Your questions and concerns addressed: Is it time for electronic medical records in your practice?
A wind of change is blowing through health care as paper systems are being converted to digital records
IN THIS ARTICLE
People. Physicians and staff in the practice are always the key to success when implementing an EMR system. Consider a vendor’s ability to assist with the human variables of change management when you assess systems. Even the best EMR cannot save a practice from a poorly planned and executed transformation.
The 2 primary configurations of an electronic medical records system reflect the way that the system holds, handles, and delivers data.
Client-server application. This type of EMR resides on-site. The medical practice owns the software and hardware and is responsible for data backup, disaster recovery, database maintenance, security, Internet distribution for remote access, and information technology (IT) support. The practice is responsible for loading maintenance and upgrade updates into computers.
Client-server applications are usually sold as an upfront purchase with annual upgrade and maintenance fees that are 18% to 22% of initial cost.
Because the cost of EMR downtime is so high to a practice, you must budget for professional IT staff to establish and maintain high-availability (redundant) servers, Internet access, business continuity plans, network and database administration, security and intrusion detection plans, and data backup.
Remote-hosted system. An Application Service Provider (ASP) system is hosted from a remote data center and distributed through the Internet. Upgrades are deployed regularly to subscribers by the vendor, also by way of the Internet, without need for the practice to install disks or make changes to the server. Data are stored at data centers and backed up in real time. Data backups are maintained at remote sites for disaster recovery. An ASP system enables physicians to have access to patient records at any location that has Internet availability.
ASP systems are usually sold by monthly subscription, which includes fees for upgrades, support, maintenance, security, data backup, and data storage. They are especially attractive to small or medium-sized practices (as many as 30 physicians).
Going shopping
Many physicians want an EMR system to support the conventional process in their practice. This is a prescription for failure! Instead, evaluate the design of an EMR system for its ability to facilitate change in the process and in roles, and to eliminate manual functions and analysis of data.
One EMR system may appear to be the same as the next, but differences are revealed in the way that they optimize workflow. Generic systems may support several primary care medical specialties well, but may impose inefficiencies in other specialties—particularly in niche specialties. Similarly, a specialty-specific system works well for the specialty for which it was designed but is inefficient in another specialty. Approximately 80% of clinical workflow needs may be met by a generic EMR system, but the 20% that are specialty-specific can make the difference between success and failure.
Ensure that the sales presentations you attend address:
- the needs of your practice
- the criteria for success that you defined during planning.
When you arrive at a choice of an EMR system, assess the learning curve that you’ll have to climb for the system to become fully functional. Remember that salesperson? He, or she, gave a slick presentation but you didn’t settle for a dry description; you were sure to try the system live to discover how easily you can learn to navigate its functions.
At last: Implementation and training
EMR vendors develop implementation and training programs to establish their system in a practice and bring it live. These programs are based on vendors’ experience with their product.
As you prepare for your EMR system, keep this in mind: One that’s been well-designed is more than a repository of data. By design, it also reengineers workflow for optimal practice efficiency, safety, and financial management.
Pearls for welcoming a system
Use EMR incrementally. Do not change from paper to electronic abruptly while you, your colleagues, and the staff are learning the system. Vendors of EMR systems design pathways by which physicians ease-in, so to speak, to EMR in a way that minimizes any drop in productivity and loss of revenue. It’s wise to ask vendors about their plan for implementation and training before you sign a contract to purchase.
Expect that it will take 12 to 24 months to convert the practice completely. The time from paper to electronic records depends on the size and age of a practice. In my experience, the half-life of converting an ObGyn practice is approximately 15 months; by 24 months, the records of approximately 95% of active patients will be entered into EMR.
