From the perspective of Extormity CEO Brantley Whittington, the Healthcare Information and Management Systems Society (HIMSS) show was a perfect venue for revealing his true identity. In attendance were hundreds of the very healthcare IT vendors that the spoof company has been mocking for the past three years.
HIMSS itself had invited the fictitious company's CEO to speak at HIT X.0: Beyond the Edge, a track at the annual meeting promoted by HIMSS as "the only event for healthcare IT leaders who want to be on the forefront of innovative ideas, gain exposure to cutting-edge scientific advances, and experience unique explorations in emerging technologies."
So Brantley Whittington, aka Jeff Donnell, one of the co-founders and creators of Extormity, exposed his real identity: president of personal health record company NoMoreClipboard, a spin-off of minimally invasive electronic health record (EHR) vendor and spoof co-conspirator Medical Informatics Engineering (MIE).
For nearly three years, Extormity has regaled tens of thousands of readers worldwide with its antics related to EHR design, installations, and security breaches gone bad. The spoof has been closely followed by more than 10,000 subscribers who registered to receive Extormity's press releases, and also those of the professional organization that certifies Extormity's products, the Society for Exorbitantly Expensive and Difficult to Implement EHRs (SEEDIE).
The reason for the dedicated following? The parodies of real-world issues strike close to home. This was apparent even in the interactive audience polling question asked of HIT X.0 session attendees as Whittington was being formally introduced.
The audience members were given four choices to indicate what they would like see happen to their EHR vendor. Only one of the responses was positive: "I would like to see my EHR vendor applauded for their wonderful products and superior support." Only a handful of attendees selected this option.
The majority of attendees selected the other options:
- "I would like to see my EHR vendor entering federal prison in an orange jumpsuit."
- "I would like to see my EHR vendor chained to a server at the bottom of Lake Huron."
- "I would like to see my EHR vendor forced to spend an eternity in hell using its own EHR applications."
After spending 10 minutes in character, Donnell explained that they created the elaborate parody to highlight the need for healthcare IT vendors to develop, sell, and support EHR systems that are easy to learn, do the work expected of them, and are interoperable, secure, and cost-effective.
The parody was also intended to empower hospital and physician end users, motivating them to reject healthcare IT systems that do not perform as needed or as promised.
"In this day and age, with all the progress being made in healthcare IT, there is no reason for physicians and hospitals to put up with some of the EHR systems being sold today," Donnell said, "There is no reason to pay ridiculous sums of money for applications that don't work and that force your medical staff to change your workflow. Why spend hundreds of thousands of dollars for custom integration packages when you can go to the HIMSS Interoperability Showcase, and you can see interoperability functionality in action today?"
Healthcare IT backlash?
What worries Donnell and the other creators of Extormity is a backlash against healthcare IT from second-wave healthcare users. The U.S. government's initiative to pay physicians financial incentives to implement EHR systems offers an unprecedented opportunity to sell software to healthcare providers. However, EHR products have a legacy of prior failures, according to Donnell.
"As the healthcare community somewhat reluctantly transitions to EHR, many physicians, hospitals, and healthcare IT experts have been frustrated with significant expenses, inflexible applications, a lack of implementation success, and less-than-stellar ongoing support from EHR vendors," he said.
Donnell encouraged end users to develop a backbone: "Tell the vendor community when it is misbehaving. Tell them: 'We don't want to put up with your irresponsible behavior and your excuses about products anymore.' "
Alternatives are available, as evidenced by the nearly 1,000 HIMSS exhibitors, many of whom have innovative products being demonstrated in booths that aren't the size of aircraft carriers, Donnell pointed out. One of these booths included products from NoMoreClipboard and MIE.
Extormity's creators felt that the time was right to use the name recognition and notoriety of Extormity and SEEDIE to leverage the marketing of their own very non-Extormity-like EHR and personal health record (PHR) products.
