Selecting or Changing Your EHR

If you live anywhere in the therapist-stratosphere, you’ve no doubt heard lots of chatter the past several months about EHRs and changing EHRs. Spurned by increased costs in a very popular platform for therapists, many mental health providers are considering their options for migrating to a new system  Having recently navigated these waters and made an EHR change, I’m sharing my experiences and clarifying any questions you might have about if and how you could make such a change.  Whether you’re considering a switch or starting off brand-spanking-new, read on and I’ll share some considerations in selecting an EHR vs paper records, common features of EHRs to consider, and my process and experience in migrating to Sessions Health.  

NB: This is a lengthy article because there are a lot of considerations involved.  If you prefer a list of options, download my checklist now from The Resource Vault (free!) and then reference this blog as you work through it.  Otherwise, read through this article and you’ll find a link to my spreadsheet guide at the end!  If you’ve already selected your new EHR, jump down to “Making The Switch” towards the end of this blog to see how I migrated my old data to Sessions Health!

But First… What is an EHR?

EHR stands for Electronic Health Record.  Sometimes this is referred to as EMR, or Electronic Medical Record.  Essentially, this is a system to store and access what would normally be in a client/patient chart: documentation, consent forms, etc. Practice Management software, on the other hand, consists of administrative software for things like scheduling, financial transactions, insurance billing, and things of that nature.  Many of the systems that therapists use are technically integrations of practice management software with EHRs: they combine the admin features with the clinical features that we need.  There are more intricacies to this and questions have arisen in the past year with open note rules, and I recommend you pop over to  Person Centered Tech for more details.

Do You Need an EHR?

The reality is, I am aware of no law in any state at the time that I am writing (please message me if I’m wrong) that dictates you HAVE to use electronic means for charting and document storage.  Therapists and psychologists for many, many decades got by just fine with paper charts. (We also walked uphill both ways through snow to school and back, but that’s a story for another day.)  Notes can be hand-written, stored in manilla folders and locked in a file cabinet in a locked file room and, boom, you’re done.  That said, there are some definite pros to an EHR:

• Functionality: an EHR does far more than store static documents–I’ll talk about features in a moment
• Ease of Access: an EHR with patient portal integrations means that you can communicate easily and securely with your clients and vice versa, you can share files without endless trips to the copy machine and scanner, new patient forms are easy and paper-free, you can allow clients to schedule on their own, and you can access a client file from anywhere in the world with internet access.
• Ease of payment: integrated payment solutions simplify tracking charges and payments, create invoices, superbills, and claim forms with a few clicks, store insurance information and scanned insurance cards, and store and encrypt client credit cards
• Ease of Insurance Billing: many EHRs have insurance integrations, allowing you to create and file claims, receive EOPs, and check benefits through the system.
• Ease of Storage: Record storage requirements vary depending on your state, and may vary for child and adult clients.  While those paper records may not seem like a big deal, they tend to multiply over the years, require space or a paid remote storage option, and will need a place to live until they reach their expiration date.  Not to mention at that point in time you’ll have to securely shred them or pay a company to do so on your behalf.  And finding an old paper record, should you need to access it, is not a lot of fun if you have many years worth in storage.
• Environmental Impact and Cost: Let’s not forget, all that paper was once lovely living trees (cue the Lorax music).  Those trees are harvested (loss of innocent tree-life), processed (environmental impact of processing plant), packaged (more materials used), trucked (more environmental impact and resource consumption) and finally arrive at your office.  Even if the environmental advocacy piece doesn’t tug at your heart strings, paper costs money, ink costs money, file folders cost money, printers and copy machines cost money and have maintenance expenses, mailing things routinely through the postal service costs money… Are you noticing a trend here? Yes, an EHR will also cost money, but a paper record storage system is not completely free.  And, the trees!  I speak for the Trees!  Don’t be the Once-ler.  

Features to Consider

Now that you’re thinking about moving from paper to electronic storage, or switching between platforms, let’s consider various features to look for in an EHR.  Here is my in-no-particular-order, your-needs-may-vary, possibly-not-all-encompassing list of features that I considered when reviewing new EHRs (you may want to open my spreadsheet from the free resource vault and follow along).

Security is a primary consideration in an EHR.  You want to make sure that your record storage will be HIPAA compliant, but that alone is not enough. Check what compliance features and security features are in place. Any good EHR will readily make this information available to you–if they don’t provide security deets front and center, don’t walk, run away. The good news is that all of the EHRs I researched are clearly aware of requirements and have probably thought about these needs in ways that your average clinician has not.  I often turn to Person Centered Tech for guidance on tech in the MH space, and would suggest you scan their blog for more info.

Assuming you have a secure platform, now you need to consider the features that will make your, and your clients’, lives easier.  I made my decision based on six general areas of consideration: Ease of Use and Customer Support, Documentation and Forms, Calendar and Scheduling, Patient Portal and Communications, Financial Records/Billing Integrations, and Subscription Cost.

