EMR: Friend or foe?

By Bradley K. Reiner
Practice Management Consultant, Reiner Consulting and Associates

Are you prepared for the onslaught? You may think you are already inundated with choices for electronic systems. If you think that’s the case, you ain’t seen nothin’ yet.

According to the government, billions of dollars will be poured into the electronic medical record market through the stimulus package you’ve read about. How much each doctor will receive is somewhat unclear. How it will be used is still unknown. What is known is that physicians will have more opportunities than ever to purchase these systems for their practice. What are the drivers pushing EMR into physician offices?

Government: President Barack Obama’s stimulus package includes specific dollars designated to help implement EMR in physician offices. Although specific details remain unclear, it is to include an annual sum for development and implementation of an EMR system.

Health Plans: Carriers are starting to use electronic systems for measuring efficiency and quality. EMR systems will improve communication with these carriers.

Patients: More and more patients are receiving their information electronically. How many times have you gone on the Web to get information about that chronic back problem you’ve been experiencing? It’s easy to get this information. These individuals prefer to communicate electronically. Patients who communicate in this fashion may have better outcomes and ultimately better satisfaction. Instantaneous information is critical to a successful practice.

How can EMRs improve efficiency? By reducing paper and improving coding and billing. Reducing paper records will greatly diminish or eliminate paper and record costs. You can also save on transcription as the need to dictate becomes obsolete. Storage costs for keeping records at an off-site location are eliminated. Staff may be reduced or reassigned as EMRs provide a more efficient process for organization.

Most physicians struggle with coding. Very few of the doctors that I worked with knew anything about coding. EMRs can enhance coding. Codes that may never have been used before can be utilized because the EMR can assist with recommending services that may not have been considered. In addition, levels of evaluation and management services can be more accurate. However, be warned: EMRs will not help with the subjective nature of code choice, especially medical decision making. Medical decision making is the process of determining the management options, the complexity of data and the level of risk associated with the condition. These issues require a physician’s decision rather than an automatic EMR process.

The question then is how do you choose the right system for your practice? The companies all sell similar systems with different bells and whistles. Some are very expensive. Some are more reasonable. You may wonder if price indicates quality. I will attempt to give you a process for selection to help you make the best decision when choosing an EMR.

Needs Assessment: Determine what you want an EMR to accomplish. There are hundreds of systems available to review. Before even looking at one, you must know what you want. This can be accomplished by interviewing all physicians and staff. Each department should be involved in communicating what they would like the EMR to do. This information can really help select the right system. The doctors are only one piece of successful selection. Employees who are involved in the process can give excellent insight into the selection. Don’t underestimate the knowledge of your staff.

Time: Give yourself 10-12 months to adequately review systems, provide demonstrations, do site visits, arrange financing and do training. If you are going to spend this much money, you want it to be successful.

Selection: Making the right selection is critical. That’s why reviewing at least 7-10 systems is important to ensure that you have given yourself enough options to make the right choice. Fully integrated and ASP models should be considered. There are several things to keep in mind when choosing a system.

Have a demo of the product. Get the company to provide a full demonstration so you can see the product in action. Ask questions pertinent to understanding how the system works and be specific. Things to ask include: how long has the company been in business, what is their total customer base, what practices are using this product in your area, and does it offer an ASP and fully integrated model. Get details on the cost of either option: what about maintenance, training and support after the sale? Does the system integrate with other practice management systems? What happens if the system fails? Also, have your staff ask questions.

Get names of practices that use the product. Make sure it is a practice of the same specialty. Go to that office and watch it in use. This is critical to know how it works and if you would consider it for your own office. Questions for the office who uses it include: why did you choose this product, what other products did you review, how much does the system cost, how was training, what is support like, how did implementation go, were you paid to be a reference, did you have any problems with the network or crashing issues, would you buy this system again, would you recommend this system, and do you feel you got your money’s worth and was your ROI met.

Trimming the Fat: From these reviews, choose 2-3 that you believe might be a good match for your practice. Submit a request for proposal. This is an outline that gives the vendor specific details on what you need an EMR to accomplish so the vendor can tailor its proposal around your needs. This proposal should be shared with all staff so additional input can be given. Does it include everything the practice wants the system to accomplish? Things to include in your RFP include goals for EMR: size and location of the practice, specialty, physical space, current system, current network, cost of implementation and set up, etc. The goal is to give the vendor specific information about your practice while clearly communicating your needs.

Now that you have chosen a system, what do you do? Here are the critical elements in successful EMR implementation.

Leadership: Not only do you need a physician champion and co-champion to lead the effort, but you must have sign off from everyone including all physicians and staff. Even having one physician who is not on board 100 percent will end up jeopardizing the successful implementation of the EMR. Without good leadership, implementation of a successful system will be impossible.

Technology Needs: What is needed to implement an EMR? To determine this you need to decide whether you plan to buy a fully integrated model or application service provider, or ASP, model.

Fully integrated models require the purchase of all software and hardware needed to run the system effectively. A good information technology person is needed to assess your current technology and determine additional technologies necessary to implement the desired system. The practice will be required to back up all data and provide technical support. Implementation of this method typically includes higher out-of-pocket expenses because of the additional hardware requirements needed to run the system effectively. The positive to this type of system is the practice usually has more control of how the system works.

ASP models are essentially Web-based products. The practice leases the software and server through the Internet. Typically, no special or updated hardware is needed. A robust Internet connection is required to run the ASP model effectively. Backup of data is generally done by the ASP and technical problems are handled by the vendor as well. The cost is much lower but the practice does not own the system. Upgrades are done automatically. The negative is that if the Internet goes down, the system goes down unless you have a back-up plan available, which is hard to manage.

Your vendor can go through the two different options and help determine which one might be best for your practice. Talking to offices that have implemented each type of system can help in the decision-making process.

Maintenance, Training, and Support: There are many areas important to successful EMR implementation, but none are more crucial than this area. Who is responsible for maintenance, training and support should be clear in the RFP. What will the vendor provide and what is the cost of these items? A good EMR is useless if everyone is not adequately trained and support is not provided consistently as needed. Make sure this is detailed before purchasing a system.

Financing: Look at financing a new system if a fully integrated system is adopted. Look at bank options and finance options through the vendor. Analyze carefully the cost of each.

Your checklist for successful EMR implementation should include the following:

• Team: Your physician champion and co-champion.
• Needs assessment: What do we really want an EMR to do?
• Technology needs: What hardware and software do I need to make this happen and how much will it cost?
• Communication: All staff need to be involved in the decision-making process. Have them involved early.
• Demonstrations and reviews of existing products: Look at many to get a wide range of options.
• Request for proposal: Every bid should spell out exactly what you want.
• Training, support and maintenance needs: Without this, you will not be successful.
• Selection and implementation: Make sure you have people assisting with the transition process.

Choosing an EMR does not have to painful. It can be accomplished satisfactorily if you follow these rules and give yourself ample time to choose and implement a system.