the path to paperless
Choosing the Right Software
Find a vendor that meets your specific needs.

By Peter J. Polack, M.D., F.A.C.S.

For those of you who have been following this column from month to month, it may come as a surprise that we are just now discussing the decision-making process in deciding which EMR software we would use.

But it was our original plan beginning about 2 years ago to first establish a strong foundation and infrastructure to ensure the successful implementation of whatever EMR product we chose.

In this article, I will outline the criteria that our practice used in the selection of our EMR vendor. I will also explain how and why we made the decision to go with a specific vendor that we found to be right for the needs of our five-location, 140-employee practice. I would like to emphasize that other large and small practices now contemplating an EMR implementation might have different requirements and should base their choice of a vendor on criteria of their own choosing. I present our process only as an example of how a choice on an EMR vendor can be made.

	ILLUSTRATOR: MARK HEINE/ DEBORAH WOLFE, LTD

Our Plan Evolves

But first some history.

Ocala Eye had been using an electronic practice management (EPM) program called Fiscal until the late 1990s. That company then decided that it would concentrate on hospital-based systems and would no longer service practice-based systems as of the year 2000, and the version of Fiscal we had was not Y2K-ready. The practice decided to switch to Medical Manager's EPM, which was well-established at the time, was a robust program and was Y2K-ready. We had no immediate plans to convert from paper records to an EMR system at that time, although we knew that Medical Manager was developing its own EMR system.

We, as physicians (and particularly as ophthalmologists), tend to be easily enamored with new toys and gadgets. And there were many times when we had to resist the urge of bringing home a flashy EMR product that we fell in love with at the latest Academy meeting. But then we remembered our plan and turned over the information to our EMR committee, which comprised administration and representatives from IT, the business office and our technical staff departments. A primary goal of our EMR committee was to establish the major criteria for selecting an EMR system that would be specifically suited to our practice.

Selection Criteria

First, our EMR committee established some general guidelines for what we wanted from an EMR vendor. We were only interested in companies that had at least a moderate market presence and that could be expected to be around for quite some time. The vendor also had to have an existing EMR program and some experience with ophthalmology.

Next, we settled on four major criteria on which we would base our decision:

1. We wanted a robust ACID- compliant relational database for several key reasons: we wanted the data to be protected and able to recover fully from failure, not just restore from backup; we wanted a database backend that would scale well as we grew, and we wanted something with an open interface that we could report on. By the way, ACID-compliant means that the database has the desired features of atomicity, consistency, isolation and durability.

2. We wanted a system that could be fully supported on both thin and fat clients (remote control and direct control, respectively) to accommodate the low bandwidth of our satellite offices.

3. We wanted a system which would give us the ability to create, modify and design powerful graphically based EMR templates with normalized data (not text).

4. We wanted a product and company with a strong practice management product that integrated with EMR. We did not want to install a system with duplicate data entry and where all patient information is not accessible from both the EMR and EPM.

After reviewing the products of about a dozen or so EMR vendors that had some experience with ophthalmology, we narrowed these down to a short list of about four. These vendors were then invited to make a presentation to our EMR committee. After analyzing their capabilities and checking references from ophthalmology practices and practices of other specialties, we chose NextGen Healthcare Information Systems from Quality Systems, Inc.

Reasons for our Choice

In addition to having a strong database and full support on thin and fat clients, we found NextGen met our needs regarding customization of its EMR templates. Also, NextGen not only had an award-winning EPM product, but we found its interface to EMR superior. Today, NextGen no longer uses an interface, but rather both EMR and EPM share a common database. Rather than shipping patient data from one product to another, it is already native to the application because of the common database.

An added bonus provided for by this integration is the fact that the EPM is a fully HIPAA ANSI X12N-compliant claims engine, which allows us to have direct EDI (electronic data interchange) with all HIPAA-compliant payers. We were able to drop our clearing house totally, which not only saved us $11,000 a year, but also enabled us to shave a few days from accounts receivable because it removes the middle man.

We have found NextGen to be a good company with which to work, a critical element in the success of a project of this magnitude. They have been receptive to suggestions and have a helpful users group made up of members from practices across the country. This group periodically meets for training and discussion.

Next: Setting up a Training Plan

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 140 employees. Dr. Polack can be reached by email at ppolack@ocalaeye.com.

In a multipart series, Dr. Polack is describing how a seven-partner practice, Ocala Eye in Ocala, Fla., with five locations and 140 employees, makes the major transition from paper medical records to EMR. During the course of the series, Dr. Polack will provide readers with a "real-time" look at how the implementation is progressing. This is part 11 of the series.