Choosing an EMR: How to determine what's best for you

Like many of my colleagues, you may be investing in an electronic medical record system in the near future. An essential aspect of this process is the development of a request for proposal (RFP), a checklist of your needs that will help determine which system is best for you.

The leading cause of disappointment with an EMR is not defining your needs beforehand. The RFP outlines your needs for the vendors whose systems you're considering. Vendors should answer "yes" or "no" to each item. List all the features your practice must have, along with all the other items on your practice's "wish list."

You need to know all of the possible changes in your practice or environment that could affect your agreement with an EMR vendor. For example: What if the vendor goes out of business? What if you add additional providers after the sale?

From a negotiating standpoint, vendors are always more willing to give concessions before the sale and will often agree to make exceptions to obtain your business.

Set a timetable for the implementation process, Daigrepont says. The best performance guarantee you can get, which is easily obtainable, is to set up a payment schedule commensurate with your pace of installs. Pay 25% upon signing the contract, 25% when the equipment (hardware) is installed, 25% after successful implementation of the software, and 25% after successfully "going live." This payment plan gives you some leverage with the vendor if you are not satisfied with any of the products or services.

You must also have a full understanding of the kind of technical support the vendor will supply and what it will cost. Because your support needs will likely be greater in the beginning, consider requesting that, for the first 50 hours, the vendor not charge for special requests, such as customization or modification of your templates. Your special requests should be discounted for the first year of service, as well.

Another caveat that Daigrepont stresses is never to pay in advance for any trainer-related expenses, including those involving travel. For instance, if a physician reserves a whole day for the training rather than seeing patients, the practice could lose up to $6,000 in revenue if the trainer doesn't show. Although the vendor won't likely reimburse you for that day's lost revenue, you shouldn't be held responsible for the trainer's travel expenses either.

Because emergencies do arise in medical practice, you should expect the trainer to be somewhat flexible if a physician is suddenly unavailable for training on the scheduled date. Stipulate in the contract a plan to handle such circumstances.

To protect yourself from the unexpected, be sure to include a warranty clause in your contract. Daigrepont has provided the following example:

"The vendor guarantees to correct any error, malfunction, or performance defect in its software within 90 days of the reported problem. If the error cannot be corrected within 90 days or reasonable substitution cannot be established, the client will be given a 100% refund of all expenses paid to the vendor, including hardware and expenses paid for professional services, including travel. This concession will remain in effect for a period of 2 years after going live. Thereafter, the client will be entitled to a 75% refund up to 5 years, 50% up to 7 years, and 25% for all years remaining."

It is also important to include an acceptance clause in the contract that states that you are not accepting the software or the terms of the contract until it can be verified that the software performs to expectations.

Ask for a demo

To narrow the field of vendors, the next step after examining your returned RFPs is to invite vendors to your practice to demonstrate their products. To ascertain how the EMR will work in a real, unscripted day at the office, prepare some curve balls to challenge the product with scenarios typical of your practice. For example, give a male patient a female diagnosis, or try upcoding or downcoding a procedure and notice whether the software generates an error or alert.

Arrange visits to other practices to see the finalists' products in action. Send three or four key members of your selection committee on site visits. Talk to as many non-leadership personnel as possible for the most honest answers about the system. If you follow the suggestions listed by Daigrepont, you are likely to avoid costly mistakes that impact the morale, productivity, and bottom line of your practice. If you would like more information on the RFP process, Daigrepont can be contacted at jdaigrepont@cokergroup.com
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Neil H. Baum, MD, is a urologist in private practice in New Orleans. He is the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically.