EHR. Buyer's Guide. An Insider s Guide to Purchasing EHR and Billing Software

Transcription

1 EHR Buyer's Guide An Insider s Guide to Purchasing EHR and Billing Software

2 An Insider s Guide to Purchasing EHR and Billing Software Introduction Recent healthcare provider surveys rank provider DISsatisfaction with EHR programs at an abysmal 76%. YIKES! How the heck are these EHR vendors surviving with these abhorrent numbers Fair question, and if you find out, please let us know as we re quite curious. 76 % If you re in the market for a new Electronic Health Records and/or Medical Billing Software program, by now you realize it s really tough to see the differences that separate the good and bad Health IT vendors. Furthermore, it s even harder to understand what risks to guard against. In fact, if you re researching systems, you might already have a condition we like to call Vendor Blur, where all the vendors start to look alike with similar messaging, products, etc. The goal of this guide is to give you helpful tips that will assist you with segmenting the best vendors so that you can make a purchase you re happy with. If we can reduce the dissatisfied provider rankings from 76% to 50%, we ll all be happy! We hope you find the wisdom of a Health IT Insider incredibly helpful. Introduction Page 1

3 1 Ease of Research and Transparency One of the biggest complaints medical practices have about purchasing new EHR and Billing Software programs is that the vendors they re researching make it challenging to get information about their products, company and services. It is, after all, 2015 and the digital era is upon us, so you have probably grown accustom to making purchases through websites such as Amazon.com, and the Apple and Android App stores. Ultimately, nobody wants to be harassed by a pushy salesperson until they are ready to talk. Why then, do so many EHR Software vendors do such a poor job of simplifying the purchasing process for their potential customers The problem with EHR vendors that aren't transparent during the sales process is that it s hard to trust them no matter how great their products/services are because you re starting the relationship from a questionable place. Most healthcare practices have been burned on bad deals in the past, so it s not unreasonable for you to demand that vendors be 100% transparent with you about exactly what they re selling and how much it costs. Ease of Research and Transparency Page 2

4 Here s a checklist of the things the most transparent vendors provide to make it easy for you to conduct your system research: Demo Video Library Ideally, your prospective vendor can provide you with a library of product demonstration videos that shows all facets of the product. Even better, you will have access to this library 24/7 so that you can watch the videos from your iphone while you re sitting on the couch at home with your family. Note, videos that provide you with an overview of the vendor are nice, but you really need to see the actual details of the product, and the features you would use on a daily basis. Transparent Pricing & Packaging Options The very first thing you should have access to, before you even speak to your prospective vendor, is their pricing and packaging options. Practices are small businesses, so most of them are budget constrained; consequently, they need to know the price of the software prior to having a conversation with the vendor, not the other way around. It s not fair or reasonable for the vendor to expect the practice to sit through a one hour demonstration before understanding their pricing and packaging up front. Make sure you understand all of their costs including setup fees, and potentially hidden costs because these can sometimes create untenable surprises in the future after an initial purchase with balloon payments, etc. A Detailed List of Product Features You can only understand how a product will fit into your unique practice workflow once you can see all of the company s features. The most transparent companies will have an option to see all features or review features from their website. Look for screenshots and descriptions so that you can learn more about their products. Which Medical Specialties Are Supported Make sure you ask the company which medical specialties they support so you can be sure they can support your practice s unique workflow. Every EHR and Billing Software Solution is different; some can support only limited specialties, others can support all. Make sure you review the specialty-specific templates that your practice would be using. Customer Testimonials Most vendors provide customer testimonials on their website. You want to look for a combination of videos, case studies and written testimonials so that you can fully understand how other medical practices are using their products. Ease of Research and Transparency Page 3

5 2 How the Systems Interface The phrase All-In-One has become a bit of a buzzword in the Healthcare IT Industry, but it can be a very tricky topic because there s no uniform definition an Integrated or All-In-One system. Furthermore, since nobody is really holding the EHR community accountable for any particular standard, it seems most vendors claim to have an All- In-One solution. However, that s not always the case. So to create a clear definition of an All-In-One System, it s an Electronic Health Records, Billing Software Program and Clearinghouse available from a Single Sign-On, not multiple user logins. Below, we identify some of the nuances and challenges associated with data integrations between separate EHR and Billing Software vendors, and we also provide you a list of questions you should ask to make sure you are receiving the full and honest truth about how their systems are interfaced. True All-in-One True All-in-One Systems don t require multiple logins and passwords, and allow you to chart your visits in an EHR, manage claims from billing software and even submit e- claims to a clearinghouse electronically. These systems are the most convenient, efficient and secure way to go. Vendor-to-Vendor Data Integrations One popular, emerging Healthcare IT trend is to build data integrations between an EHR and Billing Software - each owned by two separate vendors. If you re already using a Billing Software program, it makes good sense to just build an interface with an Electronic Health Records System, right Not so fast. There are hidden risks that our Systems Engineers have uncovered through decades of experience researching interfaces. How the Systems Interface Page 4

