The EHR They Barely Use

Sometimes the value of software has very little to do with how much of it you use.

I drive a Tesla.

It's an impressive piece of technology, capable of doing far more than I ask it to do on any given day. There are features I've rarely used, others I've never explored, and probably a few I don't even know exist.

But I don't measure the value of my car by how many features I use.

I measure it by whether it does what I need it to do.

Think about owning a 5,000-square-foot home but spending most of your time in just 750 square feet. You sleep in one room, cook in another, relax in your favorite chair, and go about your daily routine.

Does that mean the rest of the house is worthless?

Of course not.

You have room for guests, family gatherings, new hobbies, or whatever life might bring.

I've come to believe healthcare software should be viewed much the same way.

And a plastic surgery center we've supported for the past two years is a perfect example of why.

A Physician With a Practice to Open

A couple of years ago, I decided to try something different with our EHR pricing.

At Affordable Custom EHR, we provide fully hosted and managed electronic health record systems based on OpenEMR. Our customers range from physicians opening small practices to healthcare organizations requiring extensive customization and integrations.

Most of our customers contact us before making a purchase.

They have a vision of what they're trying to accomplish. They've researched OpenEMR, explored their options, and eventually found us through the OpenEMR professional support community or a recommendation.

Then we have a conversation about what they're building.

But I wanted to see whether someone would purchase our software directly from the website without first talking to us.

So I ran a pricing experiment.

I lowered the subscription price considerably and waited to see what would happen.

Eventually, someone purchased.

No discovery meeting.

No lengthy conversation about workflows.

No demonstration.

Just an online purchase from a physician preparing to open a plastic surgery center.

He needed an EHR, found our offering, and signed up.

That was the beginning of a customer relationship that continues today.

An Entire EHR for Two Everyday Jobs

Over time, something interesting became apparent about how the surgery center was using the application.

OpenEMR is a comprehensive electronic health record system. It supports clinical documentation, patient management, electronic prescribing, billing, scheduling, and numerous other functions.

It can also be customized and integrated with external healthcare systems.

But this practice wasn't making extensive use of those capabilities.

The surgery center operated on a cash-pay business model. It wasn't dependent on the insurance claims workflows that are so important to many other medical practices.

Its primary use of the EHR was straightforward.

Scheduling appointments.

Collecting payments.

That's where the practice concentrated its activity.

We had provided a system capable of supporting a much broader range of healthcare operations, but the customer was using only a small portion of it.

And here's what I find interesting.

Two years later, they're still our customer.

The subscription price has increased since that original experiment, but the practice has continued using the service.

Apparently, the functions they rely on are useful enough to keep the relationship going.

I don't know exactly how the physician measures the value of the software. We haven't had a conversation in which he explained that.

But I can observe something important.

The practice found a way to incorporate the software into its daily operations, and it has continued doing so.

Are We Buying Features or Solutions?

When healthcare organizations evaluate EHR systems, they often begin with feature lists.

Does it support electronic prescribing?

Can it submit insurance claims?

Does it have a patient portal?

Can it communicate with laboratories?

Does it support telehealth?

Can it generate reports?

These are reasonable questions. Depending on the practice, some of those capabilities may be essential. The workflow-first approach to EHR evaluation addresses exactly this — the risk of selecting software based on a feature checklist rather than on how the practice actually operates.

But I've watched organizations become so focused on comparing features that they lose sight of what they're actually trying to accomplish.

A feature has little practical value if it doesn't solve a problem the organization has.

For a cash-pay surgery center, sophisticated insurance billing functionality may not be a deciding factor.

For a behavioral health practice, clinical documentation and treatment planning may be much more important.

For a physician opening a small office, scheduling patients and collecting payments may be the immediate priorities.

The software doesn't have to be different in every case.

The way each practice uses it can be.

And that brings me back to my Tesla.

I don't need to use every feature in my vehicle to get where I'm going.

I need the features that matter to me.

There's Value in Having Room to Grow

Now, someone might reasonably ask why a practice would purchase a comprehensive EHR when it only needs a few functions.

