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Hello, I am curious as to what is the cost to use your Electronic Health Record Software on a yearly basis. I am a small business that does work in the province of Ontario and find your QuickBooks and other integration features very attractive. I look forward to your response.

Cost is important to everyone. But vendor cost should not be the primary reason for selecting an Electronic Health Record or EHR (or PMS or CMS) system. The system with the lowest vendor cost may be more expensive, all things considered. Here are three considerations:

First, some systems are installed locally and require a server to be installed on. Added components may include antivirus, firewall, primary backup and disaster recovery, remote desktop, maintenance, etc. These components are all part of your overall system costs. A cloud-based system, like Skedulex, bundles all of these costs into one monthly payment.

Second, most EHR systems are not integrated or only partially integrated. This means that you are entering the same information in multiple places in order to run your business. Three examples:

  1. Your HCAI system is only partially integrated. As a result, you submit some information directly to HCAI website. You track your plan balances on a separate spreadsheet or paper. You enter the same information in 3 to 5 places. This may take an extra 4-6 hours per week.
  2. Your QuickBooks is not integrated, and you manually re-enter all your invoices in QuickBooks or another accounting software.
  3. Your EHR system has no payroll or contractor report, so this is done manually or on a separate spreadsheet.

Third, for every 10 new clients that moved to Skedulex in the last year, 7 transferred another EHR system. The costs of transitioning outweigh any savings from their first system. Pick the best system on the first go around.

In the examples above, the company incurs extra admin or office cost of a recurring nature. Let’s say 6 hrs. per week. Your extra annual cost: 6*52*$20 = $6240 or an additional $520 per month. In reality, this is part of your system costs. Had you invested in an integrated system, your monthly vendor’s license costs may be marginally higher, but you would save the extra admin and systems costs discussed above. 

Do consider all the costs when looking at a system. The vendor cost is only one piece of the cost. Here are a few questions to ask yourself:

  1. Would I need a server?
  2. Are HCAI plan tracking and line balances included?
  3. Do I need to keep spreadsheets for HCAI or Payroll?
  4. Do I need to re-enter my invoices in QuickBooks or accounting program?
  5. Do I need a remote login program to access my program?
  6. Does the EMR have a mobile App?

My advice: Invest in the best system. It may cost a bit more but, in the end, you will save money and time and lots of aggravation.

Q: Why did you keep using your old system for the last 7 years.
A: Well, first of all, we did not know there was such a thing as an integrated EHR system that saves time. Second, we dread the thought of moving to a new EHR. You know, migration costs, a new learning curve, the cloud option, continuous assurances from our old vendor that a cloud system is coming soon.

Q: What changed your mind?
A: One of our part-time staff uses Skedulex. She brought her laptop in the office one day and said, “if you have 5 minutes, I would show you a better EHR program. The rest is history. I am just glad she did.
 

 

Selecting the Best Electronic Health Record Software

Selecting the best Electronic Health Record Software is one of the most important decisions you would make, one that will impact your company for years to come. I can write extensively on this question, but let’s start from the top, with the platform options.

Platform Options

Electronic Health Record Software comes in two basic options: On-premise application or a web-based solution. On-premise solutions have been around since the 1990s and are continuously being replaced by more flexible web-based systems.

On-premise application

An on-premise application is loaded on to a server located within your clinic.

In addition to the EHR software, you must invest in a server, data services (storage, data backup, and disaster recovery), maintenance and security (firewall and anti-virus). You also have the crucial responsibility for keeping your server and EHR software up-to-date.

EHR vendors who market on-premise applications argue that it gives you control over your data. While this claim is relatively factual, you cannot copy out your data or use it outside of the EHR solution. If your server or drive dies or you wish to use a different system, the only way to access your data is to have it migrated out of the old system in a usable format.

The drawback of this system is that it limits your access from outside of the clinic. Some vendors have resorted to Log-me-in or Remote Desktop programs, but these have many limitations, may expose your system and can be difficult to work with. Today, fewer new on-premise applications are being developed today, as developers transition to more flexible hosted solutions.

The cost of an on-premise application must include your server acquisition and setup, data services, security and maintenance costs. These costs are in addition to your licenses’ costs.

Web-Based Solution

A web-based (or cloud-based) solution is hosted on a server located in a secured data centre such as a Microsoft, Amazon or Rogers data centre. Most vendors offer a 99.9% uptime guarantee, meaning that the chances of your EHR going down is almost nil. The system relies on internet connectivity, but so do most internet phones, e-commerce applications and businesses.

Web-based EHR solutions are packaged as a service bundle that includes hardware, software, data services, security. All maintenance, updates, daily data backups are handled by the vendor. There are no servers or software to install and maintain. 

EHR vendors who market web-based applications argue that it allows you to work from anywhere at any time, with secured access to your data. Additionally, web-based applications are ideal for small to mid-sized companies who do not have an in-house technical staff.

Unlike an on-premise application, web-based solutions cost less to get started and bundles your cost into a single monthly or annual cost. 

Selecting the right platform and services

On-premise or web-based? Deciding which is best suited for your operation can be challenging. Here are five additional considerations to ponder and which may help to answer the question.

1.    Where will your therapists work from, now and in the future? Are you running a clinical operation where all your therapists work in the clinic? Would you like to have the flexibility to work on your clients’ file when you are away from the clinic or from home? Do you have a second location or plan to add a second location?

