ECPHO Eastern Connecticut Physicians Hospital Organization, Inc.

Tools for Your Practice

Electronic Health Records

Tools for Your Practice

On this page you will find:

Web Links

ehrCentral
Electronic Health Records Dynamic Resource, from The Provider’s Edge, LLC
www.providersedge.com/index.html

EMRConsultant
The physician’s guide to EMR solutions
www.emrconsultant.com/theemrlist.php

Wikipedia
Electronic Health Records
http://en.wikipedia.org/wiki/Electronic_health_record

California HealthCare Foundation
EMR Evaluation Tool and User Guide
www.chcf.org/topics/view.cfm?itemID=21520

Michigan State University Clinical Center Information Services
The EMR: What, Why, Which?
www.emr.msu.edu/emr_what_why_which_intro.htm

American Academy of Family Physicians
Why I Love My EMR
www.aafp.org/fpm/20021000/35whyi.html

Allscripts
www.allscripts.com

eClinicalWorks
www.eclinicalworks.com

Frequently Asked Questions about EHRs

Would you like to keep these FAQs for reference? Click here to download a PDF version of the following questions and answers. [link to pdf]

About Electronic Health Records

Q1: What are Electronic Health Records (EHRs)?
An Electronic Health Record is a personalized medical record in digital format. An EHR is typically accessed on a computer or over a network. An EHR almost always includes information relating to the current and historical health, medical conditions, and medical tests of the patient. In addition, the EHR may contain data about medical referrals, medical treatments, medications and their application, demographic information and other non-clinical administrative information. EHRs are a new form of healthcare record-keeping that represents the ability to easily share medical information among the key parties within the healthcare universe (providers, patients, payers).

Q2: What is the difference between EMR & EHR?
An Electronic Medical Record (EMR) typically has full charting and document imaging management, along with e-Rx with formulary tracking by health plans, automated E&M coding and verification, medical necessity checking by CPT and diagnostic codes, comprehensive orders and results reporting with integrated workflow routing and tracking. The application typically has interfaces to multiple practice management systems.

An Electronic Health Record (EHR) has full EMR capability, plus internet based Patient Health Records, health maintenance tracking, proven interoperability with other EHR vendors, national clinical standard couplers, and clinical decision support with nationally recognized alerts and other features.

Mark Anderson of The AC Group (which is a healthcare technology advisory and research firm that provides tools to assist physician practices in their technology decision-making) emphasizes that the requirements of clinical systems today are far less than what will be required in the near term. A practice cannot afford to purchase a system today that will not meet the functionality requirements of the future. The additional features of an EHR will become increasingly important as “Pay for Performance” and Disease Management Programs begin to provide incentives based on EHR reporting. In addition, malpractice insurance carriers have indicated that they will provide discounts for those providers that implement an acceptable EHR application.

Q3: What clinical activities are supported by EHRs?
EHRs support seven main types of clinical activities – including:

  1. Easy access to health information and data – EHR users have the ability to view current and past clinical information (progress notes, problem lists, medications, allergies, lab results, and other related clinical data).
  2. Easy documentation of clinical information, either in the exam room during the patient visit or subsequent to the visit. EHR systems typically use templates that are specific to the type of visit or diagnosis and prompt physicians to guide the patient exam and discussions. Most EHR systems also allow physicians to use a combination of typing-in free text as well as clicking on structured boxes (pick lists) that have built in template language, which provides standard text phrases or sentences for that prompt.
  3. Electronic ordering allows physicians to enter prescriptions using electronic forms, selecting from a choice of options, and receiving decision support (alerts) on drug to drug interactions or allergy warnings. These electronic orders can be printed out for the patient and/or faxed/emailed directly to the pharmacies. Many EHR systems have built in capabilities that offer formularies of many major health plans in the local region. Although the initial prescriptions take time to enter, significant time is saved for physicians and staff in refilling prescriptions. ECHN is currently building the capability to allow physicians to also submit orders for lab tests and other orders directly to EHCN facilities.
  4. Electronic communication (messaging) and connectivity features provide efficient, secure and readily available communication within the office (between physicians and staff) and outside the office.
  5. Decision support for care management and follow-up activities are supported by the EHR’s prevention and disease management capabilities, along with the documentation features. Templates can be developed to automatically prompt providers to question about health maintenance status or to provide condition specific clinical practice guidelines.
  6. Analysis and reporting features are available in most EHR systems and can be used to search patient data and to support various Pay for Performance (P4P) efforts.
  7. Improved coding of services – Billing and scheduling activities can be supported by EHR systems if the physician office’s Practice Management system and EHR systems are integrated or interfaced. Greater integration reduces duplicate data entry and helps support automatic service capture and more appropriate (higher) visit level coding.

