Choosing an EHR for Your Practice

You're looking for an EHR. An Electronic Health Record, or paperless office, is the Holy Grail for which practices across the country are searching.

As a computer company working specifically with pediatric offices, we've had the benefit of learning from the good and bad experiences of practices of different sizes, different needs, and different skills, located all over the country. PCC can help you in your quest for an EHR by sharing key search tactics.

• We can help you prepare to search for an EHR
• We can tell you what to look for and what questions to ask
• We can show you the results of our own research

Our suggestions will put you a step ahead of most practices and, perhaps, save you lots of time and money. The suggestions below don't include a long list of "necessary features of an EHR." This discussion focuses on the items most often ignored during an EHR search.

Researching and Preparing for an EHR

Like any important endeavor, your success—or ease of your success—can be greatly improved with a little preparation. The biggest problem pediatricians have when looking for an EHR is that they don't know what they are looking for.

That is, if you are a partner in a four-doctor practice, chances are you have somewhere between one and six different charting styles stored in any given chart. Any half-decent EHR salesperson can make a mismatched collection of chart notes look really bad and the EHR demo look amazing. Of course an organized, consistent method of charting is going to look great compared to yours, especially when it's up on a computer screen! It's not hard to prove that.

The first preparatory step in your your EHR search must be to agree, as a group, what makes a valid chart in your office. What goes in your charts? How are they organized? What notes do you take? Can you agree on the protocols that we will follow for each well visit? Each sick visit?

Once you have organized yourselves in this way, design your chart notes. Use a series of stamps, your copier, different-colored pre-printed paper, your computer system—it really doesn't matter. Once your practice can present a united front of charting style you can compare what you need to do with each EHR more accurately. That is, you're only comparing a single, consistent, working charting style—yours!—to each of the EHRs, rather than comparing your disparate chart styles to the consistency of each EHR.

There are plenty of excellent examples of charting "templates" that you can borrow online and off-the-shelf. Get your practice used to using these consistent—and neat—templates now. For example, the American Academy of Pediatrics Bright Futures initiative offers a vast array of visit-specific templates. You'll be better prepared and you can probably put off purchasing that EHR a little longer while you look for the best solution.

If the value of this process isn't clear to you yet, perhaps we should look at it another way:

When is the best time to identify and fix the various kinks that might be caused by converting your office to a consistent charting method: before you install an EHR or after you spend all that time and money?

What Do I Look For in an EHR and What Questions Do I Ask?

First, you want to find a company you can trust. How do you determine whom to trust? You have to rely on:

• Companies with a Proven Record

  Finding a company with a "proven" EHR record is hard to do, but start with getting a company history. How long has it been in business? Is it the original company, or are is part of another, larger organization? Is it publically held? (Publically held service companies are beholden to two very different groups of people—bad thing!) Will it give you a list of all of its clients? How about more than just the 1/2 dozen "happy" ones?

• Companies that Understand Pediatrics

  How long have they worked with pediatricians? How many pediatricians do they have as clients? Do they have evidence, beyond a growth chart, that they understand the high volume, broad diagnostic spectrum of your work? Can they give you a list of pediatricians who use their system? Are there any happy ones?

  What do they know about immunizations? Do they work with your state registry? Can they print a valid school form? Can they help you recall children who have missed shots? Do they understand pediatric dosing? This list is only a start, so don't forget how different pediatric medicine is from the rest of the world.

• On-site Visits

  EHRs are often expensive. If you are about to invest a great deal of money and time in a software program, wouldn't you want to visit 2 or 3 practices using the software, even if you have to fly there? Seeing actual users work the software is much more effective than any sales demonstration.

• Hands-on Testing

  When you get a demonstration, don't let the salesperson do the typing or input. You do it. You'll learn whether it's intuitive for you or matches your charting method. The car dealers don't test drive the cars for you, do they?

  If an EHR company won't let you play with their system on your own, give them a red flag.

