How to Choose an EHR Software Vendor

As we all try to adapt to new healthcare rules and regulations, the healthcare software industry is in a feeding frenzy.

Armed with a mandate to acquire an EHR system, agencies are “ripe for the picking”.

The Software Selection Process – What you need to know

Be on the lookout for three types of vendors, all of whom claim that their solution set will “save you time and money and increase performance”:

  • Vendors who don’t have EHR software but will “build” one for you.
  • Vendors who don’t have EHR software but have recast their “practice management software” as an “EHR” system.
  • Vendors who have EHR software.

Rather than try to evaluate the merits of the different software solutions, most agencies simply give up and hire a consultant.  This changes nothing because the decision point has simply shifted from software/vendor selection to selection of a consultant.  Any consultant you hire will also claim that they will “save you time and money and increase performance”.

Regardless of what course of action you take, at the end of the day, there is “no-free-lunch”.  You need to document your agency strategic objectives and then select a software system on the basis of its ability to support these objectives.  Writing an RFP that launches a “features war” across vendors and ends up with a selection on the basis of who has the most installations will not work because no vendor at present meets all of the requirements for “ongoing meaningful use”.

Why do you want an EHR?

Let’s start with some basics – do you want an EHR in order to get a one-time incentive OR is it perhaps not more important to “save time and money and increase performance” on a daily basis going forward?  This is not a difficult question, because you can have both.

Quantifying Potential Savings

Since all vendor solution sets claim to “save you time and money and increase performance”, try calling their bluff by establishing some metrics and ask them to help you quantify the potential savings.  Include the results of your findings in the vendor contract.

Saving Time

Quantify the time required with the proposed system to:

  1. Respond to an incoming phone call, record basic demographics on your agency face sheets, do some screening using a non-trivial triage algorithm and reach a decision whether to accept or refer (3 minutes versus 10 makes a big difference over the long haul).
  2. Book an initial appointment with a provider who is willing/able to attend to the specific needs of a patient across a provider list of say 50 providers, each of which host different event types at different times of day at different locations.  If the proposed Scheduler does not accommodate pre-scheduling of clustered events, e.g. six 10-minute med checks back-to-back, don’t waste any more of your time on the solution set you are looking at.
  3. Count the keystrokes required to retrieve a patient record, determine what the next care step is for this patient and document the intervention at this step using forms that are appropriate for the care step.  More than 5 key strokes probably mean you are working with older technology.
  4. Record data relating to a typical 10-15 page initial assessment where one healthcare professional starts to perform the assessment, then goes off shift, leaving a second healthcare professional to complete the assessment.  Examine closely how the handoff takes place e.g. does the second user have to “break glass”.

Saving Money

  1. What capability does the proposed system have for automatic allocation of tasks across agency staff with the obvious objective of being able to handle current transaction volume with less staff, or processing an increased volume of transactions with current staffing levels?
  2. What percent reduction will the agency see in terms of clinical/admin errors with the proposed system and what will be the annual dollar savings for, say, a 30% reduction in clinical/admin errors?  How exactly will the proposed system “reduce errors”?

Increasing Performance

  1. How will the proposed system simplify progress note recording for, say, a group session scenario where different providers write up individual patient progress notes and one provider writes up the group session note?
  2. To what extent does the proposed system replicate the “good” features of old paper “charts”?  i.e. Does the proposed system allow users to view data, as it was, on the form versions that were in use at the time the data was collected, complete with date/timestamps and signatures?  Is there both a longitudinal as well as an episodic history?

Contracting Options

If you are in the market for acquisition of an EHR system, you basically have three contracting options:

  1. No contract. Acquire an open source EHR system and take on the task of customizing it and carrying out ongoing maintenance on your own.  Your agency could end up being an IT organization that provides healthcare services as a sideline.
  2. Buy or rent a “practice management system” that you can use as-is or have the system customized by the vendor or an independent consulting firm.  Unless you spend a lot of time and money on customization, you will end up changing the way you deliver healthcare delivery services to accommodate the way the system “works”.
  3. Buy or rent a “workflow management system” that lets you put your clinical and administrative “best practices” in-line and have the software system guide the processing of patients.  You will end up with software that mirrors your agency “best practices”.  No more/no fewer steps than what you know you need to efficiently run your agency.

The benefits of Option 3 are obvious:

  • Agency “best practices” become the “application” – you end up with software that does no more/no less than what you want it to do.
  • Improved performance (staff efficiency, patient throughput, and compliance with internal/external rules & regulations are increased, and administrative/clinical errors are reduced).
  • No customization is required.  (Implementation time/costs are greatly reduced.)
  • Ongoing maintenance fees are reduced.

For more information, call Walter Keirstead at 800.529.5355 or visit our web-site at


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, major crimes case management, healthcare services delivery, and b2b/b2c/b2d transactions. (C) 2010-2019 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
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