Twenty-first Century Electronic Health Records: What is Out There Now?

In early 2021, the second of two large podiatry-specific electronic health record (EHR) systems sold to a large multispecialty company. I was satisfied with my previous EHR, but when the company was among those sold last year, I took the opportunity to look for new options that could provide additional efficiency and streamlining to my practice.In addition, I have observed a significant shift in how many podiatric physicians document their clinical experiences. As we move into the third decade of the twenty-first century, in my experience, the increasing robustness of these systems provide opportunities for growth, and these newer technologies could make practices more efficient and produce better patient outcomes. This is largely due to greater communication with and access to care information by the patients!

I admit that I am old enough to remember paper charting (gasp!). My hand used to hurt a LOT after working with some of my attendings and seeing upwards of 40 patients each day. By the time I finished my residency training in 2008, it was quite the mixed bag when looking at who used a computer system versus who still charted on paper, and it was still a year or two more before I observed those "meaningful use" incentives dominating our language and documentation patterns. I knew, however, that I wanted to be on the cutting edge of this process and early on committed to having an electronic health record for my patients. 

Fast forward 13 years; I was one of many clients who had an important decision to make in early 2021.  After a year of COVID-19 chaos, the last thing I wanted to do was vet out a new EHR! I know many colleagues have felt similar apprehension, and I hope that the lessons and questions below will help YOU if (and when) you make the leap to a new documentation system.

There Are Significant Changes in Electronic Health Record Purchasing

I needed to reconcile with the fact that the days of "purchasing" software (in a one-and-done scenario) are well over. Tangentially, I knew this already, as my previous EHR had moved to a subscription service several years ago. But I was in for an intense sticker shock regarding the price point of some of the snazzy, full-suite products out there.

Pro Tip #1 – Everything is negotiable! Every single company that I vetted for our practice had a tiered pricing structure (mostly) based on three main components:

1.     the number of billing clinicians (regardless of full timepart-time status or patient volume – in the mind of these companies, “a doc is a doc”);

2.     the length of the subscription contract (ie sign up for a longer term to negotiate a lower monthly fee); and

3.     there is truly no such thing as an "all-in-one." Every single company had significant "add-on" options. The process reminded me of buying a car; do I want adaptive cruise control, heated leather seats, a sunroof? Those are ALL going to cost me!

Comparison Shopping is Key

Check out at least three companies to price shop not only the cost per monthprovider, but also the price of those pesky add-ons, the fee structure (more on that in a minute!), the customer service during purchaseimplementation and beyond, training for you and your team, and the cost for conversion of old records into the new system (including what EXACTLY gets converted).

Pro Tip #2 – Many companies will ‘carve out’ certain featuresexperiences. Nothing is an apple-to-apple comparison. But, in general, fees are either the monthly subscription or a percentage based on collections into the practice.

So, if you collect money at time of service from patients andor you have a large cash-based practice where you collect the money up front, the company with the percentage-based fees will get a piece of ALL OF IT unless you run a second ledger for cash-based services. It's not good or bad; it is simply something to consider as you vet out these companies.

An additional consideration for those of us who use an outside billing company is to discuss any HER changes with the biller and ask for their specific recommendations! You will likely need to change a clearinghouse andor the processing of some claims. It is vital to limit your cash flow weak points! 

What Bells and Whistles Does Your Practice Need? 

I am, admittedly, a tech geek. My CPA husband is even more so. We knew we wanted a fancy portal to communicate with my patients. We wanted the special quote tools to allow us to estimate patient cost responsibility, and we wanted to be able to text the patients and give them access to the practice in ways that seemed impossible even 2 years ago. In short, we wanted adaptive cruise control, heated leather seats, AND a sunroof. You may not need those things. Remember, most of these fancy add-ons are “a la carte,” meaning, they can add up quickly in your monthly cost! 

The Devil is in the Details

A special word of advice as you vet out these companies. Speaking from personal experience, as well as seeing how we all mitigated risk with the COVID-19 pandemic, think very clearly about how long of a service contract you want. Is there an out clause if your practice situation changes (ie partnership dissolves or associate doc leaves)? Due diligence is crucial in asking the "what ifs" with respect to company longevity, long-term growth plans of the company itself, and whether or not that particular company puts forth the resources to support podiatry as a specialty within its suite of products.

Finally, please feel free to reach out with specific recommendations based on practice scenario! I successfully transitioned to our new EHR in January 2021 and love it so far. Even with the increased cost, it truly makes my office more efficient in so many ways! 

Dr. Lockwood is a Fellow of the American College of Podiatric Medicine and the American Society of Podiatric Surgeons. She is a Diplomate and Vice President of the American Board of Podiatric Medicine. She practices in Bloomington, IL.

This content was created in partnership with the American Academy of Podiatric Practice Management.