EHR Countdown: Lessons learned from medicine's mistakes

After spending three days at the Chicago Midwinter Meeting last month discussing the future of electronic health records (EHRs) with dentists, office managers, and vendors, I am convinced we are not reinventing the wheel here.

Healthcare IT expert Michael Uretz.

Healthcare IT expert Michael Uretz.

And coming out of those discussions, I am more convinced than ever that experiences and lessons I learned during the past decade being involved with the purchase and implementation of medical EHRs can translate directly to dentistry. So perhaps we are fortunate in dentistry that we are just now at the beginning of the adoption curve of dental EHRs. Hopefully, we can avoid the pitfalls experienced by our medical colleagues during the past 10 years of EHR adoption.

There are many scenarios to look at in which a wrong decision or action involving the selection, purchase, or implementation of an EHR system can lead to negative long-term effects for the practice. Here are a few to take note of as you begin this process.

Best practices and processes

Whether it's a small practice, large multiclinic group, or hospital, I have seen too many providers and administrators choose an EHR system by, in effect, throwing a dart at the board. I can't tell you how many conferences I've lectured at where medical staffs go from booth to booth checking out a few really cool features and wind up excited by a great vendor presentation. Or endlessly contacting peers asking what they think about various EHR systems. Or staying up nights with lots of caffeine searching for that piece of information that will help them make the right decision.

So the lesson to be learned here is that an EHR system is a substantial investment, not only in terms of dollars but in terms of how you run your clinical operations from this point forward. As a result, getting the best system for your needs takes appropriate due diligence. The medical practices I have worked with that ultimately purchase the best EHR system for their situation and have the most successful implementations are those that take the time to determine features and functionality they need now and in the future, send out requests for proposals to candidate vendors, carefully analyze responses, and conduct demonstrations that are not vendor-driven but that address real-life clinical scenarios in the practice

Devil's in the details

I once had a group multispecialty practice come to me to do a final review of their EHR contract. Their healthcare attorney had negotiated the original contract, and they just wanted another set of eyes to look it over.

When I reviewed the contract, I was amazed at how many omissions and errors there were, and I basically wound up rewriting most of the contract. The interesting thing was that their attorney had addressed legal sections such as dispute resolution, limitation of liability, and confidentiality. Where the contract was lacking was in the area of business issues; sections such as support assurances, implementation guarantees, milestone-based payment terms, transition assistance, software warranties and remedies, and many others weren't addressed adequately. When I called the practice's healthcare attorney and asked him about this, he conceded that he didn't have a lot of experience with software contracts and none with EHR contracts specifically.

The lesson here is that many practices just depend on their attorney to review their EHR contracts. However, as illustrated above, it's not just crossing your T's and dotting your I's that you need to look at, but also business issues and questions that address your assurances, protections, rights, and remedies. At the very least, make sure the individual reviewing the EHR contract has experience with the nuances and peculiarities of software contracts. It isn't a bad idea to review the contract yourself in detail with a discerning and skeptical eye, as you know best how you want to run your business.

Vendor accountability

I wish I had a nickel for every time a medical practice or hospital has called me -- either during their implementation or after the system has gone live -- and told me that the implementation is taking much longer than expected or the vendor doesn't return their support phone calls on a timely basis. When I look into these situations, more than likely I find out that there have been issues ongoing for quite a while and, for one reason or another, the practice has either ignored it or chosen not to confront the vendor.

Most EHR vendors are busy with multiple implementations and supporting numerous customers, and the old cliché of the "squeaky wheel" is very appropriate here. In the medical world, this has become especially challenging with the introduction of meaningful use incentives, making the vendors even busier. Inevitably, though, my clients that do choose to approach the vendor and take care of issues as they occur on a timely basis seem to have the most success at implementation and support.

Lesson learned from this? When it comes to EHRs, issues and problems don't go away by themselves. They have to be dealt with sooner or later, so why not approach your vendor with implementation and support issues as they occur and demand resolution? Also, it's important to understand that your vendor will probably appreciate this timely approach, as they would rather take care of issues early than let a pressure-cooker scenario build up.

Remember, at the end of the day, implementation and support are a partnership between you and your vendor, so effective and timely communication is essential.

Mike Uretz is founder and executive director of DentalSoftwareAdvisor.com. He is now applying his 10 years of knowledge and experience with electronic health records and health IT to the dental industry to introduce dentists to software best practices and help them avoid the pitfalls experienced by other healthcare professionals. Uretz is also director of the EHR Group.