Choosing a system for electronic medical records requires planning

Implementing an EMR system is the new cost of doing business as the health industry moves toward electronic transactions.

Implementing an electronic medical records system can be time-consuming and expensive, but in the long run can reward a practice with increased efficiency and revenue, according to one expert.

Practices that are considering adopting an electronic medical records (EMR) system should know the costs involved, be aware of the time it takes to implement such a system, and understand the practice’s needs and what it expects to gain, said practice management consultant Ron Sterling.

If properly researched and thoughtfully selected, an EMR system should benefit the practice, not hinder it, he said.

“It’s a worthwhile investment for many practices. They should seriously consider how it will affect them, how it will allow them to improve patient service, differentiate their practice, provide more services to their patients on a cost-effective basis, as well as make better use of their staff,” he said.

Mr. Sterling, a consultant who specializes in implementing EMR systems and practice management systems (PMS), said physicians have been told for years about the supposed benefits of EMR by the federal government, but few have adopted the systems to date.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) pointed the way toward electronic transactions between health institutions, but a provision that would have mandated the adoption of EMR systems was left out of the Medicare Modernization Act of 2003.

The issue of EMR has also risen as part of pay-for-performance initiatives aimed at instituting evidence-based medicine and lowering the cost of health care, he said.

The time is now

Regardless of government or private insurance initiatives, an EMR system can be a beneficial addition to a physician’s practice by improving the efficiency of the office’s operation, Mr. Sterling said. He said the time is now right to consider an EMR system for several reasons.

First, Mr. Sterling said, the price of the hardware has decreased. Second, the health industry is driving toward electronic transactions as the primary way of doing business. The medical profession is one of the few still working primarily with paper-based documentation, he said.

“Health care is one of the last industries where … physician practices are virtually not using computers at all in providing patient services on a day-to-day basis. They’re completely paper-based operations,” Mr. Sterling told Ocular Surgery News.

EMR systems have been met with skepticism by physicians, primarily because of their cost and because of questions about their benefits. If a practice knows what it wants out of EMR, however, the right system will be an investment that improves provider services, he said.

Where to begin

When considering an EMR system, know the implications and be realistic about the cost, Mr. Sterling said. Implementing an EMR system is a huge effort that requires commitment and use of resources. Some practices begin working towards a system but stop when they find out the cost, he said.

“A lot of practices undertake this effort. They start moving towards it, and when they find out what it’s going to cost, everything comes to a screeching halt,” he said.

To budget the cost of an EMR system, estimate between $1,000 and $2,000 per provider per month, Mr. Sterling said.

“If you consider the idea of that level of investment, you’ll have a lot more options,” Mr. Sterling said.

He said practices also should know the rewards. An EMR system can improve patient care by reducing the time to track patient medical records, especially if there is more than one office. It can decrease transcription costs and the cost of locating medical records, improve patient tracking and relationships with co-managers, and increase revenue, he said.

Know thyself

Practices should know what they want out of an EMR system once the costs are understood, Mr. Sterling said. They should devise criteria for the product they need: What issues does the practice deal with? Is there more than one office? How much time is spent on locating or faxing records to other offices? Can scheduling be improved?

“You have to understand who you are, where you are going, and what you want out of it,” he said.

Creating the selection criteria for an EMR system entails three main objectives, Mr. Sterling said. Practices should consider how patient charts are managed, how the work flows through the office and what documents are used.

“Those are the aspects you have to look at and ask, ‘What am I expecting out of my practice?’” Mr. Sterling said. “There are hundreds of other factors, but if you look at those three aspects, you’ll find there are some products that focus on charting and don’t do anything else.”

The goal is to create a list of wants and needs that fit the practice and avoid underbuying a product. Few systems can have features added to them, and replacing a system is nearly impossible, Mr. Sterling said.

“A lot of practices come up with lists that are very basic and may not fit their needs,” he said.

