Electronic medical records

Elizabeth Woodcock, M.B.A., F.A..C.M.P.E., C.P.C.

Before you start shopping, take time to plan your evaluation process. Follow these tips to avoid costly mistakes:

• Understand what you're getting — and what you're not. Undoubtedly, an EMR will change the way your cosmetic surgery practice operates. But it will not instantly solve all operational woes. Although some EMR systems fall short of expectations, the practice's personnel, culture and work systems are often the real culprits in EMR failures. To get the full value of an EMR you must carefully evaluate how you work and be willing to make necessary changes. In sum, an EMR is a great tool, but it cannot truly be a solution unless it meshes well with your practice and all of its resources.
• Research. Obtain a few names from potential vendors, but be sure to do your own research. Contact your local medical society, specialty society, professional trade associations or neighboring cosmetic surgery practices for references. Recognize that no vendor will provide a dissatisfied customer as a reference. Without taking your research a step further, you'll never hear of any negative experiences.
• Do site visits. Once you narrow the field down to one or two candidates, arrange to spend a few hours at a practice that uses the same system. Ask the vendor to find a cosmetic surgery practice similar to yours. To get an idea of how the EMR really works and affects work flow, arrange peer-to-peer conversations between your practice and the field site: physician-to-physician, manager-to-manager, nurse-to-nurse, biller-to-biller and so on.
• Test it out. EMR vendors have multiple product demonstrations to show off their systems. Hands down, those demos will work flawlessly. Watching demos is fine, but you must take time to test an EMR yourself. Moreover, the tester should be one of your future super-users — a cosmetic surgeon. Set up a real case — from the notification of the patient arrival to the charge being recorded after the encounter — and run that case through all of the systems you're evaluating. Be aware that the EMR may run slower once installed depending on your hardware and other software systems with which you want it to integrate.
• Evaluate installation and service. The product is important of course, but be sure to research, test and ask potential EMR vendors and their references about installation and customer service. The post-sales process is one of the most widely reported reasons that practices become dissatisfied with their EMR. Ask questions like:
• 1. How often does the vendor provide system updates?
• 2. Does the vendor provide periodic system upgrades and does it charge for them?
• 3. Have the vendor's previous updates and upgrades gone smoothly or was there downtime or system bugs?
• 4. How quickly and adequately does the vendor respond when customers find bugs in the system?
• 5. How long does installation typically take?
• 6. Will current hardware and any other software you use have to be replaced or modified?
• 7. Does the vendor provide sufficient staff and physician training?
• 8. Will the vendor put into writing a formal communication plan, an assignment of roles and responsibilities, a project risk management plan and a deployment plan?
• Use consistent criteria for selection. Look at your current operations, the shortcomings of your current records system and your expectations for new hardware and software. Then put your wish list in writing. Segregate criteria into "must haves," "should haves" and "would love to haves." Make sure the list goes beyond system features. Include cost, customer service and installation on your criteria selection list. Consider developing a weighting system to help compare systems. Use the same wish list with the same weighting to judge every system. Without consistent evaluation criteria, your judgment will be based only on what you liked about each system, not what it really could do for you.
• Don't forget about the revenue cycle. Evaluate each EMR's interface with your practice management system or the billing module with which the EMR is bundled. Today's market forces require dermatology practices to take a sophisticated approach to billing and collections. Successful billing relies on interaction between the billing system and the clinical cycle. You'd be taking a giant step backwards if your new EMR did not mesh well with your billing and collections processes. Regardless of whether your EMR will include a billing module or just be interfaced with your existing system, it's imperative to get your billing manager's feedback and advice during the EMR selection process.
• Consider alternatives. Leasing software through an application service provider (ASP) — a company that manages and distributes software services from a central data center for a monthly fee, often based on collected revenues — can be a more affordable option. ASPs can help keep start-up costs low. ASPs may also have lower annual maintenance and training costs than EMR installations. Annual maintenance costs for EMR customers can run anywhere from 5 percent to 20 percent of the purchase cost.