The Grass Is Always Greener? (EHR edition)

There are very few topics that inspire solidarity in the house call community like attitudes toward Electronic Health Records.  This topic has dominated the lunches and happy hours of the annual AAHCP conference, as a particular struggle for house call practices.  If you’re a house call practice currently weighing implementing or changing your EHR solution, some thoughts from my past experiences:


 1)     There is no golden solution.  I’ve helped to vet EHRs for two different house call operations, and none of the considered vendors were built for this type of practice.  Though every sales team promises that enhancements will be quick and effortless (as sales teams are wont to do), this is almost never the case.  After contracts were signed, I saw three different EHR groups suddenly become very slow at building enhancements or tried to convince my client to change their workflow to fit the EHR’s current processes.  It can be a very frustrating experience and, in one case, came at great expense to the client due to a delay of nearly six months.

2)     Most EHR companies do not have an understanding of the differences between house calls and facility care.  The key issue seems to be the reports that are needed to effectively schedule your provider teams.  The top 20 EHRs in the United States do not have the ability to produce these reports.  Further, these same EHRs need significant enhancement requests simply to manage the patient data in the ways necessary for a house call practice.  Due to the complicated nature of the house call patient base, a robust organizational solution is needed … but EHR vendors need to begin shadowing house call practices to understand how to build it.

3)     Beware the free option.  It should not come as a shock that implementing an EHR is not a cheap process.  There are some more affordable choices out there – but many are not certified, meaning you’ll have no Meaningful Use or Physician Quality Reporting System dollars coming in to help subsidize your EHR costs.  There are some certified options that will give you an EHR solution for free, but these are often billing companies that built EHRs in order to get your billing business.  They assume responsibility for billing and take a percentage that, for house call practices, can be cost-prohibitive.  And you also have to consider what would happen if you wanted to switch your EHR, because it becomes extremely difficult when your current vendor is rooted in your reimbursements.

4)     Do your homework.  I mean really do your homework – dig into information that sits outside of online reviews and peer thoughts.  Do a quick check to see if the EHR provider has been involved in any litigation.  If so, how many times?  For what?  During the vetting process with one vendor, we discovered the company had been sued 15 times in the past year for breach of contract.

5)     Verify cache.  One of the biggest obstacles with mobile EHRs is that, with the exception of one non-certified vendor, none of the current options have a cache solution.  So if your team is in a patient’s home and loses connectivity, they also lose their exam notes and have to switch to paper.  Without a cache solution, you’ll likely need to send a hot spot into the field with your providers.  I have tested the hotspot with house call groups in the past and, while it worked great within city limits, it was completely unreliable in rural and suburban areas.  In fact, outside of cities, the hot spot lost its signal approximately 60% of the time.

So, where does that leave you, as a house call practice seeking an EHR vendor?  Unfortunately, not in a great spot.  Obviously, if your EHR solution is collapsing, you must do what you need to do.  But after vetting so many EHR providers, I feel the industry is at least two years away from a true house call solution, as the issues with generating the correct reports and keeping a signal in the field seem to be universal. 

If you’re an EHR company reading this – I highly recommend developing a house call-specific program.  It’s a growing market, desperate for a solution that understands its unique challenges.

Some things to consider,