Wrong! Ask any non-medical person involved with EMR implementation and his or her opinion would be that the EMR software is the last (or one of the last things) to choose.
But let’s assume that you already know that there are some basics that must be set up first, such as your building’s infrastructure, your network design, determining staff skill sets, etc. (If not, then check out this blog for previous posts on these topics before proceeding).
In this article, I¹ll discuss how to decide on both an EMR software vendor and the actual EMR software. Granted, this is somewhat of a generalization; large and small practices have different requirements and will want to base their choice of a vendor on additional criteria specific to their situation. But for the purposes of illustration, I am using the process that our seven-doctor, ophthalmology practice went through in our decision.
We had been using an electronic practice management (EPM) program called Fiscal until the late 1990s. It was clunky but fairly sophisticated compared to other EPM systems at the time. Fiscal decided it would concentrate on hospitals and would no longer service practice-based systems as of the year 2000, and our version of Fiscal was not Y2K-ready.
So the practice decided to switch to Medical Manager¹s EPM. Medical Manager was a well-established vendor and their EPM was robust and Y2K-ready (although also clunky by today’s standards). At the time we weren’t really thinking about switching to an electronic medical records (EMR) system but we knew that Medical Manager was developing one, and kept that thought on the back burner.
As physicians, we tend to easily fall in love with new toys. But you must resist the temptation to bring back the first slick-looking EMR program you see at your annual specialty meeting. Instead, you should strongly consider setting up an EMR committee, comprised of administration and representatives from information technology [IT] (or a consultant), the business office and technical staff/nursing departments. The primary goal of our EMR committee was to establish some guidelines for choosing a vendor as well as the major criteria for selecting an EMR system that would be specifically suited to our practice.
The company selling the EMR product should:
- Have at a least a moderate market presence – you wouldn’t want to be up and running with your EMR system only to find out that the vendor went out of business
- Have an existing EMR program, not a brand-new, untested product
- Have a good EPM product – this can avoid a lot of finger-pointing if there is a problem
- Have some experience in your particular field – ask for references
Suggested major criteria for the EMR system:
- An ACID-compliant relational database for the following reasons: data protection and the ability to recover fully from failure, not just restore from backup; a “back end” that would scale well as the practice grows; an open interface for generating reports.
- A system that could be fully supported on both thin and fat clients (remote control and direct control devices, respectively) to accommodate the lower bandwidth of satellite offices – thin client devices can also be lighter, less expensive, and generate less heat than say a laptop.
- A system which would give us the ability to create, modify and design powerful graphically based EMR templates with normalized data (not text).
- A product that integrates well with the EPM system. We did not want to install a system with duplicate data entry and where all patient information isn’t accessible from both the EMR and EPM.
After reviewing the products of about a dozen or so EMR vendors that had some experience with ophthalmology, we narrowed these down to a short list of about four. These vendors were then invited to make a presentation to our EMR committee. We then analyzed their capabilities and checked references from not only ophthalmology practices but also practices of other specialties.
Ultimately, we decided to switch to a company that had both an EPM and EMR system and ditched the EPM system we had been using since 2000 – that company’s EMR system was woefully inadequate and we strongly felt we needed an integrated solution. First we changed to the new EPM system and now, four years later, we are in the process of implementing the EMR module.