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Choosing Software for Smaller Providers

November 1, 2007
by Katherine E. Peres, PhD
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How agency size affects software selection

The size of the organization in which you work affects your view of all aspects of the behavioral healthcare community, including the rapid changes occurring in the industry. Your organization's size also should impact your considerations and choices when selecting electronic health record (EHR) software. Allowing your organization's size to inform your software decision is essential; believing that your size must control your decision is a trap.

There is no question that the number of consumers your organization serves, the number of providers it employs, and the size of its budget affect your resources for evaluating and implementing products, the software you can afford, the functionalities and features you need, and the vendors from which you can choose.

Large behavioral healthcare organizations establish teams responsible for reviewing software products. They hire consultants to facilitate the project from the needs assessment through implementation. They budget significant dollar amounts over several years to cover the costs of the purchase and its implementation. Large organizations have the freedom to determine whether they prefer an integrated system with comprehensive, enterprise-wide functionality or independent products that work together to meet their various needs. Large organizations can choose among vendors ready and able to meet all of the needs they define.

On the other hand, smaller organizations are more limited in how they can approach software selection. They have fewer staff members who can divert themselves from service delivery or administrative duties to work on a software project, and they probably cannot afford consultants. Their budgets are smaller, with more dollars dedicated to direct service delivery and fewer to technology. Smaller budgets impact their ability to purchase an integrated system, so they instead focus on independent products to accomplish their goals.

Advice for Smaller Organizations

Even with their greater freedom in choosing EHR software, many larger organizations freeze up when confronted with the task's size and complexity. Even the bravest executives are frightened by a software project's costs and staff commitment. For smaller organizations, the prospect of shopping for an EHR may feel especially overwhelming. To make the process easier, keep the following advice in mind.

Remember that the choice you make now is not necessarily permanent. I know you are saying to yourself that the cost of software requires that this be a long-term solution. While you hope that your software choice will be the best product for your organization, and that you will never again need to go through this process, this is unlikely to be the case—and perhaps should not be the goal.

During the next five to ten years, your organization likely will change dramatically. It's unlikely that your software needs will remain the same. For example, the development of the Nationwide Health Information Network (NHIN) is an emerging reality. Additionally, technology changes rapidly and dramatically. While a product may be a perfect fit for your organization today, in five to ten years your needs will change. Your current vendor may be committed to having its products work with the NHIN, but many details can change over time. Therefore, try to keep an open mind about a software purchase. View it as an incremental step toward accomplishing your long-term technology goals.

Look for scalability. A product that allows you to start as small as necessary and to gradually add capabilities and users may be better for a small organization than one that requires it to purchase everything for all possible users at the initial purchase. This is an especially important consideration if your budget is small. Even if you purchase one of the larger products on the market, being able to scale upward or downward as your organization changes gives you flexibility. Make sure that the product you purchase and your contract for implementation give you at least some flexibility.

Ensure data accessibility. Most products on the market are in some proprietary format with limitations on the modifications that can be made to the data and database from external sources. This may limit your ability to write to your database, but there shouldn't be limitations that keep you from accessing your information or exporting it to other programs and in other formats, on your own or with your vendor's assistance. As an NHIN participant, you will need to send data to and receive data from other providers. Both functions will be necessary eventually, but accommodations are likely to be made for smaller organizations as long as they can send information. If you later decide to move to different software, having your data easily accessible will diminish the cost of data conversion for a new product.

Avoid all-or-nothing thinking. Organizations with large budgets have many options when shopping for software features. Smaller organizations may need to learn that they do not need all the bells and whistles in order to function well. In fact, in some small organizations that do not have IT staffs, having complex products often is not useful.

When you see full-featured products, you may feel that you must have all those features or nothing at all. Try to keep your needs in perspective and carefully determine what you really require. You may find that less costly products have all the essentials for your organization. And if they do not, vendors may be willing to work with you and other organizations with identical needs to customize their products to accomplish your goals, thereby sharing the cost of customization.