Electronic medical records should speed up documentation of the patient visits, make documentation more complete and extensive and include all the redundant things that we always say, but never document (because they are soooo obvious to us). Faster documentation means finishing earlier or seeing more patients and more complete documentation means more payment and higher coding levels! And the “redundant parts” may one day very well save your behind in court. With an EMR Patient charts are available wherever you are – office, hospital or home.
At least those are the benefits that the EMR companies keep on repeating. Those benefits nevertheless are by no means certain or even guaranteed!
To my big surprise I ended up being disappointed when my health care system bought and installed the GE product "Centricity" (it used to be sold as "Logician"). You get the feeling that it is an old system that has been updated over the years, but it is far from being as modern as what we are used to from working with Google or Yahoo.
GE is rather inflexible and is not too eager to individualize it to you (or they make it expensive). Using Centricity has drained my productivity rather than improving it. Visits take longer, I do not have an easy overview of my patients data as I had before, there is no space for personal notes on patients (!!). Personal notes on patients are very important to me. They make each patient unique and allow us to pick up a conversation where we left of the year before. A note could be "likes cold climate, considering moving to Maine", "loves teenageers, thinks that they are in the most interesting age", "has winter house in Florida, plans to move there in 5 years", "husband is in the national guard" and things like that. Those are all facts that not only make a patient unique and memorable, but also may serve as a basis for marketing to patients. Centricity offers absolutely no help in marketing. No field for the answer to "who referred you to us" at the first contact! No field for preferences of referring physicians. No thought of marketing has gone into that system. To market to patients based on patient information I would neede a separate database, and who wants to do that!
Yes, EMR software has the potential to do certain great things, but the real system you end up working with might not do nearly as much as it could. The dream is much better than reality!
So, find out about the systems that are out there, look at their websites and then have one or more demos in your office. I do not have a clear favorite yet; they all have their flaws. “Tops Suite” from “e-MDs” seems good and might be one of the lesser expensive solutions. It includes scheduling, billing and patient records.
I would only get a system that allows me to store all data in the office – I do not want to negotiate with someone who holds my data hostage. Information has to be accessible anywhere (home, hospital.) at any time, preferably over the net. The system should be VERY intuitive to use. Secretary and nurses should enter the demographics and history, and it should take you only a few clicks to finish the rest. The goal is the three click visit.
Patients should be able to request an appointment online or even book an appointment themselves. They should be able to fill out their patient history online, they should be able to fill out the complaint and history part of the visit / encounter form online before they come into the office.
As an alternative it would be nice to have patients fill out a questionnaire on a computer in the reception area or have your secretary fill it out for those patients who prefer not to deal with the computer. This questionnaire should be interactive, so that it asks only the questions that are relevant to the occasion, which could be an annual visit, postoperative visit, Ob visit, problem exam, follow up visit, etc. For each problem the software should ask tailored questions.
These data should be processed to give you a tentative diagnosis and algorithm to proceed, what points to focus on, what tests to do. These data should select (or offer to select) for you the template that you will document the visit on, and consequently also the billing codes etc. The system should offer templates categorized and accessible under diagnosis or treatment or SOAP notes from previous visits to be reused for faster documentation. The system should more or less automatically print prescriptions in the office - or fax them directly to the pharmacy, it should print patient instructions that correspond to the problem or diagnosis or time in pregnancy when the patient presents or age of the patient at the time of the annual visit - customized with name and issues, fill out any forms you may need (disability, booking for surgery, request to have a medication paid etc), fax prescriptions to the pharmacy and - very important for your practice marketing - fax letters to the referring doctor, so that they have the report the moment the patient leaves the office.
All this should be EASY, hear me, engineers, EASY.
The ideal is the “three click visit”. The system should offer alerts and reminders (pathological Pap, mammograms, overdue annuals etc.) and should offer the ability to email patients the results of tests and appointment reminders as well as monthly or three monthly practice newsletters.
The program should also send follow up emails where appropriate to increase compliance, such as more information on Kegel exercises, more information on how to stay health, how to continue to monitor the irregular, PMS, menopausal symptoms etc.
Administrator love to forget that an EMR should make life easier, oh, sorry, let me word it so they understand it, an EMR should make the physician faster and more efficient. An emphasis on safety is NOT an excuse for a cumbersome system that requires clicks and clicks and acknowledgments of pathetic detail after pathetic detail. Safety happens behind the scenes! I drive a Volvo for safety, but the car drives exactly the same as an unsafe car. I do not notice that it has extra airbags and a better suspension and electronic roll-over protection. "Safety" is a very important goal and the software has to accomplish it without annoying us! Software has to make us faster!
And essentially you should never ever have to enter any data twice. It should synchronize with the PDA you carry around and on which you capture billing data in the hospital. those billing data should be effortless be transmitted to the main system. Your PDA should receive your daily schedule including your operative schedule. In the office you should have a wireless network with tablet computers - make sure your EMR program actually can be handled with pen clicks alone!
When you consider buying, don’t fall for high monthly “maintenance” fees, which are just a way of charging you or for an outrageous purchase prices in the range of 100K. Forget the proprietary systems and the Unix systems. See what works and what did not work for colleagues in your area. Most systems are in the range of 5-10,000 per provider or even less and prices should go down in the future. Never buy without a 3 or 6-month money-back guarantee in case the system fails in everyday life. Make sure that you have it written in the contract that you can get your data back for a minimal fee if you do not want the system! Companies tend to abuse you with high fees for returning the data! They know that you desperately need them and take advantage of this.
Go to http://www.emrupdate.com/ or org and take a look at an objective website without marketing hype where you colleagues give feedback on emr systems.