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The other day I came across a great quote by Paul.C over on EMR Update.

"Choosing an EMR is like getting married: Unless you make a really lousy choice, you will be happier than before.. It can take as long to find an EMR as a spouse, and it's a huge deal to divorce your EMR and wed another. I'm still waiting to see if I have a midlife crisis with my EMR."

The idea of Electronic Medical Record (EMR) software has attracted much debate as of late. Physicians are hearing about the benefits of EMR, and the impending federal mandates concerning the conversion over to electronic medical records. Unfortunately a common mistake committed is that we tend to rely solely on the EMR vendor to make the right hardware and implementation recommendations. You must consider the product, its fitness for your specialization, the cost, ease of implementation, office work flow changes, ROI and long term non-financial benefits such as improved quality of care, automation, and quality of life changes. Here are some tips you can use to help ensure that you can make the right choice.

The simplest path to purchasing an EMR could be Planning, Vendor Selection, Request for Proposal, Support, Client/Server vs. Web Based EMR and the Final Considerations.

let us look at each stage,

Planning:

Before jumping onto the proverbial EMR/EHR (electronic medical records/electronic health records) bandwagon, it is important to look at the total picture. The place to begin would be to examine your motives for thinking that it is time to convert over to electronic medical records. Perhaps asking yourself whether you want to improve patient care or the efficiency of the office, or whether you want to make more money or the fact that you want to go home earlier might be factors in establishing your goals of implementing the electronic Medical Records system at your practice.

Next let us outline a couple of financial based studies that a Physician can do to help with the selection process

EMR Cost-Benefit Analysis: This is an estimate of costs against benefits done by the EMR system. Some of the most common costs that are taken for granted or overlooked are staffing, transcription, billing and collection costs, office supplies, chart management, and storage. By weighing the cost of the EMR against the current expenses like those mentioned above that might decrease upon the implementation of an EMR, we get get good idea of the cost benefit.

EMR ROI: The Return On Investment (ROI) is more a exact form of assessment than a Cost Benefit Analysis. Keeping in mind that it is not simply the product, but how it is utilized, the physician needs to think of the impact on other systems such as billing, networking and other computer systems. How will the interfacing work? What is his time and that of his staff's worth? In addition to the EMR software, costs for maintenance and upgrades to the software, additional hardware, and hardware maintenance costs are incured. How will this affect the ROI?

EMR Vendor Selection:

With so many variations in feature and functions of the EMR products existing, the question of technical proficiencies needs to be addressed. If the product is too technically advanced for the user full use of its capabilities may not be possible and this would result in paying more for more than is required and not getting the benefits of a good return on your investment. This is why matching up the practice with the right EMR is so critical.

No two practices are identical, so choosing an "off the shelf" EMR application vendor will introduce costly shortcomings in the effectiveness of its use. Almost all practices use some type of EMR application and Practice management Solution. Most Vendors provide complete solutions that are actually well interfaced individual applications. These have their own data bases and data communication is via interfaces. This has been the cause of widespread concern because duplicity of the data entered and the chances of incorrect or forgotten details occurring. Savvy vendors tightly integrate the two there by ensuring that you get the benefit of the seamless work flow.

Ask the right questions when you interview the EMR Vendors: Before interviewing the EMR Vendor you must spend time researching on EMR products and trying to understand which one best suits your practice. A set of questions must be prepared well in advance before you meet the vendor. Some questions that you might want to ask are, what is the cost per physician license? Do you have any existing clients in our specialty? Does your system come pre-loaded with templates for my specialty? Is your company the developers of the software or is it re-branded from another vendor? Is your system client/server based or ASP based? Does your system include practice management software? How many clients does your company have? Is your system HL7 compliant? How long has your company been in business? Is your development done overseas? Is support done overseas? How often is the software updated? As you meet more clients you will learn more.

