From a technical perspective, a specialty EHR may be appropriate. But don’t overlook key business considerations.

Selecting your first EHR, or switching to another, involves many technical and business considerations. This is one of the biggest technology decisions your specialty practice or clinic will ever make. It’s not easy to evaluate complex software applications, let alone sort through the hundreds of vendors each touting its self-proclaimed “best solution.”

As a specialist practice or clinic, you have the added layer of deciding to go with an EHR for general practices, one that accommodates multiple specialties, or a niche player specifically designed for your patient and practice needs.

For many practices, a larger or more established general EHR with a comprehensive solution, a longer list of referrals and more overall experience is the best route. For other practices, specialty and niche players have grown in popularity, and are an attractive alternative to address the workflow and productivity limitations of first wave, multi-use EHR systems. These specialty and subspecialty practices are looking for a more customized solution that goes beyond the basics of gathering data, documenting care, sharing information and facilitating communications.

Selecting the best EHR provider for your specialty practice takes more time than a generic solution. To help you with the evaluation process, let’s do a deeper dive into some key technical and business considerations:

Terms

The selection process starts with the kind of practice you are, and your EHR should reflect that.

Multi-Specialty EHRs – For multi-specialty clinics, or general practices with overlapping capabilities, this approach has advantages. It ensures greater compatibility, and avoids a patchwork approach of installing an EHR system for each specialty. This can reduce the added costs and time of interconnecting your different specialty groups.

Niche or Specialty-Specific EHRs – Niche players target standalone specialties or subspecialties designed to meet the ultra-specific requirements and reporting needs of the patients they treat.

Key Technical Considerations

Regardless of specialty, a dedicated EHR needs to have the flexibility to meet the unique demands of your particular practice, and must be able to:

• Maximize efficiencies and minimize costs
• Remove workflow disruption
• Improve care coordination
• Avoid errors and adverse events
• Enhance healthcare quality and safety
• Improve patient outcomes and patient satisfaction

In evaluating EHR alternatives, here are some key technical considerations:

Documentation Forms and Templates – As a specialist or subspecialist, you have very specific workflows and quality measurement requirements.

Understanding how the EHR handles documentation forms and templates (medical charting, patient intake, flowcharts and lab orders, etc.), how they’re configured and how easily they can be customized to accommodate your clinical processes and data collection needs is essential.

As one clinical applications director for an oncology clinic told me, “Chemo is complicated. It’s a rhythmic event that must be carefully scheduled and coordinated with nurses and staff; you can’t do it on an Excel spreadsheet.”

Content and Clinical Data – Assess their knowledge base and decision support capabilities (best practices/guidelines, reference information, clinical protocols, alerts, etc.) and determine if they can handle the data and content requirements of your specialty or subspecialty.

Evaluate how it’ll support your data governance efforts. Determine how the system will evolve with the changes that come with value-based care, including predictive analytics, increased data interpretation, data visualization and population health.

Interoperability – When selecting a niche specialty player, interoperability is a critical consideration. Determine if and how well your vendor can integrate with referring practices, health information exchanges, acute care facilities and inpatient facilities. Evaluate how seamlessly it interfaces with your current technology, and if it can connect disparate systems.

Key Business Considerations

In addition to technical issues, specialty practices need to factor in the business considerations of smaller niche players.

Investment Costs –  Given their added specialization and complexity, specialty EHR implementation can often be more costly and time consuming. And that’s without factoring in the added cost of training your staff and administrators. You need to weigh these costs against improvements in workflow, increased productivity and better patient outcomes.

Reputation – Carefully consider the reputation and background of the vendor’s leadership, and the experience of the staff. What prompted its founders to form their company?  Was it a business opportunity, or based on a passion and understanding for your specialty and subspecialty?  How committed are its leaders to continual upgrades, future technology trends and working with you and your staff with installation and ongoing maintenance of their system?

Financial Health – It’s critical to determine if the EHR is large enough to meet your needs. Do they have resources for product enhancements in an evolving industry? Ask how recently they made improvements, and what kinds of practices aren’t right for them. Lastly, assess whether they have a long-term commitment as an independent company, or whether they’re looking to be a takeover target. This last point is very important, given the growing consolidation within the EHR market.

It’s interesting to note that physicians are heavily influenced by their peers who are, understandably, risk averse. The temptation is go with an established player, but I point to a quote from John D. Halamka, MD, MS. Halamka is Chief Information Officer of the Beth Israel Deaconess Medical Center and Chief Information Officer/Dean for Technology at Harvard Medical School: “As an engineer, I select products and services based on requirements, and not based on marketing materials, procurements by other local institutions, or the sentiment that ‘no one gets fired by buying vendor X.’”

Government mandates – Determine your potential vendor’s capacity for accommodating value-based care requirements. Specialists need EHRs to help them provide a more holistic approach to identify and treat high-risk, high-cost patients.

To be sure, many of these considerations aren’t unique to specialty EHRs or niche players. But if this is your first EHR implementation, or if you’re making the switch from a generic EHR, you need to make sure that you’re making informed decisions when selecting an EHR vendor.