6 1. Revenue Losses Interfaced systems rarely offer features such as appointment-to-claims reconciliation to make sure every appointment was billed out a claim. It s not a surprise these systems don t offer such advanced features because, after all, they weren't designed to work together. This will almost always result in revenue losses for a practice, something that modern day budget strapped practices simply cannot afford to endure. 2. Data Loss One of the biggest risks of using a different EHR and Billing Software program with a data bridge (that pushes patient demographics, appointments and charge data back and forth) is that data invariably gets lost and falls between the cracks. This can lead to revenue losses when Superbills or claims never make it out of the EHR and into the billing software to be submitted. 3. Poor Design Separate EHR and Billing Software programs that are bridged together often suffer from poor design that leads to an undesirable user experience. While each interface is different, the common thread is there are always limitations with what data flows back and forth between the systems. For example, one customer explained that they were using a data integration where patients had to be entered using the EHR, but the EHR didn't allow the practice to run an insurance eligibility verification. To do so, they had to hand-key the patient demographics into the Billing Software program. which defeated the purpose of an "integrated" system. 4. The 'Runaround' TOP 5 RISKS of Bridging Separate EHR & Billing Systems When using an Electronic Health Record and Billing Software program designed by two different vendors, there will come a time when one of the systems isn t working as designed, and when you pick up the phone to call each vendor, they tell you to call the other one. There s nothing more frustrating for a medical practice than having to deal with the runaround. 5. EHR to Billing Integrations with a Single Vendor The majority of Integrated EHR and Billing Software systems contain at least one system that was acquired from a separate company due to a larger company needing to expand their product suite. This has happened whereby EHR companies purchased Billing Software companies, and vice versa. The challenge with these interfaces is that while they re owned by a single company, the user experience is often similar to that you would experience with a vendor-to-vendor data integration because the systems were not originally created to work together. You ll know you re using two separate systems from a single vendor if you have two separate logins for your EHR and Billing Software system. How the Systems Interface Page 5

7 13 QUESTIONS To Ask Potential Vendors Regarding Data Bridges 1 2 How do your two systems reconcile appointments versus claims to make sure no claims go unbilled What type of security do you have in place to ensure our data won t be hacked 3 Is there an audit report to make sure every appointment becomes a claim and every SOAP Note gets billed out 4 Specifically what data elements flow between the two systems 5 Is the interface uni-directional or bidirectional (Uni-directional means data only flows one way, bi-directional means it flows both ways.) 6 Can you demonstrate the specifics of the data integration I d like to see all of the interface points where data flows in each direction and see it function with my own eyes. 7 Is there any duplicate data entry required to use your interfaced systems For example, will I have to re-enter data to do a patient eligibility verification 8 If two systems are offered by a single vendor, was one of those systems acquired from another vendor 9 Does the EHR and Billing Software application require one sign-on for both systems, or two different sign-ons 10 Does your software system include a clearinghouse If so, what are the fees Do you require users to login to an external clearinghouse 11 If your system doesn't include a clearinghouse, do you require users to use your clearinghouse, or can they select their own 12 If your clearinghouse isn t embedded in the EHR and Billing Software, how does it exchange data with the EHR and Billing Software 13 If there s a problem with the data interface, who does the practice call If we get the runaround, who can we escalate our phone calls to The reason for this question is if you get the run around, you need to make sure you know who you can call at the company to get your problems resolved. How the Systems Interface Page 6

8 3 What's the Scoop on Free EHR's One of the newest trends in Healthcare IT is the offering of Electronic Health Records free of charge. This option provides many medical practices a lot of value. However, the vendors offering the free EHR are funding it elsewhere because it costs money to deliver EHR. It remains unclear to many industry analysts who is actually paying the bills, and more importantly, how that may affect medical practices and their patients in the long term. EHR Free EHR for FREE Make sure you protect yourself even if that means asking hard questions to the Free EHR Company. You deserve to know! From a legal perspective, it s critically important to understand what Free EHR companies are doing with your patient data, and as a medical practice, it s important that you be the ultimate decision maker about what happens to your patient data. On the following page you'll find a list of proactive questions practices should ask to the vendors to ensure they understand how the EHR is being funded, and what impacts, if any, it may have on their practice. Free EHR Page 7

