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EHRs: 10 Essential How-To’s
By Michael Nissenbaum, CPA

Physicians are scrambling to achieve eligibility for American Recovery and Reinvestment Act (ARRA) incentives connected with the adoption and meaningful use of EHRs. Likewise, they want to avoid the government penalties for not adopting and using EHRs by federal target dates. Unfortunately, financial, competitive, and government pressures sometimes lead physicians to select and adopt faulty or marginal EHR/practice management (PM) systems. By working with the following 10-point EHR checklist, physicians can avoid the pitfalls that often plague EHR/PM system selections, purchases, and implementations:

1. History: What’s the vendor’s track record?
Search for vendors with a tradition of meeting legislative and regulatory requirements and fulfilling association guidelines and standards. If a company has successfully addressed mandates and requirements in the past, chances are good that the company will perform equally well as the initial details surrounding meaningful use come out in the months ahead and are subsequently updated in the future. For example, ask the EHR/PM system vendor how it addressed previous programs such as the Physician Quality Reporting Initiative (PQRI). Dig deeper to find out whether the PQRI reporting was automated or manual. Ask the vendors’ customers what results they experienced. Given that you’ve identified a vendor with a track record of delivering compliant solutions, you should then have your vendor provide you with a letter of commitment and guarantee that it will meet all requirements necessary for your practice to take advantage of the various incentives for which it is eligible.

2. Tryout: Will I be able to test drive and use the EHR/PM system?
Beware of vendors who try to make a sale solely on the basis of a slide presentation, conference call, or Webinar. The best vendors are eager to let you use their EHR/PM product, typically for one to four weeks. Moreover, they should support that trial period with at least two hours of one-on-one or online training. Doing so will help you get familiar with system functions and features, formulate important questions, and adapt to the application’s nuances. In addition, the trial period will help speed your practice’s transition to using an EHR with your patients following system implementation. Ultimately, this puts the decision-making criteria in your hands, not in those of a sales person.

3. Patient Care: How will the system improve it?
EHR/PM systems liberate physicians to spend more time in patient care—from prevention and diagnosis to treatment and follow-up. Top-tier systems enable providers to care for additional patients. Users of the best systems attest that they are able to close all patient charts on a daily basis. Determine how a particular EHR/PM system will streamline practice operations, minimize routine tasks, boost productivity, and enhance patient and staff satisfaction. In an ideal scenario, an EHR should push tedious, time-consuming tasks such as data entry to the lowest possible labor cost.

4. Training: How will physicians and staff learn the new system?
Make sure the vendor provides training with multiple options, such as seminars, one-on-one tutorials, or computer-based sessions. Training should be conducted at convenient times—even on weekends if the practice so requires. Initial training should help you master system features, workflow, and elements of the patient visit. Additional training—typically conducted four to six weeks later—should focus on elements such as the use of one-page summaries and follow-up visit encounter forms.

5. Adaptation: How well does the EHR/PM system work in your specialty’s environment?
The best EHR/PM systems feature as many as 1,000 common complaints that embrace all medical specialties. While some vendors may have expertise in a specific specialty, EHR/PM developers who work with a range of practices, from primary care to specialties such as orthopedics, neurology, and urology, are able to apply best practices from multiple disciplines to deliver a more robust solution. Furthermore, such vendors are the only ones to approach for implementations involving multispecialty clinics, where it is important for providers to seamlessly migrate from one specialty-focused knowledge base to another.

6. Assessment: How will the vendor evaluate my practice’s needs and workflow? 
The most reputable EHR/PM system vendors use on-site project managers to assess workflows, identify best practices, and customize their training program. They invite staff to access preliminary definitions and insights through an online training resource. Doing so familiarizes staff with basic concepts prior to the launch of a formal training program.

7. Trend Tracking: Is the EHR/PM system vendor prepared to monitor and respond to new and emerging trends?
EHR/PM system vendors should always be on the lookout for new and emerging trends in PM, medicine, and HIT. As an example, growing numbers of experts have endorsed EHRs enabled with discrete reportable transcription. Such an innovation would send physicians’ transcribed notes through a natural language processing program, which would then generate and upload data in the practice’s EHR. The issue: Is the vendor in a position to monitor and respond quickly to emerging trends and developments?

8. Autonomy: Does the EHR/PM system allow physicians to maintain personal preferences?
With an EHR/PM system, every staff member in the practice benefits from leaving behind the albatross of paper medical charts. Beyond the ease of electronically locating records, the practice faces constraints with poorly designed systems, which demand that all users conform to similar workflows. Seek out systems that respect individuality, allowing each physician to maintain personal charting preferences. Find a solution that respects the practice’s existing front- or back-office technology while offering a choice among integrated EHR/PM, EHR only, or PM only options. Demand pricing based on the functionality implemented on a per-provider basis instead of a pricing model with a blanket licensing fee regardless of the capability deployed.

9. Speed: How will the EHR/PM system save time and accelerate the practice’s workflow?
The most effective EHR/PM systems are interoperable with those of payers, hospital and healthcare systems, and medical devices. The result: speedier transactions and a reduction in errors. You get to choose your favorite and fastest method for inputting data into a tablet PC and can access patients’ records no matter where you happen to be—at home, at work, or on vacation.

10. Ease of Use: Is the EHR/PM system built on a single database?  
All too often, EHR/PM systems have separate databases or mask separate EHR/PM databases with a common interface. A superior approach is to use an EHR/PM system developed on the same database. For example, the single database design allows you to access a patient’s demographic or insurance information without having to close one database and open another. Another real-world example: A provider notes in the chart that the patient should receive specific health maintenance reminders. In a single database application, specific health maintenance criteria are developed in the clinical environment (the EHR) and are proactively supported in the PM function every time a patient calls to make an appointment. This is done automatically; however, in a system with two databases, manual or redundant data entry would be required to transfer the data between the EHR and PM.

— Michael Nissenbaum, CPA, is president and CEO of Aprima Medical Software, Inc, www.aprima.com.