Symposium on Health Information Technology - July 2006
By John Lubrano, PhD
Choosing an electronic medical record (EMR) system is fundamentally different from choosing a practice management system. Electronic practice management systems are well established, and functionality across products has largely been standardized. Scheduling, billing, and reporting are fairly straightforward processes, and medical office professionals are well versed in these systems. Typically, the physician's interaction with the practice management system is minimal, so the preferences and requirements of the practice administrator influence both selection and use of the product.
The opposite is true of EMR systems. Functionality across products is nonstandardized and complex, the learning curve is steep, and physician interaction with the software will be intense.
Because physicians are typically the main users of EMRs, they cannot delegate the evaluation and selection of a product.
Devils and Details
When evaluating EMR systems, be very specific with the vendor about exactly what you expect the product to do. This requires developing a very specific list of features and functions you expect from a system. Lacking a clear view of what you're trying to achieve will increase the chance that you will be disappointed in your purchase.
For example, one physician wanted his EMR system to sync his schedule with a personal digital assistant (PDA), so he purchased one with a PDA-sync feature. When he ran the sync for the first time, his schedule for the next 30 days and the charts for the patients on the schedule were downloaded to the PDA. However, he expected and wanted his schedule for the entire year, and he wanted the ability to download only selected charts.
Document scanning was particularly important to another practice because many patients would have existing records from other practices. When the first patient presented a 12-page chart, the chart was scanned. However, instead of generating a single, 12-page image file, the system's scanning feature generated 12 one-page images. That EMR system did not support multipage scanning.
These examples highlight the importance of thorough research and planning when you select your EMR product. With a decision of this importance, it is imperative to get references and visit a few practices using the product(s) you are considering. Ask the vendor(s) to provide references that share your practice size and specialty, have been using the product for at least a year, and use the components you are considering. There is no substitute for seeing a product in action and getting feedback from physicians who have been through the process with a specific vendor.
Tablet or Not?
A tablet PC (in the truest sense) is a computer that resembles a slate or legal pad. Instead of a keyboard or mouse, the operator uses a digital stylus to select prepopulated information or to write.
While tablet PCs can be very effective for electronic charting, in my opinion, these devices have been somewhat oversold. EMR systems almost always presume the use of a tablet PC and neglect to account for the user's proficiency. Clearly, some people are uncomfortable with using a stylus. For them, a keyboard/mouse or dictation is far more effective.
It's not uncommon to find physicians struggling with both the software and the input device. The combination results in high anxiety and broken tablets. Before you buy a tablet PC, be confident you can use it (or learn to use it) effectively. If not, don't feel you have to get one. Traditional laptops or workstations outside or inside exam rooms are viable alternatives. The bottom line is: Use the input method that will allow you to chart in the least amount of time and will match your practice style.
If you are going to chart with a tablet, take some time to pick the one that's best for you. You should be able to find one or two models at local consumer electronic stores. Alternatively, visit other practices using tablets, or ask software vendors if they have units you can borrow. The weight, look, feel, and screen size vary across manufacturers. Find the one that matches your preferences.
You Say poTAYto, I Say poTAHto
To an EMR vendor, implementation means managing project deadlines for hardware installation, software setup, and training. If these deadlines are met, the vendor's implementation responsibilities end. The product has been installed and the users have been trained. All subsequent issues fall under "support."
But to a physician's practice, system implementation means the users are fully engaged with the product and are fully exploiting all of its capabilities. There is a common and understandable expectation that the vendor will proactively and systematically follow up to keep the EMR adoption on track. This, of course, never occurs. To EMR vendors, this is outside their responsibilities.
As a result, the physician's practice can feel left to sink or swim on its own. Users struggle to learn the software and flounder. Support calls are made. Some issues are addressed, others are not. A gulf between what the practice expected and what it achieves develops. The end result is dissatisfaction with the product and/or vendor - all because of a difference in the definition of implementation.
Implementation is not adoption assistance. EMR adoption takes time, effort, and coordination. This won't come from the EMR vendor, so don't expect it to. Instead, appoint a taskmaster responsible for keeping the EMR adoption on track. He or she will keep the list of functionality to be implemented, the timeline, and deadlines. He or she will remind those in the practice to fulfill their obligations and will call the vendor for support and clarifications when necessary.
This need for a taskmaster is especially important for an existing practice converting to an EMR system. A full patient load and administrative demands make it easy to stagnate. EMR adoption gets relegated to whatever time is left over, which often is not much.
Be careful about burdening your office manager or practice administrator with this role. He or she already is working hard to manage the administrative side of the practice. A portion of EMR implementation will necessarily fall on him or her by default.
John Lubrano, PhD, is the founder and owner of Protis I.T. Solutions. For eight years, Protis has provided information technology consulting and support for professional service firms inTexas . Dr. Lubrano specializes in office automation and EMR deployment for medical practices and works exclusively with TMA Physician Services as its technology expert.
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