November 12, 2007

Ten Best Practices for Selecting EMR Software
By Don Fornes
For The Record
Vol. 19 No. 23 P. 8

Your degree is in medicine, not computer science. Then why are so many physicians finding themselves focused on software these days? Government, payers, and market forces are all pushing physicians to consider an electronic medical record (EMR) strategy. As if practicing medicine wasn’t challenging enough, now physicians need to adopt a new layer of technology infrastructure.

At the same time, the value of implementing digital patient records is becoming increasingly clear as technology comes of age. Just as practice management systems optimized patient scheduling and improved receivables, today’s EMRs promise to automate clinical workflows. An EMR can reduce time spent charting, provide more efficient patient visits, and help meet regulatory requirements.

The good news is that selecting an EMR doesn’t require in-depth technical knowledge. Instead, practices need to roll up their sleeves and run a disciplined selection process—knowing what criteria to consider is half the battle.

While there are hundreds of software packages on the market, you can often quickly narrow them down using these 10 processes and criteria.

1. Take ownership of the decision. Your EMR software will impact how you practice medicine, so this is not a process that should be delegated to back office staff or the local “computer guy.” While staff should play a key role in selection, this process demands medical expertise and leadership that only the physician can provide. What if the computer guy selected a system based on an underlying database he liked but failed to recognize that the system forces the practice into rigid workflows that change how it interacts with patients? Take ownership of the selection process to avoid buying the wrong EMR.

2. Determine your own requirements. Too many physicians let software salesmen drive the selection process. Only physicians know how they should practice medicine. Therefore, it’s critical to map the ideal workflow and the interaction with office staff necessary to complete a patient visit. Do you want to limit the system to electronic charting, or do you want an end-to-end solution that extends all the way to claim management? At the same time, realize that interactions with software vendors are opportunities to learn new best practices and workflows that could improve the way you work. Based on 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 the practice. Realize that new modules can be phased in over time.

3. Get the right EMR for your specialty. Most EMR products are designed to serve a wide range of medical practices, while some are designed for specialties. There are benefits and drawbacks to each approach. The narrow focus of a specialty EMR vendor allows it to design its systems around the unique needs of physicians within its target market. For example, an obstetrical/gynecological EMR has special screens designed for antepartum visits resulting in a more familiar workflow and less software customization. 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 a wider reach but may not offer specialty features and workflows. Ask 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 all these functions exist in one complete suite or should the 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 develop more accurate claims during the encounter, reducing the need to “downcode” or have staff scrub the claim later. 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.

5. Focus on ease of use. Medicine is complex enough without software making things more difficult. Therefore, it’s critical to find a system that makes each encounter easier, not harder. The system must be highly intuitive and easy to use. The simplest way to evaluate ease of use is to sample a demo copy. Try to manage a common process such as documenting a frequent diagnosis. Did you figure it out immediately? These days, the right software should simplify matters. Features that augment ease of use include online help functions, tablet or stylus interfaces, and voice recognition. A straightforward system will be especially important when staff turns over and new employees need to be brought up to speed quickly.

6. Assess support and upgrades. You'll most likely want weekend support and possibly nighttime support, even if only while reviewing records. Most leading vendors offer support 24/7. Also consider how that support is delivered. Are you prepared to talk to foreign call center staff? Do you want help on site? When it comes to software, support isn’t just technical assistance—it often includes access to new features, bug fixes, and major upgrades. Assess the vendor’s track record in delivering high-quality new releases—after all, you’ll likely pay for them annually.

7. Consider vendor viability. An EMR isn’t all you’re buying; you’re also entering into a long-term software/vendor relationship, making it 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 poised for dramatic consolidation? Can and will it invest in new development? Will it continue to meet regulatory requirements and support new standards? Will it sell out to a larger company that shortly thereafter “sunsets” its product?

All these situations could have big implications. Make sure to assess the vendor’s reputation, financial well-being, and vision for the future.

8. Budget smart. With EMR prices ranging from $1,000 to $100,000, you can quickly narrow down the search based on price. However, this approach will more than likely limit your ability to find the right system. While software does not have to be expensive to be good, never buy on price alone. The more sophisticated buyer will consider the system’s value (as measured by return on investment), rather than thinking in absolute dollars. More expensive systems typically meet the latest standards (eg, the Certification Commission for Healthcare Information Technology), offer more sophisticated features, and integrate with third-party devices such as heart monitors and imaging systems. They may also include sophisticated decision support protocols to standardize care across large groups or delivery networks.

9. Consider deployment strategy. With faster Internet connections and new technologies, it’s now possible to access medical records entirely over the Web. These SaaS (software as a service) or ASP (application service provider) options lower up-front costs, simplify maintenance, and provide the ease of use of a Web application.

SaaS vendors have invested heavily in security, HIPAA compliance, and data redundancy to provide a secure EMR platform. At the same time, an 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 SaaS solutions and the more traditional path of installing and maintaining your own IT infrastructure.

10. Don’t forget the technology. In healthcare—and any other industry for that matter—development languages and databases should not drive a software selection process. Instead, assess underlying technology from a defensive standpoint. For example, reimbursement procedures and regulatory requirements change frequently, 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.” Acquired and interfaced solutions may require redundant databases while preventing seamless integration. Avoid purchasing an EMR with exceedingly rigid or soon-to-be-obsolete technology.

— Don Fornes is founder and CEO of Software Advice and can be reached at don@softwareadvice.com.