Q4: What are “Patient Focused” features offered by EHRs?
Most EHR systems have various optional “patient focused” features that allow internet based communication with patients through special patient portals resulting in the following benefits:

  1. Save time telephoning patients with their lab / radiology reports, since they can view them online;
  2. Allow patients to fill out their past history on-line, or in a kiosk in the waiting room, minimizing staff time in obtaining this information;
  3. Allow patients to make and modify their appointment schedules online, thereby minimizing staff expense for scheduling; and
  4. Reduces the number of telephone lines required in the office because much of the office/patient interaction can occur via the Internet.

Q5: Should my EHR system work with my practice management system?
Your practice management (PM) software, allows your staff to track patient demographics, visits, and diagnoses; collect, transmit, and track billing information and insurance payments; manage appointment scheduling; and generate a variety of reports. PM software improves the efficiency of an entire practice, from physicians and nurses to clerks and billing specialists.

The industry-standard HL7 protocol allows health care applications to share data with each other, so make sure both your EHR and PM software use such protocols. For truly seamless integration, you should not have to export batches of data from one and import them into the other — they should communicate in real time.

Many software vendors offer both types of software or even one software package that combines the functions of both. They also share many characteristics, so it often makes sense to look into both at the same time. Of course, the easiest way to ensure seamless integration is to buy both systems from the same vendor. However, you may find that the provider with the PM that is ideal for your business does not offer the best EHR. Both systems are critical to the day-to-day functioning of your office, so be sure to choose them based on your specific needs, not solely on convenience.

Q6: What is the difference between the ASP and Client Server models of EHRs?
An important decision to make when choosing an EHR system is where you want the software hosted. If you run it in-house, the solution is usually referred to as a client-server system; vendor-run applications are referred to as application service provider (ASP) solutions. Both options provide distinct advantages: consider which are more important to you.

Client-server solutions: Most software programs used today are locally hosted — the program runs on your computer and stores the data either on a hard drive or on a network server in the office. This familiar setup gives you the greatest control over every aspect of your EHR system. Client-server solutions also tend to offer more comprehensive feature sets.

However, installing and maintaining the necessary SSL security and firewalls requires technical expertise and effort. In addition, keeping the data in-house gives you the added responsibility of making regular backups — preferably daily — in case of a system crash. Client-server proponents point out that EHR applications are generally quite stable and require little maintenance. And you can create scheduled backups that copy your data to off-site computers fairly easily. If you choose the client-server route, you’ll pay a lump sum upfront to buy and set up the system, including software and servers.

ASP solutions: In an ASP solution, both the application and data reside on the vendor’s servers, and your staff accesses them via the Internet, through a web browser or specialized client software. The main advantage of ASP solutions is that IT professionals at the vendor’s office maintain the system. Multiple layers of firewalls and security, uninterruptible power supplies, fail-over (instant switching from one computer to another in case of a crash), and reliable backups are all standard operating procedures for these vendors. They combine to virtually guarantee that your application and data will always be secure and available.

The biggest risk of online solutions is that they require a broadband Internet connection at all times. Since no Internet connection works 100% of the time — your internal network may fail, your ISP may experience an outage, or an Internet worm may cause congestion — you may not always be able to access the system. These types of outages are very rare but possible. With online providers, payment is based on a smaller setup fee and ongoing monthly payments based on usage.
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Benefits of EHRs

Q7: What are the benefits of implementing an EHR system?
The following are some benefits that an EHR system may provide:

  1. First and foremost is improved patient care/quality of care (refer to Q3).
  2. Built-in reporting can let you see statistics and trends across all patients, treatments ordered, visit times, and total costs. In the event of a drug recall, such as with the recall of Vioxx, using an EHR will allow you to easily identify and contact all of your patients who are currently taking recalled medication.
  3. Improved quality care leads to lower medical malpractice exposure. Malpractice exposure is reduced because of better documentation, less misdiagnosis; reference to current clinical guidelines; and no lost charts (refer to Q8).
  4. Improved operational efficiencies and lower office costs (refer to Q9).
  5. Increased reimbursement for services provided (refer to Q10).
  6. Better positions your office to respond to the requirements of Pay for Performance (P4P) programs and potentially maximize P4P payments (refer to Q 11).
  7. Implementing an EHR system can enhance the reputation of physicians and their offices within the medical community (refer to Q12).
  8. Improved connections and communication with other providers regarding patient care (refer to Q13).
  9. Supports/enhances electronic billing efforts.
  10. Over time, leads to improved quality of life for physicians and a less stressful office. The remote access capability allows doctors to access patient records from outside the office allowing them to more productive over time.

