Knowing what to expect can make the EHR selection process easier.
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| Michael Nissenbaum |
Purchasing an ambulatory electronic health record system is a complex process that requires a significant investment of a physician’s office time and resources. Creating an open channel of communication with the vendor from the relationship’s inception is essential for long-term success. The more knowledge physicians and administrators have about the process and scope of working with vendors, the better equipped they will be to ask the right questions, manage expectations and optimize their investment.
This physician practice EHR “bill of rights” provides a brief guide for effective EHR decision-making and helps to reduce physicians’ reluctance and skepticism in selecting and purchasing a system.
What to Expect
The EHR vendor should be willing to understand your practice’s needs, goals, priorities, staff structure and budget. The vendor should inquire about your practice’s business and clinical needs, culture, and system selection criteria. What you want from an EHR system and what you hope to accomplish should be among the vendor’s first questions. Next, the vendor should ask how your experiences with similar systems have shaped your expectations and whether you foresee see any barriers to EHR selection, implementation and acceptance. Then, the vendor should ask about your ideal system’s essential criteria, even though the practice may not fully understand all available benefits. Rather than pushing a specific product, the vendor should provide a high-level consultation that includes a discovery or needs assessment.
The EHR vendor should become a consulting partner and share best practices, recommendations and candid feedback on its ability to meet the practice’s needs. Because an EHR is a complex solution, there are many decisions to make about how the solution is implemented and phased into the practice environment. Those choices affect software and implementation costs and timelines. Drawing from information obtained in the needs assessment, the vendor partner should recommend features, functions and the surrounding implementation processes that support your goals while reducing the impact on financial and human resources.
After the options are discussed, an accurate and frank assessment of the vendor partner’s ability to deliver the system requirements is a must. Closely aligned with this discussion should be a conversation about the recommended resources, knowledge and expertise, and timeframe the practice should allocate to effectively handle the implementation.
The EHR vendor should conduct a workflow analysis of your present working environment and apply findings to design optimum electronic workflows. The vendor partner’s qualified team should perform workflow analysis, software installation and administration, training and ongoing support. Workflow analysis is an integral component that should become a basis for future efforts and process optimization. Because all team interactions are important, make sure you get a biography or outline on each technology professional, including information on education, knowledge, experience, health care expertise and previously completed ambulatory EHR projects. Team members should have experience in working with physician practices in similar specialties and of comparable size and revenues. Additionally, they should have interpersonal and consulting skills to work effectively with the practice and their own team while also being capable of working on their own.
The EHR vendor should provide you with adequate references and case experiences. Vendors are more than willing to share case studies profiling practices with examples that outline a problem or opportunity, implementation steps, results and lessons learned. In reviewing these case studies, consider how the implementation process was carried out, if the profiled practice faced challenges comparable to those of your organization and whether the qualitative and quantitative results achieved justified the financial investment.
The vendor should also provide references from several physician practices that are willing to discuss their experiences. With these practices, explore what changes they would make in the selection, implementation and training processes. Ask about the system’s most beneficial features as well as those that may be problematic or missing. Finally, ask if they would purchase the system today given what they now know.
The EHR vendor should stay in close contact with the practice. Throughout system selection, implementation, training and support, the vendor should be easily accessible. Communication should include regular status reviews to discuss milestones achieved, obstacles identified and resolved, and client feedback on how interactions and processes are meeting expectations. The best vendors clearly define in the early stages of the relationship all communication channels and their frequency. These vendors stay in touch throughout the process and are willing to make adjustments based on practice feedback such as shifting dates, modifying training schedules, conflict resolution, or expanding the scope and quoting additional features and functions.
EHRs are an extensive toolset. A practice’s ability to fully leverage all the benefits of the EHR will be an iterative process spanning 18 months or more and is likely to require future training on existing and new functionality. Vendors should assist the practice achieve near- and longer-term efficiencies by proposing future optimization services that continue to enhance practice workflow efficiencies. After initial implementation, practices should also seek out other organizations using the system and attend the vendor partner’s local and regional user groups to share knowledge and refine system use.
What to Provide
Working with an EHR vendor is a two-way street. It demands the participation of both the vendor and physician practice staff. Physicians can ensure success by taking a proactive approach to managing the relationship with and expecting a high level of service from the vendor, in addition to the system. Setting clear expectations about what the practice wants from the vendor and the system, and providing complete, accurate information on the practice’s needs, priorities and culture are paramount. Finally, the practice should strive to keep lines of communication open by offering ongoing feedback and meaningful participation in decision-making during system selection, development, testing, launch and evaluation.
Michael Nissenbaum is president and CEO of iMedica, Carrollton, Texas.
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