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).
For a physician practice that is adopting health information technology (HIT) the two most important systems will be the selected EMR and the practice management (PM) system. Most physician practices already have a practice management system. The EMR and PM systems have different purposes. The EMR primarily has clinical functions and the PM system primarily has billing and scheduling functions. However, both of them manage the same patient encounter processes that start with the patient phone call for an appointment and end at the completion of the billing processes. Any technology that is used to facilitate a single set of processes such as this must work seamlessly and facilitate an efficient workflow. In this situation the clinical, scheduling and billing information should be easily accessible at defined points along the encounter processes and shared between the clinical and administrative systems whenever and wherever needed to support an efficient work flow. This means that the EMR and PM system must work together and flow data back and forth.
There are two strategies that can potentially lead to an efficient workflow for the physician practice. In the single vendor strategy the physician uses an EMR that includes an integrated PM system. In the best-of-breed strategy the physician purchases an EMR that can be interfaced with a different PM system (either a new one or the physician's current one). A third strategy that will not meet these workflow needs is to use an EMR that is not interfaced with the PM system. This is not a recommended strategy becasue it causes inefficiencies such as the need for staff to duplicate entries of demographic information and charge codes in both systems. That strategy is also likely to make it more difficult for the physician to meet the quality reporting requirements that Medicare and Medicaid will be providing bonuses for over the next 6 years.
The ambulatory EMR market currently includes many small, stand-alone EMR vendor products that do not include a practice management system and other robust functionalities. There are fewer vendors with robust, integrated products that include a practice management system. Smaller vendors sometimes cater their product to a niche set of specialty physicians. Others offer products that can be customized to meet a large range of needs.
When selecting an EMR physician practices will first determine what they need an EMR to do for their practice. Once these EMR needs are identified, one of the next ways for physicians to further narrow down the list of EMR vendors is to weigh the risks and benefits of the single vendor (integration) and best-of-breed strategies against each other within the perspective of the practice's needs and technology prowess. Some of the risks and benefits are noted in the chart below:
Both models have advantages and disadvantages. Most notorious among the differences are the interfaces that are needed in the best-of-breed strategy. The physician practice should become familiar with each strategy including the challenges of interfaces used in the best-of-breed strategy. A decision on which model to select will be dependent on the EMR goals, budget constraints, desired future workflow, the technology prowess of the practice, risk-tolerance for notorious interface issues and on other things found to be most important to the practice. This author advises physicians to strongly consider using an integrated, single vendor strategy. A physician who is interested in understanding the finer points on interfacing disparate systems should proceed with due diligence to ensure selected vendors have recent experience interfacing their two products to each other. At a minimum the EMR vendor should have experience with interfacing the demographics, charges and check-in/check-out between their EMR and the desired PM system. In addition the physician practice should request a site visit to a practice that is using these interfaces to discuss issues and verify their satisfaction with results. Be wary of vague statements by the vendor that they can interface but are unable to provide you any contacts of such an interfadce done within the past year.