Considering an EMR or EHR Software System? Clinical Management Features to Consider

If you are thinking about buying an electronic medical record (EMR) or electronic health record (EHR) software system for your physician practice, make sure you do your homework. Even the most affordable medical software systems require a few thousand dollars of your money, making it important that the software you select meets your expectations.

Following are some of the clinical management features you should consider before deciding on a medical or practice management software system. If the EMR or EHR vendor doesn't discuss one of these features, it's a good idea to ask them yourself.

1. Does the EMR software have the ability to enter all demographic and registration information in Practice Management System and transfer it to EHR without any data entry needed into EHR?

2. Can the user customize the patient demographic fields to display any number of Practice Management System fields to the clinician?

3. Can the physician or medical support staff quickly and easily switch from one patient record to another?

4. Is it possible to organize the screen and to customize tabs or modules according to user preferences?

5. Does the EHR software have the ability to display a patient summary or “face” sheet, including patient demographics, problems, medications, allergies, health maintenance, encounter listing, patient tasks, recent encounters, patient picture, and personal profile?

6. Will the EMR display and manage health maintenance alerts including chronic disease reminders per patient?

7. Does the EHR system notify to physician of critical lab and other test results for immediate attention, with a prioritization alert?

In Office Medication Dispensing

8. Does the medical software system check each orderable item for medical necessity and duplication?

9. Can the physician fax or electronically transmit prescriptions to the patient's pharmacy?

10. Will the EMR automatically alert the user when a prescription conflicts with a documented allergy, or when one prescription medication conflicts with another?

11. Does the EMR/EHR have the ability to easily search and report on prescribed medications in case of a drug recall?

12. Is the EMR/EHR software recommend best practice(s) based on current medical literature?

The right electronic medical records software system can save a physician practice time and money, while also improving patient outcomes. But it's important to ask the right questions when doing your homework. Later this month, we'll outline clinical documentation features to consider.

Have we missed any important clinical management features? Post a comment.

Common EMR Medical Software Terms: Glossary Part 1

Most physicians have at least started to consider the pros and cons of healthcare information technology solutions - e.g., electronic medical records and practice management software. But if you're like most private practice physicians, you also struggle to understand those fancy technology buzzwords that EMR medical software vendors love to throw into their sales presentations.

Don't become overwhelmed with their talk about alpha-tasting, backward compatibility, 128-bit encryption and virtual private networks! Instead, consult this handy glossary, written in a language that should look more like plain English.

ASP (or Application Service Provider): A third-party company that manages, delivers and remotely hosts software that customers access via the Internet. The ASP generally handles maintenance, upgrades and security issues. This allows the customer (the physician) to use sophisticated software without the need for expensive computer hardware or highly skilled IT employees. Most ASPs charge a monthly fee instead of an upfront fee.

Is an ASP EMR System Right for You?

Audit Trail: A software tracking system that chronologically records the history of who used a specific computer, when they used it, what information they accessed, and any action(s) taken or modification(s) made to computer files or programs.

Authentication: A method that many computer software programs use to confirm the user's identity before allowing him or her access to the software.

Backward Compatibility: The capability of software to work work earlier versions. It's important that new software programs can work with older versions.

Bandwidth: A measure of how much information can be sent at once through a communication medium (e.g., a telephone line or an Internet connection). The higher the bandwidth, the more information that can be sent at one time.

Broadband: Any system that is able to deliver multiple channels and/or services to users via a "very high capacity data transfer medium." Said another way, a broadband connection is able to deliver many different types of content at a very high speed to customers.

Clinical Decision Support System (CDSS): The use of automated (or pre-defined) rules based on clinical evidence. These systems bring together relevant information to help a physician better care for his or her patients. Alerts or reminders are examples of a clinical decision support system.

Cookie: A text file on a computer's hard drive that stores information about a computer user. Many Internet sites automatically put a cookie on your computer; when you return to the site, the cookie on your computer makes the site run faster, and generally saves you from re-typing user names and passwords. Despite popular belief, cookies are not computer programs.

Domain: The location of a Web site or e-mail address. Common Web site domains include ".com" (commercial sites) and ".edu" (educational sites).

