data-transfer-frustration
When a veterinarian told colleagues that his practice data was being "held hostage" by a practice management software company, they voiced concern, but no one expressed shock.
Dr. James Clark said his practice software company appeared unwilling or unable to supply his data to a new software company, frustrating his hopes that the new program would better manage the medical records, invoices, inventory, client communications and more for his solo practice in Kansas.
Each software provider blamed the other for the impasse, Clark explained in a June post on a message board of the Veterinary Information Network, an online member organization for the profession and parent of the VIN News Service.
VIN News contacted both companies. A representative from the current software provider said he knew there had been issues early on, but he believed his company had done all that was required. The new software company declined to comment.
For the moment, Clark's giving up on switching PIMS. "I don't know where to go with this," he said by email last week. "It doesn't look like I'm going to be able to leave … for the foreseeable future."
Practice information management systems, or PIMS for short, have been around for more than three decades, and complaints about migrating data aren't new. But until recently, changing PIMS was a rare event in the life of a practice.
With the recent proliferation of cloud-based programs, more practices are switching, highlighting that many practice software programs don't play nice together, according to PIMS experts and software users interviewed for this story.
While none could describe a time when a PIMS company actually held data hostage, several said it sure can feel that way. They described many conversions as disruptive, frustrating and painful.
"[PIMS companies] say, 'Everything is going to be sunshine and rainbows,' " said Dr. Mark Massaro, a director of veterinary software for a seven-practice hospital group in New Jersey who also has worked for several PIMS companies. "But it can be a disaster."
From few options to many
Thirty years ago, practice management software was downloaded on clinic computers, and the data was housed there. The programs were relatively simple. One PIMS provider described the early software as "glorified Rolodexes and cash registers." The scope of this software, sometimes referred to as legacy systems, expanded over the years. Server-based software still comprises the majority of practice management software in veterinary hospitals.
The mid-aughts brought cloud-based options, in which computing services are hosted off-site on massive servers that can be accessed through any browser with a good internet connection. These proliferated after Amazon launched its commercial cloud in 2006, followed by Google in 2008. Several programs have been created by veterinarians who were dissatisfied with what was available. Right now, there are more than a dozen cloud-based PIMS for small animal practices on the United States market.
Some of the allure of cloud-based programs is that they don't require the upfront hardware costs and upkeep of server-based options, and data can easily be shared among practices in a group.
Early on, veterinarians expressed concerns about the security of client data kept "in the cloud," several PIMS creators said, but those concerns have faded as cloud-based programs expanded into industries including banking and human health care and as major providers invested heavily in protecting their infrastructure.
"It seemed like that was where everyone was going," Clark said of his decision to move to the cloud. Another veterinarian said he switched to follow the "cloud crowd."
Massaro proposed that one source of switchovers is baby boomers who, hoping to sell their practices, believe having a cloud-based practice management system will make them more attractive to younger buyers.
Lost in translation
Information in practice management systems is stored in databases comprised of tables. How the information is organized in those tables is not normalized or standardized across the industry. In addition, practitioners have their own idiosyncratic ways of entering data.
Dr. Sam Meisler, a veterinarian in Tennessee who created his own PIMS, said that using tables is about the only thing the various PIMS have in common. Meisler's software, EasyDVM, is used primarily by the 28 practices in the PetWellClinic franchise group, which he co-owns.
"Everybody develops their own database and style and look. … That's the number one complication," he said.
"When you change, the new group has to go and grab that data and try to match it with the way they put it into their tables," Meisler explained. With so many variables, transferred information can get garbled or lost.
Clinics often rely on the new software company to normalize the practice data so it works for the new database, a process for which the new PIMS company generally charges. The "transfer cost" can run into the thousands for a single practice, Meisler said, and still, "it won't be perfect."
One veterinarian told VIN News that he paid $15,000 to a PIMS company to input all the practice data from the old system and train his staff on the new one. He said the transition was smooth; well worth the price.
Massaro, the veterinary technology director for the New Jersey veterinary group, describes the data mismatch as a translation issue. "They don't speak the same language," he said of PIMS providers. "Vets get stuck in the middle between one company saying they sent the data and the other saying it is not usable."
He recalled helping a practice out of a conversion gone wrong, when the species designation for all the exotic animals — a few hundred — showed up as "unknown." There appeared to be no automated way to correct the problem. Eventually, he manually updated the records by sleuthing other information in the record.
Massaro and a cloud-PIMS provider said the gap between old and newer PIMS technology contributes to the conversion challenges.
Dr. Caleb Frankel, an emergency veterinarian who in 2017 co-founded Instinct Science, a web-based PIMS, said that since new programs have vastly more functionalities built in, there is much more nuanced information today that needs to be translated between systems.
"Think about the eight years you've spent setting up your documents to how your workflow is and the product names, the product list. It's a dirty little secret, but there's no standard product list that comes with a PIMS," he said. "And what about your AR [accounts receivable] balances on the finance side? Those are very tricky to extract. You don't want to screw that up. And then there's fields that legacy PIMS never really had."
