EHR Software Demonstration Tips and Tricks 2.0: What Providers Need to Watch Out For

Choosing the right behavioral health EHR is one of the most important decisions a mental health organization will make.

Before you dive into purchasing the software that will be running your practice make sure the vendor providing the demo is not really a magician. In our time spent only selling mental health EHRs, we have done demos exactly as trained by the creators of the products. We found out later this was horrendously misleading and when we started doing demonstrations of the products exactly as they worked, sales of these EHRs slowed down to a trickle. As they should.

everythingEHR has been reviewing behavioral health EHRs for the past few years. Many of our clients from mental health billers to behavioral health providers have come to rely on our EHR knowledge to help them during the often painful process of selecting a system that will ultimately run their practice. We have demoed more than forty behavioral health EHRs. Some are 100% mental health focused and others serve many sectors of health care and include a behavioral health component. We found that the process of vetting EHR vendors can and should be a time-consuming journey but often filled with missteps and some landmines. Our clients always report a serious reduction in anxiety by having one of our advisers join them on each and every demo.

There is some potentially serious “hocus pocus” when it comes to mental health EHR demonstrations.  We realize that some techniques simply compress timing to illustrate many different objectives in a short amount of time.  There can be some “slight of hand” at work in an online demo but the worst trickery can obscure how the system performs in real time.   We prepared this article to offer our insights and are proud to share it with our behavioral health readers.

The acronyms EHR and EMR can have a negative connotation associated with them.  Some software vendors don’t even know the difference between an EHR and an EMR.  Make sure these important distinctions are clearly defined.  Ask the person doing the the online demo to explain these differences.  It is a good way to find out if s/he is simply trying to sell you software—or is an individual who knows the mental health market and is dedicated to it.

During the online demonstration watch for these other potentially deceptive practices:

 Slow loading.    No one escapes the occasional problem of slow loading online.  Software vendors do know there is only a brief period to  make a good impression.  If the software staff encounters the cringe-inducing problem of severe slow loading they can either acknowledge  it—or they can try to pretend it isn’t there.  As the consumer you should watch carefully how the vendor deals with this problem. Do they try to cover it up by pausing the screen or quickly moving the “offending” slow-loading indicator out of view? Do they just keep on talking as if nothing is wrong? Do they start asking you questions in order to distract you? To get a true appraisal of how the software will perform in your office make sure you ask for a minimum of three EHR demos with the same product:  General Overview, Clinical, and Billing. Request a demo site to try out the software in order to let your staff experience how fast (or slow) the system will work in real life—after all, this is THE software that will be running your practice. Is this a Windows based EHR (not Browser based) and do they make excuses for their slow software on their website, in user reviews, and during your demo? *Demo account is a term used that consists of a demonstration database that should have realistic clinical data in it so you can see exactly how the product will be used. Many vendors will not give you access to a demo site without their guidance. We completely agree with this precaution. Proper use of an EHR takes time and training. Allowing users to play in demo site without a guide is never a good idea. Allow the vendor to work with you in a demo site but you take control of the mouse.

The online, dual screen demo.  Many vendors have beautiful brochures that can be downloaded and canned demonstrations of their software on their website. When you are getting close to decision time it is important to see the software during real time. Make sure the person performing your demo is working in the same environment as you will be in your practice—not pulling information from other sources and dragging it to the monitor you are viewing in order to skip all the delays. If someone does this repeatedly it could mean that a whole lot of action is going on behind the scenes but s/he doesn’t want to let you see how much actual time it takes to engage other areas of the program. A common tactic is to have two or three instances of the software already open on their own computer and simply move the appropriate screen to the demo viewing screen to make it look like windows pop up quickly. You need to know how much time each of these functions will actually take. You can ask for mouse control during the demo and then click on various buttons and menus yourself.

Errors and Pop-Up Screens. How many times during a demo does an error message pop-up? How does the vendor handle the situation if one does occur? How many times does a message asking you to please wait because important processes are going on in order to fetch your data? Think about your busy practice. Will your staff have time to wait for this application to process your basic needs when you are at peak times of daily use? If this is happening during your demo, imagine how it will be when your entire organization is trying to get their work done in the application and all at the same time.

