fundamentals how-to-choose-electronic-health-records-software 3163376
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Report ID: S4280312
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How to Choose ElectronicHealth Records SoftwareThe government is offering financial incentives for small physician
practices to transition from paper files to an electronic health records
system. While the deadline is fast approaching, doctors can turn to
Regional Extension Centers to help with the daunting task. This
report provides insight on how to work with a REC and advises
physicians on the ins and outs of choosing an EHR product.
By Rose McNeill
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CONT
ENTS
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TABLE OF
March 2012 2
3 Author’s Bio
4 Executive Summary
5 Getting Started With EHR
5 Figure 1: Importance of Healthcare IT
Initiatives
6 Take Advantage of RECs
6 Figure 2: IT Project Plans
8 Stages of EHR Implementation
8 Project Management Success
8 Figure 3: Meaningful Use Reimbursement
9 Figure 4: Barriers to Adopting EMR or EHR
10 Choosing the Right EHR System
10 Figure 5: Confidence in Meeting Stage 1
Meaningful Use Criteria
11 Figure 6: Cloud Use Among Healthcare
Providers
12 On-Premises vs. the Cloud
12 Figure 7: Cloud Computing Plans: Healthcare
Providers
14 Getting Paper From Folders to Digits
15 A Spoonful of Sugar
16 Related Reports
ABOUT US
InformationWeek Reports’ analysts arm business technology decision-makers with real-world perspective based on qualitative and quantitative research, business and technology assessment and planning tools, and adoption best practices gleaned from experience. To contact us, write to managing director Art Wittmann at [email protected], content director Lorna Garey at [email protected], editor-at-largeAndrewConry-Murray at [email protected], andresearch managing editor Heather Vallis [email protected]. Find all of our reports at reports.informationweek.com.
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March 2012 3
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H o w t o C h o o s e E l e c t r o n i c H e a l t h R e c o r d s S o f t w a r e
Rose McNeill is a Michigan-based freelance writer with more than 30 years of experience in the technology industry. Her areas of expertise include software reviews and employee training booklets, articles on sustainability, blogging, andspecial reports for national technology magazines and websites. You can find heron Twitter (@rosewritesdaily) and LinkedIn.
Rose McNeill InformationWeek Reports
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Electronic health records aim to cut medical costs, boost efficiency and improve patientcare. However, the transition from paper to electronic records can be daunting, particu-larly for small practices that have tight budgets and little expertise with software andcomputer networks. To help small practices make the transition, the federal government has created
programs to reimburse practices that purchase and use EHR systems. Local organizations,called Regional Extension Centers (RECs), have also been created to help practices chooseand implement EHR and demonstrate “Meaningful Use,” a set of criteria to show thatEHRs are being actively employed by the practice.This report provides a road map for small physician practices of up to 10 practitioners
that are ready to investigate the use of an EHR system. The report describes how to findand interact with a REC and how to seek EHR reimbursement from the government. Italso provides essential information on how to select an EHR vendor and product, includ-ing the initial planning stages, product evaluation and selection, and implementation. Italso discusses the pros and cons of cloud-based EHR services, including issues of securityand service levels.
EXECUTIVE
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SUM
MAR
Y
H o w t o C h o o s e E l e c t r o n i c H e a l t h R e c o r d s S o f t w a r e Table of Contents
March 2012 5
The federal government is using both sticksand carrots to encourage hospitals and doc-tors’ offices to meet the 2014 deadline to be-gin the transition from paper to electronichealth records (EHRs), which are expected toimprove the quality of patient care and reducecosts. The big stick is financial: Penalties fornonadherence range from 1% to 5% againstMedicare and Medicaid reimbursements.But the government is also deploying car-
rots. For one, the American Recovery and Rein-vestment Act of 2009 allocated $28.5 billion instimulus funds for health information technol-ogy specifically aimed at electronic medi -cal/health records. The act provides funds toreimburse practices that implement electronicmedical record systems that hold to the crite-ria and certification of “Meaningful Use.”The simplest explanation of Meaningful Use
is a list of tasks, including testing, daily usageand reporting, on how the EHR system is be-ing used in a way that enhances provider ser -vices. By demonstrating Meaningful Use, pro -
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How high a priority will the deployment or expansion of IT systems for the following initiatives be for your organization over the next 12 months? Please use a scale of 1 to 5, where 1 is “not a priority” and 5 is “top priority.”
