We recently spoke with a former hospital CEO who had some insights into EHR evaluation and selection. Phil Hanna has been in the hospital and health services industry for 45 years. For a large portion of that time, he served as CEO for a rural hospital. He now spends his days meeting with other hospital CEOs and consults them on how to balance administrative, board, clinical, IT, financial and other medical challenges. Phil noted that, when looking at current EHR solutions, there are three things to keep in mind: 1.) What is driving the change in your business? 2.) What does the current hospital EHR landscape look like in your market? and 3.) What are the core elements that make an EHR a good choice for you? (by price, fit, and functionality). Read on to learn how these three factors can help you navigate the EHR landscape.

What Drove EHR Adoption in the Past, Versus What is Driving that Need Today?

  Seismic changes in the healthcare world have driven hospitals to evaluate EHR solutions. In 2009, EHRs were promoted by the Federal government under the Health Information Technology for Economic and Clinical Health (HITECH) Act. This act served as the foundation for other healthcare IT related mandates all aimed at increasing adoption, driving to interoperability, and promoting data transparency. However, mandates encourage compliance, not good business and IT practices. As a result, many hospitals missed the opportunity to use these solutions as a clinical and operational asset. Meanwhile, vendors were primarily concerned with meeting Federal guidelines and standards. This ultimately created a culture that feared change and penalties, rather than a culture focused on driving clinical value from IT and ensuring quality care. We are entering a new phase in EHR evolution—one that puts clinical intelligence over compliance and leverages lessons from other industries on design, integration, and user autonomy. Emerging solutions are bringing together delivery strategies that use a SAAS approach, thereby eliminating hardware costs and drastically lowering maintenance and upgrade fees. They are predicated on user autonomy. End-users are empowered to make configuration changes to accommodate individual workflows and unique clinical requirements thereby mitigating coding costs and cumbersome change request processes. Additionally, these solutions are designed around an open API structure to allow for streamlined integration and the incorporation of clinical applications that, when added into the EHR, create a true system of clinical intelligence.  

What Is The EHR Landscape For Small To Mid-sized Hospitals?

  The small to mid-sized hospital landscape is shaped by the careful balancing act of affordability versus functionality. The landscape is represented by a handful of vendors, most of which are older and built their systems around the need for compliance. Additionally, a few key players in the EHR rural market have abandoned this market, creating a void. Old vendors are being displaced by new, competitive solutions that are offered at a more affordable and transparent price point, which include greater flexibility and scalability. Some vendors claim to be able to handle every application of the EHR. These are the vendors who have the ‘one size fits all’ solution. However, it is rare, and perhaps unrealistic to think that any one solution can meet all the needs of an organization, and as a result many aspects of the ‘one size fits all’ do not address the functional needs of many end users. Inflated cost and expectations are tied to the ‘promise’ and ‘value’ of these monolithic technologies. The idea that one solution can be everything to everyone has left many providers grappling with solutions that are “a Jack of all trades, and a master of none.”

A Rural CEO’s Evaluation Process

When considering all the EHR options, hospital CEOs must start with what the hospital really needs. What can the EHR software do for your hospital? How can this specific software cater toward your hospital? Will it solve the problems you are currently experiencing? This is not about compliance; this is about solving problems and how vendors can support the process. Challenging vendors can help you better understand what your hospital needs and what they can provide. Therefore, an initial self-evaluation process is critical. Specifically, examine fit, functionality, and price.

Fit

  When thinking about ‘fit’ regarding EHR solutions, make sure to first sort out the practical issues, if you have not done so already. Are your servers already in-house? Or are you currently cloud based through a third party? What resources do you have to take care of servers? Should you be in the IT business? Look to SAAS solutions as the next step in your EHR evolution. SAAS solutions (Software As A Service), or web-based solutions, might be better for your hospital than traditional in-house servers. SAAS is cloud-based and all updates are done remotely. It frees your IT department from complex software and hardware management. SAAS solutions, comparatively, have lower initial costs, advanced security, and are scalable as the company grows. Access to applications is easy, and most times training services are provided to get the most out of your service. A SAAS solution might be the right fit for your hospital.

Questions to Ask Yourself:

 

• Do you have different care settings (clinics, post-acute care etc.) that need to be accommodated?
• What departments/specialties do you need to accommodate?
• Do you have the facilities to house servers?

Functionality

  Functionality for an EHR solution means finding a system that enables physicians to have access to records and can update patient information with ease. Make certain that your vendor can get what you need without your hospital having to make large sacrifices in your organization. How can the program support the different levels of care within your organization? Telehealth use has been steadily on the rise for years but has experienced a recent spike during Covid-19. In terms of functionality, your EHR solution should be able to provide and support telehealth. Does the EHR solution support all desired elements of telehealth? Additionally, patient portal access needs to be very accessible to patients while also meeting federal standards of security. The vendor needs to be able to juggle this paradigm. Your EHR solution needs to be easy to use but have the upmost security. Ultimately, what are you looking for in an EHR? Understand your key issues and then find a vendor who can solve the majority of them. As one size does not fit all, the EHR solution may not be able to fix 100% of the issues. However, does the vendor have an open technology platform that is interoperable with other products?

Questions to Ask Yourself:

 

• What are the key department issues you are trying to solve?
• Are applications such as telehealth and patient portal included in the solution?
• Is the solution configurable to different workflows and care levels?
• What is the Information accessibility?

Price

  When buying an EHR, be wary of contracts that are vague and vendors who cannot fully articulate the proposal in detail. Fees can get buried. The bottom line should not be difficult to calculate. You should not have to dig to understand what you are paying for. Frankly, they might not want you to know. Additionally, it is key to understand the pricing model offered and the initial costs of installation, as well as things like maintenance fees and hardware upkeep. Know what your hospital can afford and what it might have to pay for, either up front or in a few years time.

Questions to Ask Yourself:

 

• What is the cost of installation?
• What kind of pricing model is offered – flat fee, transaction based?
• If transaction related, what risks are there to the hospital and how can these risks be mitigated?
• Are there maintenance fees or hardware upkeep?

3 Final Thoughts on Implementation from a Rural CEO

 

1. How Quickly Can This Be Implemented?

  A faster and easier installation is not always better. The price that is paid to achieve things quickly, so that you can move on to something else, is not always as it seems. A lot of hospitals are driven by this ‘objective’ to implement EHR solutions as fast as possible. Some hospitals do this quickly to obtain the most ‘incentive’ money. However, this is not a desirable course of action. Take the time to analyze your hospital’s needs, as you might be paying the price down the road

2. EHR Implementation Demonstrates the Needs to Change Management Strategies

  Everyone in the hospital is touched by the EHR. A hospital CEO needs to be able to articulate clear objectives and keep circling back to determine how he/she can be the most supportive to assist others in meeting their objectives in EHR implementation.