Thursday, August 30, 2007

Six Tips When Searching, Evaluating Electronic Medical Records Software Options

There are hundreds of electronic medical records systems on the market today, leaving physicians with the daunting task of reviewing dozens of medical software systems in their "free time" (as if physicians really have free time), often with little or no expert help. It's no wonder so many doctors are leery of buying an EMR and using it in their medical practice. Choosing the right EMR system doesn't have to be so difficult.

Jerome Carter, FACP, offers six tips for evaluating and selecting the right electronic medical record software, writing in the American College of Physicians' ACP Observer.

1. Create a policy to review EMR products. Don't begin contacting an EMR vendor until you've created a formal procedure for evaluating EMR software.

Carter recommends setting up regular meetings with both physicians and office staff in order to give everyone an opportunity to discuss their needs, fears and budget concerns, and to present unresolved questions to the group. Then, invent guidelines and ground rules for everything from contacting software vendors to reviewing their EMR or EHR products. Record everything you learn for future reference. You won't be able to remember all the information.

Saving Money with Electronic Medical Records: Cost Savings Tool

Carter says the EMR software evaluation process should take a few months if done properly, and allows that detailed and orderly notes will make the profess go more smoothly. It will also help when you're ready to submit a request for proposals (RFP) from EMR vendors.

2. Define the problems you want to solve with the medical software. Then, find all the EMR systems that contain the features you need. Carter calls this a problem-based selection process.

Ask and answer the critical questions that establish your physician practice's needs. Need remote access to electronic medical records? Want the ability to write prescriptions or identify patients who need preventive medicine? This is the time for these important questions.

You should list in as much detail as possible every single feature you want in an ideal EMR system. Your "EMR wish list" should be comprehensive but also specific. Listing "prescription writer" as a required feature, for example, doesn't provide enough detail to help you decide later between two systems, Carter notes. Instead, you might decide an ideal electronic medical records system will provide drug interaction information with user-controlled severity alerts. This level of detail lets you make much more precise comparisons between EMR systems.

Strategies for Implementing an EMR System

Carter warns this step should take at least four weeks, and up to six months if you're in a large physician practice. Once your list of required features and functions is complete, you are ready to take your first look at available EMR products.

3. Identify APPROPRIATE vendors. Yes, the market for electronic medical records EMR software is huge, but narrowing the field is not very difficult. Many EMR vendors target practices by size and/or specialty, and some vendors only sell their electronic medical records in certain parts of the country. Eliminating systems that do not fit your specialty or practice will remove a long list of EMR systems from consideration.

Don't forget to determine the economic vitality of the EMR vendors! Although there are many stable and profitable companies in the electronic medical records or medical software space, there are also many "fly by night" vendors hoping you won't ask hard questions about their financing and future prospects. You can measure the economic vitality of electronic medical records companies by reviewing industry surveys, asking how long they've been in business, examining the geographic spread of customers or reviewing financial statements.

4. Ask for and receive a demonstration (or "demo") copy of the EMR software. If you're considering an ASP (or web-based) electronic medical record system, ask for a live software demo. A demonstration copy will perform exactly like the real product, but the vendor will either limit the number of patients you can enter or the amount of time you can use the system.

Be careful when watching canned demonstrations where vendors walk you through a database with hypothetical patients. These types of EMR software demos can be valuable, but they can also be misleading. Stay on your toes - if you're paying

Helpful Advice When Selecting an Electronic Medical Records System

Once you have seen for yourself how the EMR software performs and you've received its accompanying product literature, you'll begin to assess how each software product meets your needs. It's important to quantify how each EMR system measures up, so assign a numerical score for important electronic medical records features and functions or use some other objective scoring system. Set a cut-off score and eliminate all products that do not exceed your scoring threshold, Carter advises.

5. Compare software features directly. If you have completed the problem-based selection properly, you should have no more than three to five potential EMR systems to evaluate. It is now time to compare the electronic medical records side by side to see which software system works best for your office.

You should narrow the field to three or fewer EMR systems at this point in the process. You're now ready to conduct a site visit.

