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Electonic Health Records » Which EHR is for us?

Finding the Right EHR for Your Practice

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News flash: One out of five electronic health records programs is eventually uninstalled. Here's good advice for docs who don't want to contribute to that statistic
You've seen the handwriting on the flat-panel monitor--electronic health records will replace your dog-eared, sometimes illegible and often misplaced paper charts. Medicine is copying the banking industry, which moves your money around on one vast electronic network so you can snatch a $20 bill from any ATM in the world.  
And maybe now you're ready to buy a program that digitizes vital signs instead of dollars. It's not just a matter of storing that data on a hard drive instead of paper. An EHR (sometimes called an EMR, or electronic medical record) will make all clinical data easier to use, automatically compiling and displaying a list of a patient's current diagnoses, for example. And a typical EHR will not only digitize common tasks such as prescribing, but also help you perform them with more medical acumen, thanks to "clinical decision support"--artificial intelligence that enables your EHR to warn you about harmful drug interactions as you write a script, or remind you when a patient's due for a Pap smear or colonoscopy.
However, figuring out what software to buy requires, well, a software program. Roughly 200 companies sell EHR software for physicians that varies widely in terms of capabilities, ease of use, vendor support and price. Some can't export a chart summary to a different EHR system or tell you--and quality-minded insurers--what percentage of your hypertensive patients have their blood pressure at a safe level. Clinical decision support may be minimal or nonexistent. And while low-end systems will ding you for only a few thousand dollars a year, others can cost up to $50,000 per physician over three years, according to one estimate, when you include implementation, training, support and other ancillary expenses. And this figure doesn't include hardware.
"If you don't choose the right program, you can experience a pretty costly failure," says Atlanta internist Jerome Carter, M.D., whose consulting company NTM Informatics helps doctors avoid such failures, which are common. Roughly one out of five EHRs gets uninstalled, reports the Medical Records Institute.
So how do you select the EHR that's best for you? We interviewed Dr. Carter and other experts to come up with doctors' orders for your shopping expedition.
1. Analyze your needs, set goals.
Before you contact any software vendor, consider: What exactly do you hope to accomplish with an EHR? Answering that question means dissecting your office routines, pinpointing your biggest logjams--unfiled lab results, say--and then determining how computerization can eliminate them. You also can frame the question in terms of opportunity. Perhaps you want an EHR to produce data reports--like the percentage of diabetics whose hemoglobin A1c is under 7--that will qualify you for an insurer's pay-for-performance bonus. Once you set specific goals for your EHR, you'll know what crucial features to look for.
Involve your employees in this analysis, adds Dr. Carter, author of the guide Electronic Health Records (available from the American College of Physicians at ACPOnline.org for $64.95, with ACP members paying $10 less). "Your staff will use the new system just as much as you, so it should solve their problems, too," he says.
2. Consider a certified program.
One way to narrow down the field is buying  an EHR with a stamp of approval from the private, nonprofit Certification Commission for Healthcare Information Technology. This group certifies EHRs that meet 275 performance standards, whether it's the ability to write a prescription, maintain a log of who has viewed the chart as a security precaution, or exchange data with another EHR program. So far, CCHIT has blessed 146 office-based EHRs from 98 vendors, representing almost half the market.
Don't put blind faith in certification, however, cautions Rosemarie Nelson, a health care computer consultant in Jamesville, New York. "I've seen certified programs that perform miserably," Nelson says. Certification, after all, doesn't factor in user-friendliness (more on that later). Certified programs also tend to cost far more than uncertified ones and cater to the needs of large groups that can afford them. In contrast, small practices often get good results from inexpensive, less complex and uncertified programs.
Still, it's hard to ignore certification, especially when it's becoming a requirement. Minnesota, for example, has mandated  that all health care providers begin using EHR systems by 2015, with the extra stipulation that the software must be okayed by CCHIT.



3. Take advantage of specialty-group resources.
Web sites of major medical societies such as the ACP and the American Academy of Family Physicians abound with advice about selecting an EHR. They often include what resembles a preferred list of vendors as well as product reviews by doctors. Members of the Medical Group Management Association can find similar resources at its Web site, including an EHR selector tool.
You may be able to get your high-tech questions answered on specialty-group Listservs , notes family physician Lou Spikol, M.D., in Allentown, Pennsylvania. Sometimes a doctor will hear a complaint about a program only to discover on a Listserv that most users have never experienced it, says Dr. Spikol, a former consultant for the Center for Health Information Technology at the AAFP. "The wisdom of the crowd is not to be pooh-poohed."
4. Consult product rankings.
A health care IT research firm called KLAS constantly surveys EHR users to rate software vendors, focusing mostly on customer satisfaction after the sale. Poor implementation, training and support can doom an otherwise stellar program. Blunt questions like "Would you buy from this vendor again?" get to the truth. KLAS charges doctors $500 for its "Top 20 Best of KLAS" report, but you can research individual vendors at its Web site free of charge by completing a questionnaire about medical software, equipment or computer services that you use.
A consulting firm, AC Group, periodically ranks EHR vendors on factors such as software functionality (what companies say their products can do), price and customer satisfaction data from groups like KLAS. Soloists should focus on rankings in the one-to-five-doctor market. Summaries of software reports cost $49.95; AC Group charges you $129.95 for the whole shebang.
5. Test drive software.
You can sense a program's degree of difficulty--is the screen overloaded with buttons and tabs?--by viewing a demo on a vendor's Web site, but nothing beats giving an EHR a spin around the block yourself. That's possible by attending a medical-society conference and hitting the exhibit floor where EHR vendors have pitched their booths. Some companies may come to your practice for a show-and-tell session. Or ask a colleague with an EHR to let you click away.
To make these tryouts meaningful, use the EHR in a clinical scenario of your choosing--a patient who needs prescriptions for two chronic conditions, for example--as opposed to following a salesperson's lightweight script. All the while, evaluate user-friendliness, says Dr. Spikol. Is the program intuitively grasped, or does it defy medical logic? How many mouse clicks does it take to renew a prescription--2 or 12? How easy is it to look up an old blood pressure reading? Give employees a turn at the controls, since their opinions also count.
Take all these steps, and you'll able to identify three or four safe picks--and, ultimately, an EHR system you won't be unplugging a year later in a fit of frustration.

Editor's note: Next month's column will discuss how to select a champion from the field of contenders and close the deal.


Number of years EHRs have been around

Percentage of office-based physicians with
partially or fully automated charts in 2006

Percentage of doctors with comprehensive
EHR software in 2008 allowing them to order prescriptions and tests, view test results, and chart patient visits.  

Award-winning journalist Robert Lowes has reported on the medical profession for 20 years.


Source: http://www.diversion.com/technologybusinessdetail.aspx?id=17&pageid=2 by Robert Lowes                  

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