Importance of Healthcare IT Initiatives
Note: Mean average ratings Base: 337 respondents in January 2012 and 357 in December 2010 working at a doctors’ practice, hospital, healthcare center or other healthcare provider Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals
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Getting Started With EHR
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Figure 1
March 2012 6
viders are then eligible for federal reimburse-ments. The actual term is discussed in an 800-page document, but you don’t have to be-come an expert on the subject becauseorganizations called Regional Extension Cen-ters have been set up to help physicians tran-sition to EHRs. In addition, you can find a com-plete list of software products certified underMeaningful Use criteria from the Health andHuman Services Department.This list has more than 800 certified Mean-
ingful Use EHR systems, each having beentested against required criteria. You cansearch through the database for a specificproduct and for specific needs (for example,electronic prescriptions).
Take Advantage of RECsRegional Extension Centers were created to
assist physicians with the transition from pa-per to electronic records. Each state has atleast one center, which focuses specifically onsmaller practices. Practices that work with aREC will be assigned a project manager, whowill assist with the process from start to finish
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What are your organization’s plans for the following IT projects over the next 24 months?
Already completed
Will complete within 6 months
Will complete within 12 months
Will complete within 24 months
Currently piloting
Evaluating No plans
Base: 337 respondents working at a doctors’ practice, hospital, healthcare center or other healthcare providerData: InformationWeek 2012 Healthcare IT Priorities Survey of 476 business technology professionals, January 2012
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IT Project Plans
53%
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March 2012 7
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and ensure that the EHR product and imple-mentation meet the guidelines of MeaningfulUse. These project managers have variousbackgrounds, such as in healthcare informa-tion technology, project management, nurs-ing and practice administration.To qualify for funding, which is paid out in-
crementally as milestones are reached, a prac-tice can employ no more than 10 licensedpractitioners, including physicians, physicianassistants, midwives and other licensed staff.
If you meet this crite-rion, you should con-tact your local RegionalExtension Center. Anita Somplasky, ex-
ecutive director for theREC of Pennsylvania,which covers all loca-
tions east of Pittsburgh, says each REC has amodel of engagement for participating prac-tices. All RECs are nonprofit. If a hospital isdesignated as the REC, it will work with selected contractors to install EHR systems inpractices within the hospital and associated
practitioner firms. As an example, for firms located in Pennsyl-
vania, the REC provides 20 to 30 hours of on-site consulting. This will include office work-flow analysis, which examines the practice’s intake process, the creation of patientrecords and supporting documentation, paperwork movement for labs, and adminis-trative filings and billing. The practice will receive its first payment
once it achieves full EHR usage and can pro-vide the scheduled and required reporting bythe EMR certification authority. The final pay-ment will be received when the practicedemonstrates that its EHR product qualifiesfor Meaningful Use. The product chosen orupgraded (for existing systems) must eitherbe from a list of more than 400 certified pro-grams or be approved by the REC.Note that the REC program is not available to
managed-care providers or providers that onlyuse private insurance. However, these practicescan pay fees to a REC for project assistance.Only practices that serve Medicare and Med-
icaid patients can receive funds. For practices
with Medicare recipients, up to 75% of theirMedicare billings in a year are reimbursed,with a maximum reimbursement of $44,000.However, a practice must have at least $24,000of Medicare billings in a calendar year to re-ceive funds. For example, if a practice billsMedicare more than $60,000 for a year, it’squalified to receive the maximum of $44,000in reimbursement. By contrast, a practice with$24,000 in Medicare billings would receive upto 75% of that figure, or $18,000. Practices withMedicare patients will receive funding afterthe practice demonstrates 90 days of Mean-ingful Use of its EHR system.Those practices serving Medicaid patients are
eligible for up to $63,750 and have up to fiveyears to implement an EHR system. The moneyis funneled from the federal government intothe REC, which validates that the practice’s se-lected records system meets the requirementsto receive reimbursement dollars. To qualify for these monies, you must ad-
here to a timeline of tasks to be completed.Reimbursement takes place only under thefollowing conditions:
To qualify for funding, a practice can
employ no more than 10 licensed
practitioners, including physicians,
physician assistants, midwives and
other licensed staff.