9 Here are some proactive questions practices should ask to vendors offering "free" EHR services How are you offering a Free EHR How can you afford to offer training and customer service to customers with a free product Are there advertisements that pop-up in your EHR Are you selling any of our patient data If not, how are you funding a free program If your customers aren't the ones paying you, what incentive does your company have to build features that appeal to our practice If you are selling patient data, is it breaking any laws or crossing any moral doctor-patient lines Do the patients of your practices know you re selling their data Do you have an integrated EHR and Billing Software program Why aren't all of the EHR vendors making their products free Is your company profitable If not, how is your company funded Which investors have a financial interest in your company What would happen if the investors pressured your management team to sell your company How would that impact your customers Free EHR Page 8

10 4 Which Medical Specialties Are Supported EHR and Billing Software companies can have vastly different client bases. Some companies support only specific specialties, while others support all specialties. While conducting your research, make a short list for yourself inclusive of the unique specialtybased challenges your medical specialty faces to make sure the vendor has a good solution for those issues. Here s a good example of why specific specialty support can be important. Mental Health and Physical Therapy practices have a serious need for strong Authorization tracking because almost all of their patients require an insurance authorization number to be submitted with each claim before the payers will reimburse; whereas, OBGYN clinics need ACOG-Compliant chart notes. The point is, each Medical Specialty has unique needs, and it s critically important that the vendors you talk to can and do support your specialty. It s recommended to research each vendor s website to find useful information about if they support your specialty, and if it s not online, ask the sales person if they have specialty screenshots, workflow explanations and how they support your unique specialty. Which Medical Specialties Are Supported Page 9

11 5 Client Server vs. The Cloud Technology has come a long way in the past 5 years, so there are more and more Electronic Health Records Systems being made available via the internet. However, it s important for your practice to decide if a client-server system, or a cloud-based or internetbased system better meets your needs. In the table below, there s a pro/cons list for Cloud-Based and Client-Server Technology followed by a list of questions you can ask the vendor to better understand your hosting options vs. CLIENT SERVER CLOUD BASED Setup Fees Financial Risks Equipment Fees Configurability Usability Mobility Reliability Control Innovation Upgrade Fees High High High High Low Low Medium High Low Medium - High Low Low Low to None Depends on Vendor High High High Low High None Client Server vs. The Cloud Page 10

12 vs. Questions to Ask Server-Based Vendors: Questions to Ask Cloud-Based Vendors: Can you host our data in a data center Was your system designed to run over the internet * If you can host our data, what are the associated fees What type of browsers does your system run on How are data back-ups conducted on your system What equipment is necessary to conduct a data backup and how much additional server space will we need to do so What is your up-time What security protocol does your system use Is there a separate hosting or maintenance fee How often will we need new servers What are the setup costs of servers, and professional services to get the system up and running How often do you do data backups What type of security does your data center have to protect our information Have you ever had a data breach What can we do if the internet goes down ** * If the answer to this is yes, the system should run on an internet browser such as Internet Explorer, not a Citrix Connection or Remote Desktop Protocol (RDP) connection. ** Most cellular companies such as Sprint, AT&T and Verizon offer mobile Wi-Fi via iphones. This can be a good back-up in case of internet outages. Client Server vs. The Cloud Page 11

13 6 Mobile-Friendly Running a Medical Practice is a lot of work. Being home for your children s sports events or family dinner is important to most medical providers. Selecting a vendor that offers you mobility options will provide you more freedom, and help you deliver better patient care because you ll be able to run your practice from anywhere. However, please note that most EHR vendors don t provide all of the features available in their system within their mobile platforms, so provider and physician adoption isn t as high as it could be. A good Medical Office Software program will allow you to do the following from a mobile device: Send Secure Office Inter-Office Communication Review Chart Notes Create Tasks and Reminders Review Practice Financial Performance Record Voice Dictation into the EHR Review and Schedule Appointments Write E-Prescriptions Take & Upload Pictures from your Mobile Device Capture Charges & Receive Charge Capture Alerts Reminding you to Submit Superbills Ask your prospective EHR vendor about any additional costs for a mobile EHR as well as what mobile platforms and devices their mobile EHR can run on. Most vendors have ios support, and a few are now offering Android support. The key is to make sure the features available in the Mobile EHR add convenience to your professional life so that you can spend more time with family, and less time tethered to your office. Mobility Page 12