Most importantly If the EMR vendor promises customization or enhancements to features that will suit your needs, get it in writing beforehand and add it to the contract. Remember, if it is not in writing, it doesn't exist.

RFP: Request for Proposal:

The most preliminary step in the decision making process, a request for proposal is sent to a set of shortlisted Vendors. Some may not respond to this as they would like to find out whether you are a serious buyer or just shopping for quotes. Responding to a RPF can be quite time consuming and expensive, so if you just want to know the cost you might want to ask for a "ball mark" Figure. Just try and make sure that This figure is broken down to an itemized account of the costs involved like
the cost of the software, installation of software, training on software application and in most case the travel expenses of the vendors training staff.

Don't be afraid to tell the companies that you are looking at different vendor quotes as this could allow you to drive a better price with little to no cost for customization.

Electronic Medical Record Support:

A common saying in the Software Industry best showcases the importance of support: "Clients buy on features and leave because of the lack of Support". While interviewing the EMR Vendor, be sure to check references asking about technical support. what is the maximum "on hold" time before your telephone call is answered? Do you get an issue tracking service which allows you to track online the
status of reported issues. What are the time frames involved with regard to the resolution of issues raised. A common mistake committed is the confusion of technical issues with customization needs. These should be treated separately, while a technical issue should be resolved by the technical support team, a customization requirement is bound to take to take longer as it is depended on the allocation of the
Programming staff and may even require a separate RFP.

As more and more Practices go with an EMR, the vendor is faced with a resource crunch and the need to add to the technical support team will grow. Some vendors address this problem quickly while others don't. As your Practice grows the need for additional training for the new hires by the EMR vendors technical staff may arise. inquiries on how this need will be met can be used to approximate how well the company is managing growth and how likely they will be able to support you in the future.

Deciding whether Your practice should opt for Client/Server or a Web Based EMR:

Both models have advantages and disadvantages. Lets explore the advantages and disadvantages of each model so that you'll be able to make an educated decision when choosing the right EMR for your practice. The Web Based EMR is a remotely hosted software system accessed via an internet web browser.
Its is usually accessed by paying a rental or service fee. As the server is not located in your office your initial setup costs are almost negligible with the added advantage that all technical aspects of the server are managed by a professional IT company. it is secure and HIPAA compliant. It also allows you to access all of your information at any time, from any place with internet access. The obvious disadvantage is that because the fees never stop the cost over the long term adds up and it usually ends up being more expensive than using a Client/Server-based system. You would also not be able to have the level of customization that you would like because the host server is being accessed by other practices so a generic template is offered that takes care of all users needs.

The Client/server EMR model on the other hand is much faster and depending on the number of patients and the size of the practice you might want to verify whether you can justify the vital seconds that are spent everyday waiting for data to transfer over the internet in a web based model especially during the peak traffic hours of internet usage. Client/Server also boasts the benefits of practice having the control over their data. However with this control comes with the responsibility of data management as you now become vulnerable to the risk of theft, fire, hard-drive failure and data corruption.

Final considerations:

Final vendor selection should include input from your office personnel. Will their lives become simpler in not having to file or track down the paper chart; or will they loose their job? The last being a major concern among most staff members. Studies have shown that Involving the staff members in the selection process can help in the success of its implementation.

A lot of people have asked me whether a practice should seek out the assistance of a professional EMR consultant? I feel the decision to move to an EMR is a big step. The practice is now recognizing the need to convert for many different reasons. This should be an exciting time in the practice, not a tumultuous uprising. Working with a professional organization during this time can remove much of the unease from the decision and implementation.

With years of experience in successfully providing Custom Health care Software Development solutions for clients across the globe, we at Binary Spectrum have honed our processes and skills to cater to your specific business needs. We do not believe in the "one box fits all" philosophy but instead work with our clients to acquire a greater understanding of the processes of their practice before implementing a customized Solution for them.

The Author Prakash T.C. is a Support Manager at Binary Spectrum