Kareo is a more recent entry than some other EHR’s, going back to 2004 with Dan Rodrigues, a family medicine physician, setting out to build a better platform. 

Today, over 75,000 current providers use Kareo, and for a total of 150,000 active users. At five US locations, with 485 employees, Kareo processes $20 billion in insurance claims, and secures 80 million patient records in 45 different specialties. Kareo serves to transform a paper based medical office into a digital enterprise.

• You can learn more about Kareo here

Features

Playing to its roots, namely that it was designed by a family medicine physician, Kareo focuses its efforts on independent practices, and not large hospitals and institutions. Even now it is managed by a team of doctors, with an emphasis on ease of use.

At the core of any EHR is the EMR, and at the center of that is electronic charting, a burdensome task to clinicians, that weighs down the flow of patients in a busy office. Kareo is set up to make it simpler, and faster to create these notes, and get back to patient care. This is also supported by a robust Patient Portal, to share important medical and billing information with patients at any time- for secure communication, which automatically integrates into the electronic chart.

We also like the support for e-prescribing, and automated marketing from the front office. 

Telemedicine is an emerging technology, allowing physicians to conduct visits remotely with video and voice for a sort of “Virtual housecall.” Done correctly, this is fully reimbursed by private payers. Kareo is on the forefront of technology as its Kareo Telemedicine module provides the tools for this type of visit. These include a text to a patient to confirm the appointment, the patient filling in insurance info prior to the visit, and help with billing after the visit.

Workflow also gets enhanced. The Agenda Overview serves as a to-do list, which keeps track of items that need to be completed each day. The staff is also supported, with functions to upload documents, and transmit secure messages.

Billing is another core mission of Kareo, and is ICD-10 compliant. There is a module that supports electronic superbills that can be created with just a few clicks. The billing is entirely paperless, with electronic charting and billing, and charges can be directly entered into Kareo. Tools are also provided to help create “Clean claims,” that get paid faster, and with less rejections, thereby enhancing the practice’s cash flow. 

Drawbacks

Kareo does have some shortcomings, although less than some other platforms. One issue found is that while the administration of a vaccine in the office automatically brings up an automatic template for ancillary info to be entered, such as the lot and expiration date of the vaccine, this does not come up for other medications administered in the office. This should be streamlined to include any and all medications given in the office setting, and not just for vaccines.

Another gripe focuses on the ICD-10 code. Clinicians have been often confused with these codes, which grew to include approximately four times the codes of the former ICD-9 system. When choosing a code in Kareo, the most often used codes are not highlighted, or brought to the top. Nor do they automatically populate based on the clinician’s note, but rather the clinician is forced to wade through a multitude of codes just to locate the one that applies to their encounter.

Users also have an issue with updates. Kareo needs to be more transparent on what is getting updated, as end users don’t get a change log, and are not sure what features were updated. They also complain that the updates could be done more frequently.

Finally, users complain about sending medical records out to another provider is not a smooth process. For example, Kareo is lacking the feature to request records from a certain date range, and rather the records need to be selected manually.

Pricing

What is too commonplace in this industry, the pricing is opaque, and not upfront. It requires company contact to get any idea of the costs, making it burdensome to cross shop EHR vendors. 

Annoyingly, when we filled out the information requested in order to obtain the pricing, and clicked on the “Get Pricing,” button, we again did not get a price, and only a canned response that “Someone from Kareo will be in touch soon to schedule a meeting. We look forward to helping you build a customized solution for your practice.” We found it takes too many steps to not get a price without a phone call, and we hypothesize a sales pitch. 

Elsewhere, we gleaned that the starting price for Kareo is reportedly $80 (£63) per user per month.

There is a free demo, but no free trial.

Support

Initial setup and onboarding gets handled via “Free 1-1 Success Coaching.” This serves as a single point of contact for a successful transition, to make sure enough support is provided to get things underway.

Afterwards, we only found a single option for support - an 800 number. We did not find any hours of operation, nor did we find chat, email, fax or a support portal. We also looked for some self help content, such as a webinar, ebook, or online articles, but did not find these either. 

Kareo works as a SaaS through a web browser, with storage in the cloud. There is also software for installation on a computer platform, although only Windows, and not Mac. Similarly, a single mobile platform is supported, iOS, leaving out users of the Android platform. A key advantage of a SaaS is that the software updates happen on the back end, and not at the physician’s practice.

Final verdict

Kareo is an EHR built by physicians to streamline the workflow of a busy outpatient practice. Highs include electronic superbills, the telemedicine module for virtual housecalls, and the well done Patient Portal. Kareo’s misses focus on the difficulty in obtaining pricing, the challenges with entering non-vaccine office medications, the single support option, and the need for a changelog of updates. For practices focused on outpatient, primary care, Kareo is a modern, and clean choice for clinicians.

