Assess Vendors

Because there are so many EHR vendors to choose from, you can begin to narrow your search by finding out which vendors have been approved by the Centers for Medicare and Medicaid as meeting the HL7 standards.

You can also consult with your specialty society to identify specialty-specific software vendors, and utilize the information on Highmark’s website www.highmarkehealth.org.

Attend vendor fairs to view many different systems at one time. Vendors also offer "Webex" seminars where you watch and hear how their system functions by accessing a special presentation via the internet and by dialing into the seminar with your telephone.

Assess EHR Functionality and Features

As you compare EHR systems, it becomes evident that there is more than one way to accomplish the same objective. Since features and functionalities differ in each EHR package, be sure to determine which ones are most important for your practice. It is like purchasing a home or a car. There is a certain look and feel that will appeal to you.

Some of the more common functionalities of an EHR system include prescription writing, health maintenance tracking (to help manage patients with chronic conditions such as diabetes and asthma and can also track immunizations) and medication lists/problem lists.

All EHR systems have a mechanism for handling telephone messages. Patient information on the system can be viewed while talking with the patient on the telephone. Contact information can be verified immediately and the system provides on screen alerts if there are any outstanding issues to address with the patient.

The EHR system will automatically fill in the patient’s contact information on the telephone message form and the message travels to the physician or nurse via an internal messaging program. It can be flagged or prioritized according to urgency. The physician or nurse receives a notice on their EHR screen that they have a telephone message. They can open the message and take immediate action from the message screen. All actions are recorded in the patient’s chart.

All EHR systems have standard templates that aid in documentation and allow the user to design forms and letters. These features can greatly assist with operational efficiency improvement.

An important function of all systems is the capability of producing charts and graphs by pulling the "searchable data" that has been entered into your system. Data can be entered into the system using a variety of methods including scanning, digital handwriting, voice recognition, and point-and-click. Unfortunately, some of these methods do not produce searchable data. Make sure that the majority of the information you put into your system can be incorporated into reports.

As with many billing systems, the production of management reports can be the Achilles heel of some EHR software. Do not overlook this very important functionality. You will need reports from your EHR system to measure your compliance with pay for performance initiatives. Buy a system that will give you the reports you need. The importance of this cannot be overstated.

If your EHR system incorporates all the functionalities listed above but doesn’t interface with your current billing and scheduling (PM) system, it will just be a waste of money. Since some EHR systems only work with their own PM system, make sure you know the compatibilities of the EHR systems you are evaluating.

Request for Proposal (RFP)

A vendor selection team comprised of staff members from all levels of the practice should be assembled to evaluate which vendors should receive a request for proposal (RFP). All physicians in the practice should be given the opportunity to participate.

Send your RFP to all vendors who have a product that fits your practice’s needs and be sure to include a deadline for submission. Submit the RFP via email and ask for pricing information in an Excel spreadsheet. You’ll find that having this information in an electronic format will help you immensely when you begin to evaluate vendor responses.

You can access an RFP outline from the Pennsylvania Medical Society. Go to www.pamedsoc.org/ehealth.

You should provide pertinent information about your practice in the RFP such as number of physicians, mid-level providers, nurses, and office staff; number and address of other practice locations; current practice management system; and computer configurations. Try to provide accurate and specific information about your practice.

The RFP should require that vendors provide company background, client references, detailed technology system information and pricing, a functionality checklist, implementation and training prices, and ongoing support costs.

Prices that appear in the initial RFP response are preliminary. The vendor will not be able to provide final pricing until they visit your office and gather specific information for the system’s technical requirements. However, the vendor should be requested to provide initial pricing based on the practice information supplied in your RFP. These preliminary figures can help you determine which vendors are in your price range and will assist your accountant in determining financing options.

The RFP should require the vendor to provide specific descriptions and detailed pricing for:

· Servers.

· Portable and desktop PCs and workstations.

· Printers.

· Scanners.

· Modems.

· Wiring.

· Installation/labor costs.

· Service/warranty.

· Software licenses, number of users.

· Annual support costs.

· Practice management system interface costs (if applicable).

· Third party software (if applicable).

· Clearinghouse charges (if applicable).

· Data conversion.

· Training costs.

· Application Service Provider (ASP) costs (if applicable).

Costs for software licenses can vary greatly depending on which method the vendor uses. Some determine costs based on the number of users or the number of computers, or a flat fee for the first physician and partial fees for subsequent physicians, etc. Find out from each vendor which method they use.

Some vendors build third party software into their systems – medical, clinical, drug references and formularies, report writing, and document faxing. Other vendors consider these as add-on options available for an additional cost.

Vendors may provide data conversion – transferring your current patient demographic and billing information into your EHR system. It is money well spent if the data in your billing system is of high quality.

Ask each vendor for an estimated training schedule so you are familiar with what it covers and how long it will last. Most vendors create their training schedule based on historical data from practices of similar size and may charge a per-day rate, or by the hour.

An Application Service Provider (ASP) is a company that stores your data off-site. Not all vendors offer this as an option, but if you use an ASP, you won’t have to purchase a server. If you decide to use an ASP, it is important to define how many users can concurrently access the system at one time.

Make Your Selection

RFP Response Comparison. If each vendor followed your RFP format and submitted a response electronically, you can use an Excel spreadsheet and cut and paste responses to make the comparison easier. Don’t just focus on the final cost – remember that all costs are negotiable and cost is just one aspect of the final decision. Usability and quality of each system must also be compared.

Demonstrations. Invite all physicians and key staff to be a part of the on-site demonstrations. The vendor will most likely walk you through a basic presentation; however, you should prepare some challenging, but realistic patient scenarios and ask the vendor to show you how the system would handle them. Don’t hesitate to slow down a vendor intent on clicking through screens at 100 miles per hour. Specifically ask each vendor what features are contained in their standard package and what features will cost extra.

A vendor rating tool that covers all the functionalities the vendors were asked to respond to in the RFP should be developed and completed by all vendor demo participants. Because a lot of the systems have similar features, everyone should be as detailed as possible as they rate each system. Solicit both positive and negative feedback from all vendor demo participants. Hopefully you can choose the top two systems – these two vendors will need to come back on-site for an office assessment to be able to generate a final cost proposal.

References. Prepare a list of detailed questions to ask each reference. This is an opportunity to not only assess the vendor’s capability, but to also obtain insight about the overall process.

Negotiations. It is likely that the vendor’s initial price quote allows room for negotiation. Do not accept a lower price, however, as a tradeoff for hardware that is cheaper or for a reduction in service or training. If you like the price in your proposal, you should still try to get some additional service and training for free or at a discount.

Some physicians might want to purchase their hardware from a different vendor than the software vendor. This doesn’t really save a lot of money, and some vendors don’t allow it because of finger pointing that can occur between software and hardware vendors.

When you have the best and final offer from your vendor finalists, you are in position to make a decision. Occasionally, this is a no-brainer. But, more often, this is a very difficult decision because of the investment involved.

Implementation

Once you have selected a vendor, ask them what you can do in advance to prepare for implementing the system. Staff members can begin to gather information that will be downloaded into the system such as fax numbers for pharmacies and labs. You will also have to decide how much information in the old charts should be transferred into the EHR system.

Inform your patients about the new system and how it will benefit them, and give them opportunity to ask questions and provide feedback.

For a successful transition to EHR, you must be positive, expect problems, look for the best solution (which may not be the most expensive system), and last, but not least, be realistic.

It is good to have high expectations for what EHR software can do to help your practice, but you must also keep in mind that results take time, focus and dedication – like most things that are worthwhile.