Electronic Health Reporter

Because I’m fascinated with the lack of information surrounding pricing of various electronic health records and because I admire the work of AmericanEHR Partners, I thought it relevant to shine a little light on another interesting piece of information from the organization.

As this seems to be the year of the big EHR switch, and because seemingly the folks at AmericanEHR hear as much as I do about the lack of transparency in the pricing structure of these solutions, I thought I’d publish some guidance for what to consider when making the transition to EHRs. In my research on the subject – I’m developing a piece on the subject of EHR pricing – I came across this piece, compiled by the AmericanEHR from the Maryland Health Care Commission.

For starters, one thing is sure when the considering an EHR: pricing should not be the only factor. If pricing were the sole factor to consider, you may think you’re getting a deal when spending a little more up front might have a more favorable outcome.

I’ve seen very expensive EHR software given away as a tool to secure long-term contracts that included with huge monthly service agreements. In the end, for those who “purchased” the software, they may have actually been better off spending a little money on the system and perhaps they could have avoided the mountains of fees that followed them every month for seven years.

Speaking of licensing and fees, there are several key elements to consider, according to AmericanEHR.

• Is the license/subscription fee based on an individual clinician or is it per FTE (full-time equivalent)?
• Is there a licensing fee for additional staff beyond a certain number? – this may apply to all who actually touch the system including nurses and PAs.
• Does the licensing fee apply to a comprehensive EHR including the practice management system or the EHR alone? In many cases, the practice management system is extra, though, this is becoming rarer. However, practice portals are almost always separate fees. You need the portal for meaningful use so be sure the price is right.
• As I’ve said, systems are usually licensed on a monthly basis.

Things to consider when shopping for a practice management system:

• If purchasing a combined EHR/PM system, additional fees should not be applicable for a practice management system interface. Nothing more needs to be said.
• In some cases, a vendor will have two different levels of practice management interface with different pricing. A more sophisticated version that provides coding support based on information provided in the clinical encounter, or a light version through which limited information is passed back and forth between the EHR and the PM system.
• Purchasers should ensure that the level of PM system interface is sufficient to allow for Meaningful Use reporting.

For patient portals:

• Some vendors may have tiered pricing for portals based upon level of functionality. Some, as I’ve said, are part of the EHR while others are priced separately.
• Ensure you have a clear understanding of the portal functionality of your intended system(s). Can it do everything you need it to do, everything you’ve read it can do and everything you’ve been promised it can do?

Support and training (these are the fees that always seem to surprise):

• Support costs vary significantly based upon different tiers and the hours during which support services can be accessed. You’ll likely be billed hourly with a minimum number of hours per installation. This is where a lot of vendors recoup their costs.
• In addition to a training fee, travel expenses incurred by the vendor are frequently charged in addition the core fee. Sometimes the travel fees are assessed on a flat rate. Even trainers close to you will charge the same rate as those who have to travel 3,000 miles.
• As I’ve stated, training costs vary significantly between vendors and can be time-based (charged on a hourly basis) or purchased as an inclusive bundle of training.
• Clarify exactly how much training will be provided with the purchase of an EHR. You can negotiate this to a certain degree.
• Advanced training is usually not included in any initial fees and should be priced out separately.

Maintenance:

• Maintenance fees are generally included with ASP software as part of the ongoing licensing fee.
• Maintenance fees for client-server systems are generally 20% of initial licensing and interface fees.

Hopefully this helps. If you know more or would like to discuss in detail, I’m always looking for good sources for stories such as this.