Follow the Process When Choosing an EMR

If you've been thinking about integrating an electronic medical record into your practice but have yet to pull the trigger, welcome to the club. The National Center for Health Statistics reports that roughly one-quarter of office-based physicians are using full or partial EMR systems. In other words, three-quarters of the physician universe is still in limbo.

If you’ve been thinking about integrating an electronic medical record into your practice but have yet to pull the trigger, welcome to the club. The National Center for Health Statistics reports that roughly one-quarter of office-based physicians are using full or partial EMR systems. In other words, three-quarters of the physician universe is still in limbo.

“Confusion is the obstacle,” says Jerry Miller, MD, president of Kingsport, Tenn.-based Holston Medical Group (www.holstonmedicalgroup.com), which has been using an EMR system for its 140 physicians for the past 11 years. “I don’t know many physicians who don’t drive a pretty nice car or don’t make a pretty good income, so it’s not affordability. It’s confusion.”

Michael Uretz, executive director of the EHR Group (www.ehrgroup.com), a consulting firm, estimates that there are more than 300 systems that claim to be electronic medical records systems. “There is a step-by-step process that will help you weed out what you’re looking at,” he says. “But [following that process] doesn’t happen enough.”

First, get buy-in

Uretz suggests that the first step a practice needs to take is to obtain universal buy-in from all physicians. Then consider the three major areas an EMR focuses on: clinical, registration and scheduling, and billing and finance. For a successful adoption, an EMR needs to link compatibly with the current practice management system. So, says Uretz, sit down and determine what requirements you need and don’t need from a system. That’s important to do even in a small practice.

James Saul, MD, is an Ohio-based internist in private practice. The practice consists of two other internists, both part-timers, and three full-time medical assistants. Cost was a consideration when Saul adopted an EMR nearly 5 years ago, but equally important was looking at the EMR as more than just a documentation tool. He suggests asking the following questions: What do you want the system to do for your practice? How easy will it be to make the system do what you want it to do?

“Does [the system] fit the way you typically practice medicine?” asks Saul. “You don’t want to concentrate on your EMR every day. It’s going to impact workflow regardless because you’re bringing in a new technology, but you don’t want it to completely change the way you approach your day in general.”

Do you know?

Of course, Uretz points out, “You don’t know what you don’t know. In other words, how can I determine requirements when I don’t understand what an EMR system should or shouldn’t do?”

That’s where the Certifying Commission for Health Information Technology, or CCHIT, comes in. The organization researches EMR systems for security and sustainability, and determines certifying criteria for EMR vendors. “I know there’s security, there’s interoperability, and I know there’s the ability to transfer pertinent and secure patient data throughout the nation,” says Miller. “It adds quality and it brings safety, which is huge.”

Once you’ve narrowed the field, Uretz suggests that physicians then take control of the selection process. He explains that typically, physicians will have salespeople visit the practice for a demonstration. But by doing so, the salespeople are controlling the process. Instead, he encourages doctors to understand their needs and put together a Request for Proposal as a means of truly learning about the vendor you’re considering. “Too often, doctors focus on what they see on a screen and how it looks to them, but they don’t consider the people they’re buying from.”

And during that demonstration, adds Uretz, make sure the vendor shows you how you could use the EMR system in your daily life.

Get referrals

When considering a referral, Miller suggests asking the vendor for the name of a medical group or physician within 50 miles of your practice who is utilizing the same EMR system. Then, when you reach out to that practice, ask questions like: What have been your failures? What have been your mistakes? Rather than asking about successes, focus on the potential problem areas and how they were rectified.

Uretz says that if you’re a 15-provider cardiology group, ask the vendor how many mid-sized cardiology groups they’ve worked with. And when you talk to the reference, ask them to tell you what it was like when the system was first put in. “They may have the system for 2 years and it works fine now, but maybe they went through a terrible implementation and the vendor was really poor at it,” says Uretz. “Don’t just ask how they like the system, delve into the implementation aspect.”

And don’t be afraid to jump into the water. “Every practice, whether it’s a 4-person group or 150 doctors, must realize that modern medicine is here,” says Miller. “I think it’s about facing reality as providers.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@frontiernet.net.