Electronic Health Records, or EHR software, have numerous advantages for health care practices and practitioners, especially since the Affordable Care Act (ACA) and the Medicaid EHR incentive programs were passed. EHR makes it possible for patients and physicians to access medical files digitally. This ease of access can often help increase patient satisfaction and improve care. EHR has become an essential part of any practice, so much so that even single-physician practices can’t afford to go without them. In this article, we will take a comprehensive view of the EHR selection process so you can understand in detail how to select an EHR that will work best for you.
That being said, selecting an EHR is no easy task. They are often a large investment monetarily, and more importantly, most EHRs have a long data migration and onboarding process that might interrupt the practice’s operations. To add to that, the learning curve associated with gaining proficiency with the system can be substantial.
All EHRs are not created equal. To find the solution best suited to your medical practice, a deep dive into understanding every EHR you are considering becomes necessary.
What is EHR?
Simply put, an EHR is the patient’s chart in digital form. Over the years, they have evolved to become patient records that are updated in real-time and can be accessed by authorized users. They not only contain patients’ treatment and medical histories but also show other areas of care, like a patient’s diagnosis, treatment plans, radiology images, medications, medical history, allergies, immunization dates and laboratory test results. It automates workflows for providers and gives caregivers access to tools that support decision making. Patient data can be shared with other care providers and health care organizations like specialists, pharmacies, laboratories, emergency facilities, medical imaging facilities and workplace clinics.
Why is EHR Important?
EHRs are an important part of the health IT landscape. They are at the center of a federal effort to let healthcare institutions and providers share medical data with patients, other healthcare providers, information exchanges and regional organizations. With that goal in mind, the Center for Medicare and Medicaid Services introduced an incentive program to adopt an EHR. The meaningful use program encourages providers to adopt an EHR by providing financial incentives. Providers’ systems must comply with HHS standards and have three levels of objectives that hospitals and practitioners must meet to receive government-based financial benefits.
Before the financial incentive program was implemented, adoption and use of an EHR was viewed as a way to provide better patient care, improve workflow and enable data analysis.
Two of the most significant benefits of EHR are better care and 24/7 access to data for both patients and physicians. From the perspective of ACA and HIPAA compliance, the biggest benefit of EHRs is their interoperability and standards of meaningful use.
EHRs not only provide all three of these major benefits but many others as well. From interoperability, which permits EHRs to integrate with other programs practices use, to customization, which allows you to build the precise EHR solution you need, to scalability, which ensures your EHR grows with your practice or organization as it grows, it’s difficult to find a reason not to implement an EHR today.
Before upgrading existing paper patient records to a digital EHR, there are two critical steps that you should follow. The first is evaluating your EHR. If the answer to the first step is that you should go EHR shopping, the second step is to choose a new EHR. Make sure to keep your business’s requirements and budget in mind when shopping for a new EHR. Below is a step-by-step guide to selecting an EHR wisely.
Assess your Current Solution
Since migrating data from an old EHR to a new one isn’t exactly easy, the first thing to do is take a step back and carefully evaluate your existing EHR. While every EHR has its advantages and disadvantages, it’s very important to check periodically if your current EHR no longer matches the needs of your medical practice. Ask yourself: “Is my current EHR increasing the practice’s efficiency?”
After implementing an EHR fully, if you don’t see an increase in efficiency and ease of management with everyday operations, it might be time to consider implementing a new solution. A few more questions consider would be:
- Is it flexible?
- Is the data secure?
- How often does it backup?
- How often is it updated?
- Does my staff have the support required EHR?
After the onboarding phase, both physicians and other medical staff should be able to use the EHR seamlessly. It should increase productivity and employee morale as most processes that would otherwise be done manually can be automated by the EHR.
However, it is time to re-evaluate your EHR if the current solution is not running smoothly and technical glitches keep coming up. Hanging onto a system that requires constant maintenance and error correction is a waste of both time and money.
A few more questions to think about:
- How many times a month do you seek help from your vendor? Does it interrupt your workflow?
- How much time does the vendor take to resolve an issue?
- Is vendor support free? Do you buy it every year?
- Do you get support over a phone call? What is the quality of the support?
- Are there videos, forums and webinars available on the vendor website?
Are there interoperability issues?