Q8: How do EHRs improve quality of care & potentially lower Medical Malpractice costs?
Many EHR systems provide the following features that help improve patient care:

  1. Better documentation of patient information, services rendered, instructions provided, prescriptions, diagnostic tests ordered;
  2. Access to more current and complete information leads to less misdiagnosis;
  3. Charts are maintained electronically, resulting in no lost charts;
  4. EHR systems allow you to treat patients according to current clinical guidelines by providing clinical guideline prompts during documentation of a patient visit;
  5. Notifying you of new medications, dosages, complications, etc.;
  6. Assists with HIPAA compliance;
  7. Helps maintain confidentiality of patient records and minimizes the exposure due to charts left inadvertently in accessible areas;
  8. Automatically maintains multiple levels of security, access, etc. to patient records;
  9. Pharmaceutical related Quality Improvement helps to:
    • Prevent Dosage Errors;
    • Prevent Handwriting misrecognition;
    • Prevent medication conflict with allergies;
    • Prevent medication conflict with other medications;
    • Prevent medication conflict with medical conditions; and
    • Prevent medication conflict with family history (ex: Malignant Hyperthermia).
  10. Enhance patient education by providing appropriate printed instructions in the patient’s language and allows patients to participate online with their chronic illness care, including keeping the patients apprised of their current medical condition. Some EHR systems offer physicians the ability to provide language appropriate pamphlets to patients as they leave the office and offer online tutorials to patients concerning their medical conditions.

Q9: How can EHR systems improve operational efficiencies and lower office costs?
Improved administrative efficiencies and costs by:

  1. Allowing multiple users to access a record at the same time – administrative staff can update insurance and billing information while the doctor meets with the patient;
  2. Providing remote access which allows doctors to access patient records from outside the office;
  3. Supporting/enhancing electronic billing (medical records are already in an electronic format and thereby easy to transmit electronically; billing is already correlated with the medical records, and in a format appropriate for electronic billing);
  4. Eliminating/reducing transcription costs;
  5. Reducing data entry requirements;
  6. Reducing copying and paper costs;
  7. Having fewer paper documents to file and less time searching for and pulling charts;
  8. Allowing easy access to files which makes it easier to locate, copy and transfer charts when needed;
  9. Eliminating/reducing costs of storage of paper charts;
  10. Reducing the cost of destruction/shredding of paper charts;
  11. Allowing the office to operate with fewer staff members.

Q10: How can EHR systems increase reimbursement for services provided?
EHR systems can help increase reimbursement for services you perform by:

  1. Improving the coding of services through more accurate reporting, resulting in improved revenue and fewer denials (some EHR systems have prompts that identify what additional features/services are required to allow coding at a higher level);
  2. EHR documentation assists in defending users in the event of an audit; (the system’s comprehensive documentation supports the higher coding levels which can frequently be accomplished because much of the documentation is generated rather easily, such as Family History, Past Medical History, etc.);
  3. Helping to ensure that you code for ancillary services performed;
  4. Helps to eliminate lost super bills;
  5. Allows you to apply for enhanced revenue from various payers associated with higher quality care, e.g. the DOQ-IT Project of CMS and various Pay for Performance (P4P) Programs of commercial carriers;
  6. Allows billing of email consultations (with payers that accept such billing); and
  7. Allows practices to have medical data which will be valuable to research companies and will allow practices to more easily qualify to participate in medical research studies.

Q11: How can EHR systems improve results on Pay for Performance Programs?
The built-in reporting capabilities of EHR systems enhance the ability of practices to respond to the requirements of Pay for Performance (P4P) programs and potentially maximize P4P payments.

