EHR/EMR Software Buyer's Guide
Just a few years ago, EMR and EHR were considered to be different types of medical records. EMR was referred to records of a specific instance of illness (say appendicitis) while EHR referred to longer duration records concerning the overall health of an individual. This distinction is now slowly going away and EHR is becoming the dominant data type.
Compliance with the HITECH Act requires medical practices to demonstrate meaningful use of EHRs. This implies e-prescribing, data sharing and demonstrable proof that a practice’s use of EHRs has resulted in improvement in patient care. There are strict requirements to ensure privacy of patient data and prevention of unauthorized disclosure.
While in theory a medical practice can implement only limited functionality and stay compliant with the law, vendors found that once electronic records were being maintained, they could be used very fruitfully to make practices far more efficient.
Benefits of EMR/EHR
Studies show that a small practice of just five physicians and associated staff can achieve the following benefits from their EHR implementation:
- 101% increase in total billing
- 96% decrease in transcription costs
- 100% decrease in chart supply costs
- Annual increase in revenue per practitioner: $ 461,868
Nearly half a million in additional revenue per practitioner annually is a big incentive for getting the EHR implementation right.
Getting Ready for an EHR Solution
As you decide to evaluate and license an EMR/EHR system, answers to the questions listed below could prove important:
- What are the benefits you seek from the system?
- Are your present workflows well designed and documented? Understanding the areas that can be improved makes it simpler to look for EMR /EHR systems that are strong in those specific areas.
- Will there be a requirement to integrate the EMR /EHR system with other solutions? Do you want an interface with your laboratory or hospital? Do you have a practice management or a billing system that you need to connect to? These issues need to be known before you short-list solutions.
- Does the new system require to be integrated with your medical equipment and devices?
- In which format is your data? Can it be easily imported to a standard database or will you need to change the format or structure of your data?
- What is the expertise level of your administrative staff? Do you anticipate hiring additional staff to handle this solution?
- What features of an EMR /EHR system are critical to your practice?
Selecting the Right Features
Broadly, there are eight different feature groups for any EHR system. Once you’ve defined your needs, you can select those that are important to your practice. These groups are:
- A robust web portal and patient portal
- Records of Physician / Patient interaction
- Physician support modules
- Data lifecycle management & System administration
- Support for mobile phones and tablets
- Security and compliance modules
- Physician Quality Report System (PQRS)
The features of each of the above subgroup are listed in succeeding paragraphs. Notice that billing and practice management do not form part of basic EHR modules although they can be linked and can sometimes be offered in the same package.
This is a website created by the EHR solution. It performs actions similar to what the practice’s reception would do. The portal offers two versions, customized for practitioners on one side, ad patients on the other side. The web portal automates and streamlines repetitive tasks and save patient data in a standardized format, which saves everyone a lot of time. Some essential features to look out for are:
- Patient registration, patient data management, patient login and account management
- Patient medical history records and management
- Creation of patient care chart
- Handle instructions specific to individual patients
- Patients follow-up, patient communications
- Information and support for caregivers
- Claims and reimbursement modules
- Appointment scheduling, intake forms, health education, etc.
Records of Physician / Patient interaction
This group relates to the documentation of patient interaction and overall health
- Handle physician’s clinical notes, SOAP notes, voice transcription
- Record and handle patient care instructions
- Order and record diagnostic tests
- Follow up on specimen collection
- Record and classify test results
- Assist in communication between physician, patient and their family
- Handle prescriptions and correct dosage
- Handle patient specific medication, suggest alternates
- Prevent drug-to-drug interactions, check for known allergies and drug interactions
- Direct transmission of prescription to preferred pharmacy
- Support latest version of clinical codes and simplify data entry
Physician Support Modules
- Record and manage patient authorizations and consent
- Automatic scheduling for routine and preventive patient care
- Various alerts and notifications to patients and caregivers
- Two-way communications between physicians and patients
- Handle cases of multiple physicians seeing a common patient
Data Lifecycle Management and System Administration
- Handle external documents
- Data lifecycle management, ensure compliance with regulations
- Securely handle legitimate demands on data. Share data with authorized agencies
- Ensure specified standards of patient care are achieved
- Assign tasks, ensure follow up and link to patient records
- Provide support for hospital workflow
Support Mobile Phones and Tablets
- Implement rules pertaining to “Bring Your Own Device” to allow physicians to use the device of their choice
- Entry of patient data as it is generated
- Review of patient details on mobile devices
- Handle referrals
- Handle appointments and communication with patients
- Synchronization with the main system
Security and Compliance Modules
- User authentication and rights
- Role-based access control and control over data access
- Controlled and secure data exchange with authorized agencies
- Compliance with patient privacy rules
- Set up administrative and financial rules
- Compliance with regulatory provisions
- Certifications: Certified EHR, CCHIT, ONC-ATCB
Physician Quality Reporting System (PQRS)
This is not a mandatory requirement under HITECH but proper implementation of PQRS helps practices gain 2.5% in their Medicare reimbursements. They avoid a 2% penalty and get 0.5% extra initiatives. When shortlisting EHR systems, ask vendors how they have implemented PQRS.
Quality of User Interface
If there is one thing practicing physicians are concerned about, it is data entry. Most practitioners are worried that they will waste valuable time entering patient data into the system. This is a genuine concern. Most modern EHR provide automatic transcription of notes, and sometimes voice recognition modules that populate data fields in-real time during the visit
When it comes to hosting the solution, there are two options: on-premises or in the cloud. Pricing usually depends on the number and type of users.
There are several advantages of running the solution in the cloud. The primary ones are:
- There is no requirement for additional infrastructure. The entire setup is managed by the vendor. You only use PCs / tablets that connect to the data center over the Internet. Costs of initial set up are low, payment is monthly; even small practices can afford a solution.
- Expenses on rental are listed as operating expenses. This can help reduce your taxes.
- You do not need any specialist staff to handle the solution or the database since the vendor handles all of these.
- Security and compliance are often far better than what is possible with a solution that is hosted in-house.
- Connectivity to smartphones and tablets is available instantaneously without any extra effort or cost.
- Upgrades are automatic.
However, do remember that once you commit to a cloud-based solution, you are dependent on Internet connectivity to access your solution; you will need to build in some redundancy for the Internet connection to your practice. Also, there are issues of control over your data. You will need to see the vendor’s policy statement about how they will assist you move your data out in case you choose to end your contract with them and move to another vendor.
Buying a solution outright frees you from the rental and data ownership issues and may make sense if your practice is very large. However, you must be prepared for high initial costs, qualified manpower requirements, backup and security issues, compliance and upgrades, etc.
In today’s environment, it often makes more sense to go in for a cloud based solution unless you have some very specific requirements or you are looking for very large scale deployment.
All medical practices will eventually migrate to EMR / EHR solutions. Doing so will take them to better standards of patient care, greater savings, better compliance, and improved overall efficiency.
During the selection process, it is important to assess whether the solution is easy to use in your own practice environment. This single factor can have a big impact on adoption and whether your implementation is a success or not.
In many cases, it makes sense to choose a cloud-based solution that costs much less upfront and can be set up with the least amount of effort. Even small practices with no technically qualified staff can implement a cloud EHR.