Opening the kimono
Whittington/Donnell officially revealed his real identity and those of fellow Extormity and SEEDIE creators at a press conference held several days earlier at HIMSS, where he disclosed the history and details that drove the parody.
MIE was founded in the mid-1990s and built one of the first sustainable health information exchanges (HIEs) in the U.S. Almost 95% of medical professionals and hospitals in northeast Indiana currently use its products to share an average 1.5 million clinical messages per month. Overall, approximately 65% of healthcare providers in the state of Indiana use some form of computerized health record.
After building the Indiana HIE, the company started to develop a portfolio of Web-based EHR products. This included EHR software for programs that operate through employee health clinics. MIE's current customers of this type include Eli Lilly, Dow Chemical, and Google.
In 2003, NoMoreClipboard was spun off. It was created as a separate legal entity largely due to philosophical concerns about the concept of a tethered patient portal, Donnell said. "We really believe that a portable EMR module that enables patients to easily compile, manage, and share their information with any EMR provides value to both patients and their physicians," he said.
When the two companies started to market their products to healthcare providers outside of Indiana, they expected to encounter a more challenging sales environment. Indiana is very progressive when it comes to using healthcare IT. But the resistance they found shocked them.
"What we learned was that most physicians would rather adopt an ugly baby than an EHR," Donnell said. "They'd heard too many tales of woe from early EHR adopters. Physicians would tell us horror stories about a buddy across town who'd spent an arm and a leg on an inflexible system. The physician had to change his clinical workflow to fit the software. He had to reduce his patient load for six months so that he and his office staff could get used to using the system. We found not only that people didn't want to talk about our products, they didn't want to talk about EHRs at all."
How could MIE and NoMoreClipboard spotlight the fact that some questionable practices in the vendor community were creating roadblocks to adoption and hurting sales? After doing some research, the primary complaints that Donnell identified were cost and physicians having to change their workflow to fit the application.
"We created the name of the company from the combination of 'extortion' and 'conformity,' " he said. "Extormity would be an EHR company whose systems are expensive, exasperating, and exhausting to deal with. It would be the embodiment of everything wrong with the healthcare IT vendor community. The legitimate-looking website practically wrote itself."
The concept behind Extormity was simple: to poke fun at EHR stereotypes while also pointing out that there are alternatives. "We wanted to show readers that there are affordable, flexible, and innovative EHR and PHR solutions that actually help improve clinical outcomes and reduce costs," added Doug Horner, co-founder and chief technology officer of MIE.
To get the website noticed, Donnell and Horner worked some "back channels" to get blogger coverage. A three-sentence post on theHealth Care Blog on May 27, 2008, sparked an additional 100 national and international blog posts and 40,000 visitors to Extormity's website within a month.
These 40,000 visits have expanded to tens of thousands. The visitors represent a who's who of healthcare IT and include individual hospitals, health enterprise systems, academic institutions, government agencies, and lots of vendors. The companies that serve as the inspiration for the website's content are among its most frequent visitors, according to Donnell.
Meanwhile, SEEDIE was founded because management at MIE, whose products had been certified by Certification Commission for Health Information Technology (CCHIT) in 2006, was infuriated that some companies that had also secured product certification were deploying what MIE considered to be inferior versions in the marketplace. SEEDIE was created as another way to make people aware of these questionable practices.
What started out as a spoof to generate conversation has turned into a portal for healthcare IT professionals to vent their anger and frustration. Donnell said that after soliciting website visitors for their EHR horror stories, Extormity was inundated with real-life stories that were more terrifying than what he and his colleagues could ever dream up.
He cited two examples: one in which a large hospital was told that an upgrade with features it desperately needed to function would be available in two years, and another where a midnight software upgrade installation obliterated nine months of patient data.
Revealing the creators of Extormity and SEEDIE does not end the spoof. "As long as there is a subject to lampoon, we'll lampoon it. We don't see this stopping anytime soon," Donnell concluded.
