pediatric electronic health record system

How do I select a Pediatric Health Record and Practice Management System? There are many questions to ask when looking for a Pediatric E.H.R. and Practice Management System. Some items to consider include:
1. Identify a company that focuses solely (preferred) in Pediatrics or primarily in Pediatrics. Don’t be ‘fooled’ by the companies that try to provide the impression that they are focused in Pediatrics via their Pediatric-Specific advertising when they are actually an Internal Medicine/Family Practice System (look on their web sites and see what other specialties they implement their system). Just like kids are not ‘small adults’, a Pediatric E.H.R. is not just some Pediatric Templates. A properly designed Pediatric Specific E.H.R. system should be simple and intuitive to use so that you are able to see 30+ patients a day and have your charts completed within 30 minutes of seeing your last patient. The system also should have Pediatric Specific billing rules and be updated at least monthly.
2. Obtain a demonstration from the Vendor. Is the system ‘simple’ or ‘complex’? Don’t let a seasoned sales representative whom knows how to navigate your obstacle cloud your judgment on what is simple. From your years of experience, you know what is a simple/easy to use and a better design for you as a Pediatrician. Keep in mind that it is very difficult to design a system that is simple while still being complete. Some of the ‘dated’ systems are complex since that was the old model in technology as well as the old thinking around design. In the defense of vendors that are trying to maintain the ‘old’ technology, it is very expensive to redesign a system so many companies just keep adding on to their base system developed over a decade ago. In the programming world, a decade is forever (think what has changed – smart phones (e.g. IPhone), Facebook, Twitter, I Pad, etc.). One of our advisors (an executive in the Technology field), is shocked at how ‘dated’ some of the technology companies are in the Healthcare space. Interesting that some of the vendors with ‘dated’ technology is proud to answer ‘how many installs’. This is a ‘weak’ argument. Consider that there are probably more ‘tube’ TVs (old technology) than Plasma/LCD (new technology) – would you purchase a ‘tube’ TV today based on number of installs of the dated technology? Electronic stores do not sell ‘dated technology’ in TVs but E.H.R. companies continue to sell systems that were built in the pre-plasma TV/IPAD days. Their fear is that customers will see the new technology – which is better, easier to use and lower cost to the practice than the ‘dated’ technology.
3. Does the vendor provide options to customize the system? What are the costs? Some companies will not provide small customizations at a nominal to no cost (especially if they did not develop their own software but paid an outside company to develop their software). Your Pediatric Practice, in most cases, is not a ‘cookie cutter’ of the beta site for which the vendor developed their product. What can be changed and customized? Find out the cost and time frame to make changes? Ask if the company employees full-time developers or if they outsourced their development (this will provide an idea of their level of technical expertise)?
4. Does the vendor have ‘fair’ and ‘reasonable’ pricing and contracts? I am shocked at the variation of contracts by Vendors. Some vendors will have an initial cost and maintenance cost for a client server system which requires the customer (practice) to incur all the costs of a server, backups, IT team to maintain the server while providing a high maintenance fee to the practice. Many vendors make it ‘difficult’ to provide access to your data (including vendors of client-server systems). They might ‘fool’ a practice owner that they are ‘safer’ with a client-server system, but the actual occurrences in the field show that this is not true. For example, some companies do not have an export feature of their client server system so that if you want your own data out of the servers that you have paid to maintain with your own IT people, you need to pay thousands of dollars to the vendor to extract the data. The contract should state the data is yours and that you can obtain your data with a nominal fee (spelled out in the contract) or no cost. The form should be a continuity of Care Record (CCR) or similar format. If a client wants to leave our service, they will receive their data in CCR form (in our current agreements).
5. Customer Service – can you actually speak with a technically knowable person during business hours? Some companies provide either ‘leave a voice mail’ or a customer service line managed by individuals whom have strong phone skills but minimal technology skills. Call the customer service line during the day and see how long it takes for the vendor to return your call.
6. Updates – What updates are included in the price? How often are the updates? Some client-server systems only update 1-2xs per year! Many cloud systems, update continuously with this cost included to the customer. This is how this should work.
7. After your demonstration online, take a test drive for yourself of the system. Is the system easy to use? Can you call and obtain feedback and answers to your questions from team members of the vendor prior to buying? Try to schedule and see a few patients. Ask how the practice management system is integrated with the E.H.R.. What Pediatric-Specific Billing rules are in the system? Does the system have a “Pediatric Specific Scrubber” for claims? How often is this scrubber and coding system updated? 1-2xs per year is definitely not acceptable to optimize the revenue cycle.
8. Ask yourself when evaluating the options for a Pediatric E.H.R. and Practice Management System: What is the worst that can happen and best that can happen if you choose this vendor? Consider cost, how current is the technology, ability to transition to other systems, focus in Pediatrics and how much ‘hazel’ will the system be for me (e.g. there is a cost in time and effort to buy servers, maintain servers, back-up data). For example, if the vendor provides a five year agreement without a clause specifying the data format if you leave, you might be in for a costly ride. Ideally, the E.H.R. Vendor should have a one year contract with a 90 day out clause at any time after that. The vendor should also provide the data back to you in a CCR format so that all the digital data can be converted into another E.H.R.. With this contracting, there is only the risk of not liking the system since you as a practice owner can always move the data to another system without having to move through the paper to data conversion again. This is how we word our contracts – minimizes the risk to the customer (practice) and assures that the contract favors us performing continuously.
9. Do I have options for the vendor to provide billing so that I can manage my practice with less staff and does the vendor have repeatable results? Many Pediatric offices would make additional revenue with less hassle by leveraging an expert in the Revenue Cycle Management. There are many obstacles in the revenue cycle to manage that require consistent processes and management systems in place. There is a major difference from developing, selling and training on software versus managing the revenue cycle. Some vendors are trying to ‘cash-in’ without their processes and systems designed from ‘day one’ to manage the revenue cycle for their clients. Contact analysts, venture capitalists and investors, they will all point to cloud-based systems where these leaders believe today’s technology and tomorrow’s is as well. Also, you will see that the outsourcing vendors in other industries usually leverage cloud based technologies. This is very important when selecting a company to manage your billing. Some questions to ask: What is the vendor’s collection rate? What type of report do they provide the practice monthly? What is their range in A/R days for their clients? How do they train their billers to obtain new information? How do they assure that your account has follow-up and resubmission of claims? Can you view your claims real time as they manage the revenue cycle?