Choosing an EMR

The Duality of EMRs

Choosing an EMR is an important decision for every practice. The right EMR facilitates efficient scheduling, effective patient encounters, and aides revenue collections. The right EMR promotes communication and documentation among the staff, providers and patients. The right EMR is a harmonious fit for the practice. The right EMR allows providers and staff to focus on the necessities of patient care and practice performance. Everything is better with the right EMR.

The wrong EMR can simply kill a practice, interrupting every practice action on the strategic, operational and tactical levels. Part of the reason the wrong EMR is so devastating to a practice is the increased dependency on EMRs. Practices rely so much on EMRs that when they fail, there often are not prepared or available contingency plans. In the days of paper charts, a contingency plan was spare pens and pads of paper, but some practices are so accustomed to their EMR that they have no plan for when the EMR goes down. (Pens and paper still work!) The ramifications of EMR dependency can have significant consequences beyond inconveniences, though, such as when information is “lost” in an EMR with no backup available.

EMR Design

Once claim that almost all EMRs make is that they are “intuitive.” Many claim to have been “designed by providers for providers” and created because providers were disappointed in the EMR offering available for them. That may all be true–and good for those providers for wanting and finding something better. The issue for any provider choosing an EMR is how much they think like those providers, because not everybody processes information, charts encounters and responds to communications the same way. All EMRs have an architecture that dictates how processes happen. There’s no question that some EMRs have advantages over other EMRs in their design, but providers should select an EMR knowing that perfection is impossible. The goal is to make the best choice with the best information.

In considering EMR design, the object should be to understand the architecture underlying the EMR’s processes with the knowledge that every EMR represents a tradeoff. EMRs that strive for simplicity may not be able to handle more complex tasks. Some EMRs marketed to specific specialties may process information in ways that other specialties will find cumbersome. It’s not that there are necessary “bad” EMRs–though there are definitely bad EMRs–but that EMRs have to be a good fit for the office. It is important to consider features, but it is paramount that the design of the EMR make sense for the provider. Features are important–and they are discussed next–but be warned not to fall in love with features. Even the best features won’t mask an EMR design that is counterintuitive to providers.

EMR Search

Almost all have some redeeming features. They may have a robust messaging system, be more visually appealing, excel at managing documents, offer a patient kiosk, handle recurring payments–the possibility of exceptional features is considerable. At the beginning of an EMR search, the first step is to make a list of all desired features and then determine which features are “must have,” which features are “nice to have” and which features are irrelevant.

Online searches will help to generate a list of the most popular 40-50 EMRs. Include any other EMRs to consider. Make a spreadsheet with these EMRs and the must have and nice to have features with the must have features first. An EMR search spreadsheet might have “Cost,” “Cloud-based” and “Revenue Cycle Management” as the must have criteria and “e-fax,” “e-prescribing” and “patient portal” as the nice to have criteria. Include a column for Notes.

Look at each EMR for the must have features first. If an EMR doesn’t have one of the must have features, cross it off the list. If the EMR doesn’t meet the criteria for the must have feature–such as being too expensive–cross it off the list. It may take some research to get an accurate view of an EMR’s cost. Some EMRs include features in their base price, while other EMRs take a module approach with additional costs for features. EMRs may charge a fee both per provider and per staff, with EMRs using their own definition of “provider.” EMRs may charge for modules such as practice management, e-fax, and patient portal. Be sure to look at all of the expenses a practice would use to get an accurate cost estimate.

If an EMR has the must have features, document the presence and/or strengths of the nice to have features. Most EMRs now include features like e-prescribing and patient portals, but make any notes about perceived strengths and weaknesses of these features, including additional costs. Some of this analysis may touch upon the EMR design, such as where a provider can e-prescribe in the EMR. Do they have to be in the patient chart? In the prescription request? Does it take two clicks or ten clicks? Can patients be scheduled from their chart or does the staff have to go to the schedule first?

Finding the Fit

From the initial evaluation of must have and nice to have features, try to focus on the five or six EMRs with the most potential to be a good fit for the practice. Find out more about the EMR design by scheduling a demonstration of the EMR, search online reviews and talk to a representative to clarify any questions. Eliminate any EMRs that do not compare favorably to the others EMR on this final list.

Choosing from the final list of EMRs that would be a good fit for the practice really depends on the practice hierarchy. If the search was conducted by the lay staff or administration, the final choice could be up to the provider. If the provider conducted the search, the lay staff may need to weigh in on the final choice. Features can be given a weighted score by importance to calculate an EMR score to decide which EMR is the best fit for the practice. Maybe the practice decides to go with the most affordable.

By conducting an EMR search, the practice staff and providers will know what trade offs they are making for the EMR selected–as well as why they didn’t chose the other EMRs available. In creating the sample list available for the EMR Service Referral, the EMR chosen was one that was unknown at the beginning of the search, while many of the EMRs popular in integrative, holistic and functional medicine lacked one or more of the must have features for the practice. Again, no EMR is perfect, but taking the time to do some work in selecting an EMR can avoid buyer’s remorse and having to repeat selecting another EMR.