Your Guide to Software Selection

2018 Physician Practice EHR Checklist for Evaluation and Selection

Key Features, Requirements, and Questions to Ask When Choosing an EHR Provider

As key stakeholders and decision makers in your physician practice, it’s critical to stay on top of the marketplace, regulatory/technological changes impacting your business operations and the delivery of care.

Your electronic health records (EHR) system is one of the biggest technological and business decisions your practice needs to make. According to the Office of the National Coordinator for Health Information Technology (ONC), several studies estimate the cost of purchasing and installing an EHR ranges from $15,000 to $70,000 per provider. Costs vary depending on whether you select on-site EHR deployment or web-based EHR deployment.

With so many vendors to choose from, and each claiming to have a “best of breed” solution, narrowing down the list of possible candidates can be a daunting task. That’s why it’s important to understand the key EHR features your practice needs to have and which questions you should ask when evaluating and partnering with a vendor.

For 2018, we have updated our popular Electronic Healthcare Record (EHR) Evaluation and Selection Checklist. The checklist is comprehensive, but not exhaustive. Each practice has its own unique needs. To help in the process, we’ve included information for whether you’re purchasing an EHR system for the first time or looking to replace or upgrade the system you already have. We also touch on the needs of specialty practices and features that next generation EHR systems will include.

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Clinical Features Checklist

Every EHR software solution should enable physicians to have easy access and update medical records. Software systems should have tools and features to help physicians and nurses treat and care for patients. These features should include:

Charting/Note Taking/Diagnostics

 History of the Present Illness (HPI)

 Clinical patient history collection (family, survey, medication, etc)

 Social determinants

 Vitals and measurements

 Diagnosis

 Care plans

 Form customization

Guidance

 Current Procedural Terminology (CPT)

 E&M Coding

 Clinical Decision Support (CDS)

Order Management  

 Computerized Physician Order Entry (CPOE)

 Lab orders

 Radiology/Diagnostics

 Referrals

 Order sets

Task Management

 Medication refill/approvals

 Lab results review/approval

Medication Management

 ePrescribing

 Medication updates

 Patient medication history requests

 Drug interactions/dosing/allergies

 Controlled substances

 Short and long-term care management

 FDA indications

Continuity of Care

 Clinical exchange document data importing/exporting

 Follow-up care communication

Business/Administrative/Patient Features

 Patient scheduling/appointment management

 Patient registration (insurance, patient information, demographic data, consents)

 Billing systems and receivables management

 Insurance claim validation and verification

 Electronic Remittance Advice (ERA)

 Custom reports

 Third-party reporting integration

 Task management

There are also reporting functions that you should look at. Many can generate clinical quality reports and financial analysis.

Patient Experience/Patient Portal

In addition to supporting clinical and administrative functions, EHRs play a vital role in facilitating communications with patients, in addition to improving their overall experience. Some features to evaluate include:

 Online booking

 Desktop and mobile/texting options

 Desktop and mobile access

 Automatic reminders and missed appointments

 Built-in and third-party patient portals

 Medication refill requests

 View lab results

 Patient-Provider communication

 Education materials access

 Phone and email alerts and capabilities

IT, System Architecture and Security Features and Requirements

Your IT team should also evaluate technical and architectural features. These should be the basis for a strong infrastructure in the system you choose to use.

 On-premise vs cloud-based. One key consideration is how the system will be deployed. On-premise software is installed locally on your practice’s computers and servers, while cloud-based software is hosted on the vendor’s servers and accessed through a web browser.

 Business continuity/disaster recovery

 Scalability

 High availability

 Interoperability

Compliance/Data Governance

 Audit trail

 Data retention

 Document management

Security

 Encryption at rest and motion

 Access controls (authentication/authorization)

There are also technical requirements. EHR systems should comply with all legal and regulation requirements under HIPAA, ONC-ATCB, and HITECH. Compliance helps minimize harmful illegal activity, including data breaches and ransomware attacks that compromise patient data and privacy.

Specialty Practices

If you’re a specialist practice or clinic, you have the added layer of deciding whether to go with an EHR for general practices, one that accommodates multiple specialties, or a niche player specifically designed for your patient and practice needs.

See: Selecting the Best EHR Vendor for Your Specialty Practice for key technical and business considerations.

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Next Generation EHR Features

When evaluating current features and functionality, factor in how your EHR will need to adapt to the next generation, EHR 2.0 solutions appearing on the horizon. Many current EHR platforms do not have the flexibility to exchange data with, or interpret data from, other systems.

Your requirements will evolve as EHRs move from collecting data to sharing, interpreting and predicting data. And there will be much more data to analyze.

Regulatory changes will also play a role in data usage, collection and interpretation. As an alternative and potential replacement for fee-for-service reimbursement, value based care will make patient experience, wellness and preventative care higher priorities. Under the Medicare Access and CHIP Reauthorization Act (MACRA), your physician practice will need to change how you capture and report patient data.

