Evaluating an EHR System: 10 Points Every Chiropractor Must Consider
By Alex Niswander
When shopping for an EHR system there are many key factors every doctor must consider in order to best evaluate which solution is the best fit for his/her unique practice. Imagine going to buy a new car, but not knowing what brand, style, size, features, and maximum budget you need. In this comparison a 2-door sports car doesn’t work so well if you have a family of five at home. This would be a recipe for disaster when put into daily practice. You would end up trading, selling or suffering for your mistake. It is because of this we have an idea of what style, size budget and time line for the vehicle purchase. The same is true for your EHR system; you have to somewhat know what your needs are.
With the car example we learn from family, friends and even a good sales person will help us discover which car is be the best fit for our needs. EHR is not the same because the vendors typically have just one product to offer and their job is to sell it to you. That is why you must be cautious, take your time and do your homework!
Over the last decade I have been involved in over 5,000 EHR implementations. During this time I have seen too many systems shelved after frustration, lost investment and huge amounts of valuable lost time. With time as our most precious resource, it is so important that you select the best fit EHR system the first time and avoid following the same ugly path. (For information on planning your successful EHR implementation, please review our article on Implementing and Training on an EHR System)
There are many key points you need to evaluate when shopping for an EHR. These will help you identify which of the EHR solution is the best match for your budget and your specific needs. I have developed a set of ten points, which will help put any practice on track for partnering with the absolute best product/company for your needs.
Although there are no two Chiropractic offices the same, this list of evaluation points will apply in some way to all of them. Keep a note book for notes on each point on the systems that you are reviewing so you can remember them in the future as you narrow your decision. Here is the list in no particular order:
Most DCs are small business owners and have to be acutely conscious of the bottom line. Before you begin shopping and doing demos, properly evaluate the maximum upfront or monthly (as most vendors have monthly financing plans available) which you can comfortably invest in your EHR system. In our market the typical range of cost on CERTIFIED EHR is $4,500 to $14,000.
IMPORTANT: Don’t buy a system based on a possible government incentive rebate. Be smart and buy based on your current needs and budget as if you were not receiving an incentive.
It is very important that your systems “link up”. This means your new EHR software must be able to send and receive data from your existing billing system. The ability to interface with other software has been around almost since the beginning, so if a company cannot interface to your system, one of the two is outdated and one or the other (or both) should be replaced.
Software Platform, Web VS Local Client-Server:
Web based software means it runs on a web-server, meaning you can access the software through a web-page from anywhere online. The advantage to web-based is lower hardware costs (you wouldn’t need a server) and lower “buy-in” cost. You can begin using for a small down payment and so much per month based on which features you are using. The other advantage is you won’t require any extra software to login from anywhere on the internet. If you have many offices, or work from many places, this could be the best option.
The downside to web-based software is generally a higher long-term cost of ownership as you are ‘renting’ instead of owning the software. This could still be a good fit, but something to consider. Compare this to office space, sometimes renting is a better fit than buying. The other potential downside is that the web-based software has to function within an Internet browser which means the software may be more difficult to use compared to a like client-server system. Internet uptime has become very reliable, however if your internet is down, so is your EHR system. The last item to consider with web-based is what happens in the event you wish to stop using the system. Are you walking away with nothing or a text file of your patient demographics and billing? This is an important item to clarify with your sales person if you are leaning toward a web-based system.
Client-Server software means the software is physically installed in your office and you must have one ‘main’ computer (also called ‘server’). The main advantages here is costs long term could be less and the software is likely easier to maneuver. Another advantage is that you own the software and can usually still use an older version if you stop paying the annual maintenance fees.
One downside is higher upfront costs and could require additional costs with ‘remote control’ (Gotomypc, Logmein or PCAnywhere) software to access your system from anywhere. Another downside is that you would need to keep updated hardware in your office to keep up with the demands of the software.
Complete EHR Certified:
With the government EHR certification in place the best approach is to only invest in a product that has already established Complete EHR Certification. The government has a website (http://onc-chpl.force.com/ehrcert/EHRProductSearch?setting=Ambulatory) where you can search by company or product name to verify a product has past the requirements for complete EHR certification. Beware there is a ‘modular’ certification which means a company has only passed part of the certification and may or may not be able to pass the complete EHR certification.
With today’s technology an EHR system should offer a great level of what is called ‘end user customization’. This means once installed you can modify the software to have the wording and items you wish to use for your daily notes without the software’s programming staff having to make the changes. My best advice here is to ask your sales person to add /modify an entry during your demo. This will give you an idea of how easy it is to modify and if your sales person struggles, or shrugs off your request it should be taken as a red-flag for difficulty or non-ability to customize after the sale.
Specialty Specific Content:
Every specialty in healthcare has what is called ‘custom content’. This means that you see the things you routinely do like Low Back Pain, Neck, Shoulder, etc. (as having Podiatry or Optometry content wouldn’t really do you any good for patient documentation). During your demo keep an eye out for the things you do every day. I would encourage you to have a list of the top 5 or 10 things you do handy and ask to see them during your demo. If you are reviewing a Chiropractic specific system, you should easily see these items. If you are demoing a medical based system with a Chiropractic ‘module’ you will be less likely to see these things which means a lot more time customizing the system and in all reality could mean you end up shelving the system.
IMPORTANT: Be careful when considering a non-Chiropractic specific system. This means quite a bit of more time customizing upfront and may not work well for your work flow.
Ease of Use:
This one is a personal preference. That old expression here is true: ‘one man’s trash is another man’s treasure’. What I mean is that after seeing the demonstration you should have a feeling for how easy the system is to use. You probably know within a few minutes if you like the system. It could be color scheme and layout, but most likely you felt the system was easy and a good match for your needs, or you felt it wasn’t a good fit for you. I encourage you to make notes and go with your gut feeling on this point.
Speed of Product:
The speed of the product could mean many things. The way I mean it is how much time will you spend on your most common daily patient encounter? How does the system set you up to win in this situation? Does it provide you with a copy of the last visit and make a few changes in wording? Are you expected to click something to initiate this process? It is not uncommon to spend 2-5 minutes on a daily note in an EHR system, however it would be good to get a baseline for each system you are reviewing in case all other items are very close. Speed could become a deciding factor for you.
Find out the details on the support department. How many techs do they have, it is in the United States, or are you going to be calling overseas? What are their hours, how long is the typical response time. How often are patches posted and verify these when you speak with an existing customer.
This one is pretty self-exclamatory, but once you have narrowed your search to a few systems you really should check a few references. You might hear what you need to finalize your decision. Ask good questions when you speak with your peers such as:
- How long they have had the system?
- How long did it take to fully implement?
- Is there technical support and how good is it?
- How effective was the training?
- Are they being paid or receive anything free for talking with prospective customers?
After implementing these tips for researching your EHR options, I feel that you will be more successful in not only purchasing and but more importantly using your new software.