Selecting An Electronic Health Record

1
Selecting An Electronic Health Record

• A Practical Guide

2
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.

3
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
4
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.

5
EHR Timeline
Life Cycle Step Preparation Selection Implementation Upgrades-Maintenance
Task Examples Learning Readiness assessment Demonstrations Site visits Workflow Improving efficiency
This Module Discusses Pre-purchase preparation Selecting an EHR
6
EHR Selection Outline

• Ready!
• Readiness assessment
• Assemble your team
• Whats 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

7
Readiness Assessment
Ready!

• Realistic expectations?

• Everybody on board?

This will be great!
This should be a snap!
This will be horrible!
This looks to be impossible!
8
Readiness Assessment
Ready!
What are your goals for the EHR?
Safer medical care
Less paper in the office
Make more
Track chronic disease
Seven blind men and the elephant
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.
9
Readiness Assessment
Ready!
Ready to buy an EHR
Good
Ready to implement an EHR
Better
Ready to properly use an EHR
Best
Buying the right EHR will not solve all of your
problems!
10
Assemble Your Team
Ready!

• 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

11
Whats happening in your neighborhood?
Ready!

• 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?

12
Whats happening in your neighborhood?
Ready!

• 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?

13
Readiness Assessment
Ready!
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 - dont rush

14
Readiness Assessment
Ready!

• 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

15
AAFP Recommended Criteria for EHR Software
Get Set!
EHR software should pass the ACID test.

• Affordability
• Compatibility
• Interoperability
• Data Stewardship

16
AAFP Recommended Criteria for EHR Software
Get Set!

• 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

17
AAFP Recommended Criteria for EHR Software
Get Set!
18
The Rosetta Code of Health Information Exchange
Get Set!
19
AAFP Recommended Criteria for EHR Software
Get 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

20
Information Sources
Get Set!

• 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!)

21
Information Sources
Get Set!

• 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.

22
Checklists and Features
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

23
Beyond The Checklists
Get Set!
This question
Of course!
Can the software perform this function?
Should be followed by these questions.
Can you show us a practice thats using___?
Does it cost any more?
Is there any third-party software that needs to
be purchased to make it functional?
24
Beyond The ChecklistsWorkflow and Patient
Scenarios
Get Set!
Give the EHR of interest a workout!

• 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

25
Beyond the ChecklistsInterface Properties
Get Set!

• 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

26
Beyond the Checklists
Get Set!

• 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.

27
Other Considerations
Get Set!

• Financial solvency of the company
• Active user groups
• Number of installations
• Frequency of new versions

28
Other Considerations
Get Set!

• Client-server vs. application service provider
  model
• Database model
• Certification issues

29
Getting Help
Get Set!

• Should you get help?
• What?
• Help with evaluating your office
• Help with choosing an EHR
• Help with making a deal

30
Getting Help
Get Set!

• Who?
• National health IT firms
• Local health IT experts and lawyers
• National and local experienced family medicine
  physicians

31
Getting Help
Get Set!

• Finding help
• Ask around locally
• EHR email discussion lists
• Ask us (Center For Health Information Technology)

32
Visiting Friends
Get Set!

• 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.

33
General Observations
Get Set!

• 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

34
Making The DealPurchasing an EHR
Go!

• 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.

35
Making The DealPurchasing an EHR
Go!

• General business goals with your vendor
• Negotiate an agreeable contract
• Account for costs up-front
• Develop a productive partnership

36
Making The DealPurchasing an EHR
Go!

• 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

37
Making The DealPurchasing an EHR
Go!

• The art of negotiation
• Dont 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)

38
Making The DealPurchasing an EHR
Go!

• 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

39
Making The DealPurchasing an EHR
Go!

• Contract issues to consider
• How is the software licensed?
• Training issues and costs
• Implementation and maintenance costs and
  responsibilities

40
Making The DealPurchasing an EHR
Go!

• Payment issues and timeline
• Functional milestones
• Service-level agreement
• Hours and methods of support
• Response times and severity
• Problem resolution and escalation

41
Arranging For Implementation
Go!

• Hardware requirements
• Communication requirements
• Training requirements
• Look at the implementation module in this series