Here are the essential points to consider when you are evaluating an EHR system for purchase.

By Alex Niswander

If you are shopping for an electronic heath record (EHR) system, there are many key factors you should consider in order to determine which solution is the best fit for your practice. Making the right decision is critical, as a mistake could cost you a lot of time and money.

Imagine going to buy a new car without knowing the size, features, or budget you need. A two-door sports car wouldn’t suit a family of five. If you bought it, you would regret the decision. The same is true for buying an EHR system: you have to know what your needs are.

Whereas with a car your family, friends, and a good salesperson will help you discover the best fit for your needs, an EHR system is different because vendors typically have only one product to offer and their job is to sell it to you. So you should be cautious, take your time, and do your homework.

There are several key points you need to evaluate when shopping for an EHR. These will help you identify which EHR solution is the best match for your budget and your practice.

Although no two chiropractic offices are the same, the following evaluation criteria should apply in some way to most. Keep notes on each point for the systems you review so you can remember them in the future as you narrow your decision.

Compatibility matters

It is important that your various systems can “link up.” Your new EHR software must be able to send and receive data from your existing billing system. The ability of practice software to interface with other systems has been around a long time, so if a company’s EHR cannot interface with your system, one of the two is outdated and one or the other (or both) should be replaced.

Local or remote hardware

Web-based software runs on a Web server, so you can access the software through a website from any computer online. The advantage to going Web- based is lower hardware costs (you don’t need a server) and a lower buy-in cost. You can begin using it for a small down payment and price is often based on the features you are using.

The other advantage is that you won’t require any extra software to login from anywhere on the Internet. If you have multiple offices, or work from many sites, this can be the best option.

The downside to Web-based software is generally a higher long- term cost of ownership as you are “renting” instead of owning the software. This can still be a good fit, but it’s something to consider.

The other potential downside is that Web-based software has to function within an Internet browser, which means the software may be more difficult to use compared to a client- server system you keep in your office. Although Internet service has become very reliable, if your Internet is down, so is your Web-based EHR system.

Another thing to consider with a Web-based system is what happens in the event you want to stop using the system. Will you only be left with text files of your patient records and billing? This is an important item to clarify if you are leaning toward a Web-based system.

With client-server software, the software is physically installed in your office and you must have one main computer (the “server”). The main advantage is that long-term costs can be less, and the software likely easier to operate. Another advantage is that you own the software and can usually use it even if you stop paying annual maintenance and upgrade fees.

On the downside, there may be higher upfront costs and possibly additional costs if you need “remote control” meeting-type software to access your system from other locations. You may also need to keep updated hardware in your office to keep up with the demands of the software.

Complete Certified EHR

Because of the government EHR certification program, you should consider investing in a product that has already established “complete EHR certification.” The government has a website where you can search by company or product name to verify a product has met the requirements for complete EHR certification.¹

Be aware there is also “modular” certification, which means a particular product has only

passed part of the certification process, and is not immediately eligible for government incentive payments.

Product customization

Many EHR systems offer some level of “end-user customization.” Once installed, you can modify the software to change the wording of various items and labels you want to use to reflect your unique office environment.

With other systems, the software company’s programming staff would have to make such changes. Ask the salesperson to add or modify an entry during the product demo. This will give you an idea of how easy it is (if possible) to modify and customize items.

Specialty-specific content

Every specialty in healthcare has “custom content.” In the case of chiropractic, you will want to have software that lists the things you routinely do, like evaluating “low-back pain,” “neck,” “shoulder,” etc. (Having podiatry or optometry content wouldn’t help your patient documentation.)

If you are reviewing a chiropractic-specific system, you should readily see these items.

Important: If you are evaluating a medical-based system with a “chiropractic module,” you will likely need to spend more time customizing the system, which may ultimately not work well for your needs.

Ease of use

This item may be a matter of personal preference. After seeing it demonstrated, you should have a feeling for how easy a system is to use. You’ll probably know within a few minutes if you like the system or not.

It might be a matter of the software’s color scheme and layout, but you will likely come away feeling that a product will either be a good match for your needs, or you’ll feel that it isn’t a good fit. As you’re making notes, go with your gut feeling on this point.

Software speed

The speed of the product can mean many things. The most important aspect will likely be the amount of time you have to spend with it on your most common daily patient tasks.

Does the system expedite your work?

It is not uncommon to spend two to five minutes writing out a daily note on an EHR system; however it would be good to get a baseline for each system you are reviewing in case all other items of consideration are similar. Efficiency could become the deciding factor for you.

Technical support

Find out about customer service and tech support for the software. How many technicians does the company have? Is it located in the U.S., or will you have to call overseas? What are the hours of service and typical response time?

Reference check

Once you have narrowed your search down to a few systems, you should check references. You might hear what you need to finalize your decision. The company may give you a list of clients you can call, or you can check with a colleague you know who has the same system. Ask such questions of other users as:

• How long have you had the system?
• How long did it take to fully implement?
• Is there technical support and how good is it?
• How effective was the training?
• Are you paid or receiving incentives to talk with prospective customers?

The bottom line

Most DCs are small business owners and have to be acutely conscious of the bottom line. Before you begin shopping and watching product demos, properly evaluate the maximum upfront or monthly amount that you can comfort- ably invest in your EHR system (most vendors have financing plans available). In the chiropractic market the price range for a certified EHR system is approximately $5,000 to $15,000.

Important: It is not recommended to buy a system based on a possible government incentive payment. You should buy based on your current needs and budget, as if there were no incentives offered.

If you keep these tips in mind when researching your EHR options, you’ll have a better chance of being successful in purchasing — and using — your new software.

Alex Niswander is a SOAP notes expert with more than 10 years focused on clinical charting and proper noting procedures. He is also the owner of Chiro QuickCharts EHR system. He can be contacted at 888-978-5222 or through www.quick-charts.com.

Reference

¹The Office of the National Coordinator for Health Information Technology (ONC): http://onc-chpl.force.com/ehrcert/EHRProductSearch?setting=Ambulatory.