paper & technology with an EHR

4 decisions you need to make before shopping for an EHR

Laura Rose Lambert Electronic records, practice management 0 Comments

There are a ton of options to choose from for your charting software and it seems like every day sees the launch of a new EHR (electronic health record) program.



You can’t look closely at every option available. And you shouldn’t! It is easy to experience overwhelm when looking for an EHR that fits your practice. Before you start making demo appointments or signing up for free trials, make these four decisions to shorten your list of EHR and/or practice management systems.

1) Pick the device you want to use

When you start using an EHR or switch to a new one a lot of changes occur. Do not be tempted to switch the computer or tablet you use just for an EHR. It is vital to learn a new system on a device you are comfortable with. Some practice software is web based so the hardware you use does not matter. Others are dependent on an iPad/Android app or use software that can only be used on a Mac or PC computer.



My advice is to keep using what you’re familiar and happy with because this will translate to the patient when you’re using it in the treatment room. You’ll get used to your new charting system faster and with less frustration when you’re using a device you enjoy using.


A quick note: The exception to this would be if you have a device you are comfortable with but it is so old and slow that it isn’t compatible with most systems you’re looking at and it wastes your time. Buy a new computer or tablet my friend!

Tablet or computer?

Nearly all practitioners already own a computer for managing their practice. However, the industry is moving toward tablet based charting. I think this is because many practitioners feel a tablet isn’t as distracting when speaking with patients.



When it comes down to it, this decision is all about personal preference. In my own practice I use a tablet based system with handwriting that converts to text. I love this because it is easier to maintain eye contact and not as distracting as typing for me. On the other hand, I have had practitioners ask me to look for computer based systems only.

2) Should it be profession focused?

There are many universal EHR systems that are designed for any type of medical provider. They were originally geared towards medical doctors. But in recent years some of these companies have started to market their software to holistic practitioners.



Advantages of universal systems

  • If you are looking for something that can fit a wide variety of practitioners in your office, this is the direction to go.
  • They are usually Meaningful Use certified or compliant.
  • Built and maintained by established, large companies that are going to stick around.



Disadvantages of universal systems

  • The upfront work of designing the forms to fit your practice.
  • A large number of features you’ll probably never use as an alternative practitioner.
  • Larger corporate structures may mean you get lost in the crowd.

Profession focused – was it created by someone in your field?

There are so many profession focused options these days. I prefer using something designed and built with a Chinese medicine practitioner in mind. I get frustrated by the number of sections I leave blank in a universal EHR like Practice Fusion.



When I call support at UnifiedPractice they “get” what I’m talking about when I say I need an abdominal diagnosis section and they actually already have it on their list of updates for the near future. For midwives and doulas an EHR that is easily mobile and designed by a company that understands the unique intake process they use is essential.


Advantages of profession-focused systems:

  • Profession focused EHR software is often a lower price than universal or medical doctor focused EHR systems.
  • Most EHR software in the alternative medicine community were created in response to the limitations and frustrations the founders had with universal EHR systems. These systems were created by actual practitioners who understand what a doula, acupuncturist, midwife or chiropractor needs when treating patients.

Disadvantages of profession-focused systems:

  • Not as flexible – often you don’t get to customize your forms (although this is changing).
  • Working with a small company can be risky. If the company isn’t dedicated to constant growth and adding staff as they grow there can be delays in customer service. (the flip side of this is when they are good, you are heard more thoughtfully and seriously then when dealing with larger companies).

3) Do you need inventory and a point of sale?

At the moment not all EHR/practice management systems include an inventory management system with their software. If you plan on selling or prescribing any items, I feel this is a must.



There’s an even shorter list of systems that include a point of sale (POS) within the program. This is a feature that is rapidly being added to systems as well. If they do offer a POS, the merchant processing fee amount can also help you rule out some EHR programs.


The primary reason for choosing to have an inventory and a POS is to eliminate the need for yet another system that includes patient’s names. It is one of the primary questions I ask myself when evaluating a new technology based system, “Will this include patient’s names? Is this a HIPAA concern?” With hacking being one of top ways protected health information is violated, I have tried to minimize the number of systems where my patient’s names are stored. This is good HIPAA security and privacy practice. Inventory must include and association between patient and product because of the possibility of a safety recall. Payments also often include patient information.


Independent inventory systems are quite expensive and it is easy to lose track while working during the day. You’re in the EHR all day for charting and ideally it should be tracking all your financial transactions, including inventory. It is a good idea to minimize the number of systems you use every day.

Two things to watch for:

  1. Often POS systems require an additional monthly fee and may not have the best transaction rates. If your practice is clearing more than $10,000 per month it is time for a merchant account (through Sam’s Club or Costco are considered the best deals). Some programs also give you the option of multiple different credit card processors.

  2. How exactly does inventory interact with your charting? There’s a world of difference between an EHR that automatically removes items from inventory when you prescribe them in a patient’s chart versus other systems that require you to manually remove items from your inventory.

4) What’s your budget?

The price of a system is all over the place right now. I have seen the range of $19 to hundreds of thousands of dollars per month. Most of them are based on a monthly fees. There are a few who are based on per visit or patient encounter.



Many options increase in price as your monthly patient load grows. Prices also increase for services such as insurance billing (not just producing a super bill but actually filing electronic claims and verifying benefits) and text messaging appointment reminders. Like I said pricing is all over the place. You’ll find some companies charging more for one feature while another will include it in a base price.


From my experience, a good budget to start with is $50 to $60 a month. Price is an easy way to eliminate EHR options. Decide on what is realistic in your practice and only look closely at systems in your budget.

Is it really free?

The big elephant in the room is Practice Fusion.



There are multiple free options out there. Very, very few of them are good or modern in design. The one exception is Practice Fusion. I think Practice Fusion is a great way to figure out what you like and don’t like feature wise in an EHR, but I have repeatedly decided against using it for my patients. Why? It really has to do with how PracticeFusion uses patient information.


PracticeFusion is free because they strip away all the identifying information of your patient’s medical information and sell the remainder to companies (think major medical and pharmaceutical companies). They also place advertising within the EHR itself (which you’ll notice ads related to the condition you are charting).


Now we live in an age of ever increasing lack of privacy or rather tolerance of selling our own information. Everyone knows Facebook uses and sells our information. And we keeping posting. So for some Practice Fusion is no big deal and many of our patients would have no problem with this. For me, I just can’t tolerate the thought of this and would rather pay for my EHR service. I also can’t imagine onboarding patients and having this conversation about their medical data.

Get Started

After making these four decisions, you are well on your way to choosing the ideal EHR & practice management solution for your practice. In a market that is overflowing with options and new programs releasing all the time, it is important to shorten your potential list as much as possible. I’m often asked for my opinion on which EHR system is the best or perfect option. I can never really answer this question. What works perfectly for one practitioner, can be a total nightmare for another. Choosing your technology is really about knowing your individual style.



Make your life easier and answer these questions before you start shopping for an EHR/practice management system:

  • What device will you use in your practice? A computer or tablet?
  • Should your EHR be universal or based on your profession?
  • Do you need an inventory and point of sale built into your system?
  • What’s your budget?

What EHR & practice management systems made your short list? Comment below.


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