Electronic Health Records: Who’s Running the Asylum?

There is no question that dentistry is on the cusp of an electronic health records (EHR) revolution. In addition to all the patient care, operational, and financial benefits a practice can obtain from adopting EHR, various mandates and incentive programs are adding fuel to the fire and desire to get up to speed quickly. Just as physicians have evolved and experienced EHR adoption during the past 10 years, dentists who previously were looking for reasons why they should embrace EHR are now clamoring for the answers on how to do it. I, and others, have written extensively on the benefits of the technology and where it is going, so no need to rehash this area.

But actually doing EHR right—evaluating increasingly sophisticated clinical software, dealing with one-sided vendor contracts, and implementing a new generation of features and functionality—can be problematic if you relinquish control and let the vendors take charge and basically “run the asylum.”

TAKE CHARGE OF SELECTION AND EVALUATION
Throughout the years, practices have come to me frustrated after having spent months trying to select the right EHR vendor for their needs. With so many vendors in the marketplace, it seems that doctors typically take the shotgun approach by either talking to colleagues, surfing the Internet, or worse, engaging in numerous vendor demonstrations that become a blur after a period of time. When I conduct EHR workshops and seminars, I’ll typically take a survey of the attendees and ask them how long they have been engaged in looking for that perfect EHR solution, that magic bullet that will solve all their issues. And I have actually had practices in attendance that have been involved with the process for more than a year or longer.

So, why does this get so frustrating for the practices spending endless days, weeks, and months engaging in the evaluation process? From my experience, when I look at their stories, I can see how the vendors run the asylum by showing the practices what the vendors want them to see, talk about products from the vendors’ point of view, and conduct demonstrations that are one-sided, in favor of the vendor. What the practices don’t do is take control, follow an analytical vendor filtering process, conduct demonstrations from the practices’ point of view, and get their questions answered and their needs met.

I’ve been evaluating and vetting vendors for years, and even in scenarios as basic as helping to structure and conduct EHR vendor demonstration for my practice clients, it still amazes me how vendor salespeople don’t follow directions, try to control the conversation, dance around certain questions, and basically attempt to control the whole situation.

It can be a bit of work, but if you choose to take control and follow a proven process of evaluating and selecting EHR systems, which includes a needs analysis, request for proposals, practice-oriented demonstrations, and thoughtful feature comparison, you can save time, resources, and ultimately choose the right solution for your needs. There are tools that can help you along the way, such as this EHR evaluation and selection checklist (dentalsoftwareadvisor.com/dental-contracts-checklist) that I put together.

TAKE CHARGE OF YOUR ELECTRONIC HEALTH RECORDS CONTRACT
After having structured and negotiated EHR contracts for more than a decade, I can tell you now that if you don’t review your contracts and agreements, and if you do not really understand the language you are signing, then your EHR vendor definitely will be running the asylum. In this brief article, I cannot go into all the nuances and details of what to look for in EHR contracts, but suffice it to say that in 30 years of negotiating software contracts, I have not seen more vendor one-sided contracts being thrust upon unknowing practices than in this confusing world of EHR.

Many doctors just assume that either the vendor will tender a reasonable contract or their attorney will review and/or negotiate a satisfactory agreement. It is important to understand that dental software and EHR contracts are very specialized and can get very technical in nature. So, attorneys who are not familiar with software contracts, or terms and conditions for EHR, don’t necessarily have all the experience necessary to successfully structure and negotiate these types of agreements. Case in point: I once negotiated an EHR contract for a larger practice, and the partners wanted their attorney to review the agreements. After waiting 2 weeks for his review, both the practice manager and I became a little frustrated; upon questioning why even this was taking so long, the attorney shared with us that he wasn’t familiar with software contracts.

It is important to note that in addition to legalese in the language itself, there are numerous business issues that can be addressed by the practice administrator or owner. For example, the detail and length of time for warranty periods, payment terms, implementation and acceptance processes, confidentiality and ownership of data, service and support guarantees and warranties, and the list goes on and on.

