Configurations and Customizations: How to Judge an EHR’s Adaptability

While many EHR software vendors describe their solutions as easily customizable, users are often dismayed to learn that options for tailoring the program are far more limited than they had expected. That realization usually comes quickly, as they look to institute a new billing method, create unique forms, change labels, tailor reports, or gather information that goes beyond what the program allows.

Many EHR software vendors describe their solutions as easily customizable.

However, users are often disappointed to learn that the options they have for tailoring their program are actually far more limited than they were expecting.

Finding out that your EHR can’t handle a critical requirement can be downright alarming. All of a sudden, you’re in an awkward position — having to decide whether or not to switch to a new system or program a new piece of software that can handle the task.

We have two primary suggestions for making sure your behavioral health EHR solution can adjust to your current needs as well as those that might arise down the road:

1. Think through your workflows and requirements before you evaluate the software

Often, administrators go about choosing software by first asking, “What features and benefits can this program offer me?” They focus too much on the system’s capabilities and user-friendliness.

But, in our opinion, that’s not the most effective way to go about selecting an EHR system. Our experience has shown that purchasers make better decisions if they begin with this one simple question: “Given how we operate, what are all the things we need the system to do for us?” That process starts by sitting down with your staff and precisely thinking through how the system must function to run the practice/clinic efficiently.

So to help you out, here are some useful questions:

• What’s the workflow for an admission?
• How should we set up rules for billing?
• In what ways can the system facilitate compliance with regulatory requirements?
• How should we configure appointment reminders?
• What reports do we need routinely?
• You could well want to tailor each and every nuance of the workflow – to the smallest detail.

Part of that process involves discussing how flexible the program has to be to handle demands that might be unique to your operations. For example, you may have contracts with the courts that require specialized forms and reports that would never come pre-stored in a practice management system. Or you might need a system that can guide your staff members through a complicated workflow that the Department of Health established for managing patients with infectious diseases.

Bottom line is: figure out how the software should adjust to your needs, not how you’re going to make the best of its capabilities.

2. Evaluate the breadth of configuration options and the capacity for rapid program customization

Part of the trick of selecting software that’s best for you is understanding that programs vary widely in how extensively they can be modified. They also differ in terms of adjustments, some can be user-controlled and others require the vendor’s programmers to make changes.

Sure, some software packages let you generate specialized reports – but only if you send them a request. And it might be that they place limitations on which data can be included in a report. We’ve heard of programs that boast of customizable progress notes when, in reality, all they allow for is adding a set number of text fields.

One way to evaluate a system’s flexibility is to consider the extent to which you can configure options, as opposed to making fundamental changes in how the program functions.

As for configurations, most programs give you at least some options for setting how the program performs. You might be able to choose (usually during implementation) which paperwork templates are listed, the array of service codes you provide, or whether you want to turn on the module for e-prescribing.

Here we’re talking about a menu of pre-stored options that you can select to configure the program to your liking. But remember that some software programs provide just a few of these options, while others (like ClinicTracker) offer hundreds of them.

Here are some examples of fields you can configure in a form:

• Who can gain access to which set of records
• What templates for progress notes are available
• Whether a label says “Hospital ID” or “Clinic #”
• Integrated system to update information: How long a piece of paperwork needs to be overdue before the clinician gets a notification
• How reports are generated

You also have dozens of options around revenue management, including setting payer fee schedules, modifier rules, CPT code overrides, referring provider information, and more.

However, you should evaluate a program’s adaptability based on more than just how many switches it gives you to switch on a configuration menu. You’ll want clear assurance from the vendor that they are willing and able to modify the program itself with custom coding, on a quick and efficient schedule.

What’s the easiest way to judge how nimble a company is around implementing upgrades and bug fixes? Ask how often they update the program. Most vendors might do so once or twice a year. At ClinicTracker, we distribute new versions every two or three weeks. That way, we can respond speedily to user requests for new features (incidentally, this is how we built ClinicTracker over the last 20 years).

Here’s a timely example: One of our customers needed a check-in kiosk (like at the airport) so they could reduce the spread of COVID-19 by promoting social distancing in the patient registration area. Our programming team got to work immediately, and now ClinicTracker boasts a check-in kiosk module.

Conclusions

When you’re listening to a sales pitch, it’s easy to focus too much on the software’s visual appeal, rather than its capabilities. You might also make the mistake of taking at face value the salesperson’s claim that the program is highly customizable when, in fact, it’s barely configurable. Just remember that, you’ll want software you can trust to do whatever you need it to do – and quickly.