The most common question asked by physicians early on in the EHR implementation process is which software vendor offers the best product. This is a highly subjective question because dermatology offices have varying practice workflows.

As the last article in this series discussed (July 2010 Dermatology World, p. 16), the first step in determining which EHR vendor provides the best product for your practice is to determine your workflows and inefficiencies so you can settle on your future goals and approach to adoption for the practice. These goals and strategies will be the foundation on which your practice bases its EHR vendor decision.

You also should check each company’s financial standing because you want to avoid the risk of a vendor going bankrupt.

After you have settled on your goals for the practice, you will need to narrow your EHR vendor list to four to six choices. Your first decision should be to determine whether you prefer a client-server based EHR model or an application service provider (ASP) model. A client-server based model means that the practice would purchase the EHR software along with the hardware and be responsible for safeguarding the data.

An ASP model would involve purchasing the necessary hardware but running the software through an internet connection. The vendor would then be responsible for safeguarding the data and the practice would simply log onto the system each day.

Once you have decided which model is best for your practice, visit the Office of the National Coordinator for HIT website to search for certified EHR vendors for the meaningful use program. Additionally, visit the Certification Commission for Health Information Technology (CCHIT) to learn which vendors received dermatology specific certification. This certification was created by a workgroup of dermatologists.

To further narrow your list down from CCHIT-certified products, you can visit various websites aimed at providing reviews of EHRs. The KLAS group provides free reports on EHR performance based on qualitative and quantitative physician survey data. CTS Guides also provides free information on its website. You also should check each company’s financial standing because you want to avoid the risk of a vendor going bankrupt.

Your state may also have information through its regional health information technology (HIT) extension center. These centers were created by the Federal Office of the National Coordinator of HIT to provide counseling and technical support to physicians implementing EHRs in their practice. Use this link to search for your state’s extension center. In addition to these resources, visit vendors in the exhibit halls at the American Academy of Dermatology’s Annual and Summer Meetings and speak to your peers about their choices. Dermatology has a very specific niche in the EHR marketplace, and you will find that there is a short list of vendors that are popular.

After you have narrowed your list of vendors down, you will need to prepare a request for proposal (RFP). It is important to be as specific as you can in the RFP so you can determine exactly how each vendor differs. Give each vendor four to six weeks to respond to your RFP and invite each vendor to your office for a live demonstration. Compare vendors; Remember to note how long simple tasks take with each EHR and make sure you ask the vendors to document different clinical scenarios.

Each vendor will have its own baseline script built into the system, but you want to see how easily the system adapts to your practice’s clinical scenarios. Count how many clicks of the mouse or keyboard it takes to complete each task. This will give you an idea of how long it will take each person to document a scenario. Also, make sure all of your staff is participating in the demonstrations. They will all be involved in the implementation and management of the EHR, and you want to ensure everyone is happy with the system.

Once you have determined exactly which systems meet your practice’s needs, your final comparison should be cost. You should never select a product based on cost alone. Remember to look back at your cost/benefit analysis when you were analyzing your workflow needs. Think about all of the external costs involved, as well as hardware, internet services, technical support and general maintenance. You may think of an EHR as just another expense to your practice; however, it is important to realize the potential benefit.

If you select the right EHR, you should see additional profit and gains with respect to patient safety, compliance and efficiency.

This article originally appeared in the August 2010 issue of Dermatology World.

Return to listing

What are the CCHIT dermatology-specific criteria?

Thanks to the Academy’s advocacy efforts, the Certification Commission for Health Information Technology (CCHIT) formed a dermatology workgroup in 2009 to recommend optional criteria and test scripts to address the unique needs of office-based dermatology physicians and practices. Ten Academy members served on the workgroup and have recommended criteria including the ability to upload and draw on anatomic diagrams and photos, capturing characteristics of a lesion, and creating tracking logs, among others. For more information, visit the CCHIT website, where a list of certified vendors is available.

What about free EHRs?

Practice Fusion has been advertised heavily to physician practices as it is a free ASP-based model EHR. It is supported with advertisements that run on the screen of the system. There are obvious advantages to such a product, namely cost. However, dermatology practices should note that it is not CCHIT-certified. And, there is significant administrative time required because all patient data would need to be manually entered into the system. Hardware costs are also not figured into their implementation and there are limitations with respect to dermatology-specific templates, data ownership and security

Besides Practice Fusion, current “safe harbor” exceptions to the Physician Self-Referral Law and the Anti-Kickback Statute allow hospitals to donate any EHR software to physician practices as long as the physician paid for 15 percent of the estimated cost of the product. Again, this could be financially viable for your practice, but it is important to speak with a health care attorney because there are many rules and regulations concerning the donation, including the fact that hardware costs and staffing assistance cannot be donated to the physician.