Electronic Health Records

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What should your replacement EHR, vendor have on offer?

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- If you are a small practice, you may or may not have already tried out an EHR vendor in order to qualify for the meaningful use of certified EHR technology in the EHR Incentive Programs. In many cases, you may have made an initial purchase decision based on limited information and experience — and with maximum pressure to meet the deadline. Now that some time has gone by, you may either be happy with your choice or realizing that your choice did not meet your needs in the way you thought it would.

Replacing an EHR is not a small decision. In some ways, it is a bigger decision than that first choice. It carries with it not only the specter of additional work disruptions but also the need to re-install a system, migrate data, rebuild integrations, and retrain your workforce among others. So you better have a good reason for making the change as well as a set of good principles that guide your next selection.

A few things to consider in our view would include:

Usability:  This is a key factor, as it is intended that this application becomes the focus of your clinical workflow and the engine that drives your practice on the IT side; as a result, it better be something you look forward to using and that is intuitive, friendly, and hassle-free.

Mobile-enablement: Your replacement EHR should allow your workflow to flow across the devices you use, where and when you want to use them (e.g., smartphone, tablet, laptop, desktop). All of these have their place and there are specific functions of the EHR that are better suited to these devices (i.e., not all functions on all devices).

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Functionality:  The EHR replacement system should be tailored to your type of practice, whether you are a specialty, primary care, behavioral health, ancillary provider, or other. You should get the functions you need — nothing more, nothing less. This is certainly not a “one size fits all,” to be sure. Very often, the vendors who understand you best are not the “big guys” who cater to the large providers and multi-specialty group practices. Also very important, make sure the vendor is certified against the 2014 Edition, which will enable you to participate in Stage 2 Meaningful Use and beyond (nearly all of them were for 2011, but 2014 introduces new functions that not all vendors will be ready to deliver).

Pricing and business model: Certainly key in all this is how it will be paid for and managed. Attractive options now include SaaS (software as a service) where you pay a monthly subscription and the software is provided over the internet from the cloud as a service that you access securely from your office, home, etc.

Interoperability: As part of the EHR Incentive Programs, but growing in importance over time, is the need to be compliant with emerging interoperability standards. The Office of the National Coordinator for Health Information Technology (ONC) has various publications that address this, but make sure your vendor is conversant with these standards and has a plan to put them into the product within a useful timeframe. Sharing data is going to be increasingly important, both in a structured and unstructured way.

Customer service and support: This one is perhaps most important since you need a vendor you can depend on to help you when the going gets tough (and it will, believe me) — a company that will be there for the long term and that is familiar with your type of workflow and practice needs. And ideally, if necessary, the EHR replacement vendor should have resources you can speak to directly or even receive office visits from (less necessary in SaaS models, mostly).

I’d recommend that you peruse the ratings of various vendors and their customer satisfaction scores, treating this as any other major purchase: Be informed, be cautious, and make sure you get your questions answered. And talk to other users who are similar in profile to you. Don’t be hesitant to seek professional help in making the choice. There are numerous consultants out there who make their living advising practices like yours on how to make this important choice and who can smooth the process of switching vendors if you are looking to do so.


Blair Butterfield is President, North America, of VitalHealth Software, which was founded as a collaboration between Mayo Clinic and the Noaber Foundation to combine the best practice clinical knowledge with deep IT knowledge and entrepreneurial experience.













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