven’t seen that. The only one making the noise about that is SRS so far. I’m sure some people have thought about it or talked about it but I haven’t read much on that.

Eric Fishman, M.D.: But when you make noise, a lot of people end up listening and again, hybrid EMR is certainly taking off as a concept in the industry. And this concept also that putting forth extraordinary efforts in getting features and functionality, that may not be extraordinarily productive for an individual physician, may not be the proper direction to go. Do you see -- and you’ve been vocalizing this subject for quite some time -- do you see, either Pied Piper and the people, begin to follow you more and more in that direction?

Evan Steele: I’d like to see it that way although you never know. There’s a lot of voices in the industry. The blogosphere for healthcare IT is huge and massive. There’s a lot of thought leaders, but even the HIT Standards Committee last Thursday said that there’s complex solutions that we have now for complex problems. They’re wondering if, like in other industries, can we apply simple solutions to complex problems. And certainly putting lab results, radiological reports, studies, images, prescriptions and a simple list of problems on a centralized PHR is a simple solution. Doesn’t require a lot of data entry, hardly any, except for maybe the problem list. It’s simple and it would have a massive impact when one physician and the other cross treating physician - that’s all the information they really need to do a better job taking care of patients. So maybe they’ll come to their senses and come up with simple solutions to the complex problem.

Eric Fishman, M.D.: Sort of like the ATM at the kiosk at the airport. Do you find many other commercial entities following your lead in trying to get a hybrid EMR or just an EMR that concentrates so single-mindedly on office efficiency?

Evan Steele: There has been a number of hybrid EMR companies that have cropped up or existing companies that now have created hybrid EMR products. So we see that as a trend and we hope that category extends because we firmly believe hybrid EMR is the way to spur massive adoption on scale across the country.

Eric Fishman, M.D.: So obviously, there’s tens of billions of dollars being put behind the concept that physicians will be adopting this technology. Is it your opinion that in the next five years that in fact, it will be hundreds of thousands of physicians who adopt electronic health records of one form or another?

Evan Steele: I think the answer is no. The current set of solutions are the same set of solutions that are out there and the government will likely back in terms of providing stimulus funds for. If we’ve had so much trouble implementing these types of software packages up to now, what’s changed going forward? In fact -

Eric Fishman, M.D.: But that may not be enough.

Evan Steele: But it’s the same product.

Eric Fishman, M.D.: Right. What percentage of your 498 practices are re-do’s? What percentage of theme are already using a competing electronic health record and you’ve found that you can go in and do a better job?

Evan Steele: A small percent and it’s growing rapidly.

Eric Fishman, M.D.: Why do you think that is?

Evan Steele: In 2004, that’s where a lot of people started adopting EMR's when President Bush –

Eric Fishman, M.D.: President Bush said it was going to happen in 10 years.

Evan Steele: Correct. “Every American shall have an electronic medical record by 2014, in 10 years.” And no one really knew what he meant by that. It could be a PHR or an EMR but he did say that and in 2004, a number of practices bought EMR packages. And it’s interesting. It takes a good four years for a practice to buy something, realize they made a mistake and then politically to get rid of that EMR and buy something else. It’s not something that they would just buy and three months later say, let’s buy something else. That’s not how medical practices work. It’s a little bit slower. So that trend has been accelerating a great deal over the past six months to a year.

Eric Fishman, M.D.: Interesting. So Evan, obviously, there’s ten’s of billions of dollars available in this industry to promote the adoption of electronic health records. Just as obviously, you’ve gone on record many, many times as saying that you would prefer to provide your software to physicians and make them more efficient using software that is effective at business processes even at the risk of not having the physicians avail themselves of the $44,000 that is available in the stimulus payment. Now, in that business environment, it seems that you’re doing remarkably well, publically acknowledging that your physicians may not be available for the stimulus funds.

I’m sure you know that there are many health record companies that put very proudly on the home page of their website that they guarantee that their physicians will be eligible for the stimulus funds, that they’ll even give them money back guarantee if they’re not. And yet, your company is growing and it’s growing by leaps and bounds as I understand it. Tell me about the corporate policies, about your philosophy and how you run your company to allow it to go in that direction, sort of against the tide if you will.

Evan Steele: First of all about the guarantees. Nobody is guaranteeing that you will get your money. You have to read the fine print. When you read the fine print, they all say they’ll guarantee that their software will meet the meaningful use guidelines but they’re not guaranteeing that the doctors will get the money.

Eric Fishman, M.D.: Fair enough.

