Tech Talk - Using Common Sense When Selecting an EHR

If one tunes out the background noise and focuses on two simple concepts—affordability and usability—selecting an EHR becomes a lot less confusing.

Because I own an EHR company, using my column to provide guidance on adopting an EHR is a rather dicey ethical issue. But I’m tackling this topic anyway, because I hear too many horror stories from physicians who feel they were essentially fooled into buying a system they could neither afford nor use. Let’s start by disclosing that I am the founder and CEO of AmazingCharts.com, a company that develops and markets an EHR solution. With the understanding that I am biased, let’s talk about something that too many physicians appear to forget when they get marketed to and cajoled by vendors and EHR consultants: common sense.

One reason behind the huge media blitz by the EHR industry is that, with the federal government promising potentially thousands of dollars to physicians who use an EHR, these companies see an easy opportunity to make money off of technologically naïve physicians. But if one tunes out the background noise and focuses on two simple concepts--affordability and usability--selecting an EHR becomes a lot less confusing and may actually result in physicians pocketing thousands of dollars while avoiding the horror stories experienced by many early-adopting physicians (watch for an upcoming Tech Talk column, “EHR Nightmares”).

Affordability

Physicians may be eligible to receive as much as $44,000 if they can show that from 2011 through 2015 they used a “certifi ed” EHR in a “meaningful” way. The fact that there may be some money coming to physicians means that the price of adopting an EHR doesn’t have the same signifi cance as it would if physicians recognized that the cost comes directly from their pocket. The truth, though, is that every dollar paid for software is one less dollar that the physician has to spend elsewhere, or bring home. Those physicians who remember this fact and pick a less costly EHR will pocket the difference, because the federal payment is based on the total Medicare or Medicaid dollars billed, and is unrelated to the cost of the EHR system. (Yes, that means that if you don’t have a large Medicare or Medicaid population, the money you might receive will be alarmingly less than the EHR industry is implying.)

Usability

Like me, every other EHR vendor claims that their EHR is the best, and all sorts of exaggerations are commonly employed on websites, in marketing literature, and by EHR reps. The challenge for physicians is how to fi nd the least biased information and fi gure out if actual EHR users like the product they chose. Over the last few years, a number of reputable groups have surveyed actual EHR users on the benefi ts (and the problems) of their EHR system. And while these studies fail to take into account the actual price of the software, they at least shed some light on the fact that many EHRs are too cumbersome and poorly designed to effectively use in a busy practice.

The AAFP’s Family Practice Management 2009 EHR User Satisfaction Survey (www.aafp.org/fpm/2009/1100/p10.html) tallied results from 2,012 family practice physicians using 22 EHR systems. The survey asked respondents to indicate their level of agreement or disagreement with 13 statements, such as “overall this EHR is easy and intuitive to use,” and “documenting care is easy and effective with this EHR.” The results show that the more popular and expensive EHR systems are often much less usable than more affordable solutions. Medscape’s “Business of Medicine” (www.medscape.com/viewarticle/709856) surveyed 3,700 healthcare professionals and asked them to rate their experiences with EHRs in 12 areas of performance, including overall ease of use, reliability, customer support, ease of implementation, and value for the money. Again, price appeared to be inversely proportional to usability.

It is clear that the government has created a lot of fear, uncertainty, and doubt by dragging its feet on definitions of “certifi ed” and “meaningful use.” As a result, many physicians are holding off on adopting an EHR, which is increasing the aggressiveness of EHR marketing. As the hype increases, be wary of consultants and vendors waving the promise of federal stimulus dollars and HITECH money. No matter what the future holds, using common sense to choose an EHR that is both affordable and usable will make you, and not your EHR vendor, the winner in the end.

Been burned by a so-called EHR consultant? Or did your implementation story have a happy ending? Share your experiences with your colleagues. Send an e-mail to ccole@mdng.com.

Dr. Bertman is Physician Editor-in-Chief of MDNG: Primary Care/Cardiology Edition. He is a Clinical Assistant Profes- sor of Family Medicine at Brown University and president of AmazingCharts.com, a leading developer of EHR software. He is also the founder and president of AfraidToAsk.com, a con- sumer website focusing on personal medical topics. He is in private practice in Hope Valley, RI.