EMR Articles - Medical Practice Trends

How to Meaningfully Shop for an EHR System – Part 1

February 21, 2011 By Margalit Gur-Arie 6 Comments

So you’ve been hearing all about the recent EHR buzz and decided to give it a try. Whether you are convinced that electronic records are the way to go, or you have reached a point where you are willing to give it a try, the first thing to do is buy one of those EHRs. You may be staring at a glossy brochure or website featuring a distinguished silver-haired doctor holding a cool little tablet computer and smiling reassuringly at the little old lady sitting comfortably in front of him, with a large 1-800 number on the bottom urging you to call now. Don’t.

Shopping for an EHR may be more complicated, but is not much different in nature than shopping for a car or a new type of breakfast cereal. Of course, you have been shopping for cereal since you were a toddler and probably bought your first car as a teenager, so the entire shopping process is almost second nature. Not so with an EHR. Just like cars and cereal boxes, there are hundreds of EHR products out there, and just like cars and cereals, you need not bother with most, and after you narrow the field down to three or four, it makes little difference which one you end up taking home. The qualitative roadmap below will lead you to those three or four obvious choices of EHRs best suited to your particular situation. The final choice is yours to make. [ed. note: the car purchase analogy is a great one; how would you answer the question, what kind of car should I buy? Do you need to carry passengers? Off-road or not? Cargo or not?]

Goals

The first thing you need to do is to honestly list why you want to invest in an EHR. Listing goals has two purposes, one is to help guide your selection and the other is to retrospectively assess your success or lack thereof. The more specific and measurable your goals are, the better they will serve you. Let’s look at some examples.

I want to receive the $44,000 stimulus money from CMS – This is a very precise goal and can be easily measured over the next 5 years. This goal also exemplifies the need to have enough information before you set a goal. You need to know that the amount of incentives is not fixed. Instead it depends on your patient mix, your charges, your ability to meet complex requirements, the date you start using your EHR and even the next election. You also need to know that these incentives are fully taxable.
I want to improve my practice’s efficiency – I’m sure that here you are envisioning getting rid of paper charts, automating billing, having lab results and other paper artifacts come in electronically, reduce phone calls, increase number of visits and maybe reduce payroll a little. The right EHR, correctly implemented and correctly utilized can help with many of these goals, but not all. Here we consider the fact that your goals must be realistic. Expecting to be able to see more patients with an EHR is not realistic and probably the opposite is true. Reducing payroll is also not a very likely outcome, since for every medical records person you may be able to let go, you would have to hire an “IT guy”, and if you are a small or solo practice, there is no one to fire anyway. Nevertheless, break this goal down into various efficiencies and quantify your expectations.
I want to increase reimbursement levels – This is a very doable goal. The point here is that if you want to be able to measure success, you should set a better defined goal. Are you referring to being able to safely code to a more appropriate level? If so what is your desired improvement? 10%? 20%? Are you referring to ability to participate in an Accountable Care Organization? Are you intent on obtaining performance bonuses from insurers or an HMO? Perhaps all of the above. Just make sure you list them with as much specificity as possible.
I want to improve patient care – That’s a great goal, but needs a lot of definition work. You may want to be able to spend more time with each patient, or you may write down that you want to improve the standard of care for all your diabetics, or perhaps you want to make sure that all the kids in your care get all their immunizations on schedule. There are too many options to list and they will depend on your specialty, the characteristics of your patient panel and your professional views on the practice of medicine. Try to be very specific here as well.

These goals are just the most common examples. I am certain that you will come up with many more and you should consult with everybody else in your practice as to their goals as well. As mentioned above, and very similar to car shopping, during the next few months, you will inevitably find out that some goals are unattainable and others will need to be sacrificed due to constraints. [ed. note: yes, always start with goals - I bet most practices don't do this.]

Constraints

If you had all the money in the world and no kids or dogs, you would probably drive something different than what you drive today. You knew your limitations when you went looking for a car and you should know them when searching for an EHR.