For example, there are structural components to some EMR products that apply to a single corporate entity or to multiple entities, he said.

Everyone in the practice must also accept the adoption of the EMR system, Mr. Sterling said. The practice manager must devise steps to include all patient data into the system. The process of locating and updating medical records will not improve if some data remain on paper.

Shop and compare

Mr. Sterling suggested comparing products that fit the practice’s needs with the selection criteria delineated. It is helpful to contact colleagues or vendors at exhibits and have them explain their systems, he said. Understanding how the system will work with the current PMS and HIPAA rules is also important. When shopping around, do not let price dictate the product choice, he said.

“Take a look at organizations that are similar to yours. See who’s advertising, who’s at trade shows,” he said.

Practices should consider systems that are also compatible to the PMS, Mr. Sterling said.

“Look at the EMR options available on your PMS,” he said. “You want to take a look at their product and ask, ‘Is this going to work for me?’”

The PMS should not be the basis for the EMR system selected, however. The EMR products the company has may not fit a practice’s needs. If a practice is unhappy with its current PMS, using that company’s EMR product may not improve the situation, Mr. Sterling said.

“Do not fall into the trap of buying the PMS’ EMR product,” he said.

Some features of EMR systems aid in compliance with HIPAA, but they should not be relied on solely, and the practice must have policies and procedures in place to comply with the rules. The purchaser must check the EMR system’s HIPAA features to ensure the office is in compliance, he said.

“Just because the system has the capability of complying with HIPAA policies doesn’t do any good unless you have policies and procedures in place to support it,” he said.

For example, if the system has an access log, the practice should ensure that only the proper employees can access patient medical records, he said.

The practice must also consider factors other than price when selecting a product, Mr. Sterling said.

“Don’t be price-sensitive going into it because chances are you will not look at the products that are appropriate for you,” he said.

When the system arrives

The practice must be aware that implementing an EMR system takes time, Mr. Sterling said. After a product is selected, negotiating a contract may take up to 60 days. Once the contract is signed, receiving the EMR system could take another 30 to 60 days. Implementing the system, including installation and staff training, could take between 6 to 9 months, he said.

“You have to get the doctors to validate the clinical content. Then you have to work on your workflow and deal with the interface between the EMR and the PMS. If you have a lot of subspecialties, you’re going to lengthen that time,” he said.

The practice also should be prepared to pay for the EMR interface that sends data to other systems. If the practice wants to interface EMR data with the PMS, both vendors will charge for the connection, Mr. Sterling said.

In many cases, implementing an EMR system will not lead to a completely paperless office, Mr. Sterling said. Some offices manually enter information from the PMS to the EMR system. For example, they continue to use a paper fee slip for billing from their PMS and enter that into the EMR system. The practice will also continue receiving paper documents from outside offices, he said.

The practice must also consider how many hardware and software licenses to buy. Staff may need hand-held devices or workstations to access the system. Each of these will also need software licenses. Some practices buy licenses only for the physicians, which excludes nurses, technicians and office staff from accessing the system, he said.

If unhappy with your choice

There are ways to improve an EMR system if the practice is unhappy with it, Mr. Sterling said. The process is similar to selecting a new system. He suggests going back to the selection criteria and then seeing what tools the current system offers.

“See what tools you have. Ask ‘What am I expecting out of it that I’m not achieving?’” he said. “Now go back and look at the process and see where you have not taken the EMR and applied it to the way you do business.”

Similarly, if the practice is considering replacing their PMS, consider a system that sends data back and forth with the EMR system, he said.

For Your Information:

• Ron Sterling, can be reached at Sterling Solutions Ltd., 1000 Kersey Road, Silver Spring, MD 20902; 301-681-4247/800-967-3028; fax: 301-593-6039; Web site: sterling-solutions.com.

• Jeanne Michelle Gonzalez is an OSN Staff Writer who covers all aspects of ophthalmology, specializing in practice management, regulatory and legislative issues. She focuses geographically on Latin America.