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Electronic medical records (EMRs) can be a blessing or a curse.
Recently I consulted for a seven-person primary care group which was less than pleased with their EMR selection. A careful analysis revealed that the EMR was seen as an EKG machine: something to plug and play without any real commitment to training, implementation, or even selection of the correct product. Unlike Microsoft Word, where knowledge of 10 percent of the program’s feature is sufficient for getting the job done, electronic medical records are complex programs whose features require a commitment to training.
Staff buy-in is paramount. The best way to avoid a mutiny is to make sure that the staff is part of the selection process. This is crucial, as they are the best judge of their needs. No matter how many bells and whistles an EMR may contain, if it does not reproduce basic workflows in your office in an efficient way, it is not a good choice. In essence, the EMR is like a practice partner: not all personalities make for ideal partnerships. Therefore, from owner to receptionist, workflow analysis is key to a successful implementation.
Not all interfaces are created equal, and a poor billing interface is deadly. Having an interface to your billing software, and having an interface that works well is not the same. In the early years, my billing interface would randomly merge charts in the electronic medical record. Yes, it worked most of the time, but it could get quite messy, randomly. Or worse yet, finding out that you do not like your bundled billing software, and that your new EMR software does not interface with other practice management software, can be equally devastating to your bottom line. Therefore, purchasing an EMR that has proven working interfaces with multiple different practice management software is crucial.
The EMR-practice management interface is also the source of tremendous savings. Therefore, do not underestimate the value of a good bundled package. A bundled package from the same company will more likely allow for efficient charge capture, on-line appointments, and automated remittance posting. This is important, as it makes all of the mundane data entry of charges and posting of explanations of benefits (EOBs) dramatically faster. This frees up billing time for follow-up, which is usually the neglected part of the billing cycle, accounting for the majority of the billing-related losses that a medical practice must absorb.
Communication with the world outside your office is not only necessary, but it will also be legislated in the next few years. Patient portals, hospital and laboratory interfaces, and communication with state vaccine registries will be required of most practices. Unfortunately, promises made by some overzealous salesmen amount to nothing more that “vapor-ware.” It is important that you directly contact the local hospital and labs and make sure that functioning interfaces exists, and what the costs involved may be for setting up the interface. Likewise, if the closest reference site is 300 miles away, you may need to continue your search.
Implementation training is mandatory, and should be scheduled. It is not uncommon to find failed implementations as a direct result of physicians not willing to slow down their schedule to attend training. Yes, there will be some revenue loss as time is devoted to training. However, the gains made from a successful EMR implementation should more than make up for these losses. Worse still, a poor implementation will create an inefficient office, and actually cost more money, than it would have cost just to stay with paper charts.
Certification Commission for Healthcare Information Technology (CCHIT) is another important element in the decision tree. If a prospective company does not have sufficient development teams in place to keep up with ongoing CCHIT requirements, then it may not have sufficient funding or stamina to be around for the long haul. As the EMR market is expanding rapidly, there are hundreds of applications to chose from. It is unlikely that all of these EMR vendors will survive as the dominant players solidify their market shares.
For instance, Allscripts provides EMR, practice-management, pharmacy-dispensing, clearinghouse, claim-processing, patient-portal, and hospital/laboratory solutions. As all of the services are obtained from the same vendor, interfaces between the different solutions work seamlessly to provide a broad array of needed functionality to a thriving medical practice. It is important that your EMR selection meets your current needs, but it is vital that your selection will meet your future needs. Reference sites should be specifically asked about the timing, cost, and, most importantly, the depth of upgrades that have been provided over the years.
Community adoption is another important factor in a successful implementation. Having access to other sites locally can be an invaluable asset. Allowing your staff to rotate through a sister site, can be an invaluable tool to guide selection of the correct EMR, but also may lead to a much more successful training and implementation scenario.
Your EMR is like an expensive BMW: if you take the correct steps, it will help you afford a new one. Assuming it is a plug-and-play device is a mistake and will cost you the price of that convertible.
Dr. Tareq Abedin, MD, practices with Ashburn Sterling Internal Medicine and Pediatrics. Visit them on the Web at www.myhealthcare.org.
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