I don’t want to spend a fortune – This is the most common and most important constraint, but it does need a bit more detail. Do you want to make a capital investment now and pay less in the future, or do you want to get an EHR with no money down and pay a monthly fee? How much can you afford to pay upfront? Do you want to go into debt and take out a loan? What can you comfortably pay every month? What are the tax advantages of each approach? Would you compromise and drive the standard company car if it was free (read: the EHR the hospital is giving away)? Lots of decisions to be made here, but establishing a budget and sticking to it will protect you down the road.
I don’t want to deal with IT – If this is one of your personal constraints, it will narrow down the field in a hurry to only those EHRs that can be remotely hosted by the vendor or one of its business partners.
I want my data in my office – This is the flip side of the constraint above and will similarly remove quite a few EHRs that insist on “hosting” your data.
My partner refuses to use a computer – You will need an EHR that can accommodate both of you and a vendor that is willing to be understanding and work with you.
I want to install the EHR before flu season – Sounds simple, but you will find that accommodating your timelines may not be so easy when everybody is out there buying EHRs.

This list will get very long. Talk to everybody in your office and let the list grow. Your billers in particular may bring up goals and constraints that you would have never considered. The next step is to take all those goals and constraints and translate them into requirements for your EHR. To continue the car analogy, if your goal was that all three kids and the large dog fit comfortably in the back seat, then the requirement is that the car has room for at least 5 passengers in the back, which will then narrow down your choices to an SUV or minivan. Combine that with your budget of no more than $30,000 and a constraint that you only buy American, and you have arrived at your handful of car choices. Let’s look at a sample list of requirements for an EHR for a solo primary care practice in a remote rural area. You should come up with your own specific requirements.

Non-Functional Requirements

As the name suggests, these are general requirements which do not pertain to actual software functions.

No money down and no more than $500 per month for the whole thing
Ability to function with or without internet connectivity
Maximum 3 seconds for screens to load
Support dictation and hand-writing
Ability to access records from nursing home, hospital and home
All data and records, or a current copy, physically stored in my office.
Ability for multiple users to access charts simultaneously
Certified for stimulus incentives
Money back guarantees if not satisfied

Functional requirements

These are specific requirements for specific functions in the software. Most will be derived from your goals.

All 25 Meaningful Use requirements fully implemented
Coding advice in workflow and automatic E&M calculation
Automated claim creation, submission and electronic remittance
Ability to verify eligibility in real time
Connectivity to the hospital down the street to receive lab results
Longitudinal customizable flowsheets
Integrated Peds dose calculator
Good selection of customizable documentation templates
Ability to customize pick-lists for diagnoses, medications, diagnostic orders
Ability to create reminders for chronic disease management

[ed. note: these previous two make up your wish list. Be as thorough as you can - it will save you heartache later.]

Now that you have pages and pages of all sorts of lists, is it time to call that 1-800 number from the glossy ad? Not yet. If you were shopping for a car, you could of course stop by the first dealer you see and have him educate you on your choices of minivans and SUVs. A smart shopper would first consult something like Consumer Reports or JDPower, talk to friends and family and if you are like me, look at cars on the highway and every parking lot you happen to find yourself in. Alas, there is no Consumer Reports for EHRs. If you search the web for advice, you will come across a bewildering array of “free” advice sites, most of them requiring that you “register” before obtaining any help. Although it is usually very hard to tell, virtually all of them are there to lure you into buying something, be it EHR software, or services, or unrelated products and sometimes they are just collecting addresses for marketing purposes. Stay away from anything you are not already registered with by virtue of being a practicing physician. But there are some respectable ways to get good advice too. [ed. note: I would add that there are some sponsored informational sites that work with most vendors and do offer some valuable advice. Just be sure you know where they are coming from and that the process is transparent.]

Colleagues – The best sources for collecting names of EHRs that you should consider (or rule out immediately) are your colleagues. Seek out physicians that are using EHRs and ask for information. Most will be eager to share stories and give you advice. If you subscribe to a specialty listserv, or forum, you could find good information there too. For these, make sure you know the person presuming to give you advice. Sometimes you can learn a lot by just following conversation threads. You should be able to come up with a couple of good prospects and a couple of names to stay away from. [ed. note: information from colleagues is critical. And don't forget to return the favor once your EMR project is up and running - allow other doctors to come and check out how you did it.]

Medical Associations – The AAFP for example has a great EHR survey they publish every year. It is completely untainted by any vendor involvement. You have to be a member to access the results and they are mostly geared to family practice and general Internal Medicine, but pertinent to most physicians. The most recent results are from 2009 and 2010 is due out soon. Find a way to get to that survey. Other specialty associations have their own surveys. They should also have good resources and articles to help you with the process. Some have partnerships with certain vendors. Do not assume that those vendors are necessarily better than others.