Encryption: The process of transforming text into an unintelligible string of characters using a mathematical formula. Encryption allows computer users to share sensitive or confidential information over the Internet with a high degree of security. Encryption prevents hacking or illegal access by unauthorized persons. All EMR medical software systems should offer data encryption.

An EMR Success Story

Firewall: A computer or software system that prevents unauthorized or suspicious information from being downloaded onto a computer. Said another way, a firewall is a security barrier to control access and communication.

Java: A popular type of computer language used to create Web sites.

Practice Management System: Software that manages the billing, scheduling and registration in a physician office. EMR medical software vendors often bundle practice management software with their electronic medical record software.

Router: A device that connects computer networks. Routers keep track of computer network traffic and manages it efficiency.

Universal Serial Bus (USB): An external device that transmits data from one part of a computer (e.g., the keyboard or the mouse) to another (e.g., the computer hardrive). A USB drive is a small, external hard drive that plugs into a computer and allows the user to download information and manually transfer it to another computer.

Will IRS Ruling Spur Healthcare IT in the USA?

Industry experts are expecting that a two page memo from the Internal Revenue Service issued last month will encourage hospital systems to help fund electronic medical records technology to physician practices. Such donations were formerly not allowed.

Healthcare professionals sought clarification from the IRS after the U.S. Department of Health and Human Services (HHS) issued regulations allowing hospitals to provide software and services, within specific parameters, for staff physicians without violating federal "anti-kickback" laws.

Last month's IRS ruling is thought key in giving non-profit hospitals assurance that EMR donations would not jeopardize their tax-exempt status.

What do you think? Will the IRS ruling spur healthcare IT in physician practices, or is this really just a plastic carrot?

Helpful EMR Resource for Physicians

Is There a Business Case for Electronic Health Records?

If you're a physician, you've surely heard promises of greater efficiency and improved patient outcomes associated with electronic health records (also called electronic medical records, or EMRs), but do these medical software programs yield a business payoff for small physician offices?

Yes, according to Stefanos Zenios, Ph.D., a healthcare IT expert and professor of operations, information and technology at California's Stanford University.

"There is a perception that there's no business case for adopting electronic health records in small or midsize groups," Dr. Zenios said at a recent health care congress sponsored by the Wall Street Journal and CNBC. "That's not the case if one considers the economic data carefully."

Dr. Zenios cites a fourth-year return on investment of 31% due to improved billing and patient follow-up, noting that "not even the venture capitalists can see returns as high" as 31%.

Better data mining is another way that practices can increase practice revenue. In one example cited by Dr. Zenios, a 26-member cardiology group in North Carolina used EHR/EMR data to look for patients at risk of sudden coronary death, and found nearly 300 primary prevention candidates and more than 1,400 patients who were candidates for secondary prevention. The data search translated into more than 1,300 new consultations, 900 echocardiograms, 500 T-wave tests and 500 implantable cardioverter defribrillator implantations. (Not to mention $2.8 million in additional practice revenue.)

The quality of patient care also improved. Those additional consultations and tests had the clinical impact of averting 37 sudden cardiac deaths each year.

Of course, installing an EMR medical software system is not without its risks, and Dr. Zenios is careful to remind physicians to do their homework before selecting an EMR system. He offers several suggestions to help physicians better manage the risks involved:

Expect some initial redundancy with your new EHR/EMR system. "People put a new information technology system in place, and the next morning they turn off their previous system. It doesn't make sense. It's costly to have both systems in place, but that protects you. For 3-6 months, there has to be some redundancy."

Assess the system's ability to improve your medical billing process. For example, the system may be able to flag procedures for which physicians are routinely underbilled and bill them at the proper level.

Assess the system's capability to take advantage of all the data that will become available. "Some innovative practices are using this capability to deliver better quality of care to their patients and improve their revenue."

Affordable EMR Medical Software Options: Is ASP Right for You?

The benefits of electronic medical records (EMRs) are well-documented, but smaller physician practices have been slow to adopt these valuable medical software programs because of the high costs associated with implementing the healthcare technology. But with wider availability of high-speed Internet connections and more sophisticated vendor solutions, physicians are finding they can add an EMR system to their practice without breaking the bank.

