Ask the Expert: How Do I Pick an EHR Vendor?

Feeling overwhelmed by the number of EMR vendors? These guidelines will help you to select the best product for your needs.

Start by clearly defining your needs. You want to make decisions about EHR products based on your functional needs and how closely a particular product matches your needs. Write down the top 10 or 20 functions you want an EHR to do for you.  What are they? Produce consult notes? Store lab data? Keep copies of your existing scanned paper charts? Produce e-scripts? Read your EHR mission statement and include some of those priorities.

Make a scorecard of functional requirements.
Turn your wish list into a scorecard, with room to write notes by each category for each vendor that you see. Develop a simple scoring system (1-5 will do) and assign a value to each category based on how well that product performs. Evaluate all vendors based on the same list.

Make a short-list of vendors.
Now that you have your list of functional requirements, it’s time to make a list of vendors you would like to investigate. Some companies can be eliminated quickly if they haven’t been around long enough or don’t deal with a certain size practice or a particular specialty.

Many professional medical societies and other organizations have member-only ListServs that allow professionals to openly and honestly discuss their experience with particular vendors and their implementation progress.

Look at the corporate Web sites of vendors to help determine the maturity of the vendor, such as years in business, total money allocated to research and development, number of total clients and installations, etc. Also, note if there are physician owners or advisors on staff.

Is the vendor active in national EHR leadership task forces, such as the Electronic Health Records Vendors Association or the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative that seeks to certify HIT products? Their recommendations and research can help you to feel confident that you have selected a good program.

  • Obtain neutral third party reports like KLAS, the AC Group Tool, TEPR or the Forrester Report and see where common vendors rank against their peers. Some of these reports are free and some are available only for a subscription fee.
  • Attend EHR conferences and road shows that typically let you see several products at the same time. Use an EHR selection tool or report to help you to compare multiple vendors on a wide variety of criteria.
  • Read articles on the Web (your professional society will be a good resource) or in professional journals.
  • Talk to your colleagues and ask potential vendor partners for references of their own. Visit offices that are using the EHR solution you are considering. You will learn a lot about the product and its ease of use from a simple site visit. People are eager to share their experience and ‘lessons learned’ with you.
  • Consider issuing a request for proposal (RFP). This is a standardized, formal document that tells the vendor a little bit about you and what you’re looking for, and allows them to tell you about their company and their product. Reviewing a handful of these documents gives you a better idea of whether or not the product is going to fit your needs and saves you the time of sitting through a product demo for something that is truly not going to work for your practice. A sample RFP can be found at www.medqic.org (in the ‘Search’ box type ‘sample request for proposal’).

Arrange a Product Demonstration

After you’ve decided which vendors’ products you would like to see, invite them to showcase their systems during a product demonstration. Depending on the size of your practice and the availability of local representatives, some vendors will come on-site to your practice and some will invite you to see the product via an Internet demonstration.

The following guidelines help ensure a successful and productive demo:

  • Plan on spending about two hours with the vendor for the meeting and demo.
    Minimize distractions. Turn off pagers and cell phones; go off site for the demo if necessary.
  • Make sure the right people are in the room. If you’re not knowledgeable about billing, coding, compliance issues or scheduling functions, invite those who are to help you properly evaluate the product.
  • Use your scorecard to keep track of your thoughts.
  • Be proactive in telling the vendor what you want to see. Be the director of the show! Walk the vendor through a routine patient visit and see how easy the product is to use.
  • Remember that often, non-clinical sales staff are not adept or comfortable with producing clinical documentation, which is the most important function to you, the provider. Work hard to keep the vendor on track.
  • Ask if you can keep a demo copy or ask the vendor to allow you to enter data. It’s a good idea to develop a typical clinical scenario ahead of time and have the vendor show you how to enter that data.

It’s tempting to spend years choosing just the right vendor. Remember that you won’t enjoy the benefits of EHR adoption, which include enhanced patient safety, enterprise productivity, and provider efficiency, without one!

Do Your Homework on Cost

The costs associated with an EHR fall under five general categories:

Hardware.
Most physician practices will need to upgrade existing hardware (computers and servers) in order to run the EHR. Typically the vendor will give you a “shopping list” for hardware so that you purchase equipment that is compatible with the EHR. Don’t forget to factor into your business plan the cost of regular hardware upgrades including printers, scanners and personal computers.

Software.
Most EHR vendors sell licenses for the initial cost of the software based on the number of physician-users in the practice. Typically, there is a discount given for mid-level providers and office staff are generally given “free” access through the provider’s license.

Implementation and training.
Typically the physician office will pay for the cost of bringing a vendor trainer to the office to teach, test, and train on the system. This is a one-time fee for the initial implementation of the EHR which usually takes place over weeks or months.

Professional support. Depending on the existing expertise in your office, you may find yourself in need of a short-term project manager, a lawyer to review your EHR contract, and/or a technology professional to establish your server and Internet connections.

Maintenance.
Typically, EHR vendors will charge a percentage of the initial software fee (currently between 18% and 25%) on an annual basis to cover the costs for standard upgrades, regular patient education updates, drug database updates, etc. Consider that the total cost of ownership may be higher due to expenses you incur to

  • Perform project management tasks;
  • Spend time selecting a vendor;
  • Make changes in human resources (more/less staff);
  • Travel to conduct vendor research or make site visits;
  • Time away from your practice to do any of the above; and
  • Reduced productivity when you first ‘go live.’

Additional Resources

  • For more information on HIMSS, visit www.himss.org.
  • For more information on HIMSS Ambulatory initiatives, contact Valerie Griffen, Associate Manager, Healthcare Information Systems.
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Keywords: 
Medical Practice, Health IT, ambulatory, Meaningful Use