Office systems come first

Not all physician practices that want to acquire EHRs are prepared for them, notes Chuck Parker, vice president and chief technology officer of Masspro, the quality improvement organization (QIO) for Massachusetts. Parker, whose organization has been helping small practices buy and plan for EHRs under a national CMS mandate, points out that "if a practice has a lot of A/R, it may not be ready for an EHR." In some cases, he says, failed EHR installations have caused practices to break up or go bankrupt.

Aside from getting their practices on a solid financial footing before making the EHR plunge, Parker advises doctors to include "milestones" in their vendor contracts. These kinds of clauses require vendors to deliver on their implementation promises before you pay them fully.