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Choosing an EMR

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Choosing an EMREvery EMR software program has its strengths and weaknesses. The perfect EMR does not exist and never will. Even those organizations that have built their own EMR still have long lists of new enhancements and features that they wish had been included in their EMR. In selecting an EMR, it is important to match an EMR's strengths with a clinic's needs. Even more important is to acknowledge an EMR's weaknesses. Then, ask yourself whether your clinic can handle those weaknesses and how your clinic will deal with them.
This article, written by John Lynn: Student Wellness Technical Specialist - University of Nevada - Las Vegas, won't tell you what EMR to select, but will just guide you on how to make your choice.
Someone once told me that selecting an electronic medical record (EMR) is like selecting a wife: Unless you make a really lousy choice, you will be happier than before. However, it is a huge deal to divorce your EMR and wed another, so you had better make the right choice the first time. However, a quick look at the over 400 different EMR software vendors can easily overwhelm anyone interested in selecting a system.

Most doctors don't have time to go through hundreds of EMR companies. The best thing that these doctors can do is to narrow the list of EMR companies to a small set of successful EMR companies. There are many stories of doctors falling in love with the EMR selection process and making it almost like a second job. However, there are more stories of people being overwhelmed by long lists of EMR companies that, after a while, get very confusing. By focusing on a few EMR companies with successful track records, you can avoid being overwhelmed in the process of selecting an EMR. Remember that you can always add other EMR programs to your list if you do not find a good match on your first try.

Whittling the List

Choosing an EMRThe question then remains of how you should go about narrowing your choice of EMR companies. Working with a well-informed EMR consultant is one good method that can save hundreds of hours of research. Consultants are often already familiar with hundreds of EMR companies and are adept at ruling out EMR companies that will not fit a particular situation. Just be careful to find qualified consultants who have a broad understanding of the industry. It is also a good idea to ask the consultant about any conflicts of interest that might exist. Find out whether there is a reason they might suggest one EMR company over another so that you can account for any possible biases.

The Internet is also a great place to research and narrow your list of EMR companies. A number of Web sites have EMR selection tools that provide a list of qualified EMR vendors according to answers you provide to a questionnaire. However, you have to be careful to ensure that the Web site you use is credible, unbiased, and active. Many EMR selection Web sites and forums look professional at first, but upon further review are full of outdated, incomplete, or biased information that will leave you misinformed. Many may also find participating in an active discussion forum intimidating at first, but they benefit from the wealth of information provided by actual users of EMR software.

Those looking for an EMR also like to turn to various medical organizations, such as the professional academies and boards, to help them identify appropriate EMR companies. Although I don't have extensive experience in this area, the few EMR lists that I have seen from these organizations are incomplete and often do not present the wide variety of choices that exist. Furthermore, products endorsed by the Certification Commission for Healthcare Information Technology (CCHIT) or recommended in other rating systems should really be taken with a grain of salt; most certifications and ratings systems don't measure usability. Such ratings systems also do not allow you to gauge an EMR's probability of working well in your office; for example, most do not identify valuable information, such as the rate of successful vs failed implementations.

Pricing and Cost

One of the most important factors in narrowing your list of EMRs is the associated cost. A common misperception is that EMRs cost tens of thousands of dollars to implement. For clinics with multiple doctors, EMR companies that structure fees this way may be a viable option because partners can divide the large up-front costs. However, small practices can't share the large lump-sum payment the way in which a bigger practice can. This doesn't mean that small practices or solo doctors don't have other options available to them.

Many EMR companies have created innovative pricing plans that make EMR software available to small practices and solo doctors. For example, some EMR companies have no up-front fee, but charge monthly per provider; it is as if the doctor were renting the EMR system. At least 1 software vendor charges on a per-visit basis. Both of these pricing models avoid huge up-front fees and attempt to match the way a practice generates revenue.

One word of caution about many of the "free" EMR software programs in the market today: Be careful assuming that a free EMR doesn't mean you won't need to spend money. Most users of "free" EMR software still require a certain amount of custom work to satisfy their practice's unique needs. Plus, these EMR programs don't have the enterprise level support of other EMR vendors. This usually requires more technical know-how on the part of a doctor wanting to implement a free EMR and may require future expense to be able to support the program in the long term.

Those considering developing their own EMR should realize that this is an enormous task. I know of a number of doctors who have done this and absolutely love it. The problem is that while developing their own EMR, it is like they are working 2 jobs: doctor and programmer. Even after many years, a homegrown EMR still has trouble comparing to the powerful features of current EMR software. Remember that most EMR software includes charting, prescribing, ordering, and diagnosing, along with hundreds of other idiosyncrasies -- not a small project that you can just pay someone to do over a weekend.

More Considerations

After creating a manageable list of potential EMR companies, you will need to find a way to compare the feature sets offered in each tool. A simple method of comparison is to create an Excel file with a list of features down the left side and a list of EMR companies across the top. An Internet search will also find Excel files such as this already built, which can be used as a good starting point. Once you have the file, fill in the details of each software company as you participate in an online or live demo of the EMR software product.

Choosing an EMR 

The biggest challenge that a doctor faces in selecting an EMR is asking the right questions of the software vendor during a demo. Avoid asking yes and no questions that can easily be misinterpreted. Asking how an EMR vendor accomplishes a task provides better information and helps avoid what I call "sales miscommunications." For example, pretty much every EMR vendor can respond yes to the question, Do you support voice recognition software? A set of very different and more detailed responses will entail if you ask the question: How do you support voice recognition software? This type of open-ended question requires vendors to describe their system and gives you a better understanding of how they have implemented a certain process or procedure.

Another valuable method for evaluating EMR software is to visit the office of a doctor who has fully implemented that EMR. Make sure that the site you visit belongs to someone fully immersed in the EMR software. It is one thing to have played with the software and another to be using that software as an integral part of the practice. Seeing the software in action and talking with users who use it daily often opens up new perspectives about the usability of an EMR.

Another suggestion is to ask an EMR vendor to do what could be called an EMR configuration demo. Most EMR demos are done on carefully refined systems designed and configured to illustrate the best features of an EMR. The important question is how much work was required to set up the demo system. A configuration demo helps you better understand the work required to configure the selected EMR into a usable state. Questions about configuring the EMR are also very good to ask during the site visit mentioned above.

One final suggestion is to involve all your users in the decision-making process. An EMR affects the front office, medical records, and the nursing staff's jobs in significant ways, too. By inviting them to be involved in the selection process, you will face less resistance to change when the time arrives to actually convert from paper charts to EMRs.

With current EMR market penetration so small, thousands of clinics and doctors will be going through the EMR selection process. By focusing on a small set of successful EMR companies and asking good questions, selecting an EMR can be an exciting process.

More information can be found here http://www.medscape.com/viewarticle/571849_print

Last Updated ( Saturday, 19 April 2008 03:59 )  

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