Selecting an EHR system that is right for your practice requires a clear understanding of your needs and goals and thorough research. Because you'll use an EHR for nearly every aspect of your work for many years, choosing a system that most closely matches your needs and work style is crucial. The more you understand about how you work and what you want, the more likely you are to select the right EHR.
Make a point to consider your practice size and medical specialty when selecting an EHR. HIT systems are designed with specific numbers and types of users in mind, and issues such as scalability of the software and orientation to specialty can impact how manageable your EHR implementation is.
If you are a member of the EHR Adoption Program for eligible PCPs, you can work closely with your Relationship Manager to determine which system is best for you.
- Determine Software Model
- Request EHR Software Demonstrations
- Prepare Requests for Proposals
- Verify Certification of EHRs
The client/server model is a system installed in and managed by your office. Client/server installations give you more control over your data and server. They require a number of components, based on practice size, including:
- File servers
- Workstations/tablets/laptop PCs
- Networking hardware (hubs, switches, routers, cables, etc.)
This choice carries high upfront costs and requires ongoing support from IT contractors or in-house staff, but also offers depreciation savings.
An application service provider (ASP) hosts software on a remote system and offers access as a subscription. That subscription—usually a monthly fee—provides hardware and software. With an ASP, the ongoing costs are consistent and there are no high up-front expenses.
With an ASP, you do not host your system. Instead, the ASP supplies the EHR and its data from a secure hosting facility (which should include disaster recovery and backup). Ensure that any ASP agreement specifies who owns the data and how it can be accessed or moved.
ASPs protect data using firewalls and HIPAA-compliant encryption and maintain up-time using redundant systems. To use an ASP, you’ll need a high-speed Internet connection in your office, as well as a computer network and other software.
The following table summarizes EHR software models:
|Location of Software / Data||On a server located in the physician’s office||Located on a remote server and commonly accessed via the Internet|
|Security and Backups / Responsibilities||Practice is responsible for maintaining a secure data center||ASP provider is responsible for data backup and security|
|Technical Staff||Practice is responsible for providing technical support for the servers and service operating systems||Vendor typically provides support and service|
|Cost||Higher up-front costs used for hardware and installation||Lower initial fees, but there is a monthly fee payable to the vendor for access|
Vendor demonstrations are extremely important in your EHR system selection process. Vendors can bring a customized presentation to your office. To take advantage of these demonstrations, provide clinical case studies from your experience in advance of the meeting, and request that they use them as illustrations.
In preparation, perform a quick analysis of the most frequently used current procedural terminology (CPT) codes in your practice. In most single-specialty clinical practices, the number of codes that account for 95 percent of the practice revenue is rarely more than 25. Ask the vendor to illustrate how a template for documenting some of these codes might look, whether users can create templates, and what is involved in constructing a template. In other words, ensure that the vendor’s on-site presentation focuses on your needs.
During the presentation, think about the following:
- Will providers and staff find the system easy to learn?
- Is it a product that this practice can become proficient at using relatively quickly?
- Will the data capability of the system generate the information necessary to enhance quality of care and reimbursement?
Review the profiles of EHR software vendors in RI REC’s Vendor Marketplace.
After meeting with several EHR vendors, you might consider submitting a formal request for proposal (RFP).
An RFP is a carefully structured, detailed outline that includes all the decisions your practice has made so far about its HIT needs plus information about your practice:
- Goals for EHR implementation
- Practice size, locations, and description of physical space
- Provider specialty or specialties
- Current and desired practice management system
- Current computer hardware and network information
- Required interfaces
Conduct a brief connectivity survey with the entities your practice uses: hospitals, ambulatory surgery centers, clinical laboratories, physical therapy providers, imaging centers, KIDSNET, etc. If they offer the capability for electronic transactions, get the technical specifications for interfacing with them and include those specifications in the RFP.
If you are enrolled in RI REC’s EHR Adoption Program, your Relationship Manager can help you prepare an RFP.
There are many benefits of preparing an RFP. An RFP enables a vendor to focus on the issues that you have identified as important and to tailor the offering to your practice’s needs. It provides clarification of all that has been decided during your planning process. Because all vendors’ RFPs will be created using the same specifications, you can fairly compare the products and services of several companies. After you accept a proposal, the RFP can serve as the basis for creating a project timeline and minimize any potential misunderstandings with the vendor regarding costs.
When selecting HIT products and systems, you want to know that they are tested and certified to meet certain standards. You want to make sure that the EHR you choose is secure and that it can maintain data confidentially, work with other systems to share information, and perform a set of well-defined functions.
The Office of the National Coordinator for Health IT (ONC) has established implementation specifications, certification criteria and certification programs for HIT to ensure provider and patient confidence in EHR products and systems. These final rule standards are to ensure that EHR products have the technical capabilities and functions necessary for healthcare providers to achieve Meaningful Use Stage 1 objectives.
The standards and certification rule also specifies how providers use a certified EHR to meet applicable meaningful use requirements. The EHR you choose must be certified by the Department of Health & Human Services (HHS) to qualify your practice for Medicare or Medicaid EHR incentive payments.
Why is Certification Important?
Both the Medicare and Medicaid EHR Incentive Programs include a requirement related to certified EHR technology:
- In the Medicare EHR Incentive Program, eligible healthcare providers may receive incentive payments if they adopt and meaningfully use certified EHR technology (a complete EHR or EHR modules that are certified by an ONC-Authorized Testing and Certification Body, or ONC-ATCB).
- In the Medicaid EHR Incentive Program, eligible healthcare providers may first adopt, implement, or upgrade (A/I/U) to certified EHR technology in their first year of program participation and receive an incentive payment before having to demonstrate meaningful use.
How do I Know which EHRs are Certified?
Currently, there are six ONC-ATCBs under the temporary EHR certification program, created to assure providers that an EHR is technically capable of meeting the Stage 1 Meaningful Use objectives and measures. ONC’s permanent certification program is set to begin in January 2012.
Current ONC-ATCBs include:
- The Certification Committee for Health IT (CCHIT)
- The Drummond Group
- ICSA Labs
- InfoGard Laboratories
- SLI Global Solutions
- Surescripts LLC (certified for e-prescribing and for privacy and security modules)
Types of ONC-ATCB Certification
An EHR module refers to any service, component (or combination of the two) that meets at least one of the HHS certification criteria.
A complete EHR or EHR module designed for an ambulatory setting must be tested and certified as including at least nine of the CMS clinical quality measures—all six of the core (three core and three alternate core) measures and at least three of the additional measures.
Consider the following when choosing a complete EHR and EHR modules:
|Complete EHR||Less hassle with updates/upgrades||Less customizable and may not meet the needs of all the clinicians in your office|
|Better user interfaces and simpler interfacing with labs and hospitals||Cannot be used to supplement an existing EHR system that may not have complete EHR certification|
|Up-front cost may be higher|
|EHR Modules||More flexible; allow practices with existing software to add new functionality without changing the rest of the system||High level of technical expertise required for assembly of a module-based EHR|
|Allow purchased certified EHR technology to be mixed with self-developed technology||Require purchasers to evaluate the companies offering the technology, as well as assemble and interface enough modules to support all meaningful use objectives|
|Up-front cost may be lower|
There are more than 500 certified electronic health record technology products, as described on the ONC’s Certified Health IT Product List. All of the pre-qualified EHR software vendors in the REC Vendor Marketplace already have, or are working to attain, ONC certification.
If you are enrolled in RI REC’s EHR Adoption Program, your REC Relationship Manager is prepared to answer your questions, discuss the goals and needs of your practice, and address any concerns about EHR certification and its relationship to meaningful use requirements.