EMR Vendor Selection

Why is EMR so expensive? This question as it appears can seem simple in nature. While exploring this topic, you can find so many variations in the EMR products with feature and functions. Additionally, as a practice, the question of technical proficiencies needs to be addressed. If a product is more technically advanced than the user, the user will not receive the full usage of the application. If the product is not being used to its full functionality, nobody wins. If this happens, the practice is not satisfied, and the vendor now has an unsatisfied end user. This is why matching up the practice with the right EMR is so critical. The opposite effect can be just as frustrating. Cost is a fact in the investment of an EMR. An entry level EMR can cost as little as $3,000, and advanced level EMRs can cost over $100,000 for a solo physician practice. The word “expense” should be replaced with the word “investment”. Once a practice has converted to the EMR, they can now look back and understand the difference in those two, very different words. When the EMR is running at full functionality, the practice becomes very efficient. No more hunting for paper charts. A single “click” of the mouse, and the patient’s entire record is in the hands of the appropriate user. Multiple users can access the same record simultaneously as well; allowing for greater productivity. The investment now begins to pay dividends. Integrated EMR system vs. modular EMR selection Having a portion of the practice automated can be a benefit, just as it can be a challenge to overcome. There are many EMR vendors that have a Practice Management application built into their system. Many of these products can be a total replacement of existing applications. Some of the EMR vendors have taken a “best of breed” approach, meaning they have focused their efforts on a particular feature or function. Be advised that not all EMR vendors have the capability to integrate with an existing software product. This is all very important to identify prior to committing to an EMR vendor. Running separate systems simultaneously can bring much unneeded frustration if not appropriately integrated in the beginning. The number of modules that can e integrated can vary significantly from vendor to vendor. Consideration of the charge for an HL7 (as explained earlier in this document) interface should also be taken into account. The interface application can cost up to an additional $3000 to keep an existing software application. Proper management of this interface is important. Not, and won’t be, a commodity Delaying the decision to go to electronic medical records to wait for the prices to come down is only adding to the impending conversion. Every patient encounter is adding more paper to be scanned later at additional costs as well. The benefits of EMR are real and can easily be realized in your practice. As the laws of economics begin to play out in the scenario of “Supply vs. Demand” and vendors become busy with installations of EMR applications due to this increasing demand, they will raise the price to offset this demand, costing you more. You may also end up waiting for months and months to be installed or forced to go with a lesser product with faster installation times. Waiting for the prices to come down can hurt financially in the long term. Yes, new companies will pop up and offer great price incentives, however, these price incentives can cause the practice more hardship by buying an inferior product; they may need additional customization and testing. Your practice may become the “test practice”. This can translate into down time and further staff frustration. Your EMR purchase should be a good experience, but one misstep can lead to hardship. Beware of the “As is”, “Off the Shelf”, or “One size Fits all” Marketing Message There are hundreds of thousands of physician practices and no two are alike. With this being said, how can any EMR vendor claim to have a solution that can be “plug and play”? Each specialty has different needs and desires and the practice has different levels of technical aptitudes with which to contend. If a practice were considering one of these solutions, they should recognize the need to change the way their workflow and practice procedures. The cost of these types of systems is less than the competition due to the programming. Each practice operating differently should consider the unique customization they need to fit their practice. This customization is not an overwhelming task to the EMR vendor; nor is it an excessive expense to the practice. Be sure to explore the vendor’s willingness to complete the desired custom forms (templates), facts, and workflow. Remember the word investment. This system will become the life blood of the practice. Plan your work, then work your plan The decision to move to an EMR is a major undertaking. The selection of an EMR vendor is only one small step towards the EMR. Plan enough time to include the other factors of EMR. There are also considerations in computer hardware of many different variations, networking, training and implementation. Each of these factors plays a very important role in the successful transition from traditional paper charting to the EMR. Why should a practice seek out the assistance of a professional EMR consultant? Why not? The decision to move to an EMR is a big step. The practice is now recognizing the need to convert for many different reasons. This should be an exciting time in the practice, not a tumultuous uprising. Working with a professional organization during this time can remove much of the unease from the decision and implementation. Once the EMR selection has taken place, the true work has just begun. A bad experience in implementation can set the practice off on the wrong track. A professional organization can manage this process to ensure timeliness and completion. A practice moving to an EMR has many factors to consider. By hiring a professional EMR organization, the practice can get back to the practice of patient care. A professional EMR consultant has been through many EMR implementations and knows the ins and outs of the industry. This is paramount to the success of your EMR conversion. This undertaking should be considered as a step by step process. 1. Selection of EMR Vendors After spending hours upon hours of time listening to the sales pitch of trained sales representatives, the chance of selecting the wrong EMR is very high. How can you rest assured that your selection is a good one? There are many smooth talking sales representatives that promise the moon and can’t deliver. Once you have committed to an EMR vendor and trouble begins, your chance at retribution is slim at best. Be certain to look before you leap. This is not to say that all EMR vendors are the wrong choice, the question is are they the right choice for you, your special needs, your budget, your technical support requirements, and suited for your medical specialty. This is a huge undertaking. 