CCHIT – CCHIT is now one of three EHR certifiers, but their private certification is still the Cadillac of the industry. Unlike the government certification, which is pretty bare bones, CCHIT certifies for a multitude of functionalities and for several specialties, such as Cardiology, Pediatrics, Dermatology and Behavioral Health. Their website allows you to play with different Non-Functional Requirements to narrow the field down, and CCHIT is vendor neutral, so try it out and look for vendors that voluntarily committed to keeping up their comprehensive CCHIT certification (latest level is 2011).

Regional Extension Centers (REC) – Every state has one and it is funded by the government for the specific purpose of helping you out. If you are a primary care physician, you may be able to get some free consulting, but in any case you should be able to get some good information and a list of EHRs the REC selected. Those EHRs may, or may not work for you, but this is another data point in your research. [ed. note: sadly, these are probably less reliable as a source than the others may be.]

Remember to update and augment your original lists as you learn new things. When you aggregate all the information you now have, you will discover that you have in hand a list of about three to six EHR vendors that you are ready to contact and check out. If that glossy ad with the 1-800 number is from one of them, then by all means go ahead and call now. Otherwise, toss it and never look back.

In part II, we’ll kick some tires, look under the hood and go for a test drive.

This article was written by Margalit Gur-Arie from On Health Care Technology. The original article can be viewed at How to Meaningfully Purchase an EHR System.

Playing Games with ONC Certification

February 10, 2011 By Houston Neal 2 Comments

“Certified” is the $44,000 buzzword prefixing electronic health records (EHR) software. To qualify for Health Information Technology for Economic and Clincal Health (HITECH) Act incentive payments, you must use an EHR that is certified by the government. Additionally, you must use a system – or systems – that offer 100% of the functional and security capabilities required to meet “Meaningful Use” criteria.

Many EHR vendors are promoting their products as “certified,” but the claim can be misleading. There are three ways they could lead you astray:

Alternative Certifications

Before the HITECH Act, two organizations certified medical software:

Certification Commission for Health Information Technology (CCHIT) – CCHIT began certifying EHR software in 2006. Since then they have released 10 certification programs for ambulatory and inpatient EHRs.
KLAS – KLAS is a private organization that has gathered ratings on EHRs since 1997. Every year they rank EHR vendors and bestow a “Best in KLAS” award on the top 20.

In an effort to stand out from the other 300+ EHR systems on the market, vendors widely promote their CCHIT or KLAS credentials. They may even tack the word “certified” onto their CCHIT or KLAS approved product. This muddies the water for providers. They have to distinguish between CCHIT, KLAS and certification from an ONC-Authorized Testing and Certification Body (ONC-ATCB). While CCHIT and KLAS are meaningful credentials, they’re not the certifications that qualify for incentive funds.

This is especially confusing because CCHIT is now one of six organizations approved to certify EHRs for the HITECH Act. So, if an EHR vendor claims they have CCHIT certification, you’ll need to clarify which one. Is it ONC-ATCB certification, or one of CCHIT’s independent credentials?

Complete EHR vs EHR Module

Software vendors can receive ONC-ATCB certification for a complete EHR or an EHR module. This means a product doesn’t need to meet all criteria for Meaningful Use – instead, it can be partially certified if one or more functions meet a subset of requirements. For example, a vendor could certify their e-prescribing application or their patient portal.

This under-publicized detail could cost you thousands of dollars; by itself, a certified EHR module won’t make you eligible for incentive payments. You must use two or more modular EHRs that, combined, meet 100% of the ONC criteria. So while vendors can officially promote a module as having ONC-ATCB certification, it may fall short of making you eligible.

Guaranteed Incentive Payments

Be mindful of guaranteed incentive payments. It is reasonable for a vendor to guarantee they’ll meet certification criteria. In fact, you might make it a requirement in your purchase decision.

However, guaranteeing incentive payments is altogether different. Technology alone won’t make you eligible. EHRs are just a means to an end. Ultimately, you are responsible for achieving Meaningful Use status. So be wary of this type of guarantee. Read the fine print and find out how you are reimbursed if you don’t qualify for incentive payments. Does the vendor reimburse you the full amount of lost incentive payments? Or do you just get reimbursed for the cost of the software? You shouldn’t purchase a system based on this guarantee alone.

Five Key Questions to Ask Vendors

To help you avoid thse pitfalls, we put together a list of 5 questions to ask vendors. Answering these will put you in a good position to become eligible for incentive payments.