Once you've identified one or more companies that pass your inspections above, what additional questions should you ask them? Some important items include:

• Interfacing with Your Existing Practice Management Program

  Let's face it: you can count on one hand the number of companies who do practice management software well. You need even fewer fingers to tally decent EHR companies. What are the chances that one company understands and provides the software to handle these very different aspects of your practice? Especially for pediatrics?

  In our experience, we've yet to meet a company that provides both EHR and practice management functions well. PCC aims to change that, of course. We already provide the best pediatric PM software solution, and now we are developing your ideal, pediatric EHR.

  Thus, if you have a practice management system and you like it, keep it. Do whatever it takes for the PM system to work with your EHR. Most EHR companies are happy to make their end of the interface work, but some PM companies are notorious for their siege mentalities, particularly when they also sell an EHR "solution." Worse yet, we see more and more EHR companies forcing you to use their substandard PM systems.

  Even if the technical part of the interface is, in theory, easily provided to you, make sure you have a complete understanding of how the two systems interface on a practical level. Which one holds the master patient data? Does the EHR do the scheduling or does the PM? How are charges entered? Are you going to lose any features, especially time-of-service features, by adding this EHR to your practice?

• Managing your Existing Paper Charts

  Some EHR companies have very good responses to the question, "What about our old charts?" We can't suggest that one answer is better than another, as it depends on your practice needs. However, just make sure the answer they give you (scanning to an electronic file that you store within the EHR, or manual input of data into each active patient chart as they are scheduled for appointments, or whatever solution they provide) is satisfactory to you. If you have the time and inclination to put your old charts into the EHR, make sure there's an easy way to do so.

• HIPAA Compliance

  There are a few key points you want to hear your EHR salesperson answer:

  1. An EHR is not necessary for HIPAA compliance. We've heard of EHR salespeople telling practices that if they don't get an EHR, they're in big trouble. This is simply not true.
  2. The EHR company should emphasize the importance of the security and confidentiality of your data, and be able to assure you that the software complies with the requirements set forth in the HIPAA Security Standards. The company should be able to provide you with specifics on how their system is HIPAA compliant, from data integrity to remote access security.
  3. The company indicates some record of adapting quickly to market demands. If they took 6 months to be Y2K compliant, for example, or are not yet in full compliance with HIPAA, this is a real problem.


• Support and Training

  The most often neglected aspect of any complex software installation is support and training. Many vendors are loathe to sell it because their margin on it is so slim and it drives up the initial price of the system.

  If you run anything larger than a solo practice (with someone comfortable in the role of system administrator on your staff), you'll need weeks—not days—of training time in order to interface an EHR with your established billing system (or many additional weeks if you're replacing your billing system).

  What is the single greatest reason that physician's offices change computer systems? Lack of support. Don't make an obvious mistake by engaging an EHR company that fails to offer you plenty of support time and resources.

• Practical Advice

  We are always unimpressed that the practices themselves are often the ones who have had to develop solutions for some really obvious practical problems (though the solutions they've developed are often impressive). Many EHR companies seem to ignore some of the "real world" issues associated with their installation. For example:

  • What does the EHR company do in the event of power outages?
  • What happens to your charting system when your system goes down?
  • If you're using a workstation in each exam room, what do they recommend for furniture or other retrofitting of your exam rooms? Most EHRs focus on specialties whose patients are unlikely to try to "play" with the equipment in the room. Are they prepared for your pediatric practice?


• The Final Word on PCC's Research

  PCC has done a lot of the dirty work for you in researching for an EHR. What is most apparent from our research is that there is no single solution out there that suits everyone. There are several EHRs that PCC currently works with, each providing solutions that are strong in different areas. We invite you to talk to our customers and learn from their experiences, as well.

  PCC is developing a pediatric-specific EHR. Join the Design Committee now and help make PCC's EHR your EHR. As a member, you can provide direct feedback to PCC's EHR designers, participate in software testing, and get special previews of the software before it is publicly revealed.

Well, there you have it: a quick overview of the things to think about when shopping for an EHR. If you have any questions or comments, please do not hesitate to contact PCC.