Affordable EMR Software Packages

6. Go on site visits. Site visits, when conducted by educated consumers, are quite helpful when selecting an electronic medical records software system. Request a list of customers from each EMR vendor and contact the practices yourself, says Carter.

Decide the questions you'll ask each customer in advance, such as how well the EMR vendors respond to requests, how much software training time was provided, any EMR implementation difficulties, software upgrade schedules and specific electronic medical records features. Determine how well each EMR system would fit into your medical practice.

To view more advice from Carter, click here.

Tuesday, August 28, 2007

Majority of Patients Desire In Office Medication Dispensing, Study Finds

A new research study by Purkinje, a healthcare technology and services firm, finds that three out of four (75%) Americans would prefer to have their prescription(s) filled in their doctor's office instead of a retail pharmacy if given the choice. The research was conducted by Opinion Research Corporation on behalf of Purkinje.

The study examined consumer attitudes of an FDA-approved service known as in-office medication dispensing or point-of-care dispensing. The practice involves distributing pre-packaged medications directly to patients at the point of care, saving them a trip to the pharmacy and allowing them to immediately begin their treatment.

Overall preference for office-based medication dispensing appears to be driven by the prospect of saving time and improving quality of care, according to Purkinje. A majority of respondents (84%) said such a service would be more convenient, and 62% said it would help them better manage their health.

According to their media statement, "Thousands of progressive medical and dental offices around the nation are adding medication dispensing as a way to heighten the patient experience and create a new source of revenue," said Tom Doerr, M.D., chief medical officer for Purkinje and a practicing physician. "Patients like the comfort of having their prescription filled in the privacy of their physician's office, and the convenience of starting their treatment right away."

Purkinje says software programs are usually integrated with in office medication dispensing services to double check to ensure patients are receiving the right medicine, cross-check against known allergies and look for potentially adverse interactions. Medications arrive in safety sealed bottles, they say, prepackaged offsite under the supervision of a licensed pharmacist. Apparently, point of care dispensing can also be integrated with electronic medical records systems.

Our own brief research suggests the practice of in office medication dispensing (or point of care dispensing) has been around for more than 20 years, although it has failed to meet initial expectations. Although some 15,000 - 20,000 physicians dispense medications at the point of care, the vast majority of doctors do not offer this service.

This could mean one of two things. Either in office dispensing is a promising but untapped new service for physicians, or its promises don't hold up in real practice. Nevertheless, it appears a majority of Americans are receptive to this type of medication service in their physician offices.

Fair disclosure: Purkinje is currently a sponsor of this blog. (Note their advertisement)

Wednesday, August 22, 2007

Questions You Should Ask Electronic Medical Records Vendors

Physicians and industry experts alike will tell you it's important to ask the right questions when you're considering an electronic medical records, or EMR, system. Good questions will help you distinguish the reliable EMR vendors from the "fly by night" vendors. Here are a few important questions to ask when you're evaluating different EMR software options.

* How long have you been in business?

* How many live sites are currently using your software? If possible, learn which specialties do or do not use the software.

* Can you provide me a representative list of your clients, allowing me to randomly select which practices to contact? If not, why? (Most vendors won't give you their entire list, but the customer list they offer needs to be comprehensive.)

* Is the electronic medical records system being used in a multi-site environment? If yes, ask about their experiences to date.

* Is your product a client-server model or ASP model? Each has its own benefits, although smaller practices will probably want an ASP solution.

* What is the typical length of time between the purchase date and the "go live" date? No matter the EMR vendor or the EMR system, there will be a delay between the purchase date and the go live date. Look for vendors who can implement the EMR software in a reasonable amount of time, while still allowing enough time for implementation pre-work.

Strategies for Implementing an Electronic Medical Records System

* What is your plan for implementation? This plan should be thorough! Beware of vendors who don't offer a detailed EMR implementation plan. Even the most basic systems require a plan.

* What type of technical support is available, and how much does it cost? Beware of EMR vendors who require expensive technical support agreements, or those who advertise "rock bottom" prices with no mention of service or support. In many cases, these vendors require additional annual costs for service and support. To be fair, many vendors offer affordable electronic medical records with no expensive service or support requirements.