Which certification does the EHR have: CCHIT, KLAS or ONC-ATCB? You must use an EHR that is ONC-ATCB certified in order to be eligible for incentive payments.
Which product version has been certified? Ask the vendor for complete details of their ONC-ATCB 2011/2012 certification, including: product name and version, date certified, unique product identification number, the criteria for which they are certified, and the clinical quality measures for which they were tested.
Does the vendor have certification for a complete EHR or an EHR module? If module, you will need to use more than one to be eligible for incentive payments. The ONC has created a handy website that allows you to build a list of EHR modules that meet 100% of ONC criteria.
Will the vendor resubmit their EHR for final certification in 2012? The current certification is temporary and only lasts through 2011. Make sure your vendor has plans to reapply in 2012, and find out if they will certify a complete EHR or just a module.
Are you purchasing through a reseller or other business partner that renamed the product? If so, make sure the renamed product has been approved by the ONC-ATCB. Even if it is the same version with identical features and functionality, it won’t make their Certified HIT Products List unless the original vendor reports it to an ONC-ATCB.

This article was written by Houston Neal of Software Advice, a free online resource that presents reviews and comparisons of electronic medical record software. The original article can be viewed at Playing Games for ONC Certification.

Implementing EMR Decreases Productivity – Not!

February 4, 2011 By Peter Polack 2 Comments

One of my partners recently attended a medical meeting where they had a breakout session on EMR implementation. The speakers told the practices to expect to have an initial 50% decrease in productivity when they implemented EMR. Why? Because the consultants that help practices go paperless will tell practices to cut their clinic volume in half during the ‘difficult transition’ to EMR.

Now, I am not saying that switching from paper to electronic records is easy. But in our practice, with 11 physicians, 5 locations, and about 140 employees, we had NO decrease in productivity.

How was that possible? We didn’t bite off more than we could chew.

If you have followed this blog and some of the resources we offer, you’ve noted that I recommend a gradual rollout of EMR instead of the ‘Swedish-go-metric-overnight’ model that most practices try to pull off.

Now granted, many practices are feeling the crunch with the meaningful use deadlines looming. But that is no excuse to take a hit to your bottom line. An orderly, gradual phase-in of electronic records is just what the doctor [and accountant] ordered.

Comments? Please post below.

EHRs and Quality of Care

January 31, 2011 By Peter Polack 2 Comments

Recently there has been some buzz about a study out of Stanford University, which appeared in the Archives of Internal Medicine, stating that there was no significant improvement in quality of care using electronic medical records systems compared to paper record, with the exception of diet counseling for adults.

However, as pointed out in an article on FiercePM, two National Library of Medicine researchers point out in a commentary that the clinical decision support systems used in the study centers were “immature.” The issue is not whether the use of EHRs can improve the quality of care.

What is the difference between storing the patient’s information in an electronic format as opposed to a paper one? The real benefit is when there is an intelligent decision support system within the EMR software that can guide physicians towards better management of their patients: red flags for measurements that need to be double-checked, labs that need to be ordered based on time elapsed since the previous visit, ticklers to follow-up on important diagnostics, testing that should be done based on diagnosis codes and practice patterns.

And not only is this good for patient care, but it could also be good for a physician’s bottom line. If you didn’t know that a certain test ordered annually is a preferred practice pattern and you are reimbursed for same, isn’t that a win-win scenario?

Cloud-Based EMR – Is it New? Is it Better?

January 13, 2011 By Peter Polack 10 Comments

As if medical practices don’t have enough to worry about with EMR implementation, now they have to decide what kind of EMR system to get: a client-server-based system or a web-based system. The former is the kind that most of us are familiar with. You purchase a computer server, buy a license for the EMR software, install said software on your server, and you’re ready to go.

But recently there has been a lot of buzz about ‘new’ web-based EMR systems, also known as cloud-based EMR, that allow the user to pay a monthly subscription fee to access their EMR rather than having to purchase it. And since any computer can use the internet to ‘run’ the EMR, there isn’t the need to purchase more expensive servers and their associated hardware and software.

So, is cloud-based electronic medical records really a new thing, and is it really better?

In fact, running software across the internet is nothing new. Also known as Application Service Provider (ASP) or Software as a Service (SaaS), some major software companies have been offering this service to their clients for over a decade.

Depending on the nature of the business, these can run across the World Wide Web (WWW) using a simple web browser or a secure internet connection. Since this information is often stored across a network of data storage centers, it is considered to be hosted in the ‘cloud’ and in no one particular place at any time (sort of like the ambiguous nature of an electron cloud).

