Powerful forces are driving many practices toward electronic health records, especially now that incentives for EHR use are more clearly defined within the American Recovery and Reinvestment Act. Yet purchasing an EHR is a capital-intensive investment. First-time buyers, in particular, cannot afford to enter such high-stakes negotiations only half-informed.
Keep in mind that the incentive dollars promised by ARRA are garnered through effective EHR use -- not just EHR purchase. Achieving "meaningful use," therefore, is highly dependent upon the level of functionality supported.
Novice EHR users are often enticed by systems that are inexpensive, "customizable," and similar to paper charts in their documentation patterns. On the surface, these appear to be desirable characteristics. But practices must dig deeper. These three elements deserve close scrutiny.
Let's look first at clinical documentation. Because free text more closely resembles the paper chart and appears easier to use, many believe it will aid clinician acceptance of the EHR. And it might -- at first. However, practices must not overlook the principal consideration posed by ARRA: Does the EHR solution enable the correct data to be pulled back out in support of meaningful use initiatives?
Meaningful use requires the ability to query and run reports on the full range of clinical documentation, including vital statistics, diagnoses, treatments, outcomes, and more. Discrete, structured data elements are essential to this ability. Free text is like a picture; one can look at it, but cannot access individual components. Health information exchange (HIE) also is hampered without certain structured data elements in standardized format (e.g., HL7) that can be received and "understood" by other IT solutions.
A high degree of customization also seems attractive, but practices must first understand exactly what is meant by "customization." In some cases, it means the practice must hire IT professionals. In other cases, it means clinicians can choose pre-programmed preferences already set within the vendor's framework.
Practices usually are better served by instead evaluating how robust a solution's functionality is initially. It is important to remember that while every practice has legitimate customization needs, they potentially raise the cost of ownership by making future maintenance and upgrades more difficult.
Expense, of course, is the final consideration in many EHR selection processes. Fully-informed due diligence involves looking at the true cost of EHR ownership, which extends beyond just purchase price and license fees. Additional factors to assess include:
• How fast the system can be implemented;
• How quickly and easily staff can be trained to use the system;
• How difficult it is to obtain support when necessary;
• How large an IT staff is necessary to maintain the system; and
• Whether infrastructure and/or hardware upgrades are necessary to accommodate the system.
In the pressure to quickly implement an EHR and work toward meaningful use incentives, novice purchasers must look beyond surface-level demonstrations to access whether an EHR truly offers vital clinical content and functionality. Through careful scrutiny of true cost, clinical documentation format and customization options, practices can enjoy the satisfaction of knowing their EHR choices will serve their needs -- both now and in the rapidly-evolving future.
Jan Lee, MD, FAAFP, MMM, is Vice President of Knowledgebase and Content for NextGen Healthcare Information Systems.
