Today, electronic health record (EHR) systems play an increasingly important role in improving providers' administrative operations and streamlining the delivery of patient services. However, far too many providers are dissatisfied with their EHR vendors, judging from a KLAS research survey. In a recent report, KLAS found 50 percent of 300 physician groups that have purchased EHR systems are now looking for replacement systems – up from 30 percent in 2011.
From our perspective as an EHR system provider, there are two main reasons for this wave of provider dissatisfaction. First, many physicians are basing their decision primarily on cost factors, not realizing that cheaper is not necessarily better. Speaking with providers who have switched from their initial EHR, we find that in many cases the practice invested much more time and effort in their failed implementation than what it would have cost to pick the right system at a higher initial investment. Second, many practices are not 100 percent comfortable with their own internal processes, and purchase an EHR system that doesn't satisfy their requirements.
Therefore, we recommend the following approach when considering an EHR solution. Take time to evaluate the current needs and future goals of the practice, and then look at what you can realistically afford to invest in a system. Weigh out whether or not a perceived expensive initial cost will save you money in the long run. Next, analyze your current workflow to see which processes you would like to maintain and what areas you would like to improve. This will help in cultivating efficiency and organization throughout the practice, while ensuring that your EHR system supports your goals.
Then, it's time to begin looking for systems and vendors to meet the specific requirements of your practice. It's important to understand that there is no "one-size-fits-all" solution, even within the same medical specialty. For example, two dermatology practices might have different workflows and business systems. Once you have narrowed the list of vendors, be sure to check references and try to speak with several clients in your specialty that have been using the system for at least a year. They can tell you about any obstacles encountered during the implementation, their support experience and the benefits from making the switch.
Here are some other suggestions to help you purchase the right EHR system for your practice and avoid a costly mistake:
- Consider the EHR system from the point of view of the patient, as well as the physician and office staff. For example, is the EHR system easy to use in the examination room? Does it provide reports on waiting times or other service delivery issues?
- Ask the vendor if the system will accommodate any potential changes in your practice model, such as joining an accountable care organization, adding telemedicine services, or expanding upon the practice concentration in the future (i.e. bariatric, weight management, etc.).
- Be certain you understand the total cost of ownership (TCO) of each vendor's pricing structure. For example, some cloud-based vendors provide EHR services on a subscription basis. Paying $400-$600 a month for a five-year contract period would result in a $30,000 commitment plus the initial investment for implementation and training. Alternatively, the TCO for a server-based office system with a $10,000 upfront cost and a $200 monthly maintenance would only be $22,000.
- Look for hidden costs in the contract, such as additional fees for in-person training, document management services, EDI setup or annual maintenance fees in addition to the monthly support costs. Also, watch for provisions that allow the vendor to increase fees during the course of the contract.
- See if there are provisions that would allow you to get out of a contract after six months or a year if the system is not working for you.
- Be sure that you "own" the data under the terms of the contract. Some vendors charge a fee for exporting the data to a new system before the contract expiration date.
- Finally, make certain that you are comfortable with the vendor. In many cases, a small or mid-size company can provide a higher level of personal service. That's an important consideration in helping physicians and office staff take advantage of the many potential benefits of deploying an EHR system customized to the needs of the practice.