Information Week Cover Story on Selecting an EHR

Today I came across a link to this cover story for Information Week about selecting the right EHR. Unfortunately, the site requires registration to access the article, but you can also get a login for the site without registering on this great website called BugMeNot. Now to the content of the article.

The article starts off properly in describing that selecting the right EHR is a tough and challenging task. The biggest challenge is of course the 300+ EMR and EHR vendors out there. Sadly the advice they give in the article doesn’t do much to actually help individuals that are trying to select an EHR. Here’s the list of steps they offer (and my commentary):
The state of your infrastructure – No doubt this is an important part of an EHR implementation, but why they list it as a first step is a bit beyond me. The fact is that you really can’t properly assess the state of your infrastructure until you know which EMR software you want to use. Do you need a server room? Do you need a faster internet connection (ie. SaaS EHR)? Do you need tablets, ipads, desktops, etc? These answers aren’t known until you know which EHR vendor you select. So, this is an important step, but it’s done mostly during implementation instead of selection.

Features, functions and usability – The problem with this item is the order. Most doctors who are selecting an EHR don’t really know what features and functions are available in an EHR system. Sure, they have some idea of some of the features, but it is amazing how many new features they come across once they start demoing EHR systems. Remember, they’ve been focusing on patient care and not the latest EHR features and functions.

The other challenge for this area is that at a base level (which the article above mentions as well), the features and functions of most EHR software is pretty close. It is the more nuanced functions that differentiate one EHR software from another. So, this isn’t a first step in the EHR selection process. It’s a later step after doing the EHR demos. Instead of starting with features and functions, doctors should focus on the benefits they want to receive from an EMR as I describe in my EMR selection e-Book. These benefits will help to provide a guide for narrowing down your EMR options.

As far as usability, this is incredibly important. Just this is assessed at demo time as well. Although, I find this even better assessed when you either 1. do a test run of the software yourself and/or 2. talk to existing users of that software. That’s how you evaluate an EHR’s usability.

Networking and interoperability capabilities – Certainly you want to make sure it interfaces with your existing systems. This is barely worth mentioning since this is top of mind for most people selecting an EHR.

Technology knowledge – Another important aspect of an EHR implementation. Although, this isn’t very important in the EHR selection stage. I’ve never known someone to switch which EMR software they like best because they think their staff isn’t technical enough for one software but would be fine with another software. Technical skill can be overcome through training. It shouldn’t influence which EMR software you select.

Partner systems – This is the same as the interoperability capabilities mentioned above.

Deployment options – Finally something that’s a real differentiator. Knowing the pros and cons of an in house EMR and a SaaS (hosted) EHR software is very valuable and a great way to start narrowing down the field of possible EMR vendors.

Maintenance and support – Your ability to support the selected EMR matters and should be part of the selection process. Just most of the time this will really influence your decision to go with an EMR hosted on site or a SaaS based EMR mentioned above.

Now you can see why I wasn’t all that impressed with their list of EMR first steps. I won’t rehash my list of first steps. You can find them in my EMR selection e-Book. It’s free so go check it out.

The article does provide a list of best practices which is more valuable (with my commentary as usual):
1. Look for vendors that know your practice – Of course they won’t really KNOW your practice. However, there’s some real benefit in going with an EMR software that has 100 clients that are from your specialty. Don’t underestimate the value of them knowing your type of practice’s needs.

2. Evaluate the costs to acquire, deploy, maintain and support the hardware and software – Including all of the costs in your comparison of EHR vendors is really important. Don’t forget the hidden costs of training, interfaces, ongoing support, extra hardware, etc.

3. Consider a cloud-based or hosted EHR setup – Definitely worth considering. Just be aware of the benefits and challenges with going “to the cloud.”

4. Get the right training for your staff – Probably as important as getting the right training is choosing to make the time for that training. You can pay all you want for the right training, but if your doctor says he’s too busy to attend, then it won’t do much good.

This reminds me of a comment Dr. West made on a recent post:
“I know an orthopedic surgeon who bought an EMR for $25,000 but then didn’t have the time to waste in learning it, so they just use it for the scheduling calendar now. A $25,000 calendar!?”

5. Use a certified EHR – If you’re a new reader, you missed out on some of my amazing rants about certification. I’ll keep it short for this post. Basically, EHR certification provides no value to the doctor. The only exception is that it now is necessary if you want EHR incentive money. Other than that, it provides no assurance of anything of value to a doctor. Don’t focus on it. Don’t give yourself the false impression that it’s better because it’s certified. Evaluate the benefits of the various EMR software based on your needs and requirements.

6. Invest for the future – This isn’t meant to be interpreted “spend more money on an EHR system cause then you’ll be getting a better product.” In fact, the opposite case could be made that the more you spend on your EHR the more likely it’s a legacy system which is hard to upgrade and improve and won’t be great for your future needs.

The real message of this point is described pretty well in the article:
1. Assess the future viability (financial and directional) of the EHR company
2. Assess the scalability of the EHR software (do you plan to expand your practice? Can it support that?)
3. Will the EHR software be able to support meaningful use stage 2 and 3 (especially if you want to get the EHR incentive money)?
4. How much is the company investing in new features and releases? Will they be able to quickly adapt to your changing needs (ie. new interoperability requirements and needs)?

Conclusion
Obviously I think the article left a lot to be desired. It’s nice to see EMR selection as a cover story. I also think it’s hard in an article to try and cover everything that’s needed to be able to select an EMR properly. I also think it is really funny that for the article they sent out 20 RFP’s for a fictional company. Then, they compiled and analyzed information from the seven vendors that responded. Where are the other 13? Or maybe I should ask, where are the other 293 EHR vendors?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

2 Comments

  • Excellent blog post, and insights.
    I do think your comment “EHR certification provides no value to the doctor” makes no sense. $44k over 5 yrs incentive money from Medicare is of considerable value to the doctor who is running a business. And for Medicaid providers, it it $63.5k.
    Are you suggesting that one would find a non-certified EHR that provides better clinical value to the doctor (and no incentive dollars), as opposed to finding 1 certified EHR with similar clinical value from among at least a 150+ different vendors that have certified EHRs? Even if that is possible (and highly unlikely), as a business owner, why would the physician even bother with non-certified EHRs, and leave the thousands of dollars on the table? A more reasonable approach is that the doctor would make some small compromise on the certified EHR, and claim the incentives.

  • A M,
    Did you read the sentence after I said that EHR certification provides no value? It says except for those that want the EHR stimulus money.

    I think the evaluation of whether you want to go after the EHR incentive money should be a different evaluation from your selection of an EHR. Decide if it’s worth the effort to jump through the government hoops. Then, if it is, then worry about ARRA certification (not CCHIT or any other certification) since that’s what the EHR incentives require.

    Of course, all but a very small handful of EHR software won’t be ARRA certified, so that’s basically a moot point for me too which makes the EHR certification even less meaningful.

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