And many of you are already (unknowingly) running your EMR systems as cloud computing if you have a centralized data center and use it across multiple office locations. If you are seeing patients in a satellite office and entering information into your EMR system, this process is actually happening back at your central office across your wide-area network (WAN). The main difference between this and true cloud computing is that many (if not most) of your devices have a more direct connection to your network than a truly web-based system, which always must store and recall data across the internet.

Choosing a particular vendor does not necessarily limit your choices. Jim Messier, of MedFlow Inc., says that their EMR solution works as either a client-server system or a web-based system, as do many of the EMR systems out there today. “Client-server systems are not passe and are often preferred by larger practices or those with multiple offices. But for smaller groups with fewer sources, the same software can be run as an ASP or SaaS, and the user experience is essentially the same.”

Tera Roy, Specialty Director Ophthalmology at NextGen Healthcare, says that, “With or without stimulus dollars, healthcare is headed to the cloud. Our newest releases are all based in the cloud, like NextGen Mobile, Patient Portal and Health Information Exchange, and we plan to keep introducing more of these Web-driven alternatives. They will play a critical role in breaking down barriers for small practices to achieve the full benefits of automation.”

If cloud-based systems are cheaper to set up, why doesn’t everyone go this route? Mr. Messier points out that, similar to deciding between leasing or purchasing a car, it helps to crunch the numbers. And for many practices that commit to a long-term relationship with their EMR system, there is usually a better return on their investment if they buy the EMR system rather than pay a monthly access fee, with a typical break-even time of about five years.

Here are some pros and cons of cloud-based or web-based EMR systems. Have I left any out? Please post comments below.

Cloud-based EMR systems – Pros and Cons

Pros:

Less up-front costs for licensing

No server hardware or software to purchase/house/maintain

Possibly easier to transition to a different system

More cost effective for solo/small group practices

Better support

Easy to set up hot-site in case of disaster

Host companies typically have more sophisticated security measures/data protection

Vendor more likely to meet HIPAA regulations than the practice can

Onus more on vendor to meet Meaningful Use

Good for physicians who are not office-based or travel alot

Cons:

Customizability limited

Latency or lag time accessing information across web/ slower response time

Patient information may be compromised if co-mingled with other clients

At the mercy of the vendor regarding backups, security

More expensive over the long haul

Captive client – host controls your data

Practice is dead in the water with internet outage

May not be viable for rural practices with limited internet options

Practice can lose data if vendor goes out of business

May be impractical for uploading larger imaging files

Bandwidth limited by practice’s internet connection

EMR vs Paper Charts – A Moot Debate?

January 6, 2011 By Peter Polack 3 Comments

If you Google “Pros and Cons of EMR” you will pull up a plethora of listings about why (or why not) you should consider switching from paper records to electronic ones. But, at this point, is this a pretty stupid debate? And, yes, I know, even here we have discussed both sides of the argument (although obviously we are biased towards the ‘pro’ side). But the reality is that electronic medical records are inevitable. And physicians who feel otherwise, and vociferously proclaim that they refuse to kowtow to Big Government by ponying up their hard-earned greenbacks to plunk down on a non-user-friendly (run-on sentence warning), doesn’t-help-you-practice-medicine-better, electronic white elephant, are playing chicken with grim reality. So let’s just start wasting our time on more productive issues like…iPad vs Tablet.

Am I off-base here? Post comments below.

Pros and Cons of Laptops with an EMR System

December 24, 2010 By Peter Polack 3 Comments

An oldie but a goodie. Here is a nice discussion of the pros and cons of using a laptop with an EMR system by Bill Horvath II, CXO of DoX Systems. Bottom line (my take, at least): if you are solo and/or travel a lot between practice and hospital, a laptop solution might be for you. For most other docs, the expense, weight, and issues with licensing of software outweigh the advantages. The cheapest route for most EMR systems is a thin client solution, using either a desktop thin client appliance or a tablet or slate running in the same manner. But hey, it’s your money.

Webinar: Federal EHR Incentives and the HITECH Act – Part 2

December 7, 2010 By Peter Polack 4 Comments

In this two-part webinar video, Jeff Grant, President of HCMA Inc., discusses the details of the Federal Electronic Health Records incentives as described the HITECH (Health Information Technology for Economic and Clinical Health) Act. In part 1, he defined eligibility criteria and the Meaningful Use Final Rules. In part 2, he goes on to describe the Menu Set criteria, Clinical Quality Measures and Reporting, and Meaningful Use Demonstration.