Ease of Use and Customer Support

Talk to your colleagues and read up on other people’s experiences with a variety of platforms.  How intuitive is the software (you’ll gain this knowledge by trialing it, as I’ll describe below)? How responsive is their customer care team? How can you access customer care, and what is their typical response time?  Are there tutorial videos, access to a live walkthrough with a support technician, blogs, or other materials to help you get started and to troubleshoot? What is the system for uploading your old client data, is there a cost, and will you be supported with this? Is everything you need integrated into one platform, or will you be adding additional products outside of the EHR to accomplish your needs?  Some platforms include free CE opportunities, which may be of interest to you.  Another important consideration that may not be front of mind when you are shopping for a new EHR is, how difficult is it to close your account and export your data?  Some platforms make you pay for your data (and this can be pricey if you have a large group practice), or have complicated systems for accessing data.  Others allow you to click a button and receive a data export for free.  It’s a good question to ask now before you are married to your choice.

Documentation and Forms

This is really the heart of your EHR–essentially, everything that would be in a paper chart.  It should be easy to use and intuitive.  The best way to get a feel for this is by using it.  Most EHRs will provide you with a free trial. Schedule those trials at a time when you can really dedicate energy to playing in the system: create phony clients, write notes, send yourself documents and forms, and experience the documentation side from the provider and client perspective.  Assuming you’ll be using the EHR to send out all of your initial paperwork, you’ll want to see how easy or challenging it is to customize form templates, if available, and to create forms by scratch.  Can you upload documents to share with clients, that clients can then download for their use outside of session? This is a super handy feature that turns your EHR into a storage binder for all your favorite client handouts. Also consider ease of access to your documentation–can you log in from your mobile device if needed, and what is the experience like on a small screen?  If the EHR has an app, does the app give you access to everything you might want to see when you’re away from your main computer?

Calendar and Scheduling

In many EHRs, I’ve found that the calendar is the “hub” for access.  This allows you to quickly see your schedule, to schedule new appointments, to quickly navigate to a particular appointment and then see the client’s chart, pull up their last appointment note, record your new note, and initiate the billing process.  An important feature to many people is calendar syncing, which can be one way (from the EHR to your own calendar, like google calendar, but not vice versa) or two way (allowing synchronization in both directions).  Some platforms charge more for synchronization, so if you need it to make your life easier, make sure it is included in the pricing tier you are considering. Make sure the calendar is easy to navigate and intuitive, because you’ll be using it a lot.  Your calendar is also the hub for appointment reminders, another feature that sometimes is given a premium price point.  Consider your need for email and/or text reminders and ability to customize your reminders with your own text and telehealth links, if applicable.

Patient Portal and Communications

Therapists will vary on the relative importance they place on the patient portal, but, for me, this is a HUGE feature. A patient portal provides a secure way to communicate with clients.  Both you and your client will have to log in with a password to access the portal, and messages don’t ping around the internet, unprotected, like unencrypted emails do.  I teach my clients from the initial phone call to use the patient portal for communication as it is the most secure way to reach me.  Other portal activities that are helpful to my practice include sending forms for electronic signatures, sharing documents with clients, allowing clients to upload documents, and scheduling appointments.  Most EHRs that I’ve looked at which have client-initiated scheduling features also provide the ability for the clinician to turn this off and/or pre-approve appointments before they are confirmed, so if you don’t want clients to self-schedule, you’ll want to explore how this works.

Financial Records/Billing Integrations

Your needs in the financial sector will depend on your practice structure and whether or not you are in network with insurance companies.  I am generally not in network, and willingly admit that my knowledge of some aspects of insurance billing using EHRs are limited (though I cut my teeth working in a billing department and can figure out a claim form like nobody’s business).  For a mostly private pay practice, I’m looking for ease of recording payments, simplicity of generating invoices or super bills (preferably, an automated approach), ease of entering payments from third parties (like EAPs or insurance checks).  If you are direct billing insurance, you might consider a system’s ability to generate and submit claim forms electronically, ability to verify and track benefits/co-pays/deductibles, and automatically process insurance payments.  If you use a biller or someone who solely manages your insurance payments, you might want to have them trial the system with you to make sure it meets their needs. Check out the financial reports and records the system will generate for you and make sure they meet your needs for tracking within your practice, managing accounts, and, if applicable, paying employees.

