Electronic Health Reporter

While the final 50 or so percent of ambulatory physicians decide whether to implement electronic health records and others re-evaluate their technology plans, which may include switching the systems they use, it seems like as good of a time as any to continue the series I started about the steps that need to be considered when selecting an EHR.

At this point in the process, you’ve obviously gained the understanding that it’s an arduous process and requires a great deal of planning. But, you know that. You’ve done the planning and you’re beyond examining how implementing the system will affect your practice’s workflows.

So, when you’re gearing up to finally take the plunge, or if you’ve decided to get out of the water and dive back in, the Office of the National Coordinator provides the following guidance for moving forward with these EHR implementation tips.

Here’s a concise breakdown:

• Get to know as quickly as possible how vendor and its products will help you accomplish your goals. Test drive the product and never take the word of a salesperson without vetting it with other professionals using the product. You might also shy away from vendor-provided references as they tend to receive incentives from the vendors for giving them. And, according to ONC, “Provide the vendor with patient and office scenarios that they may use to customize their product demonstration.”
• Clarify pricing of the entire implementation prior to signing the dotted line. You want complete pricing for all things including: hardware, software, maintenance fees and upgrade costs, interfaces for labs and pharmacies, cost to connect to health information exchange (HIE), customized quality reports, etc. If it’s offered, ask for the price and get it in writing. Every time the deal changes, get a new written quote.
• Like pricing, define implementation: amount of time, schedule of completion, and availability of trainers and what’s included in the training.
• Ask lots of questions about data migration and how much it’s going to cost. Ensure a structure for the data rather than simply allowing for a dump of information. “Clarify roles, responsibilities and costs for data migration strategy,” the ONC suggests. The amount of data you need to transfer, the more complex the process will be.
• Know whether you’ll be better off with on-site server or a hosted, Saas solution.
• Can the system be integrated with other systems easily? If so, ho much does it cost?
• Privacy and security capabilities and back-up planning: are there any?
• Is your proposed vendor stable? Will it be sold or divested? Does the vendor have a strong local presence? Are those practices leaders in the local market? Do you hear good things about said vendor?
• Can the system connect to an HIE? How much does it cost?
• Is the length of the initial contract much too long – like a five or seven year lock in – and does it potentially keep you from exploring alternative options should you need to make an earlier exit?
• Finally, according to the ONC, though it may seem a little off topic, “Consider costs of using legal counsel for contract review verses open sources through medical associations.” Nevertheless, seek legal counsel before accepting the vendor’s agreement.

The best time to protect yourself from a poor decision involving the vetting and purchase and an EHR is during the shopping and review process. Take time at the beginning of the process to ensure you know what you’re getting, what you’re paying for and, ultimately, what type of vendor partner you’re going to get once the ink on the contract has dried.