* What is the process for fixing bugs and launching upgrades/new versions to the EMR system? Every system will have bugs. Be less concerned about bugs and more concerned about how those issues are resolved.

* How are licenses issued? Is the license fee payable monthly, yearly, or is it a one-time fee? Some EMR companies charge a one time fee, others charge a monthly subscription, and still others charge a one time fee with monthly or yearly service fees. Do your homework.

* How much do software upgrades cost? Are these upgrades mandatory?

Does Your E-Prescribing Software Pass the Test?

* Is your electronic medical record system CCHIT certified? Look for systems that have been certified. The 2007 standards were more rigorous than the 2006 standards, although any certified system is better than a non-certified system. Again, to be fair, some good EMRs have yet to receive CCHIT certification, but a lack of certification should be a red flag for more homework.

* For ASP systems, how frequently are backups performed, and how long are data stored? The more the better. It rarely hurts to "over-backup" information!

* For ASP systems, what percent of time is the system functional and online? An ASP-based electronic medical record is of little use if it's always down. Look for systems with the best uptimes, and aim for a 98% minimum.

* Does your EMR system import and export data to and from common formats, such as .csv or .txt? If not, ask why.

* What standard clinical templates, if any, are included in your software system? How were these templates created? Look for systems with templates that are based on the most recently published clinical/medical evidence, and look for companies that routinely update these templates.

Clinical Management Features to Consider in EMR Systems

* Does your system have a single summary page for each patient?
* Are both structured and free text allowed for documenting progress notes?

* Does the EMR system generate a summary at the end of the visit that provides the patient with visit findings and discharge instructions? Most systems will do this. Beware those electronic medical records that don't.

* Does the software system provide patient education handouts? These aren't as important as the end-of-visit patient summary, but they are still an important feature.

* Is there an additional cost for transferring date from my existing EMR into the new EMR software system? Some of the most affordable systems charge you to migrate or transfer data from your old EMR system to your new software system. Others allow a one time transfer at no charge. Look for the vendors who offer a free or deeply discounted transfer.

* Can the software be accessed from remote locations? For most ASP systems, the answer will be yes. Many client-server systems can also be accessed remotely, although it can be difficult.

* Can the system send prescriptions electronically to pharmacies in my local market? Can it fax orders to pharmacies? If it does neither of these tasks, look elsewhere!

* Does the EMR feature disease-specific clinical templates? The better the clinical templates, the better the system.

* Is there a dashboard that shows the day at-a-glance? If the EMR doesn't offer a dashboard, look elsewhere!

* Can a personal health record be generated? If yes, great, but you shouldn't necessarily ditch a company that doesn't have a PHR feature. If the EMR system doesn't generate personal health records, ask when the feature will be available.

* Does the system have a built-in charge capture mechanism and automatic coding advisor? These features are important; they'll likely help pay for the system. Look for a system that minimizes defensive coding. A solid medical billing component helps, too! Some vendors will offer free medical billing services if you use their software, and others will offer a free electronic medical records system if you use their medical billing services.

A few other important notes:

Uptime: This is a critical question, especially for ASPs. If the system is down, you will not have access to patient information, scheduling, labs, etc. Most EMR vendors are capable of giving you an uptime figure, and it should be 98% or higher. ASP uptime is also dependent on your Internet connection: if your Internet connection is down, you will not be able to access your EHR. A reliable Internet connection is critical for an ASP. Look for electronic medical record vendors who will provide, in writing, the statistics on the ASP’s uptime, for both the server and the application.

Data backup frequency: This is an extremely important question. The busier your practice is, the more important it becomes. For example, if data are only backed up once a week on Friday, and the system loses its patient health data on a Thursday, all data from the previous Saturday until Thursday will be lost. Ensure data are backed up to the degree patient volume warrants, usually daily at a minimum. Your EMR vendor will be able to assist you with this task. Data archive time: If you are contracting out the maintenance of your electronic medical records system, or if you are performing it yourself, you should be aware of how long the data backups will be kept, especially in consideration of legal requirements and responsibilities. Back-up files should be kept off site in a secure location to protect data in case of fire or natural disasters. More than one site ("redundant backups") are best.

