| Introduction | | | | generic. Most offices have similar needs for |
| For some, electronic medical records (EMR), | | | | scheduling, billing and collections. That is not to say |
| electronic health records (EHR) and personal health | | | | there aren't many best-of-breed choices to be |
| records (PHR) all mean different things. To others, | | | | made with practice management. There are wide |
| they are one in the same. One thing is certain - | | | | ranges in cost, complexity and technology. Some |
| we are living in the era when medicine is | | | | systems have been designed for single doctor |
| irreversibly making technology a vital component | | | | offices while others are priced for very large |
| of record keeping, practice management and | | | | groups and clinics. Practice management |
| ultimately, patient care. From government | | | | best-of-breed choices often come down to the |
| initiatives and mandates to private payer incentive | | | | extras: features beyond basic scheduling and billing, |
| programs, the push is definitely on for doctors to | | | | ease-of-use and the quality of service and |
| embrace not only electronic claim submission | | | | support. |
| through their practice management system | | | | The main advantage to this best-of-breed |
| (PMS), but also the adoption of electronic medical | | | | approach is that you're looking for the best |
| records systems. | | | | products for both PMS and EMR. If you've done |
| Knowing that you'll need to implement this type of | | | | your homework, you'll find outstanding products |
| software is one thing, figuring out which programs | | | | from companies that have extensive experience |
| are best for you is an entirely different matter. If | | | | in your specialty. The sales and support staff are |
| you do a little research, you will find that there | | | | more likely to provide better assistance tailored to |
| are over 300 companies that market practice | | | | your practice needs. |
| management software. Dig a little deeper and | | | | One disadvantage of the best-of-breed approach |
| you'll find that there is another 300 plus companies | | | | might be that you'll end up with practice |
| that say they have and EMR solution. To cloud | | | | management and electronic medical records |
| the issue further, some vendors offer all-in-one or | | | | systems that don't communicate with each other, |
| single source solutions while others stick to their | | | | causing some tasks, patient demographics entry, |
| niche and offer either a PMS or an EMR solution | | | | check-in/check-out and procedure charges, to be |
| only (best-of-breed). Even if you find software | | | | duplicated. |
| vendors that you think are reputable and have | | | | Most reputable software houses in healthcare |
| good software, you usually have to choose | | | | offer HL7 interfacing capability which can ensure |
| between a single source and a best-of-breed | | | | that patient and appointment data are shared. |
| solution. | | | | Some even offer charge postings, and some |
| In this article, I will discuss the benefits and | | | | check-in/out. Interfacing your products can bring a |
| disadvantages of both the single source and the | | | | big boost to your practice, but the level of |
| best-of-breed approaches to procuring PMS and | | | | interfacing capabilities will vary greatly from |
| EMR packages. I'll also explore another option I call | | | | vendor to vendor. Due to inherent limitations in |
| the full integration approach. | | | | some products, only a very basic level of |
| A Single Source Solution | | | | interfacing might be possible. You will want to do |
| Although both PMS and EMR are meant to be | | | | some homework and make sure that at a very |
| used in the same doctor's office, they have | | | | minimum, the interfaced systems can pass |
| completely different functions. Practice | | | | demographics, check-in/check-out and charges |
| management software typically handles the billing | | | | can be passed from the EMR back to the PMS |
| and scheduling while EMR packages are on the | | | | billing system. |
| clinical side - assisting practitioners with note | | | | Full Integration Model |
| creation, storing patient charts electronically, | | | | A third approach is emerging for PMS and EMR |
| managing test results, X-rays, etc. While both | | | | integration that can provide the benefits of both |
| systems are used by different people with | | | | the single source and best-of-breed. This |
| different job functions, they are both involved in | | | | approach, which I'll term full integration, is when |
| managing the same business transaction: the | | | | best-of-breed PMS and EMR vendors partner and |
| patient encounter. Doesn't it make sense for | | | | enhance their products so that they work |
| these two software systems to work together | | | | seamlessly together. Many systems have been |
| seamlessly, passing information back and forth as | | | | interfaced so that basic information such as |
| the patient wends his or her way through a | | | | check-in and patient demographics are passed |
| doctor visit? The short answer: yes, absolutely. | | | | from the practice management system to the |
| One approach to getting your PMS and EMR | | | | EMR. A deeply integrated solution would include all |
| programs to work together is to find one | | | | of those typical interface functions plus much |
| company that sells and supports both programs. | | | | more. For example, systems can be deeply |