Cross platform and mobile devices. The software should work seamlessly on a MAC or Windows device to give flexibility to your staff. The program should work in multiple web browsers if it is a true cloud application to allow staff to use their preferred browser. If this is a Windows application do you have to install it in order to use it? Apps to use the system on a smartphone, an iPad, or a Windows tablet should be a requirement now. How much extra do you have to pay in order to use this application in a web browser and on mobile devices or your MAC? If it is a Windows application that has been tailored for use in a web browser, is it really functional in that space? Make sure you ask during the demo if the EHR is cross-platform. One innovative salesperson simply turned on her webcam and showed the EHR at work on her own phone. During our trials we downloaded many EHR apps to our own devices for testing.

Additional Fees?  How many “must-haves” will incur an additional fee?  For example, do you have to pay extra for things like a clearinghouse, mobile apps, ePrescribing, billing and coding libraries, automated appointment reminders, secure email and faxing capabilities, and/or credit card processing? To be sure, request an itemized quote of everything you were shown on the demo and have the vendor point out what isn’t included in the price of the initial software. Also be mindful of how many additional services the EHR vendor is trying to sell you. Do they want you to sign up for their billing service, additional consulting, additional software?

Customization vs. Conformity. A great point brought up by a LinkedIn reader is around an EHR that requires a practice to conform their practice to the strange rules and best practices of using the EHR. An EHR should be flexible meaning it can be customized (easily) by the end user so that it can follow some practices that already have a proven and successful mode of operations. This is another reason we prefer to work with EHRs that were created by an actual clinician. Many of the smaller vendors with EHRs created by a marketing person (as an example) will do just that…blitz their product out to the general public and state the product was created by their “users”. This is simply not the case and why it is important to ask those questions around who created the original product, what is their background, and why are they in mental health care. If during the training you are told that you MUST use the EHR a specific way which makes absolutely no sense in terms of how an actual practice successfully operates, the problem is with who and how the product was created. Check the credentials of the CEO and the person doing your demonstrations. Are they clinicians that have used this software in their own mental health practice? *Make sure you are given mouse control for any user customization on a demo and give the vendor a list of the practice “day in the life” to see if A. The person doing the demo knows anything about working in a successful mental health practice and B. If during the demo you are shown exactly how this EHR can follow your workflow model.

Homework.  Do not rely solely on reviews posted on public boards or the EHRs website as your only reference check. Take your list of must-have features and ask more than one reference about each of those features and what, if any, issues they’ve had with the software. If they say none they aren’t being truthful. Call every practice that has posted a negative review on Capterra or Software Advice and remember that clients are rewarded for posting nice reviews. There is no such thing as software without issues. What is more important is how quickly the issues were resolved. How much support did they need in order to use the system fully? Having terrific support is wonderful but many EHRs require a lot of hand-holding in order to use their software effectively.  The best software is easy to use, flexible for growth, built with your revenue cycle management in mind, and allows you to do what you do best: treat your clients. 

Data Hostage. Many vendors will hold your data hostage even if their website and contract states they will send you a full backup of your data or the data is easily exported to an Excel format. Sadly we’ve worked with many practices where the backup they received is unusable and the data extraction is missing key information and/or must be extracted one record at a time. This is a passive-aggressive tactic used by small-minded vendors that enjoy holding your data hostage and force you to pay on-going fees in order to access your records. Professional vendors allow you readable and usable data that can be easily imported into other systems. If their marketing material on their website or social media makes grand statements about how they “would never hold your data hostage”, ask yourself why any company would need to make those kinds of assurances. Professional vendors don’t need to address these kinds of issues in their marketing. They simply do a stellar job with their software.

New Technology. Have they rewritten their software from scratch in the last 3 years? There is browser based functionality that didn’t even exist 5 years ago that is far superior to installed software solutions. When was the last time anyone went to Best Buy or Staples to purchase a box of software? Every other industry has moved to browser based solutions especially in general healthcare. Your Behavioral Health EHR vendor that hasn’t simply doesn’t have the funds or the talent to keep up with new technology. 