Why not purchase a smaller application designed specifically for scheduling and payment collection?

That's a fair question.

Sometimes a simpler application is exactly the right choice.

But there's another consideration.

What happens when the practice's needs change?

Suppose a cash-pay practice decides to begin accepting insurance.

Suppose it expands into additional services, hires more providers, or decides to manage more clinical documentation electronically.

A system that originally served two primary purposes may now need to support ten.

If the underlying platform already provides those capabilities, the practice may be able to expand its use of the existing system rather than replace it entirely.

That doesn't mean every new capability can be activated without additional work. New workflows may require configuration, training, integrations, or customization.

But the foundation is already there.

That's the value of having room to grow.

You don't necessarily need to occupy every room in the house on the day you move in.

And you shouldn't have to furnish every room just because it's available.

The Other Side of the Story

Recently, I shared another experience involving a physician who purchased an EHR from us and paid for the service for approximately eighteen months.

During that time, he never entered a patient, added staff, or completed a clinical note.

Eventually, he contacted us and requested that we shut the system down.

I never learned exactly why he chose not to use it.

That experience stayed with me because it demonstrated the difference between purchasing software and actually adopting it. If you haven't read it, The Doctor Who Paid for an EHR He Never Used tells that story in full.

Now consider this plastic surgery center.

Both physicians purchased an EHR.

Both had access to a comprehensive healthcare application.

One never put the software into daily use.

The other uses only a small portion of its capabilities but has continued using it for two years.

Those are very different outcomes.

And the difference isn't how many features the software contains.

It's whether the technology becomes useful to the business.

I can't tell you why the first physician never adopted the system. Nor can I tell you every reason the surgery center has remained a customer.

But I can tell you what I've observed.

One application remained unused.

The other became part of the practice's operations.

That distinction matters far more to me than the number of features either customer had available.

Maybe We're Asking the Wrong Question

After years of implementing and customizing electronic health record systems, I've come to appreciate that physicians don't all need the same things from their technology.

Some want extensive automation and sophisticated integrations.

Others want an application that helps them manage a relatively simple practice without introducing unnecessary complexity.

Neither approach is inherently better.

What matters is whether the software supports the way the practice operates.

And that's something I think both software vendors and healthcare organizations should remember.

A comprehensive EHR doesn't have to become a complicated EHR.

Just because a feature exists doesn't mean a practice needs to use it.

Sometimes the best implementation is one where the technology stays out of the way and allows people to concentrate on their work.

The surgery center didn't need us to redesign its entire business around OpenEMR.

It needed the application to perform the jobs that mattered to its operations.

And for two years, that's largely what it has done.

If you're a small practice trying to figure out where to start, Tarevo is built around exactly this idea — a fully configured, hosted OpenEMR system that's ready to use from day one, without requiring you to activate every capability before you see value.

Two Years Later

I still find this customer interesting.

The physician purchased our service without speaking to me.

He began using it for a limited set of business functions.

The subscription price increased.

And the practice stayed.

There wasn't an elaborate implementation story or a dramatic technological breakthrough.

Just a healthcare business using the parts of an application that were useful to it.

I think about that whenever I see software marketed primarily through long lists of features.

More features can be valuable. They can provide flexibility and opportunities for growth.

But features alone don't tell us whether a product is useful.

The real question is whether the software helps someone accomplish what they set out to do.

I drive a Tesla that can do far more than I ask of it.

I could own a large home and spend most of my time in a handful of rooms.

And somewhere, there's a plastic surgery center using a small portion of a comprehensive EHR to help run its business.

None of those situations necessarily represents wasted potential.

Sometimes having more than you need simply means having options.

You don't have to use everything your software can do to get everything you need from it.

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At Affordable Custom EHR, we help healthcare practices implement and customize OpenEMR-based systems around their actual workflows. Our goal isn't to make every practice use every feature. It's to help each practice use the technology that makes sense for its operations.

Learn more about how we work or view the software demo to see what a ready-to-use OpenEMR system looks like.