March 2012 8
1. The practice must have its selected EHR inplace by the end of 2012 for Medicaid pro -viders or 2016 for Medicare providers.2. Strict reporting must be completed
within the required timelines.3. The practice must demonstrate “Meaning-
ful Use” in everyday office workflows.
Stages of EHR ImplementationEHR implementation has six general stages,
from an analysis of your practice’s needs to daily use of the EHR software. These stagesserve as a planning framework around whichto build the project. A lack of planning can cause serious delays or projectfailures.1. Needs analysis: The REC will
help you review any existing com-puter systems that handle proce-dures for patients and docu-ments. The REC will also outlinepolicies and federal regulationsaround the security and privacyof patient information. The needsanalysis will also identify areas
where improvements are needed to en-hance patient care that should be includedin the EHR system. Documentation is createdregarding every aspect of how you handlepatients, paper charts, laboratory work, em-ployees and vendors. 2. Vendor review/presentations: You will
pick several vendors based on the results ofthe needs analysis. Request demonstrationsor small trials within your office to validateeach feature of the vendors’ systems and determine how well those vendors meet your needs.3. Implementation/installation:Once you
decide which vendor to use for your EHR sys-tem, that vendor will work with the projectmanager to plan the installation.4. Testing: Give testing a fair amount of
time in your project schedule. Each softwarefunction required by the documentation cre-ated in step one must be tested to prove if thevendor’s product claims are valid. The testingis done after the installation to find any issuesbefore the “go live” date. This gives the vendortime to make any necessary changes beforethe EHR system is in daily use.5. Training: Each staff member is trained to
use the new system.6. “Go live”: This is the
initial date when the sys-tem will be rolled out forregular use.
Project ManagementSuccessTo guarantee your project
will be completed on timeand within your budget,create a project plan and
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Meaningful Use Reimbursement
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Services provided Maximum available Practice’s minimum Deadline to qualify federal funds for EHR billing receipts to qualify (20% of annual billing)
Medicare $44,000 $24,000 Year end 2012
Medicaid $63,750 $47,812 Year end 2016
Figure 3
March 2012 9
select staff members for the project team.Designate a team leader to keep the projecton track and assimilate all the findings duringthe needs-analysis stage.
The project team should consist of membersfrom all parts of the practice, such as finance,records, human resources, legal, and adminis-tration or office management. All members
should be knowledgeable about the workflowprocesses of their respective areas so that theycan share insights as to how the EHR systemcan improve productivity or simplify tasks. Forexample, the front-desk person will know thatthe office uses the first three digits of the patient’s Social Security number and the lastfour of the phone number as a security codeto request when someone calls into the officefor patient information. A field should exist inthe new system to store these data.Involving members from multiple work
areas in decisions surrounding the project en-courages employees to embrace the new system. They will be more likely to adopt thenew system if they believe their needs andconcerns are addressed by the product.You and your REC project manager will pick
a “go live” date for your EHR system. Workbackward from this date to determine time-lines for the steps outlined above, includingworkflow analysis, testing and implementa-tion. Be generous in allocating time for eachstep to allow for the inevitable delays andcomplications that crop up in a project of this
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What are the top barriers to adopting an EMR or EHR system in your organization?
