Case Study

Easier and more efficient office workflow
Significantly reduced note completion time

Dr. Jonathan Bertman first used an Electronic Health Record (EHR) more than ten years ago when he worked for South County Internal Medicine in Wakefield, RI. While the group's EHR had features and abilities to facilitate documentation, Dr. Bertman found that it hampered his ability to see patients, “Entering something like ‘productive cough for 3 days’ turned into a painful exercise of navigating through lists of dropdown menus and checkboxes.”

When he started his own practice, Dr. Bertman researched a number of EHRs, asking each vendor to demonstrate the speed with which a brief note could be documented as well as the cost of the software.  “I felt the systems were designed by programmers,” Dr. Bertman said. “The number of windows, menus, and checkboxes required to navigate or to document a simple note was ridiculous.” Dr. Bertman also felt the products were too expensive per physician and required a steep learning curve to get everybody trained.

With that, Dr. Bertman decided he would learn how to program and write an EHR system that could run his own office.  As his home-grown program developed and matured, he offered his software to other physicians, and his product, Amazing Charts, is now being used by over 3,000 practices across the country.  Dr. Bertman has recently taken a sabbatical from his clinical practice to focus on adding new features.

Although Dr. Bertman is biased towards Amazing Charts, he believes there are a number of good products available, and following a few simple rules can help physicians avoid making the frustrating, time-consuming, and costly mistake of picking the wrong EHR.

1. Research less-biased sources.   A number of Academy websites, such as the AAFP’s Center for Health IT www.centerforhit.org, provide a place where members can rate the EHR systems they use. These ratings and associated user comments are extremely valuable as they provide untainted information on the system’s usability from actual users who tend to share not only the positives, but also the negative aspects of their EHR system. It is here that one can get a good feel of the product's true "usability."

2. Ask colleagues.  Ask your friends and colleagues using an EHR how they and their staff like it. Do they finish their notes and get home sooner than before they implemented the system? How much did it cost, and what “hidden” charges did they encounter? Most importantly, knowing what they know now, would they purchase the same system again?

3. Visit each vendor’s website.  Since it is via the website that most interactions with vendors occur once a product is purchased, ask yourself if the website is easy to understand and navigate. Is there an uncensored user-board, and can you quickly find the answers to the questions you have?

4. During the demo, go off-script and count clicks.  EHR salespeople can be very good at making software look really cool during a presentation. Take control of the demo, and have the rep show you how to document a visit that is not part of their “script.”  You’ll quickly get a sense of how intuitive the product will be to use. Counting how many clicks, drop-down menus, and windows it takes to do certain tasks is another great way to know immediately if the software has truly been designed for the busy practice.

5. Make a list of your top choices, and then compare apples to apples.  Vendors are trained at touting their positives and obfuscating their negatives. To really compare products to each other, make a spread sheet and ask the same questions of each vendor. For example:

• What is the total cost? Is training included in the price? How much does it cost for each provider? Is all staff included?
• Ask vendors to provide you a list of every fee they charge, even if it isn't “usually used by a practice of your type.” All too commonly you'll find there will be all sort of hidden expenses that they failed to disclose (e.g., lab interface fees, e-prescribing charges, and other extra “module” fees). Vendors typically won't voluntarily provide this information until long into the courting process.
• Do they have a risk-free guarantee? “You shouldn't have to take the risk that their solution will work for you. They should be so sure of their solution that they provide a completely risk-free trial of their software for use in your actual practice. If not, you should at least be able to get out of the contract and get all your money back if you decide their system just doesn’t satisfy your needs.” Even if the vendor doesn’t advertise a complete guarantee, demanding one as a condition of considering their software can often be written into a contract.

6. Don’t rush.  Despite all the hype and aggressive selling tactics by vendors, payors, and government agencies, don’t be rushed into a decision. The biggest mistake will be selecting the wrong system, and it is estimated that nearly 1 in 3 EHR implementations fail. And of those that “succeeded,” many remain in place being only partially utilized by frustrated doctors.

Dr. Bertman’s staff has experienced relief since the office shifted to an electronic workflow. “They have told me it makes everything they do easier. They don’t have to get up to pull or search for charts, and there is no filing backlog."

“For me, the bottom line is that my notes are completed a half hour after seeing the last patient. Simply put, the EHR is a tool in my office (not the other way around), and I never have to catch up or complete notes at night or on the weekend.”

Dr. Bertman’s office is looking forward to receiving the government stimulus money and improved P4P reimbursements by reaching the top level of Patient Centered Medical Home certification. “Amazing Charts is currently putting a lot of energy into building a simple PCMH/P4P wizard that will make this happen and I am 100% confident the company will do what’s necessary to make it happen.” (It should, after all, since Dr. Bertman owns the company.)