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.