| Often bundled or sold as a suite, these single | | | | integrated to achieve the following benefits: |
| source solutions offer the promise of seamlessly | | | | - Improved Workflow Management - Going well |
| integrating the office workflow. Other benefits | | | | beyond basic check-in/check-out functions, deeply |
| can include having only one contract to sign and | | | | integrated systems can share workflow |
| one point of contact for sales, service and | | | | messaging, tasks, procedure charges and provide |
| support. | | | | a single point for login and authentication. For |
| While more and more companies are announcing | | | | example, after seeing a patient, the nurse |
| that they have a single source solution, there are | | | | practitioner could send a message or task from |
| downsides to this approach. The main problem is | | | | the EMR screen to the front desk PMS screen. |
| that appointment scheduling, billing and collecting | | | | - Single Source Benefits - Similar to purchasing a |
| money are completely different activities from | | | | complete system from a single vendor, |
| the clinical side of the patient encounter. Most | | | | companies that have successfully integrated their |
| companies offering a complete PMS/EMR solution | | | | products can offer many of the advantages of |
| started life as either a practice management | | | | the single source one-stop-shop. When considering |
| company or an electronic medical records | | | | the purchase of deeply integrated systems, you |
| company. As a consequence, their expertise is | | | | may have one point of contact for sales. |
| almost always heavily weighted towards either | | | | Companies that have successfully partnered may |
| practice management or electronic medical | | | | also offer streamlined contracts and pricing, |
| records. Rarely will you find a company that can | | | | making it easier to understand your total |
| do both sides equally well. As a result, buying a | | | | investment. |
| PMS/EMR suite could run the risk of having to put | | | | - Best-of-Breed Benefits - If two companies that |
| up with a good EMR package and a mediocre or | | | | are truly best-of-breed in their market partner to |
| poor practice management package, or vice | | | | offer a deeply integrated product, you gain all of |
| versa. | | | | the benefits from the best-of-breed model while |
| It is also worth noting that many single source | | | | avoiding many of the disadvantages. If you've |
| solutions on the market today started life as two | | | | chosen your companies well, you'll have a practice |
| different applications from two different | | | | management company that has extensive |
| companies - then were brought under one roof as | | | | experience in your type of specialty. It will excel in |
| a result of an acquisition or merger. When | | | | scheduling, billing, office workflow management, |
| considering a single source solution, find out if they | | | | collections and more. On the EMR side, you'll feel |
| were originally developed by the same company. | | | | confident that the EMR vendor will have a track |
| While some products that have merged do a | | | | record with and know the proclivities of your |
| good job of integrating with each other, there are | | | | specialty. When you call in for support, you will be |
| others out there that do not work as smoothly | | | | more likely to reach people that have specialized |
| as they could. | | | | experience and knowledge of your needs. |
| Best-of-Breed | | | | Conclusion |
| Instead of looking to one company for both PMS | | | | At this time, the market for PMS and EMR is still |
| and EMR software, another popular approach is | | | | dominated by stand-alone applications that may or |
| the so-called best-of-breed approach. That is, | | | | may not be best in their breed. Increasingly, |
| finding the best vendor for each application. | | | | vendors are feeling pressure to offer complete, |
| On the EMR side, the clinical demands on a | | | | turnkey solutions. As a result, companies are |
| system can be radically different from specialty | | | | acquiring other companies in the hopes of |
| to specialty. For example, the need to track | | | | providing complete solutions. Still others are opting |
| dosage regimens and patient progress over long | | | | to develop the parts they need to offer what |
| periods of time by an oncology practice is | | | | they feel will be a complete solution. A few |
| completely different from the types of clinical | | | | companies have realized the considerable expense |
| support a family practice might need, which | | | | and risk involved with acquisitions and |
| differs even more from the needs of an | | | | development and have opted to partner with |
| orthopedic surgeon. Because of this EMR | | | | other solutions to fill out their product offering. If |
| specialization, many practices have opted to go | | | | you can find companies that have partnered to |
| with an EMR vendor that has a long history and | | | | provide a complete solution AND they are each |
| extensive expertise in their particular specialty. | | | | best-in-breed AND are experienced in your |
| They choose the best-of-breed for their specialty. | | | | specialty and type of practice, you might want to |
| While EMR tends to cater to specific specialties, | | | | strongly consider going with the deeply integrated |
| practice management tends to be a bit more | | | | solution. |