Choosing the Right EHR: A Buyer’s Guide

The latest electronic health records are designed to be easier to use, more secure, and more scalable. They’ll also make it easier for healthcare providers, life sciences researchers, and patients to share information, with the goal of improving diagnoses, treatment, and care. Next-gen EHR systems will also make use of the latest technologies, especially AI, to support advanced data analytics, automate note-taking, and provide clinicians with conversational voice access to patient records.

Switching to a new EHR vendor is a complex and challenging undertaking. This article will explore the main factors to consider when evaluating new EHR systems.

What Is an EHR?

EHR systems are software platforms for storing and managing patients’ medical data, including diagnoses, medications, treatment plans, and lab test results. EHRs based on open standards can connect to systems used by other healthcare providers, governments, and life sciences researchers, making it easy to coordinate and help enhance patient care.

EHR vs. EMR

Electronic medical records (EMRs), the precursors to EHRs, were designed to digitally store and manage the patient records of a single practice or provider. Most EHRs can pull in data from anywhere a patient has received care, regardless of the provider or location, and tap information from other sources, as long as the other provider uses a compatible system. For example, they can link to the systems of life sciences companies to connect patients with clinical trial opportunities.

What Are the 7 Types of EHRs?

Most healthcare providers looking for a new EHR are considering either vendor-developed systems hosted on- premises or ones that store and manage data in the cloud, but there are other kinds. Read on to learn more about the different EHR system options.

1. Physician-hosted. In this model, the medical practice, clinic, or hospital runs the EHR on its own servers. The organization is responsible for all the costs associated with buying and managing the computers, networking equipment, and power supply, as well as employing IT staff.
2. Remote-hosted. Such EHRs are managed off-premises by a third-party vendor, run on servers owned by the vendor, and are typically accessed by the customer over an internet-based virtual private network.
3. Cloud-based (SaaS). While remote-hosted EHRs tend to be dedicated to each individual customer, cloud-based EHRs take advantage of multitenancy—the sharing of resources and costs across a large pool of customers. Each customer’s data, however, is secured by the cloud provider and kept separate from other customers’ data. Such EHRs are easier to update with the latest features and security patches and easier to scale up and down than on-premises systems. Their IT costs are also more predictable, and they reduce the burden on customers’ IT organizations.
4. Specialty-specific. Some EHRs are tailored to specific types of care, such as cancer, cardiac, dermatology, obstetric, and geriatric. Such specialty EHRs connect to more detailed and specific clinical data and can make it easier for researchers to identify clinical trial participants in these areas.
5. Integrated EHR and practice management systems. EHRs with integrated practice management capabilities let users easily navigate between different practice management functions, including patient scheduling, registration, tracking, accounting, engagement, and reporting, all within the same application.
6. Open source. With open source EHRs, developers can download source code and modify it to meet their own needs, subject to any restrictions imposed by the distribution license. Although open source EHRs are less expensive and more flexible than commercial ones, they can be more difficult to implement and support.
7. Custom-built. Custom-built EHRs require companies to design, build, test, and maintain their own proprietary system. As with open source EHR systems, the biggest benefit is the ability to customize the system to meet an organization’s clinical and operational needs, but that benefit is often outweighed by the high cost and complexity of building and maintaining the system, as well as system interoperability challenges.

How to Choose the Right EHR

The decision to move forward with a new EHR purchase can be daunting. But providers that approach this type of project with a clear sense of the people who need to be involved, the criteria that should be used to evaluate potential systems, and the steps required to get buy-in from users will be much better equipped to achieve a successful implementation.

1. Assess your needs. Needs assessment can be a lengthy process as organizations look at current workflows and bottlenecks, identify clinical, administrative, and technical requirements, and determine how the EHR investment will support their long-term goals. Take this opportunity to survey or interview as many users from across the organization as possible. Not everyone can be involved in the EHR selection team (more on that shortly), but involving more people at this stage can help identify needs that may not be readily apparent.
2. Set a budget. The cost of an EHR varies depending on factors such as the vendor, implementation complexity, and number of users. But you should be able to develop reasonably accurate estimates of the cost of the initial implementation and ongoing use after conducting a needs assessment and deciding on your requirements.
3. Form a selection team. As with the needs assessment, an EHR selection team should include stakeholders from all parts of the organization, though it will be a smaller team. This team should include executive sponsors, clinical leaders, frontline physicians, nurses, other clinicians, IT staff, legal and compliance representatives, and business operations leaders. Include a project manager to help the team meet its deliverables and deadlines.
4. Research vendors. Once you’ve documented your organizational needs, determined how a new EHR system fits into your long-term goals, and set a reasonable budget range, start researching vendors. After putting out a request for proposals, use the responses to create a short list of vendors that match your criteria. Your criteria should go beyond EHR features and functions. Look for a vendor that will help train staff, will provide self-directed learning that users can access whenever convenient, and has a track record of sound data security and privacy protection.
5. Request demos. Demos show selection team members how different EHR features work and let them ask questions and see specific use cases in action. The goal is to determine whether the EHR will meet your organization’s business needs in terms of usability, required features, and workflows.
6. Check references. Ask short-listed vendors to give you the names and contact information of customers that are similar in size, use the same types of system functionality, and have similar organizational objectives, and ask those customers about their experiences with the vendor and its EHR. Also talk with customers who are not on the vendor’s reference list. You can find other customers through industry trade shows, associations, online communities, and professional networks.
7. Compare offers. The best offer from a vendor should show a clear understanding of your goals, the scope of the implementation, and your organization’s budget. It should provide a detailed, reasonable timeline and specifics around training and ongoing support.
8. Test the EHR. Pilot programs help determine whether a new EHR is viable in real-world situations, while trial programs test the implementation approach and help implementers better handle risk. The success of these programs requires clear objectives and good communication with all stakeholders, including end users, IT teams, and executive sponsors.
9. Make a decision. Once the EHR selection team has gone through all the previous steps, it should be ready to choose the best-fit vendor and EHR.
10. Create an implementation plan. Develop a timeline for rollout and training. For almost any provider, crucial steps include transferring data from the legacy EHR, setting up access permissions so clinicians can view pertinent data, and training staff on how to use the new EHR.