Sometimes EHRs are not compatible with other software that a medical practice may end up using, such as practice management software, public health registries and billing systems. Even if it is compatible, there may be data security issues. It may also happen that your practice has outgrown the current EHR and its limited features. Keeping the answers to the above in mind, it may be time for a new EHR.
Is my EHR up-to-date with certifications?
EHRs are generally purchased for a duration of 10 years or more. However, certification standards in the industry may change. At present, you should see if an EHR has the following :
Be Clear With Your Goals
The first and the most important step here is to assess the current size and projected goals of your practice. Keeping these in mind, decide how many patients your EHR is able to process every day. Know the present inefficiencies of the practice and ask yourself some of these questions:
- Will my EHR match the projected requirements of the practice?
- How many patients should it be able to process efficiently every day?
- What is your budget?
- What is the timeline for integration?
Choose Your Decision Makers
If yours is a single physician practice, making decisions is easy as you are the sole decision maker. However, the dynamics change in a larger practice. Selecting a committee that will represent the interests of all the parties using the EHR becomes very important. While selecting practice management software can be handled by management alone, choosing an EHR should be led by physicians.
You may even choose a “physician champion”, someone who would do research about various EHRs and promote the idea to their colleagues. Implementing a new EHR often faces resistance and skepticism. To avert a delay, include prominent people in the committee. Appoint at least one manager, or their delegate, a key nurse who is highly regarded by others, and if you think there is someone who is resisting a new EHR, invite them to be a part of the selection committee as well.
Determine Which Type of EHR Works Best for You
Today, three types of EHRs available – cloud-based, web-based and SaaS. Each comes with a host of pros and cons. Let’s take a brief look at them.
Before we take a look at the cloud’s various benefits, let’s understand what the “cloud” is. The cloud provides on-demand access to computing power and data storage, without direct management by the user. Private or personal clouds, especially for hosted software solutions, exist in data centers across the world.
For a medical practice, the advantages of cloud-based solutions include lower costs, scalability and easy access anywhere from any internet-enabled device. Unlike on-premise software systems, cloud-based EHRs do not require IT professionals to maintain hardware and software. The cloud allows practices to provide care without the need to worry about data or security.
SaaS refers to the pricing model in which users do not buy a license from the service provider. Rather they pay a subscription fee monthly or annually to access the most recent software via the cloud.
For healthcare practices, subscriptions result in lower upfront cost and ease of use. Practices don’t have to set up on location servers; they also don’t have to recruit a team of software and hardware professionals to maintain them. This also results in a better user experience as they have access to new features and security updates as soon as they are released, thus reducing downtime.
Web-based EHRs are accessed via internet browser on a trusted computer or device. Legacy software companies and outdated EHRs claim that web-based software is unreliable and unsecure. This is generally not true. Having a backup internet connection makes sure that there is no interruption in workflow. Many medical practices prefer web-based EHRs because of their ease of use.
Determine Your Must-Have Features
For larger medical practices, the next step is to request that various departments send in requests of features they would like in their new EHR. These features can be divided into three categories: must-have, good to have and not required.
Reaching out to team members is also a good way of involving all the departments in the EHR selection process. This way, they will be more committed and open to using the new EHR.
After that, the responses can be compiled to prepare for the next step, preparing the request for proposal.
Top Features to Look For
While you figure out the features you want, there are some common features that all top EHR suites have:
- Intelligent Patient Workflows: The best EHR uses technology to track and manage patient workflows in real time.
- Task Management Capabilities: Manage daily tasks like reviewing laboratory results, signing notes, answering patient messages and approving medications.
- Easy Patient Scheduling: EHRs must have appointment scheduling capabilities to register patients and schedule them.
- Speeds Up Patient Encounters: Makes patient histories accessible and lets users record clinical content, like medical abnormalities, quickly. This ease of access helps lower the cost and reduce transcription times.
- Pre-Built Templates: Templates are required to treat different patients who have similar conditions, saving time and increasing clinical efficiency. Solutions should record patient allergies, medications, immunizations, and other data points.
- Supports Meaningful Use Reporting: Access to financial and clinical data to make decisions.
- Intuitive User Interface: Should be accessible and help users proceed with minimal clicks and windows.
- Access From Any Device at Any Time: A good EHR can be accessed from multiple operating systems from anywhere at any time.
