Electronic Medical Records: Client/server or Asp?

When buying Electronic Medical Record (EMR) Software which is better ASP or Client/Server? Unfortunately there is no right answer. You’ll need to decide what’s important to your practice and what’s not. In this article we’ll explore the advantages and disadvantages of each model so you’ll be able to make an educated decision when the time comes to purchase an EMR software solution.

ASP is a remotely hosted software system accessed via an internet web browser, similar to the model used in online banking. This remotely hosted system is accessed by paying a rental or service fee. The server is secure and HIPAA compliant and is not located in your office. All technical aspects of the server are managed by a professional IT company, and you pay a monthly access fee (or per occurrence fee) for the services of this IT company. The cost of an ASP-based system is relatively low in the beginning, however because the fees never stop the cost over the long term adds up and is usually ends up being more expensive than using a Client/Server-based system. One of the other benefits of the ASP based system is that almost all computing is done on the remote server, thereby reducing the minimum computer hardware requirements on the clients/workstations. ASP allows you to access all of your information at any time, from any place with internet access. Like all comparisons with advantages come disadvantages. Loss of customize-ability; the host server is being accessed by many different users. Although your data is secure, your individual customized needs are not met as readily as you may desire. One of the other disadvantages is that an ASP system does not move as quickly as a Client/Server system. This is and important factor to consider with point n’ click intensive Electronic Medical Record software as vital time may be lost by waiting for data to transfer over the internet; these seconds can quickly add up to minutes and hours in a couple of weeks time. Accountability issues are a deep consideration to ASP. Company service degradation is felt more acutely and such things as vendor bankruptcy could have a more drastic impact on the practice as a whole. Periodically check the stability of the EMR software vendor, and ask for a backup copy of your data for your own records.

Client/Server models allow for quicker response times in the application as the data from the server to the client is transmitted much faster (usually 100 Mbits/second). The newer client/server products developed in Java and Microsoft .Net are capable of offering the “best of both worlds” as they have the speed of a local system plus the accessibility from a remote location. Where traditional client/server products required practices to use MS Terminal Services or Citrix technology to access their data from remote locations, these newer systems can be accessed from any internet browser. Client/Server also boasts the benefits of practice having the control over there data. However with this control comes responsibility; the responsibility of being responsible for your data as you are now open to the risk of theft, fire, hard-drive failure, and data corruption.

Many IT futurists consider ASP based systems to be the future however many offices find they don’t have the need for remote access and don’t want to put their data in the hands of another company making client/server systems still a popular option. In most cases, if an office has multiple locations an ASP system should always be considered but if an office requires high-performance and doesn’t have multiple locations the client/server system may be the better option. Speak with your IT consultant and the software vendor to get all the facts you need to make an educated decision.

This is an excerpt from the The Electronic Medical Record eBook by EMR Experts, Inc. (www.emrexperts.com)

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Do Electronic Medical Records Increase Revenues?

Does EMR increase revenues?The economy has been in a recessionary trend for more than a year now. Whilst the economic conditions are challenging, the insurance companies are applying a squeeze on physicians to accept lower reimbursements. Funding by way of donations from private contributions is also reducing thereby adversely impacting availability of cash to implement an EMR / EHR system. Any investment in EMR is justified only if it can help in increasing revenues, decreasing costs or overheads, improving patient care or any combination of the above resulting in maximization of reimbursements, collections and customer goodwill. How does EMR/EHR increase revenues?1. Improves charge capture: When traditional paper charts are used, many services performed in a physician’s office are lost and never billed. The billing staff may either completely leave out an E&M Code or may erroneously enter fewer units, all resulting in lower billing and therefore lower reimbursements to a physician. EMR software can increase revenues by facilitating capturing of charges for all services provided by the physician thereby avoiding lost revenues. In a case study (Nick Fabrizio, July 2005, QIO Presentation quote), a family medicine physician while seeing same number of patients increased revenues by $3000 per month due to timely visit documentation and automated charge capture.

2. Maximizes Billing: When using paper charts, to be on the safe side of the law, many physicians down code (use a lower billing code), rather than use an appropriate level of code. Providers who use EMR software can increase revenues by using System recommended E&M billing codes that are based on the service accurately documented within the EMR, without the fear of an audit.  Medical Economics magazine has estimated that physicians, who routinely down-code to avoid audits, lose an average of $40,000 annually.

3. Optimizes reimbursement process: EMR software allows physicians to produce adequate supporting documentation that complies with CMS guidelines and supports the appropriate level of service to be billed. Accurate coding speeds up the reimbursement process and results in fewer rejected claims from insurance companies. Even better, an EMR helps produce clean claims the first time, significantly reducing the number of rejected claims!

4. Increases Physician productivity: When physicians do not use EMR, they have to spend several minutes per encounter, first dictating and then reviewing the transcript before signing the same. With an EMR, progress notes are automatically generated which can be signed electronically from home or work, with no pulling or filing of charts. The time saved can be used to see a few more patients each day. Further, the medical records storage space released as a result of implementing an EMR System can be used to add more consultation rooms. As a result, practices are able to generate more revenue with the same fixed costs in the same amount of time. 5. Increases Services with Health Maintenance Reminders: EMR Systems provide computerized checks and reminders which enable reminders to be sent to all patients who are overdue for recommended services, or who are coming up on their annual check-ups. This helps the physician to deliver enhanced patient care, while at the same time increasing service volume and revenue. 6. Increases sources of income: Electronic Medical Records (EMR) software can allow providers to apply for enhanced sources of revenue from various payers associated with higher quality of care, such as:

(i) DOQ-IT (Doctors’ Office Quality-Information Technology is one of the Physician-focused Quality Initiatives sponsored by the Centers for Medicare & Medicaid Services (CMS).

