The No-Confusion Way to Choose an EHR

Cyndi Bryant Walker, CMB, CHBC


February 03, 2011


If you're still weighing the pros and cons of an electronic health record (EHR) purchase, consider this:

Forget about going to an EHR because the government may or may not force you to comply. Think of improving your practice and perhaps your quality of life with the benefits of an EHR. Your coding compliance will increase. You'll have access to data about your practice and patients that would be impossible with a paper chart. An EHR will have a major impact on your practice and the way that you currently triage patients in the office.

Here are common scenarios in offices without an EHR: A paper chart is expensive to produce and you can never seem to find it when you need it most. A chart audit will most likely confirm that your documentation does not add up to the code reported. In my chart reviews I find that physicians are either undercoding or underdocumenting services performed and that approximately 30% of handwritten charts are not compliant.

Although choosing the right EHR can be confusing, these 10 steps can help ensure that you'll be happy with your selection.

1. Take a closer look at ASP technology.

Application service provider (ASP) technology means that the EHR program and data are housed securely at a vendor's or institution's location; you don't need to have expensive servers and tech support in your office if you have high-speed Internet access.

The ASP EHR model will range from about $350 to $650 per month, plus training. Billing software will be an additional cost. The other option is buying an EHR that requires an in-house server and software. Systems like this that I reviewed averaged between $40,000 and $60,000 depending on the amount of bells and whistles added.

With ASP models, benefit changes and software improvements are continually updated on your site so that your practice is always using the most recent data and advanced software. You don't need proprietary hardware or additional servers. You do not need to house your own server, and many systems have a minimal cost up front. You also will be able to log in from home to view patient data and reports.

The downside to ASP technology is that when the Internet is down, so are you. Make sure you have good, stable Internet service before considering this option.

2. Take your time and evaluate companies thoroughly.

Two good resources for starting your search are the KLAS reports and CCHIT-certified companies. The KLAS rating will show you detailed information from physicians about software performance and cost. CCHIT (Certification Commission for Health Information Technology) is an independent organization that performs certification criteria and inspections for EHRs. Products must significantly exceed minimum federal-standards requirements, are rated for usability, and are verified to be in use successfully at multiple sites, according to the CCHIT Website.

You may consider hiring a consultant to help you review your practice's EHR needs. There are several places to locate a consultant with experience. Try your local chapter of the American Medical Association or the National Society of Certified Healthcare Business Consultants. The NSCHBC's Website ( lists consultants by state.

3. Check out your software vendor.

Ask for references in your specialty. Call practices that have worked with the vendor and ask about downtime, software support, and overall satisfaction with the software.

Choosing a company is half the battle. What will you be married to after the salespeople leave?

Once you have done your research, choose 2 or 3 top contenders and then compare what I call the "nuts and bolts," which is the daily interaction with the EHR company.

4. Evaluate the EHR company's daily support structure. How does the company handle support calls?

Some companies require you to send an email with the problem described. These emails may be handled outside of the United States and may be processed by a computer rather than a human being. You will get to speak to a real person only when the email consultation fails. Email is a frustrating medium when your software won't work. Make sure that you are comfortable with your vendor's support system.

5. Make sure the company interfaces with your laboratory.

Most companies can build an interface for lab data. Make sure you ask about the cost of the interface. Some companies will charge as much as $5,000 plus a monthly fee for an interface.

6. Scrutinize the medical notes preloaded in the EHR.

If you find that most of the data preloaded in the system will not fit within your scope of practice, pass up using that EHR. It has been my experience that it is too overwhelming to learn a new EHR and build templates at the same time. If you have to build it yourself, take a pass and find a company that suits your needs.

7. Research the billing package.

The EHR is only part of the purchase. Discuss the billing package of your new system in detail.

Must-haves in billing software:

CPT and ICD-9 codes updated yearly. You want a system that automates this process. Most cutting-edge billing software will automatically update codes every year with a download.

Automated statements will save you time and money. Most vendors offer this service at a discounted rate compared with postage. You will get to take advantage of the bulk discount rate.

Automated verification of benefits is a big plus for family practice or internal medicine groups. The patient benefits are downloaded into the system. Copays and deductibles are easily identified and save staff hours of time. Your copay can be as much as 30%-40% of your income on an exam, so this is a significant benefit to your practice.

Rejected claim reports. Most vendors will tell you that they have a "claim-scrubbing process." The software scrubs the claims for several different factors, and therefore reduces error. This is true to some extent. Invalid CPT codes and ICD-9 codes without the fifth digit are screened by this process as are claims with other basic coding errors. The most important factor in billing software is the ability to load LCD or CCI edits and specific carrier-required modifiers.

An example of this is screening colonoscopy or well exams. Most carriers only cover a specific diagnosis for these procedures. Good billing software will warn you if you are not billing the service with a covered diagnosis. This tool is a major benefit for billing staff.

Electronic posting of payments. This service is a real time-saver. A 20-page EOB from Medicare can be downloaded in seconds. The software posts all payments, adjustments, and rejections. You receive a report of all postings for review.

EDI transmission reports are extremely important to your billing success. Investigate how the company reports provide you with a list of claims transmitted. Carrier errors and rejections should be easy to access. You will also want proof of timely filing to be at your fingertips.

Hints for Introducing an EHR to Your Practice

8. Add the scheduling and billing module first before bringing on the EHR.

If you are adding a new billing system and EHR at the same time, I highly recommend that you add the scheduling and billing system first. This will give you time to populate that patient demographics and allow staff the time to train and become efficient with the scheduling software.

9. Set aside enough time to train.

Regardless of how great the EHR performs, you will not be able to enjoy its full benefits if your staff is not fully trained. Lighten your workload on the first few days of training. Don't schedule meetings or take outside calls if they are not completely necessary. Devote your time allowed for training to the trainer.

I have seen an office spend several thousand dollars for training and not get the full benefit because the patient load was too heavy or other activities were planned at the same time. When the trainer leaves, you will be lost if your staff aren't fully trained. I recommend that you schedule 3-5 full training days with a follow-up of 2 more days in a couple of weeks. You can absorb only so much information in a single session.

I also advise clients to request a seasoned trainer. EHR sales have sparked in the last 2 years and companies are hiring new trainers. Make sure that if you have a new trainer, the company will send an experienced representative to assist.

10. Prepare yourself and your staff for change.

Even with the best EHR system, you will experience confusion, frustration, and tears. Why? Because everything changes and the prized paper chart is gone. You will forget about your beloved paper after a few weeks of using the EHR, however. Educate your staff about the transition. Prepare them for confusion in the first couple of weeks.

I recommend against using a dual system of paper charts and EHR. Make the break from paper and suffer through the transition. You made the purchase in order to get rid of the paper.

In the end you will have devoted a great deal of time and some financial resources that will pay off for your practice. You will reap the benefits of change. You will wonder why you waited so long, and your beloved paper chart will be all but a bad memory.


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