2. Installation of EMR software This topic is not simple to most consumers of healthcare technology. There are many questions that must be answered regarding computer hardware needs, wants, desires, availability, practicality, budgetary goals, and expected lifespan of technology before you acquire one piece of this computer hardware. There can be many discussions regarding this ever so important decision. We will bring to the forefront the highest level of considerations. a. EMR installation Where to begin? Should a physician take this responsibility on themselves? What happens to the financial strength of the practice if the wrong technology is either bought or sold? These are two very different yet distinct realities. Is this a risk you are willing to take? Ask yourself this question before making a commitment. What is the life expectancy of this computer hardware investment? Can I expect 1-2 years before it is outdated or completely obsolete? With these very basic questions, when does a physician feel comfortable jumping into the EMR world? NOW is the answer. As demonstrated over the past 30 years, information/computer technology is an ever-evolving modern day phenomenon. This is not going to change anytime soon. The fact remains this - every day a physician continues to add paper to the patient chart, another eventual task to convert from paper to an electronic medical record. This equals more labor. Labor is very costly (no surprises here). Taken into consideration this task; think back one year and forward one year. The amount of paper added to existing charts and the addition of new charts can be overwhelming. The decision to move towards electronic patient records should be moving to the top of your practice priority list. The computer hardware is the tool of the trade and improvements in this technology should be embraced, not feared. The cost of paper and storage of the excessive amounts of paper can help to justify the cost of new computer technology. Simply stated, do the math. b. Acquiring computer hardware and managing the timelines There have been so many changes in computer hardware and so many sources to turn to when buying these tools, which is best? How much time are you willing to spend researching computer hardware? How much time do you want to spend researching? What if the wrong technology ends up in your hands? Now what? This is your practice we are discussing. Any disruption can cause a break in the revenue stream. With tight margins working against you to begin with, why run this unnecessary risk? There are experts in the computer hardware field that can help. This can be as simple as a phone call. For more sophisticated installation and networking needs, an outsourced IT company may be needed. Large clinics should have a full-time IT employee on staff. Recommendation: Do not buy the computer hardware until after the EMR has been selected! Each of the EMR vendors has different hardware requirements and minimum specifications. Minimum and optimal hardware designations need to be thoroughly scrutinized. The management of the timelines is equally important. Once the EMR has been selected and installation dates are confirmed, order the hardware. Keep in mind the laws of supply and demand. New great technology may be in short supply due to the demand, and the hardware provider may be back logged for weeks or even months. This is very important to keep in mind. c. Computer hardware setup and Network installation When selecting an IT company to setup your new computer hardware, be sure to check references. Obtain multiple proposals to compare pricing and service levels. Finding a good IT vendor is like finding a good auto mechanic. The good companies are worth their weight in gold. The wrong IT company can take advantage of you both financially and at the service level. Be sure to shop this job. d. EMR training for the doctor(s) and staff How much training is enough? Is the EMR vendor charging enough for the amount of training? Or are they undercutting the training charge only to leave room to come back and charge more? How do you know? Are you and your staff quick learners? Are you used to this technology? A staff member embracing this change vs. a staff member resisting this change can have very different learning curves. This should be an exciting time in the practice, and the desire to take this technology and grow from it is important. The technical proficiencies need to be accounted for. Being honest about your technology experiences and abilities is important for the practice and the training staff of the EMR vendor. This will allow for the right amount of training. This is good financially and will maximize the usage of the EMR. Disaster recovery for EMR is important to keep in mind Are you or will you be prepared in the event of a disaster? What will happen to your practice? What happens to the patient records? These questions should be addressed prior to the unexpected happening. Geography plays a critical role in the type of disaster recovery plan should be put in place. California is prone to earthquake preparedness, while the US Gulf States, for example, are prone to hurricanes and the list goes on. Use one person as the EMR vendor’s main point of contact The designation of one point person can make the research/evaluation process move more smoothly. This person has the ability to delegate different functions of the research, however, that point person should keep all of the information and timelines in mind when moving through the decision making steps. It also allows for the vendor to help with knowing the practice and the practice’s needs. This person can also keep efficiencies in the practice. Too many people getting involved can derive a convoluted outcome in final decisions. Preparing your questions in advance This topic can easily be discussed; however, actually acting on this topic can be another story. What questions to ask? In what order should you ask the questions? Keep in mind as you become more familiar with EMRs, the level and depth of questioning will become more sophisticated as well. Your questioning will change as you learn. This is a good thing. Once you begin to move through the process, your savvy will build. When considering the EMR think about how many times you have been through this in the past; probably never or maybe once. The vendor, on the other hand, is dealing with EMR everyday. In short, they know this technology better than any one and often use this knowledge to their benefit. Their bias will obviously come out as they describe why their product is the best on the market, and why you should buy from them. These questions should be broken into separate categories, i.e. budgetary, payment options, timeframes, computer hardware needs, current automation (replace of integrate with new), installation, networking needs, high speed internet access, routers, adequate training for doctor and staff, completion, and go live goals. Develop your top questions list in the beginning and organize the questions and their answers in an MS® Excel® spreadsheet. This will allow you to quickly include or exclude EMR vendors to your list of viable candidates. The last thing you want to do is sit through a demonstration of the EMR solution and come to the end and realize that this EMR vendor cannot provide your office with a solution to your most basic needs. This is time wasted. If there is anything that a physician’s practice does not want to waste besides money is time, and we all know that time is money. Keep your research as succinct as possible. These top ten priority questions will help you in so many ways. Because each practice is unique, there will be different priorities for each. A simple equation to apply is the 80/20 rule. Spend 80% of your time researching and developing your goals and path to take, spend 20% in action. Good preliminary questions to ask an EMR vendor: What is the cost per physician license? Do you have any existing clients in our specialty? Does your system come pre-loaded with templates for my specialty? Is your company the developers of the software or is it re-branded from another vendor? Is your system client/server based or ASP based? Does your system include practice management software? How many clients does your company have? Is your system HL7 compliant? How long has your company been in business? Is your development done overseas? Is support done overseas? Is your software CCHIT certified? If not, why? How often is the software updated? NEXT: Vendor Selection Part 2