Physician

ext">A challenge awaits the physician who has				Not all EMRs accommodate all specialties —
had enough of the frustrating inefficiencies,				regardless of what the sales rep claims. For
financial penalties, and antiquated practices				example, some leading vendors have
associated with maintaining a paper-based medical				well-developed content for family practice; ob
office. So the decision is made to digitize the				gyn; internal medicine; and ear, nose, and throat;
practice. Any initial enthusiasm quickly wanes once				but may not fare as well in specialties such as
an initial search for electronic medical records				oncology or chiropractic. By asking the vendor to
uncovers hundreds of products and vendors. It				demonstrate the product’s performance in
doesn’t take long before the 300 or so				a specific specialty, the number of potential
electronic medical records system screenshots				candidates will decrease.
and feature/benefit grids begin to look remarkably				* SCALABILITY FOR GROWTH. Just as not all
similar. The sheer number of vendors occupying				electronic medical records systems accommodate
the EMR (electronic medical records) market is				all specialties, most are geared toward a specific
unmanageable without a basic product				practice size — with features and cost
assessment/elimination strategy.				typically reflecting the product’s expansion
For physician practices with limited time and				capacity. In general, if the practice expects to add
resources, the selection process can appear				providers or additional locations over time, it is
overwhelming. Fortunately, physicians can begin to				important to start with a product that is stable
narrow down potential systems by eliminating				and feature-rich enough to handle the workflow
uncertified products, as well as those built upon				of a larger practice - even if the product’s
dated technology architectures.				features may not be fully leveraged early in the
1. ELIMINATE PRODUCTS NOT CERTIFIED BY				product’s lifecycle.
THE CCHIT® (CERTIFICATION COMMISSION				Finally, it is time to ask questions about the
FOR HEALTHCARE INFORMATION				vendor’s service and support — the
TECHNOLOGY).				most ambiguous, but arguably most important
By confining research only to CCHIT-certified EHR				aspect in the decision making process. After all,
(electronic health record) products, a substantial				you can purchase an electronic medical records
number of systems are quickly eliminated. As of				software system with every bell and whistle, but
this writing, 53 ambulatory EHR systems have				if the implementation is disorganized; the training
successfully met the 2007 standards, while only				inadequate; or the post-installation support lacking
18 have met the more rigorous 2008 criteria.				— productivity will drop; providers and staff
Using CCHIT certification as an initial benchmark is				will be frustrated; cash flow may be interrupted,
prudent for a variety of reasons: The CCHIT is				or worse.
the leading Healthcare I.T. certification organization,				3. TAKE STOCK OF IN-HOUSE I.T.
and is publicly endorsed by the American				(INFORMATION TECHNOLOGY) RESOURCES.
Academy of Family Physicians; the American				Does the practice have a staff I.T. department or
Academy of Pediatrics; the American College of				a trusted I.T. firm? If not, it’s important to
Cardiology; and the American Medical Association,				ensure that the software vendor offers I.T.
among others. In addition, a CCHIT Certified				services. Improperly installed hardware or
designation ensures that a product has met the				inaccessible support personnel can have a
basic requirements for functionality;				detrimental effect on the success of the training
interoperability; and security and privacy.				and implementation.
A 2008 CCHIT certification warrants the				Some smaller practices opt for a web-based
product’s utilization of standard formats				medical software installation to decrease the cost
enabling the exchange information with other				of hardware and eliminate the need to maintain
systems — known as interoperability. The				servers and other equipment. Web-based
exchange of patient information on a regional or				installations are known as SaaS (Software as a
national level is the underpinning of a more				Service) and are delivered by an ASP (Application
efficient and less costly healthcare system. Future				Service Provider). The ASP hosts the software in
tax incentives and Medicare reimbursements may				a secured data center, and the end-user (the
be tied not only to utilization of digital medical				practice) simply accesses the system using a web
records in general — but specifically				browser. All that is required is a high-speed
benefiting practices with CCHIT-certified EHR				internet connection and a workstation. Access to
systems.				the data is dependent upon the internet
2. ELIMINATE PRODUCTS THAT DO NOT				connection, so mission-critical applications are not
