How Pediatricians Should Choose An EHR

I am often asked for advice about choosing an EHR. Obviously, my perspective is biased but I think my advice is truthful and honest. In fact, I can (and often do) advocate strongly against working with my employer and to work with a competitor instead.

I welcome feedback and criticism because this topic is vitally important - poor EHR choices are killing the vitality of independent pediatricians. If you're shopping for an EHR or dissatisfied with your present EHR, let me give you some important advice. Note that none of what I'm about to say is pediatric specific, though I will use some pediatric examples.

EHR Purchase Advice #1: Choose the the most efficient EHR (for you) you can find, regardless of price

I can feel some of you eye-rolling at this suggestion because I work for a vendor who is often labeled as "expensive." But let me suggest this: the most expensive EHR you will purchase, BY FAR, is the wrong one. Anyone unhappy with their EHR right now knows what I mean.

To make clear how important EHR efficiency is, I'll say it up front: a vendor like PCC isn't for everyone. If you look at our EHR and don't understand the workflow right away, if you don't understand what we're up to, then you shouldn't work with us, period. Same goes for any other vendor. The moment you see something you understand or works they way you think, that should be the EHR you explore. I don't care if it's free or an unsubsidized Epic installation.

Let's walk through why.

When it comes to pure price, a vendor like PCC is going to be somewhere around 2-5% of your revenue. Real money, but not the hit on your bottom line that people think it is. A "cheaper" vendor may be in the 1-3% range, give or take. When you boil the math down, you are usually looking at a difference of 1-3% of your income, max, between any two vendors' pricing. The question you then have to ask yourself is: can I see see EHR A being 1-3% more or less efficient for me than EHR B?

What does a 1-3% efficiency difference look like? If EHR A takes only 30 seconds longer to chart per visit on average, and you see 20 kids a day...that's 10 minutes lost right there, or perhaps 1 sick visit. 5% less efficient. Over the course of a year, 250 lost visits is worth $20,000-$30,000, or *WAY MORE* than any price difference between the vendors.

I hate using car analogies, but if the local hospital came to you and said, "Hey, we're going to pay for your car and you're going to save a LOT of money!" you might get all excited. Until they hand you the keys to your new 18-wheeler. You want to drive that to work every day? Sadly, many of you have made that choice.

Note that I'm not even addressing the non-clinical impact on your time that the wrong EHR may represent.   This has nothing to do with whether an EHR includes networking support, special content licenses, support and consulting, etc.  And as much as I believe my employer does more for our clients than any other vendor (no one is close), none of that outweighs a bad match to our workflow.  If you don't think the way our EHR thinks, then all of the extra value we provide won't tip the balance.

EHR Purchase Advice #2: Go see it and play with it.

How do you know if an EHR thinks the way you think? That's a tough one to be sure. Here's my advice from having demoed more pediatric software than anyone you know:

First, sales people (including and especially me) are horrible at giving you a real understanding of an EHR.
Sales people, even excellent and ethical ones, still have an inherent bias towards showing you what their company thinks is good and important (see below). You need to make sure that the sales people listen to you and learn what YOU think is important and work from there.

I recommend that practices ask for a sandbox to play in. All the vendors can do it. Take the last 2-3 patients from your day and try entering their notes into the sandbox (it should only take a few minutes, right?). Do that for a week or so. Try building some templates. And please don't listen to any sales person who offers you a "special deal" with a time stamp on it. The couple hundred or even thousand dollars you might conceptually "save" will be wiped out before you even go on-line if you choose the wrong vendor.

Second, it's a challenge to distinguish between the nuances of an EHR workflow and the nuances of the practice using it.

I recommend talking to multiple users and practices of every system and going to see it in action at least once or twice, even if you have to fly there.  Talk to someone who loves it, talk to someone who DOESN'T like it. The vendor isn't always the problem (though usually we are), so watch, listen, and ask questions.

EHR Purchase Advice #3: Dear lord, don't forget about the billing system

Over the last 5 years or so, the shiny EHR has been the driver on all new system purchases. Heck, it's the title of this blog post. But too often, I see practices switch vendors without really digging into the relationship of of the EHR to the billing system or even RCM/billing service option.

I worked in the world of PM/billing for decades so I have a lot to say here, but here's my best summary: find out about billing performance. That's the bottom line. If the practices you meet are strong at billing and have a good business sense, that bodes well.

EHR Purchase Advice #4: Don't buy today's EHR, buy from the company you want to be working with 10 years from now

It's tough to predict the future. But you have to try. Is the company you are talking to focused on what's important to you? Do their mission statement and strategic plan line up with your future? Are they poised to sell the company? Are the people you know and understand there likely to be gone in a year or two?

Keep in mind that I'm not suggesting that there is a "right" answer to any of these questions. The answers just have to work for you.

EHR Purchase Advice #5: Ignore the price

I realize I'm repeating myself, but this is the single biggest mistake I see when pediatricians choose EHRs.  Too many doctors look only at price and not the cost.  And the EHR that will cost you the least is the one you understand and thinks the most like you do.  It could be my employer, but I know plenty for whom it isn't.  I'd rather have an independent pediatric office thrive with a competitor than perform poorly with us, so do your homework!

Ask yourself: when you hear one of your patients got service somewhere else (minute clinic, flu shot at the pharmacy), what do you say to yourself? 

I've got a lot more to say about this and even some example stories, but I thought I'd toss this out there and see how many people disagree!