Your Guide to Software Selection

The EMR Buying Cycle: A Guide For Medical Practices

Few practices decide that they need to buy an EMR overnight. Usually, the process begins when a growing number of clinicians begin to feel that the EMR they have in place isn’t cutting it, either because it doesn’t work well or doesn’t meet the emerging needs of the business. Over time, everyone in the practice realizes that they could do better with a new EMR.

If you look around, you might find that your practice has reached this stage as well. Signs include:

  • Doctors aren’t stifling their EMR complaints anymore. They say the interface is hard to navigate, the features are minimal, they’re having trouble finding the data they need, etc.
  • Practice partners aren’t confident that the existing system meets their business needs. They’ve begun to think the existing EMR can’t adequately support MACRA, population health initiatives or new services like the Medicare Wellness Visit.
  • Your technical support staff or consultants are warning you that your existing system performs badly. They’re saying that the system is hard to fix, awkward to update, difficult to secure, inefficient to run and/or listing other problems

At first, it may seem like these are routine problems that don’t demand a “radical” response like buying a new EMR. “No system is perfect,” you may tell yourself.

Doctors may complain about your EMR’s flaws, but you might very well face a new set of complaints about the next one. Your IT team might be right about the EMR’s technical limitations, but then again, you’ll probably end up with a new set of problems if you upgrade. And while the practice partners have reason to be concerned about the EMR’s ability to support new business models, there’s no guarantee other EMRs can do so. You may think: “Doesn’t it make more sense to wait and see what you really need before you make another technical investment?”

But then, you think about what you’re losing by waiting, and the problem becomes clear.

Your doctors are frustrated, impatient and probably far less effective than they would be otherwise. That has to be taking a big bite out of their overall productivity. And the longer you wait to invest in a more robust EMR, the more impact this productivity loss has on your business.

The more technical problems your EMR generates, the longer you spend putting out fires and paying for repairs. Who wants to throw good money at a doomed or outdated technology?

And your practice partners are right about planning for the future. At this point, it’s past time to have infrastructure in place that helps you thrive under new payment protocols and new care delivery models. If you wait too long to catch up with industry trends, you may never catch up at all.

When you become aware that it’s time for a major EMR upgrade, you’ve taken the first step in what will be a complicated but, ultimately, worthwhile process. Next, it will be time to decide precisely what you need from a new EMR system.

Start your EMR search on the right foot by gathering your biggest needs in an EMR/EHR System Requirements Template

Defining Your Specifications

Particularly if you weren’t involved in the purchase of the last EMR, you might be surprised by the amount of information you need to collect on your practice’s requirements. Before even looking at vendors, you’ll want to develop a detailed set of specifications that identify your practice’s business and clinical goals for the EMR. These specs should also define your budget and spell out the technical capabilities it should have. (You can take a look at some of the EMR market leaders here.)

Steps you should take include the following:

  • Determine not only what you can spend on the system, but also what the deal should include (such as hardware, software, maintenance and upgrades, interfaces to labs and pharmacies and the ability to customize quality reports)
  • Figure out whether you want the system to include integrated practice management software (which of course will mean that you’re ready to phase out your existing PM software)
  • Articulate your key clinical goals for the EMR, such as tracking chronically ill patients or improving care coordination
  • Define your operational goals for the EMR, which can include supporting the transition to value-based care, participating in health data exchange or building patient engagement
  • Decide which technical approach to EMR use works best for your practice. Do you want to host the EMR on-premise or adopt a cloud solution? What data protection and security measures are important?

To gather this information, it’s important to be sure that every one of your stakeholders can provide their input. This includes not only doctors and practice administrators, but also, if you expect to buy a practice management system as part of the package, any staff member that will use the PM system.

Depending on your practice’s culture, you may choose either an informal or formal method for soliciting this input. You should also consider whether a high-tech (e.g. online survey) or low-tech (e.g. in-person survey) approach will work better in receiving this feedback.

Tech-Friendly Processes

If your physicians and staff are tech-friendly, the best way to draw them out might be to text or email them a link to a web-based survey. You can create such a survey at little or no cost using services such as SurveyMonkey, Zoho or SurveyPlanet.

Be sure to balance your desire for detail with the need for brevity. Given how busy they are, even physicians who are passionate about the EMR issue might not finish a long, arduous survey. Shoot for something that can be done in five minutes or less.

Paper-Based Processes

On the other hand, if your clinicians and staff are more likely to prefer paper, accommodate them. To succeed at generating responses, see to it that the survey form is widely available, and make sure it offers plenty of space to add comments.

Put survey forms in every staff and clinician inbox, as well as the lunch room, meeting room and practice management office. Don’t be afraid to issue reminders that completing the survey is important to the future of the practice, and make a point of checking in politely with clinicians that haven’t completed the survey yet.

