Best Practices For Selecting An EHR

Rebecca Armato doesn't mince words. "Just as the right medical treatment is critical to a patient's survival, the right approach to EHR selection and adoption is critical to the health/survival of a physician's practice," she said.

That's why Armato, executive director of physician and interoperability services at Huntington Memorial Hospital in Pasadena, Calif., takes clinicians through an in-depth analysis and exhaustive checklist to determine which electronic health record (EHR) system and vendor is most likely to meet their needs.

Every analysis begins with a blunt piece of advice: There are no shortcuts; practice physicians and their staffs must commit serious time to the selection process. Once they've made that commitment, Armato takes them through an EHR assessment document with a long list of obvious and not-so-obvious questions. Here's a sampling:

-- What do you expect the EHR system and e-prescribing software to accomplish? While many practices are looking to qualify for government incentives under the Meaningful Use guidelines, Armato emphasizes that those guidelines are only the minimum to aim for.

-- Are you currently using an e-prescribing system? If so, how will that system interact with the new EHR system you install?

-- Do you have a practice management (PM) system? Should the electronic health record (EHR) system, which Armato defines as a combined EMR and PM system, replace the PM? Clinicians don't want incompatible PM and EMR systems, which would force staffers to do duplicate data entry.

-- Does the practice already have a website? If so, will it "play nicely" with the EHR system under consideration? Many EHR systems now let patients make appointments and get test results, for instance. If your existing patient portal already does that, how will you reconcile the two systems?

-- Do you want an EHR system that can interface with medical devices you use on a regular basis, including EKG machines, electronic thermometers, and weight scales?

-- What kind of bandwidth do you have and will it still meet your needs once you go fully digital? Can you take advantage of applications that reside in the cloud? Will you need to upgrade from DSL to a T1 line, for instance?

The Huntington assessment also covers categories like transcription, billing, patient information, and office equipment. Among the relevant questions:

-- Do you want to eliminate transcription costs by having clinicians use a data entry template built into the EHR? Or replace conventional transcription with a speech recognition program?

-- If the practice uses an outside billing service, is the service willing to use the EHR system to process payments? Or will you have to find a new service?

-- Do the clinicians in the practice choose their own ICD-9 codes (used to determine billable diagnoses) and CPT procedure codes (used to obtain insurance reimbursement for specific medical procedures)? If they do, clinician workflow can be disrupted if the EHR system under consideration can't accommodate that approach. Ideally the EHR should have an integrated, problem-oriented approach, a "smart template" approach, or at least include a section in the patient visit template for the code to be inserted in this kind of situation, Armato said.

-- How much of each patient's paper chart should be scanned and added to the EHR system? There are pros and cons to including all the data, so this is a conversation that you need to have with the vendor and the rest of your staff.

-- Equally important, what patient data needs to be accessible on the e-record's opening page? Many clinicians complain about information overload and want to gain quick access to the most vital facts and figures.

-- How will clinicians access the EHR during patient examinations? Do you need laptops, smartphones, tablets? Will the positioning of the workstations require clinicians to look away from the patient, hindering the patient-doctor relationship?

Armato summed up her advice to office practitioners: "Don't make a knee-jerk decision. This is not about picking technology. This is about picking your business partner. ... Not approaching this correctly and with commitment will cost the practice much more than the stimulus they have coming."

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)