EHR Software : Best Practices and Key Considerations
Successful implementation of medical EHR software can only be achieved by following a sound and comprehensive process for evaluating potential solutions and implementing the chosen solution. This post outlines top 10 best practices that providers should incorporate into their EHR selection and implementation process.
- Take leadership & build your team comprising of at least three main roles should be identified, the physician leader, the office manager, and the "super users".
- Whether implementing your first or nth EHR, list all 'Required' EHR features.
- Find the right EHR vendor for your EHR install by following the 5-step process listed below.
- Assess your EHR vendor by asking all the right questions.
- Opt to implement an Integrated EHR and Practice Management Software System (no standalone EHR).
- Vet the EHR Software Thoroughly for Workflow Adaptability, Customizability, Ease of Use, etc.
- Ensure Adequate Training, Technical Support and Maintenance
- Understand Total Cost of Ownership (TCO), determine budget & negotiate contract
- Ensure EHR Certification (ONC-ATCB, MACRA, APM, MIPS, etc.) to qualify for maximum incentives
- Question your EHR Vendor on plans to incorporate new technology like artificial intelligence or machine learning.
As soon as you have successfully passed the Health IT readiness survey provided by the AMA, secure full support from stakeholders in your organization who are responsible for strategic, medical practice, clinical, operational, and financial functions. As part of the selection process, at least three main roles should be identified, the physician leader, the office manager, and the "super users". There must be clarification, understanding, agreement, and alignment of organizational objectives and priorities.
Key goals should include:
- Increased operational efficiency
- Reduced documentation time for clinicians
- Improved billing operations
- Improved patient scheduling
Begin the selection process for an EHR System with a clear understanding of what your EHR should deliver for your practice. This is perhaps the most critical step of the journey. The EHR selection team should help lead the effort to identify the essential features and components a system must offer in order to effectively serve the practice and its patients.
RevenueXL provides a detailed checklist which can be used as a starting point. Depending on your current situation, one of the following scenarios may apply to you.
• New Installation
Start with a broad needs assessment for the practice and follow it up with a much more detailed list of features. You require a clear understanding of what your system needs are. Functions and features of the latest technology are not necessary if they don’t improve or enhance your business needs or business objectives you want to address.
Make a careful assessment of your current software. Compile two lists: one of the features that you are satisfied with and one of the features that are below your performance standard. Check with you vendor to determine if an upgrade to the latest version of the software can solve outstanding issues. As part of the upgrade (and cost agreement), consider purchasing new modules and functionalities that help to simplify and streamline practice workflows. Look into changing your data storage. A cloud-based solution might be more effective and less expensive.
- work toward physician and nursing satisfaction
- choose a system that meets growing and evolving needs
- take your time to make a final decision.
In general, the replacement process should not be as lengthy and time-consuming as a new installation because EHR users already have a much better understanding of how EHR software "feels and thinks". Here is a detailed guide on how to overcome replacement challenges.
Currently, there are roughly 1100 vendors that offer EHR Software. Hence the task of finding the right vendor is not only daunting but complex as well.
EHR Vendor selection is a 5 step process:Step 1: EHR Planning: Decide between Cloud-based EHR and locally hosted EHR solution.
Step 2: Set Goals That Can Be Achievable Through EHR Benefits
- Review the current goals and objectives of the practice to determine the EHR benefits to be achieved.
- Outline the scope and functional needs to achieve anticipated benefits from the EHR.
- Review the practice’s key workflows.
- Does the software work with your practice management system?
- Create a matrix to compare EHR functions to benefits.
- “Best-fit” vs. “Best-of-breed” EHR software
- Research the EHR
- KLAS Research (provides reviews and reports on vendors)
- Black Book Rankings
- Create a shortlist of 2-5 vendors with possible fits to the practice’s criteria.
- Develop a written RFP based upon the requirements.
- Send the RFP to selected vendors asking them to provide an EHR proposal.
- Evaluate proposals by EHR functionality to meet organizational needs.
- Request a demo of the top 2-5 EHR vendors. If possible, request a usability test with test scenarios
- Make the final decision.
- Conclude purchase by negotiating all details related to the services required, including any ongoing maintenance.
As in personal life, before entering a long-term relationship you need to ensure that your future software partner meets your expectations. The list of desired attributes is long.
Desired Vendor Attributes
Here is a list of important questions to ask. Take the time to enhance the list below and create your own list so that you can discuss it in a one on one conversation with the vendor representative.
- Can the vendor provide references in your specialty? Ask for references and follow them up!
- How much experience does the vendor have? How many installations?
- What specialty specific interfaces have already been built and what is the roadmap for new interfaces? What is the cost associated with them, if any?
- Physicians believe that EHR systems do not accommodate clinical practices sufficiently and frequently reduce the amount of time physicians are able to devote to the patient-provider relationship. How much would the vendor be open to making any suggested changes in the near future?
- How much implementation support is provided?
- What is the support model after implementation?
- Will the vendor migrate my EHR data to a new system in the future? What are the costs?
- Does the vendor offer free trial of the software?
- What are the different components of cost inbuilt into the monthly price (for cloud based option)?
- What types of interoperability have been proven and implemented by other providers using the EHR platform?
When choosing an EHR System it is best practice to choose a fully integrated system. EHR and practice management software should work together seamlessly.