Barriers to Adopting EMR or EHR
Note: Three responses allowed Base: 315 healthcare provider respondents in January 2012 and 319 in December 2010 who are piloting, evaluating, will complete or have already completed EMR or EHR Data: InformationWeek Healthcare IT Priorities Survey of business technology professionals
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March 2012 10
magnitude. Make sure your project team isaware of the timeline, so that you can keep asclose to the “go live” data as possible.Dr. Prab Tumpati, who operates a private
practice for sleep disorders and obesity inBrooklyn, N.Y., has been using EHRs for aboutthree years. He says it took his practice abouttwo weeks to fully implement an EHR prod-uct. This is a very fast turnaround, and otherpractices may find the project will take signif-icantly longer, depending on the needs of thepractice and the product selected. Tumpatialso notes that he was familiar with EHR systems, which sped up deployment.
Choosing the Right EHR SystemSelecting a vendor can be painstaking and
time-consuming, but it’s worth the effort.Choosing the wrong company or productmay hinder, rather than help, your transitionto EHRs and can diminish many of the bene-fits that EHRs provide. One reason the vendor selection process is
so important is that the product you choosehas to meet the guidelines of Meaningful Use
if you want to be reimbursed. While comply-ing with Meaningful Use is one important criterion, perhaps the most important is usability. If the product is cumbersome orcomplicated, members of your practice will re-sist using it. As mentioned previously, yourneeds analysis should provide guidelines on
product requirements, but you can also takeadvantage of other sources to help youchoose a short list of products to evaluate.First, consult with practices of similar size.
They may have insights and recommenda-tions that can save you trouble down the line.The Web is also an excellent resource; for in-
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2012 2011
To be eligible for maximum federal Meaningful Use incentive funds, healthcare providers must meet Stage 1 Meaningful Use criteria by the end of 2012. How confident are you that you’ll meet the first stage of Meaningful Use?
Confidence in Meeting Stage 1 Meaningful Use Criteria
Very confident
Somewhat confident
We will miss the deadline
Don’t know
Base: 315 healthcare provider respondents in January 2012 and 319 in December 2010 who are piloting, evaluating, will complete or have already completed EMR or EHRData: InformationWeek Healthcare IT Priorities Survey of business technology professionals
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58%52%
25%31%
6%6%
11%11%
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Figure 5
March 2012 11
stance, physician forums are a great place tosolicit honest feedback and guidance.Second, professional associations may have
a list of companies that have been certifiedand implemented at various practices. Youcan also check to see if any medical associa-tions to which you belong have agreementswith software companies to offer discounts.Third, investigate your existing vendors. For
instance, the company that provides yourbilling or electronic prescription servicesmay also offer full EHR products. You mayfeel more comfortable adopting a new prod-uct from a company with which you alreadydo business.As you look at vendors and their products,
identify a handful of systems for closer inves-tigation, including demonstrations andhands-on evaluation. This step is essential be-cause while a product might seem perfect onpaper, you may find it’s not the right fit onceyou test-drive it.“Short-list at least three software products
and try all of them for a few weeks, and havethe staff try them,” Tumpati advises. “An EHR
implementation is l ike choosing a l i fe partner—make a mistake and you pay for life!”For instance, Tumpati found that some EHR
systems make simple tasks more complicated.“If you were to describe pain in the left hand,
some EHRs force you to choose the body partwhere it is located, and choose multiplemenus and submenus about the details of thesymptom. I like a simple system that allowsthe physicians to free-text type as opposed tousing menus and clicks.”
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2012 2011
Is your organization using public or private cloud computing?
Cloud Use Among Healthcare Providers
Yes; private cloud, inside our own data center
Yes; public cloud, from a third-party provider
Yes; both public and private cloud
No, but we plan to use cloud computing in the future
No, and we have no plans to use cloud computing
Base: 337 respondents in January 2012 and 357 in December 2010 working at a doctors’ practice, hospital, healthcare center or other healthcare providerData: InformationWeek Healthcare IT Priorities Survey of business technology professionals
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19%18%
5%8%
11%6%
22%21%
43%47%
R
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Figure 6
Strategy: Security ViaHIPAA Compliance
IT professionals can maketremendous progress on security initiatives using theHIPAA Security Rule for leverage.
