American Academy of Ophthalmology Web Site: www.aao.org
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October 2009

 
Practice Perfect: Information Technology
EHRs: 10 Questions That You Should Ask About a Vendor and Its Software
By Leslie Burling-Phillips, Contributing Writer
 
 

(PDF 90 KB)

With so many vendors to choose from, selecting an Electronic Health Record (EHR) system that is right for your practice may seem a daunting task—not to mention a substantial investment of both time and money. “Around 30 percent of all information technology (IT) projects fail,” said Jeffrey Daigrepont, consultant with the Coker Group in Alpharetta, Ga., “so careful consideration of the options is mandatory.”

Mr. Daigrepont explained that there are two primary factors that contribute to system failure: 1) “The vendor overpromises and underdelivers. In this case, the buyer’s expectations were incorrect or the system does not operate as promised. 2) Buyer’s remorse occurs at about the same rate. In general, the buyer did not realize how difficult the transition would be and it is creating a threat to productivity. If you don’t see the light at the end of the tunnel, you will eventually throw in the towel and quit the program,” he said.

To boost your chance of success, here are 10 questions to ask about a vendor and its software.

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5 Queries About the Vendor

  1. How long has the company been in business? While a company’s longevity does not guarantee it will endure future challenges, it provides a clue to the company’s prospects. “When a practice purchases an EHR system, it is with the anticipation that it will be a long-term investment. The process of conversion is so labor-intensive, you want to avoid changing vendors before fully realizing your return on investment,” said Julia Lee, JD, chairwoman of the American Academy of Ophthalmic Executives’ EHR subcommittee and executive director of Ophthalmic Partners, a multisubspecialty practice in the Philadelphia area.
     
  2. How stable is the company? Companies come and go. Economic instability has affected businesses of all types. Pay close attention to impending mergers and acquisitions, as well as the potential for business failure. “Over the next few years we are going to see some of the smaller companies either merge with larger companies or simply cease operation. You need to know if the vendor will be around and have the resources to upgrade their software regularly to keep up with the federal requirements for certification and interoperability,” said Ms. Lee. Mr. Daigrepont agreed, “Many of the problems that we deal with relate to mergers. When companies come together, it is often because one vendor does not think its product is as modern or strong as another. They link up because it is cheaper to buy than rebuild. This may result in inadequate support for the original product.”

    Niche ophthalmology vendors have some appeal—after all, they are focusing their expertise on meeting the needs of eye care providers—but you should be diligent about reviewing their prospects. “There is concern about whether or not they can get enough market share to maintain viability,” said Mr. Daigrepont.

  3. What type of technical support does the vendor offer? As with any computer software, questions and problems will arise once the system is installed. Fast, efficient and continuous support is essential to keep your practice productive. “Make sure the company offers good maintenance support,” recommended Ms. Lee. “Find out when you can access their help desk and determine if this will meet your needs.”
     
  4. How much experience does the vendor have within ophthalmology and/or specific subspecialties? Having a great track record for developing and supporting EHRs does not mean that a particular system is suitable for your practice. “Ophthalmology is unique in that it is diagnostic image– intensive and requires certain functionalities that other specialties do not. Find out what a vendor’s presence is in the ophthalmology market and look for a company that has completed numerous installations,” Ms. Lee said. “You want to see a lot of examples where the system has worked, and you want to talk to people who are satisfied with it,” said Mr. Daigrepont.
     
  5. Does the vendor guarantee compliance with federal requirements for incentives? If you are hoping to participate in the incentive payments that are tied to EHR adoption, you need to find out which vendors are committing themselves to comply with those regulations. “Many vendors are now including language in the contract guaranteeing the ability to submit data per the government’s requirements. Some awareness and commitment from the vendor that they are going to give you the tools necessary to participate in the incentive programs is vital,” said Ms. Lee.
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5 Queries About Software

  1. Does it offer ophthalmology-specific and subspecialty-specific content, features and templates? Treatment plan descriptions, decision support tools, medication lists and other items unique to eye care should already be banked into the system. “Ophthalmologists frequently make annotations and draw pictures. So, when you look at an EHR system, make sure that it has all the critical capabilities for your practice. Although some features may intuitively seem standard, not all systems will allow for freehand drawing on an electronic form, for example,” said Mr. Daigrepont.

    “Look for a system that has both depth and breadth with regard to ophthalmology installations because even within ophthalmology there are different needs among the subspecialties,” said Ms. Lee. “Find out if the ophthalmology templates allow for customization and how much work such customization involves. Ask for a demonstration of the product and find out if there is a live site nearby that you can visit. Go to a practice that as closely approximates your practice as possible in terms of size, number of providers and subspecialties.”

  2. Will the EHR system be interoperable with current patient management system and practice software? Most practices already have a patient management system (PMS) in place for billing, scheduling and other administrative tasks. If the EHR product that you are going to buy won’t work with your existing PMS, then you will need to upgrade to a compatible PMS system. “This can really change the scope and complexity of your conversion, but make sure the two systems will work together,” said Ms. Lee. Bundling services together with one vendor can simplify the integration process and make both systems easier to maintain.

    “The Academy sponsors a standards- based effort to integrate different systems,” said Lloyd Hildebrand, MD, who is chairman of the Academy’s Medical Information Technology committee. “This effort is known as Integrating the Healthcare Enterprise (IHE) Eye Care initiative. If both the EHR and PMS systems are IHE Eye Care tested, then they should be able to work together.”

    Furthermore, said Mr. Daigrepont, “find out the basic programming language of the system. If it uses a proprietary database or programming language, you may have more difficulties working with the database as opposed to an Oracle- or Microsoft-based program, which has countless people who can help you.”

  3. Will the EHR system interface with your current diagnostic devices and equipment? When meeting with a vendor, take a list of every device in your practice that will require integration. Some devices will integrate on one side, and others may need bidirectional integration—one on the vendor’s side, and one on the device side—which may mean extra fees.

    “You should also take the basic statistics about your practice,” said Ms. Lee. “For example, the total number of providers, users and practice locations. This will give the vendor an idea of the scope of the installation.”

    “Again, a standards-based approach—as pioneered by IHE Eye Care—saves you money by alleviating the need to create custom interfaces for all your devices and equipment,” said Dr. Hildebrand. “The VA went from writing 700 different device interfaces to writing just one because they were using a common standard. This year, even old equipment can be integrated through software known as ‘middleware.’”

  4. What are the vendor’s plans for the product in the future? An EHR system is a long-term and costly investment. You therefore should make sure that it is not at the end of its life cycle. “Do not take the chance of becoming technologically isolated. Even if the vendor continues to support the software, it will become outdated because research and development on the product ceases,” Mr. Daigrepont said. “Find out who they are hiring. If they are hiring a lot of Windows programmers and the product was Unix driven, chances are that is not where they are headed in the future.”
     
  5. What are the terms for upgrades and new releases? At what frequency? Expect to receive a new release approximately every six months as a part of your maintenance agreement. To ensure delivery of these enhancements, “your contract should explicitly state that the vendor is required to provide you with future upgrades, new versions and releases at no additional charge. And, these improvements should be in compliance with federal requirements,” said Mr. Daigrepont.
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