5 Crucial Categories Missing from Your EHR RFP

By the time you submit an RFP—the document that helps you determine if an EHR has what you need to meet your EHR and practice goals—you’re serious about purchasing an EHR. RFPs are well intended—they are used to weed out inappropriate EHR contenders and to focus on asking the questions that are important for your practice.

Unfortunately, most RFPs do not address all the crucial topics and questions. In fact, many RFPs focus on the bells and whistles and other superficial components of an EHR, but don’t address the most important factors that actually make or break a successful EHR adoption.

Wouldn’t it be nice to address those factors?
RFP—the request for proposal—it’s an interesting choice of words. It’s nice to learn what vendors “propose,” but wouldn’t it be better to know what they will deliver? With the right questions, a generic RFP can transform into an RFD—Request for Deliverables.

So, what’s missing to make your RFP an RFD?

Here are 5 critical categories—and related questions—that should be included in an RFD. If these are given priority, you have a much greater chance of making the right EHR decision the first time around.

1) Implementation

  • How long will implementation take, what are all the required steps, and how soon can it begin?
  • Can the EHR company guarantee a successful implementation with the amount of training time offered in their contract? Can the vendor provide an hours budget or an unlimited number of hours for a specified time period?
  • What is the experience level of the implementation team that will be assigned to your practice?
  • If your practice is not using the EHR successfully after the allotted training time, will the vendor provide extra hours of training for free or at a cost?
  • If implementation fails, will the EHR vendor reimburse your purchase or take steps to make it successful?

A structured implementation timeline will help to set realistic expectations for your practice. An experienced and professional implementation team will make success more probable. Identifying additional training costs and securing reimbursement in the event of an implementation failure will save you from an unpleasant financial surprise to your bottom line.

2) Company size and bandwidth

  • How many employees does the EHR vendor have?
  • How many clients/customers are currently using their EHR product?
  • What percent of the EHR vendor’s staff is dedicated to support, what is the staff’s experience level, and what percent of the support staff have advanced Microsoft certifications?
  • What percent of the EHR vendor’s staff is dedicated to development and improving the product?

The bandwidth of the EHR company is extremely important. The EHR company should have a development department large enough to keep up with the rapidly changing government regulations that define how an EHR should work and how data should be shared. EHR companies with development teams that are too small will most likely not be able to keep up with these changes.

3) Efficiency and productivity

  • How easy to learn and navigate is the EHR?
  • How efficient is the EHR during a patient encounter?
  • How many clicks does it take to do routine tasks like submitting electronic prescriptions, reviewing basic chart information, or documenting patient exams?
  • How much time does it take to complete standard clinical workflows with the EHR system?

The amount of time and clicks it takes to move through a standard patient encounter is critical in a medical practice—conducting time/click comparisons among EHR vendors is a good way to measure EHR efficiency. It’s important that these efficiency comparisons be done by members of the medical practice and not demonstrated by a tech-savvy sales expert. Additional clicks and windows add a cognitive burden to physicians and hinder the seamless flow through patient encounters. Anything that distracts the physician’s focus from the patients benefits neither the practice nor the patients.

4) Support and customer service

  • What is the process the vendor has in place for handling EHR problems?
  • What is the response time of the EHR company after a support ticket is submitted?
  • What is the average time needed for the support team to resolve an issue?
  • How long does it take to get a “live” support representative on the phone in an emergency?
  • How does the vendor work proactively with clients to avoid problems?
  • Is the EHR vendor’s support department overseas?

Superior customer service and timely support should be the cornerstone of all EHR companies—support turnaround time is crucial to the workflow of your practice. Your RFD (RFP) should also include a box to put the EHR vendor’s KLAS rating.

5) References

  • How many practices in your specialty are using the EHR system?
  • How many practices is the vendor willing to provide as a reference?

Collecting EHR reference feedback is one of the most critical steps in the EHR search process. Providing 10-20 references will highlight the vendor’s experience in EHR implementations in practices similar to yours. Make sure your physicians call other physicians at random from each reference site.

Make RFPs more valuable to your EHR search process.

Include usability and performance questions that are not seen on typical RFPs. A well-crafted RFP (now RFD since you are measuring deliverables like usability and performance) will identify how the EHR performs, how the vendor handles client relations, and will give you true insight into whether the EHR will actually deliver on its proposal to your practice.

Is It Time to Break Up with Your EHR Vendor?

So, is it time to break up with your EHR vendor?

Is it Time to Break Up with Your EHR Vendor?We’ve talked about the good, the bad, and the ugly EHR stories we’ve heard over the years. If your experience falls into the “bad” or the “ugly” categories, you may want to consider breaking up with your EHR vendor.