Here is a list of the most important benefits:
- Easy access to your patient data and billing information with one secure login
- Easy data sharing between office staff no matter whether it is medical, scheduling or claims data
- Improved workflows and better data flow
- Integrated billing software checks for unbilled appointments and partially entered patient's notes
- Only one vendor to deal with regarding training and support
- Software updates are easier to apply because of one system and one database
RevenueXL offers an integrated practice management and EHR solution. Schedule a demo today!
Best Practice 6: Vet the EHR Software Thoroughly for Workflow Adaptability, Customizability, Ease of Use, etc,
Many EHR solution systems are not efficient or lack the “intelligence” and context-sensitivity to present or request data to the right person at the right time and the right place. A study at the University of Wisconsin found that primary care physicians spend nearly 6 hours per day interacting with the EHR during and after clinic hours. It is paramount to carefully compare workflows provided by EHR software with desired workflows. This practical assessment will reveal multi-user and multi-tasking capability of the software. Data entry needs to be granulated enough to allow simultaneous data entry and nearly instant display of the same information at different places in your practice.
As soon as you have made a list of 3-5 of your preferred vendors, schedule a demo. RevenueXL is a leading provider of cloud-based EHR systems.
It is imperative to test the software in a planned and structured way. Ideally, the practice team should have a good understanding of their workflows and current business solutions. If not reviewed already, the Workflow Assessment for Health IT Toolkit by the Agency for Healthcare Research and Quality (AHRQ) provides invaluable information on how to approach this task. Another useful resource provided by HealthIT.gov is "Workflow Redesign for EHRs". You may also review our blog on how to get the maximum from any EHR Demo.
Make your own list of features that you want to evaluate. Here are some assessment tasks you need to consider:
- Do you like the look-and-feel of the software? Are touch-screens supported? Can the EHR be operated with keyboard only?
- Does it have inbuilt voice recognition which not only works for free text entry but also for navigating the software? Does the voice recognition work with your specific vocabulary, e.g. cardiology? Is it good in recognizing acronyms and abbreviations (e.g. "EKG", "VSD", "QT", "SVT" etc.)?
- Is the physician or practice dashboard well organized, dynamic and customizable?
- To test interoperability with patients and physicians send test data to other practices
As part of the final contract, make sure that everyone on staff will receive EHR training by the vendor. Depending on the size of your practice, it is good practice to train super-users first who will then make themselves available during further roll-out of the EHR software. Ask your vendor these key questions in terms of support and maintenance:
- How long will the support team be on-site during implementation?
- How can the support team be contacted? Via phone, email, online-chat, user forum?
- What is the usual response time when contacted via email or user forum?
- Is there a ticket tracking system with monthly reports to ensure correct documentation of issues?
- Is the support team available 24/7 and 365 days?
According to the ONC, the cost of purchasing and installing an EHR system ranges from $15,000 to $70,000 per provider. Obviously, the final price tag will depend on your individual specific requirements but keep in mind that the benefits of EHR software outweighs its cost.
Please refer to RevenueXL's online blog to learn how much an EHR system cost.
This topic is complicated because of many new regulations and the paradigm shift from fee-for-service to value-based reimbursement. As part of this process, you need to ensure that your vendor delivers certified EHR Software. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) marks a new era in physician reimbursement. Discuss with your vendor how to optimize your EHR for MACRA.
RevenueXL's EHR software helps you to prepare for the new reimbursement system. Contact us and ask us how we can make tour practice more efficient and improve your revenue!
Here are some important questions to ask your vendor:
- What is your roadmap to enable artificial intelligence into your EHR?
- How do you plan to enhance the electronic information provided to doctors by the power of analytics and machine learning?
- In terms of data quality, how sophisticated is the system's data validation? e.g. the user should not be allowed to enter a heart rate of 1 or a respiratory rate of 250!
- How easy is it to export some, or even all (!), clinical and administrative data?
- Does the system provide a query tool and understand SQL?
- Do the exported files have a standard format (e.g. CSV, XLS, XML)?
- Is the content easy to understand. E.g. by humans and software (Tableau, Excel)
- Do the exported tables have meaningful headers and correct date/time stamps?
Soon you will either be ready to install a new EHR system or ready to replace your existing software. Our full-featured, specialty-specific EMR systems are easy to use and give you all the functionality you need to practice medicine and manage your practice workflows your way. Focusing on the needs of small to medium-sized practices, RevenueXL offers affordable and cloud-based EHR solutions that can be deployed straight out of the box or customized to your precise needs.
More than a Great EHR
At RevenueXL, we offer a completely customizable and flexible suite of billing and practice management tools you can configure to your unique practice needs. These tools are far from template or cookie-cutter – our systems are carefully designed to work with you and your workflows, not to replace them with something different, redundant and difficult to learn. You know what works for you and your practice – we simply help you do it faster and more efficiently, with fewer errors and less duplication of effort.Contact us today to schedule a live demo and discuss a custom solution for you practice.
You will find the following posts useful:
- Finding a Replacement EHR Software - Some Do's and Don'ts!
- Achieving ROI After EHR Replacement: Patience and Beyond
- EHR Replacement - 9 Signs That It Is Time To Make The Switch!
- Increasing Productivity with Your EHR: 5 Strategies