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Electronic Health Records

EHR product, including the license fee and license renewal frequencies. This will aid in better revenue forecasting and business planning. The products are usually licensed on the following terms: per user/per month, one-time fee and annual fees. Practice owners should understand which model works best for them in the long term. The owners should also check for discounts provided on longer commitments.


Another important factor for a practice owner to con- sider is the amount of training required before staff can use the system effectively, and if the training costs are included in the licensing fees.

Implementation charges

Owners should also determine if there is an implemen- tation charge levied by the solution provider during the implementation.

Upgrade/update charges With changing standards and new guidelines and rules being rolled out by authorities on a regular basis, there is a constant need for upgrades to existing solutions. Prac- tices should get a clear understanding of the inclusion of upgrade costs for any future compliance demands arising from updates to the MU defi nition or other healthcare and IT standards.

Financial health of the vendor

One of the most important factors is to ensure that the EHR vendor is fi nancially stable, and some of the key factors to look for are: longevity of the company, customer list, annual revenues and management team.

Eye on the future

While selecting an EHR product, physicians will be well served if they factor in future possibilities. For example, is there a plan to accommodate another practice in future? If so, is the product extensible to accommodate such an inclusion?


Most product vendors usually provide different levels and types of support based on the fl avor of the product purchased by the customer. The nature of support (e- mail, voice) and service level agreements for resolution should be considered and fi nalized during the time of negotiations.

Recommendation With the vendor’s ability to squeeze in more charges at later stages of engagement, it is very important that

24 August 2010 Recommendation

Each of the technologies mentioned above have its own merits and demerits. While the Web-based solution might work better for individual practices, the bigger practices might benefi t from an on-premise (LAN-based) solution. However, the decision makers need to evaluate these carefully before making a fi nal selection.


The adoption of an EHR system by a practice should not be driven by the monetary benefi ts beings offered by the federal government. Instead, the goal for an EHR implementation should be to improve the effi ciency and the cost effectiveness of the practice. Although this article provides various factors on which prospective solutions can be evaluated, the practices should evaluate the various options holistically keeping long-term benefi ts in sight. For further support, medical practices may also look to enlist the services of qualifi ed independent consultants during the evaluation and implementation process. It is important that the management team provides full support during the implementation of the solution and not give up; initial problems are bound to happen.


SaaS (service-as-a-software)-based solutions In SaaS-based solutions, the application and the data are hosted by the service provider at a remote site and are generally easier to implement as they require minimal infrastructure. As a result, a practice can get started with few hassles. In addition, these solutions can be more cost effective, as the cost is distributed over a period of time and have less administrative overhead.

Client server

In client server solutions the software is installed on a server inside the premises and is accessed by the users with workstations called clients, which are physically connected to the server over a high-speed network. The main advantages for client server solutions are the security of data and speed of operations. These solutions can be benefi cial when the practice is large, and they generally require internal IT specialists or third-party IT support.

practice owners seek clarifi cations and get comfortable with the factors highlighted above. These factors are most often missed during the decision-making process and can result in higher costs in the long run.


The clinical management systems are available on various technologies and each has its benefi ts and disad- vantages.

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