How to select the best EHR for your practice
Solo and small group practices in the market for an electronic health record system face a plethora of choices. The federal Office of the National Coordinator (ONC) for Health Information Technology lists more than 2,800 “meaningful use certified” EHR products for ambulatory practices. And the list continues to grow as more and more software developers seek to capitalize on the ever-expanding, highly lucrative HIT market.
How can osteopathic physicians sift through so many options? A number of DOs who have developed expertise in EHRs or have simply gleaned insights through trial and error readily share their knowledge with others in the profession.
General internist David L. Miller, DO, of Macomb, Ill., had been using an early-generation EHR system in his two-physician practice for 10 years before deciding to upgrade. He and his wife, a pediatrician, wanted to find a new vendor because their previous one had undergone a series of mergers and buyouts that had adversely affected both product quality and customer service.
“When we went through the process 10 years ago, we listened to some suggestions from local physicians and basically took what was available,” Dr. Miller remembers. “This time, we decided to be more proactive about choosing the right product.”
After assessing their practice’s EHR needs, they searched for systems that met their priorities using the databases of the ONC and CCHIT, a public-private partnership that tests and certifies HIT products and services. Focusing on EHR products well-suited to both internists and pediatricians, they were able to narrow down their list to 10 potential vendors.
Dr. Miller and his wife visited the websites of these vendors to view product demonstrations and read more about product features. “We cast aside any vendors that did not have online product demos, as well as those that clearly did not meet our requirements,” he says, noting that they were able to winnow their short list down to three vendors. Of these vendors, they eliminated one that didn’t return their phone calls.
One of the finalists, NextGen Healthcare, had a sales representative drive 400 miles to do an onsite product demonstration in Dr. Miller’s office, while the other vendor put on a web-based demonstration for the practice. “We felt both software systems could fit our needs. But ultimately, we were more impressed by the salesperson who drove all that way to meet with us,” Dr. Miller says. “We felt that vendor really wanted the sale and would provide better ongoing support.”
Practices that have no experience with EHR systems may benefit from more guidance upfront than Dr. Miller received. An officer with the American Osteopathic Association of Medical Informatics, family physician Gary L. Knepp, DO, advises osteopathic physicians to contact their Regional Extension Center (REC), one of a network of 62 federal government-supported HIT consulting services across the country that guide physicians in selecting and implementing EHRs. Because many EHR vendors are regional and some focus on hospitals rather than office-based practices, Dr. Knepp recommends that DOs work with their REC to come up with the top 10 vendors appropriate for their practice’s size, specialty and location.
“You should contact your Regional Extension Center when you’re starting to think about what your business needs are for an EHR,” says S. Bre Jackson, the chief information officer of the California Health Information Partnership and Services Organization (known as CalHIPSO), the REC covering most of California. “With Stage 2 of meaningful use just around the corner, we want to make sure that physicians consider EHR features that are forward-thinking. And we want to give physicians the confidence that they are selecting a system that has a good shelf life.”
“You’d better talk to each person in that office to find out the good, the bad and the ugly about the product.”
Alternatively, to determine which vendors and products are best-suited for one’s practice type and size, osteopathic physicians can look toward independent proprietary EHR rating services, such as KLAS Enterprises and AC Group. For free, physicians can view the “Best in KLAS Awards,” which rank the most desirable EHR systems for practices with 1-10 physicians, 11-75 physicians and more than 75 physicians. And for approximately $90, a physician can order a series of reports from the AC Group that rate the top EHR systems for different-sized practices on such criteria as vendor stability, ease of use, ease of modification and end-user satisfaction.
To implement an EHR system, the cost outlay for a practice is $30,000 to $50,000 per physician, says Kevin P. Hubbard, DO, who chairs the Information Technology Task Force of the American College of Osteopathic Internists. And it costs another $4,000 to $8,000 per physician per year to maintain the system. Given the size of the investment, it’s crucial for practices to find the best system for their needs.
First, physicians need to take an inventory of how they practice, says Dr. Hubbard, a hematologist and oncologist who was in private practice for 20 years before becoming the chairman of medicine at the Kansas City (Mo.) University of Medicine and Biosciences—College of Osteopathic Medicine. “This is the time for being brutally honest with yourself about what you do,” he says. “What’s important to you? What’s not as important to you?
“For example, if you’re a physician who does nothing but ambulatory care, having a system that ties in with a hospital may not be as important as it would be for a physician who has both an outpatient and an inpatient practice. You also need to take an inventory of any outside services you use, such as laboratory services and technology services, and see how they would tie in to the EHR system.”
