10 Steps to Selecting the Right EHR Solution For Your Practice

By Reda Chouffani

As many medical practices shift gears toward a paperless environment, it’s clear to many they must first investigate what potential incentives will be available to them if they participated in the Stimulus healthcare information technology HITECH. Additionally they will need to identify which product would be the most cost effective and offers the highest return on investment.

In selecting an EHR, most healthcare organizations face conflicting reports on products they are evaluating, some of which can be based on lack of proper product implementations. Others failed products that did not fit the practice’s workflow. As an example; by knowing how to select an EHR product, and examining how some of the previewed products compare, the medical practice will be able to properly identify its need and which products can successfully meet its challenges.

Practices have had plenty of time to make paper charts work for them since the early 20s, when the US saw the spike in private group practices grow. This provided ample time to perfect the efficiency of using paper based workflows. While several software vendors come with a promise of a new world where no paper exists and practice’s revenues increase, it would be very naïve for any Practice Administrator to take their word for it.

Today’s technology is fully capable of automating and streamlining many clinical workflows, as long as it is the right solution with the right planning and readiness.

To avoid being just another statistic in the failed world of EHR, there are a few critical objectives that should be met to ensure a thorough assessment, smart selection and careful planning for an EHR selection.

The following are the ten steps that can help you during your EHR selection stage:

1. What are Your SMART EHR Goals?

It is critical to define what the practice’s EHR goals are. This will enable the practice to ensure that providers, practice administrators and other stakeholders are on the same page. Document the top 10 goals everyone needs this EHR to accomplish.

The goals can be further divided into financial and or operational objectives. Each goal must document using the S.M.A.R.T. methodology (Specific Measurable Attainable Realistic Time Bound). By doing so, everyone will have a clear understanding of what to gain and expect from the adoption of an EHR system.

2. Current State Analysis

Since every practice differs in workflows, you will need to consider that there are different EHR’s. We recommend that all major workflows must be reviewed, and establish which can be automated and streamlined through an EHR and which will require additional resources to properly document electronically.

Example:

• Physician completes visit, and marks on the encounter
• Physician writes a prescription for some medication
• Patient takes the paper encounter and gives it to Check-out staff
• Check-out staff enters data in the billing system
• Check-out staff collects the co-pay / balance.
• Patient gets receipt and takes the prescription to the pharmacy

Future State Analysis:

• Patient pays at the time they come in for any balance or co-pay requirement
• Physician completes visit electronically and selects the procedures performed
• Physician creates an electronic prescription for the patient and submits it online
• Patient leaves the practice without one piece of paper
• Patient picks up their medication at the local pharmacy

3. Define What Devices You Are Planning on Utilizing

During this assessment phase, it is critical to identify the proper set of devices, interfaces and hardware that you will need as part of your paperless endeavors. There are several aspects to identify so you have a clear understanding of the complete scope of the project:

• Does the current Ultrasound machine allow you to submit studies electronically? If yes, how much for licensing from the vendor?
• Does the Dexa machine support imaging export? How much is the cost for that?
• Are insurance card scanners needed? Are they double sided?
• How many high speed scanners are required?
• Are the providers going to need tablets or plain laptops?
• Do you need wireless set up at the practice?
• Are the lab interfaces included in the EHR package or is the lab company willing to pay for them?
• Do you need signature pads to eliminate form printing?
• Does the transcription company support interfacing with EHR?
• Does your router allow for remote connectivity, and do you have redundancy on the connection?

4. Create a Comprehensive Vendor Questionnaire

This should include questions about company history and certifications.

Currently, there is no finalized decision on certification body for the ARRA, financial viability, business agreement, system cost, post-implementation maintenance costs, system functionality, system technology and most importantly references.

Some examples are:

• What is the cost per physician?
• Total cost of ownership, yearly fees, support costs and upgrades
• Can you design and modify the current system templates?
• Is your system true client/server or it is web based?
• How many installations do you have that are current?
• Is support local or outsourced overseas?
• Is your product a certified product (certification body to be determined)? If not, do you plan on it?
• Can your product interface with another PMS application?

5. Narrow Down the Vendor List

Creating a list of vendors based on product specialty, reputation, and references will help you tremendously. This list should consist of 3 to 5 vendors at most.

There are several web sites such as KLAS that will provide you with some additional reviews of software packages that are available, and may further assist you in narrowing down your list.

6. Request System Demonstrations

During this stage, it is highly recommended that the practice provide the implementation and project manager with a number of scenarios. These workflows should be performed during the demonstration.

Examples can be:

• Documenting review of systems and adding family history
• Documenting initial prenatal visit
• Documenting requesting/scheduling and post surgery notes
• Documenting colonoscopy procedure and viewing clinical imaging

7. Request References From Vendors of Practices Such as Yours

At this step, a list of practices using the product that you can contact would be advisable. This would shed some light on several components.

Questions to ask are:

• How long before the practice was seeing the same volume of patients?
• What specific items do the providers see as value with this package?
• What items does your clinical staff say is slowing them down?
• How would you rate the company support?
• Has this impacted your billing cycle?

There are several questions you should ask, but the main focus is to be specific. Get facts which will help you determine whether or not this package is a good investment.

8. Review the Business Case

Whether the vendor provides you with a strong business case to justify the investment you are about to embark on or you take it upon yourself to create a financial analysis, it is a must to have some financial measurements such as return of investment (ROI), total cost of ownership (TCO), net present value (NPV) and discounted cash flows (DCF). This will enable you to have a clear understanding on whether this solution will pay for itself or drain your practice of income during these difficult economic times.

Some of the items to review are:

Soft ROI: This is the element of your business that will have soft savings. For example: First begin to perform time and motion studies. This is where you measure the time it takes for the physicians to document a visit, prescribe or record the diagnosis and procedures on the encounter. Then measure the time it will take for the same activity but with the EHR package (s) you are evaluating. The difference in time gained will be one of the practice’s soft ROI.

Hard ROI: This can be associated with the cost savings from eliminating things like paper charts, folders, material, filling cabinets, and space leased for storing paper charts, transcription costs and such.

Risk Mitigation: The final section will cover the risks of using such a product. It is clear that by digitizing paper charts, practices reduce the risk on misplacing or losing patient charts. With the proper backups in place, a healthcare organization can rest assured that no matter what, the patient charts are protected. In addition, some of the prescription modules enable drug interaction and allergy alerts. This reduces the patient’s health risks dramatically.

9. Visit Local or Remote Client’s Site

Being exposed to a live site using the product(s) you are evaluating is key. This can help you get candid feedback, and will demonstrate how it is being utilized.

10. Decision Time

When you have considered your goals and challenges, what to resolve and what products to select, reviewed their existing install and had everyone on the same page, it’s time to evaluate your findings and use the attached checklist to assess which of the products will fit your need.

As the market and healthcare regulatory changes continue to affect medical organizations, executives are under pressure to reduce IT costs, automate current processes and increase revenue. Some of the changes can also determine if current implemented EHR will be a source of incentives or penalties.

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