What issues are most important when choosing an electronic health record (EHR) system? Regardless of practice setting, four questions must be answered to help narrow the selection from among the hundreds of EHRs on the market. A little planning now can prevent some costly mistakes in the future.
1. How Much Does It Cost?
The first question may seem obvious, but it must be answered. How much does the EHR cost? This is often the easiest way to eliminate a large number of prospective vendors. Get prices for initial purchase, technical support, monthly fees, upgrades and data storage. Some vendors charge per prescriber per month. Some companies charge extra to turn on the various modules, such as e-prescribing, each laboratory interface, imaging center interface, interoffice messaging, faxing, insurance verifications, practice management, scheduling, coding, and customization. Inquire if the cost is per person or for the practice as a whole.
2. How Easy Is It to Transfer Data?
How easily can patient data be transferred out of the system to another EHR? Some EHRs charge another fee to get the patient data out of the system in an easy and meaningful manner. Data extraction and migration are important, since technology companies have been known to rise and fall overnight.
3. Does the System Provide Meaningful Use?
Does the Office of the National Coordinator for Health Information Technology certify the EHR for meaningful use? This designation is supposed to be the industry standard for technological capability and security as determined by the Department of Health and Human Services. For an EHR to be awarded this standard, it must also comply with the Health Insurance Portability and Accountability Act.
A final word of caution: Vendors can choose to have only select modules of the EHR certified, so it is essential to investigate before you select a product. Search by product name at http://oncchpl.force.com/ehrcert/ehrproductsearch
4. Who Will Use the EHR?
Who will be using this product and for what? Envision the workflow from the perspective of everyone who will use the EHR. Facilitate a discussion with colleagues about their daily tasks and documentation needs. Inquire about their frustrations and any workarounds they have devised. Ask what they wish could be the new norm. Ask what they really like about the status quo.
Speak to everyone who has anything to do with patient care, from the office manager to the biller, to the nursing staff who may conduct patient teaching and administer medications, to the NPs or PAs who may require co-signatures or chart reviews.
Perhaps most importantly, consider your patients. Patients are becoming more comfortable communicating in the technological age. They often express frustration with waiting on hold and not being able to ask simple questions or request refills or referrals easily. Some EHRs have patient portal features that allow the patient to securely communicate nonurgent information, request appointments, refills, upload documents, pay bills, review patient education materials, and receive electronic appointment reminders. Patient portals will be a requirement of step 2 meaningful use criteria.
Once you have narrowed the field of prospective EHRs, consider the unique aspects of your current or prospective practice. Do you have one or multiple practice sites? Will you make house calls? Will you be using the EHR on a laptop, desktop or tablet? Do you need extra equipment? Will the EHR communicate with other practice EHRs? Can the EHR store audiovisual files? Will the EHR work with existing software such as dictation?
My final recommendation is that you do not store data on your local desktop, laptop or tablet. Ideally, patient data should be securely and automatically cloud-stored using 128-bit SSL encryption in multiple geographic locations with multiple power backup supplies. If your local device is stolen or damaged, you would potentially lose all patient information. If it is cloud-stored, the data is secured and retrievable no matter what happens to your device. This also provides the option to log on remotely when you are called in the off hours about a patient concern.
Raymond Zakhari is a nurse practitioner who owns Metro Medical Direct, a home-based, Internet-enabled primary care practice in New York City. Follow him on Twitter at @RZakhari or visit his business website at http://www.metromedicaldirect.com/.