Strategic “Best of Breed” Approach Ensures EHR Success

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Common perceptions

One might wonder why more hospitals don’t plan for a best-of-breed approach from the beginning, given its obvious benefits. Hospitals may not pursue this approach, in part, because many core vendors steer them away from it, maintaining that they alone can provide all of the essential functionality. As a result of this and other confusing messages in the market, a number of perceptions exist about core vendor solutions that don’t always hold up under closer scrutiny. It’s important for hospital decision-makers to be aware of these perceptions and to understand how best-of-breed solutions may fit into their EHR implementation approach.

Perception #1: Core vendors offer single-source solutions.

Core vendors may represent themselves as delivering single-source solutions that can accommodate the needs of every function in the hospital. For the facility’s IT professionals, the single-source concept can be very appealing, suggesting total interoperability and integration among the vendor’s components. However, the concept often doesn’t reflect the reality.

First, these solutions often are not derived from one single source. Rather, they may actually include a combination of individual products from multiple smaller vendors, perhaps resulting from previous acquisitions or partnerships. For example, core vendors routinely plug in other applications, such as an ED system, Charge Master, ADT or registration system, or encoder system. The result becomes essentially a multiple-source solution, possibly requiring interfaces in order to function.

A second problem stems from how a vendor defines “single source.” The term can be confusing to hospitals because vendors may use it to mean a single source only for the main components of the Electronic Health Record (e.g., the registration system, radiology, laboratory, clinical systems, ancillary systems, physician order entry, or pharmacy) – not truly for the entire EHR. When hospital decision-makers see this term used, it is essential that they clarify with the vendor the functions and components of the EHR that are specifically included.

Perception #2: One core vendor solution can effectively address all functions within the facility.

The simplicity of the “one solution for all” concept is also appealing. And it’s reasonable for hospital decision-makers to assume, based on the strength of a vendor’s clinical applications, that the HIM functionality offered will be robust as well. In reality, these solutions may offer products with only basic functionality for essential HIM operations. Further, HIM users may discover that they are not able to customize the vendor’s “vanilla” offering for their own needs and that they are forced to adapt their workflow to accommodate the new software.

These product design limitations can impact every aspect of HIM. They’re a major source of frustration for release of information (ROI) professionals, who typically develop their own workflow handoffs to accommodate their facility’s unique requirements. In addition, ROI specialists commonly define sets of documents to be released based on the type of requester, such as one set of documents for an attorney request and a different set for a patient request. A best-of-breed software vendor who truly understands HIM will offer users these options and more. A core vendor’s product may be “hard coded” to define only one set of documents for release.

Functional limitations are also found in deficiency management products, where, for example, an EHR vendor may not provide the ability to track and report on unsigned verbal orders. The assumption has been made – incorrectly – that in the EHR environment all orders will be electronic and signed automatically, so no tracking will be necessary. Because of similar assumptions, electronic signature products from core vendors may not enable physicians to easily print their signed documents. A best-of-breed HIM vendor understands HIM processes and needs, and knows that paper output may still be required in an electronic environment, if only during a transition period.

Facilities may find that the offering from their core vendor does not include any solution at all for key functions such as documentation queries. Queries are an inherent component of the coding process, and unanswered queries can significantly impact both documentation quality and reimbursement. Yet many hospitals are managing the query process manually. A best-of-breed solution can automate both concurrent and post-discharge query workflows and provide the robust reporting capabilities facilities need to effectively track and manage the query process.

Involving HIM professionals in the EHR decision-making process can help illuminate the differences between Electronic Health Record products that truly meet HIM’s functional needs and those that likely require best-of-breed add-ons.

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