EHR Optimization

If you are part of a paper-based practice that has not adopted an electronic health record (EHR), it is time to adopt one. CMS has made it difficult to participate in the Merit-based Incentive Payment System (MIPS) program without an EHR.

Dermatologists can still report quality data through paper-based claims, but then they must also obtain an exemption for the Promoting Interoperability (PI) category. Each year, the MIPS requirements become more stringent, and exemptions may no longer be offered. The Academy advises dermatologists who wish to participate in MIPS to adopt an EHR now.

Before you begin researching EHR systems, it helps to evaluate your needs, informally or through a request for information (RFI). An RFI informs prospective EHR vendors which features are most important to your practice.

Certification

CMS revised the definition of CEHRT to align with the Office of National Coordinator for Health IT (ONC)’s regulations. You can check your EHR on the Certified Health IT Product List (CHPL) site to ensure it has been successfully tested and certified by the ONC Health IT Certification program.

Practice needs

Assess your practice’s EHR needs. Consider the functionality that is most important to your practice.

Workflow and documentation

How well can the EHR accommodate your workflow? What are its templates like, and how easy are they to customize? Adopting an EHR necessarily means changes to workflow, but the system should be responsive to your needs.

Documentation requirements are a major administrative burden for doctors. Some EHRs require more clicks to complete the same task.

Integrations

Explore how EHRs integrate with other technologies. For example, if you already use practice management (PM) software, will it work with the EHR? If you are going to use the Academy’s DataDerm with your EHR, you should explore how well they will work together.

Does the EHR come with a patient portal, to provide patients with access? If not, how well does the EHR work with portals from other vendors? The Academy suggests utilizing a patient portal to improve patient efficiency. What about voice transcription software, to reduce typing and transcription? There are virtual mobile applications that can assist dermatologists with documenting a patient’s visit.

Access

Patients increasingly expect access to their medical records through a patient portal. But patients also use mobile health apps and other smartphone applications. Many EHRs use special software to communicate securely with apps. Explore what each EHR supports.

Security and storage

Certified EHRs are designed to be HIPAA compliant, but protecting patient information still depends on you. HIPAA requires doctors to make backup copies of patient data that can be restored even if the facility is completely destroyed.

This backup requirement is one reason why it is important to decide where you will store your data. Today, many EHRs use cloud technology, which can help simplify storage and backup. These systems typically store data off-site automatically, but you should be sure you know how to restore data if necessary. For practices that prefer to store data locally, a server in the office remains an option, but data must still be stored offsite.

Federal regulations also require that all staff complete HIPAA awareness training annually.

Network

Colleagues who have already adopted an EHR can be a valuable source of practical information. Do they like their EHR, and what are their reasons? Remember that practice needs vary, but other doctors can often give you an “inside scoop” worth considering.

Top EHR vendors Academy members use

Source: 2019 American Academy of Dermatology Practice Profile Survey

Evaluate

When you have identified leading EHR candidates, open discussions with vendors. Vendors are eager to address your questions and usually do so through an in-person or virtual visit. The ONC offers useful questions* to ask vendors.

Conduct demonstrations or “test-drives” with staff who would actually use the EHR. Be sure to include non-clinical staff, especially if they will be using the system as well. Use a vendor compare tool* (PDF) or otherwise rate prospective systems on how well they meet your needs.

Cost

It can be a challenge to evaluate the true costs of an EHR. A server-based system might have a larger upfront cost but could be cheaper over time. Cloud-based systems available by subscription can be cheaper by saving on labor and maintenance, but the subscription costs are fixed.

There can also be hidden costs, in the form of additional fees for licenses, training, and more. Use this vendor pricing template* (XLXS) to help evaluate overall costs.

Sign and implement

Make your selection, negotiate the terms of the contract, and review everything with your legal advisor before making a decision. The EHR vendor should support your practice in learning the new system and adapting it to your workflow. The level of support, including any type of communication varies, so be sure it is covered by the contract.

Making the most of your EHR should be a continual process. After implementation is complete, explore ways to improve efficiency and workflow. You can learn more using the Academy’s EHR optimization resources.

* The Academy is able to share these options on an informational basis only. It does not represent an endorsement by the Academy. Please compare, evaluate, and consider which ones best meet your needs.

Additional AAD resources