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Meaningful Health Care Informatics Blog

Jul 25 2010   9:25PM GMT

The 10 critical steps to selecting an EHR

Posted by: RedaChouffani
EHR, selecting EHR, top 10 steps toward ehr

As many medical practices shift gears toward a paperless environment, it’s clear to many as they discover the newly flexible meaningful use requirements that they will further investigate the implementation and adoption of an EHR solution.

In selecting an EHR, most healthcare organizations face conflicting reports on products they are evaluating, some of which can be based on lack of proper product implementations. Others failed products that did not fit the practice’s workflow.  As an example; by knowing how to select an EHR product, and examining how some of the previewed products compare, the medical practice  will be able to properly identify its need and which products can successfully meet its challenges.

Practices have had plenty of time to make paper charts work for them since the early 20s, when the US saw the spike in private group practices grow. This provided ample time to perfect the efficiency of using paper based workflows.  While several software vendors come with a promise of a new world where no paper exists and practice’s revenues increase, it would be very naïve for any Practice Administrator to take their word for it.

Today’s technology is fully capable of automating and streamlining many clinical workflows, as long as it is the right solution with the right planning and readiness.

To avoid being just another statistic in the failed world of EHR, there are a few critical objectives that should be met to ensure a thorough assessment, smart selection and careful planning an EHR selection.

The following are the ten steps that can help you during your EHR selection stage:

1.      What are the organizations SMART (Specific, Measurable, Attainable, Realistic and Time bound) EHR Goals.

2.      Current State Analysis where an extensive review of current workflows and systems is performed.  In many cases this will assist in identifying all the steps that will need to be streamlined and replaced when going paperless.

3.      Identify all entities that will be integrated, or interfaced to the system>  Ranging from LIS (lab Information System), Imaging system (medical imaging), EKG machines, Lab companies and any other entity that retains medical information relating to a patient.

4.      Create a Comprehensive Vendor Questionnaire and define all the elements that are more relevant to the practice’s specialty and challenges.  Some of the questions that must be prepared would be:

Some examples are:
* What is the cost per physician?
* Total cost of ownership, yearly fees, support costs and upgrades
* Can you design and modify the current system templates?
* Is your system true client/server or it is web based?
* How many installations do you have that are current?
* Is support local or outsourced overseas?
* Is your product a certified product (certification body to be determined)?  If not, do you plan on it?
* Can your product interface with another PMS application?

5.      Interview and evaluate the products according to your workflow.  This was a very successful method to really see the products in action.  This would be the step where you present your top commonly used workflows to the vendors and have them use those workflows during the demo.

6.      Request References From Vendors of Practices Such as Yours

At this step, a list of practices using the product that you can contact would be advisable.  This would shed some light on several components.

Questions to ask are:
* How long before the practice was seeing the same volume of patients?
* What specific items do the providers see as value with this package?
* What items does your clinical staff say is slowing them down?
* How would you rate the company support?
* Has this impacted your billing cycle?

There are several questions you should ask, but the main focus is to be specific. Get facts which will help you determine whether or not this package is a good investment.

7.      Review the Business Case

Whether the vendor provides you with a strong business case to justify the investment you are about to embark on or you take it upon yourself to create a financial analysis, it is a must to have some financial measurements such as return of investment (ROI), total cost of ownership (TCO), net present value (NPV) and discounted cash flows (DCF).  This will enable you to have a clear understanding on whether this solution will pay for itself or drain your practice of income during these difficult economic times.

Some of the items to review are:

Soft ROI: This is the element of your business that will have soft savings.  For example: First begin to perform time and motion studies.  This is where you measure the time it takes for the physicians to document a visit, prescribe or record the diagnosis and procedures on the encounter.  Then measure the time it will take for the same activity but with the EHR package (s) you are evaluating.  The difference in time gained will be one of the practice’s soft ROI.

Hard ROI: This can be associated with the cost savings from eliminating things like paper charts, folders, material, filling cabinets, and space leased for storing paper charts, transcription costs and such.

Risk Mitigation: The final section will cover the risks of using such a product.  It is clear that by digitizing paper charts, practices reduce the risk on misplacing or losing patient charts.  With the proper backups in place, a healthcare organization can rest assured that no matter what, the patient charts are protected.  In addition, some of the prescription modules enable drug interaction and allergy alerts.  This reduces the patient’s health risks dramatically.

8.      Visit Local or Remote Client’s Site

Being exposed to a live site using the product(s) you are evaluating is key.  This can help you get candid feedback, and will demonstrate how it is being utilized.

9.    Create a matrix, add the score each of the products based on each of the steps discussed above, then analyze the results.

10.      Decision Time

When you have considered your goals and challenges, what to resolve and what products to select, reviewed their existing install and had everyone on the same page, it’s time to evaluate your findings and use the attached checklist to assess which of the products will fit your need.

As the market and healthcare regulatory changes continue to affect medical organizations, executives are under pressure to reduce IT costs, automate current processes and increase revenue. Some of the changes can also determine if current implemented EHR will be a source of incentives or penalties.

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