How do you find the best Electronic Health Record (EHR) for your practice?

By Paul Lynch, MD, Tory McJunkin, MD, Tina Sebring, MS, MPA, Ryan Tapscott, MSpmnlogo

Dear Arizona Pain Specialists,

We are considering purchasing an EHR system for our pain practice.  We’re not sure how to get started or know if it’s even worth the headache.  Can I get some advice please?

Thank you,


Dear Technophobe,

Bravo! You have taken the first step, which is to simply begin having the conversation. In today’s environment of costly paper charts, lost time searching for patient records, undecipherable scribbles and poor handwriting, and high document storage fees — there is no question of if you should purchase an electronic health record (EHR). The question is which EHR is the best fit for your practice?

Pain management services are crucial to the well-being of patients and the entire healthcare system. With this work being fundamental to improving the quality-of-life for those living with pain, medical record software solutions are a must. A clinic that is prepared to focus on the needs of its patients should be as efficient and secure as possible.

Selecting an appropriate EHR for a pain practice requires both a significant financial investment and a large investment of time. No short-cuts can be taken during the EHR selection process; it is too costly of a decision, in both software and manpower, to rush such a decision. One must spend the time and resources to properly screen medical software vendors. Also, once an EHR is purchased, dedicated on-going effort is required to set-up the system for your needs and implement properly. Unfortunately, there are no perfect software solutions or implementation short-cuts — regardless of what any charismatic EHR salesperson might tell you.

As pain specialists, our practices can be quite complex and robust software may be required to perform many of our duties. Examples include:

1)      Multiple services are often ordered (e.g. obtain imaging, EMG/NCV, procedure ordered, referral to other specialists…)

2)      Multiple services are often performed (e.g. interventions, testing…)

3)      Order tracking must be robust to monitor services ordered

4)      In-office injections vs ASC vs Hospital performance require differing coding/bills to be submitted (e.g. If service is performed in an ASC, the application must be able to bill facility charges on a uniform billing (UB) form)

5)      Physicians require the ability to set-up “bundled” services which allows the provider to select the applicable injection (one-click). All related items automatically appear on the encounter form.

6)      The ability to enter on each visit and trend a pain scale is critical to our specialty.

7)      The ability to thoroughly track referral sources, both incoming and outgoing, for purposes of sharing patient information and to grow business.

8)      The ability to bill claims, track denials, and respond appropriately

Why purchase an EHR? Ultimately, they improve the quality of patient care. A fully functional EHR system gives physicians, nurses and technicians a patient’s comprehensive medical history at the point of care, whether in the doctor’s office, ambulatory surgical center or in the emergency room. It is also remotely accessible for providers who are on call, allowing them to make informed decisions that expedite patient care.

EHRs also have the potential to increase efficiency and contain costs by reducing duplication and improving patient safety.  Their ability to calculate, network, automatically check facts and provide targeted research results is remarkably powerful. Applied to medical care, it provides the patient and physician with not only more information, but ideally accurate and current information too.

The Federal government supports EHR development and implementation. Veteran hospitals across the country share an electronic system, called VistA, which allows for all veterans’ health records to be shared. Healthcare workers treating veterans in the system are able to see current medical records, whether the patient is being treated from any VA facility.

In addition, President Obama signed the American Recovery and Reinvestment Act in February 2009 (ARRA), which initially included $26 billion towards Health Information Technology for Economic and Clinical Health Act (HITECH). This is an unprecedented investment in Health Information Technology (HIT), with the final goal of establishing an electronic health record for each person in the USA by 2014.

To make the best selection of an appropriate, effective EHR for your practice, consider:

An EHR is a marriage:  Think of an EHR selection as a marriage between your practice and the EHR product/vendor.  Implementing an EHR for your practice will dramatically change the work-flow for every area and process of your practice.  Think about this decision as you would think about any major decision.  You will be tied to the EHR software, support team, company, and product idiosyncrasies for a long time.

Make a Top 10 List:  The first step in selecting an EHR is to identify the most important items/services for your practice. This would include your most profitable services and goals for the future (e.g. adding pain services, locations…). Consider your immediate needs and include future objectives. It is better to grow into your software over time than replace the costly system whenever your practice expands.  As you create this list, determine what specific workflows are vital to your practice.

