The key difficulty in selecting an electronic healthcare record (EHR) is that few practices have a clear vision of what the EHR should have and what constitutes an effective EHR. With several hundred potential EHR options, the average practice is faced with a dizzying array of options and products.
Surprisingly, the EHR product selected can affect medical professional liability (MPL.) Not all EHR products are the same or have the same capabilities. If you buy an inappropriate product, you may have to make operational and management compromises that affect how well you track and administer patient care. In order to avoid such risks, you need to purchase a product that effectively handles three key needs:
Workflow Tools – If patient paper charts are eliminated, how will you be able to track events and activities in your office? EHR workflow tools allow you to view patient status in the office as well as the various reports and messages that need clinical review or response. Unfortunately, not all EHRs can manage all situations. For example, some EHR workflows do not deal with mid-level providers or lack tools for in-house diagnostic services. In some situations, vendors use strategies that can manage a doctor, but complicate management of a busy office or large practice.
Patient Service – One of the key added value benefits of an EHR is the ability to track outstanding patient orders. Unfortunately, some EHR products cannot effectively track and manage the doctor’s treatment plans and recommendations. For example, some EHRs accept orders to be completed by the practice, but cannot track patient orders that involve outside diagnostic centers. A number of EHRs cannot track the status of the order to help you determine if the care recommendations of the doctor were ever completed. Patient service deficiencies can lead to workarounds that may increase MPL risk and undermine services. For example, an ineffective order entry feature may necessitate tracking future tests in a message that is not part of the patient’s clinical record. In the event of a malpractice challenge, you may be hard pressed to prove the efforts to manage the standard of care or be challenged on the disconnect between service messages and the patient record contents (which does not include the message.)
Charting Clinical Content – Clinical content is the specific forms, checklists and setups that are relevant to your area of medicine and practice. Not all EHR products have the clinical content needed by every practice. Indeed, the specific needs of a practice may not be met by the general clinical content of a particular product. For example, an EHR with sports medicine clinical content may not be able to support effective charting for a general orthopedic practice. If the vendor does not have the clinical content for your specific practice, they may offer to develop the needed clinical content. However, such an endeavor may involve significant commitment from your doctors as well as complicate the implementation of the EHR. From a MPL perspective, you may be the only practice using that particular clinical content and will not be able to rely on the collaboration with other practices on effective and appropriate clinical documentation and treatment information within the EHR. In the final analysis, you should seek a product that already has the clinical content that you need and can see in action at a similar practice that is already using that EHR.
Given these needs, you need some general to focus you search and selection process.
First and foremost, you should seek out EHR products that have been certified under the EHR Stimulus Program. Regardless of your interest in the stimulus program, products that are not certified will be excluded from consideration by a wide range of practices. Exclusion from certification will not help the EHR product that you will depend on and the EHR product success that you need to protect your practice from contending with a commercially tenuous EHR.
Secondly, you should seek products that have clients that look like your practice. Not only do you need to make sure that they have the clinical content you need, but serve practices of the same size and complexity. For example, you should review the number of offices, use of midlevels and technicians, and offering of ancillary services (Ex. Optical shops, Physical Therapy, Diagnostic Equipment) in clients that use the EHR product that you are considering.
Next, you should have a concise and practical list of requirements to evaluate the product with. The list should focus on the key needs of your practice and avoid simple requirements that all products have. Longer lists do not necessarily make for better evaluation tools: long lists can obscure the important features. For example, patient demographic information contents (a common feature) may not be as significant as the coordination and supervision of patient visits with mid-level providers.
Finally, you should review EHR products using a script that covers the way your practice works and not a presentation that emphasizes the highlights of the product you are considering. Such a script should cover the basic flow of the practice and include items that differentiate the practice. For example, the script may include entering a procedure order for a patient that has to be routed to and managed by a procedure scheduler. Similarly, you may want to simulate queuing a patient for an in-office procedure as well as review how the clinical staff will be able to identify patients waiting for a procedure.
Selection of an effective EHR product is the first step in an implementation process that has to managed and staged to enhance your practice while managing the various risks EHRs may pose.
© Sterling Solutions, 2010