The Medical News Today newsletter dated 12/14/06 reported that Congress approved a bill (HR6408) that would maintain the current level of Medicare reimbursements to physicians for 2007 and provide a 1.5% increase in reimbursements to physicians who agree to report data on certain Quality-of Care measures. Under the bill, beginning July 1, 2007, physicians would qualify for a 1.5% bonus if they report to the government certain data on the quality of their care, such as how often they prescribe certain medications to heart attack patients or how well they manage blood pressure in patients with diabetes. Medicare officials say the data will allow the government in the near future to reward doctors who follow clinical guidelines and perhaps penalize those who flout such standards without justification.

Q12: How do EHR systems enhance the reputation of physicians’ practices?
EHR users have identified the following benefits that have led to improved reputations:

  1. Practices with EHR systems typically have fewer complications and treatment errors;
  2. Allows you to provide more comprehensive documentation to your referral sources;
  3. Allows you to provide information produced in your office concerning patients to other physicians electronically, thus increasing their confidence in you;
  4. Allows you to provide referral reports in a more timely fashion;
  5. EHR systems “patient focused” features can improve communication and service for patients generating positive feedback to referring sources;
  6. Practices with EHR systems typically are more organized, have fewer lost records, can respond to information requests more quickly and have less stressful office environments; and
  7. Allows you to be seen as a leader in technology.

Q13: How does an EHR system provide improved connections and communication?
The following are some examples:

  1. Easy connections with pharmacies for e-prescribing (allows you to be certain that the prescription that you are providing to your patient is available in the pharmacy, is within your patients insurance plan’s formulary, and is affordable for your patient);
  2. Allows you to connect directly with laboratory and radiology facilities;
  3. Allows lab results to automatically populate your patient charts;
  4. Allows you to have abnormal laboratory results flagged automatically, alerting you to issues which need to be addressed immediately;
  5. May allow you to connect directly with ECHN’s health information systems for ordering and results reports and other clinical information;
  6. Ability to send and receive clinical data to and from other physicians;
  7. Most EHR systems have optional “patient focused” features that can improve communication and service for patients (refer to Q4);
  8. Allows you to incorporate findings from ‘ancillary’ equipment, such as ‘scopes’, EKG, Ultrasound etc., directly into your office chart;
  9. Minimize or eliminate duplication of documentation from other medical equipment, such as cardiac catheterization, etc.; and
  10. Allows full video to be part of the medical documentation on your patients.

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Financial Issues

Q14: What can I expect to pay for an EHR system?
The PHO’s research indicates that the initial costs for an EHR system ranges from $20,000 to $50,000 per physician, with the median cost around $30,000. The amounts depend on many factors including:

  1. The number of concurrent users that will require the licensed software to be installed;
  2. The actual hardware & periferal software needed – PDAs, tablet PCs, scanners, printers, servers;
  3. The level and amount of training required;
  4. Whether the system purchased is an integrated PM & EHR system or is a separate EHR system requiring an interface with your office’s existing Practice Management system (refer to Q5); and
  5. How your practice selects to have the software hosted. If the system is run in-house, the solution is usually referred to as a client-server system; vendor hosted solutions are referred to as a applcation service provider (ASP) solution (refer to Q6).

Usually, the initial costs can be spread over a number of years. Many vendors can set up leases or extended payment schedules, turning a hefty purchase into a more palatable monthly fee. In addition, there are typically annual maintenance fees that will range from $1500 to 3,500 per practitioner.

There are additional types of fees that you may be expected to pay (refer to Q15). Some vendors may include these as part of their monthly fees, and some may bill each item separately. As long as you know exactly what fees you will be expected to pay, you will be able to compare vendors more accurately.

Q15: How do vendors price their EHR systems?
Vendors use different standards to determine exact pricing, such as the number of physicians, concurrent users, or computers that will have the software installed. And pricing model will depend in large part to whether your office purchases a client-server system (software hosted in your office) or an on-line ASP solution, which is a vendor-hosted solution (Refer to Q6 & Q20).

Software license costs for a client-server based system, start around $2,000 and can range up to $15,000 per user. This does not include the hardware, peripheral software, interfaces, training or implementation costs that will be required; those charges are extra.

ASP software pricing usually includes setup fees of less than $1,000 and monthly fees ranging from $50 to $300 or more. Some ASPs charge for actual usage: $0.50 per updated chart, $0.80 for each new record, etc. Often, they have monthly minimums no matter how little you actually use the software. Note that these usage-based pricing arrangements are generally fair — typically totaling $60 to $200 per month in fees for a small practice — but they require you to estimate your average usage before you can compute the total cost.