10 Factors to Consider When Choosing an EHR

Once you’ve pulled together your selection team, consider giving different team members responsibility for evaluating different EHR features and functions, depending on their areas of expertise and potential use of the EHR. Here are 10 places to start.

1. Cutting-edge technology. Incorporating the latest AI and other tech advances not only can help improve patient engagement and support efficient, evidence-based decisions, but it’s also a signal that the EHR system vendor is committed to ongoing innovation.
2. Usability. Early generations of EHRs were difficult to use and update, contributing to clinician burnout. But new EHRs offer easy-to-navigate, consumer-grade interfaces and advanced voice recognition to not only ease the administrative burden but also help reduce data entry and transcription errors.
3. Interoperability. It’s increasingly important for healthcare providers to be able to share EHR data with patients, payers, researchers, and public health officials, making system interoperability a top consideration.
4. Cost. It’s important to evaluate not only the up-front license or subscription price of the EHR but also the costs associated with evaluating the EHR (such as the cost of pulling people away from other work) and the costs related to change management, loss of productivity as the new solution goes live, ongoing training, and maintenance (where applicable).
5. Training and support. The quality of training and support is crucial. Ask your prospective EHR vendors about how they’ll deliver the training (in person, online, some combination?), how it will differ for different roles, its duration, and its cost. Ongoing support needs to be timely and comprehensive. Ask vendors how quickly they respond to and resolve different kinds of support tickets. The latest EHR capabilities, such as AI-augmented features and ambient listening, will require different kinds of training and support. For example, with ambient listening, clinicians need to understand that they must verbalize information for it to be added to the patient record—ambient listening won’t record a patient’s blood pressure in the EHR if it doesn’t hear it.
6. Scalability. Scalable EHRs can seamlessly support increases in users, system traffic, and the amount of data stored without causing performance and reliability issues. The ability to scale storage is particularly important for accommodating the rapidly increasing data quantities associated with AI.
7. Security. Look for EHRs that incorporate sophisticated access controls, encrypt stored data, and provide an audit trail of who accessed the data, when, and what changes they made. Continuous monitoring capabilities can help flag potential security, privacy, and regulatory compliance events.
8. Reporting and analytics. Healthcare providers require strong analytics tools that connect EHRs, payer sources, and healthcare data repositories so data analyzers can collect, combine, cleanse, and standardize data into a single dashboard that’s available to staff on the clinical and business sides of the operation. Descriptive analytics can provide information on patients, such as their disease and surgical history, previous treatments, and emergency room visits. Diagnostic analytics can explain why certain medical events or outcomes occurred—for example, why certain types of patients are more likely to experience surgical complications. (In this context, “diagnostic” refers to a type of data analytics rather than medical diagnoses.) Predictive analytics can look at data on patient risk factors, public health trends, and resource availability to help providers forecast demand for medical supplies, staff members, and real estate space. Prescriptive analytics can compile care alternatives that clinicians can recommend for a patient based on a combination of characteristics—for example, their age range, history of chronic disease, and the likelihood that they will comply with clinical directives.
9. Mobile access. Clinicians should be able to access EHRs from everyday smartphones and tablets to call up patient data at the point of care, update patient records in near real time, and help avoid administrative backlogs.
10. Patient portal integration. These portals enable patients to view and renew their prescriptions, look up test results, communicate with their care team, schedule appointments, make payments, and perform other tasks. Look for portals that are easy to use and stress interactivity.

Create a Better Healthcare Experience with Oracle Health EHR

Oracle Health EHR is helping care providers tackle some of healthcare’s toughest challenges, including identifying tests to help keep groups of patients healthy, targeting those who need follow-up appointments, and combining cleansed and compiled data from disparate healthcare providers to create a complete, accurate patient record. Oracle Health EHR runs on Oracle Cloud Infrastructure, enhancing the security of the sensitive health data it stores. It also applies AI to the most common provider tasks to help boost clinician productivity and decision-making.

Choosing an EHR FAQs

Who uses EHR systems?

Individual hospitals, large multisite healthcare systems, individual physician practices, and small clinics all use EHRs to store and manage patient data. Public health managers tap EHR data to help track and analyze population health trends.

What is the difference between ERP and EHR?

ERP (enterprise resource planning) systems help companies in all industries manage their finances, procurement, projects, and other processes. EHR (electronic health record) systems help healthcare providers store, manage, and share patient data with the goal of improving diagnoses and treatment.

Are EHRs more secure than paper records?

Although paper records can’t fall victim to cyberattacks, they can be lost, mislaid, or destroyed. Patient records stored in cloud-based EHRs are protected by multiple layers of security and backed up remotely.