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10 Best Practices For Selecting EMR Software

Don Fornes, for HealthLeaders News, October 4, 2007

Your degree is in medicine, not computer science. Why then 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 Records strategy. As if practicing medicine weren't challenge enough, now you need to adopt a new layer of technology infrastructure.


At the same time, the value in going digital with your patient records is increasingly clear and the technology has come of age. Just like a practice management system optimized your patient schedule and improved your receivables, today's EMRs promise to automate your 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, you simply need to roll up your sleeves and run a disciplined selection process--knowing what criteria to consider is half the battle. Here we present ten best practices for selecting an EMR system. While there are hundreds of software packages on the market, you can fairly quickly narrow them down using these 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 your staff should play a key role in selection, this process demands medical expertise and leadership that only the physician can provide. What if your computer guy selected a system based on an underlying database he liked, but failed to recognize that the system forces you into rigid workflows that change how you interact with your 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 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. Do you want to limit the system to electronic charting, or do you want and end-to-end solution that extends all the way to claim management? 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. There are benefits and drawbacks to each approach. 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, reducing the need to "down code" 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 use a demo copy yourself. Try to manage a common process such as documenting a frequent diagnosis. Did you figure it out right away? These days, 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, seven days a week. You'll most certainly want weekend support if you work like most physicians, and you might want nighttime support too, even if only while reviewing records. Consider also how that support is delivered. Are you up for talking to foreign call center staff? Do you want help on-site? 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 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. 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 discontinues the product? All of these situations could have big implications for you. Make sure you assess the vendor's reputation, financial well-being and their vision for the future.


8. Be smart about your budget. With EMR prices ranging from $1,000 to $100,000, 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. While software does not have to be expensive to be good, never buy on price alone. The more sophisticated buyer will 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, 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 your deployment strategy. With faster Internet connections and new technologies, it's now possible to access your medical records entirely over the web. These software as a service (SaaS) or Application Service Provider (ASP) options lower up-front costs, simplify maintenance and provide the ease-of-use of a Web application. 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. There are tradeoffs either way.


10. Don't forget the technology. We put this last for a reason. We do not think that development languages and databases should drive a software selection process in healthcare or any other industry. Instead, we advocate that you 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. 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.


Best practices are critical for selecting the right software for your practice. While we could suggest many more criteria for your process, managing to these 10 best practices will get you most of the way to finding the right system.



Don Fornes is the founder and chief executive officer of Medical Software Advice. Prior to founding Software Advice, Don was a software company executive in Silicon Valley and a software industry analyst on Wall Street. Don can be reached at don@softwareadvice.com.

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