Choosing the Right EHR Vendor for Your Practice

So your practice has decided to finally take the plunge and get an electronic health record. But with more than 300 software vendors to choose from, chances are you're racking your brain about what to do next.

Here's your guide to asking the right questions, to make sure you pick the EHR that's right for you. These are only a few of the many questions to ask an EHR vendor, but they touch on the critical information you should know as you embark on your technology shopping expedition.

Shared vision

What does it take to pick the right EHR? Savvy purchasers - those with years of experience with various technologies from multiple vendors - say it's a bit like choosing a life partner, as opposed to a dream date: go for shared goals and long-term compatibility instead of looks.

The federal government's meaningful use criteria, part of the EHR incentive program, may lead to more similarities than differences between EHR systems, but choosing the right system has not gotten any easier. Now, as always, finding the right system means finding the right vendor.

For Gina Tucker, a practice manager in Northampton, Mass., getting the right vendor meant taking a chance. In 2001, the five-physician practice she manages, Hampshire Obstetrical and Gynecological Associates, Inc., opted for an integrated EHR and practice management system. The vendor was new on the scene and still developing its product line, but the bet paid off, she says. Not only has that vendor grown into a top-10 player in physician EHR systems, but it continues to deliver the high levels of service and support that Tucker gambled it would.

Looking back, Tucker says it wasn't an entirely risky bet; in large part due to the method her practice used to select its EHR. Because the software for electronic medical records was still a work in progress a decade ago - much more so than today - Tucker and her practice's selection team looked as carefully at potential vendors' market strategies, as it did their products.

"We didn't go to software vendors and say 'here's what we want to fix,' but rather (we said), 'our goals are thorough documentation and staying on top of everything we need to so we can provide good patient care, be efficient, and keep improving,'" Tucker says. "We felt the company we chose was on the same path as we were to improvement."

Tucker says to look beyond a vendor's statements about being the best in the business, best in breed, and other similarly inflated phraseology. Instead, look at how much it invests in research and development of new products. Ask whether its product-development team includes seasoned pros with success in developing information technology for physician medical practices and similar environments.

"You want to feel that they understand your business," she says. "It's a feeling that you have a melding of philosophies, which goes well beyond any statements that a salesperson can make."

Scoping out vendors: a checklist

There are many questions you should ask vendors and other users to figure out what the right system - and vendor - is for you. Here's what Tucker suggests asking:

Questions to ask the vendor:

• How many practices use your system nationwide?
• What are the specialties and sizes (in number of physicians, not full-time equivalents) of practices using your system?
• How many users have switched to other systems and why?
• Are any physicians involved on a day-to-day basis in your research and development, implementation strategies, design, or other key areas?
• How does your company integrate ideas submitted by end users?

Next, here are questions to ask other users of the product (ask your vendor for references):

• Do you feel the vendor and its staff understand medical practice business and clinical challenges?
• Is it easy to reach someone from the company on the telephone?
• What is the number one reason you chose the system?

Train to perfection

Qualifying for the federal government's full complement of EHR Stage 1 meaningful use incentives might cover much of a new system's cost. Or it might not. It's all too tempting to cut corners on training costs to lower the acquisition cost of a new system. Don't do it, says technology consultant Rosemarie Nelson, with the Medical Group Management Association's Healthcare Consulting Group.

The train-the-trainer approach is necessary to build a core of in-house experts, but don't expect that a few people on your staff can adequately train the many others who need the knowledge, too, she says.

"There's way too much to absorb in a new EHR for one or two people to quickly get the big picture and be able to transmit that to everyone in the practice who needs the knowledge, which is pretty much everyone in the practice," Nelson says.

Make sure there is enough money in the proposal for the vendor to train several employees, she says.

"My recommendation is to listen to the vendor's recommended schedule of training and don't try to shortcut it," Nelson adds.

There's no argument from Anna Randall about the role of training in a successful EHR implementation. She worked with several EHRs and managed implementations at other practices before becoming practice administrator of Middle Georgia OB/GYN, in Warner Robins, Ga., seven years ago.

"The best investment you can make after determining what EMR to buy is the training hours," Randall says. "It will help you create a better form and learn the little tricks that make using the system much less time consuming for providers."

Recently, Middle Georgia OB/GYN opted to replace its EHR with one from a different company. Implementation of the new system went better than expected: The practice's two physicians didn't skip a beat, seeing their usual combined daily workload of 48 patients and entering every bit of necessary documentation into the record on that first day. Randall says Advance training made it possible for Middle Georgia OB/GYN to avoid the physician productivity dip so common in the first few days to months after a practice takes its EHR live.

Randall says that in the weeks leading up to the EHR go-live date, she created a group of administrative users and set up a separate training area for them to use a few hours a day. Next, the head of each department received a half-day of training. Then the physicians were trained one-on-one by the vendor.

Scoping out the training: a checklist

Picking an EHR is often easier than training staff to use it. So when you're shopping around for your EHR, Randall suggests asking a vendor the following questions about training:

• Will you give us a written estimate of the number of hours of training we will need?
• Will you observe a typical patient visit to determine the intensity of training we will need?
• Will you create a training-skills checklist designed specifically for our practice?
• Do you take into account each provider's previous computer experience?
• Do your training suggestions also account for our practice's size, specialty, and its existing information technology?
• Do we have choices in Web-based, onsite, and off-site training?
• Will you provide one-on-one training for the physicians, either via the Web or in person?
• Can you offer training (via Web or in person) during or after our office hours?