Write a Request for Proposal (RFP)
A request for proposal (RFP), though tedious, is a necessary step. It tells prospective vendors everything they need to know about your practice and priorities. This will allow you to compare the features of EHRs side-by-side. Below is some information you should provide prospective vendors in your RFP:
- Information about the size and location of the practice.
- Which practice management system, EHR and billing system you are using at present.
- Computer hardware and network details.
- What functions you are looking for in a new EHR.
You should also request this information from your vendors:
- Company history, number of employees available for support, management and research and development
- Financial statements
- Other practices that are similar to yours in type and size using the EHR
- How it performs the functions you are looking for and other functions if any
- Compatibility with your current practice management software and billing systems
- Product brochures and software versions
- Computer hardware and network requirements
- Onboarding and implementation plans
- Type of support provided – email, phone and training plans
- Cost and payment schedule
- Sample contract and warranties, if any
Choosing RFP Recipients
There are more than 200 vendors in the EHR market. The question is: how to select which vendor to send the RFP? There are a couple of parameters based on which vendors you should select:
Is the EHR compatible with your practice management system and medical billing system?
EHR and medical practice management systems can help avoid double entry by sharing data across both systems with a single interface. Building and maintaining the interface requires not only software interoperability but also the cooperation of employees from both practice management and EHR vendors. Every time either is upgraded, their interfaces also must be updated. Many developers claim that they can make their solutions compatible with any practice management software, but this isn’t always true. To be sure, it is best to ask your provider which EHR works with their practice management system. That being said, your providers should be the same; it reduces the need for a special interface between practice management and EHR software.
Do other practices your type and size use the vendor?
Vendors target their product to small, medium and large practices and a few market to all sizes. This can save time when choosing a solution since EHRs that are incompatible with your practice’s size can be filtered out.
Evaluation and Ranking Vendors
After sending the RFPs and receiving responses, it’s time to sort through and rank them in order of how they match your requirements. Take a look at our SelectHub analyst curated comparison report for a view of some top market performers. Here are some other ways you can evaluate potential vendors:
- Implementation: How much time does it take to implement? Will it disrupt workflow? Does the EHR integrate easily with billing systems, practice management systems and public health registries?
- Customization: Can it be customized to support various specialties? Can the dashboards be customized to suit the practice’s requirements?
- Customer Service, Training and Support: Does the vendor have 24/7 customer care? How long is the turnaround time to reply to an email? Do they have training videos and user manuals on the website? Do they offer on-site support? What is the cost of support?
- Technology: Are they web-based, cloud-based or SaaS-based? Will it require you to purchase new hardware?
- Security and Backups: Where will the data be stored? What kind of encryption will be used? How often will the system backup automatically?
- Financials: What is the initial price and how often will you need to renew your license? What is the total cost of the software, the payment schedule and cost of upgrades?
Based on the above, rank your vendors and shortlist about six to ten of them.
Attend Vendor Demonstrations and Site Visits
After ranking the vendors according to how well they match your requirements, the next step is to attend vendor demonstrations. Demos can give insight into how the vendor operates, their work culture and if they are financially secure.
Site visits also help see how the systems perform. Visiting practices similar to yours in size and type that use the same practice management software will show you if the EHR suits your practice. Make these visits with at least one physician and one decision maker, and spend the day observing patients.
After every site visit, check and review your vendor rankings. Select two vendors and negotiate over the cost and other things you may want out of the system. If the negotiations don’t go well with the winner, consult with the runner-up.
Discuss Finalists With Management
If you are a solo practice or a small practice, you have likely involved other stakeholders by this time. However, if you are in a large practice, now is the time to involve the other stakeholders. You may also invite the vendor to present a demo to them and answer questions about the EHR.
Negotiate a Contract
Typically, an EHR contract spans from 10 years onwards. If the duration of the contract is 10 years, ask the vendor what happens after that. If there are any costs – present and future – find out what they are and the payment schedule. Also, inquire what would happen if the vendor goes out of business during the contract period. Take the help of a lawyer with experience in software contracts to take it forward from here.
While an EHR can be instrumental for all the reasons detailed above, selecting a new EHR is not an easy task. It is time-consuming and involves many steps, but if done right, it should ensure an increase in efficiency and revenue. The key is to be methodical and careful at every step.
Have you recently evaluated and implemented a new EHR? Or are you in the process of selecting one? Let us know what challenges you faced or are facing in the comments.