Shopping for Electronic Medical Records

Wendy W. Lee, M.D., M.S.

About Author

Electronic medical records (EMR)are the direction that most medical practices are going, if not already gone. These EMR systems replace paper charts, imaging studies, prescriptions and all other patient information that normally appears in a chart. Advantages beyond the environment that we will be saving include ease of which we will be able to obtain information and the ability to access remotely. Illegible handwriting will be a thing of the past and as a result, fewer mistakes will occur. Think about all the time we loose each clinic day searching for lab results, pathology reports, X-rays or notes from other physicians. Now imagine all the extra time you will have if everything is consolidated into an electronic file accessible by the push of a finger.

Choosing the right system is critical in the success of a practice. There are hundreds of different systems available, some good for certain practices, but not necessarily for others. These systems may also be tailored for a specific specialty since practices vary so widely: for instance, a large hospital practice has different needs than a small rural private practice. In eye care, a large academic ophthalmology practice has very different needs than a solo private practice general ophthalmologist. It is paramount to find an EMR system that fits your specialty and office size.

What to look for in a system will vary depending on what is important to you and your staff, but below are some items to consider.

• If you are part of a large practice with satellite offices, make sure the program can address these different sites and multiple doctors.
• Ease of use and a smooth transition are key factors to consider. How easy is it to find information? How much is automated? Is it easy to navigate through the various screens? Do you like the way the system lets you organize and view information, including ease of access to ancillary tests such as labs, imaging and pathology? Do you like the design of the screen, from color and space to size and shape? You will be staring at this screen all day! Does the screen allow intuition on the physician’s part for a smooth human/computer interface?
• Make sure the program recognizes all of the CPT and ICD9 codes that are used in your practice and ensure that the charting style is to your liking.
• There are different ways to enter data. Some systems allow you to type notes while others have you choose from a list of exam codes and diagnoses. There are touch screen systems, speech recognition for those of you who prefer to dictate, or you can continue to write with a handwriting recognition tool. You can choose an EMR system that supports multiple data entry methods, a benefit for large practices with doctors who have different styles and habits.
• HIPPA compliance must be in place. Most programs meet HIPAA requirements, as there are very strict security rules when it comes to patient data online. Even so, it is wise to get details from the vendors. The software should use Secure Sockets Layer for secure communication.
• You can install desktop units or laptops, work with tablet PCs or handheld PDAs.
• Simultaneous access of the records by different doctors and staff may be important. This feature will allow medical staff to enter billing and insurance information as the doctor is entering visit information for a more efficient practice.
• Prescription handling will automatically cross check drugs for potentially harmful interactions. This feature also allows direct transmission of the prescription to the pharmacy.
• You can also connect with medical practice management (MPM) systems that will also help with insurance and billing issues, allow for more accurate coding, allow tracking of patient demographics, statistics of the practice and help manage patient appointments among other things. The industry-standard HL7 protocol allows health care applications to share data with each other, so you will want to make sure both your EMR and MPM software use it, avoiding the need for exports and imports, allowing for automatic data sharing. Many vendors offer both programs and it may be wise to purchase them together to ensure proper integration.
• The company you choose will most likely be with you for a very long time and you will rely on them to contribute to the success of your practice. You will want to ask several important and pertinent questions. How accessible and helpful is the company’s technical support team? Is the technical support team available at all times? Medical care has no closing time, so you will want to be sure you have support staff available for instance if you are on call and meet a glitch in the middle of the night. How will they structure the training? Will it be different for physicians versus staff? How long will it take to train your entire staff? Will it be online or in person? Do some background checks on the company to find out about their reputation, financial status, and stability.
• Where do you want the software to be hosted: in house with a client-server, or by the vendor via an application service provider (ASP)?
  With Client-Server systems, the program runs on your computer and stores the data on your computer. This is currently the most common program used by systems. This system offers control over your EMR system, but also adds pressure to keep continuous backup of files in case of system failure. These systems can be programmed to have automatic backup, even at a remote location. Client-Server systems are ideal for practices that are staffed with computer knowledgeable people. With Client-Server systems, a lump sum for the program and set up is usually required.
  
  
  
  With the ASP system, data is stored with the vendor and staff accesses this information through the Internet or specialized client software. IT professionals at the vendor’s office maintain the system. The high level of security is standard procedure with this system and may be a good choice for a practice in which the staff has little computer expertise. A disadvantage of this system is the need for continuous broadband Internet connection. Since this is not possible 100% of the time, you may not always be able to access the system. With these online providers, usually a small payment is due at the beginning for setup and a monthly fee applies. This service is gaining popularity.

When shopping for an EMR system, it is best to get a real feel for it with some hands on experience. Some systems will offer a free trial by either logging onto a sample account or via a sample CD that lets you try the software. You can also visit a medical office that uses the system you are interested in. That way you can get an unbiased opinion about the program regarding the points listed above. In your evaluation, try out some of your most common office tasks to see how easy the system is to use.

Pricing of systems will vary depending on size of your practice and specific needs. A desktop EMR can range from $2,000 to $15,000 per user. Again, ASP programs usually charge a set up fee around $1,000 and a monthly fee that can range from $50 to $300 and usage fees may apply. Beware of additional fees that may apply to either system, such as data transfer fees, exit fees, support fees and training fees.

Below is a video interview with Dr. Liao. Dr. Liao was an early adopter of Ifa Systems EMRand answers many questions about what went into his decision while shopping for his program.