Additional equipment and software: Unless your vendor or consultant is contractually bound to provide a "turn-key" system, a new electronic medical records install will sometimes require additional or upgraded equipment. For a single computer practice, this only may be a new computer workstation, but if there are multiple users connecting in multiple ways, it may require a substantial investment in additional equipment, software such as database licenses, etc. You should ask your EMR vendor what you will need to actually use the EMR. You should ask about both software and hardware. This is especially important when considering a client-server electronic medical records system.

In the client-server model, the server, database, and all software are kept on site at the practice; the practice is responsible for doing maintenance and back-ups. (A server is a heavy-duty computer that handles the majority of the processing tasks.) If you have an IT person, this should not be a problem. An Application Service Provider (ASP) is a company or organization that provides access over the Internet to software programs like an electronic medical record. The EMR would run on remote servers not owned or supported by the end user's organization (i.e., not an in-house server). Data are usually housed at the remote location. This should not be confused with a network program, which is owned and supported by in-house staff.

Client-server models tend to work best in large physician offices (for example, practices with more than 10 physicians), and ASP models tend to work best in smaller offices (for example, practices with fewer than 10 physicians), but both types of systems can work in all sizes of practices.

Tuesday, August 21, 2007

EMR Cost Savings Tool: Use This Tool to Estimate the Expected Cost Savings from an Electronic Medical Records System

If you're concerned about the cost of an electronic medical records software system (EMR system), or want to accurately estimate your return on investment (ROI) of your EMR, this cost savings tool should help.

It was designed by a Medicare Quality Improvement Organization under the DOQ-IT program. The spreadsheet helps quantify potential monthly savings as a result of an EMR or EHR implementation. Simply answer a few questions and see whether or not your electronic health records software is worth the initial investment.

Additional benefits associated with improved clinical care process and efficiencies may or may not be represented by a dollar amount in this tool. The worksheet represents the areas of EHR or EMR use where common efficiencies and saving are realized. A full ROI request should be performed with your electronic medical records EMR vendor during the contracting phase of your EHR implementation.

Monday, August 20, 2007

Study: When it Comes to Electronic Medical Records, Osteopathic Physicians Say Cost is Biggest Hurdle

A new research study by the American Osteopathic Association and the Medical Group Management Association finds the cost of an electronic medical records (EMR) software keeps doctors of osteopathic medicine (DOs) from transitioning to electronic medical records. In some cases, the costs kept physicians from fully utilizing EMRs they had already installed.

The study shows larger medical groups (at least 51 full-time doctors) tend to have more funds available for information technology investment, and adopt electronic health or medical records systems at a rate of 55.1 percent. The rate was much lower (25 percent) in solo physician practices.

What's keeping physicians from adopting EMR or EHR systems? According to this study, a “lack of capital resources to invest in an EHR”. Researchers found that the median EHR/EMR purchase and implementation cost was $20,000 per physician, with an additional $250 per month per physician for maintenance.

Affordable EMR Software Options: Is ASP Right for You?

Of those that had moved to an electronic medical records system, nine out of ten respondents said they would not go back to paper medical records. Among AOA members, “improved access to medical record information” ranked highest as a potential benefit to their medical practices. Other high-ranking benefits with more direct impact on practice financials were “improved accuracy for coding evaluation and management procedures” and “improved charge capture.”

Overcoming Financial Fears Important When Considering an Electronic Medical Records System

This research also seems to support the theory that although these software systems can be expensive, they lower practice costs in the long run. Of those with systems, 22.3 percent said their practice costs had decreased. To be fair, an almost identical percentage of DOs claimed their practice costs had increased. The balance wasn't sure.

Is There a Business Case for Electronic Medical Records?

MGMA conducted the study of AOA members in spring 2006, although the results were released in August 2007.

Tuesday, August 14, 2007

Can Electronic Medical Records Defend, Prevent Malpractice Claims?

