Part VII: Mistakenly Choosing Best of Breed Over An Integrated System

Here is the seventh installment of WRS Health’s 10-part series dedicated to Dr. Lawrence Gordon’s recent white paper, “10 Implementation Mistakes to Avoid: Why Practices Fail.” Each segment of the series examines one of the 10 most common implementation mistakes by medical practices when implementing electronic health record (EHR) systems.


You may have heard the term “Best of Breed.” The term commonly refers to using a specific software program or package for each specific application or requirement. Best of Breed is a likely recipe for failure. It is cumbersome, inconvenient and costly. An integrated EHR solution is mandatory in order to manage the complexity of the modern healthcare enterprise and it is also advantageous for solo practitioners.

The case of Coastal Ear, Nose, and Throat, LLC in Georgia underscores the myriad benefits of having a completely integrated EHR system versus Best of Breed. Dr. David Oliver understands fully the negative consequences of not having an integrated system with his first web-based EHR. Dr. Oliver practiced with six physicians in a Savannah, GA-based ENT practice for 15 years. A few years ago, he was going bankrupt. The main culprit: the practice had transitioned from paper charts to an inefficient EHR software system that turned out to be a money pit. There were also some bad business decisions that had been made.

“Our EHR killed our productivity, it was crushingly expensive and it absolutely ruined our practice. I was going bankrupt. There were big licensing fees upfront, a big purchase price, and big monthly licensing fees. You have to have your own servers and you have to pour money into your infrastructure. The problem with those Electronic Health Record systems is that they are not designed for Otolaryngology—that is, for specialists. I can order a pap smear more easily than I can order CPAPs. They didn’t give me any support for integrating your EHR,” states Dr. Oliver.

Intent on putting his dire financial and business problems with the multi-provider otolaryngology practice behind him, Dr. Oliver decided to open Coastal ENT, a solo ENT practice. Dr. Oliver points out that his wife is a certified procedural coder and that she has a degree in healthcare management. “She had already done a lot of work and she talked to me a lot about the problems with our EHR system. It really caused a lot of conflict in our practice because I was telling these doctors, ‘Why did you get this EHR system? It doesn’t do this, it doesn’t do that.’ The doctors were feeling some pressure from me that the system was not performing.

Dr. Oliver goes on to explain that because the new system he selected is integrated with the clearinghouses there’s a plethora of benefits in the system when it comes to the business aspect of the practice. “The new EHR prevents your practice from going bankrupt. It helps me bill. If you don’t have a good web EHR you may have a system that doesn’t tell you when there are changes in your payment schedule from the insurance companies. All of a sudden, insurance companies will decide they are not going to pay you for ‘xyz’ and they drop your reimbursement 10% on some of the things that you do regularly. You are guarded against those kinds of things by having an EHR system that is integrated and that keeps you up with all the facets of the financial side of your practice.”

An integrated EHR solution is indeed paramount for success in order to manage the complexity of the modern healthcare arena, agrees Nurse Practitioner Karen Lee. She was an early adopter of EHR software for her women’s health practice, which she founded in 1975. She was also a pioneer when it came to utilizing billing software in 2003. But as time went on she realized she had to carve new territory. The reason: the two systems were inefficient because they were separate. In 2010, Lee began searching for an integrated web based EHR and practice management software solution for Woman to Woman.

Lee serves 10 to 12 patients a day and provides lengthy visits. “I had a server-based system that didn’t have billing associated with it. I had to have separate billing software. The government was telling providers that we would have to have an Electronic Medical Record. I realized the wave of the future is web based and not server-based. So, I started looking for a new Obstetrics and Gynecology EHR system that included billing.”

Frank’s Wellness Clinic, which has offices in Tampa and Seminole, Florida, realized that “Best of Breed” wasn’t working in the practice’s interest. The practice initially had two separate managers as well as two separate software systems. David Frank, Office Manager said, “We used a practice management software for scheduling appointments and for billing at one location and another system for scheduling and billing at the other practice. I merged the two practices and I set the same standards for both locations with the idea of growing the practice and adding more providers.”

The practice finally chose one end-to-end EHR and practice management system that boasted robust billing capabilities. Although the practice initially planned to do billing in-house, they thought it was prudent to outsource billing to their new EHR company. “They are already providing EHR and their Team already understands how to maneuver through the Electronic Health Record program. Who else would be best to get this done? We are able to utilize the EHR system more efficiently by posting payments and sending claims to the insurance companies on an immediate basis versus delaying it a week or more. Our software company has the ability to negotiate with the insurance companies for payments that haven’t been received or payments that have not been fully paid. That’s always a plus. We started using the new system on May 1, 2012, and our revenue picked up at least 40% almost immediately. There were a lot of things that weren’t previously being billed out. They were still sitting in queue,” reports Frank.

Dr. Syed Rizvi adds that with his integrated web EHR system, “We can do everything in one place. We don’t have to do multiple tasks in multiple systems.”

According to “Principles for a Successful Computerized Physician Order Entry” study, from a technology viewpoint, integration of different systems was desired by users for ease of use and times savings. Joan Ash and her colleague researchers found that users “wanted seamless access to different systems through CPOE and they especially wanted both inpatient and outpatient orders written this way. They wanted CPOE to be integrated into their workflow so that it did not disrupt their work. Organizational and human integration, such as working on multidisciplinary teams, was strong as well.”

An additional benefit of integration in Bazzoli’s words: “Achieving Meaningful Use will also cause providers to place a premium on integration, because current and future objectives will require a high degree of workflow and data integration, application interoperability, and data sharing amongst EHRs. Providers will demand compliance with all relevant HIE standards required by various standards and integration bodies.”




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