The following is a list of additional types of fees that you may be expected to pay. Some vendors may include these as part of their monthly fees, and some may bill each item separately. As long as you know exactly what fees you will be expected to pay, you will be able to compare vendors more accurately.

  1. Data transfer fees — when you import existing data from an existing system, vendors will often charge you for an extra step of cleaning, de-duping, and preparing the data for the new system.
  2. Exit fee — when you leave the service, this fee covers the expense of exporting your data so you can move it to a new system.
  3. Support fees — For Client Server users, basic support is typically included in an annual maintenance fee; while with ASP users, it is normally incorporated in the monthly fee.
  4. Training — as with support, basic training is usually included in the initial purchase price. If additional training is needed, or your office requests an on-site classroom training program, you can expect to pay extra.
  5. Upgrade pricing – ASPs will usually upgrade their software without charge. Client server users will usually pay an annual maintenance fee that includes the upgrade; however, some vendors do charge an extra upgrade fee to help install the new software. Check the proposed service agreement to see how often upgrades will occur and if there is a fee associated.

Q16: What Return on Investment (ROI) can I expect?
ROI of an EHR system can vary widely, depending in large degree on the level of physician committment to the EHR systems. Typically those physicians that invest the time to learn how to use more of the EHR capabilities, experience the most benefits.

Most offices will experience return on investment in three major areas:

  1. Medical file associated savings – thru reduced time allocated to filing (preparing new charts, chart pulls and searching for lost charts), reduced paper costs, reduced filing costs and space, savings in RN time due to reduction in chart pulls).
  2. Enhanced revenue thru improved coding and billing/collection (refer to Q10). Offices with integrated EHR/billing software typically see the most improvement in revenue from more complete capture and billing of services provided (refer to Q5).
  3. Reduced transcription costs The most successful practices have experienced decreased costs through lower transcription costs, less data entry and reduced staffing. Physicians who dictated a lot prior to EHR implementation will typically experience more savings.

In addition, for most EHR users, malpractice exposure is reduced because of better documentation, less misdiagnosis, reference to current clinical guidelines, and no lost charts. It is currently difficult to assess the financial benefit of the reduced exposure; however there is a growing trend of the health plans to provide incentives for practices to implement EHR systems.

Another financial benefit of implementing an EHR system is the improved marketability of your practice. In the event that you wish to hire another physician, or sell your practice, having an EHR and having all of your patient data on an EHR can make the transition for a new physician easier, and therefore may make your practice more valuable.

And one final potential benefit to practices with EHR systems is improved results from Pay for Performance (P4P) programs.

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Purchasing Considerations

Q17: What factors should be considered when buying an EHR?
The following are some issues that should be considered. These items are described in greater details in other sections of this FAQ as indicated.

  1. Determine/define the goals for implementing an EHR system in your offices. What potential benefits of implementing an EHR system are most important to your office? (Refer to Q7 thru Q13).
  2. Determine which EHR systems can integrate with your existing Practice Management System. (Refer to Q5).
  3. What operations model is best for your practice – ASP versus Client-server model? (Refer to Q6 & Q20).
  4. Understand the way EHR systems are priced (Refer to Q15).
  5. Consider the experience, reputation and local presence of potential EHR Vendors (Refer to Q21).
  6. Visit a practice that has already implemented an EHR system.
  7. Review the proposed implementation/training and support programs offered by the various EHR vendors. There are major differences in approaches and costs.
  8. Understand how to maximize your Return on Investments (ROI) – (Refer to Q16).

(In addition, you should review the document in the EHR Information Kit entitled “EMR Buyer’s Guide: Considerations for Practices Evaluating EMR” prepared by Misys Healthcare System, one of the endorsed EHR vendors of the PHO.)

Q18: What is the recommended process for acquiring an EHR system?
The following recommendations have been accumulated from various sources that have gone thru the process.

  1. Seek professional help from someone who has assisted other practices through the overall process.
  2. Conduct a thorough “needs assessment” before you start shopping. You need to determine who will use the system, and how. This will help make for smoother negotiations.
  3. Build a test plan. Create a script that walks through your most common office tasks, both simple and more complex. Use it when you try out each solution, and you’ll get a balanced comparison of how easy each EHR system package is to use. Consider doing dry runs in your office.
  4. Ensure that everyone in the office understands the goals and objectives for acquiring an EHR system and if possible have as many key individuals involved in the overall acquisition process.
  5. Read as much as you can about EHR/EMRs in order to understand what you will be getting into.

