Web EMR decision even more difficult now

Marketers analyze internet activity with respect to how you search. What terms are being searched to look for your first or next web EMR or web EHR?
Here are the steps you may take:

  1. Search online – see keyword terms popularly used below.
  2. Ask your peers for their opinions of the systems they use.
  3. Use a third party (online, like Software Advice, or a consultant you may know) for recommendations.
  4. Narrow down your search to your top 5.
  5. Organize Demonstrations – online or offline.
  6. Call References of systems you like.
  7. Negotiate pricing.
  8. Sign and implement.
  9. Don’t Start over.

Search Online

Let me show you what most providers – you – are looking for and searching. I have found most providers using the word EMR but you may substitute it for EHR.

  • <your specialty> EMR
  • EMR software companies
  • Electronic Medical records software companies (or some combination thereof, based on if you really want to type everything)
  • Web-based EMR
  • Free-based EMR (you know you are looking for alternatives to Practice Fusion and don’t want to pay anything)
  • Best web-based emr
  • Web EMR reviews
  • Cloud EMR
  • Top EMR vendors
  • … you get the idea

All EMR companies – yes, all of them – know this and they try to manipulate their sites so that when you search, their websites appear on the first page of Google, Bing, or any such search engine.

The second method they use is Advertising. Search engine advertising is a huge business. How does Google make its Billions? When you search online, a lot of providers are not aware that the top three ‘search results’ and the ones that seem very relevant are on the right side of your screen. These are really advertisements that are sponsored by EMR vendors. Nothing wrong with that, but you should be aware.

When you search online, what should you be looking for? A well-designed website is no guarantee of a good product. It just says this company has good marketing and design folks. Look for these four things:

  1. Does the company list its top executives? Is it easy to contact them?
  2. Does the company have customer testimonials? How many are there? Are they listed by Specialty? Are these real providers and practices, or just anonymous quotes? How old are these?
  3. What are their products and services?
  4. Is this an independent company? Who are the owners? Do they have other businesses? Do the founders/owners have a deep background and knowledge of the healthcare space – more importantly, experience that is relevant to your business?

Peer Opinions

Asking your colleagues and peers is an extremely important ‘tool’ in your search. However, there is a big caveat. Let me explain.

If I ask what car you drive and whether or not you are happy with it – what is the likelihood of you saying you’re not happy? Slim to None.

What I am really trying to say is, that if you simply ask someone their opinion about their software, they will generally say ‘Good’ – unless they are considering switching.

Instead, here is how you SHOULD ask.

‘I am considering getting the system you are using. Can you share your lessons learned (from using it?) What can go wrong? What worked well? How is their support and services etc?’

Now you are engaging them in a conversation rather than a simple – are you happy? If they have any reservations, it will come out at this time. Some vendors offer incentives to their clients if they recommend the system to their colleagues, so be aware of that.

Using a Third Party

Online third-party aggregators – When you search online, I am sure you will run across sites like these – Software Advice.  Don’t get me wrong, they are a great resource. You should just be aware of how they work. Most sites like these get their money from vendors when they recommend vendors that match your needs. The good thing is, that they have a lot of top vendors as clients. They get the same amount of fixed fee from vendors irrespective of who they recommend. I just want you to be aware of this, so that you can use this as one resource, and not be entirely dependent on it.

Individual Consultants – if you personally know anyone, by all means, use their help. These may be your hardware or network vendor, your suppliers, etc. Just make sure that they do not have a vested interest and that there is no ‘insider trading’ involved.

Narrowing your list

Your final list should not be more than 5. Before you narrow down your list, make sure you talk with representatives of those companies. Don’t do demonstrations yet. Ask them all kinds of questions (see the four things to look for on a website). This must be almost as if you are conducting an interview to hire them.

You must have very clear goals and criteria for selection. Unfortunately, too many people go by their ‘feelings’ of what looks good, and who sounds better. Buy with:

  • Product (features, functionality)
  • People (behind the product, support, services)
  • Processes (Do they have well-defined processes for implementation, training, and support?)

Apply the 80-20 rule. Nothing is perfect, nothing is 100%. Be ready to make compromises.


Online or offline demonstrations? If a vendor has a local representative who is willing to stop by for a demonstration, by all means, do it. But you don’t need to hold it against vendors that do remote demonstrations.

Again, the only way to get the maximum out of demonstrations is preparation. I have seen too many demonstrations where they are all over the place. In the previous section, I mentioned you must know what you want. Write it down. Here is a simple guideline.

1. Write your current workflow. Office workflow, from patient calling for appt, check-in to check-out. List your staff, and write down who does what and in what order.

2. Identify ‘gaps’ or ‘areas of improvement’ in your workflow map.

3. Potential pitfalls and fears in implementing technology.

Now, Prepare a Demonstration Script.

1. Take your most common encounter/patient visit. Look at a few finished visit notes.

2. De-identify the set of note(s) so that patient information is removed.

3. Send it to the demo person(s) – at the time of the demo, or just before so that they have enough time to review it, but not enough to ‘fudge’ their system. Also, send them or tell them your workflow.

4. Ask them to stick to the script. Only after that is done, they can show off their system with other ‘features’. But tell them what you care about and what you don’t.

5. Finally, ask them – ‘What would you do to improve my workflow and make my practice more efficient’? This is one of the most important questions, don’t skip it. It will tell you a lot about how this vendor approaches things.


I have written about checking references. Read this.

  1. How to check – who to call.
  2. Also, Check out your salesperson.

Negotiate Pricing

How Much?

Is this the most important question? And also, when should you ask the pricing question – before or after the demonstration?

I will split the pricing issue into two parts. First, before you engage the vendor with a demonstration, you must have an idea of the approximate price range – you don’t need a final quote. That way, you know whether or not you can afford this solution and it falls within your budget. (This means, as a part of your preparation, you MUST) decide on an approximate budget.

Part two is where you negotiate with the top 2 vendors. I don’t need to tell you about negotiation here, you probably are an expert at that.

Sign and Implement

Signing is the easy part, but make no mistake about Implementation. This is where everything begins. Just because you, the provider have signed the dotted line, your job is not done. You must either take control and become your internal project manager, or assign someone that can stay on top of the entire implementation process. Don’t leave it just to the vendor. The vendor will do a great job, but they need your help. It is a two-way street. If you and your practice do not cooperate 100%, it will fail. Cooperation does not mean just providing information on vendor needs but being an active participant with your vendor implementation team.

Finally – Don’t Start Over.

Barring unforeseen situations, you should not have to do this all over again. EMR is a paradigm shift for your practice and you certainly do not want to go through the process again.

Good Luck!

Author: Chandresh Shah

Chandresh Shah specializes in Healthcare IT and Medical Billing. He knows the market inside out; what works, what doesn’t. He advises and works with small business owners.