Here are the top 6 reasons medical practices’ relationships with their vendors end up on the rocks:

  1. Implementation woes. Implementation is incomplete and staff members are not fully trained. The practice is stuck halfway between using charts and using the EHR system, resulting in workflow disruption and misplaced patient data. The practice may also be in a position where the implementation budget has been consumed halfway through the process, and the full installation of the EHR looks like a money pit. In addition, the EHR vendor hasn’t been responsive to the practice’s requests for improved and complete implementation, nor has it proactively approached the practice with a solution to get them fully functional on the EHR system.
  2. Usability issues. The EHR is cumbersome, has too many windows, and requires too many clicks. Worst of all, it requires too much thought—all this imposes a “cognitive burden” on physicians. The EHR does not deliver a seamless experience and physicians find themselves torn away from thinking about patients so they can focus additional attention on drop-downs and clicking. Prior to using the EHR, many physicians wrote prescriptions while speaking with patients—it was second nature and easy to accomplish. By placing additional cognitive burdens on physicians, the EHR fails to provide the same comfort and ease, which detracts from the physician-patient relationship.
  3. Workflow disruption. Physician and staff productivity suffer because the EHR system does not fit the practice’s workflow needs—patient volume decreases while data entry workload increases. Physicians and medical staff now spend more time each day entering data than providing the patient care for which they were trained.
  4. Lack of support. Somewhere along the way, communication with the EHR vendor disappears. It now takes days or weeks to receive a response to calls for support—and sometimes calls and support tickets go unanswered altogether.
  5. Lack of EHR benefits. The practice-wide improvements that were promised by the EHR vendor are not delivered. Instead, the system creates a long-lasting negative impact, including practice-wide inefficiency, a decrease in patient volume and satisfaction, unforeseen increased expenses, and decreased profits.
  6. Decreased quality of life. The EHR creates extra work that not only keeps physicians and medical staff in the office after hours playing “catch up,” but also creates a more stressful work environment for both staff and patients during the day.

If any of the above sounds familiar, it may be time for you to break up with your EHR vendor and make lemonade out of your EHR lemon.

So, how do you break up with your EHR vendor?
Parting ways with your EHR vendor doesn’t have to be a difficult, stressful ordeal. Here are the 4 items you’ll need to review to make the process easier:

  1. Get everyone in your practice on board with the decision. Having everyone support the decision to terminate your relationship with your current EHR vendor will make it much easier to move forward. If you meet resistance with any staff member, create a laundry list of the problems your practice is experiencing with the EHR system and present it to the resistant staff member to emphasize the stark reality of the situation and the resulting consequences.
  2. Carefully review your EHR contract. Read your EHR contract thoroughly. Were you guaranteed certain services that were not delivered for which you can hold the EHR vendor liable? Or are there any binding restrictions or termination penalties written into the contract? Make note of all the fine print and consider input from a legal expert in the healthcare IT field. Covering all your bases in advance will help move the process along.
  3. Decide what you will do with your data. Will you return to paper charts or do you plan to migrate the digital data over to another EHR? Map out a plan when it comes to your patient data. Many EHR vendors have special transfer pricing and can work with your current vendor to migrate the data over to the new EHR. Perform your EHR search again from the beginning—this time, you know exactly what will work for your practice—and narrow down your choices. Collect transfer pricing information and options before contacting your current EHR vendor.
  4. Call your EHR vendor and play hardball. With all your ducks in a row, call your EHR vendor and give them one last chance to fix the problem(s) you are experiencing. If they don’t, let them know you are not satisfied and you plan on switching to another vendor. If you face a penalty for ending the relationship, suggest an addendum to the current contract waving the termination penalty in return for a non-disclosure agreement. (After all, word of mouth recommendations—or warnings—to peers can make or break a purchase in the EHR industry.)

Nobody wants to be stuck in a bad relationship—the same goes for relationships with EHR vendors. With so many EHR systems available on the market, finding one that suits your clinical workflow and productivity needs is a much better option than sticking with the inefficient EHR system you may currently have.

Don’t settle for less, find the right EHR match for your practice.

EHR: The Good, the Bad, and the Ugly—Real Life Stories

EHR: The Good, the Bad, and the UglyIn 14 years of business, we’ve heard thousands of EHR stories from physicians, administrators, and other medical staff. We’ve noticed a few clear trends as the stories fall into 3 distinct categories. Let’s call them the Good, the Bad, and the Ugly:

The Good

“With [ABC] EHR, I navigate my patients’ clinical data faster and more efficiently, and I don’t have to wade through other physicians’ notes to get to my own notes. It’s quicker to electronically prescribe than to write out a paper prescription, and it bypasses the sloppy handwriting problem that can lead to errors. This results in better patient care and can lead to sharply reduced malpractice risk. In addition, our response time to patient inquiries has improved greatly, which is something our patients have gladly noted.”

