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Selecting An Electronic Health Record
A Practical Guide
Welcome
This is the third office health information technology learning module of a series.
These modules are designed to introduce and teach family physicians, other providers and office staff about health information technology (HIT).
They can be learned sequentially or as stand-alone sessions.
Center for Health Information Technology Part of the AAFP Established in October 2003
Our mission: To promote and facilitate the adoption and optimal use of health information technology by AAFP members and other office-based clinicians, for the purposes of improving the quality and safety of medical care and increasing the efficiency of medical practice.http://www.centerforhit.org
Learning Objectives
Understand the methods and available resources to evaluate your readiness for an electronic health record (EHR).
Understand the process of selecting your EHR and be aware of available resources.
Understand the process of making a successful EHR contract and establish a strong business relationship with your selected vendor.
EHR Timeline
Life Cycle Step
Preparation Selection Implementation Upgrades-Maintenance
Task Examples
LearningReadiness assessment
DemonstrationsSite visits
Workflow Improving efficiency
This Module
Discusses
Pre-purchase preparation
Selecting an EHR
EHR Selection Outline Ready!
Readiness assessment Assemble your team What’s up in your neighborhood
Get set! AAFP recommended criteria
ACID test Partners for Patients
Information sources Checklists and such Beyond the checklists Other considerations Visiting friends
Go! Making the deal Arranging for implementation
Readiness Assessment
Everybody on board?
Ready!
This will be great!
This will be
horrible!
Realistic expectations?
This should be
a snap!
This looks to be
impossible!
Ready!
Readiness Assessment
What are your goals for the EHR?
Make more $$$
Safer medical
care
Less paper in the office
Track chronic disease
The goals of all the providers do not have to line up exactly, however different EHR products have different strengths and
weaknesses in these areas.
“Seven blind men and the elephant”
Ready! Readiness Assessment
Ready to buy an EHR
Ready to implement an EHR
Ready to properly use an EHR
Buying the “right” EHR will not solve all of your problems!
Good
Better
Best
Assemble Your Team
Who? Physician, nurse and/or front staff in a small
office
When? Early in the process
Tasks Identify EHR functional requirements Narrow down the contenders Evaluation and site visits Serve as liaison with the rest of the office Generate a request for proposal to be
submitted to vendors
Ready!
Ready!
What’s happening in your neighborhood?
Are the local hospitals engaged in an EHR project?
Are other local primary care and family medicine offices already using an EHR?
Are there specialty offices with an EHR in your area?
If your office is in a rural area,can you get reliable high speed Internet connections?
How many laboratories do your patients use and are they willing to provide an interface?
Can you get imaging information in digital format?
Ready!
What’s happening in your neighborhood?
Ready!
Readiness Assessment
Finally you are ready! Now slow down and take your time.
A good deal of money is involved in an EHR purchase
The most costly aspect will be the time and effort spent going from paper to an EHR
Make sure you purchase the “right product" for your office and make the business deal you want
It pays to invest adequate time and thought in the selection process - don’t rush
Readiness Assessment Tools CHIT readiness assessment tool
CHIT readiness assessment link
EHR impact assessment tool
CHIT 2005 Vendor Survey 2005 EHR vendor survey link
AHRQ readiness assessment presentation AHRQ readiness assessment link
Ready!
Readiness Assessment
Get Set!
AAFP Recommended Criteria for EHR Software
EHR software should pass the ACID test.
Affordability
Compatibility
Interoperability
Data Stewardship
Partners for Patients Members of Partners for Patients are
companies that have come forward voluntarily to sign a declaration of support for the ACID test principles, upon which the Partners for Patients initiative is founded.
Partners for Patients list on the Web
Get Set!
AAFP Recommended Criteria for EHR Software
Get Set!
AAFP Recommended Criteria for EHR Software
The Rosetta Code of Health Information ExchangeGet
Set!
Recommendations Summary The AAFP recommends that you favor purchasing
software from a vendor that is a Partners for Patients member.
The AAFP recommends that you favor purchasing software from companies that are developing CCR-enabled software. CCR information link
Get Set!
AAFP Recommended Criteria for EHR Software
Information Sources Center for Health Information Technology Web site
www.centerforhit.org General information and tutorials EHR vendor specific information EHR user reviews
AAFP EHR email discussion list A discussion list of EHR users
Friendly, valuable advice (and opinions!)
Get Set!
Information Sources Other Web sites
www.emrupdate.com www.docsboard.com
Health Technology Resource Guide (aimed at community clinics but very useful) is downloadable at: Community Clinics Initiative
Meetings and shows
Local resources Hospital, IPA, other providers, etc.
