Practice technology

Choosing practice technology: EHR, AI scribes, billing, and what a bad vendor costs

An independent practice or ambulatory surgery center lives or dies on its software: the EHR, the revenue-cycle system, scheduling, and now AI documentation tools. These are five-figure annual decisions with ten-year consequences, and the demos are designed to hide the hard parts.

Start with the workflow, not the product

Write down the three things that cost the practice the most time or money: charting after hours, denied claims, no-shows, prior authorizations. Every vendor must show, in your specialty's workflow, how its product changes one of those numbers. A vendor that cannot map onto your list is selling features.

AI scribes and ambient documentation

• Typical pricing is $100 to $600 per provider per month. Model it against hours of documentation saved per day; most physicians report one to two.
• Require a signed HIPAA business-associate agreement and ask whether your patient audio or notes are used to train the vendor's models.
• Test with procedure notes and complex visits, not simple follow-ups. Accuracy on medication lists and laterality is where errors hide.
• Confirm it writes into your EHR, not a separate window you copy from.

Questions for any practice-software vendor

Data ownership

Can you export your full chart and billing history in a usable format if you leave? What does that cost?

Security

SOC 2 Type II, HIPAA BAA, and a recent penetration-test summary. Ask how breaches are disclosed and who pays.

Pricing mechanics

Per provider, per claim, or a percentage of collections. Percentage-of-collections billing services commonly charge 4 to 8%; make sure the number includes denials follow-up.

Interfaces

Lab, imaging, e-prescribing, device and payer connections. Each missing interface becomes a manual step.

Exit terms

Contract length, auto-renewal, and what happens to data and any customizations you paid for.

Run a pilot that can fail

Pick one provider or one location, set a 90-day window and a threshold in advance (claims denial rate below X, charting done before leaving the building Y days a week). Measure cycle time and dollars, not satisfaction surveys. Budget for training and integration, which usually exceed the software fee in year one.

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