“One of the best things I love about our EHR is that I can check the charts from home. Sometimes patients make appointments before they are instructed to, which doesn’t allow me to maximize my time in the office. I also spend less time in the office doing research and can easily accomplish my research goals from the comfort of my home.”

“Because of the efficiency gains [QRS] EHR brings to our practice, the staff now spends more time reviewing patient charts for quality and completeness, which has directly enhanced the level of patient care. Patient satisfaction levels have notably increased, as has the physicians’ confidence in the comprehensiveness and quality of the clinical data.”

“Our EHR is the primary tool at the foundation of our practice—the tool that the physicians and staff count on to be reliable, provide accurate clinical data, and build and secure the integrations necessary for the current and future digital age.”

Trend: The good EHRs deliver substantial practice workflow enhancement and productivity improvement, while simultaneously creating an organized and less stressful work environment for the physicians and staff. The good EHRs support an enhanced level of patient care and help create an improved patient experience.

The Fix: If you fall into this category, consider yourself a success story—sit back and marvel at your practice’s new-found efficiency and focus your attention on the patients and growing your practice now that inefficiency and stress are no longer a part of your day.

The Bad

“[XYZ] EHR is quite complicated, and we ended up having to hire a full time, in-house IT employee. We rolled out the EHR to physicians from April to June. The doctors who went live in April and are really good with the system are still 25% down in productivity. This has slowly been improving, but the doctors have quite a lot—about 2 hours—of ‘after work’ to catch up at the end of the day. We had to set up VPN connections between the office and every doctor’s home so they could finish their work at home.”

“It took our practice four years to narrow down and select an EHR vendor. We went live 6 weeks ago and our physicians say they are doing more work now than they were before. One of our physicians says he has to cut patients out of his schedule on a daily basis. In addition, he used to go to the hospital at 6:45 AM and get home at 6:15 PM. After implementing the EHR, now he leaves the office at 7:00 PM and his wife and kids are upset with him for the lost time. He is also upset that he has to do more work, manually entering in patient data, which is not why he became a doctor. He became a doctor to take care of patients, not to type and treat fewer patients. The only good thing he could see from it is being able to access patient charts from home, and then perhaps a light at the end of the tunnel for better patient care sometime in the future (keyword = sometime). The check-out staff member said, ‘They trained us in two days and then left us for the wolves.’ It was real bad, patients were very upset.”

Trend: The bad EHR stories always involve practice-wide workflow disruption, unexpected increases in expenses, decreased quality of life, and/or decreased patient satisfaction.

The Fix: Call your EHR vendor and request their Professional Services Group to come in and evaluate your practice’s workflow. Whether your staff needs more training or more face-time with super-users, your EHR vendor should take care of you. (After all, they want you to succeed using their EHR, right?)

The Ugly

“We are a 200+ physician group that signed with an EHR vendor 3 years ago. Satellite offices that have already gone live on the EHR system are still using paper charts and writing prescriptions by hand. Our central office planned to fully implement this fall, but we have suspended that indefinitely since the other offices that are already live on the EHR had patients lined up out the door due to slowness and difficulties using the EHR.”

“After trying to use the EMR and failing, we SHUT IT OFF! We have 7 doctors—our head doctor made numerous calls to the higher-ups at the EHR vendor to try to get the program to work. Nothing worked and he’s 100% convinced that they just don’t understand our specialty.”

Trend: The ugly EHR stories always involve failed EHR implementations, extreme productivity losses, physician and staff frustration, and wasted revenue.

The Fix: Go over your contract to see if you have a “failed implementation” clause. Many EHR vendors guarantee success or are willing to work with your practice towards EHR implementation success. However, in some cases, the EHR vendor can’t fix the problem because the software just doesn’t match your practice workflow or their support/implementation teams are inexperienced. Sadly, if this is the case, it might be time for you to break up with your EHR vendor.

But all is not lost, many EHR vendors offer transfer pricing from one software to another. You’ve learned from past mistakes and the next time you’ll know what your practice requires to achieve success and the questions to ask to make sure the vendor will deliver it.

Don’t feel stuck—you too can have a happy ending:

“After suffering through three failed attempts to implement traditional EMRs, we were thrilled to find a solution that was fully embraced throughout our entire enterprise. This EHR vendor clearly understands our complex clinical workflows, and their robust EHR easily conformed to the diverse requirements of each of our providers. We could not have found a better partner.”