14 7 Customization According to recent surveys, EHR customizations are responsible for the majority of cost overruns when installing new EHR applications. Every practice is unique, and it s important to find a vendor that can work with you to fit their EHR to your needs, not the other way around. The following are questions you ll want to ask the EHR Company to make sure you have a clear understanding of how well they can customization their program, and how much it costs: Do you have templates for my specialty If so, could you please send me several so I can review them What are your Setup Fees How much customization is included with the setup fees How much do you charge for additional customization Can I pay by the hour instead of paying for large blocks Will I receive a written documentation of the tasks and costs involved Before agreeing to any customizations, always ask for an estimate in writing that contains the cost, and the estimated time to completing the customizations. You also want to ask what specifically will be included in the customizations, and if the vendor misses their timeline, are they able to make financial restitutions. Customization Page 13

15 8 Implementation and Training Implementation and training, also known as on-boarding, is a critical element to consider. Without adequate on-boarding support, your practice may not be able to successfully complete your system implementation. Below, we've broken down three core areas of on-boarding; data imports, training and clearinghouse enrollments. Each segment offers important questions to ask your prospective vendors: Data Imports One of the first things you ll need to address before switching to a new vendor is what resources they have available to help you get some or all of your current data into their system. Most EHR and Medical Billing Software companies have the ability to help you import patient demographics, appointments, payer lists, fee schedules and clinical data. But few, if any, vendors can import financials and A/R from your previous billing program. Questions you ll need to ask about data imports include: What records do you have the ability to import What type of file format do you need to do the data import Can you help me get my data out of my current system How much will it cost to do the import Are there any hidden costs Is there a chance it will cost more than what we agree to How long will it take to complete the import If you run behind, will I receive a refund What steps do you take to ensure the data import was done properly Implementation and Training Page 14

16 Training Training is critical to your practice s success. You want to really get an understanding of how the training process will be conducted with your new vendor. Most companies nowadays can do all of the training remotely - which offers convenience and also keeps costs low. You ll want to ask the following questions to gain an understanding of how your practice will undergo training: Will I have a personal contact during training How long will this person be assigned to our account Once that person is no longer our point of contact, how will we get customer service thereafter How long does training typically take How is training conducted Online or in-person Is there an in-person option if we elect to pay extra If so, how much does it cost If you do web-based training, do you record it for the practice so we can reference it at a later date for new employees that are hired in the practice Are there training videos we can access during off-hours What do we need to do prior to the training sessions to be ready for training Clearinghouse Enrollment Getting enrolled in a new clearinghouse can be a pretty time consuming process especially for someone who isn't well versed in the process. The risky part about enrolling in a new clearinghouse is that if you miss a step, it could have negative implications to your cash flow. So it s important to make sure you don t miss any steps during the clearinghouse enrollment process. Some vendors offer what is referred to as Assisted Clearinghouse Enrollment. This can be incredibly helpful because it means that an expert is responsible for getting the agreements to your practice, and all you need to do is sign the paperwork. Implementation and Training Page 15

17 9 Customer Support Customer service is one of the most important aspects of any software system, and many healthcare providers complain about the support they receive from EHR and Medical Billing Software companies. Below, you ll find a few questions you ll want to make sure you ask your new vendor to gain an understanding of how they deploy customer service: Where are your customer service centers located Are they US-Based, or located in a Non US facility What are your hours of operation for customer service What support resources does your company offer online What is the average call hold time for your support team What is your customer retention level What happens if I submit a support ticket with no response Customer Support Page 16

18 10 Size of the Company The topic of what the right size of an EHR and Billing Software Company presents some great questions. Some medical practices believe that selecting a large and established vendor is best for them because they feel the vendor is more secure; whereas, other practices prefer to work with a smaller company that they feel has a better understanding of their business. There s no right or wrong answer when it comes to discovering if you prefer to work with a larger or smaller company. What really matters is the quality of customer service you re going to receive. Below are a few questions you might ask your vendor to help you decide how important their size is: Is your company privately held, or public Is your company profitable Is your company venture capitalized If so, what are the company s goals insofar as selling the business, and what would happen to us if you sold the company How many medical providers do you currently support Can we talk to your CEO (This will give you a sense of a) the size of the company, and b) how important your business would be to them) Company Size Page 17