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Athenahealth is a US based company, started back in 1997, and combined with Virence Health in 2019. At the center of their services is a cloud-based electronic medical record service, known as athenaClinicals (with a quirky spelling that includes a lowercase first letter, and the capital letter in the middle). There is also an emphasis on networking for both exchange of patient information, and benchmarking of outcomes. AthenaHealth’s EHR solution is part of a larger ecosystem of services that includes Patient Engagement, Telehealth, Population Health and more.

• You can learn more about Athenahealth here

Features

The athenaClinicals EHR component has plenty of features to support clinician’s workflow. This includes functions such as appointment scheduling, billing, compliance tracking, charting and e-prescribing. Entering data is performed, in addition to the usual typing via a keyboard, via voice recognition - powered by Nuance, including  on a mobile device - although handwriting recognition is not offered. To keep this affordable, it is also certified for meaningful use (which can provide a financial incentive), and is fully HIPAA certified.

There is also support for a patient portal, as well as scheduling of patient appointments. Through this portal, patients can schedule their appointments, get access to practice forms, and pay their co-pays online. This then integrates with the automatic messaging tool, that then sends out automated reminders to patients for their appointments, and bills. Alerts are also messaged for test results that the patient can access in the patient portal. This level of automation is ideal for reducing staff time, and appeals to younger patients that are more likely to engage via this type of experience.

E-prescribing is an area where athenaClinicals shows its evolution and flexibility. E-prescribing is the important process of electronically transmitting prescriptions from prescribers to the patient’s pharmacies. With the current opioid crisis, many states now have instituted, and in some cases require, that prescribers check the database of prescriptions that the patient has received prior to entering the prescription. This state level database is known as a Prescription Drug Monitoring Program (PDMP), and not only does the prescriber in some regions have to check the database for other restricted prescriptions before , which can take some minutes each time, but also that the PDMP was reviewed as part of the prescribing process. Furthermore, this process needs to be documented, a laborious process  s the database is logged into, the patient is located, the information is reviewed, and then printed out to be separately scanned into the patient’s EHR. Well, with athenaClinicals this entire process is now streamlined, so the EHR now directly integrates with the PDMP, with the patient’s prior drug information instantly available to the clinician, and equally important that this whole process gets documented in real time- a major timesaver from the previous fragmented process.

There is also support for pediatric use, with support for vaccine management, and custom bundles.

In addition to direct clinical use, athenaClinicals also ties into administrative functions. This includes components that support medical billing, inventory management and physician management. There is also integration with accounting, and with policy management.

Finally, the athenaOne mobile app allows for access to the EHR from anywhere. A shortcoming is that it is only available for iOS, both iPad and iPhone, as we did not find it in the Google Play store. 

Drawbacks

No EHR is perfect, and athenaClinicals has its share of shortcomings. For example, some users complain that while the support is quite robust on the initial setup, that subsequently it can take significantly longer to get assistance, and it is not as readily available as on site. This can impact some more advanced tasks, such as clinicians creating templates for notes, and if not done at the outset, the support for this is lacking.

Billing is another service offered through the EHR, and it can certainly be an attractive savings proposition to any practice (and especially a solo practice) to eliminate their costly biller. However, this is not a realistic promise, with practices complaining about too aggressive statements being sent out by athenaClinicals to their patients that turn folks off, little experience with Medicaid billing, and overpriced fees, particularly with lower volume practices that get charged higher percentage collection rates. Another annoyance is the requirement for a physician practice to be limited to certain banks that AthenaHealth approves to receive their payments, and also a delay of a few days for the funds to be received into the account.

Furthermore, users indicate that onboarding is too difficult, and are disappointed at the level of support offered. 

Pricing

The pricing for athenaClinicals, similar to other EHR products, is not available on the website. While this makes it a challenge to comparison shop between competing solutions, at least Athenahealth makes it simple as they do provide a link prominently on their website to “Schedule a 1:1 meeting,” to facilitate obtaining the custom pricing. It is indicated that there are no upfront costs, nor monthly premiums, but rather the pricing is based on a percentage of collections. 

While there is no free trial, a free demo is offered.

Support

There is a phone number listed, with the phrase to “Call anytime,” but it is not specified if this is for sales, support, or both. The other options for support are limited to only online self help. We found possibilities for training which includes options for webinars, case studies, and whitepapers. 

The supported platforms gain access via a web browser. This is the simplest in this day and age, as just about every computer and device with a web browser can then gain access to athenaClinicals, without the need to install the software directly to your desktop. Additionally, no data gets stored locally, as athenaClinicals is a  SaaS, with all data hosted in ‘The Cloud.’ Finally, as detailed above, there is an iOS app as well.

Final verdict

Athenahealth offers a robust platform for an EHR, with many useful features. It focuses more on the physician practice market than on larger institutions, with useful features for e-prescribing with PDMP, clinic note writing and accounting. While integrated billing has particular attraction for smaller physician practices that generally do not have a dedicated billing department, the shortcomings should give these practices pause before adopting this platform. On balance, Athenahealth, with their athenaClinicals EHR platform offers a comprehensive and balanced solution to both the clinical, and the business side of a physician practice. 

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