Recent studies of the US healthcare market share report that over 95% of American hospital systems currently use Electronic Health Record (EHR) technology of some sort . As these systems mature, as the EHR market itself matures, and as the consolidation of health systems continues, there remains a strong need to find scalable, sustainable and suitable health information technology for healthcare practices of all size and scope.
EHR technology forms the foundation of a hospital system’s operations. Patient care is driven by the ability to understand and add to the patient’s narrative as it relates to acute care and long-term care for disease and injury. From check-in through billing and revenue capture, EHR platforms assist organizations run smoothly and derive value from the business they conduct.
The convergence of the Electronic Medical Records (EMR) and Electronic Health Records (EHR) markets has created a variety of blended products that function in nearly the same way. EMRs and EHRs are used as the platform for clinical, financial, and operational activities related to both hospital and ambulatory locations. These systems are designed to follow the patient through the entire continuum of care. Whether a solo provider or a large integrated hospital system, EHR technology has matured to fit the needs of the clinical encounter.
Comparing EHR Systems: Considerations for Selection
There are many options for EHR software application. To help you evaluate the best system to meet your needs, listed below are the key differences among various software you could select.
- Documentation habits and clinical workflow are considered some of the most important aspects of patient care, and therefore, are key to selecting the appropriate EHR application. Make sure that the EHR you select will allow all providers both physicians and administrative staff, to incorporate their work and efforts into the clinical record. Evaluate the current and best-practice workflows and documentation styles as they fit the clinical environment. Be aware that not all workflows and documentation styles will be supported within any one EHR. Even though it is possible that a system can be configured and customized to fit the specific workflow and style of patient through-put, assurances that functionality can be built are usually not satisfactory in creating an environment for success with an EHR application.
- Billing systems within EHR applications are crucially important to its success. Without the ability to accurately and efficiently code and bill for services rendered, operations will grind to a halt and profits will not be realized. You should select an EHR with an internal module to bill patients and insurance, or ensure that the EHR can connect seamlessly to your existing revenue cycle management (RCM) service.
- Population Health Management is a key aspect of EHR software that should also be considered when evaluating new platforms. If the clinic is currently involved in/or has any plans to begin using patient data to improve care or populations of patients, or if the organization is part of any risk-bearing contracts or partnerships with payers, including CMS (Medicare / Medicaid), or if the organization takes part in an Accountable Care Organization or any other diverse partnership related to quality and utilization, then an EHR that includes features that best allow for these activities should be considered. It is also wise to consider how an EHR would support the needs as they are today and how they may advance in the future.
- Hosting: EHR hosting can be accomplished in two distinct ways. They can be client-hosted or accessed through a web-based connection to the ‘cloud’. Both function similarly, but some software requires a server or group of servers to host the application and interfaces while others do not.
The benefits of accessing a remote or cloud-based EHR vastly outweigh the risks of leaving the accessibility of a critical system to the whim of an internet connection. Investing in the time, resources, personnel and space to accommodate the hosting of an EMR does not provide the long-term return on investment that was commonly believed as little as 3-5 years ago. It is less expensive and contains less risk to have multiple internet connections available than it does hosting and deploying servers for EHR technology. As well, the cloud-based EHR provides accessibility to providers and staff in any location at any time. The ability to have more staff access these applications from home, while on travel or vacation, as well as when they are rounding or working from hospitals and other patient care areas is incredibly efficient and effective. These features become more difficult to stand up when done from a private server that is managed by an internal team of resources.
- Hardware compatibility may not be at the top of your wish list when determining which EHR system to select. However, given how important the hardware is to clinic operations and efficient workflow, it is worth considering some of the following questions and ensuring that you select an EHR that is compatible with the way you currently operate and the ways you might want to work in the future. Consider, for example:
- Do your providers want to use a tablet?
- Do your providers want to continue to use a narrative built by dictation/transcription?
- Do you have providers that want to use speech recognition software?
- Do you have previously built templates that you’d like to leverage for future use?
- Does your clinic have any other specific documentation needs that need to be considered?
Having a prepared list of documentation requirements is important for successful vetting of EHR software. Without appropriate methods for capturing the patient story and the clinical moment, a new EHR system may inevitably cause more issues that initially anticipated.
- Interoperability is the ability to share and receive clinical content with outside agencies, organizations and clinics. Clinical, financial and demographic data can be shared with others can be through a variety of approved technological functions. From intensive interfacing to the use of secure email, an HER that includes the ability to share information is key to creating a longitudinal patient record. The longitudinal record can decrease costs, increase patient compliance, and limit potential for error. Though certified applications will have some aspects of interoperability built into their systems, it is important to understand the neighborhood with which the sharing of records is important — and to know what methods are currently in use and available. This could include connecting to a local or regional Health Information Exchange (HIE), joining a clinically integrated network (CIN), or building interfaces to the key locations with which a majority or plurality of patients are shared.
