XLEMR - Request a quote.

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Request Demo Request Quote

E-Prescribe Demo XLEMR Demo

Thank you for your interest in XLEMR. Please use the form below to complete a needs analysis. This form will help us better understand your practice and produce a quote for your EHR system.

When requesting an appointment to go over your quote, please allow a minimum lead time of one week. If you have special forms you would like us to include in your demonstration, please fax them to 678-623-3217.

Please fill out the form completely if possible; the more information you provide, the better we can meet your needs. E-mail is our preferred communication. Although not required, it is much easier for us to communicate detailed information via email rather than phone or fax.

Have you already seen a demonstration of XLEMR? If not, please request a demonstration here. Our demonstrations are performed online via web meeting.

Practice Information EHR General Information Third Party Services and Contact Information IT Infrastructure

Practice Information

Practice or physician name*

Contact Name*

Specialty*

Email

Phone*

Fax

Address

City

County (if GA)

State

How many full-time providers are at your practice? Anyone a NPI number counts as a provider. *
Part-time providers see fewer than 75 patients per week.*
What is the average number of patients seen each day by the entire practice?
Please give us an estimate of the annual allowable charges you submit to Medicare. This information will help us determine if you qualify for meaningful use.*
What percentage of your patients have Medicaid as either primary, secondary, or tertiary insurance? This information will help us determine if you qualify for meaningful use.*
Does your practice have any satellite offices or remote locations, if so, how many?

How soon do you anticipate making a purchase decision?*
What is your overall, all-inclusive budget for an EHR system?*
If you were paying for a system monthly, what would your budget be?*

Please describe the computer skill level of your providers and employees.*
Please list the first and last names of all providers.

*denotes a required field.

EHR General Information

Do you currently have an EMR, EHR, or other medical information system? If yes, which?

What are some of the main reasons you want to implement electronic health records?*
What are the most important features for your EHR? (voice, handwriting recognition, faxing, digital image integration, etc)*
What are your main concerns or fears when moving to EHR?
Are you looking at any other EHR vendors, if so, which?
How do your providers feel about moving to EHR? Are any of them strongly in favor or strongly opposed?

Training: Would you prefer one-on-one with each provider, or a train-the-trainer model?*

one-on-one train-the-trainer

Training: Would you prefer web-based or in-person training? *

web-basedin-person

Please give us any additional information you think we should know.

*denotes a required field.

Third Party Services and Contact Information

What practice management, billing system software, or third party billing service do you use? Please describe.
Are you happy with your billing system, if not, please describe your ideal billing solution. Please be sure to include the features that are most important to you.
Would you prefer to interface your current billing system, or provide you with a new integrated system? Please describe.*
Are there any CPAs, consultants, or IT service providers with whom you would like us to talk? If so, please provide their name and contact information here.
Does your practice use dictation and transcription? If so, approximately how much are you paying per month?

*denotes a required field.

IT Infrastructure

Note: If you would not like us to quote any computers, networking, printing, or scanning hardware, please skip this section.

How many computers do you currently have?

Do you feel like your practice has enough computers to support EHR use for all employees?

YesNo

If not, please review our hardware page, and indicate here what type and quantity of computers you would like us to include. Please specify if you prefer new or refurbished gear.

Do you currently have a server?

YesNo

How much free space is available on your server (please specify GB or TB)?

Do you have high-speed internet at your office?

YesNo

Do you have a local area network at your office?

YesNo

Do you have a local area wieless network at your office?

YesNo

Would you like us to include any printers or scanners in your quote? If so, please list the specifications and quantities you need. Please specify if you prefer new or refurbished gear.

Are you regularly backing up your data onsite and offsite?

YesNo