Subscription Cost

Finally, how much is it going to cost you to drive this thing off the lot?  Are you on a 2007 Ford Focus budget, or looking at the newest Tesla?  Given that I don’t use a lot of the insurance functions (the expense of which might offset paying a biller if you need this),  I am not willing to spend a ton of money on my EHR, though I do want a lot of functionality and ease of use.  When my old EHR not only increased the monthly rate but also rolled out new tiers of functionality, my monthly increase would have been $40 to have the same features I used, resulting in a $99/month charge.  My new platform, Sessions Health, is costing me $35 a month. That’s saving me $64 a month, or $768 a year.  That extra cash in my pocket made the temporary labors of migrating the platform a little easier to swallow.  I am very happy with this choice and was able to preserve the functions that were most important to me.  As always, YMMV depending on your needs.  You might also consider costs for additional providers and/or admins in your practice if you’ll have multiple people accessing the system, costs if any for additional services you need like claim filing, appointment reminders (some systems charge by the reminder sent!).  If you do give Sessions Health a try, give them my name as a referral and you’ll get a $35 credit if you subscribe!

Making the Switch

Now that you’ve considered all the functionality aspects of the EHR you need and are ready to make a change, here are the steps that I took to transition from my old EHR to Sessions Health.  First, I familiarized myself with the platform as best as I could and reviewed all of the functions I needed as part of my “interview” process (my spreadsheet in the resource vault will help you with this).  Next, I scheduled a time to conveniently make the switch.  I wanted an overlap between my old EHR and my new one of at least a week, so I considered when my old EHR’s billing period ended.  I also planned this for a time when I had several days without clients scheduled, so I wouldn’t have to access charts and have a lapse between my old data export and my new files–for me, this was a Friday-Monday stretch.  I exported the data from my old EHR, which was quite easy to do, with a zip file emailed to me within a few hours.  To load this into Sessions Health, I just needed to add the zip file to my uploads and then let the system admins know it was ready to be imported.  The import took about a day (but apparently can take several days so plan accordingly), was free, and pulled in all my client documentation and forms for all active and inactive clients. I then randomly pulled several charts to make sure the data transferred correctly and I was pleasantly surprised. There were several things that did not import that I had to do manually, which Sessions Health alerted me to: I had to change status from active to inactive on all inactive clients (easy, but time consuming depending on how long you’ve been in practice), and I had to add any appointments that had not occurred yet to the new calendar.  Pro tip: configure your automated email appointment reminders before adding new appointments to the calendar so that the correct information will go out to your clients–for me this included customizing my emails to send folks to my doxy.me link for telehealth.  For clients with an account balance, I needed to manually enter this information (lucky for me, I waited until almost all my payments had cleared before transferring, so this was minimal work). Client completed and signed forms transfer over, but my credit card authorization forms needed to be renewed which I did when I set up the patient portal (see below).

Other materials that did not auto transfer included all my blank forms: consent forms, privacy practices, intake forms, release of information forms, etc.  This was probably the most time consuming aspect of the transition.  I managed it by having my old EHR open with the forms accessible.  By opening my old forms in “edit” mode, I was able to copy and paste text and use the forms builder in Sessions Health to make totally new forms or to customize some of their existing templates.  I also downloaded pdfs of all my old forms from my old EHR and created a folder on my computer to store these, in case I needed to access them in the future.  Another item that went into this folder: financial records.  I pulled my tax records from my old EHR and downloaded the reports, and pulled yearly financial records.  These spreadsheets are now stored on my local disk in the event that I need them. Sessions Health also allows these to be part of my document uploads, so theoretically I could store them in my EHR if I wanted to, but they would not integrate with my current financial records.

Speaking of the documents folder, I had accumulated quite a number of helpful documents in my old EHR that I used as client handouts.  To make life simpler, I spent some time downloading all of them from my old EHR and then uploading them into the new EHR.  Yes, in theory, I could have done this as-needed, but the time spent locating the original pdfs of each document, or, heaven forbid, re-scanning them, was something future-me would have been unhappy about.

The final step was configuring my patient portal and alerting my clients.  This required manually sending  an invitation to each client to authenticate their patient portal.  To reduce confusion, I first sent a message through my old patient portal, alerting them to the change and letting them know to look for the new portal authentication email.  I then sent all my active clients an invitation to the patient portal (literally, toggling a button in their chart to allow access).  At the same time, I was able to send out a new credit card authorization form for any clients for whom I wanted payment integrations using Stripe.

Et voilà, c’est fini!  While it took some time, nothing in this process was unsurmountable and I had an ongoing dialogue with Sessions Health support, with very responsive replies.  Based on my experience making the switch and using the platform this past week, I’ve been very happy with my decision to move. Again, if your search takes you to Sessions Health, use my name as a referral to make the switch extra sweet!

Free Spreadsheet!

What’s the right choice for you?  Well, I can’t answer that, as your needs will be different from mine.  But I made you a handy dandy spreadsheet to use as you interview possible EHR companies.  It’s my gift to you, and you can find it in my Resource Vault, along with lots of other great (and free!) practice building tools!  Grab it when you sign into the resource vault, here!

How’s your EHR journey been? What questions do you have about choosing an EHR or making the switch?  Jump on the Intentional Private Practice–Community FB group, where we talk about all things private practice, and I’m happy to answer your questions!