Review Medical Software Vendors:  To narrow the lengthy list of medical software vendors, identify those who offer products for your practice size and specialty. Vendors market certain products to specific size practices with reason. The size and specialty of your practice typically indicate the features you will most likely use. Regardless of features and support, it would not make sense to purchase an enterprise application designed for 200-plus physicians if you are a sole practitioner. Do not base your decision on price alone. The EHR software will in essence run all important aspects of your business, and a good decision can be invaluable. The appearance of a few thousand dollars in savings at the beginning may cost the practice thousands later – in both upgrades and manpower. Avoid this classic mistake by considering the growth of your business before purchasing.

Look for consistent success and stability — vendors who have longevity; has the vendor been in existence for many years with a significant customer base and a vested interest in the industry? Ten-plus years of experience provides a long-term reputation and track record you can research. These companies also invest a significant amount of money in staying current by employing large programming teams to increase product functionality in order to continue to meet the ever-changing industry and government requirements.

Take Several Test Drives: At first glance, vendors may appear to be similar. However, there are differences in exactly how the software accomplishes your goals, and to what degree. Have each vendor illustrate how their product functions for each of the items you have listed as your top 10 priorities.  Also, ask about mobility – how to track hospital rounds, off-site visits, and procedures in remote locations. Make sure your practice has a record of service to compare to what a hospital billing department is sending. There is no gray area on this feature; the system will either be able to track this, or not. Create a scorecard to keep track of results. This will help you narrow the vendor list.  Make sure you do not make the decision for EHR based solely on how well the system performs for a clinician, but instead think about billing, scheduling, authorization, and every other process that occurs in your office.

Cost of Ownership: Most software vendors have a preferred payment structure that can range from full payment at software delivery to pay-as-you-go. Consider the finance plan carefully. No upfront costs and a monthly rental fee may not actually be a better financial choice. Compare the purchase of licenses and professional services upfront with a one-time capital outlay to a monthly rental fee. Negotiate the final payment on or after you have gone live to maintain leverage for any remaining issues. There is always pain as the dust settles in any new endeavor. It is nice to have a financial safety net.

Existing Customer References: Obtain 2-3 references from each shortlisted vendor. Ensure references are from a practice of similar size and specialty. It is preferable to have the references in the same geography so that you and your staff can visit the reference facility and see the system being used in day-to-day operation. Diligence with this step is imperative. Unfortunately, it is often skipped, which is foolish. You would not hire a physician without calling references first. Consider this the same type of homework – critical to avoiding a classic EHR purchasing mistake.

What about Meaningful Use: In order to be eligible to participate in the Hi-Tech EHR Incentive Program, the electronic health record software system must be certified. There are three certifying organizations: CCHIT, InfoGuard and Drummond. This ensures the features are in the system for your practice to utilize in order to demonstrate Meaningful Use Attestation for the 90 consecutive day period.

For the official list of certified EHR products, visit

Assistance: Selecting the right medical software solution for your office can be a daunting task. The good news is you have options for additional assistance. The Internet provides a flurry of information at no additional cost. There are also consulting firms available for hire in every major city, and Arizona Pain Specialists (APS) can help too.  Boost Medical Services, a subsidiary of APS, offers a wide range of services to assist medical practices. The single best selling feature is our own success. You are able to view our facilities first-hand, and see what we use and trust our recommendations.

As more organizations adopt EHRs, physicians will have greater access to patient information, allowing faster and more accurate diagnoses. Complete patient data helps ensure the best possible care. Patients too, will have access to their own information. They will have the choice to share it with family members securely, over the internet, to better coordinate care for themselves and their loved ones.

Digital medical records make it possible to improve quality of patient care in numerous ways. For example, doctors can make better clinical decisions with ready access to full medical histories for their patients—including new patients, returning patients, or patients who see several different providers. Laboratory tests or x-rays downloaded and stored in the patient’s electronic health record make it easier to track results. Automatic alerts built into the systems direct attention to possible drug interactions or warning signs of serious health conditions. E-prescribing lets doctors send prescriptions electronically to the pharmacy, so medications can be ready and waiting for the patient.

Although EHR require ongoing investments of time and money, clinicians who have implemented them have reported saving money in the long term. With the efficiencies that EHRs promise, their widespread use has the potential to result in significant cost savings for our health care system.

The best advice we can give is to take your time. In spite of the fervor for EHRs in government and the press, now is the time to be sure you have conducted a thorough evaluation, taking into account the specific functional needs of our specialty and your practice.