One the hottest areas of contention in EHR contracts came on the scene with the introduction of the federal EHR incentive program. Having conducted some of the first EHR workshops in the country for dentists and practice managers, I can tell you that along with the new Health Insurance Portability and Accountability Act rules, the incentive program was of tremendous interest to my attendees. Because of the great amount of money involved and potential business for vendors, many vendors proclaimed that their software allowed a practice to obtain the incentive monies available. However, when you look at many of the contracts, there were no teeth in these guarantees and warranties. So, potentially a practice could purchase an EHR with the belief that they would be able to obtain incentive monies, yet there were no remedies laid out for the practice if the vendor fell short.

The point is that vendor attorneys have a duty to develop and structure one-sided contracts which favor the vendor (if I were working for a vendor, I would do this as well) and, if the practice doesn’t do its due diligence and take care of itself, the practice can suffer the consequences of these vendor-oriented contracts. So again, who should run the asylum when it comes to your EHR contract: your vendor or you? I have provided a checklist of some basic EHR contract items (dentalsoftwareadvisor.com/dental-contracts-checklist) that you need to know.

TAKE CHARGE OF YOUR IMPLEMENTATION
So, who’s running the asylum when it comes to your EHR implementation? The correct answer is both you and your vendor. Without a partnership on this crucial phase of your EHR journey, inevitably one-side or the other will contribute to issues that can lead to an over-budget, problematic, and frustrating implementation. Many practices assume that once an EHR is selected, and the contract is signed, a vendor will come riding in on a white horse with a team of experts, take charge of the implementation, and just get it done. In theory, this would be great if the practice could just step away, continue with its business, and let the vendor do all the heavy lifting. However, having managed numerous projects over the years, I can tell you that without assigning at least one resource in the practice as a point person for the implementation—a liaison of sorts for the vendor project team, managing time and resources from the practice side—an implementation can quickly get off on the wrong track.

If you count on your vendor to run the asylum completely without accountability and management from your side, I will tell you that when issues come up and are not addressed in a timely manner, then you only have yourself to blame. After I work with clients, helping them select and acquire EHR technology, many times I wind up providing oversight and vendor management. These experiences reinforce my belief that without proper project planning, communication, issue triage, and involvement from the practice, this critical part of your EHR success can be laden with problems.

Based on years of experience helping manage these types of projects, I have put together an implementation checklist (dentalsoftwareadvisor.com/dental-contracts-checklist) to help you understand a proven process and associated steps for success.

DOES YOUR PRESENT SOFTWARE VENDOR RUN THE ASYLUM?
As in any new profitable opportunity, there will be a growing list of additional software vendors entering the market. I have found this to be true in the medical software market during the past decade, and dentistry will not be any different. You can’t necessarily count on vendors with whom you have done business with in the past, as not all “major” software vendors will keep up with the demand for innovation; some will, and some will not. Many vendors count on the fact that you are using their software and therefore assume you will be purchasing their EHR solution. The bottom line is that even if you have had a relationship with the previous software vendor, in this new world of increasingly complex software, you do yourself a disservice by not at least comparing what’s on the market and then making your decision. The selection of your dental EHR system will affect you for many years to come.


Mr. Uretz is a 30-year software veteran and nationally recognized healthcare software and electronic health records (EHR) expert. He has consulted with hundreds of practices and multiclinic groups to help them properly evaluate and select their software solutions, structure and negotiate contracts, and provide management and oversight for their implementations. As co-chairman of the Best Practices Advisory Committee for EHR contracts, he was instrumental in developing standards for structuring software contracts and pricing used nationwide. He is the founder and editorial director of the Web site dentalsoftwareadvisor.com, a trusted and objective resource on all matters related to dental software. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Disclosure: Mr. Uretz reports no disclosures.