Does a New EHR Mean Switching Practice Management Systems?

Four years ago, pediatrician Jeffrey T. VanGelderen and his partner at the Children's Medical Group of Saginaw Bay in Michigan were looking for an EHR for their practice. Before shopping, they had a difficult decision to make: Find an EHR compatible with their current practice management system or buy an EHR and at the same time, buy a new management system designed to work with it.

In an effort to increase compatibility between the two systems, VanGelderen and his partner chose the latter option, going with brand new systems. They first investigated the EHR offering from their management system vendor, and found it user-friendly, but not as robust as the newer software from another company.

"In a lot of cases like ours, practices already have a management system in place and have had it there for a long time," he says. "When you make the decision to go to an EHR and fully integrate it, you usually go to another [management system]."

In 2008, Children's Medical Group debuted its new practice management system and less than nine months later, had its EHR online with the two systems working collaboratively together.
VanGelderen says the result has been great. The cost of the two new systems already has been more than made up for, he says, and in fact, the new systems have freed up staff time through better efficiencies in the software.

"We are using that time for better quality of care, like follow-ups and identifying patients who need well checks, and our nurses are doing more patient education versus paper shuffling," he says.

If you are considering implementing an EHR at your practice and want one that works with your current management system, how much of an investment should you make? Our experts weigh in with two trains of thought.

Assess your needs

You wouldn't make a big capital investment in a medical device without a little research on cost, use at your practice, and training, right? Well, our experts say when it comes to weighing a potential relationship between your practice management system and an EHR you also need to do your homework.

Fred Pennic, a healthcare IT consultant and technology blogger, says if you like your current practice management system, make a complete assessment of what it will mean to bring an EHR online also. This includes ensuring you have the proper resources to support it, in terms of IT staff or other employees, knowing what your licensing agreement will cost you, and estimating training hours required to get any new system up and running.

You also need to weigh the pros and cons for your practice, adds Don Sickle, a former EHR specialist with national consulting firm Welch Allyn. Sure your current system is all paid off and familiar to staff, but does it also have lingering problems that require tricks and shortcuts by your staff - costing time and money just to get it to work? If so, perhaps it is time for an upgrade, Sickle says.

If you are ready for an EHR, both Pennic and Sickle advise taking the same first step as Children's Medical Group - call your current practice management system vendor to inquire about its EHR offering. If you are happy with one of the vendor’s products, you may like a companion that works similarly and is more likely integrated than two systems from two different vendors.

Sickle, who was also president of advisory firm EHRInsider, says two different vendors means more "interfaces" between products so they can communicate, which isn't always a good thing.

"Interfaces are all links in a chain, and eventually, one of them will be weak somewhere at some point," he says. "The key is to have as few links in this technological chain as possible."

When calling your existing practice management system vendor to inquire about its EHR offering, Sickle advises inquiring how long the vendor has had the product in place and whether the EHR was purchased from an out-of-business company - making it less likely to work seamlessly with your practice management system. Just because it is from the same vendor doesn't mean the systems will work together in perfect harmony.

If the vendor does have a product you are happy with, schedule a Web demo, Sickle says, or even an onsite visit to your practice so you can learn more about the EHR and how it will fit into your practice's current operations.

Time for a change

But what if, during that assessment, you find that your current practice management system is not as efficient as when you bought it years ago? Then it may be time for a change.

Margret Amatayukul, president of Margret/A Consulting in Schaumburg, Ill., says when it comes to getting practice management systems and EHRs to work together, the answer is simple:

"You cannot find an EHR today worth its salt that will really integrate well with an old practice management system," she says.

So practices hoping for harmonious integration between an EHR and practice management system should at least consider buying both products new, she says.

"You should not be closed-minded about being open to looking into a new practice management component that makes sense for you," Amatayukul says. "Keep an open mind, even if you are dead set against it."

Now that you are ready to shop for some technology, try to hit as many EHR vendors as possible. Where is the best place to do that? Trade shows, says Sickle. Check for local and national trade shows where multiple vendors will talk to you and provide you with lots of literature on their products.

Take the 10 to 20 in-person visits and make a shorter list of vendors, about five or six, and set up Web-based demos for you and some of your key staff. From there, choose the two or three you want to do an in-depth demo that will include how the practice management and EHR components work together effectively.

Learn from others

More likely than not, you are not the first practice to make a big investment in a new practice management system and EHR at the same time. So to best gauge how your new products will work together, talk to those who've already done it, say our experts.

Get references directly from your potential new vendor partner, Amatayukul says, and be specific - ask for a similar-size practice making the same decisions you are.

"Don't take 'we've done a lot of these' as an answer from a vendor," she says. "They need to dig deep in terms of how many have you done on my version [of the system] and in the same size and type of practice I am. …Vendors often have references for EHRs, but don't get references for [management system] conversion. If the vendor can't come up with a reference exactly like yours, steer clear because they don't have the experience."

VanGelderen agrees, saying it is very important to see demos, but also talk to other practices.

"I have several colleagues in the medical field who opted for one system or another simply because it was more compatible with what they had," he says. "But often times, that doesn't work well if you don't have a good system. You want to be sure the system has everything to offer and the flexibility you need for your practice."

Again, just because the systems can talk to each other doesn't mean they are always the best fit, VanGelderen warns. He recalls a neighboring practice that placed compatibility over function and as a result, did not get the most from its EHR.

"You don't just want to pick something because it is an easier fit with your management system," he says. "You may lose [capabilities] on the EHR side, which is why you are making the switch in the first place."

Where do you want to go?

Marlin Moyer, program director for information technology with Pennsylvania-based Geisinger Health System, also warns small- and mid-size practices against just looking at an EHR without even considering the impact on their current practice management system.

He says going with a non-integrated system means your practice has to have the manpower in your office or the money for consultants to get those two systems talking and working together, "and that goes with significant maintenance."

At a minimum, Moyer says, get the "front end" of your management system - like scheduling, patient registration, follow-up appointments - synched to your EHR and you can live with a separate billing system.

Geisinger, which employs more than 800 physicians in 42 Pennsylvania counties, developed its own EHR in the mid-1990s to work with its in-house management system. An important part of the system's work was to adapt its operations to the EHR and not vice versa.

"Practices try to make the technology work with their current work flow versus looking at the bigger picture," Moyer says. "Look at what you want … with a combined EHR and management system. Are you looking to just get something that meets 'meaningful use' guidelines or to transform your practice, become more innovative, and take things to the next level? It's looking at where you want to be in 20 years, not 'do I want to get the incentives offered right now.'"

Keith L. Martin is associate editor at Physicians Practice. He can be reached at keith.martin@ubm.com.

This article originally appeared in the April 2011 issue of Physicians Practice.