Benefit from a Switch to Electronic Medical Records
What You Should Know Before Purchasing an EMR System.
By Jerry Helzner, Associate Editor

Healthcare providers who make the transition to electronic medical records (EMR) systems are likely to see improvement in such key areas of their practices as productivity, patient satisfaction, reimbursement levels, patient volume and overall staff morale.

In a broad-based survey of providers conducted by the Medical Group Management Association (MGMA) Center for Research and Pfizer Health Solutions Inc., a majority of respondents said that switching to EMR helped performance in one or more key practice metrics. (See "The Benefits of EMR Implementation" on the next page). The one negative that a significant number of respondents did associate with EMR was cost -- more than 27% of those who replied to the survey said implementing EMR had at least initially increased their operating costs.

The results of the survey reflect a growing interest among medical practices in making the transition to EMR. Survey responses indicate that while only 21.6% of healthcare organizations have already implemented EMR, another 67.9% are considering adopting such a system.

"Many assume that the healthcare industry is afraid, and slow, to adopt technology," says William F. Jessee, M.D., CMPE, president and CEO of MGMA and the MGMA Center for Research. "The results of our survey show an exciting paradigm shift in the healthcare industry. Physicians are realizing the importance of technology and embracing it to improve productivity and patient satisfaction."

If your practice is one of the many now interested in installing EMR systems, it's important to recognize that the switch from a paper-based office to electronic record-keeping involves a great deal of detailed research into which vendor can best identify and meet your practice's needs. It also involves an initial investment that could run into hundreds of thousands of dollars, and a difficult transition period.

In this article, we'll look at how practices that responded to the MGMA survey have approached EMR implementation, and also offer some guidance on the questions you need to ask before undertaking your own EMR installation.

EMR is the wave of the future

"Despite what many believe about the Health Insurance Portability and Accountability Act (HIPAA), there's no government mandate that's going to force your practice to switch from paper charts to EMR anytime soon. But the entire healthcare industry is quickly moving in that direction and even smaller practices should be able to derive real benefits from going electronic," says Robert M. Tennant, MGMA government affairs manager and board member for the Work Group for Electronic Data Interchange (WEDI). "I've talked to many practice administrators who've made the switch and they all say they'd never go back to a paper-based records system."

Experts say one of the major reasons that every practice should consider having EMR is because electronic capability can be used to achieve a higher level of patient safety. With many electronic medical records systems, a physician who's on call over a weekend or on a holiday can remotely and immediately access a patient's complete record and make sound treatment decisions. The ability to access records becomes even more important when the on-call physician is dealing with a colleague's patient with whom he has had no previous contact. The on-call physician can even print out a treatment protocol and provide it to the patient in the office, or via e-mail.

"Having that kind of capability not only increases patient safety, it also results in a higher level of patient satisfaction with the quality of care you're delivering," says Tennant.

Another benefit is that an EMR system is efficient and, in the long term, cost-effective. With electronic medical records, you'll eliminate time-consuming hassles with lost or misplaced paper charts. You'll also save the estimated $7 to $15 it costs a practice each time a paper chart has to be pulled.

Determine your needs

Tennant and other experts say that your first big decision is determining whether you want only a computerized medical records system, or a completely electronic office encompassing such functions as practice management, billing and scheduling.

"It's best to go with a modular system that will enable you to upgrade as you want to add more electronic functions," says Tennant. "There are literally hundreds of vendors of EMR systems around, offering everything from off-the-shelf software to customized solutions tailored to individual practices. It's important that you purchase from an established vendor who'll be around 3 years from now when you need to upgrade your system."

Specialty-specific medical records software is now available. For example, HealthIS has just introduced EMR+ Ophthalmology, which the Connecticut-based company says is "designed by ophthalmologists for ophthalmologists." The basic EMR+ Ophthalmology software can be further customized to meet the specific needs, preferences and terminology of any ophthalmology practice.

Implementing EMR

According to the MGMA survey, practices that experienced the smoothest and most productive EMR implementations give several reasons for their success. Those factors cited most frequently include:

• generating active physician and staff involvement in the implementation process
• conducting thorough on-site staff training, provided by the system's vendor
• having a pre-installation plan
• making a site visit to a healthcare organization already using the same system.

The survey also indicates that practices that are hesitating to make the transition to EMR say that they're having difficulty in surmounting the following barriers to implementation:

• insufficient financial resources to invest in improved information technology
• lack of time and human resources to retrain the staff for switch to EMR
• anticipated problems in attempting to integrate systems
• no assurance of a return on the investment
• lack of physician support in making the change.

Choosing a vendor

Clearly, one of the most critical decisions you'll have to make if you decide to install an EMR system is selecting a reliable vendor who'll meet your needs..

Tennant advises doing extensive research before making that decision.

First, gather information about specific vendors and possible implementation issues. Have your practice administrator talk to the administrators at other ophthalmology practices that have already installed EMR systems and learn about their experiences. Perhaps they can warn you of a potential pitfall or recommend a particular vendor who's satisfied their needs. Also consider contracting with a consultant who will do the legwork and recommend an EMR system that's suitable to your practice's requirements.

In recent years, The American Society of Cataract and Refractive Surgery (ASCRS) and the American Society of Ophthalmic Administrators (ASOA) have offered an annual, comprehensive 3-hour course in implementing an electronic health records system The course, which includes live demonstrations of competing EMR systems, typically draws standing-room only audiences of practice administrators and physicians. It will be offered again at the ASCRS convention in Philadelphia in June, says Lucy Santiago, ASOA executive director.

Once you've familiarized yourself with all the features that can go into an EMR system -- and you've decided what you want -- interview several potential vendors that have passed your initial screening. Find out if the EMR system they want to sell you will seamlessly integrate with other electronic systems, such as billing, that you already have in your office. Have them demo their system for you. Request a site visit to see how one of their installations works in a real-world situation at a similar-sized ophthalmology practice. Ask what kind of transition training they'll provide to your staff. Determine if the vendor's system will be compliant with the strict federal patient privacy regulations that go into effect in April of next year, and the security regulations that are expected to follow soon after. Ask about the cost of the monthly maintenance fees the vendor charges for system upkeep.

Don't be afraid of making a pest of yourself. You're going to be making a major investment in your EMR system, and you're going to have a long relationship with the vendor you select, so continue to ask questions until you feel completely comfortable with all the answers. Then, and only then, should you make your final decision.