You can thank the application service provider (ASP) model for the advent of affordable EMR software programs. In the ASP approach, another organization houses and maintains the application and related computer hardware; physicians simply access it remotely over an Internet connection and pay a monthly or annual fee. The hosting organization assumes responsibility for securely storing patient data and supporting the expensive computer hardware. The model is particularly ideal for small offices with fewer than 9 physicians.


A September 2005 survey by the Medical Group Management Association found the most widely cited barrier to implementing an EHR/EMR was a lack of capital resources. For these physicians, the ASP model gives access to a comprehensive electronic health software system without the enormous capital costs traditionally associated with robust EMR systems.

To be sure, the ASP model is not the best choice for every physician, so you'll want to do your homework. In particular, make sure the software vendor takes the appropriate steps to safeguard patient data, that they regularly backup such information, and that they offer a wide range of user support and service.

One thing is for sure. The ASP model eliminates the many hassles and costs associated with operating medical software. When a doctor uses the ASP model, there is no software to install or expensive hardware to purchase and maintain. All that is required is a computer and a web browser. You simply log onto a secure website and are ready to go.

EMR Software Partly Responsible for Slowing Medical Cost Increases, Says Report

A new report predicts health care benefit expenses and average medical cost increases in 2008 will slow at least partly because more physicians will use health care information technology (IT) and electronic health records, Modern Healthcare reports.

According to the PricewaterhouseCoopers report, private insurers should anticipate an average increase in medical costs of 10 percent for most types of plans. Such increases are down about 2 percent from 2007.

In addition to wider use of EMR software systems, the authors attributed slowing cost increases to increased transparency and cost-sharing with employees, slowed spending growth on prescriptions, and total-health management approaches to benefits.

An EMR Success Story

The Need

Listowel Memorial Hospital and Clinic sought to enhance patient care by improving clinical and administrative workflow processes. The Listowel Clinic was a typical practice drowning in a sea of paper: illegible or incomplete charts, missing or misplaced charts, duplicated charts (clinic vs. hospital), etc. Because of the clinic’s layout, nurses and doctors often had to put whatever they were doing on hold in order to track a chart down that could be as far as on the other side of the building! In addition, as an integral part of a close-knit community, the Listowel clinic and hospital needed not only a clinical and practice management solution - they were looking for a community Electronic Medical Record (EMR). The need was clear: patient information had to be stored in one place and made available at all times, whether at the clinic or its partner hospital.

The Solution

The Listowel Memorial Hospital and Clinic partnered to find an EMR solution that would help them to better serve the community. Vendor selection took two years and focused on finding a provider that could deliver the following: a user-friendly, flexible, modular, scalable, secure EMR solution that would improve workflow and was already installed in hospitals and clinics with proven results. Furthermore, the EMR had to provide a clinical data repository and interface with existing ADT, PACS, lab, and billing systems. Security, in terms of controlling access to patient information was also a major consideration. The Purkinje EMR fit all of these criteria and more. Implementation began in 2002.

The Results

After the to-be-expected growing pains that always accompany the implementation of a new system, the benefits of the Purkinje EMR became imminently clear. Nurses and Doctors marvel at the immediate availability of patient information - “It’s right there, wherever you are” - and the legibility of the charts, which was a major concern before Purkinje was installed. Everyday tasks now take less time: one receptionist reports that she now saves almost an hour per day when greeting and checking in patients because all of their information is at her fingertips. A nurse concurs, stating that she also saves an hour per day or more making follow-up phone calls. Doctors report that writing or renewing prescriptions now takes seconds instead of minutes. The bottom line: less time is spent waiting, which is good for everyone. Both doctors and nurses describe benefits to patients as well: abnormal results, for example, are now flagged and immediately delivered to a doctor’s Inbox, so that patients are advised up to a day earlier. In the words of one doctor: “When you are dealing with a patient’s lab results, a day is a big deal.” In addition, the Purkinje Prescriber module also tracks drug interactions - essential to avoiding many complications. In short, Purkinje not only saves time, it also saves lives.

Dr. Annis' EMR Presentation

Dr. Rob Annis, Chief of Staff at the Listowel Memorial Hospital, shares his experience with the successful implementation process of an electronic health record and the benefits he now reaps from this solution.