OPERATE ON A SHARED DATABASE FOR				appropriate in a SaaS environment under most
BILLING AND PATIENT CHARTING.				circumstances.
As little as five years ago, interfaced				The alternative to a web-based installation is Client
practice management/billing and patient charting				Server, requiring an onsite server and regular
systems were the norm. Today,				maintenance of the system by the vendor. Both
interfaced systems are technologically				types of installations have advantages and
inferior to medical software that has been				disadvantages, so it is important to discuss
developed from the ground up by a single vendor,				installation with potential vendors.
on a single platform, and utilizing a single database				4. ASSESS TECHNOLOGICAL SKILLS OF
— described as integrated’ or				CLINICIANS AND ADMINISTRATIVE STAFF.
unified’ electronic medical records and				ENSURE THE VENDOR’S PROJECT
medical practice management systems.				PLANNING AND IMPLEMENTATION STAFF CAN
Interfaced systems are still sold today, so it is a				AID THE PRACTICE IN CHOOSING WHO THE
buyers beware market. In the past several				FUNCTIONAL AREA CHAMPIONS WILL BE.
years, there have been a number of mergers and				Medical software training and go-live
acquisitions between vendors having market				support expenditures account for a substantial
share in one side or the other (scheduling and				portion of the total initial system cost, and careful
billing or charting/EMR) but desired a				planning is essential for a smooth implementation.
comprehensive solution to offer physicians. As a				The vendor should provide a project coordinator
result, there are products currently marketed as				that will help the practice make critical decisions
a suite, but were developed by disparate				and schedule the project timeline. Most practices
vendors on different platforms, tied together				utilize a combination of web-based and on-site
using a separate application. Although generally				training prior to go-live (the days or weeks
transparent to the practice, there may be				dedicated to using the new system). In addition,
questions of data integrity; patient safety (for				the vendor should provide onsite support for the
example, a patient’s practice management				practice during the go-live. The number of training
billing record does not match the clinical record and				days, go-live days, and the delivery (web-based
lab results get overlooked in the mess); and even				or onsite) is determined by the size of the
the vendor’s long-term maintenance of the				practice and the skill levels of the staff. Follow-up
system.				sessions to reinforce original training or introduce
Unfortunately, uncovering if a system is				advanced concepts is important for continuity.
integrated or interfaced is not always				To keep costs down, some practices may utilize
straightforward and may require the buyer to				a heavier web-based training plan for the bulk of
conduct some detective work. The first step is to				the staff with designated superusers who attend
ask the vendor questions about the				advanced training. For practices with less
product’s history — which company				technologically savvy staff, more handholding
developed it, does it utilize a common database,				through onsite training may be the best option. In
and is there a single login for billing and charting?				addition to improperly installed I.T. (hardware,
Some interfaced systems require users to log in				networking, security, workstations), insufficient
separately to access the practice management				training or post-implementation technical support
billing and the clinical portions of the software.				are prominent failure points in medical software
Following the elimination of uncertified products				implementations.
with dated technology, the pool of suitable				5. WHO SUPPORTS THE PRACTICE FOLLOWING
products begins to shrink and the specific needs				THE GO-LIVE? THE ORIGINAL TRAINING AND
of the practice should be defined and considered.				IMPLEMENTATION STAFF, OR AN OUTSOURCED
* ESTABLISH A BUDGET. Medical software				CALL CENTER?
systems vary widely in cost. By establishing a				Not only does unresponsive technical support
flexible budget early in the process, practices can				frustrate and discourage users, it fosters lost
avoid wasted time looking at systems that are				productivity when users struggle with denied
too expensive or potentially not robust enough to				claims; unanswered questions; or broken
meet the needs of the practice. Ask questions				functionality. Still, large vendors often outsource
about ongoing maintenance costs and what the				support to overseas call centers —
maintenance covers, just as a buyer would ask				lowering vendor overhead at the expense of
when making decision to purchase a car.				high-quality, timely, and knowledgeable support.
* EVALUATE SPECIALTY-SPECIFIC CONTENT.

Integrail

Physician