How 7 Vendors Of EHR Systems Measure Up

All seven EHR system vendors that responded to our request for information are viable options for Wellness First Health Associates, the medical group we created for this RFI. They all have ambulatory EHR systems aimed at small and midsize practices. All are certified under the Office of the National Coordinator for Health IT's meaningful use program, as well as the Certification Commission for Healthcare IT. And all are HIPAA-compliant. (For an in-depth look at the vendors that responded, download our full Analytics Report.)

Each vendor's EHR system has most of the features Wellness First requested. The distinctions among the systems are found in their advanced capabilities, such as wellness and preventive care, health education, and business intelligence.

Wellness and preventive care is a hot-button issue for Wellness First. Nearly all the vendors offer the ability to alert doctors to the need for exams, tests, procedures, and other patient health maintenance items. NextGen, for example, provides these alerts based on guidelines from the American Academy of Family Physicians and the U.S. Preventive Task Force Service. It also provides doctors with preventive care information.

Health education also is one of the optional EHR system objectives under meaningful use Stage 1. EClinicalWorks stands out in this area, offering materials, such as after-care instructions for patients, from Krames and other well-known health education vendors. It also lets practitioners attach their own patient education materials and content at no cost.

Integrated business intelligence tools is another area where vendors distinguish themselves. At a basic level, these tools let practitioners generate lists of patients with a specific condition so they can target them with counseling and other programs. This capability is also an optional Stage 1 meaningful use objective.

NextGen's EHR system lets practitioners generate reports on a single patient visit, on all a patient's visits, and on all patients within the system. Medical Communication Systems (MCS) gives caregivers at small practices the reporting and analytics capabilities of Microsoft SQL Server 2008, along with additional data mining capabilities. EClinicalWorks' practice management software includes a Cognos Enterprise Business Optimizer module that generates reports in a number of areas, including quality of care at both the patient and practice level.

Cerner's PowerInsight enterprise data warehouse uses SAP BusinessObjects tools for query, reporting, and analysis, making it easier for doctors to extract data they must provide to the Centers for Medicare and Medicaid Services. The warehouse also analyzes cost accounting data uploaded from an external system, providing reports such as cost per case.

All the RFI respondents provide their systems as commercial software, either as hosted software-as-a-service products or as on-premises software. Commercial SaaS-based EHRs, with their low up-front costs and few hardware requirements, are the preferred option for a small practice like Wellness First. For those practices concerned about data security and integrity in the cloud, a private cloud--a dedicated cloud environment behind a firewall--is a viable alternative with fewer risks.

The vendors responding to our RFI all provide on-site training, usually at a cost of about $1,000 per day plus airfare and expenses. They also provide online training. For example, Aprima emphasizes that its Learning Management System lets users train at their own pace and at times convenient to them.

EHR pricing can be complicated and varies depending on the capabilities required and the number of people using the system. Not all the RFI respondents provided pricing data, and some that did didn't provide it specifically for Wellness First's requirements. Cerner, MCS, and SOAPware provided the best pricing information, ranging from SOAPware's $350 per month SaaS implementation to MCS's $2,925 per month. Cerner has a one-time fee of $2,500 and MCS and SOAPware estimate implementation costs to be about $5,000.

Wellness First would be well served by any of the vendors that responded to our RFI. Using the data from the RFI, it should focus on the less expensive SaaS products, since they have lower up-front costs and fewer IT support requirements. Cerner and SOAPware fit in that category, but Wellness First should follow up with several of the vendors to get more pricing information in order to make a final selection.

Story edited on Feb. 4, 2011, to remove an incorrect description of Athenaheath's offering.