Regardless of how you collect information, analyze it thoroughly and be transparent with the results. Even if you aren’t thrilled with the responses, it’s important that everyone knows what their colleagues are looking for in an EMR solution. In that spirit, when you compile the results, circulate your summary widely and get further feedback on whether it accurately depicts the group consensus.

Once you’ve gathered the data and shared it around, only then should you create specifications. Drawing on what you’ve learned, write up a list of your key EMR requirements. This should include not only technical needs (such as making the EMR available via mobile platforms) but also clinician requests (such as providing templates designed for your specialty area). When that list is done, circulate it once again if anyone’s questions remain unanswered, and make sure your specs address those concerns. Better to address them now than after you’ve bought the system.

At this point, you’re prepared to start searching for EMR vendors. Be prepared to learn that no existing EMR meets your specifications precisely. But don’t be discouraged – chances are you’ll find that the search process helps you understand your possibilities better.

Conducting The EMR Search

Even with good specifications in hand, choosing the right EMR can be difficult. As you review the information from various vendors, you may feel that you are swimming in technical details or wonder whether one option is really better than the other. The reality is that different vendors may explain the same features in different ways, gloss over problems with their product or, in some cases, deceive you outright. You need to be prepared.

Fortunately, there are steps you can take to improve the outcome of your EMR search:

  • Research the EMR market
  • Interview potential EMR vendors
  • Demo your shortlisted EMR systems
  • Clarify technical and contractual issues
  • Check vendor references

Nothing you do can 100% guarantee that you’ll be perfectly satisfied with your new EMR, of course. However, if you work the steps through, you’ll substantially improve your odds of making a successful purchase. Below, we’ll offer more detail on each stage of the EMR search process:

1. Research the Market

By all means, review the websites of vendors that you stumble upon during web searches and the ones that are featured in articles. However, perhaps the best way to sort out which EMRs are worth considering is to reach out to your colleagues and ask them which systems they use, as well as which others they may have considered seriously. In either case, search out reviews — and even gossip, just for perspective — that offer a realistic picture of the vendors you’re evaluating.

2. Interview EMR Vendors

It’s often helpful to ask the following questions of EMR vendors you’re interested in:

  • How many clients does your company have, and how long have you been in business?
  • Do you have any existing clients in our specialty area, and does your system come preloaded with templates for our specialty?
  • How many hours of product support do you offer per week/month/year if we buy your system, and is support available around the clock?
  • How quickly do you respond to support requests? Do you guarantee a specific turnaround time?
  • How often do you update the software?  Do you notify us in advance when this happens? If so, how long is the lead time?
  • Do you charge for upgrades, and if so, how much? Also, how often do you expect to upgrade the software?

You may have additional questions of your own that spring from your internal research. Ask those as well, and don’t let an overeager sales rep distract you from your purpose. You need this information.

3. Demo Your Shortlisted EMR Systems

It’s critical that you get a realistic picture of how an EMR system actually works before you sign a contract. That said, EMR software demos might not be that helpful if you don’t know how to get the most out of them. Here are some tips on making the most of EMR demos:

  • Drawing on your internal research, create a list of your key requirements, and make sure the vendor can address at least 90% of them before you proceed further.
  • Share information on your practice (such as your website address, the number of physicians, staff and a list of technologies you already use) and see if the demo addresses those specifics.
  • Don’t base your impressions solely on a canned demo offering an overview of how the system works. Insist on having a chance to use the actual EMR software and roam through it freely.
  • When you do test the EMR live, check out how usable it is and whether key functions perform as promised. See to it that both clinicians and support staff are able to give it a try.

Avoid common tricks some vendors employ, such as using unrealistically small databases or workarounds to make the system seem faster. Insist on testing the system under real-world conditions.

In addition, don’t make the mistake of leaving your clinicians out of the demo process.They have to use the system every day and will know when an EMR doesn’t meet their needs. It’s crucial to get their input on whether a particular product will work outside of a demo setting.

4. Clarify Technical and Contractual Issues

Technical

Even if you delegate technology management largely to IT staff or consultants, you’ll still want to review the basics of what you’ll get and what you need. If you’re planning to run the software on-premise, find out whether you’ll need new hardware to do that and if so, what kind. Meanwhile, if the vendor will host the system off-site, ask how often they backup your data, how they secure it and what they do if the system crashes.

Contractual

There are many complex issues involved in contracting, but web-based licenses can pose especially tricky challenges. A few key questions to ask EMR hosting vendors include how many people will be licensed to use the EMR system, what it will cost to add new users (if need be), contract termination requirements and, most importantly, how and when you’ll get your data back after your agreement with them ends.

5. Check Vendor References

If you’ve done your homework properly, this may be the easiest step in the process. Gather your notes from the interviewing process and ask your colleagues for feedback.  Be sure to get input on the strengths and weaknesses of a given product, as well as stories that illustrate how the EMR worked (or didn’t). You can also find people willing to comment via social media or by posting on related websites.