Get Set!
Think about desirable features ahead of time Rank desirable features
Features that are absolutely necessary(Improve efficiency, quality and/or safety)
Features that would be nice to have Features that are optional
Resources: E-Health Initiative master quotation guide
Link to EHI-EHR master quotation guide Selecting the right EHR
Explore the CHiT Web site after this presentation
Get Set!
Checklists and Features
Beyond The Checklists
Get Set!
Can the software perform this
function?
Of course!
Should be followed by these questions….
Can you show us a practice
that’s using___?
Does it cost any more?
Is there any third-party software that needs to be purchased to make it functional?
This question…
Beyond The ChecklistsWorkflow and Patient Scenarios
Document a complex patient Multiple problems Problems with no template
Sample workflow scenarios Converting paper into digital format Ordering laboratory and radiology studies Workflow requiring interfaces
Get Set!Give the EHR of interest a workout!
Beyond the ChecklistsInterface Properties
Consider how the particular EHR looks and functions: Some look like a paper chart (tabular) Some will use checkboxes and pop-up lists,
while others will enter blocks of text with text “expanders”
Ability to reuse information Tracking, disease management and reminder
functions
Get Set!
Beyond the Checklists
What makes an EHR more expensive? Extensibility
Provision for one to hundreds of users Runs on advanced databases
Configurability Customizable for different individuals, offices and specialties Look and feel of the program can be adjusted
Granularity Program permissions and options can be set at the individual and group level
Integrated EHR and practice management system
Bells and Whistles Web module, PDA module, etc.
Get Set!
Other Considerations
Financial solvency of the company
Active user groups
Number of installations
Frequency of new versions
Get Set!
Client-server vs. application service provider model
Database model
Certification issues
Get Set!
Other Considerations
Get Set!
Getting Help
Should you get help?What?
Help with evaluating your office
Help with choosing an EHR Help with making a deal
Who? National health IT
firms Local health IT
experts and lawyers National and local
experienced family medicine physicians
Get Set!
Getting Help
Finding helpAsk around locallyEHR email discussion lists
Ask us (Center For Health Information Technology)
Getting Help
Get Set!
Visiting Friends
Since the work and time necessary to transition the family medicine office from paper charts to electronic format represent the main cost of an EHR implementation, it is always worthwhile for a provider and, ideally, key office staff to make a site visit to another office using the EHR of interest .
A site visit is a good investment of money and time even if the decision is to not purchase the EHR in question.
Get Set!
General Observations
“More” is not always better Match the EHR capabilities with your needs Avoid excessive complexity
Concentrate on “core” EHR capabilities that use digital information well: Connections to outside information sources Communication within the office Ability to reuse information that is entered once Ability to facilitate teamwork and collaboration Ability to have the patient enter information in the office or at
home
Get Set!
Making The DealPurchasing an EHR
Office and provider satisfaction with an EHR is as dependent on the final deal and vendor collaboration as it is on the selection itself.
Take the time for due diligence. Understand who is involved in the
agreement (vendor, third-party reseller, hospital etc.).
Take a step-by-step approach.
Go!
General business goals with your vendor: Negotiate an agreeable contract Account for costs up-front Develop a productive partnership
Go! Making The DealPurchasing an EHR
Doing your homework -- Resources:
AAFP Center for Health Information Technology: EHR 110 - Understanding EHR Contracting
and Pricing
Community Clinics Initiative: Fundamentals of negotiating the deal: Do's and
Don'ts
Go! Making The DealPurchasing an EHR
Go! Making The DealPurchasing an EHR
The art of negotiation: Don’t rush the process:
You may forget to include important points in your contract
You may be at a disadvantage
Being tough can be painful but: You never know what you can get unless
you ask If you start by asking for minimal
requirements, that's what you will receive (or less)
What vendors need from the family medicine office Clear requirements Active involvement and commitment to the project Staff resources for implementation and testing Realistic timeframe expectations Timely responses to questions and issues Understanding of contracts and business practices
Go! Making The DealPurchasing an EHR
Contract issues to consider
How is the software licensed? Training issues and costs Implementation and maintenance costs and responsibilities
Go! Making The DealPurchasing an EHR
Payment issues and timeline Functional milestones
Service-level agreement Hours and methods of support Response times and severity Problem resolution and escalation
Go! Making The DealPurchasing an EHR
Arranging For Implementation
Hardware requirements
Communication requirements
Training requirements
Look at the implementation module in this series
Go!
