Everyone by now has at least heard the rhetoric (good and bad) about electronic medical records systems (EMRs) for physician offices. Some of the readers of this may even have one installed.
So, do you need an EMR for your office? And, as importantly, should you get an EMR for your office?
The question of need must be qualified further: need now, or need in the future. While there are many qualities of an EMR that suggest EMRs are truly desirable for improved patient safety, improved quality of care, and often improved productivity, whether or not your office will see such benefits is a much more difficult question. A readiness assessment of your office’s ability to adopt new technologies is the first step to determining your practice’s ability to successfully implement an EMR. (see " Are you really ready for an EMR in your office?" )
The answer is, of course, more complicated than a simple “yes” or “no”, much like a similar question of “what is the best automobile for me”.
What car is best for you depends on a multitude of factors: your budget, intended purpose(s) (commuting by yourself, pulling horse trailers, carrying the girls’ basketball team, etc.), reliability expectations, nearest dealer for service, etc. A BMW or Mercedes convertible would be great for top-down summer driving, but perhaps not so great for pulling the horse trailer. A budget that allows only the purchase of a Kia will put a new Buick out of reach. Thus, there is no one best car for everyone, just as there is no one best EMR for everyone.
The biggest question on physicians’ minds, though, is not just “should I get an EMR”, but “is it worth it?” Like the above “do I need it” question, the return on investment is dependent upon a slew of factors, most importantly of which centers on actual use of the system selected. Enhanced functionality of an EMR is of little use if the practice does not universally use the system. Systems that require significant manual entry of data, rather than interfacing and interchanging data with external and third parties, are less usable. Patient ability to access their data, on-line and independent of visits, will likely significantly increase usability of the system when deployed. Yet many physicians, practices, and vendors seem to forget that just automating existing processes may not yield the desired improvement in efficiencies. Automating bad processes just yields bad outcomes faster.
Electronic medical records have been available for decades, but the office marketplace for EMRs has not had good penetration to date, with about 15% of offices in the U.S. having an EMR (varying widely based on specialty and practice size). Some specialties are well suited to automation, with similar and predictable reasons for patient visits (such as OB/GYN and Pediatrics). Other specialties and sub-specialties may have sufficiently niche requirements for content to be difficult for the large, generic EMR companies to address.
The federal government is weighing in on the need for EMRs, with CMS (Medicare / Medicaid) pushing for EMR use to be able to address quality and performance measures. Already there is a “bonus” of 1.5% of Medicare payments available to physicians that can provide certain performance metrics that can only be reasonably and economically captured via electronic health records. E-prescribing, also able to be accomplished now with some hand-held devices, really does work better within the electronic medical record world, with the automatic importation of a patient’s current medications into the system. As healthcare information technology is a priority for not only the current administration, but both the Democratic and Republican candidates for president, one may expect a continued push for EMR adoption as a priority of the next administration as well.
Electronic medical records can be net-positive time savings, making the practice more efficient and profitable. An EMR may also be net-negative, with the wrong system, poor implementation, or poor technology adoption. EMRs can certainly improve patient safety and quality of care, provided rules and alerts are not turned off, and the EMR system is a modern one.
Some of the challenges of functionality evaluations are being addressed by the Certification Commission for Healthcare Information Technology (CCHIT), which lists vendor companies that have successfully passed a testing scripting. The benefits of this testing means that physicians can know that Vendor A’s software will do certain things that they may want. The down side is that, at present, actual usability of the software is not tested, meaning Vendor A’s software may do X, but it may take 20 clicks of the mouse to actually do it! And, the current testing for CCHIT does not include most specialties, including OB/GYN. The first specialty certification will be Cardiovascular, and the first population care will be Child Health. OB/GYN is not likely to be included for some time.
So, where does that leave us? The first step recommended in considering an EMR is the readiness assessment of the practice as mentioned previously. Enthusiasm of one or two members of the practice is not usually sufficient to carry the rest of the practice if all are not in agreement. An independent evaluation of the readiness can help identify obstacles and define whether change management techniques can assist in the process.
Second, assuming a go-ahead for purchasing an EMR is the outcome from the readiness assessment, evaluating the available choices of vendors is next. Setting requirements to be met by the vendor’s product by a RFI or RFP process may be appropriate for some practices (particularly large or complex ones) but may also be unduly burdensome both for the practices and the vendors. Consultants again may assist in creating a good process and plan for evaluation, and winnow the field of prospective products to a short list for a full evaluation engagement.
How successful your practice will be, and how good your return on investment is, are partially dependent on your time and input in preparation for not only the vendor selection, but the implementation of the chosen product. Done properly, an EHR can be a great thing. Done wrong, like most other things, leads to unhappiness and regret. Choose wisely and well, with the support of those who understand and have gone through the same process successfully, and your odds of success are greatly enhanced.
The author, Michael McCoy, MD, FACOG, is CEO of Physician Technology Services, Inc., a consulting firm based in Nashville that is focused on EMR selection and deployment, optimizing office operations with Health Information Technology, as well as planning and support for data and disaster recovery.