DownloadDownload
March 2012 12
On-Premises vs. the CloudAnother important decision regarding your
EHR system is whether to deploy it on prem-ises (that is, within the physical confines ofyour practice) or in the cloud. In a cloud deployment, a third party provides and main-tains the equipment and software to run theEHR system. The application itself is presentedto users via a Web browser.The benefit of an on-premises deployment
is that the computer equipment, software anddata are under your control. If you aren’t com-fortable having sensitive patient informationstored off-site, an on-premises deployment isbetter.The downside is that you must purchase, set
up, and maintain the equipment and softwareyourself (or hire a consulting firm to do it foryou), as well as pay all the up-front costs forsoftware licenses and maintenance fees. Youwill also have to control access to patientdata, secure the electronic records and backup all the data. These requirements may notbe burdensome, depending on how comfort-able you and your staff are with technology;
some practices may have an on-site computersupport staff or someone who does double-duty as office computer guru.
If you choose an on-premises product, youshould also purchase a support/mainte-nance contract, which will entitle you to a
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Which applications does your organization host or plan to host in the cloud?
29% 18%3% 9%
25% 23%3% 8%
28% 20%5% 6%
27% 21%5% 6%
18% 24%7% 8%
21% 17%5% 8%
21% 16%2% 8%
19% 28%7% 7%
Currently hosted Planned within the next 3 months Planned within the next 6 months Planned within the next 12 months
EMR or EHR
E-prescribing
Storage
Computerized physician order entry (CPOE)
Clinical decision support
Financial (including insurance-related apps)
Picture archiving communication system (PACS)
Other clinical applications
Base: 192 healthcare provider respondents at organizations using or planning to use cloud computing servicesData: InformationWeek 2012 Healthcare IT Priorities Survey of 476 business technology professionals, January 2012
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Cloud Computing Plans: Healthcare Providers
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Figure 7
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certain amount of technical support fromthe vendor, as well as software upgrades andrefreshes. These contracts usually run for ayear, and it’s wise to renew them annually. Ifyou let the contract lapse and a new versionof the product comes out at some point inthe future, you’ll likely be charged full pricefor the upgrade.In addition to on-premises products, you
should investigate cloud services. A cloudprovider would house, maintain and supportthe applications, which practitioners wouldaccess by Web browsers via an Internet con-nection. Instead of having to buy computerhardware and infrastructure (cabling, powerand cooling, etc.), you would pay the hostingcompany a monthly or yearly fee for the useof the EHR solution, as well as all associatedtasks of management and data storage. If you need to expand usage of the EHR
application in a cloud service (for instance,add more users to the system or expand stor-age capacity), it’s relatively easy for theprovider to make changes. However, your feeswill also rise accordingly.
