Does Your EHR Consultant Have Your Best Interests in Mind?

February 18, 2009
John Lynn

MDNG Neurology, February 2009, Volume 11, Issue 1

When selecting an EHR for your practice, using an EHR consultant can save you time, money, and headaches.

When selecting an EHR for your practice, using an EHR consultant can save you time, money, and headaches, but only if you select a consultant who knows what he or she is doing and who is a good fit for the needs of your practice. Selecting the wrong consultant can turn an already arduous process into a disaster: some are in the pockets of EHR vendors; others are only interested in locking you into a long-term services contract. So, how can you tell whether a consultant is right for you?

There are many bad EHR consultants who have given the industry a black eye. After hearing all the horror stories about practices being railroaded into selecting unsuitable EHR systems, consultants whose advice seems only to lead to additional billable services, and consultants who leave the job half-finished and in disarray (requiring the practice to engage the services of another consultant to help get things back on track), it makes you wonder why physicians continue to use consultants at all. The unfortunate reality is that most doctors and clinics do not have the time to appropriately research the EHR selection and implementation processes, meaning that the services of EHR consultants will continue to be widely used. Although there will always be an element of risk involved with the complicated process of selecting consultants and vendors and implementing an EHR system, practices can remove a great deal of uncertainty by gaining a better understanding of the types of EHR consultants, the pros and cons of each type, and how to select a qualified EHR consultant who best fits the needs of the practice.

Types of consultants

In order to effectively deal with them, it is essential for physicians to understand several things about EHR consultants, including the fact that many of them are not really consultants at all. The title “EHR consultant” is self-appointed; there is no EHR consultant regulating body or credentialing organization. Therefore, physicians and their staff must exercise caution and good judgment when evaluating the capabilities and claims of prospective EHR consultants. For simplicity’s sake, EHR consultants fall into one of three types: selection, implementation, and cleanup.

Selection

By far, the majority of bad experiences with EHR consultants have been with consultants hired to assist with the selection of an EHR. The problem is that most of the so-called EHR selection consultants are not really consultants at all. Instead, they are EHR salesmen disguised as EHR consultants. They are the “realtors” of medical IT, focused only on selling EHR software from vendors that pay them a large finder’s fee. One look at their list of clients will reveal a limited list of EHR vendors. These wolves in sheep’s clothing should be avoided at all costs.

A qualified EHR selection consultant is someone who knows and has contacts with dozens of EHR software vendors; a look at their list of clients should show a broad spectrum of EHR vendors. Their focus is on understanding each individual medical practice and selecting the EHR software that best matches the practice’s needs.

The difference between these two types of consultants is best described as the difference between a bounty hunter and a hired gun. The bounty hunter is only interested in collecting the referral fee (bounty) from the EHR vendor. The hired gun is interested in protecting the interests of the medical practice.

Implementation

There are two types of EHR consultants available to help with an EHR implementation. The true EHR consultant has immediate, short-term goals: get the practice on the right track, build momentum, create an implementation plan, and transfer knowledge. The other form of EHR implementation consultant could more aptly be described as a contractor; essentially, they stick around to provide extra manpower to assist with the myriad of implementation tasks and details. Sometimes, a little extra help is all that is needed, but do not confuse them with a true EHR consultant. Most medical practices choose not to use an implementation consultant, which often leads to the need for a “cleanup” consultant.

Cleanup

Unfortunately, many medical practices end up having to bring in a consultant to “clean up” an EHR implementation gone awry. The cleanup may involve fixing the mistakes made by a previous EHR consultant, saving a failed EHR implementation, or even improving an already fairly effective EHR implementation. These cleanup EHR consultants are usually quite effective because they are brought in to solve specific, identifiable problems. The most effective consultant will be deeply biased to the specific EHR software and vendor your practice uses, with extensive experience with and understanding of that EHR in a medical practice.

The reality is that every EHR consultant is biased. This can actually be a good thing when using a consultant for implementation and cleanup. However, it can pose major challenges when using an EHR consultant to select a vendor. It creates an even larger conflict of interest when you use the same EHR consultant for EHR selection and implementation. A consultant’s desire to assist with your EHR implementation may influence which EHR they push you to select.

Benefits of an EHR consultant

Now that you know what to look for (and look out for) when selecting a consultant, it’s important to establish why it is worth your time to find one who is truly qualified.

