The idea of EMR has attracted much debate as of late. Physicians are hearing about the benefits of EMR, the horror stories and the impending federal mandates concerning the conversion over to electronic medical records. Before jumping onto the proverbial EMR/EHR (electronic medical records/electronic health records) bandwagon, it is important to look at the total picture. You cannot just consider vendor or product selection and leave it at that. You must consider product, fit for your specialization, cost, implementation, office workflow changes,
ROI and long term non-financial benefits such as improved quality of care, automation, and quality of life changes.
In the simplest sense the EMR path looks something like this:
Select > Install > Train > Implement > Evaluate > Refine > Set new Goals
However, there is plenty to think about before selection even begins.
Determine Readiness
Take a good look at your office staff. Are they the type of employees who are computer literate? Do they embrace or are they resistant to change? Communicate to your staff how the new system will impact them. If someone feels they are being replaced, their natural inclination will be resistance. Spend some time showing them how it will make them more efficient and more productive.
Is your office currently set up for technology? Where does the office fall on the scale from being techno-savvy to not being able to turn on a computer? Identify how much of a change this will be for you and your staff.
Budget is another point to address. Financially how will this impact your practice in the short term? In addition, you must take into consideration that initially you will have revenue losses due to fewer than normal patient visits as you get used to the system and keep the office workload at a minimum. In a study done by the University of California in 2003, it was estimated that “initial EMR costs ranged from $15,000 to $50,000 per physician.” Since 2003 as competition grows, there has been very competitive pricing on some very good. However, the very expensive solutions are still out there.
Identify Key People to Lead
EMR systems are embedded in technology. Having someone who is somewhat tech-savvy to captain the ship is paramount. Another important attribute for this person is the ability to embrace change. If you select the right product and implement properly, then a change to the flow of your office to realize the new benefits of EMR is imminent. The old definition of stupidity is applicable here-“doing the same thing over and over and expecting different results”. Your new captain of the EMR ship must “stay the course” through all the ups and downs and focus on the long term goals established by the office. The physician will want all the benefits of EMR without the hassle. In short, the physician wants to be able to tell time, but not know how the watch is made.
Determine your Goals
Why are you looking at EMR?
Has all the buzz made you think it is time?
Do you want to improve patient care or efficiency of the office?
Do you want to make more money?
Do you want to go home earlier?
Do you feel you have to?
Have you even thought about it?
The implementation of EMR can help you answer yes to all of these questions or to none of them if you do not think it through. The biggest mistakes physicians make are selecting the wrong product or, believe it or not, not using the product they purchased effectively. You can’t just implement and think everything will take care of itself. You need to monitor, change systems, evaluate, set goals, review progress, analyze data and make more changes.
EMR Pre-Selection Analysis
There are many ways to evaluate an EMR and the company that sells it to you. Each physician will have their own hot buttons in regards to price, ease of use, financial impact, etc. We will outline three financial based studies that you can do to help with the selection process.
EMR Cost-Benefit Analysis
A Cost-Benefit Analysis, just as it sounds, is an estimate of costs and benefits done, before selecting a company, to determine the feasibility of, and the budget for, an EMR system. Weigh the cost against the current expenses in the office which might decrease upon the implementation of an EMR. Such examples would be staffing, transcription, billing and collection costs, office supplies, chart management, and storage.. These are costs that are taken for granted or overlooked.
EMR ROI
Return On Investment (ROI) is more exact than a Cost Benefit Analysis. This information is received from the final vendor candidates and is one of the final steps in the selection processYou must be careful to look past the hype of some vendor’s claims. Ask them for specifics and ask to speak with practices that have experienced their ROI related claims. In the same University of California study mentioned previously, it was found that physicians “realized savings of between nothing and $20,000 per year”. Again, it is not simply the product, but how it is utilized.
When looking at ROI, it is also important to not overlook the “soft” costs in EMR implementation. What is your time and that of your staff’sworth? Think of the impact on other systems such as billing, networking and other computer systems. How will the interfacing work? Will you need consulting and implementation services? In addition to the EMR software, you will also incur costs for maintenance and upgrades to the software, additional hardware, and hardware maintenance costs.
Use our FREE EMR ROI Calculator
Post Selection Analysis
Benefits Realization Study
Benefits Realization Study is an evaluation of benefits that have resulted from the EMR investment in an office. This is performed at specific preset intervals throughout the life of the EMR, and is used to help make adjustments to office flow and to plan for future systems. This would be done after the EMR implementation to determine whether or not the vendor’s “promises” have been realized. The value in this lies in identifying areas that need correction to improve efficiency and, at times, cost savings. You should identify a set of quantifiable benefits that can be easily measured and chart and analyze over time.
EMR Industry certifications, ratings and awards
In the recent years many organizations have started ranking EMR vendors, some of these include CCHIT, TEPR, AC Group, KLAS and MS-Hug. Certification Commission for Healthcare Information Technology (CCHIT) is an organization that launched an initiative in 2006 to certify EMR products in hopes of weeding out the bad products in the market. While this is a relatively new initiative and many vendors are still in the process of being certified, it is not the end all be all. The cost for a vendor to become certified is very high and is cost prohibitive to many of the smaller vendors. Many of the products in the list of certified products have some of the poorest reputations for user satisfaction. With this being said, it’s important to still do your due diligence, and simply use the CCHIT certified vendors list as an additional resource.
TEPR, KLAS, AC Group and MS-Hug all provide ratings on the vendors. These are all great resources to use during the selection process but are no substitute for doing your own due diligence. Links to these organizations can be found in Appendix B.
NEXT: How to buy an EMR - Vendor Selection