Osteopathic physicians in single-specialty practices should consider “best of breed” EHR systems, suggests pulmonologist Elliott R. Schwartz, DO, of Oklahoma City. “These systems are designed for the specialists who are going to use them,” he says. “This eliminates the frustration of having a bunch of features that aren’t pertinent to one’s specialty or subspecialty, and it improves efficiency.” Vendors of such EHR systems often exhibit at the conventions and conferences and advertise in the professional publications of medical specialty and subspecialty societies.
DOs should also find out whether the hospitals at which they have privileges lease out use of their EHR systems to independent practices, advises Dr. Knepp, the chief medical officer of Methodist Medical Center of Illinois in Peoria.
AOA offers discount on tablet EHR
Two years ago, at OMED in San Francisco, family physician Ronald E. Baird, DO, walked the exhibit floor looking for an electronic health record system that would meet the needs of his four-physician practice in Bangor, Pa. He was most impressed by the MediTouch EHR system developed by HealthFusion, a California-based health information technology company founded and managed by two osteopathic physicians. The AOA and HealthFusion have partnered to allow AOA members to receive a discount for purchasing MediTouch, which is certified for “meaningful use.”
“I liked that the CEO of HealthFusion is a DO, that the company has a strategic partnership with the AOA and that unlike other EHR systems, MediTouch has a built-in osteopathic module,” Dr. Baird says. He was also drawn to the product’s touch screen technology. His practice purchased the system, which went live in March 2011.
Two physicians in the practice are elderly, so they weren’t exactly enthusiastic about using EHRs, Dr. Baird notes. But all four of the physicians are completing the attestation requirements for Centers for Medicare and Medicaid Services’ incentive payments.
More than 500 AOA members are using MediTouch, a Web-based application designed for a tablet. The system is fully compatible with HealthFusion’s practice management software.
While Dr. Baird appreciates MediTouch’s osteopathic module, he points out that it needed to be customized as do all of the other built-in modules. “Using an EHR system has been the hardest, most intense challenge I’ve ever undertaken,” Dr. Baird admits. “None of these systems are intuitive. It’s like learning to read again.”
But he has only praise for HealthFusion’s training and support staff. “The support staff is young and vibrant and very helpful,” he says.
“Some health systems are beginning to do this because they want physicians’ business,” adds Dr. Schwartz. “But the disadvantage to using hospital legacy EHR systems is that they’re cludgy; they don’t think like physicians. And it’s very difficult to get changes made to these systems.”
The third major EHR option for independent practices is a stand-alone system that is either server-based or cloud-based. Most small practices today select remotely hosted cloud-based systems that are accessed through the Internet, so they don’t have to hire nearly as many IT personnel or be responsible for data security, Dr. Schwartz says.
Many HIT experts urge practices to send out requests for proposals to vendors of the systems under consideration. This allows practices to detail their priorities and helps ensure that the proposals from vendors can be compared point by point.
Once a practice has decided on a short list of EHR systems, it is crucial to speak with current users of these products. “This doesn’t mean talking with just the physicians the vendors want you to talk with,” says Dr. Schwartz. “You need to get a ‘megalist’ from each vendor and decide for yourself whom you’re going to call.”
After the vendor list is narrowed further, it is advisable to visit practices similar to one’s own that are using those EHR systems. “When you visit a site, it’s important to talk with the physician who likes the system the most and the physician who likes it the least,” Dr. Schwartz says. “It’s also important to speak to nurses, medical assistants and schedulers, as well as billing people if you’re planning to use the system for billing. You’d better talk to each person in that office to find out the good, the bad and the ugly about the product.
“If you’re only talking to the doctors, you’re making a big mistake because you may end up buying a system that is holy hell for the nurses and other staff to work with.”
Dr. Schwartz recommends asking users of the EHR system how much training they needed, how much was provided by the vendor, and when they received it. “Sometimes people are trained too early, so that by the time the system goes live, they’ve forgotten what they’ve learned,” he says.
Practices need to find out whether EHR training costs cover vendor personnel assisting onsite—not just on the day the system goes live but for a period of time after that, Dr. Schwartz says.
Osteopathic physicians who are switching from an old EHR system to a new one should also ask vendors about the ease and cost of data conversion, Dr. Miller suggests. Because his EHR vendor and three consulting firms were unable to convert his patient data electronically, Dr. Miller ended up having to print out his existing electronic patient records. “I have one employee who is dedicating her time to inputting the data into the new system as if it were coming from a paper chart,” he says.
“Selecting an EHR system is fraught with risks,” cautions Dr. Knepp. “Look for a vendor who has a strong track record and is likely to be in business for the long haul.
“The last thing you want is to have to replace your system because you can’t get it supported anymore. Find a vendor that is going to survive the shakeout that is invariably going to continue as we go forward.”