How much should you pay for EHR?

They range from $0 (Practice Fusion) to $800 per provider per month. Most EHR systems charge a monthly subscription fee these days.

So, how much should you pay?

If you think all EHR systems are the same, buy the cheapest Certified EHR system. Right? 

When you say 'they are all the same', what you really mean is that all certified EHR systems have the same 'features'. i.e., they do charting, they store patient data, labs, ePrescription, ICD-10, CPT and E&M coding, etc.

For Example, both iPhone and Android devices have all the 'features', yet you choose one versus the other. Why?

OK, so they are all NOT the same. 

Second Question: How much can you Afford to pay?

Before we try to answer that, ask your self this.

What would be at stake if this is NOT the right system for your practice, makes everyone non-productive, staff wastes lot of time?

EHR should not be taken likely. The negative impact is very critical. By implication, looking at EHR as a cost and expense is not correct. EHR must be a proper financial and investment decision. You wouldn't hire a nurse that wants the lowest salary would you?

Let's break it down.

  1. All EMR are NOT the same.
  2. Don't go by Price. Don't start a conversation with 'how much'? You are not buying potatoes.
  3. Prepare very hard and meticulously - as if you are starting a business. 

Prepare very hard - as if you are starting a business

This is one element of your practice that, as I mentioned earlier, can have a tremendous impact on our business bottom-line if you choose the wrong system and wrong vendor. Here are some things I recommend you must do before you see any demonstration.

  • Have a written document outlining the complete practice workflow.
  • Have your staff write specific parts of the practice workflow that are inefficient and can be improved.
  • Identify 5 cases that represent 80 - 90% of your patients (unless you're a super-specialist where each patient is truly unique). Use these cases to benchmark systems. Share these cases with the vendor (de-identified) and ask them to walk you through these cases.
  • Ask the vendor to show how they can bring improvement to your practice rather than focusing on particular features. There may be many ways to accomplish the goal.

And finally, determine a budget that you can afford and something that can bring positive 'return-on-investment' (watch the video below)


EMR Systems are NOT expensive.

Talk to your Accountant/CPA. Look at your Profit and loss statement and determine the distribution of costs. You may quickly find that you sometimes spend more than the monthly fee of an EMR on things that do not have such an impact on the success (or failure) of your practice.

And finally, don't be afraid of spending slightly more than you can afford to get the maximum value and support from your vendor. It will pay off!

A Pre-Judgement Problem - Why Most Practices select Wrong EMR/EHR

For most companies, businesses, medical practices included, success depends a lot on the team that you have recruited. It goes without saying that picking a winning team is crucial. The problem is we are very bad at it.

SAT is a bad indicator of college performance and even life performance. Yet colleges have to use it anyway. Somehow we keep on pushing our kids along the same path.

Professional sports spend billions of dollars every year to recruit what they think are the best players. Yet scouts continue to pick the wrong players. Having watched Moneyball we know that we tend to ignore useful data and rely too much on our instincts.

Selecting and choosing EMR systems is no different.

When we invite vendors for a demonstration do we even think about what was a criteria for their preselection? We may have gone by recommendation of a third-party or a trusted friend. We allow somebody else to prejudge for us. What we should really be doing, is to understand our internal needs first by talking to the entire team. Focus on prioritizing what is important and what is not.

It takes guts to stop prejudging because it feels like we're giving up control. But, as far as EMR is concerned, we never had control did we?

Inspired by Seth Godin.


What is wrong with this Title - "AAFP and HealthFusion Partner to Deliver EHR Benefits..."

When you read this headline, what goes on in your mind? If you are a Family Physician, and member of AAFP, wouldn't you think - 'my academy had whetted, evaluated, or done something where they tested hundreds of EMR out there and picked the best one for me'.

Media twists it even more - read this.

Nothing can be further than truth. 

I am sure AAFP does not have the time do any of that. Also, AAFP in general does not endorse any product. Furthermore, this headline gives the impression that AAFP picked Healthfusion exclusively and recommends it. If I want, I can read even more into it thinking there is perhaps an incentive for being an AAFP member, or that it is being subsidized.

This is misleading Advertising.

AAFP should be more strict about how their partners put out press releases. 

Wrong Reason not to choose Cloud EHR

A Doctor mentioned today he does not want to use cloud EMR. 

Reason? A colleague 'lost data on the cloud'. 

I'm not really sure what that means, but I have a sneaky suspicion that the vendor of that particular cloud EMR system did not provide data when the doctor wanted it, or that the EMR vendor was holding data hostage for a large fee. 

In fact, client/server systems are more prone to losing data in the traditional sense. The solution to that problem of not getting the data from a cloud EMR vendor, is not to use client server systems, but to do a better job of negotiating upfront and incorporating associated data extraction fees into the contract. 

I have seen too many cloud EMR vendors holding doctors data hostage and demanding a large sum of money if the doctor wants to switch their EMR system.

What should you do?

Don't jump from frying pan to fire. If you think cloud systems are a problem with your data, client server systems are even worse - unless you spend a lot of resources managing the infrastructure internally.