EHR: Doctors—What’s in It for You?

“My job is taking care of patients.” We agree.

Physician taking care of patientWith the full-time job of taking care of your patients and staff, who has time to worry about an EHR system? You’re already bogged down with too much bureaucracy, worried about whether your patients will follow your instructions, and concerned if you’ll see your next patient on time.

But did you know an EHR system can actually help you provide the exceptional patient care you want and free up your time? The right EHR can minimize paperwork, create a calm, proactive medical staff, and keep you on schedule so you can leave the office on time.

So doctor, what’s in it for you when it comes to an EHR?

1) Accomplish your goals. Spend less time with busy work and more time doing what you love, whether it is research, seeing more patients, going home earlier, or getting to an afternoon tee time. An EHR focused on your workflow will enhance the time you spend with your patients and the care you provide. Say goodbye to waiting and inefficiency and hello to a smoother day in the office and a better lifestyle.

2) Control your bottom line. If you’re like the physicians we know, you watch your schedule like a hawk. Patients that make appointments before they are instructed to or who do not have their test results back in time can be rescheduled to make room for new patients in your schedule. With the right EHR, it only takes minutes for your staff to proactively review and prep your next day’s charts, making sure you are spending your valuable time productively and maximizing your time in the office (and your bottom line).

3) Share clinical data instantly. Patient information entered in the digital chart can be shared simultaneously with your staff and referring physicians. Transferring a patient call from the front desk to the physician? No problem—you have immediate access to the patient’s clinical data including the most current notes entered by any member of your staff, so you can answer the inquiry quickly and easily.

4) Provide quality care. An EHR allows you to access your charts from anywhere at any time. Preoccupied with answering on-call inquiries at night without reviewing patient information? Respond to patients confidently with their clinical history, last exam note, and any test results right at your fingertips. Not sure if your patients are following through and taking the tests that you ordered? Track orders and results and feel confident that your instructions are being followed.

5) Enhanced Communication. Communicate with your scheduler, nurses, and entire staff in a quick and efficient manner. All this can be accomplished from wherever you may be—home, office, or hospital.

Of course, not all EHRs are built the same. Finding the best EHR for your medical practice is key to a productive office and a better quality of life.

12 Crucial Questions to Ask EHR References

In your search for the best EHR for your practice, you’ve already asked the 10 Key Questions to Ask EHR Vendors; now it’s time to see if their responses live up to your expectations. However, you can’t rely entirely on vendor promises—the only way to get a clear and truthful picture of whether an EHR vendor can deliver what it promises is by speaking with its current and past clients.

Collecting EHR reference feedback is one of the most critical steps in the EHR search process, and it is most easily and effectively managed when split among practice employees. If each employee makes a few calls, the interview process will not require a large time commitment from any one of them. Further, both administrative staff and physicians should call so they speak to their peers at the reference sites, and your practice should speak with several physicians and staff members at each facility to collect different perspectives and opinions. Finally, don’t just call the references provided by the vendors—find other practices using the EHRs you are considering by joining listservs such as MGMA, AAOE, and other professional societies.

12 Crucial Questions to Ask EHR ReferencesAfter you have 10 references from each EHR vendor of practices with a similar size and specialty—along with a few practices that weren’t provided by the vendors—ask each reference these 12 crucial questions:

  1. When did you install your EHR?
  2. How long was the installation/implementation process?
  3. How would you describe the installation/implementation process?
  4. What percentage of your exam notes are fully templated using your EHR?
  5. Was the system as easy to use as it appeared to be when the salesperson demonstrated the software?
  6. How many patients per day did you (and your partners) see before the installation/implementation of your EHR, and how many did you see after?
  7. Approximately how much more time do you devote to entering exam data into your EHR now compared to how you documented exams before you began using an EHR?
  8. How has your patient volume per hour changed since you installed your EHR?
  9. How do you like the quality of the EHR-generated exam note compared to your exam notes before you went live on your EHR?
  10. Have you had to hire scribes to enter data for you? If so, how many and what is their annual cost?
  11. Has your EHR completely eliminated the paper charts in your practice?
  12. Given your practice’s experience with your EHR, would you recommend it to a similar practice?

Asking these questions will give you a clear indication of whether or not a specific vendor will be able to deliver the success you expect from your EHR implementation.

Keep this “cheat sheet” of reference questions handy throughout your EHR search process. It will prove invaluable and provide you with the information you need to save yourself from a potential mistake.