Electronic Health Reporter

Fee, fees are everywhere, and not all EHRs are similar. But when purchasing an EHR, there’s much more to consider than just the amount of cash you’ll have to spend for the actual system you want. More than the sticker price of the system alone, you have to account for all the other functional pieces — like support, training and licensing — that need to be bolted on.

So, let’s hear it for the Maryland Health Care Commission. The Commission provides some great insight into all of the things you need to consider before making an EHR purchase and some intangibles that, when addressed, may determine your long-term happiness or misery with the tools you decide to implement.

The Commissions’ list is succinctly published by AmericanEHR Partners, which also makes a fine and sincere recommendation to take into account during the pricing of any EHR: “Price of the system alone should not be used as the primary determinant for the system, but rather one single factor to help make the decision.”

Licensing and Subscription Fees

Check to see how licensing and subscriptions work with the vendors you are shopping: Do you pay per clinician or per user, and do you pay more for more “seats” at the table if you need them? Is your payment all inclusive, meaning, are getting a fully integrated EHR with practice management system or are covering for additional features?

The Commission makes an interesting point here: Client server systems are usually licensed based upon a one-time fee with maintenance costs.

I’ll add the following: Hosted, cloud solutions are less expensive than client server to implement; typically fees are paid on a monthly retainer; and they often are less robust systems than on-site server-based counterparts.

Practicing with Your Practice Management System

If purchasing an EHR that includes and PM system, be cautious of paying extra for the practice management capabilities. With continued integration of the systems and requirements brought on by regulation, such as meaningful use, there really should not be any additional fees for the capability.

Vendors may offer a full version and a light version of PM. Make sure the light version can meet your practice’s capabilities if you decide to take that option.

It goes without saying, but make sure that the PM, like the EHR, is meaningful use compliant.

Paying for Patient Portals

According to the Commission, “Vendors may have tiered pricing for portals based upon level of functionality.”

Make sure you have an understanding the portal’s functionality, how it fits with your system and if it’s part of the EHR or an add on. It could go either way, but from experience, you’ll be paying extra for it. Don’t forget to budget for it if you plan to meet meaningful use.

Support, Training and Maintenance

No surprises here, vendor support costs vary significantly based on the level of service you need and when the support can be accessed. You’ll pay more for support at certain times like nights, weekends and holidays.

Training cost may be a bit more difficult to figure. Don’t get undersold, either. For more about training, read my recent post, “The More EHR Training You Receive the Happier You’re Likely to Be.”

To budget for training, you have to account for the trainer’s time, travel expenses and the amount of training you want. Plus, there may be a flat fee built in to cover it with additional hours sold in blocks.

The most important thing with training is to clarify how much you’re going to get for the price paid. A word of advice: Log your own hours. Track how much you’ve actually used and compare it to the amount that you’re billed.

Another cautionary tale from the Commission is to be prepared for any training initial fees and should be priced out separately.

Finally, the maintenance. Maintenance fees are generally included as part of your software agreement. If not, proceed with caution and read the agreement carefully.

And, according to the Maryland Health Care Commission, maintenance fees for client-server systems are generally 20 percent of initial licensing and interface fees.

Hopefully, some of the preceding information helps as you price and shop for your EHR. If you have additional tips or insights, please post them in the “comment” section.