A cloud service is also very easy for physi-cians and staff to test. The provider can set uptrial accounts that let you use the actual ap-plication. This is very valuable because youcan see firsthand whether the application is afit with your practice’s needs.The major downside of a cloud service is
availability. No cloud service can guaranteethat its services will run without interruption.Anyone who uses online services such asGmail, for example, knows that outages hap-pen. Problems at the provider’s data centermay bring down your application during busi-ness hours. In addition, problems with your Internet service provider may also affect yourservice. If you go with a cloud offering, have aplan in place so that patient care won’t be affected by a loss of service. You may alsowant to work with your ISP, or another ISP, toprovide a secondary connection that can beused in the event of a problem. According tothe InformationWeek Healthcare IT PrioritiesSurvey, 43% of respondents have no plans touse cloud services.When using a cloud or hosted service, the
availability of that service is typically described in a service-level agreement. Ingeneral, the SLA promises a certain amount ofavailability during a prescribed period, suchas 30 days or a year. Availability is typicallymeasured in a range of 99% to 99.999%. While99% availability may sound great, it translatesto approximately 3-1/2 days of service down-time in the course of a year. If measured overthe course of a month, 99% availability meansapproximately seven hours of downtimeevery 30 days.The SLA will also make provisions around
how quickly the provider will respond to out-ages. SLAs can be complicated, so it may beuseful to engage an independent computerconsultant to help you understand the agree-ment and the metrics that the provider willuse to meet its agreement. For a detailed dis-cussion of SLAs, you can download the Infor-mationWeek report “Cloud SLAs.”Another possible downside is the security
and privacy of patient information. Cloudproviders that specialize in applications thatdeal with medical records should have nec-
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essary controls in place to protect patientdata, but the possibility exists that thosecontrols can fail, whether because of malfea-sance or simple error. This is another areawhere you should consider using a consult-ant or expert to determine whether theprovider meets state and federal privacy andsecurity requirements.In addition to security, it’s worth under-
standing how the provider protects its owninfrastructure from power loss, equipment
failure and natural disasters. At the veryleast, be sure you’resatisfied with the pro -vider’s ability to backup your data to pre-vent records from be-ing lost in the event of
an emergency at the provider’s site, such asfire or natural disaster.Finally, whether you choose an on-premises
or cloud-based application, you should exam-ine the financial stability of the vendor and itscommitment to the product you choose. You
don’t want to be left holding the bag if yourvendor decides to abandon the EHR systemyou’ve chosen. In addition, you’ll want assur-ances that the vendor is committed to provid-ing ongoing upgrades to the product’s fea-tures and capabilities.
Getting Paper From Folders to DigitsOnce the new system is in place, paper
charts will need to be converted into elec-tronic form and transferred into the new sys-tem. Most practices have reams of paper doc-uments, so conversion can take a long time.When you begin converting documents, startwith the most frequently used files, such asactive patients. From there, you can scan inolder records. “Within about a year, we were able to con-
vert almost all active patients in the clinic tothe electronic format,” says Dr. Tumpati. “Wedecided it would be too expensive and te-dious to scan all the charts, so we kept the oldcharts. Whatever was relevant was scanned inwhenever we saw the patient.”Although you may intend to be completely
paperless, consideration must be given to thelegal requirements for paper charts storage.Consult your attorney for advice on this subject.Talk with your vendor about the best way to
convert paper charts. The vendor may havesoftware and hardware available to assist withthis task, such as a high-capacity scanner, orcan recommend appropriate hardware and aprovider. Services may also be available toperform the conversion for you.The software and accompanying scanning
hardware will likely have the capability to cre-ate an image of the chart. Some applicationswill scan the chart but capture only certain information found in a targeted area of apage. Your EHR system should allow you to access converted charts once they’re in thesystem. Many products can search by numer-ous criteria. For example, if your paper chartsare filed by last name, your system can emu-late your filing methods.As you transfer paper charts to electronic
records, have a staff member spot-check elec-tronic files against their paper counterpartsto ensure that data is being correctly con-
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Whether you choose an on-premises
or cloud-based application, you should
examine the financial stability of the
vendor and its commitment to the
product you choose.
March 2012 15
verted. If data is missing or inaccurate, it’s bet-ter to pinpoint the problem and correct it be-fore the majority of charts are converted.
A Spoonful of SugarThere are many requirements to consider
when transitioning from paper to electronicrecords. Each practice is unique in how it op-erates, so no one solution will fit all practices.Take a structured approach to select the EHRsystem that best improves patient care andyour workflow processes.Take advantage of the assistance available
from a REC as you adopt electronic healthrecords, and don’t miss the opportunity for reimbursement available from the AmericanRecovery and Reinvestment Act. The federalmandate for EHRs doesn’t have to be a bitterpill for your practice.
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