The value of going digital with patient records has become increasingly clear to one and all. Just as a practice management system optimized patient schedule and improved receivables, today’s EMRs promise to automate clinical workflows; they can reduce time spent charting, provide more efficient patient visits and help meet regulatory requirements.

Though it seems like an overwhelmingly ‘techie’ task, the good news is that selecting an EMR doesn’t require in-depth technical knowledge. One simply needs to run a disciplined selection process.

While there are hundreds of software packages on the market, you can fairly quickly narrow them down using some easy processes and criteria. Here we present ten best practices for selecting an EMR system.

1. Take ownership of the decision

Your EMR software will impact how you practice medicine, so this is not a process that should be left to back-office staff or the local “computer guy.”

While your staff should play a key role in selection, this process demands medical expertise and leadership that only the physician can provide. The computer guy may fail to recognize that a system of his choice forces you into rigid workflows that change how you interact with your patients.

2. Determine your own requirements

Only you know how you should practice medicine. Therefore, it’s critical to map out your ideal workflow and how you interact with office staff to complete a patient visit.

At the same time, realize that your interactions with software vendors are good opportunities to learn new best practices and workflows that could improve the way you work. Based on your initial requirements and those that arise during the selection process, build a comprehensive list of features and then prioritize them based on what will provide the most value to your practice. Realize that you can phase in new modules over time.

3. Get the right EMR for your specialty

Most EMR products are designed to serve a wide range of medical practices while others are designed for specialties.

The narrow focus of a specialty EMR vendor allows them to design their systems around the unique needs of physicians within their target market. For example, an OB/GYN EMR would have special screens designed for ante partum visits. This results in a more familiar workflow for the specialist and less customization of the software. At the same time, specialty vendors may be challenged to generate enough revenue to support the wide range of ongoing development required by client demand, government mandates and device integration. Large, broadly-focused vendors may have more resources and broader reach, but may not offer specialty features and workflows. Ask the larger, more generic vendors how they will meet your unique requirements and request references from customers within your specialty.

4. Integrate practice management

In addition to EMR functionality, consider how you want your system to support medical billing, patient scheduling and practice management.

Do you want all of these functions in one complete suite, or should your EMR interface with existing systems? There are advantages to managing clinical and practice management functions in a single system. For example, an integrated coding engine can help physicians to develop more accurate claims during the encounter. Meanwhile, health alerts made available during scheduling ensure a higher quality of care and patient compliance. On the other hand, many practices have already made significant investments in their existing practice management systems or third party billing services. Simple integration may suffice just as well.

5. Focus on ease-of-use

It’s critical to find a system that makes work easier, not harder. The simplest way to uate ease-of-use is to use a demo copy yourself. Try to manage a common process such as documenting a frequent diagnosis. The right software should make it easy. Features that can augment ease-of use include on-line help functions, tablet or stylus interfaces and voice recognition. Ease-of-use will be especially important when staff turns over and you need a new employee up-to-speed quickly.

6. Assess support and upgrades

You’ll need them. Leading vendors provide support 24 hours a day / 7 days a week. You’ll most certainly want weekend support if you work like most physicians, and you might want night-time support too. And remember, when it comes to software, support isn’t just technical assistance; support often includes access to new features, bug fixes and major upgrades. Assess the vendor’s track record in delivering consistently high quality new releases of their software. After all, you’ll likely be paying for them annually.

7. Consider vendor viability

Often an EMR isn’t all you’re buying. You’re also entering into a long-term software vendor relationship. It’s critical to assess the software company’s viability – not just if they survive, but how Sure, healthy margins in the software business keep most established vendors afloat, but what about the vendor’s “strategic viability” in a market that is poised for dramatic consolidation? Can and will they invest in new development? Will they continue to meet regulatory requirements and support new standards? Will they sell out to a larger company that soon thereafter “sunsets” their product? All of these situations could have big implications for you.

8. Be smart about your budget

With EMR prices ranging from USD 1,000 to 100,000 (approx.INR 40,000 – 4,000,000), you can quickly narrow down your software search based on price. However, this approach will more than likely limit your ability to find the right system. You must consider the value of the system (as measured by return on investment), rather than thinking in absolute dollars. More expensive systems typically meet the latest standards (e.g. CCHIT), offer more sophisticated features and integrate with third party devices such as heart monitors and imaging systems. They may also include very sophisticated decision support protocols to standardize care across large groups or delivery networks.

9. Consider your deployment strategy

With faster Internet connections and new technologies, it’s now possible to access your medical records entirely over the web. Application Service Provider (ASP) options lower up-front costs, simplify maintenance and provide the ease-of-use of a web application. Software as a Service (SaaS) vendors have invested heavily in security, HIPPA compliance and data redundancy to provide a highly secure EMR platform. At the same time, a SaaS system requires a consistent, high-speed Internet connection. If the connection is slow, the practice will be less efficient. If the connection goes down, so too will the ability to access patient records. Think hard about the tradeoffs between a SaaS solutions and the more traditional path of installing and maintaining your own IT infrastructure.

10. Don’t forget the technology

Development languages and databases should not drive a software selection process in health care or any other industry. Instead, you must assess underlying technology from a defensive standpoint. For example, reimbursement procedures and regulatory requirements change often. So a system must be built on technology that is flexible and enables the vendor to release frequent, quality updates. It is also important to assess the support requirements of systems with questionable “architecture.” Avoid purchasing an EMR with exceedingly rigid or soon-to-be-obsolete technology.

Best practices are critical for selecting the right software for your practice. While one could suggest many more criteria for this process, managing to use these ten best practices will quite do to find the right system. Good luck! 

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Related November 2007


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