EHR requirements and key features: your complete guide

Think of determining your practice’s EHR requirements like planning a vacation - you need to decide what you would like to get out of it (a chance to unwind), and what a particular destination would need to have to help you achieve this (nice countryside, good weather, well-regarded local cuisine).    

EHR requirements gathering requires a similar thought pattern - if your main goal is to increase patient throughput, you need to map out the key features (patient portal, scheduling, e-prescribing) that will help you achieve that.

A successful requirements gathering process can be distilled down to three key elements:

• Clear, objective, and measurable goals.
• Understanding of how an EHR will contribute to your practice’s goals. 
• Subsequent knowledge of which EHR features best complement achieving your practice’s goals.   

Basically, if you lack a clear direction and understanding in the requirements gathering process, which can translate to problems in the selection process, a practice risks any number of negative consequences which can ultimately result in lost revenue, unnecessary costs, and a diminished ability to deliver quality care.

This guide will cover:

• What requirements gathering is and how you should carry it out
• The importance of requirements gathering in the EHR selection process
• The core features an EHR should possess
• The role Meaningful Use requirements occupy in requirements gathering 
• Advanced, specialty, and general EHR features

Gathering your EHR requirements. Why? How? 

To figure out what you want from a new EHR, you have to be systematic. 

Put simply, requirements gathering is similar to creating a grocery list. Instead of a list containing items from the supermarket to make certain meals, an organization engaged in requirements gathering is generating a list of specific EHR software features that would assist a practice in meeting its strategic goals.

Why create a set of EHR requirements?

A poor requirements gathering phase means you could waste money by choosing an inadequate system and risk losing excellent clinicians because of poor operations. In the end, patient care could suffer.

It is important to create an EHR features list containing products whose features best complement strategic goals; the requirements gathering process provides the foundation of the selection process.

How do I map out my practice's EHR requirements?

1. Define your practice’s goals. What do you hope to achieve by implementing a new EHR? Where is your existing software letting you down? What are your future practice needs, and how will replacing your EHR now place you in a position to meet them? 
2. Consult your key stakeholders to build an extensive list of requirements and understand key user needs. Remember: you may not be able to give your practice staff every single feature they want - best to manage expectations here rather than giving everyone a blank slate to dream up their wildest EHR unicorns, only to end up disappointed. 
3. Determining requirements and needs using an objective criterion. Using this approach, requirements are determined by using a ranking system that assigns a numerical value to each function or usability characteristic identified as important on a scale of 1 to 5, with 1 representing the lowest priority and 5 representing the highest priority. 
4. Prioritizing requirements after data collection should be conducted to create a refined list that ranks the most essential requirements at the top of the list and less pressing requirements lower on the list. 
5. Combine and document EHR software requirements and EHR hardware requirements data in an EHR functional requirements document after it has been validated as accurately representing the needs of stakeholders.

Core EHR features to help you meet practice requirements

The Institute of Medicine (IOM) has identified what it considers 'Key capabilities of an electronic health record system', or a set of eight core functions that EHR systems should be capable of performing. These are:

1. Health information and data: storing clinical information and data in an electronic format that can be retrieved and viewed efficiently. 
2. Result management: the ability to manage test results. 
3. Order management: electronic processing of orders and prescriptions. 
4. Decision support: warn providers of possible risk and provide information to aid in clinical decision-making.  
5. Electronic communication and connectivity: communicate and connect with other providers across multiple care settings.  
6. Patient support: provide patients with information and allow patients to communicate with their providers. 
7. Administrative processes and reporting: practice management functionality such as billing and scheduling, among others.   
8. Reporting and population health: produce and share reports on clinical data concerning patient population health.   

These core features should be treated as a baseline when deciding on the functions of an EHR system. However, practices will likely require features that offer more sophisticated versions of these core functions.

For example, practices may require more advanced practice management features such as the ability to analyze revenue trends or manage supply orders. Further, more advanced features go beyond simple data collection and reporting, such as predictive modelling of patients who display a high risk of developing a chronic illness or are at risk of readmission during recovery.  

What are the requirements for EHR incentives and Promoting Interoperability?

Historically, the Centers for Medicare & Medicaid Services administered the Medicare and Medicaid EHR Incentive Programs, commonly known as Meaningful Use. These encouraged healthcare professionals and hospitals to adopt certified EHR technology and demonstrate its effective use through financial incentive payments.

However, these programmes have since evolved. Click here for more on that subject

The current requirements are organised around five main objectives:

• Electronic prescribing: Using certified EHR technology to support electronic prescribing.
• Health Information Exchange: Enabling the secure electronic exchange of health information between healthcare providers.
• Provider to Patient Exchange: Giving patients access to their health information electronically.
• Public Health and Clinical Data Exchange: Supporting the electronic reporting and exchange of relevant clinical and public health information.
• Protect Patient Health Information: Maintaining appropriate safeguards for the confidentiality, integrity, and availability of electronic health information.

Eligible clinicians must use appropriately certified EHR technology and report the applicable measures and attestations for their reporting period, subject to relevant exceptions.

Selecting an EHR system that supports these capabilities can help healthcare organisations meet applicable CMS reporting obligations while improving clinical workflows, information sharing and the overall quality of patient care.

EHR and practice management software

In recent years, the functional difference between EHR and practice management products has become more blurred as these products have integrated. In this shift, practice management systems rely more heavily on clinical data collected by an EHR and vice versa. The greater integration between these systems has offered practices more nuanced and comprehensive data on which to base their decision-making.

The primary difference is not in how the software functions from a general perspective, as EHRs and practice management solutions are offered as an integrated suite so that data can be shared between the two systems.

However, EHRs are mainly concerned with clinical tasks, whereas practice management enables practices to provide better clinical care by making the administrative side of a practice more efficient.  

Specialty vs general EHR features

Some EHRs offer features that are flexible in nature so that they can be adapted to meet the needs of specialty practices.

For example, templates for data input fields can be modified to meet the needs of specialty practices, or workflows can be modified with little effort to accommodate varying types of practices.

However, certain specialties often benefit from specialty EHRs that do not require modification. These can be delivered with specialty-practice-focused features that offer greater functionality than their general practice EHR counterparts, such as behavioral health, pediatrics, dentistry, and oncology.

An example of this specialization is found in physical therapy EHRs that provide integrated physical therapy-specific forms and the ability to manage testing and performance data.

Similar specialized features are found in oncology EHRs, which provide features that cater to the data-intensive nature of oncology practices, such as managing data generated from testing and the administration of chemotherapy.

Aligning a practice’s requirements and the key features available on the market forms the foundation of a successful selection process. The main driver of an effective selection process is a rigorous requirement gathering process.