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October 2009

Using an Electronic Medical Record (EMR) Vendor Comparison Scorecard to Evaluate Products

Selecting an EMR: Ready, Set…Go Compare!  is a series of blogs that serves as a resource for physicians who have decided to select and implement an ambulatory electronic medical record (EMR).

Using a vendor comparison scorecard to evaluate ambulatory EMR products is a useful way to identify an EMR product that is a good fit for a physician practice.  An important assumption, however, is that the scorecard is customized to the individual practice.  This hyperlinked example of an EMR Comparison Scorecard adopts the "Best Uses" of EMRs as recommended by DOQ-IT resources as well as other recommendations that frequently surface in reports on successful EMR implementations. In order to customize a vendor comparison scorecard the physician should:

  1. Perform a comprehensive work flow analysis of their practice
  2. Identify current processes that are "bottlenecks" and other key processes that the practice desires to improve
  3. Review lists of "Best Uses" of EMRs such as:
    • DOQ-IT
    • AHRQ.gov (Health IT Toolbox)
    • CCHIT.org (Certification Commission for Health IT)
    • Networking with colleagues (especially those in same specialty)
    • Medical and specialty organization's resources such as websites and listservs
  4. Identify how an EMR could be used to improve the identified key processes
  5. List any other desired uses of an EMR 
  6. Prioritize all of these intended uses of an EMR
  7. Identify what an EMR needs to be able to do in order to be used in these ways
  8. Prioritize these EMR needs
  9. Modify the EMR Product Comparison Scorecard to align with customized EMR needs
  10. Focus the EMR comparison on the top priorities

CCHIT certification provides some comfort to physicians that the certified EMR can meet all of the EMR functional requirements that are listed on the CCHIT website.  What CCHIT certification does not tell physicians is how well the EMR works for each function.  If an EMR comparison is limited to CCHIT-certified EMR products, then the physician can focus primarily on their own "Top Ten" list of things the EMR must do well for their practice rather than worry about all of the hundreds of other things the EMR is certified for.  By taking time upfront to clearly identify a prioritized list of the top things an EMR must do well, the physician practice will be well-prepared to select an EMR that will meet their unique needs.   

 

 EMR Selection Guide provides an outline of additional topics on the selection  process

 EMR Implementation Guide provides an outline of topics on the implementation  process


Setting Practice Goals for Ambulatory Electronic Medical Record (EMR) Leads to Implementation Success

Selecting an EMR: Ready, Set…Go Compare! is a series of blogs that serves as a resource for physicians who have decided to select and implement an ambulatory electronic medical record (EMR).

The selection and implementation of an electronic medical record (EMR) in a physician practice is a complex and expensive effort.   An important factor for success is the early development of EMR goals that identify what the practice wants to achieve by implementing an EMR.  These EMR goals create a common vision that everyone in the practice can understand and share.  Involving a broad representation of each discipline within the practice during the development of EMR goals will create a team-oriented environment and "positive energy".   Such an effort will naturally involve a lot of communication between the staff and physicians.   Sharing a common vision, creating a team environment and maintaining effective communications help create trust and promote buy-in for this complex endeavor.   Weaknesses in any of these areas are known pitfalls that can sabotage an implementation.

EMR goals will help the practice make better decisions, keep the EMR implementation activities on track and act as a catalyst that keeps the project moving forward.   When important decisions are discussed, dialogue on how well the various options align with established goals is valuable.   When one person or a group of people get diverted onto rogue activities, a good project manager, with a finger on the pulse of planned project tasks and on the EMR goals, will proactively identify these and re-align efforts back to the goals.   During difficult times the EMR goals can become a rallying point for the practice to hang on to until smoother days arrive.

What are the best kinds of goals to develop?   In general a practice will discuss goals that relate to ways to improve patient care, become more efficient or be more productive.   But it is helpful for the EMR team to focus on developing a set of EMR goals that is really meaningful to them.   Every physician practice is unique and every physician practice has a different set of priorities.   Goals that are meaningful to the practice are more likely to unite the physicians and staff and and remain useful throughout the EMR implementation.

Ideas for EMR goals may be developed by discussing questions such as the following:  

  • What are three things most important things the practice wants to achieve with an EMR?
  • What three changes will be most meaningful to the practice?
  • What three quality improvements do we want the EMR to help us achieve?
  • What three gains in efficiency are desired with the new system?
  • What changes, if any, are expected with regards to productivity?
  • What financial impact is expected?
  • What else is desired to be gained or lost?
  • What is expected to not change significantly?

The following suggestions may be helpful for the EMR project team to consider when developing EMR goals:

  • Invite participation and/or feedback from all of the physicians and staff in the office
  • Goals should be challenging but also realistic—they need to be achievable
  • The best goals are meaningful to the physicians and staff
  • Gain insights on EMR "Best Uses" (how other practices have successfully used EMRs to improve care or gain efficiencies)
  • Identify current workflows and processes that are bottlenecks or cumbersome; consider how an EMR could facilitate an improved workflow for those processes
  • Consider other future workflow redesigns that your practice could benefit from based on EMR "Best Uses" insight
  • Instead of focusing on the technology, focus on the workflow or process
    • "Implement and use an e-prescribing tool" is focused on technology
    • When this goal is viewed from the process perspective it becomes, "Reduce time spent refilling prescriptions"; now it becomes more meaningful and is measurable
  • Consider starting with broad goals (related to quality care, efficiency or productivity) and then refining them to more detailed, meaningful goals
  • Not all broad goals can be refined— but they may still be considered important milestone goals
  • Broad goal examples:
    • Improve revenue per patient visit
    • Improve our revenue cycle
    • Decrease amount of time spent on phone
    • Qualify for "Meaningful Use" incentive payments
    • Improve adherence to preventative care guidelines
    • Perform patient satisfaction surveys
  • Related but more specific goals might be:
    • Increase charge capture by X% (through EMR's chart documentation and intelligent charge capture)
    • Decrease the number of accounts receivables days
    • Reduce pharmacy call backs by using e-prescribing
    • Send the identified Meaningful Use quality reports to CMS as specified
    • Identify and notify diabetic patients who have not had an HgbA1C in the past year
    • Improve patient satisfaction by a certain percentage
  • Selecting a smaller number of specific, meaningful goals will likely be more satisfying than a large number of broad, ambiguous goals
  • At least some of the goals should be measurable and baseline measures known
    • i.e. for the aforementioned e-prescribing goal, spend a couple of days tracking time spent refilling paper prescriptions, then repeat 6 months after EMR implemented
  • Other goals should be quantifiable:
    • i.e. track total # of patients that were recalled for being deficient on a HgbA1C lab
  • Prioritize the list of goals
  • Document pre-implementation measurements
  • Develop a plan and timeline to assess goals post-implementation (i.e. 2 weeks, 6 months, 1 year later….)
  • Share these with everyone in your office; perhaps some can be shared with your patients
  • Remember to measure the progress toward goals after the EMR implementation

 

EMR Selection Guide provides an outline of additional topics on the selection process

EMR Implementation Guide provides an outline of topics on the implementation process