One size does not fit all

There are typically two types of EHR tools. The first type targets small- to medium-sized medical facilities such as primary care offices, walk-in clinics or urgent care clinics that have about five to 300 employees. The second group is geared toward small, midsize or large hospitals that typically require more extensive systems to manage more complex data, including medical imaging, labs, nutrition, pharmacy and emergency medicine. The two EHR tools are significantly different from one another and they both have a different set of features, infrastructure requirements, clinical workflows, training, and overall implementation process. So for the EHR buyers, making this distinction early in the buying process is the first step in determining which platform is a fit for them.

The purpose of an EHR is to centralize patient data, making it easier for healthcare workers to review a patient's record prior to or during their visit.

For the outpatient environment, the suitable EHR software typically tracks the patient health records over a longer period of time. The system captures patient data and documents it as part of the patient record. During these patient-doctor interactions, the physician usually has a template that they can customize to fit the type of visit and the workflow. This EHR software generally focuses on tracking the patient over longer periods, offers limited integrations with external systems like medical imaging and, lastly, typically offer comprehensive billing, scheduling and medical records all in one platform. These products also tend to not require complex infrastructure -- just a database server and an application server. AthenaHealth, Allscripts, eClinicalWorks, NextGen and eMD are some popular EHR platforms for these non-hospital settings.

The second type of EHR software that is common in inpatient settings captures medical records documentation from across multiple departments like imaging, nursing, nutrition, physical therapy, ER and hospital pharmacy. In order to support data from all those different departments in a hospital environment, this EHR platform must support the integration between different systems or offer functionality for those departments to natively integrate. These systems also require more robust infrastructure to support the increased data sets and number of users. Cerner, McKesson and Epic are some EHR tools notably common in hospital settings.

Sold alone vs. integrations

A number of EHR vendors acquired other products with billing and scheduling applications, due in large part to physician demand for an all-encompassing platform. Currently, the majority of EHR products are available as one stand-alone package. In a hospital environment, things can get complicated since there is a need for more than one or two applications. Different hospital departments require different products and some EHR vendors offer add-on products to address this. Some hospital buyers ultimately purchase the leading products and build software integrations between them.

Accessibility for the providers and patients

With the increase in smartphone use and the need for more patient engagement, EHR vendors have begun to introduce web and mobile-based access for both patients and providers. For physicians, the flexibility of using a mobile app to review patient records or take notes provides immediate accessibility to records and eliminates the need for them to stay late in the office completing paperwork. If doctors can do this work on the go without having to log in to a workstation, it streamlines processes and frees doctors to focus more on the patient while still allowing them to review patient charts at any time. This can also improve clinical documentation because physicians are able to complete clinical progress notes on the spot while it is still fresh in their minds, reducing chart inaccuracies and potential medical errors. For patients, a web portal provides them with easy access to their health data at any time of day.

Certified EHR

Buyers must also consider a product's current certification designation, which is awarded from federally authorized, third-party certification groups. This is especially important for healthcare organizations with a significant number of Medicare or Medicaid patients. Without a certified EHR technology (CEHRT) system, a company can face Medicare payment cuts and loss of Medicaid incentives. The certification requires EHR vendors to meet a number of requirements involving security and interoperability. Unfortunately, not all EHR tools meet those requirements. But for medical groups that have a small number of Medicare and Medicaid patients, this feature isn't as important as it is for large healthcare orgs that rely on Medicare and Medicaid patient payments.  

SaaS vs. on premises

Most EHR applications are available in two distinct models. The first model, which was available before cloud use became prevalent, requires the applications to run in a client-server mode where all the data is stored in a local server. This implementation does require some investments in hardware and is more expensive upfront, but it may be a more secure option. Many providers are still hesitant to entrust third-party cloud providers to manage the security of sensitive patient data. The second model is the SaaS model.

Mobility and accessibility

When it comes to accessing patient data, buyers must consider ease of remote access, flexibility and the mobility that prospective EHR vendors can offer. Using a platform without mobile access is a drawback for health organizations as it reduces timely access to patient data during care episodes, as well as access to the system for when workers need to record or update data quickly. The value proposition is that employees such as physicians and nurses interacting with the EHR can be more efficient by having access to information at their fingertips. Today, most innovators in the EHR market have opted to provide pure cloud offerings and native web-based platforms instead of the traditional client-based model. Some examples include AthenaHealth, Practice Fusion and DrChrono. Another key capability that all cloud-based EHR platforms offer is mobility. A mobile EHR vendor should have an app available for both tablets and smartphones to facilitate access to patient data remotely.

Licensing

There are a wide variety of pricing models available from EHR vendors. Despite the clear push for a SaaS pricing model or subscription-based licensing where a healthcare group pays per user per month, some EHR vendors still rely on the traditional pricing structure. In this pricing structure, vendors charge for the EHR tools based on the number of physicians, which is added to the annual costs for support and maintenance. Buyers should note that the marketplace is moving more toward the subscription model since it offers more flexibility and organizations can scale up and down as needed without as many upfront costs.

Clinical specialty

Some specialty departments like nephrology, orthopedics or gastroenterology may opt to purchase and implement an EHR platform designed for patients with specific conditions. Products like NephroChoice and gGastro Suite by gMed offer features that are specific to those specialties and are appealing to physicians because they can track things that are specific to their specialty like dialysis for nephrology specialty that most generic EHR tools cannot without extra customization and programming.

Big contenders

The more established vendors like Allscripts, eClinicalWorks, NextGen, Practice Fusion, AthenaHealth, GE Centricity and Greenway are continuing to evolve. For the inpatient side, many of the popular names include Cerner, Allscripts, CPSI, Epic and Meditech.

During product evaluation, buyers can access a number of resources that rate the different EHR tools in the market. Some of these online sites include Capterra, Klas, Software Advice and Medscape. They generally offer insights and comparisons of the different products available to help buyers with their selection process. Some of them rely on physician surveys and others use consultants to evaluate the products. EHR ranking sites are a great starting point for anyone looking to evaluate some of the options available online, but buyers should be mindful that there are a number of newcomers to the market that can potentially shift the EHR vendor landscape in the future.

Since the EHR marketplace offers plenty of options to choose from, buyers should ensure that they understand the differences available in the packages and what options would suit their organization.