101 Tips for purchsing your EMR: 101-80 Support Tips
Posted Jul 12 2010 11:00am
Purchasing an Electronic Medical Record / Electronic Health Record (EMR / EHR) is a huge decision for today’s medical practice. Physician adoption is tentative, but has been spurred on over the past few years due to economic stimulus dollars and impending sanctions if an EMR has not been adopted by 2015.
101 tips for purchasing an EMR is just a scratch of the surface. Purchasing a new EMR can be very complicated and will have a long lasting effect on the service, quality, safety, and finances of your practice. This table shows you the first segment of tips and questions to think about when you engage an EMR vendor.
The 101 tips are broken down into Support, Quality, Safety, Finance, and Efficiency. Some questions will have more or less relevance to your practice based on the size and electronic maturity of your environment.
Tips & Qs
Trust, but verify
Remember that vendors are trying to make a sale, and salesman, even if well intentioned, rarely have quality clinical experience in multiple areas. You will hear many things, but make certain to verify the answers to your questions in a written process.
Ask about the learning curve
Every application, no matter how simple, has a learning curve. That curve can be very large if you are adopting your first EMR, and may still be significant even if you are on your tenth (let's hope not) EMR. If the vendor says "super easy" than make sure they show it to you.
Ask what platforms are supported
You don't want to adopt a brand new product that is created for yesterday's technology. Can you get the EMR on your Blackberry or iPhone? Can you get to it from the web?
Look for long life and long term support
Once you have an EMR, you will want to stick with it long term. You don't want to redesign your clinical practices any more than you have to. Make certain the product you want will have a serviced life of at least 5 years and hopefully considerably more.
How will your teams be educated on the EMR / EHR?
When adopting a new EMR everyone in the medical facility will need training. Nurses, registration, physicians, etc will all need to understand their aspect of the EMR. The question to ask the vendor is "how will this training be done?". Different people will learn different ways. It is best to have multiple ways to connect, i.e. hands on classes, 1-1 training, virtual sessions, webcasts, etc.
Ensure audit logs are easy to get to and are comprehensive
The last thing you need is to get a court order asking for electronic discovery just because you can't get the proper usage audit logs. This is oddly a failing with many EMR manufacturers. They often have security added as a second thought.
Background check the vendor's support team
Every vendor will say they have wonderful support. Ask the vendor for some references and give them a call. Also, call some folks that you were NOT given as a reference. Ask what they think of the support they received.
Ask how the vendor ensures disaster recovery and business continuity
Hurricanes, earthquakes, tornadoes, fat fingering, and crazy people that like hacking things are just a few of the everyday issues that we continually run into. We need to ensure that clinical data is safe no matter the event that takes place. Make the vendor describe their process, and then prove it!
TRY to use a vendor that actually has standards in their system
I say "TRY" because it is actually difficult to find sometimes. Many vendors use proprietary databases and languages to write their software. This means that getting support from the wider community is a pain. You will often be stuck with high cost consulting fees to get something changed or updated. Look for standards driven software (SQL, C#, Java, etc). Your life will be easier.
Google "product name + support forum"
You want to make certain there is a community to support you. The vendor is nice, but having real world people that actually use the product is better. The vendor's core business is software development, not care delivery. You will want to find people that actually understand your business model.
Google "product name + Twitter / Facebook / etc...
If the vendor isn't engaging social media, then you will want to scrutinize them closer. They may be missing engagement opportunities with the medical community, they also may still be stuck in 1984. Either way, it is not a good sign.
How does the vendor prioritize issues?
Make sure the vendor can tell the difference between what is "nice to have", "necessary to fix", and "OMG HELP!!"
Evaluate your overall support needs
Are you a clinic that works 7am-5pm? Do you have weekends open? Are you a hospital that needs 24x7 on site support? You will want to evaluate your complete support needs before committing to any contracts.
Make sure you have solid control, and a backup plan, for user access
Nothing is more irritating than bringing in a new staff member and having them sit around for a week while you wait for someone to create an ID so they can use the EMR. Make certain you have a solid plan locally to handle new staff. Don't rely simply on calling the vendor.
Have a defined Service Level Agreement
SLAs are a bit different than your standard contracts. They will define the precise expectation for support. If you want to be 99.99999% of the time, you will need to tell the vendor. Just don't be surprised at the price tag.
Define a local Service Center before going live with the EMR
Most people think of the "Service Center" as the Help Desk. However, in a clinical environment, a service center is a much more robust group. They include application analysts and often informatics and clinical staff specifically for the purpose of handling EMR issues. Have this group setup and performing before going live on the EMR. This will help your adoption immensely.
Test, retest, and test the network and wireless
Once you go live with an EMR or EHR, your providers will have very little patience for slow or spotty network coverage. Make sure the infrastructure is solid before building and deploying applications.
Have ONE number to call
Don't try the age old "if you have an EMR problem press 1, if you have some other problem, press 2". NO! This simply doesn't work. Every single problem will be an "EMR problem". Give people one number to call and let the support staff do the triage. They can figure out whether the issue is an EMR issue or a PC issue, etc. Remember the support team's core customer are care givers, not IT folks.
Remember who the support team's customers are
Many caregivers have never had to use computers in their daily practice. These are highly educated, very knowledgeable people, but they won't have much experience in EMR process or tools. You will need to take time with them and be patient.
Have a communication strategy for when things go wrong
Technology inevitably breaks, or gets a virus, or needs to be rebooted, or some other nasty thing. Make sure you have a tool (NOT EMAIL) for communication and a way to make certain everyone gets notified. Also, don't be afraid to over communicate.
Make all of your planning very public within your organization
If you want an environment that is easier to support, make certain your stakeholders completely buy into the process and the project. Making your planning public is a good way to keep stakeholders engaged, and is a good way to find difficulties between specialties or supporting teams.
Make certain the leader of your project's support team is a physician
Simply, IT is IT, they are not caregivers. You don't need to have a physician be the Service Center manager, but you do need a physician to be the face and driver of the overall change. This will help adoption and create a bridge between your IT folks and the clinical folks. IT and clinicians speak different languages, we have to be aware of that difference and attempt to mitigate it whenever possible.