Ambulatory EHR buyer's guide

The global market for ambulatory EHR products represents the largest segment of the overall EHR market. Given the massive size and opportunity presented by this market, ambulatory practices searching for EHR solutions will not go wanting for options. The ambulatory EHR market, when compared to other segments of the EHR market, is the most competitive with a broad range of vendors vying for users. Although competition can produce significant benefits for consumers by forcing vendors to offer more competitive pricing and focus more intently on product development and performance, it also presents challenges for selection teams who, at times, may feel overwhelmed by the number of options available to them.

Considering the challenges selection teams may face when considering purchasing an ambulatory EHR, it is important to understand the similarities and differences between inpatient and ambulatory EHRs, and know some of the most useful features available in ambulatory systems.  

Ambulatory EHR vs. Inpatient EHR

In recent years, hospitals have increasingly acquired community ambulatory practices or entering alternative arrangements whereby the hospital is involved in the operation of the clinic. In either scenario, the hospital who assumes ownership or control over the ambulatory practice will be faced with the question: what is the difference between inpatient and outpatient medical records systems? The differences arise from the practical realities of each clinical setting.

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Ambulatory practices function as part of a larger ecosystem of providers situated in different locations. As such, ambulatory practices must share clinical information and coordinate with other physicians, outside laboratories, pharmacies, x-ray, and imaging centers. The hospital environment differs in that the environment in which information is shared is more self-contained, in that information is primarily shared between hospital departments. As such, the inpatient EHR’s will reflect this difference in their complexity given the diverse amount of clinical data that is collected and shared.

However, at their core, basic functionality is the same between the two types of systems.  Inpatient and ambulatory EHR systems share some common features such as the minimum level of security, keeping problem lists, medication lists and adverse interaction, and allergy alerts among others.

Ambulatory EHRs differ from inpatient systems specifically on the types of reports and summaries collected from a patient’s clinical data, for example, inpatient EHRs will require features to prepare discharge summaries whereas ambulatory systems primarily require treatment summaries. Further, the types of quality measures patient systems must track differs from inpatient to ambulatory EHR systems. The Clinical Quality Measures for inpatient systems track a larger number of metrics whereas in the ambulatory setting the quality measures focus primarily on management of chronic conditions, immunizations, and preventative screenings.

Specific functionality needed for ambulatory EHR

A 2018 article published in the Journal of Managed Care examined the extent of EHR functionalities in ambulatory practices. The study used survey responses from 30,123 ambulatory practices with an operational EHR, and examined the use of EHR-based health IT functionalities for each practice. It was reported that seventy-three percent of ambulatory practices were not using EHR technologies to their full capability, and nearly 40% were classified as under-users. One can take these findings and set them in the context of other recent data collected from ambulatory EHR practices regarding what these organizations expressed as features they anticipated were necessary features in their next EHR purchase. The results reported in a survey by Black Book Research show that ambulatory practices indicated the following features were a high priority for ambulatory practices.  

Cloud deployment

Thirty percent of ambulatory practices with more than 11 clinicians will likely replace their EHR system by 2021, according to the 2018 Black Book Integrated Ambulatory Systems report. Of the practices looking to change, 93 percent stated that cloud-based mobile solutions for on-demand data was their top priority. Given the need for clinicians to be able to access clinical data from several remote locations, cloud-based solutions offer an effective way to address these practices data portability needs.

Telehealth/virtual visit support

Eighty-seven percent cited telehealth/virtual visit support as their key interest. For practices that serve chronically ill or disabled patients who are not able to travel to a clinic to receive services, telehealth technology offers clinicians the ability to provide care to hard to reach patient populations.    

Speech recognition

In the Black Book survey, 82 percent said they wanted speech recognition solutions for hands-free data.  The ability for clinicians to input data in a quick and streamlined manner has been an issue that has dogged EHRs. With accounts of clinicians falling victim to backlogs of clinical data that must be entered the EHR, speech recognition can expedite data entry and make workflows more efficient, particularly in busy clinics.   

Top ambulatory EHR systems

The systems reviewed below represent EHR products that have received favorable consumer satisfaction ratings and offer the required core and advanced features required for ambulatory practices.  

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eClinicalworks, Epic, and athenahealth’s ambulatory products have been noted by practices as offering the highest overall satisfaction ratings from users.  eClinicalworks received the highest customer satisfaction rating at 82 percent. Epic received the second-highest satisfaction rating at 67 percent, while athenahealth users also reported relatively high levels of physician satisfaction at 58 percent.

eClinicalWorks

eClinicalWorks cloud-based EHR is a fully customizable system that offers e-prescribing, clinical decision support, and registry and quality measure reporting embedded in the system. Further, eClinicalWorks ambulatory system relies on a single on-demand database to ensure a patient’s comprehensive record is available anywhere.

Epic

Epic’s standard ambulatory EHR suite that contains an integrated practice management system. is available in on-premises and cloud-based deployment. Epic’s system can also be accessed through its mobile interfaces, and decision support modules, population health management tools, and patient engagement features.

Athenahealth

Athenahealth’s cloud-based EHR for ambulatory practice provides users with a standard suite of features. In addition to core EHR functionality, the system also provides users with the benefit of fully-integrated practice management and billing solutions. Athenahealth’s workflow design is attuned to efficiency and quality care through an integrated EHR homepage. The system’s interface offers a single view of priority items, including full daily schedule, with complete patient information, the reason for visit and symptoms presented by the patient during intake.