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Selecting the EMR Electronic Medical Records System: A Daunting Task
What are you looking for?
Just like it’s a bad idea to visit the car dealer without some basic ideas on what you’re looking for (sports car, 2 seater, pickup, sedan, hybrid, etc..) you’ll need to make sure you have some general criteria on your practice requirements and what you are looking for in an EMR.
Create a list of “must have” features so it will be easier to eliminate potential systems. For example, if you run a pediatrics or family practice, you’ll want to be sure your system has superior growth curves and vaccine administration documentation. If you are a rheumatologist, how easy will it be to customize the templates for your use to make notes on the joints and skin of the patient? If you are an Ob-gyn, can the system automatically calculate EDC from LMPs. Can your EMR automatically plot BMI for age? (do you care?)
Can this EMR already interface with your local lab, (or will they build it for you at a reasonable cost), your vital signs machine, your in house lab Coulter counter, etc…
Does this EMR include a way to automatically send faxes to pharmacies, or patients? Can it send secure email to patients? Do you want a patient portal? This would allow patients to view things like upcoming appointments, update their contact information, contact the physician, view lab results in a secure way. This should help reduce phone call volume to your office, and would be one thing to measure return on investment (ROI), after you implement the system. For example, if it saves 10 phone calls per day, that’s one hour of your time (or your staff’s time). And of course, time is money.
Ok, so how much already?
As nice as it would be to only compare EMRs by feature, some EMRs are much more expensive than others. Some have fees in the $10,000/provider neighborhood, while others are much less, in the $1000 range. Again, feature set and support varies widely, so some EMRs have a la carte pricing, touting the ability for the provider to only pay for what you need. More expensive EMRs often advertise their “all-in-one” features and the fact that they don’t “nickel and dime” customers for every little feature. You’ll want to be sure to include the costs of any required hardware (PCs, servers, scanners) as well as support contracts (annual or monthly fees), and upgrade costs (software costs) in your calculations. If it’s out of your budget, don’t go crazy trying to stretch your dollars, because costs will invariably be higher than anticipated once the dust settles.
What about workflow?
No matter how nice an EMR looks during a demo, you need to think carefully if the EMR setup works for your office workflow. Does the order of check-in, vital signs, lab tests, progress notes, etc… flow with your existing model of practice? How will your MAs or RNs know when Mr. Smith is ready for his CBC? How will you know when a patient is in the room waiting to be seen? Consider what you want your workflow to be, and how it will be with the EMR. While some EMRs are adaptable, and your office workflow will also be adaptable, you want to make sure the solution fits for the way your office is already set up.
Charting Ease of Use
You want your EMR to make your life easier, cutting back on repetitive tasks you have to do on a day to day basis. You want to streamline the “same old” physical exams for routine visits and save time on charting things like consent forms, and lab results retrieval. Make sure the EMR fits your personal practice style. Does it involve typing a SOAP note (do you want that?) Can you dictate instead of type? Do you want checkboxes and drop downs for your HPI and physical exam? No matter how pretty an EMR is, you can’t make up for slow or clunky workflow.
But I already have three thousand paper charts!
OK, so how does your EMR company take care of your existing patients? How does it handle scanned documents? Where will they be “deposited” in the new electronic charts? Can it import basic demographics from your existing practice management software (or from your billing company) to save the additional staff time to create new charts?
Looking for emergency exits
Some of the more “confident” EMR companies often offer money back promises within the first year of service. You may be tempted to take one of these offers. Even if you don’t, and you are choosing an EMR, you want to be sure you can get out of a sinking ship if things are not going your way. Can the patient chart be exported into a format you can use? Will you be able to print out all charts in PDF format? Can they be exported into XLS, CSV, XML, HL-7, or CCR so you can move the data into another EMR? You’ll want to be sure you have a way out if you ever come against that possibility.
What’s in a Name?
Some people want only to work with the “Microsofts” of the business. For those, vendors may decide only to look at companies with major backing behind them, such as GE Healthcare, Cerner, EPIC. These companies are the biggest and likely the most financially stable names in the business, but they may also be less likely to listen to the “little guy” when it comes to contract negotiations and feature upgrades. You may be attracted to the new kid on the block, attracted by the flashy EMR demos, high energy of the product demonstrators, and new technologies. Just be sure the company will be around in a few years when it comes to updating your product.