Once you’ve narrowed your search down to a few possible candidates, compare them carefully. Look at how the vendors meet your essential needs, as well as listing any other features you find interesting or useful.

One good way to do this is to create a grid comparing the vendors’ performance. You may find it easier to visualize vendors’ strengths and weaknesses this way, as well as getting a look at the tradeoffs involved in selecting one vendor over the other.

When in doubt, go back and collect more feedback from clinicians and staffers. Even if your options seem clear, don’t discount the value of getting their gut feelings about the vendors and system. If you take advantage of their intuition, you may discover issues that didn’t turn up during your research process.

When you’ve completed the research process and signed a contract with the vendor, you’re most of the way home. However, you still face one final hurdle: getting everyone on board and using the new EMR successfully.

Launching Your EMR

No matter how involved your clinicians and staff have been in the selection process, they’ll probably need help getting acclimated to the new EMR. Even if they love the new system, clinicians will have to adapt to its interface and structure before they can document care properly, and staff who use the practice management system may face some challenges performing basic functions like billing and scheduling appointments.

To make things as easy as possible for everyone, it helps to make sure they’re prepared to use the new system before it goes live. Also, you’ll want to make sure all of your technical blocks are in a row.

Here are some tips on making that happen:

Offer Multiple EMR Training Options

Although in-depth, in-person training is one of the best EMR training options, don’t forget that everyone learns differently. Offer as many training options as possible, including video training (for both desktop and mobile systems), self-paced online training sessions, email-based coursework and paper-based guides.

Find an EMR Champion

While using outside trainers is fine, sometimes clinicians respond best when their peers help them work with a new EMR system. If your practice has someone who’s particularly enthusiastic about and comfortable with the EMR, consider them your “EMR champion,” and give them a central role in getting their peers acquainted with the system.

Encourage Problem Reports

No matter how well written your EMR software is, your users may run into minor (or even major) technical problems. Create a special email address they can use to report any problems they have, put printed tech problem report forms in a common area and create a special page on your site for this purpose. If users create workarounds rather than letting you address the technical issues, it can lead to trouble further down the line.

Share Tech Support Options

If a doctor is frustrated with the EMR’s data search function, or a billing staffer’s computer crashes when she enters a claim, you want to know. However, it’s equally important to let them reach out to the vendor. Make sure all of your clinicians and staff have the information they need to reach tech support, including the support website URL, email address, phone number, customer forum link and whatever other contact information that may be important.

Hold Regular Check-In Meetings

During the early days of your EMR rollout, you’ll want to give clinicians and staff frequent opportunities to share both good and bad stories about the EMR and, if relevant, the practice management system. Start with weekly meetings, and as everyone gets more comfortable, cut back from weekly to twice a month. After that, you may want to continue with monthly meetings reviewing the system’s clinical and administrative performance to make sure it’s still working properly and fulfilling your needs.

As you might have guessed, the process of keeping users productive and happy never ends completely. You can use the tools and techniques in this guide to address any concerns that emerge as you continue to tweak the system.

The Cycle Continues

After making it through such an exhausting process, you may wish you never have to think about a new EMR ever again. If your vendor is smart and offers meaningful upgrades to their products, you might decide to keep your new EMR in place for quite some time. However, no technical relationship lasts forever.

The truth is, very few software packages continue to meet your needs for more than three to five years on average. Given how quickly healthcare is changing, even the biggest, best-financed technology companies are likely to lose their edge over time.

EMRs will continue to evolve, and features you haven’t even imagined yet will suddenly become must-haves. Startup companies with new ideas for transforming care will pop up regularly. Other vendors will incorporate existing technologies such as artificial intelligence or virtual reality to change the way EMRs work. Not only that, from time to time the healthcare industry sees an abrupt shift, forcing everyone to use their healthcare tools differently.

This may sound frightening, but it doesn’t have to be. Your clinicians may have felt cramped and miserable using first-generation EMRs, but future generations are likely to be far more useful and do much more to improve care quality and outcomes. They’ll help physicians deliver precision medical treatments; improve care for chronically-ill patients, the elderly and others with special needs; allow them to predict which patients are likely to develop conditions like congestive heart failure; and far more.

When your clinicians eventually start to sense the new EMR’s limitations, and staffers tell you that the practice management system doesn’t get the job done properly, don’t resist. Listening to and understanding their concerns is crucial. This will prepare you for the next evolution in how your healthcare technology.

Think of the EMR buying process as a cycle rather than a road to a single destination. You and your colleagues will work with a new EMR system, adapt to it, learn what it can do, become aware that they’re ready to do more and decide to invest in something new. If your practice is to keep growing, you need to move through the cycle gracefully. It’s the best way to adapt to healthcare’s ever-changing needs.

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