Contract negotiation

Large practices have a fair amount of negotiating room when it comes time to purchase an EHR system. Vendors realize that physicians have a growing number of options when selecting software, and are thus often willing to be flexible when setting the terms of a contract. A well-trained EHR consultant should be well versed in EHR contracts and be able to assist with negotiation, point out problem areas, and suggest missing details. EHR consultants can even help small clinics negotiate things like long-term pricing arrangements, concessions for time spent hosting site visits for vendor prospects, and upfront costs.

Outside perspective

A consultant can provide a perspective that is not influenced by organizational norms. Fresh eyes are often able to see problems that daily users of a system have learned to overlook. Manage expectations Experienced implementation consultants can cut through the sales talk and provide a realistic understanding of how an EHR will affect a medical practice. Plus, they can help create realistic timelines.

Vendor relationships

When selecting an EHR, this could be a problem. However, once an EHR is implemented, an EHR consultant’s relationship with a vendor could be the key in obtaining needed changes or fixes to the software.

Educated configuration decisions

Most EHR systems require extensive configuration. Bad configuration decisions can have a long-lasting impact on the end users. Experienced EHR consultants know what has worked before in similar settings for a particular EHR and what hasn’t and can assist you in determining which configuration options best meet your clinical needs.

Knowledge of available technology

Not many doctors are experts when it comes to fax servers, voice recognition software, microphones, biometric authentication, scanners, card readers, digital cameras, printers, tablets, desktops, wireless, shared drives, OCR, IM, etc. An EHR consultant should understand the capabilities and limitations of these technologies and be able to advise which are suitable for your practice.

Converting paper charts

A number of options exist for handling old paper charts. Selecting the option that fits the needs of your practice is best done by someone who has experienced the transition firsthand.

Improved clinical buy-in

Consultants with a proven track record of successful EHR implementations instill more end-user confidence. They can also share firsthand experience related to the benefits of an EHR implementation.

Targeted training

EHR vendor training is usually generic training that covers every feature of their EHR software. This training can be confusing, overwhelming, and a waste of time because no clinic uses every feature of an EHR. A good consultant can train end users on only the features likely to be used by the practice.

It is unrealistic to expect that every EHR consultant provides these benefits. In fact, it is unlikely that any EHR consultant can provide all of the benefits listed. Instead, physicians should study this list and decide which are most important for their practice, and then use those criteria when researching and vetting EHR consultant candidates.

Finding a qualified EHR consultant

The first step in selecting an EHR consultant is determining whether you want a consultant to assist with selection, implementation, or cleanup of your EHR. This decision will drastically influence the type of consultant you want to use.

The best way to find capable and reliable EHR consultants is to ask colleagues who have had good experiences. Local colleagues are even better, since they can recommend consultants who know the local labs, payers, and pharmacies with whom your EHR will interface. Request to speak to and meet with a consultant’s previous clients, and do not be distracted by glossy marketing material or special pricing. Instead, ask for actual examples with measurable results.

Remember that every EHR has its limitations, and be wary of a consultant who hypes an EHR as the perfect solution. Instead, select a consultant who is aware of the challenges associated with EHR implementation and who will openly discuss those challenges and real world solutions for overcoming them. Fit is very important. If you do not feel comfortable around that consultant, then keep looking for one who does make you feel at ease.

Practices interested in an EHR selection consultant need to first identify his or her biases. Consultants who tell you they do not have any biases should be dismissed out of hand. Next, request from the consultant a list of clients that reveals the size of the practice and EHR selected. Look for trends that indicate a bias in favor of a particular vendor or vendors. For example, all large practices selected the same EHR. These trends may not prevent you from using this EHR consultant, but should be used to more thoroughly assess their decision-making process and the quality of their advice.

Practices interested in finding a good EHR implementation and cleanup consultant should start by asking their EHR vendor. Vendors are often aware of consultants who are familiar with their software. EHR-related blogs (eg, www.emrandhipaa.com, http://ehrphrpatientportal.blogspot.com) and forums (eg, www.emrconsultant.com/forum, www.emrupdate.com, http://nnlm.gov/pnr/advocacy/ehr-forum.html) are also a great place to learn about specific consultants or to find EHR consultant referrals. However, do not just read the blogs and forums; participate in the conversation.

Save time, headaches, and money

Physicians considering engaging the services of an EHR consultant should evaluate which type of consultant is needed and what benefits that consultant will bring to their practice. Not all EHR consultants are EHR salesmen posing as consultants. Many are genuinely interested in a practice’s long-term success. Finding a qualified EHR consultant isn’t easy, but can save you large amounts of time, headaches, and money when done right.

John Lynn is the creator and author of the website EMR and HIPAA, which covers EMR, EHR, HIPAA, and healthcare IT.