EMR search, while tough, can be done

Question: With so much information in the trade journals and on the Internet, and so many systems from which to choose, we're overwhelmed with the prospect of considering an electronic medical record system. How can we put our arms around this process?

Answer: First of all, just because everyone is talking about electronic medical records doesn't mean practices are jumping right into them. Most are discovering exactly what you are talking about -- selecting and implementing the best EMR for their office is not an easy task. It requires a great deal of thought, soul-searching and stamina to do it correctly.

We recommend addressing the following considerations when trying to determine which (if any) EMR is right for your office: the reasons for wanting an EMR, the features to consider, your budget, and availability of resources to implement and maintain an effective EMR.

What are the reasons for wanting an EMR? Some physicians want to merely eliminate the space being taken up by files and use it for something more productive. Other reasons include wanting to reduce staff size, being able to streamline processes and communications within the practice, having a method of collecting data consistently for research and/or other outcome measurement endeavors and reducing ancillary costs associated with transcription, copying and labor. Finally, there are those who want to implement an EMR because they think it is the right thing to do.

Just as there are many reasons, there are many features to consider when purchasing an EMR. Before beginning a search for the right EMR, the doctors, administrator and key staff members should create a list of features and functions that would work best to meet the practice's needs. Then you can determine which functions are most important.

For example, you might determine you want a system that offers structured data entry, integration of the EMR with scheduling and billing systems, multiple-user access to a single patient record, or any of dozens of choices.

Also, EMRs differ in other areas, including but not limited to: integration with practice management systems; how scanned items are indexed and accessed by the user; documentation templates; hardware and telecommunications requirements; and compatibility with other electronic devices such as PDAs and dictation equipment. Implementation options also include an in-house server or a Web-based system.

Once you have your wish list, then you can figure out what will fit into your budget. Pricing for private-practice EMRs range from the low thousands to more than $100,000, depending on the size of the practice, number of users, number of locations, hardware, and selected system features and functions.

Don't let the overall proposed cost scare you away until you've had a chance to look into the vendor's cost implementation method and financing alternatives. If a return on your investment is what you are looking for, you can anticipate that it will take at least 1½ years to start realizing it. The direct and indirect start-up costs can seem high. But if the implementation is done correctly, it's more likely that there will be a payoff in the future.

If you do buy a system, you must ask yourself: Who will be responsible for implementing and maintaining it? Commitment of dedicated resources toward the implementation and maintenance of an EMR is critical to its success. Therefore, it is important that there is someone designated to spearhead the implementation to ensure optimal use of his or her time, as well as that of the office staff.

It is important not to rush the implementation, which can take anywhere from six to 12 months, or more. During this time, the EMR vendor will work with the practice to develop a plan that incorporates transition to new software and hardware, along with the development and implementation of new processes.

Maintaining the EMR so that it continues to be an effective tool in the practice is key to the success of the implementation.

Staff most likely will be assigned new roles within the practice, and some of the processes that were previously performed by one or two employees will be dispersed among several people. Therefore, it is important to establish internal performance benchmarks and monitor them on a regular basis.

Identifying and monitoring appropriate performance benchmarks on an ongoing basis ensures that this huge undertaking continues to increase the quality of patient care, along with the practice's bottom line.