You've decided to enter the 21st century and modernize the way you document patient care in your medical office, just how you've modernized your ability to communicate socially with technology. At home, you know your way around an iPad, your smartphone, laptop, and desktop computers, but electronic medical record (EMR) systems remain a daunting consideration. Perhaps you're hunkered down in old-fashioned paper charting, or you are using older, legacy systems based on text files and word processor documents. The EMR industry is saturated with numerous options for bringing your medical documentation into the modern era. Navigating this space requires that you know your needs and ask the right questions of your EMR vendors. Ahead is a list of some questions you should ask.
What to Ask
Is the system client-server or cloud-based? Client-server systems are installed locally on hard drives in workstation computers/laptops in your office. They tend to require significant data storage and backup infrastructure with costly servers and IT support. They are typically sold on a per-workstation license arrangement, although this varies. Data may be accessible with remote login systems (VPN remote hosting), although not necessarily on mobile devices. Cloud EMR products generally require less technical infrastructure and capital outlay and may allow greater mobility of access to records for the doctor and office staff. Most cloud technologies are also platform-independent, meaning you can use them on Windows, OSX, and Android devices in a variety of Internet browsers. Pricing is usually on a monthly subscription basis per user/provider, rather than tied to the number of devices accessing the data.
Does the system support interfaces with practice management (PM) software? Some vendors offer “all-in-one” packages that include PM, billing, inventory, marketing, and EMR systems, while other systems are designed to interface with a wide variety of other PMs to allow the users to “mix-and-match” tools that may suit the practice's workflows better. This is a highly personal decision and it is important to know how the systems work together, if they are not completely integrated.
Will the system generate billing codes? EMR systems should help your staff reduce workload by assisting with generating E/M and CPT codes, as well as ICD9 codes. Be sure to ask the vendor's strategy for implementing ICD10, as this can substantially impact your practice's productivity and bottom line if not delivered properly or on time for the impending changes in ICD coding regulations.
What kinds of documents can be stored within the system, and how easy is it to import these? What are the costs for storing this data in the cloud?Remember that even consumer cloud products for music and photo storage often have costs if you exceed the maximum for free storage, which is easy to do in this era.
What will it cost me, all in? What additional charges will there be for integrating the EMR system with other software in my office, if possible? What about if I add an additional doctor/provider to the practice? Are support and training costs included? What are the terms of typical contracts (monthly, yearly, multi-year?) and are there discounts for extended commitments? Are you expecting any price increases in the next year to 18 months?
What happens to my practice data if I change vendors? Can you import data from my older system, and can we export data from your system if I eventually switch to a different company's product? What are the costs of data migration?
Can you show me how easy it is to teach front desk personnel or a medical assistant to use this software so that my job as a doctor/ office manager is made easier? Time is money. Software should increase efficiency and improve portability of information. It should be powerful while easy for staff members of varying skill sets to navigate. It should be enjoyable, rather than exasperating, to use.
While not exhaustive, this is a straightforward set of questions that any EMR system sales rep should be able to address with a demonstration. Do your homework so you can make an EMR system purchase that enhances your office day experience for you, your staff, and your patients, as your practice keeps pace with the rapid evolution of modern technology.
Tim A. Sayed, MD, FACS is Medical Director, EMA Plastic Surgery™ and EMA Cosmetic™ at Modernizing Medicine. He is also an Executive Committee Member of HIMSS EHR Association.