Do you think an electronic medical record system can help protect your physician practice from malpractice cases? According to a survey by the Medical Records Institute and Professional Risk Associates, nearly half of physicians (45% of respondents) think an EMR or EHR can make a physician practice less vulnerable to malpractice claims.

The survey of 115 physician practices of various specialties also found that:

* Some 20% of respondents said their malpractice insurer offers a discount for having an EHR or EMR system; and

* Nearly 20% of respondents said they have had a malpractice case in which documentation was based on information from their Electronic Health Records systems, while 55% of those respondents said the technology was helpful in the case.

Two-thirds of respondents with an EHR system said providers at their practices fully use the systems. Meanwhile, about a quarter of respondents said their electronic medical records systems do not have all the functions necessary, and a similar percentage said they have not been adequately trained on the systems.

The survey was conducted between March 21 and June 30 through links on both organizations' Web sites and e-mails to clients. This story was originally posted on

Monday, August 13, 2007

AAP Notes Special Functions for Pediatric EHR Systems

A new report in the American Academy of Pediatrics' journal Pediatrics explains that while clinical information systems, such as electronic health records, typically are designed for adult care, unique functionality requirements are needed to support pediatric care. The report includes EHR functions for pediatrics in areas such as:

* Immunization management;
* Growth tracking;
* Medication dosing;
* Patient identification;
* Norms of pediatric measurement data changing over time;
* Privacy;
* Pediatric terminology; and
* Accuracy of the data being collected and presented.

Electronic medical records functions should enable the registration of infants without Social Security numbers and support a temporary and prenatal identifier that links to the postnatal record, according to the report. EHRs also should support changes in an infant's name and the retrieval of data when previous names are searched, the report said.

The American Academy of Pediatrics has previously published a policy statement on the rationale and functionality requirements for electronic prescribing systems for pediatrics.

Tuesday, August 7, 2007

Electronic Medical Records Implementation Strategies

There are two schools of thought when it comes to implementing an electronic medical records (EMR) system.

One camp says you should take baby steps; learn to crawl before you try to run. We'll call this the incremental approach. The other group advises making the transition to electronic records all at once; face your fears, work out the kinks and enjoy your new software. Let's call this one the big bang approach.

Each implementation strategy has benefits and drawbacks, especially depending upon the size and type of physician office that will use the EMR. The incremental approach tends to lend itself best to larger physician practices, multi-specialty groups and environments where "office politics" runs high. It also works well when you're implementing a very complex electronic medical record system. The big bang approach, on the other hand, tends to work well with small (fewer than 10 physicians) practices, or offices where strong leadership exists.

Here are some of the pros and cons associated with both implementation strategies. If you're considering an electronic medical record purchase, think about which approach might work best in your practice.

The Incremental Implementation Strategy

The Pros
• Reduces "change shock" to staff and physicians
• Spreads out costs of software and implementation over a longer period of time
• Portions of EMR functionality are rolled out in phases across all units
• In many cases, the project is less likely to lose momentum

The Cons
• Total training, implementation costs may be higher
• Longer overall implementation of your electronic medical record
• ROI is not achieved as quickly
• Morale may decrease as implementation lags
• You may introduce a training lag if implementation phases are too far apart from training sessions

The Big Bang Implementation Strategy

The Pros
• Everyone goes live at once
• Paper processes cease shortly after the EMR is "turned on"
• You're less likely to end up with a dual system
• You'll shorten the parallel paper/EMR operation period
• ROI is achieved more quickly
• When it is over, it's over!

The Cons
• If you choose a complex electronic medical record system, there's a higher risk of blow up
• You'll likely encounter significant productivity reduction when you begin using the software system, and this could last for up to three months
• Inadequate planning may jeopardize full implementation
• Staff or physicians resistant to change may become overwhelmed

No matter the strategy you choose, it's important to stay focused (and committed!) to successfully implementing your electronic medical record system. Even the most affordable EMRs represent a considerable time and financial investment. With a little strategic planning, you'll get the most out of your software.