Choosing the Right EHR

November 1, 2009

In the market for an EHR? Here’s a step-by-step selection guide by internist and pediatrician Rob Lamberts, who’s been through the process himself.


In the current economic stimulus bill, large financial incentives are put in place for medical practices that use an approved EHR product. The buzz is at an all-time high.

With all this buzz, why is it that most physicians assume EHR adoption is bad? A recent study suggests that a high proportion of physicians would rather quit medicine than adopt an EHR.

Offices like mine that have not only survived, but thrived with an EHR suggest that tragedy is not inevitable. However, the transition takes careful planning and deliberation before making an EHR purchase.

What’s broken? The first step in the purchasing process is to figure out what you need. Ask the following questions about your practice:

  • Where are the areas of greatest frustration in our office? Don’t limit this to physician frustration. Inefficient front desk or nursing processes often cost practices more.

  • Where is the most time wasted?

  • What are the things that make our patients most frustrated? This is a good marker for inefficient processes.

  • What areas expose our practice to the most malpractice risk?

  • Where does our practice lose money? Under-billing? Missed procedures? Low volume? Over-staffing?

What would “fixed” look like?

Once areas of frustration and inefficiency are identified, consider how an EHR could fix these problems. For example:

  • Searching for lost charts - this will never happen with an EHR. Lost charts are a huge source of wasted time and resources for practices.

  • Answering telephone inquiries - because the chart is immediately available when a patient calls, response times are much quicker.

  • Accessing lab results, consults, and procedures - scanning interfaces between the laboratory and your office can make results almost immediately available.

  • Patient follow-up - an EHR can make this calling process automated, increasing patient volume and improving quality measures.

How do they stack up?

After you’ve composed your list of problems and solutions, you can compare different vendors/products based on how well they will meet your needs. Vendors should also be able to tell you:

  • How their product will be implemented;

  • How disruptive implementation will be to your practice; and

  • How quickly they can respond to any problems you might run into.

The finalists.

Once you’ve narrowed your EHR choices down to a small number, ask each vendor to arrange a site visit with a practice similar to yours that uses its EHR. Ask each practice:

  • How did the vendor make the practice’s EHR implementation successful?

  • Did the vendor specifically address any areas of pain; how quickly?

  • What would they have done differently, if given a choice?

What’s the price tag?

Cost should be only considered on products that meet your needs. Potential gains from a well-implemented EHR outweigh the cost, so focusing on cost first will possibly rule out the best products.

Remember that you get what you pay for. Viewing an EHR purchase as a chance to improve your practice rather than as another unwelcome expense is the best way to make sure your money is well spent.

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. His practice won the 2003 Davies Award for outstanding application of IT in a primary-care setting, and he has lectured extensively on EHR. He can be reached at rob.lamberts@gmail.com.

This article originally appeared in the November 2009 issue of Physicians Practice.