When calling other users who have installed the EHR, be sure to ask:

• How many providers were trained by the vendor?
• How many of your staff needed to be trained?
• What was your impression of the content of the training materials and the quality of the vendor's training, including the individuals conducting the training sessions?
• Was the Web-based training offered live or was it in the form of pre-recorded tutorials?
• What is the quality and flexibility of the training modules the vendor provides for the practice to train new employees?

Support counts

Vendor support seems to the area of an EHR purchase that brings the most mystery and, sometimes, the greatest number of complaints. Tucker says support was an area of concern when her practice made the leap into an integrated EHR and practice management system.

"It's not just 'can I get a hold of somebody on the vendor's support line,' but will they know about our software and understand the types of things a medical practice will be asking them about," she says.

Nelson adds that technical support is important enough to include in a purchasing contract. Spell out the expected response times and, perhaps, penalties for poor or late response - such as discounts on technical support, staff training, or other considerations. An additional protection for the purchaser is for the contract to spell out how the penalties would escalate if the vendor's support remains less than promised.

"Support is really instrumental in what will make you happy as a customer," Nelson says. "Trying to gauge support is something I would be asking of the vendor's references, but also what I'd ask of the users I found through professional societies, online user forums, or other ways."

Another support snafu Nelson often sees is when hardware and software from different vendors fail to mesh as promised with the new system. While technology mismatches can be costly, a lot can be done in advance to prevent the finger pointing that slows down the search for solutions.

She suggests setting up a conference call with the EHR vendor, software and hardware suppliers, and your information technology support staff or contractors. Let them hammer out details, such as the right type of PCs, the proper wired or wireless network configuration and so on. Otherwise, the practice administrator is left playing middleman, she says.

"Before the purchase, you should be able to speak with the person who will be handling your support," Nelson says. "Ask questions that will give you a sense of what kind of people this vendor is hiring to support you."

Nelson suggests that you approach conversations with support staff as if you were interviewing them for a job in your practice. Questions to ask might include:

• What do you feel are your greatest strengths in helping clients?
• How did you learn to operate this system?
• What other experience do you have in this technology?
• What is your background in healthcare?
• Have you ever worked with medical practices?

Nelson says you can avoid disappointments with the support you'll get by asking vendors:

• Do you offer live support during my practice's usual daytime work hours?
• What is your turnaround time for returning customer calls?
• Are your support telephones answered by operators who take messages, or will your technical staff be immediately available when I call with a problem?
• How long does it take to get a response when a question needs a more senior person to respond?
• Is there a way to ask non-urgent questions via the Web?
• What percentage of customer questions is answered within the first 15 minutes?
• Describe the process your implementation staff will follow to hand my account over to your telephone support group?

Finally, when calling references or other users, ask these questions about the vendor's support:

• How quickly do you get a response?
• How long does it take to resolve problems?
• How hard is it to get someone from support on the telephone?
• When you have a problem with the vendor's system interacting with another company's software or hardware, do they cooperate to help you find a solution or do you feel abandoned?
• Are management and staff satisfied with vendor problem solving?
• What is the name(s) of your "go-to" support technician? What is the name of the best trainer?
• Who do you call when you can't get the resolution you need?

In the long run, though, finding the best EHR software is a matter of finding the best company, and that's not easy. It took Randall nearly three years to find that perfect partner for Middle Georgia OB GYN.

Says Randall: "I looked at the financial backing of the company to see if they are going to be around for the long haul but also if they were putting money into research and development so they can give us new tools down the road."

Beyond the questions

In addition to checking out what other EHR users have to say, there are many resources for scoping out the capabilities of EHR systems, figuring out what system features best suit your needs, and how to prepare your practice for the transition. Here are two places to start:

• Check out our "Essential Guide to EHR Acquisition and Financing," featuring a readiness quiz, implementation checklist and pricing worksheet at http://www.physicianspractice.com/essentials/ehr-acquisition-financing.

• The Certified Health IT Product list maintained by the Office of the National Coordinator for Health IT (ONC) at http://onc-chpl.force.com/ehrcert will help your practice locate an EHR certified for use in the government's multi-year, multi-billion dollar EHR incentive program.

Robert Redling is a freelance writer based in Tacoma, Wash. He has been practice management editor for Physicians Practice, Web content editor and senior writer for the Medical Group Management Association, and a speechwriter for the American Academy of Family Physicians. He can be reached via editor@physicianspractice.com.

In Summary

Even with certification bodies eyeing systems for federal meaningful use requirements, picking the EHR for your practice is a challenge. In addition to the questions you can ask in a request for proposal, give careful thought to the answers you get when asking vendors, references, and your practice's physicians and staff about:

• Shared vision: Are you and the vendor on the same wavelength about quality measurement, improvement, and product development?
• Training: Does the vendor offer high-quality instruction, and are you underestimating your training needs?
• Support: Do references admire or complain about the vendor's support staff?