By Adele Field, ZyDoc Marketing & Communications Director
Which EHR Should You Choose?
1. Is your practice ready to adopt a new workflow?
Do your research to learn how closely the proposed new EHR’s workflow will approximate your current (legacy) methods of handling PHI. If the new workflow logic will force a radically different approach to entering, organizing, and accessing patient health records, there will be a difficult period of adjustment for your physicians and staff. EHR usability is a hot-button issue, with many vendors falling short. Poor usability will cause significant frustration and inefficiency for your EHR users. If the user interface feels very difficult or will require significantly more staff resources than available, look for another EHR. Charting in an EHR requires a constant flow of data in and data out, a process that can take up to 2 hours per patient visit. An interface that is not user-friendly can make this process onerous. On the other hand, if the interface is generally user-friendly, it may be a good choice for your practice.
Make a list of what you want the EHR to do, and compare features between several different systems.
A specific EHR might be the best fit for your practice, but still lack certain functionalities that you want or need. There are third-party apps and service partners that can fill these gaps and enhance EHR usability. For example, a dictation-transcription service may solve the data entry bottleneck. Computer-assisted coding (CAC) and clinical decision support (CDS) can be integrated as add-ons. A mobile app can be used by physicians to connect remotely into the EHR by smartphone and securely view patient schedules and other information away from the office.
2. Is the EHR certified for Meaningful Use?
To comply with Meaningful Use measures and qualify for MU payment incentives, CMS requires you to use a certified EHR. According to the ONC Quick Stats Dashboard (#30), “Certified health information technology (health IT) meets the technological capability, functionality, and security requirements adopted by the Department of Health and Human Services.”
Below are some helpful resources to check out.
• The ONC’s Quick Stats Dashboard provides access to the latest facts and figures about health IT at https://dashboard.healthit.gov/quickstats/quickstats.php.
• For a list of certified Ambulatory EHRs in use ranked by number of users, drill down further from the dashboard to Health Care Professional Health IT Developers at https://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Professionals.php.
• A comprehensive listing of both ambulatory and acute systems is available at https://www.healthit.gov/sites/default/files/policy/chpl_public_user_guide.pdf.
3. Financial viability factors: Does the EHR have a wide user base? Does it integrate with other EHRs and applications?
An EHR with a large user base is a good sign of financial viability. The last thing you want is for your EHR company to go out of business, leaving you with an orphan system that is no longer supported. Another good indication of stability is integration with other EHRs or third party platforms.
4. Does the EHR system include a billing (RCM) component, or does it support integration with a claims management clearinghouse?
Clinical documentation entered into the patient health record provides the data needed for coding and billing, so it must be available to your billing system. Many EHRs have a revenue cycle management (RCM) component or can integrate with a third-party electronic clearinghouse like Change Healthcare (formerly Emdeon). This function may also be part of a practice management system integrated with the EHR. Given the complexities of claims management and payer networks, RCM connectivity to the EHR is a must. Having all information accessible in one system streamlines the generation of reports and audit trails, and minimizes delays and errors. An important caveat: if the EHR you are considering has a billing component, do your research and speak to other users regarding their satisfaction with the ease and accuracy of the interface.
5. Can the EHR communicate with other EHRs, providers, and agencies outside your network?
Interoperability – the ability to achieve successful information exchange across disparate platforms and systems – is one of the strongest tenets of Meaningful Use. Siloed data is antithetical to coordination of care. Data blocking (aka information blocking) is worse. Clinical documentation frequently must be shared with, or available to, another physician, hospital, or healthcare agency for longitudinal patient care. Registry submissions and other mandatory reporting requirements also necessitate the sharing of data.
MACRA requires healthcare providers (eligible providers, hospitals, and critical access hospitals) to attest to three statements, referred to as “Prevention of Information Blocking Attestation,” about how they implement and use certified EHR technology (CEHRT). But while some EHR vendors are making efforts toward enabling seamless data exchange because of the government’s push for interoperability, the reality is that proprietary system architectures typically can’t communicate with each other without a separate connectivity solution, often at a hefty cost for the healthcare provider.
Interoperability within a vendor’s own closed ecosystem, e.g., communication across all users of that particular EHR, does not address the challenges of sharing data with other EHRs. There can also be financial incentives that discourage an EHR’s willingness to share data. For a statement of the problem, see testimony by David C. Kendrick, MD, MPH, before the U.S. Senate, “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions,” July 23, 2015.
When systems don’t talk to each other, sharing data is difficult or impossible to do electronically. Some EHRs are “walled” proprietary systems that guard your clinical data and severely limit its shareability. Various protocols exist to share data that are platform-agnostic, but the EHR must be able to transmit and accept data in those formats. Some of these protocols are HL7 messaging (CDA, CCD, ADT, FHIR); and DICOM (for radiology images). Application Programming Interfaces (APIs) also offer a bridge, by allowing two disparate software platforms to connect via an API key. As an example, an EHR’s API can be used to populate EHR sections with transcribed documentation. Depending on the EHR vendor, the vendor may charge from $2,500 to $40,000 for this connectivity. Or, a third party may be able to implement its own generic open source API. In either case, the end result is that the API will enable documentation to be transmitted across systems to other providers using an HL7 or other standard messaging protocol.
ZyDoc's cloud-based MediSapien Connect™ enables cross-platform API integration with any EHR, allowing doctors to dictate to populate their EHR at the section level with NLP-driven intelligent data capture.
6. Discuss your needs with third-party ancillary service partners that will need to interface with your EHR. Manual cut and paste? Look elsewhere.
Learn what connectivity solutions the EHR offers, and at what cost. Is a proprietary API required? Does the EHR communicate only with other users of the same vendor’s EHR? Does the EHR have existing interfaces for ancillary services such as RCM or transcription? For example, a dictation-based transcription service such as ZyDoc can seamlessly populate EHR sections to alleviate time-consuming pointing, clicking, and typing in multiple screens if a viable interface exists or can be implemented. Getting clinical documentation into and out of the EHR is one of the biggest hurdles for practitioners. Doctors’ frustration with EHR usability has been well publicized. While there are other methods for populating your EHR, if you use transcription you will want to carefully weigh the security and accuracy risks of using manual cut and paste. A better option to accomplish section-level EHR insertion relatively painlessly is a secure, automated connection with a transcription provider – unless the EHR vendor’s fee for connectivity is prohibitive.
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