Buying a new car or an EHR?

Buying a new car or an EHR?

Why does shopping for the right EHR seem so complicated? After watching many colleagues struggle with this decision, I decided that it is very similar to buying a car. Now, I have to preface this by admitting that I once bought a car over my lunch hour. (A Pathfinder that I drove for 7 years until my husband convinced me to get something with better mileage right before gas prices got really crazy.)I had done my homework up front, knew about the features that mattered to me, and would not let the salesman highjack my focus or distract me with details that were not on my list when I walked into the showroom.

First, your practice must decide who is going to do the research and who/how will you make the decision. Are you going to take along your kids and their friends and let them choose the car? You will get totally distracted by their need to have the cool cup holders and the TV screens in front of every seat or by your spouse who insists on dual climate control because he/she is always cold. Are you going to do this by majority consensus or do you need a unanimous decision? (You may be kicking tires for months or even years and by then new models will come out to confuse you even more.)

So the car buying gig is a hassle in itself. Now think about trying to do it before you even learn how to drive! You get in and they show you the cool stereo system, and the reclining seats, and the voice recognition audio system. But are you supposed to look at that or the engine or the driving console? At least when most of us buy a car we have driven other cars and know what we like and don’t like about them. We also don’t even have to think about starting the car, putting it in gear, steering, breaking, etc. Those are now “automatic” processes which take little/no thought or concentration.

Apply those same principles to buying your first EHR. It’s a big ticket item that is not easily returned and has implications for your daily life. You have never had to use an EHR in your daily life to get you to where you need to go. So before you go looking, decide what things you do multiple times every day that matter to you. As a pediatrician, you see well visits for children of all ages and give anticipatory guidance, discuss development, do autism screening and counsel adolescents privately about risky behaviors. You make medical decisions about vaccines, and combination vaccines, and those decisions change every time ACIP releases a new schedule. You calculate liquid medication doses based on current weights. You fill out camp forms, school forms, sports forms. A parent updates a family medical history, and you need to record it in all 6 sibling’s charts. Your staff speaks to many families, triages patients and records messages. You order/review lab results, send messages to your staff to discuss those results and follow-up with families. You see LOTS of the same kinds of seasonal illness-related issues over and over again.

So what should you really have on your checklist when you walk into the showroom? Show me all your well visit templates including handouts, anticipatory guidance, attached screenings (lead, MCHAT, hemoglobin, hearing, vision, development) for appropriate ages. Show me your growth charts (CDC, WHO, Down syndrome, Prematurity). Show me your vaccine module….does it tell me what is due in an intelligent manner? Does it understand vaccine administration codes (especially now that they have changed?) Does it prompt/stop me if I try to order a Varivax and the patient just had their MMR 21 days ago? Is it integrated with a vaccine inventory module? Show me your messaging system. Show me your camp/school forms. Show me your templates for common illnesses. (Do they include pitryriasis rosea and nasolacrimal duct obstruction, or are they mostly angina and COPD?)

Just like cars, it can be overwhelming to look at all the “cool” features of EHRs. Some of you with more knowledge and experience will want to investigate the bells and whistles, but don’t let that highjack your focus on your pediatric needs. Oh the other hand, you don’t want to go back to driving a horse and buggy! Your “decision maker” should make sure the system is sophisticated and robust enough to support additional functionality that you will want to be available after you have been “driving the car around for awhile”. Above all, don’t just buy something because your cousin’s husband can get you a “really great deal.” Give the process the thought and investigation it deserves, but keep your focus. Don’t buy something for emotional reasons that are not in keeping with your original intent.

There are now several studies that have shown how buying the wrong EHR for your practice, can have far-reaching negative implications. If you are a pediatrician, buy an EHR that understands pediatrics and has the features that matter to you every day!

Coming soon: OK, I bought the car…..where the heck is the ignition?