2.    Mobile Application: Today, everyone carries a mobile phone.  Having a mobile App that integrates securely to your EHR has tremendous advantages. Some common advantages include easy access to viewing or booking appointments, client contact information, one-touch dialing or address mapping, notes and reminders and clinical notes. You may be surprised to learn that 75-85% of your routine EHR interactions could be done on a mobile App. 

3.    Service Options

What are the service options you would like to have from your vendor?

a.    Data migration – your data is your business intelligence gathered over many years. Keep it if you can afford to.

b.    Customization – Some software companies offer an out-of-the-box EHR solution with a one-size-fits-all approach. Is your company the same as your competitor? If not, a customizable software is better suited. Customization provides additional options and removes the noise from the software and makes it simpler.

c.    Training – Proper training in the use of a software is critical to its efficient use. Be wary of companies that charge you for training. Look for companies with unlimited training. 

d.    Support – Getting the support when you need it is important. Every company provides some level of support for its software. However, some companies provide prompt support with a live person answering the phone while others take hours or days to return your call or respond to your email.

Software Features

No two software are the same.  What are the critical software functionalities and features you need to manage your business effectively? I encourage you to develop a checklist detailing the EHR features and functionalities to consider in product selection. You may classify these into must have, should have, and nice to have.

An Integrated Solution

An integrated solution reduces the amount of time your staff spends on administrative work. For instance:

1.    Your QuickBooks is not integrated and you manually re-enter all your invoices in QuickBooks.

2.    MVA Billing (Ontario Only) HCAI is a time-consuming system. Time is money. If you service clients in Ontario and do any MVA billing through the HCAI system, selecting a system is integrated with HCAI. HCAI tracking is a critical time saver.

•    An integrated HCAI software saves time (less data entry & improved accuracy) and keeps all your records in one place.

•    A good HCAI tracking software tracks your plans and maintains line and plan balances. Otherwise, you will find yourself having to maintain an added tracking sheet for every plan you work on.

I have seen companies that spend many long hours and weekends every month billing HCAI.

In the examples above, the company incurs extra admin or office cost of a recurring nature. Let’s say 6 hrs. per week. Your extra annual cost: 6*52*$20 = $6240 or an additional $520 per month. In reality, this is part of your system costs. Had you invested in an integrated system, your monthly vendor’s license costs may be marginally higher, but you would save the extra admin and systems costs discussed above. 

Software Cost

The Total Cost of Ownership (TCO) is a concept developed by the Gartner Group to help managers make more informed financial decisions about software investments. Rather than just looking at the license fee, TCO looks all of the direct and indirect costs.

a.    Equipment cost includes hardware, operating software, equipment maintenance, upgrades, back-up, and disaster recovery costs. Typically, your server and associated equipment are upgraded every 4-5 years. By comparison, when you acquire a web-based solution, equipment and maintenance costs are bundled into one single price.

b.    Implementation cost is a one-time charge to set up and configure the application to support your business needs. Some vendors charge an installation fee while others include this cost into a monthly. 

c.    Customization charges are paid by companies wishing to have the solution modified to align more closely with its business needs. These costs vary depending on the level of customization and the complexity of the organization and software.

d.    Training cost is the ongoing cost associated with training (i) end users to use the software effectively; (ii) administrative users to manage and maintain the software. Some companies charge for training while others include it in the licenses’ fees.

e.    License Fees are License costs are either charged upfront or bundled into monthly charges.

f.    Invisible cost is the most misunderstood cost, mostly due to its hidden nature. No two software applications are alike in features, ease-of-use and productivity. Each extra minute endured in processing your files represents an added cost to your business. These extra minutes should be considered in calculating your overall costs. For instance, if your software does not track HCAI plans automatically, you must pay someone to do it manually.

Arrange a demo

After you have decided on the platform, arrange a demo(s) and have a look at the product and features. Use your EHR features and functionalities’ checklist. Ask questions, as many as you can. Some software vendors offer a free trial. While a free trial of the software has its advantages, it can be a frustrating experience. It’s like taking a car for a test drive when you have never driven a car before. A demo allows you to take a guided tour while drilling down on any feature of interest.

Get a proper license’ agreement

Whether you choose an on-premise or web-based solution, securing a proper license agreement is just good business practice. From time to time, you may need your vendor’s assistance to make changes to your system or assist you with resolving an issue that requires you to delegate access to your computer and clients’ files. A good agreement does not tie your hands but protects your rights and your clients’ files.

Conclusion

Do your homework. Look at all the considerations and decide on a platform. I encourage you to consider all the costs: Equipment, implementation, training, support, Licensing and invisible costs.  For larger companies that are guided by Return on Investment (ROI) or Internal Rate of Return (IRR) in assessing its software investments, the TOC concept is equally applicable.

Technology is an enabling tool that supports your critical business needs. It helps with your compliance and management of your clients, in a big way. Investing in the right technology gives your business a comparative advantage. Alternatively, investing in people to compensate for an inefficient software or manual system is a poor business decision that costs you money, loads of it every month.  The longer you hold on to your old technology or manual system, the more it costs you in labour charges and lost advantages. Don’t put off the inevitable!  Invest in a good EHR System!!

Good Luck!

 

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