1. Physicians will learn the most from practices that have used EHR technol- ogy for one to two years. Those who have used it less than that are still in an educational phase.
2. Physicians should only buy a system they have seen operating in a work- ing medical practice. Vendor demon- strations are not enough.
The guide also covers preparations physicians should make for customized vendor presentations at the practice. Physicians should gather some clini- cal case studies, provide them to the vendors in advance, and request they use them as illustrations. The practice should ask the vendor to demonstrate how a template for documenting some codes might look, about whether us- ers can create templates, and about the work involved in constructing a tem-
plate. In other words, the sales presenta- tion should fit the practice’s needs. After thorough research, Dr. Fleeger’s practice selected an EHR and solicited the help of an attorney in the contract negotiation process. “We used a lawyer who was familiar with EHR vendor contracts and was able to add provisions that protected our practice. We made sure we’d have access to patient data in formats that can be easily transferred should the company go out of business, or should we decide to stop using the product. We also made them guarantee in the contract that the system wouldn’t be down for a signifi- cant period of time without the vendor incurring some financial consequences,” he said. Dr. Spencer and his partners began
researching EHRs in 2009 by focusing on vetting the vendors.
“We examined each vendor’s finan- cial viability and sustainability and lo- cal market share. Once we’d narrowed down our choices, we visited other pri- mary care physician offices to see how the systems worked for them. We chose an EHR vendor that provided good train- ing and had products that were user- friendly,” Dr. Spencer said. Dr. Fleeger compares purchasing an EHR to buying a car. “The contract is ne- gotiable, and so is the price. Physicians don’t have to pay the sticker price.” The following questions from the
Electronic Medical Record Implementation Guide are a starting point for discussions with vendors:
• How long has your company been in business?
• How long has the product been of- fered?
• What were your total sales last year and last quarter?
• What is your total customer base? Of those, how many are new within the last year?
• Does the company hold regular user meetings or have user groups?
HIT help from TMA
For tools to help assess whether a physician practice is ready to adopt an electronic health record (EHR) system and to obtain guidance on choosing a system, visit the Health Informa- tion Technology (HIT) page on the TMA website, www.texmed
.org/HIT. Resources include the second edition of TMA’s Electronic Medical Record Implementation Guide: The Link to a Better Future, a white paper titled “EHR Buyer Beware: Issues to Con- sider When Contracting With EHR Vendors,” an EHR readiness assessment worksheet, and more. TMA members can access the EHR vendor comparison tool
at
www.texmed.org/EHRtool (sign-in required). For more information, contact TMA’s HIT Help Line at (800)
880-5720, or e-mail
HIT@texmed.org. In addition, TMA Practice Consulting offers doctors a prac-
tice assessment and workflow analysis to start them on the path to adopting and implementing an EHR system. Informa- tion is available by calling (800) 523-8776 or e-mailing practice .
consulting@texmed.org.
34 TEXAS MEDICINE July 2013
• Is your software sold modularly, or does it need to be purchased as a complete package?
• What functions are available? • What operating platform does the product work on?
• Will your company guarantee in the contract that the software will com- ply with all current and future federal and state mandates?
• How are the licenses issued? • What is the cost per practitioner (or concurrent user) for the entire pack- age?
• What does the price include? • How much will ongoing maintenance and upgrades cost?
The road to implementation Once the practice accepts a vendor’s pro- posal, the HIT adoption process moves into the implementation phase. During this period, the practice needs to focus on redesigning workflow, learn- ing the new software, and moving es- sential information from existing paper records to the new EHR.
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