Six Critical Criteria To Use In Selecting An Electronic Health Records (Ehr) System Vendor

With several hundred vendors, and counting, how do you go about narrowing the field of vendors to those that have a system suitable for your practice? It's not easy, but there are ways to set criteria and begin to focus on a limited number of systems.

Six critical, and a few other, criteria are...

  • Meaningful use
  • Certification
  • Stability of the vendor
  • "Lineage" of the applications
  • Target market of the vendor
  • "ASP" or "SAS" - hosted or "in-house"
  • Scalability
  • Financing
  • Support

Of course, if you intend to qualify for incentive payments under the HITECH Act, you must be making "meaningful use" of certified EHR technology. There are some high-level requirements, such as e-Prescribing and submitting information on clinical quality measures, that most vendors are already capable of supporting. Furthermore, a serious vendor should be able to demonstrate a corporate commitment of some kind to improving the system to meet the criteria in the future as they evolve.

  • So if the first (1) criterion - able to meet the Meaningful Use criteria - is a moving target, be prepared by insisting that the vendor is committed and prepared.
  • The second (2) criterion to consider is certification. The Commission on Healthcare Information Technology has been certifying systems as meeting its criteria since 2006. In addition certifying organizations are being established to certify systems relative to Meaningful Use and other criteria.
  • Stability of the vendor is another important (3) criterion. A vendor should have a track record of building a strong customer base, giving it the financial resources to continue to improve its applications. While you cannot be sure a given vendor is about to be sold, or to get an offer its Board of Directors can't refuse, you should ask if there are any plans to sell the company, or to allow it to be acquired, in the near future.
  • One thing to keep in mind is that there is considerable consolidation going on in the industry these days, and stand-alone systems may be more difficult to implement and connect than they were in the past. For instance, a large company recently bought a popular practice management system that previously could be interfaced to a number of stand-alone EHR systems. The company has decided it will only support an interface to its own EHR system, leaving those practices that are using a stand-alone EHR system to wonder when upgrades to their PM system will render the interface - and their system - unusable.
  • The fourth (4) criterion to consider is the "lineage" of the applications. Many EHR and PM systems started out as separate applications - maybe even developed by separate companies - but are now sold together as a package. Initially, the information stored on these applications may have resided on separate data bases, requiring an interface to transfer information such as billing and demographic information. At the very least, systems that are composed of two previously developed applications should now be running on a common data base.
  • A fifth (5) criterion is the vendor's target market. A solo practice should consider vendors who target individual or small practices. A multi-specialty group with 35 physicians should consider vendors who target that segment of the market. There are several reasons for this type of consideration. For instance, a vendor targeting individual practices may be ill-prepared for the more complicated implementation and training phase required in a large group setting. The pricing of vendors who target larger groups may be unfavorable for solo practitioners.
  • The sixth (6) criterion to consider is the vendor's approach to making the software available. Some vendors will only make their software available via the internet, the "hosted" or "ASP" or "SAS" approach. This approach to obtaining the use of software has certain advantages - but it also has some disadvantages. Practices can often implement a system faster using the ASP approach, and the initial investment is usually much lower. The vendor typically updates the software with new releases for no extra charge, may offer training continuously (usually via the web), and the initial hardware requirements are lower, e.g., no office server.

The main disadvantage is the long-term cost will usually be higher after 5 or 6 years, compared to the client/server approach. You may also have a harder time disentangling yourself from the vendor - and getting usable copies of your patient and billing records - if you decide to change systems.

There are several other criteria to consider, such as scalability for growth, references, financing options and pricing.

Using some or all of these criteria can help you reduce the number of systems you should consider to a manageable number.