Evan Steele: Even though it seems that way, its really not. So read that fine print. Caveat emptor. Again, our philosophy, like you said, is efficiency. It’s our belief that if you slow a doctor down, or speed him up or hire a volume specialist --let’s say an orthopedic surgeon -- you take MJA average numbers, a one minute change in productivity will either cost them or gain them a half a million dollars in revenue in bottom line profits over the course of five years. And that dwarfs by a factor of more than10 to 1 anything that the government might give a doctor if they could prove meaningful use. So with that, we aim to keep widening the gap between the existing products and our product in terms of efficiency because seconds count. And that’s the first pillar of what we offer - a better, faster, more ergonomic easy to use product for our providers.

Eric Fishman, M.D.: And maybe as a digression, you’ve even done some time motion analysis to try to get the seconds to count to get better productivity out of your physicians.

Evan Steele: Correct. You said a minute is $500,000. Fifteen seconds is $125,000 and 15 seconds, 15 clicks. So we were always reducing clicks, always making the software more efficient to use. The second part is customer service. I have an open check book policy with my chief operating officer. I told him five years ago when he started, provide the best support. I want the best support. You have an open check book. I never want to hear, I don’t have the resources to provide the best support. So whatever it costs, make sure that happens. And on top of that, hire people who we call ETP’s.

Eric Fishman, M.D.: I understand there’s an acronym at SRS that’s called ETP.

Evan Steele: Right. Eager to Please. Our entire 100 person staff is eager to please our clients. So we have the budget and instead of spending money on marketing, we don’t advertise. You never see an SRS advertisement anywhere. We feel the best marketing is happy clients. So you look at our KLAS score. It’s 96, the highest of any company in the EMR industry. That’s because of our open check book policy and our focus on providing the best customer support. Also our 20 developers are developing the most efficient, ergonomic and easy to use product. So you combine great support with eager to please employees with awesome software -- you’re going to have a lot of success from that recipe.

Eric Fishman, M.D.: Are most of the employees in the headquarters up in New Jersey?

Evan Steele: All but 16 of them. So 84 plus another 16 that are out in the field, mostly sales representatives.

Eric Fishman, M.D.: And shortly after February 17 of this year there were a number of articles that came out that said that there would be a shortfall of hundreds of thousands of health care information educated people. Do you find that it is harder to hire people at this point and time that it was maybe even six months ago because much of the good talent is already snapped up?

Evan Steele: We have so many people that come to us looking for jobs. They know the success of our company. And when you implement an EMR at SRS and the client’s happy, you never get that phone call where, “I’m unhappy. Fix this for me.” They’re happy, the doctors are happy --

Eric Fishman, M.D.: And it makes the employees happy.

Evan Steele: It’s makes the employees happy. It’s very easy to hire employees. Unfortunately, we have a policy that we never hire an employee from a client. A lot of employees come and ask to work for us but they recommend their friends and we’ve had an easy time and a constant flow of resumes and finding those high quality people. Plus, we’re in the New York City metropolitan area and we draw from a very deep labor market and we find some top notch, excellent people to work for us.

Eric Fishman, M.D.: Good. Evan, what do you see as the future of the industry, the next 12, 24 months, maybe even 5 or 10 years out?

Evan Steele: I think there’s going to be a massive shakeout as soon as people realize that the existing products in the marketplace will not help doctors meet the increasing demand for patients. It’s kind of like a perform storm, right? You’ve got 31 million people they want to put on the insurance rolls that will have unlimited access to physicians with health care reform. In the next 20 years, demographically, there’s going to be another 31 million people who are over the age of 65. This is by 2030 including you, including me as well. I’ll be 45 this year. So now, there’s 62 million more people half of which are new to the insurance rolls and the other half are getting older and see the doctors more.

There’s a shortage of doctors, so there’s just a huge demand for medical services and doctors will need solutions that will help them cope with the volume. Those doctors whose productivity are impacted and are not able to handle efficiently the volume of patients will have a waiting room full of patients and will not be able to service patients. Those doctors who are efficient would be able to grow and prosper. I think people will realize that in the next 12 to 24 months and they are going to seek out products that are simple that make their businesses run efficiently and allow them to take better care of more patients.

Eric Fishman, M.D.: Very well said. Evan, anything else you’d like to add to today?

Evan Steele: Thank you so much for having me here, Eric.

Eric Fishman, M.D.: It’s been fun. This is Eric Fishman. We’ve been speaking with Evan Steele, CEO and co-founder of SRSsoft. Until next time. Thank you.

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