Lawsuits. EHR vendors in pending suits from behavioral health providers should make a quick exit from your list of vendors. This information is public record and easily searchable on Google. 

Paying for customer and vendor reviews. Ask the company if they offer incentives and pay their customers or vendors for reviews and testimonials. Does their website shout out about having unbiased reviews? Why? Reviews on websites such as Capterra, Software Advice and public review boards are meant to be unbiased. If the company is paying for them you may not be getting the true picture. Unfortunately there are many websites that exist that tout the BEST behavioral health EHR or a long list of vendor reviews. Look for popularity indexes like Capterra top 20 list. There is a reason this software is popular. 

Who created the software and why? Here at everythingEHR we are passionate about what we do. We spend our personal time volunteering in the mental health community. It is important for us to promote software companies run by people who are just as passionate about the industry we support and love. Don’t be afraid to ask the vendor what their background is and what they think about the other products and vendors you are considering. Get personal. You are a behavioral health care provider after all – use the skills of your profession. Does this person simply want to sell you software or do they truly care about providing your organization a great solution? Ask if the founder of the organization is a mental health provider that uses their own software in their own successful mental health practice. This is not a requirement but it certainly speaks volumes about the caliber of the organization HOUSING YOUR PATIENT MENTAL HEALTH RECORDS.

Stick to facts:

How many people do they have on staff and what are their credentials? Are there many mental health clinicians on staff? Former Medicare/Insurance auditors? Certified billers and coders? Software engineers? How many people are in the training, support, and development department? Are these all the same people?

Remember, showing up on Capterra, Software Advice, or Technology Advice means vendors are paying for placement. Many times we’ve had agencies think that just because an EHR vendor shows up in the top 10 list or their software is showcased as “Best In Class” on any of these sites it is because the software is wonderful. Vendors pay huge dollars for those listings. These companies, while terrific, are funded by vendors NOT by users of the software. The same goes with conferences. Just because a vendor shows up with a booth at a conference does not mean the conference endorses their product. They are simply a vendor paying for a booth. Some of these vendors need to hold back on purchasing leads, paying for booth space, and flooding the market with marketing efforts. They should do what is best for practices and organizations and invest that time, energy, and funding into having appropriate staffing levels (do you really want your hundred user or more agency being supported by a vendor that has less than a dozen people on their staff?), the ability to obtain funding because they have stellar and new technology, as well as, quality leadership and staff.

Have they won any notable awards?

Does this vendor work with mental health students at large colleges and universities?

Do they have their own employees that are clinicians providing CE courses to their clients?

Are they prepared for Meaningful Use 3 yet?

Do they have funding sources to keep them ahead of technology?

Are they on this list for funding sources?

Is anyone on their staff especially the CEO an invited speaker at mental health conferences across the United States?

Who is on their advisory board? A big advisory board does not equal a large staff of an EHR organization and many of these people have never used the actual software. It is a nice bump on someone’s resume to be an adviser for a software company. Are they really doing any advising about this product? How often does this advisory board meet?

Ask the vendor if they will offer things like the company financials and commit in their contract to meeting Meaningful Use stage 3. If they were not able to meet stage 2 by September of 2014 but met stage 1, why? Has a behavioral health practice ever left a vendor because they lied about their Meaningful Use status in order to make a sale? If they can’t or won’t provide either, be concerned. Does this company have adequate funding to keep them in business?  In other words, is this a software company with longevity in mind?

No software is perfect. How they handle those imperfections is what we care about.

An important journey for us as advisers was moving away from vendors that are not honest while claiming they are honorable. We have absolutely recommended and worked with EHRs that have hurt our client’s practices. This was a great learning curve for us and part of why we are so passionate about what we do. Through our own errors in not vetting EHRs properly, we have learned exactly what to look for when it comes to behavioral health technology. We don’t want anyone providing mental health treatment to be misguided on the important and necessary road of EHR adoption.

If you would like everythingEHR to help you traverse the rocky road to finding the best EHR and billing organization to support your practice please email us.  For a copy of our complimentary list of question for EHR vendors visit HERE.