EHR records are created so they can be extensible and leveraged at other points of care, regardless of the EHR in use. Transitioning from primary care to specialist, inpatient to outpatient, from one health system to another are all important aspects to consider when evaluating new EHR technology. The resulting chart notes that are shared with consulting and complimentary providers are the ‘calling-card’ of the practice, both from the perspective of the referring physician as well as the patient. If the notes that are shared during a transition aren’t adequate, thorough, or provided in a manner with which the data elements can be easily incorporated into another application, the patient and the provider will see this as a negative reflection on the practice. It is worth considering, due to this, what interfacing, connection and dissemination methods are available for the EHR in question, as well as what upfront and on-going costs are included.
- Certified “EHR Technology” is relied upon by a variety of EHR incentive programs from payers and other organizations. This is a distinction bestowed upon EHR vendors that have products that meet a variety of criteria related to functionality, security, and interoperability amongst other agencies and vendors. Depending on the organization’s goals, it may be beneficial to limit potential vendors to only those that have received certification from a trusted organization.Certification alone does not, in it of itself, create a successful partnership and should be looked upon as a feature and not a sole reason to acquire a specific product. Using a certified product, however, at a minimum, will afford a clinic or hospital the opportunity to participate in a variety of programs that, if successfully implemented and adhered to, can prove to be lucrative and rewarding.
- Costs: To many organizations, an EHR is built into the traditional costs of doing business and without one, the operations would not be possible. For other organizations, they are trying to build a model in which to discern the return on investment to move to an EHR application. At this point in the maturation of EHR technology, the best way to justify the increase in costs is to determine how much more efficient, well-connected, well positioned, and competitive clinical operations can be if a new EHR application was implemented, rather just a straight-forward revenue opportunity.
- Migration of data: If an EHR is being replaced and there is data to migrate to a new clinical system, it is important to take this section very seriously to ensure that all clinical data is appropriately ported to the new application. Without including the historical data into the new application, a lot of problems, errors and additional costs can be accrued. Many EHR organizations will work with existing EHR to port data over before a cut-over and go-live of the new application. There are a variety of potential formats in which to transfer existing data into a new EMR. Full records can be sent using HL7 CDA format, SQL queries, and/or proprietary import functions. If a prospective vendor is unwilling (or unable) to incorporate your historical clinical data into their system as part of your EHR implementation, they may not be the best fit. It is of the utmost importance to prioritize the re-creation of every patient in your new EMR without the loss of any key historical and billing data as current and likely future reporting requirements highly value the continuity of data.
- Engagement of staff: Beyond the structural and technical objectives of an EHR evaluation, it is imperative to make sure that clinical resources and staff are engaged and willing to make the change. A lot of processes and workflows within an organization will inevitably change due to a new application. Some of these changes will be for the better, but there will inevitably be some changes which are met with resistance. Build a team of advisors from all areas of a clinical environment to assist with the evaluation process. Let each resource objectively evaluate the technology and functionality to ensure it matches the needs of the representative group of employees.
EHR Adoption and Selection
It is important to have representatives from any vetted EHR vendor demonstrate the functionality and usability of their application on-site at your clinical location. Let clinical staff use the application in a simulated environment to observe their interaction with the application within the defined workflow of normal clinic operations. This process should be repeated for ancillary staff (billing, coding) should there be an expectation that those resources will also utilize the application. Though an application can be customized and/or configured for specific use, it is crucial to evaluate existing functionality to limit bottlenecks and frustrations in patient care areas.
Site visits to similar organizations is an important step in which to glean objective information from existing clients using the same application. Conduct both a walkthrough of operations as well as a candid conversation with key leadership to learn about functionality, workflow, as well as any service or outage complaints, issues with upgrades and custom functionality. The unbiased feedback that can be provided by a similar clinic is important as it will identify expected issues that can be planned/accounted for.
When a final EHR partner has been identified, the contracting process becomes a formidable step to ensure a sound and successful investment. It is important to leverage experts in the field of procurement and negotiation to assist with building the price for services rendered and software delivered. A well-negotiated EHR contract is important to maintaining financial sustainability and profit as well as to ensure that all systems are running without issue or inappropriate downtime. When a new EHR is being implemented, plan for a significant reduction in productivity and patient through-put as the new application is being launched to the organization. It is important to spend the time and resources up front to ensure that all resources are adequately trained and familiar with the system before expected volume of patient visits and encounters to return to normal levels. Document all processes and workflows to assist with the on-boarding of new employees in the future as it will be helpful to have a turn-key approach to bringing aboard new resources.