(The EHR Information Packet includes a document entitled “EMR Buyer’s Guide: Considerations for Practices Evaluating EMR” prepared by Misys Healthcare System, one of the endorsed EHR vendors of the PHO.)

Q19: How do I buy the right EHR system for my practice?
Implementing Electronic Health Record (EHR) software in your office can be very beneficial for your practice; however, buying the wrong EHR can be disastrous. Relying solely on your EHR vendor to make the right hardware & implementation recommendations can be a mistake. Here are some tips you can use to help ensure a successful EHR implementation:

  1. Set realistic goals. What do you wish to gain out of an EHR? An EHR system can help you reduce your number of staff, reduce your expenses, reduce medical errors and reduce documentation time. To realize all these benefits you need to set milestones and implement the right plan. To maximize the potential benefits, users must be committed to using the systems capabilities.
  2. Perform a cost-benefit analysis. All offices work differently and have different inefficiencies. It’s important to have realistic expectations of what type of Return on Investment (ROI) can be expected.
  3. Seek out unbiased sources of information. Distilling fact from fiction in the medical software industry can be difficult. The internet offers many unbiased information sources on EHR. You should consider bringing in the expertise of an IT company or EHR consultant to help guide you through the process of selecting the right vendor.
  4. Leveraging hardware to improve your EHR functionality. It’s a great thing when you have technology on your side to manage your patients’ records and become more efficient. To do this it’s imperative to select the right hardware based off your office’s needs and user experience. Involve the right IT company from the beginning to ensure a successful implementation.
  5. Determine the features that are most important for your office. Once you know which features you want, you’ll be able to narrow down your list of options. However, comparing these features across multiple packages can be difficult: you’ll often see similar features going by slightly different names or with slightly different options. Make sure you pay the most attention to the features your staff considers important. It helps to be a bit of a cynic – avoid letting yourself be “wowed” by bells and whistles that you are unlikely to use. Stay focused on evaluating the features that are important to you.
  6. Ease of Use. Don’t just depend on a feature checklist, either. Getting doctors and staff to adopt new EHR medical record software can be difficult, so it’s important that the system be easy to use. Every salesperson will tell you their EHR software is easy to use. You need to decide for yourself what “easy to use” means, but here are some examples.
    • Is entering information intuitive?
    • Can you skip sections or include non-standard information?
    • How much is automated for you?
    • Can you easily find specific information about a patient?
    • Are the various screens easy to understand?
    • Consider real-life situations: what happens when a doctor is in the middle of editing a record and gets a phone call? Does the system allow for quick jumps from one spot to another, outside the typical flow of work?
  7. Customization. You are likely to hear quite a bit from salespeople about how much they can customize their electronic medical record software for you. This is another instance where you should be skeptical. The software you choose should already include all the basic features you need and allow for some “tailoring” to provide for a good fit. Customization can often result in significant additional costs to your practice.

Q20: Which EHR model is best for my practice – ASP or client-server?
The answer for Q6 of this document explains the difference between an ASP model and the Client Server Mode. Basically, the difference in the model is where the software hosted. If you run it in-house, the solution is usually referred to as a client-server system; vendor-run applications are referred to as application service provider (ASP) solutions. Both options provide distinct advantages: consider which are more important to you.

Which is right for you? Client-server software is a much more familiar setup to most users, and it makes up the vast majority of currently installed systems. However, the ASP model is gaining popularity, particularly among smaller practices. Here are some areas you should consider:

  • Can your employees handle it? If you have in-house staffers with computer expertise, a client-server solution may be your best option — but make sure you involve them in the purchasing decision. Smaller practices with little to no computer expertise are probably better off choosing an ASP solution.
  • Do you need extensive customization? ASPs can easily make basic changes in appearance and functionality, in effect giving you more control over the application than you would get from an internal IT team. However, if you need extensive customization, client-server can provide more flexibility. If long-term integration with other systems is your ultimate goal, client-server solutions are probably the way to go.

Since both options provide secure, reliable options, a final way to choose is to consider which of the potential downsides you fear more: being unable to access your system while your Internet connection is down; or losing data and time because your server crashes.

You can also start off with a hosted service, and then move to an in-house solution: ASPs should offer a seamless migration path that will allow you to easily export your data. If you’re unsure of which direction you should go, this could be an easy way to get started without committing fully to either direction.

