Key Takeaways:
- Choose an EHR that evolves. Urology billing, coding and documentation rules keep changing, and the urology EHR needs to change with them. Dr. Littlejohn strongly advises independent practices to be mindful of the EHR’s product and development strategy.
- Ensure customizability. Be sure the EHR can suit the unique needs of urology. Look for the ability to create your own templates, smart-phrases and protocols
- Protect physician time. In urology, patient volume is high and this requires visit documentation, orders and prescriptions to take as little time and in as few steps as possible.
- Connect the entire care team. Mobile access and a shared EHR with oncology partners lets urologists act without logging into multiple systems.
- Medical coding at the point of care. Integrating coding during the visit, plus clear reporting, keeps records clean and claims moving efficiently.
Jump to Dr. Littljohn’s checklist: the 5 questions to ask an EHR vendor
Migrating from a hospital EHR to a system for independent practice
When Triple Crown became an independent practice in 2023, leaving its large hospital system’s EHR presented an opportunity to evaluate the EHR landscape and discover which EHRs were (and weren’t) suited to the unique needs of urology. Dr. Nathan Littlejohn is the practice's main EHR liaison, leading the evaluation of EHRs, which led to the selection of Flatiron Health’s EHR for oncology and urology. He recommends practices use the following questions as a roadmap urology vendor evaluation.
How is the urology EHR adaptable and flexible?
The rules urology practices work under are always shifting. Dr. Littlejohn came back to this topic more than any other. "Billing, coding, and documentation is constantly evolving," he said.
"It's so important to have a product and a team that is willing to change as the landscape of medicine and medical documentation changes."
Things in the clinic move fast, especially where urology and oncology meet. "The oncologists are so smart and know so much about the new drugs, and they teach us all the time," he said. Keeping pace takes urologists, oncologists, and technologists each bringing what they know best, so patients benefit from the latest innovations. Flatiron's product teams are always improving the software, shaped by conversations with practices like Triple Crown.
How can the urology EHR be customized?
Customization can occur at two levels: what the practice configures for everyone, and what each clinician can adjust for themselves.
- At the practice level: Templates can be built for notes and order sets, and the ones within OncoEMR are urology-specific. Practice admins and superusers can edit and build new ones, bundle frequent orders into order sets, and encode standard of care into flowsheets and protocols.
- At the user level: Each physician has their own way of doing things, and too often the EHR constrains that way of working rather than enabling it. User-level customization can make all the difference. It ranges from small click-savers, like being able to "star" the orders and note templates they use most so they open in one click, to more significant time-savers like building their own macros — a short key like “.cysto” that expands into a full block of text.
One of Dr. Littlejohn's favorite examples is the patient header — the strip of information sitting at the top of every chart, which a physician can set to surface what matters most to them. "You can set it up to show what you want to see," he said. "Allergies are right on the header, and your insurance information can be up there too, because that often dictates care."
How can an EHR save time for urologists?
It should help get routine tasks done in as few steps as possible. Triple Crown is a high-volume practice, so every extra click or task adds up in a day.
"Orders are very quick and easy to place, for imaging or for labs or whatever the case may be," Dr. Littlejohn said about OncoEMR. “Sending prescriptions is user-friendly and intuitive, and as a urologist [who sees] many patients in a day, that really helps cut down on your screen time.”
This applies to clinical workflows and as well as medical coding and billing: “The billing screen at the end of the visit has been a monumental improvement,” he shared. “In one screen you create the diagnoses, attach the E/M code, add any modifiers, add-on codes and procedural codes, then connect them with their appropriate diagnoses… It's a big time-saver.”
How can the EHR connect urologists, staff and specialists?
It should give every user mobile access to the same chart. Urology care happens in many places at once. At Triple Crown, each physician works with their own pod of clinical staff, and the physicians cover several hospitals and facilities.
- Mobile access: "If I get called about a patient, I can see most of what's in OncoEMR in the app and make clinical decisions without pulling out a computer," said Dr. Littlejohn. "When I'm rounding, I can quickly see what procedures we've done, without logging into multiple EMRs at different hospitals." OncoAir is OncoEMR's mobile app which keeps physicians connected to patient care at all times.
- Connection to oncology: Triple Crown’s urologists and American Oncology Network’s (AON) oncologists work in the same EHR, so when they share a patient, the urologists can go straight to the oncologist's notes. "We're able to just read their note and say, 'This is what their treatment plan has been, and this is what they're needing from me to do next,'" he said. “It's a direct way to communicate with our oncology partners, and it makes patient care easier.”
"When everyone becomes a team like this and is on the same page, the patient wins."
How can the EHR support urology billing and practice operations?
By capturing coding and billing details during the visit and flagging gaps that still need to be populated. Dr. Littlejohn is quick to say that his office manager knows the business details best. From a physician-owner's view, though, the practice success starts in the exam room. When clinicians capture diagnoses, procedures, codes, and modifiers during the visit, complete encounters reach billing sooner and the team has less to follow up on later.
"If there's any outstanding codes that haven't been signed off of, they can go back in and review," he said of OncoEMR’s reporting. "Was that just a missed sign-off, and we need to bill for that procedure or that office visit? Or is it something that was put in error?" The result is a record that's "clean and easy to view."
5 essential questions to ask an EHR vendor
Choosing an EHR is one of the biggest decisions a physician practice makes. It shapes how quickly clinicians move through a full schedule, how care teams stay connected, and how smoothly the practice runs behind the scenes. Ultimately, it shapes the care every patient receives.
Dr. Littlejohn’s checklist for urology practices evaluating EHRs:
- Evolution: How does the EHR keep up with changes in billing, coding, and documentation? How often are product updates made, and is the development roadmap influenced by client input?
- Customizability: Can the system be altered to meet the specific needs of your practice? Is the product customizable across users?
- Physician workflow: What is the physician workflow like? Can you finish a visit, including procedures, orders, and coding, in one workflow?
- Connectivity: Can clinicians, staff, and specialty partners see the same chart wherever they work, including on mobile?
- Medical coding: How does the EHR work with our practice management and billing systems, how does it enable fast and efficient medical coding, and what reporting will administrators have?
Evaluating EHRs for your urology practice?
If you lead an independent urology practice, we'd love to talk through these questions with you. Connect with our Urology team. Thank you Dr. Littlejohn for sharing this advice.