Frankel and Massaro each described the PIMS industry as the Wild West, in contrast with human medicine, for which federal rules require that data in electronic health records (EHRs) be standardized and able to flow between different programs. Despite the standards, achieving easy data exchange on the human medicine side is a work in progress, according to a 2022 Harvard Business Review article.
In another point of contrast, Frankel added that veterinary PIMS companies don't have the funds to transform programs like their human health counterparts.
"In human health, the PIMS, what they call the EHR, most hospitals pay multimillion dollars for it. That's what the cost is," he said. "Now, no PIMS provider is charging a veterinary hospital multimillion dollars for implementation of our PIMS."
Another issue: how the data is provided
On top of these translation challenges, companies aren't obligated to provide practice data in a standard format.
Dr. Lance Roasa, a practitioner and lawyer in Nebraska, used to co-own a group of practices, each with its own PIMS. He wanted to put them all on one cloud-based system back in 2018, but he was told by one of the PIMS providers that the client records would be provided as PDFs, which the prospective software company couldn't upload as data into its program. He decided against the conversion. When he sold the practices in 2019, each had its own software.
Roasa, who is also an attorney, said the terms and conditions of PIMS contracts are often vague about what happens if a clinic wants to move to a new provider.
"They'll say, 'Hey, we'll provide the data,' " he explained, "but it's not always in a form that is readily accessible or convenient to the veterinarian or the people that are doing the upload into the new practice management software."
Such was the case for Dr. Daniel Slovis, who owns a five-veterinarian practice in Virginia and has been trying to leave his PIMS company for close to a year. He, too, described feeling like his data was being held hostage.
Slovis has switched PIMS several times before. "I'm not scared to make changes if I'm not happy," he told VIN News. He's also willing to be a squeaky wheel when things don't go right. He said once he realized the data transition was hung up, he began emailing the CEO of his current PIMS twice a day to check the status.
Initially, the original PIMS company provided data in a CSV format, Slovis said. CSV stands for comma-separated values, which is a way to store tabular data in plain text. The new PIMS company said it couldn't extract the information it needed from the files.
Eventually, the new provider hired a third-party data normalization company (more on that below) at their cost. Slovis granted the data firm direct access to his database so they could grab the information they needed.
The veterinarian said he's on track to begin working on his new PIMS in October, but he plans to keep his current program running — paying the monthly subscription — for up to a year so he can access the old data if he needs it.
Roasa urges veterinarians to run old and new software side by side for some period to look for gaps in data and functionality. "This may seem extremely repetitive, but it may save a massive headache later," he said.
'Common ground'
The third party brought in to assist the transition for Slovis was Bitwerx. Based in Kentucky, the company has specialized in normalizing and standardizing veterinary practice data since 2019. Bitwerx provides conversion services to PIMS providers.
Susannah Orsuga, Bitwerx's chief revenue officer, said these services are aimed at supporting "the freedom of choice by veterinarians and veterinary staff to use the technology … that they feel is going to support their abilities to run their businesses, engage with pet owners, as well as provide great pet health."
She added that demand for PIMS conversion services has grown over the past three years.
"Veterinarians really want to move into the modern era of cloud PIMS ... leveraging technology to shore up the bandwidth of their team so they can spend time with pet owners and focus on pet health," she said.
Orsuga describes Bitwerx's specialty as finding "common ground on the data and the data structure" so it can be used by an authorized third party. "It absolutely is a specialty of sorts that tends to require certain resources and skills," Orsuga said, adding that some PIMS companies would rather use a third party with these capabilities and use their resources to build out software features.
Orsuga said she is not aware of any other independent, third-party companies that offer data normalization for PIMS conversions in the U.S. but that some PIMS companies have teams that do that work.
While mastering data normalization may be outside the scope of some PIMS companies, it is also possible that improving the ease with which customers can walk away from a contract is seen as counterproductive.
"I don't think that people are probably going out of their way to make it challenging for a veterinarian," Orsuga said, "because a lot of these organizations have much larger portfolios, and they would not want to erode their relationship over one piece of that business."
However, she offered a hypothesis: "Maybe it's something where they say, 'If you choose to leave us, this is how you're going to get the information,' and that's that."
Instinct's Frankel was once skeptical about the incentives. "Before I was a PIMS provider, I thought it was like a nefarious sort of trap that people have created so you can't move from PIMS to PIMS," Frankel said. "Now I'm a PIMS provider, and I have a whole new perspective."
He commiserates with veterinarians and his software competitors. "Building a PIMS is a really big and endless job," he said. "The reality is, there's just so much surface area to cover when you build a program like this for a complex environment that [data migration] ends up just being a back-burner item for PIMS companies historically. Roadmaps get busy since we listen to our customers, and they want us to build the features they want. They don't really ask for this."
Until they do.