Some of these next generation EHR features include:

 Predictive analytics

 AI/Machine learning

 Data visualization

 Internet of Things (IoT) integration

 Mobile apps

 Native apps

 Interoperability

 Fast Health Interoperability Resources (FHIR)

 Real time alerts monitoring

 Clinical care protocols

 Care coordination

 API integration  

 Telemedicine

 Wearables

 Population health management

 Natural language processing (NLP)

 Voice recognition

Other Resources

Using our EHR selection templates can help you figure out which EHR system to select. If you’re looking for a category that isn’t mentioned or have questions, feel free to contact us.

See: top EMR and EHR systems

HealthIT.Gov also has excellent resources on implementing EHR.

Evaluation and Selection

It is best to keep in mind that there are plenty of ways to help narrow the list of possible solutions.

Doing your homework is critical when selecting a vendor. Look specifically at reviews and surveys. This allows you to immediately eliminate any with poor reviews or suspect ratings. A mismatch in priorities can happen if the vendor works primarily with companies that are a different size than yours – either smaller or larger, or have limited experience with your specialty.

There are a variety of important questions that you should ask when choosing a system. Take into account a variety of issues before deciding which system is best for your physician practice:

  • Will the new system have the features you truly need?
  • What kind of inefficiencies does your current system have?
  • How will the EHR system improve your organization?
  • How will its design, user interface and functionality impact workflow, increase efficiency, and impact patient outcomes and financial performance?
  • Does the system at the top of your list introduce new limitations, or will it solve the problems you currently have?

EHR Vendor Qualifications and Services

Vendor Certification

You should check to see if the system is certified.

See: The Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program

U.S. Centers for Medicare & Medicaid Services (CMS)

Certification “helps healthcare providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentiality, and can work with other systems to share information.”

Operational: Data Storage/Maintenance/System Security Questions/Content Management

  • How is data transferred within the system and with another?
  • Where will the data be stored? In your organization’s offices, or in a secure data center?
  • If at a secure data center, what kind of security and encryption is employed?
  • Can the vendor make sure that the data will be accessible constantly?
  • What backup is in place for a temporary outage or a total system failure?
  • What happens in the event that security is breached?
  • What role will your vendor assist/manage content updates?

Operational: Installation, Implementation, Training, Support and Upgrading Questions

  • How will the new system interface with the other systems in place?
  • Can the EHR be easily integrated with the other services you use (billing systems, public health interfaces, etc.)?
  • How well will the data you have in your existing system transfer to the new system?
  • Who will implement the new system?
  • Who will provide, or be given training for, the new system? How?
  • What support is offered when the system does not work as planned, or needs to be upgraded?
  • Is replacing your current system ultimately an improvement from your current one, after you factor in cost, training and workflow disruption?

Financial Questions

  • What is the startup/installation cost?
  • What is the cost for training?
  • What are the warranty/maintenance options, terms and costs?
  • Will upgrades and customer service be included as part of the purchase?

Vendor Credentials and Reputation

  • What is the vendor’s financial stability and longevity?
  • Who is its customer base?
  • What is its previous experience with comparable practices (size, specialty, subspecialty) and needs?
  • Can it provide comparable customer recommendations?

Once your list is narrowed down to the top 2 or 3 vendors at the most, it’s easier to determine which company to trust with your data. Have your top contenders respond to a request for a proposal (RFP). This will give the vendor the information about your company that they need, such as top criteria for the EHR system and what your organization’s primary focus is.

When you have the responses from the vendors, invite your top choices to come to visit your organization. Ask them to demonstrate how their system will work, and how it performs when in action. A rating form can be handed out to employees (clinical, administrative, IT) if you’d like to have their input before making a final decision. Do this before each demonstration in order to ensure the audience can easily follow and understand the system. This creates a simpler way to get feedback on a particular vendor.

Be thorough. Talk to references for each vendor. But don’t only rely on your vendors’ references, who will likely offer the most positive reviews. Ideally, you should reach out to additional contacts for more information and opinions to get a complete picture of your candidates.

Some questions to consider asking:

  • Would those references choose the vendor again?
  • How satisfied are they with their decision to use a specific vendor?
  • How disruptive was the installation of the new system?

Bear in mind, this process can be labor intensive. But understanding the time and expense in purchasing and implementing a new system before signing an agreement can potentially save you even more time, money, and grief down the road.

Done right, your final EHR selection will reward you with:

  • Better clinical results and patient care
  • Improved population health results
  • More transparent and efficient practices
  • Empowered patients
  • Robust growth in health data

Compare Top EHR Software Leaders

Dan Greenfield2018 Physician Practice EHR Checklist for Evaluation and Selection

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