CLICK HERE to download a PDF of the slides

InfoGard Newest EHR Certifying Body

November 15, 2010 By Peter Polack 2 Comments

According to a report in Health Data Management magazine, InfoGard Laboratories has been selected by ONCHIT (Office of the National Coordinator for Health Information Technology) as the latest entity for certifying EHR (electronic health records) systems. Based in San Luis Obispo, California, InfoGard, a federally accredited IT security testing laboratory since 1995, joins current certifiers CCHIT and the Drummond Group.

How to Hire an IT Manager – Part 2 – Your Action Plan

November 11, 2010 By Peter Polack 2 Comments

In Part 1, I discussed some of the challenges we face in hiring IT (information technology) personnel, a role which is becoming an increasingly common part of the medical practice. One of the major challenges is trying to validate the skillsets and credentials of a prospect. In Part 2, I present an action plan for finding a well-skilled IT employee who will be a good fit in your organization and help keep your network (or EMR system) up and running.

Create a job description. Do you already have a good idea what this person will do for you? Great. If you don’t, get some assistance. You can either ask the Director of IT for a practice in your area or the local hospital to help you come up with a very specific job description. This should include the certifications required for the job (see Part 1) and the expected hours as well as duties – for some people, squeezing through crawlspaces to run network wire is a deal-breaker. You’ll also want to ask your expert what the expected range of salaries would be in your particular market, given your specified skillsets. Even in this economy, people in the IT industry with experience can command some decent pay.
Post the ad. Do you live in a small town? Then you might want to think locally. It might be difficult to recruit someone away from a major metropolitan area and your salary offer might be less than they are accustomed to. Apart from placing the ad in your local newspaper, you should post it on a major job listing site like Monster.com. One advantage of using a site like that is that the resumes are stored in an electronic format which makes going through the information much easier (see number 3). It also makes it easier for potential candidates to search for the appropriate job.
Start vetting the candidates. Rather than using a head-hunter (more on this later) we opted to go with a consultant, Mike Sellers of CVPSite.com, a credential-verification company. They offer a free service to employers that verifies the credentials claimed on the resume of a potential IT candidate (they charge the applicants a fee for going through their certification process, thereby giving them their seal of approval and making them more attractive a prospect). Based on our job description and some other specific criteria, Mike ran the resumes through their proprietary system to rate the candidates. He then took the top sixteen of these and interviewed them by phone in order to ascertain whether their listed qualifications were genuine – he could usually tell after just a few questions if the applicant truly had the experience and credentials that they listed. In one instance, the candidate gave up early and readily admitted that his credentials were bogus. When the process was complete, we were handed a spreadsheet with all of the applicants and their ratings on a multitude of specific criteria, ranked top to bottom, with the finalists clearly identified.
Considering using predictive testing. Recent research is showing that personality or IQ tests are less predictive of an employee’s success in a particular job than what is known as conative testing. This describes a person’s modus operandi or M.O. – how are they likely to act in a particular situation. The most well-known of these is called Kolbe Testing. The practice administrator and/or direct supervisor of the applicant take one test to determine their own Kolbe ‘profile’, then take another test to determine the profile of the ideal employee. Last, the job applicants take another Kolbe test to see if they would be a good ‘fit’ for the practice. Obviously this should be just part of your overall assessment (we have just started using this tool, so the jury is still out). Another type of assessment tool to consider is Predictive Index testing from PI Worldwide .
Final interviews. After going through the process above, you should have four to six finalists for your face-to-face interviews. Since your expert has already vetted their credentials and assessed their technical skillsets, your finalists are all on a level playing field. Now all you have to do is subject them to the same rigorous evaluation process as you do for any other (highly-compensated) employees and make sure that you feel that person is a good fit for your practice. You know they are highly skilled, but do they also have good people skills? It is critical for the person in this position to act as a liaison between the technical world and the real world. You might also want to consider involving a subordinate in the evaluation process – a person who works in the same technical field can have valuable input.

Why didn’t we just retain the services of a head-hunter like we do when hiring a medical associate? Like a listing agent in real estate, the head-hunter doesn’t necessarily represent the buyer – in this case, our practice. Their main job is to place their clients, the job applicant, i.e. the ‘seller’. Sure, their reputation is at stake and they want to make sure you are satisfied so they can count on you for more business. But they will make their fee, regardless of who is placed in your practice. And although most reputable head-hunter firms have some sort of guarantee if the prospect doesn’t work out, this is not something we wanted to waste a lot of time on. For this reason, and for reasons I listed above, we decided to go with a ‘broker’: an expert who performs a formal candidate analysis.