How To Choose An EHR System: 8 Reasons Why A Decision-Making Team Beats a Solo Flight

The gist: A team-based approach to choosing EHR software helps small practices avoid compliance risks, usability issues, and budget overruns while ensuring access to the right features and support.

Choosing electronic health record (EHR) or electronic medical record (EMR) software for a small- to midsize healthcare practice can be difficult, especially because you have to consider the features best suited to the practice and its current clinical workflows. Plus, sometimes an otherwise effective EHR can be complex for some team members to use, further complicating the decision-making process. And when you factor in the need to adhere to compliance requirements, the puzzle gets even more intricate.

This is why a solo EHR software buying process can result in a solution with inadequate features, usability issues, and even compliance problems. 

What’s the solution? By adopting a collaborative approach, you can prevent miscommunication and ensure that decisions account for all relevant considerations. By involving others in the buying decision, you gain multiple perspectives and insights. This ensures you get a solution with the right subscription price as well as the ideal tools for managing and safeguarding important data.

8 Key Factors to Consider When Choosing an EHR

Here are eight essential factors to consider.

1. Type of EHR

The EHR software buying process hinges on whether you use a cloud-based, on-premise, or hybrid environment. It’s essential to acknowledge that this isn’t a binary decision—cloud vs. on-premises—because for many organizations, a hybrid approach is the most suitable solution.

For example, a clinic in a rural area may have to deal with an unreliable internet connection. In this case, a hybrid solution may maximize uptime.

2. Essential clinical features

Each organization's wish list is going to be different, but here are some features that many find helpful:

• Charting templates. EHRs can come with features such as dropdown menus, phrase-based searching, macros, checkboxes, auto-filled data fields, and more, which make charting faster and more accurate.

• Patient history tools. An EHR platform can help you store and organize data, including previous diagnoses and treatments, medications, allergies, family history, test results, and more. You’ll want to make sure the EHR has tools for working with the record details you need and also making them searchable.

• Integrated lab ordering. Shortlist tools that can integrate with diagnostic labs, whether located in a hospital or coming via an outside provider, using Fast Healthcare Interoperability Resources (FHIR) or Health Level Seven International (HL7) standards.

• e-prescribing (eRx). The right EHR can connect directly to local pharmacies, national pharmacy networks, and controlled substance prescription networks.

3. Interoperability

Interoperability is a must-have because it enables seamless interactions with key healthcare partners, such as hospitals and imaging centers. It’s especially crucial if your facility already has workflows that depend on other providers.

While many include HL7- or FHIR-based communication, you may also need APIP functionality, so it's worth including on your checklist.

4. An EHR that comes with practice management tools

Many care facilities opt for an EHR system that enables them to streamline their practice management, potentially by eliminating one or more existing tools. You may even be able to reduce monthly subscription costs by replacing your current practice management solution with your EHR—if it has the necessary features. Some top options include:

• Scheduling

• Insurance eligibility checks

• Revenue cycle tools

• Billing, accounts receivable, payable, and collections management tools

5. Compliance verification systems

An effective EHR aligns with the most recent compliance requirements, including HIPAA and certification by the Office of the National Coordinator for Health Information Technology (ONC).

Compliance verification tools can also check for necessary security features, such as multi-factor authentication options and user role management, both of which ensure that only authorized personnel have access to sensitive information.

6. User experience

Ideally, your EHR solution should streamline everyday tasks and make them easier and faster. There may be a learning curve, but relatively soon after implementation, the system should:

• Reduce the number of clicks needed to perform routine tasks

• Eliminate the need to navigate to additional screens for your clinical or billing teams

• Make workflows smoother, especially by unifying disparate tasks under a single umbrella, such as past medical, social, and family history checks

• Enable access for mobile devices, such as phones and tablets, as well as IoT imaging devices, if necessary

7. Vendor support and reliability

Vendor reliability is fairly straightforward to assess by checking their uptime history. When weighing two top options against each other, uptime is a good tie-breaker.

However, vendor support is more nuanced. Some teams may need a more hands-on approach to support, including implementation and integration assistance. Others can handle the technical aspects in-house, but may have staff who need support in determining the most effective ways to optimize workflows. Once you have multiple stakeholders at the table, narrowing down the kind of support you need becomes much easier.

8. Total cost of ownership (TCO)

Your TCO calculations may start with licensing costs, but that’s just the beginning. You also have to factor in:

• Hardware purchases, if necessary

• The cost of data migration

• Long-term support cost, as well as different support packages

• The cost of training existing and new staff

How to buy EHR software—step-by-step

Buying EHR software takes more than a quick look at a few feature pages. The best way to maximize your chances of success is to sit down with your team, and do the following:

1. Define business needs and compliance requirements. Your compliance requirements will vary depending on the regulations that apply to your practice. However, it is essential to also consider non-healthcare-specific bodies, such as the payment card industry data security standard (PCI-DSS) and OSHA.

2. Shortlist vendors based on features and budget. Choices between pricing models may come down to minimum subscription time periods or setup fees. On the other hand, your features list should focus on what’s absolutely necessary, such as integrations with existing partners.

3. Evaluate user reviews and demo experiences. Mining user reviews is a good way to surface the pain points that others have encountered while using an app. This step is also where your clinicians and staff get to dive in and see how the software complements their workflows.

4. Compare implementation timelines and support. Factors that may affect implementation timelines include data migration issues, the amount of training staff will need, and the setup of user accounts, all of which your solution provider may be willing to help with.

5. Finalize with contract and onboarding planning. Put service level agreements (SLAs) head-to-head, comparing uptime guarantees and support terms. As you build your onboarding plan, be sure to factor in training and security testing, which may require a basic penetration test.

How a decision-making team improves outcomes

Taking a team-based approach reduces blind spots because each team member can identify features that will benefit their workflows. Here are some real-world examples:

• Clinicians can identify missing specialty features, such as chest pain scoring for cardiologists or fetal monitoring data for OB/GYN specialists

• IT can pinpoint security issues, such as cross-site scripting vulnerabilities or weak authentication systems

• Administrators can weigh in on the impact of long-term costs or evaluate compliance reporting capabilities

• Billing staff can identify issues with claims workflows or explain the value of specific coding tools

Common pitfalls when choosing EHR software alone

When you use a single decision maker, you may inadvertently introduce significant issues, such as:

• Missed compliance risks. Without an understanding of compliance requirements around role-based access controls, someone may choose a solution that doesn’t align with HIPAA.

• Overlooked integration needs. Integrating with current partners is only one consideration. By using a team, you can also identify opportunities to expand your integrations, which could save time and improve accuracy.

• Budget overruns. Some solutions may have clearinghouse fees that increase usage costs, or even require customizations that necessitate hiring an expensive developer.

FAQs

Is it best to use a cloud-based or on-premise EHR for small practices?

Because cloud solutions tend to have lower upfront costs, many smaller practices choose the cloud over on-prem when comparing EHRs.

What’s the easiest way to save money on our first EHR?

You can save money by opting for a less expensive solution that meets your most basic needs, and then only agree to a month-to-month commitment. You can always upgrade later if necessary.

How long does an EHR implementation take?

For small to midsize businesses, it’s best to assume an implementation will take between two and three months. This gives you enough time to work through any data migration issues and provide staff with basic training.

Next steps for choosing the best EHR