Q21: What factors about the EHR vendor should be considered?
When selecting an EHR system, you are choosing a new partner for your practice. The application you choose will be part of your operations for years to come, so it is important that you go with a vendor who will be around to support it. You should consider the vendor’s financial stability; the number of years the product has been on the market; awards/recognition received; reputation for service/support; the imlementation process and overall cost.

  1. Size of Installed Customer Base – this is one way to help assess the stability of potential vendors. Usually, a vendor with a large installed customer base will continue to upgrade and improve the product. The large customer base also demonstrates that the company has an ongoing revenue stream to keep them in business.
  2. Training and installation is critical – The vendor should provide training for everyone who will be using the system. Ask if the vendor provides different types of training for doctors and support staff — and find out how long it takes to get training set up once you sign a contract. Many practices prefer having a trainer come to their office, but that is not always possible; web-based training can also be effective, if done properly. Regardless of the type of training, it should take users through the basics of setting up, operating, and troubleshooting the system.
  3. Support – As with any software, you should expect occasional problems or outages. While “guaranteed 99.5% uptime” and other vendor assurances are fine, more important is how they react when something does go wrong. Inquire about their support policies: do they have live support staff on the phone during business hours only or? Do they guarantee a specific response time? Depending on the specific needs of your practice, the answers to these questions can make or break an electronic medical records decision.
  4. Do a site visit – Ask to be put in touch with a local practice similar to yours so you can bring your team for a visit. If you can set up a visit with the other practice by yourself, all the better — you are more likely to get honest answers without a vendor representative looking over your shoulder. During your visit, have these questions ready:
    • How responsive is the vendor when you have problems?
    • Does the software do everything they said it would do?
    • Did the vendor provide adequate training?
    • How much downtime have you experienced in the last year?
    • If you were starting over, would you work with the same vendor again?
    • What do you like least about the program?
  5. Integration – You should also ask the EHR vendor which Hospital Information Systems (HIS) they have integrated with; and specifically you should determine whether they have interfaced with a Meditech system, which is ECHN’s HIS. This will help ensure they have some experience with such integration.

Q22: What other factors should be considered when purchasing an EHR System?
You should also consider the following factors –

  1. Portability of data. If you leave, how easy will it be to export your records to take them to new system? Remember that the patient data is yours, not the vendors. The EHR system must allow you to download the appropriate data to build the electronic records on alternate systems.
  2. Agree on your charts. Multiple physicians in the same practice often have different charting styles. Make sure you have a standard chart worked out before you start evaluating EHR software.
  3. Go for the standards. Make sure any software you choose for your practice uses both SSL (for security) and HL7 (for seamless data exchange). These industry standards ensure that your system is dependable and built for the long haul.
  4. Consider C-CHIT certified EHR systems and systems that can meet the reporting requirements of DOQ-IT (the Doctor’s Office Quality-information Technology project of CMS).
  5. Training – A critical factor to any successful implementation is adequate training – ensure that the vendor from which you purchase the EHR systems has a high reputation for training and support.

Q23: Are there any general recommendations for EHR implementation for small physician practices?
The following “Recommendations for Small Groups” are from a document entitled “Electronic Medical Records: Lessons from Small Physician Practices”, which was prepared by the University of California, San Francisco for the California HealthCare Foundation. A full copy of this report and other publications in the iHealth Report Series can be obtained by visting the Foundation’s website at www.chcf.org.

  1. Identify an EMR Champion – or don’t implement. One or more physician EMR champions must be willing to lead in purchasing and implementing the EMR. Potential EMR champions need to assess whether or not they have the personal characteristics, including determination, needed to succeed with an EMR.
  2. Obtain physician commitments to use the EMR. Physicians in the practice must make specific time commitments to document electronically and learn to use the EMR effectively to generate benefits.
  3. Maximize electronic data exchange. This is critical for reducing paper and data entry and thus costs. Practices need specific commitments from the labs and vendors that they will set up efficient electronic data exchange and adequate data exchange between the practice’s EMR and the billing and scheduling software.
  4. Arrange comprehensive support. Support should address all technical and process issues. Although some vendors provide good support, it tends to be less comprehensive than needed. It may be very difficult to arrange truly comprehensive support in most areas.
  5. Incentivize physicians to use the EMR. Practices should reward those physicians who generate benefits from reduced medical records, transcriptionists, and data entry staff time.

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