Choosing EMR / EHR Medical Software: The Critical Questions You Need to Ask

By Sheldon Needle

Why are some practices successful at selecting and implementing EMR / medical practice software while others are not? Here are some of the major areas to evaluate when choosing medical software. Now that the medical industry has moved on from Practice Management and Billing software model to the next generation of more integrated EMR (Electronic Medical Record) / EHR design, important issues and questions – some of them old, and some of them new – need to be asked:

• Overall design of the EMR (Electronic Medical Records) system. Can the system handle multiple providers, offices, and business entities comfortably? Can the system share common files such as patient information and master files? Is the current version of the system thought out, or is it a patchwork of former and earlier systems that are likely to confuse the user (that is you)?
• Security: Does the system have enough security levels to satisfy the needs of the practice? Are HIPAA requirements and related confidentiality requirements satisfied by the EMR system? Is there a secure way to verify user authorization? In small offices security is generally not a major concern but as more people use and have access to the system, the practice may want to establish multiple levels of security to restrict access to areas such as master file maintenance and practice financial data. Do audit trails show which users performed data input?
• If you are happy with your current practice management system, can it be upgraded / integrated with a full EMR system? If your current vendor is a major player in the EMR field, he will surely have an EMR as well as a stand-alone practice management system. If so, can the upgrade from the old system be done with a minimum of pain and effort? Can the database truly be shared rather than interfaced? Interfaces may work, but they carry with them a degree of data integrity risk that one shared database would eliminate
• Does your EMR integrate well with portable devices (laptop, tablet PC, PDA) and provide security measures to guard the data on portable devices? If a physician needs access to his current data and charts from a car, or some place other than his/her office, can she continue to work, and then safely upload information back to his / her main server?
• If your practice is small and not yet working with an EMR, does it make sense for you to consider SAAS (Software as a Service) or Web Based EMR? The initial costs of SAAS / Web Based EMR that is handled as “cloud computing” is much smaller, at least to start with, than a proprietary server and traditional EMR would be. Could a SAAS system provide you with enough customization to meet the needs of your practice?
• Ease of Use: Are screens easy to read and understand? Is data entry set up to minimize keystrokes? Does the system have the ability to let the user customize screens or define required fields that are particular to the practice? The practice must look to how the patient and billing flow is functioning in their office. If data entry is performed at the end of each day the system should be more oriented to batch charge entry as opposed to real time entry when the patient checks out for the visit.
  
• Is the scheduling system adequate to meet not only the current needs of the practice but if the practice expands to more providers and/or offices? Can scheduling be performed at multiple locations for the same provider? Can appointments be double or triple booked? How quickly can new patients be scheduled with a minimal amount of data entry?
• Does the EMR have an ePrescription module so you can receive bonus payments for its use? If not, can the EMR you are considering be integrated with outside ePrescription software?
• Does the Electronic Medical Record System you are considering support PQ00RI (Physician Quality Reporting Initiative) and make it easy to fulfill their reporting requirements? Reporting requirements are complex, and different measures will apply to different types of medical practices. Look for a system that makes is easier to maintain such reporting audit trails.
• Any practice that works with managed care contracts must pay particular attention to the managed care features of the system: Does the system have a separate managed care module that will have to be purchased or are managed care capabilities built into the base system? Can the system handle referrals for both primary care and specialists? If the practice has capitated contracts, does the system record the capitation payments correctly without distorting the financial data? Will the system generate reporting data to determine the profitability of the managed care plans? If the practice is not currently enrolled
• Report Writing Ease and Flexibility: Reporting Capabilities and Requirements is an important area in which competing EMR/ practice management systems differ. All systems have "canned" reports, that is reports that have been pre-defined by the software manufacturer and can be easily accessed by the user. However, when a practice wants customized reports, how difficult is it to produce these reports? Many systems use a proprietary report writing language that usually is not user friendly to a non computer professional and may require days of specialized training at additional cost to the practice. An alternative is to have the software vendor write these custom reports at a cost to the practice. Many vendors are starting to use third party report writing products that are industry standard and easier to use. Make sure report writing is explored in depth before a decision to purchase the product is made.
• Does the EMR Vendor supply adequate training and support to new installations and new users? Will your new installation pay a flat fee or an hourly fee for training and tech support help? Thinking realistically, you will need a lot of support transitioning from a paper system to an EMR, or even from a less sophisticated practice management system to a top of the line EMR. Training is often as important a part of your purchase or lease agreement as is the software itself. Make sure you obtain references, and talk to others who have recently installed the EMR you are considering.

Many variables other than system features can also determine the success or failure of a practice management system implementation. Issues such as the implementation plan and schedule, quantity and quality of training, data conversion and vendor support all play a role in the success or failure of an installation. Many excellent reviews, including CTS’ medical software reviews, are available, to help you understand the differences between vendors and their packages.

A successful conversion from a paper based system to an electronic system requires a good software system plus the determination to change many things about the day-to-day functioning of a medical practice on the part of physicians and other practice employees. Good planning, good culture, and good luck are necessary ingredients for a successful transition.

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