Choosing the right EMR

Many SLPs are looking for a technology to use but they’re not sure exactly what their practice needs. It would be nice if there was an all-in-one solution that took care of everything your practice may run into. Unfortunately, today isn’t an option. Technology is certainly moving in that direction, but it is a ways away from that becoming reality. In the meantime you’re stuck choosing between dozens of different options with a variety of different applications.

This article will leave with a clearer idea of how to evaluate your practice needs, provide you with a list of questions you should be asking a vendor before you become a customer, and give you a better understanding of the perspective of a technology provider.

Let’s start with a good technique other SLPs shared with us when they were trying to determine their biggest and most immediate needs.  Over the next two weeks take 15 minutes each day to look back on everything you did. Also, record how much time each activity took. Some common examples of items that appear on these lists other than therapy are billing, scheduling, note taking, writing evaluation reports or creating progress notes. At the end of your two weeks, total up the amount of time you spent on each activity. Hopefully, giving therapy takes of the largest amount time. Although therapy might be the largest number, if you are like most speech pathologists, the other items on your list are taking up more time than you expected or wanted. Next, rank these items in terms of convenience from 1 to 5. With 1 being something you don’t mind doing it just needs to get done and 5 being it the most frustrating things you deal with on a daily or weekly basis. Now that you have ranked the items and determined what takes the most time, you can start reviewing them to decide what is most important to you.

Now that you know what is important to you, you can start narrowing down the dozens of options to just a few. Then the decision usually comes down to price. This is many times where SLPs get stuck. Often times there are concerns of large up-front implementation costs, hidden fees, or unannounced price jumps. Most of these concerns can be eliminated simply by asking if the price you see is truly the price you pay. From the perspective of a technology vendor, we always encourage our clients to think in terms of what they are getting back rather than what they are giving up. To better understand this, let’s look at an example.

ClinicNote has a price point of $60 per user per month. We occasionally have customers who are concerned they cannot afford that. ClinicNote has been able to save its current customers, on average, between 1 and 4 hours a week. That 4-16 hours per month. Our clients can use some of that saved time to give additional therapy sessions which, in turn, generates more revenue than $60 per month. So, they have already covered the cost of ClinicNote, and given themselves a few extra hours reallocated elsewhere.  

Granted, this works both ways and it can help you make sure you’re not spending too much on a product. This is a great way to figure out what you are willing to spend and what you get in return for you investment.  

Once you have determined what your practice needs and what you are willing to spend, you probably have a good idea of what product you will be looking at specifically. Before making a decision there are a few other things you should be familiarize yourself with. One is data security. Everyone knows that data and personal health information (PHI) stored in a third party application must be secure. Some vendors have built their own internal data storage and they believe they have followed all the HIPPA guidelines. More commonly today, companies are turning to third party services to store data in the cloud and pulled for use in their applications. Either way, you should certainly know who else may have access to and PHI. I would encourage you to ask your vendors if they engage with any other entities that might handle your personal health information. Regardless of how the information is stored, you should ask if the location it is being stored in has been professionally audited to validate HIPAA compliance. This will verify their HIPAA compliance to ensure your information is truly secure.

An additional item that is often overlooked when dealing with data security is the Business Associate’s. Agreement (BAA). The BAA is a contract between a HIPAA covered entity (therapy clinic, school, hospital, etc) and a HIPAA business associate (EMR that handles PHI). It is very important that you sign a BAA before putting any PHI into a software. This will transfer any liability of a data breach from you to the vendor and makes the vendor legally obligated to notify you if such an event were to occur.

Most vendors will have their own BAA that they will want you to sign. It is in your best interest to read it over and ask questions about anything that is unclear; a good vendor will happily walk you through the document with you and be able to translate the legal jargon into something more easily understood. A common example of information in a BAA is that you should not store log in information to applications containing PHI in your web browser. This is a pretty common habit of many people these days. This would void your BAA and make you liable for a breach in information rather than your vendor. The BAA is mainly for the protection of the therapy provider. Knowing what to expect from your vendor and what they expect from you to uphold the BAA is critical to ensure your protection if anything goes wrong.

Now that we have discussed data security, we can look at some other, less daunting, but equally important issues. Many people don’t stop to think about what the relationship with a vendor would be after they become a customer. This usually ends up causing problems down the road. This is commonly referred to as Customer Support. Remember earlier when we said many people get frustrated because of hidden fees that pop up? This is probably where they came from.  These issues could be easily avoided by asking yourself and the vendor some very simple questions like:

  1. Are you expecting 24/7 phone support, email support, both?
  2. Are you going to have to pay for certain levels of support?
  3. What is the expected procedure if you were to run into a problem?
  4. How long do you have to wait for a response to your issue, and when will you know if it is being addressed?
  5. Is there a guaranteed up-time for the technology, and what happens if this is not met?
  6. Does the vendor offer unlimited document storage space, or if you go over a certain amount will you be charged extra?

Now the last thing vendors want you to think is that is all about hidden fees jacking up prices. There can be perks that you may not be aware of as well. For example, many companies have referral programs. Companies often will give significant price breaks or even completely subsidize costs if you refer others to their platform. This can be a good way of saving some money on your end. There may also be rewards for people who volunteer to test new updates and provide feedback to help make the product better. It may not always seem like it, but we do listen to your feedback. It is very important to us, and it is the most beneficial way to improve technology. You are the ones that are out there in the fields using the technology every day and understand what works and what does not.

If you do find yourself in a situation where your feedback is being ignored and a particular product is not working out for, you should certainly understand what happens to all of your data in the program if you decide to leave. Who has the rights to this information? How will you get your data back?. By law, the technology company is not allowed to withhold any PHI from you. However, it may not necessary be given back to you in a convenient format. Some vendors do this to discourage you from moving to a different platform. You will certainly want to ask your vendor what happens if you choose to leave just in case you find yourself in this situation.

Let’s quickly review everything discussed in this article. We talked about how to break down your day and analyze your time to decide what your practice needs. We discussed how to determine what you are willing to pay. We ensured that all of your security questions have been answered. We know what you can expect in terms of levels of support if you became a customer, and we came full circle to understand what happens if things don’t work out with a particular vendor. None of this is meant to make the process of choosing the right EMR a difficult process. It is simply a good idea to be fully educated before making a decision. Always remember, technology should be a tool to help make your life easier. It should be reliable, save you time, and eliminate frustrations.

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