(ii) Healthcare Pay-for-Performance (P4P) programs like Medicare Care Management Performance (MCMP), which is a 3-year, pilot P4P program that encourages physicians to follow strict quality-control guidelines for treating chronically ill patients.  During the first year of treatment, physicians receive bonuses for reporting data on quality measures and in the second and third years, participating clinics receive an extra annual performance-based bonus of $10,000 per clinician plus, an additional 25% reward for using a CCHIT Certified EMR.To participate in a P4P program, a physician will need to track and measure care, and monitor the efficiency of delivering quality care at an optimal cost. One must also document the patients’ experiences using post-exam surveys. Most EMR systems are capable of meeting these requirements while simplifying the process. How does it decrease administrative costs / overhead?

A typical medical office employs a transcriptionist, billing and clerical staff such as appointment schedulers, medical billers, collectors, file clerks and others. As a Practice grows, EMRs significantly reduce the need for more personnel to provide these functions, while at the same time, reducing existing office staff time that will no longer be needed spending valuable time hunting down records or filing patient charts. EMR-enabled medical offices mean fewer bodies in the office, generating greater efficiencies and accomplishing more.

1. Reduces transcription cost: Many physicians pay hefty fees for transcription of their medical charts. EMRs ‘virtually’ eliminate transcription costs since medical charts are created electronically at the time of the patient’s visit itself.  According to Medical Economics (March 2002), physicians spend between $15,000 and $25,000 over the course of a year for transcription-related services. Implementation of an EMR eliminates the need to use in-house or outsourced transcriptionists.  Integration of voice recognition software with EMR Systems also plays an important role for the people who want to have free formatted notes or for some providers who are not comfortable using mouse and keyboard.

Assuming an average of 25 visits per day and a conservative average of $2 per chart, an EMR brings instant savings of $50 per day per physician. Assuming that a physician works for 240 days in a year, this translates into potential savings of $12,000 per physician. Even if some or all of a practice’s physicians continue to use transcription, there is no doubt that these costs can be reduced significantly.

2. Reduces costs associated with storing paper charts: Once a medical office successfully converts to electronic medical records, all costs associated with purchasing, copying, management, storing or destroying paper charts can be eliminated. Additionally, the space typically used for storing patient charts can be utilized to create additional patient exam rooms, or increased office space, resulting in a more profitable use of resources. It is estimated that the total cost associated with maintaining a paper record average $3 per medical chart.

A case study revealed that a 12-physician practice saved $5,000 a year in storage space after converting to EMR. In another study, a major medical center in Boston seeing 750,000 patients a year, estimated they will save $6 million annually by reducing their dependence on paper records. At this saving rate, a practice seeing 5,000 patients annually could potentially save $40,000. In another case study, EMR implementation resulted in a reduction in office supplies expense by 50% with the elimination of paper charts.

3. Reduces liability and malpractice insurance premiums: Improved documentation, audit trails, and accuracy not only reduce incidents of medical errors, but also improve the chances of physicians receiving discounts from insurers. The cost of malpractice insurance has been showing a constant upward trend. A good EMR system leads to reduction in costs associated with poor documentation that otherwise generally means higher malpractice premiums.

a.    In a 2005 survey by the Medical Liability Monitor, a four-state average of the highest liability rates for OB/GYN was $230,919. With a two to five percent credit from malpractice insurance companies, clinics would save $4,600 to $11,500 per provider, per year, if they implemented an EMR.b.    In another example, the Midwest Medical Insurance Company (MMIC) is offered a two to five percent credit to physician groups that used an EMR in 2008.

4. Self-service by Patients lowers data entry costs: The Patient Portal module of an EMR allows patients to enter much of their own demographics, even before they arrive to the Physicians office, including health insurance information, medical, family, and social history, and other pertinent data and this can save office staff a lot of data entry time. It can even allow patients to view certain information from their medical electronic file, and schedule appointments.

5. Saves time and increases efficiency: Staff and physician time is often ill spent due to:i. Waiting: If a pharmacy calls while the chart is being used, or waiting to be filed, the staff receiving the call cannot access the information in a timely manner. EMR Systems allow multi-use access that enables staff to access and update patient records simultaneously – this saves time that would otherwise be spent in waiting for access to patient records.ii. Time spent in pulling Medical Records: It is estimated that the cost of pulling and handling paper charts averages $5 to $12. In an EMR deployed Practice, Medical Records are accessible 24 x 7 from any web-enabled device or web access point, and this is done, securely.iii. Data entry for billing purposes: When the EMR System interfaces or integrates with the Practice Management or Billing System, data entry workload reduces significantly while maintaining billing accuracy. In a recent case study, a Practice reduced labor costs by 10% in the first year after implementing an EMR solution due to more efficient workflow and, the reduction of filing, coding, and data entry staff, while reducing time spent to complete clinical tasks such as Rx refills, referrals, lab, and diagnostic orders.

Revenue Acceleration and Denial ManagementEMR implementation can help increase revenues but a physician practice must not forget to look at two other important and often neglected aspects:1.    How can revenues be accelerated by proactive AR Follow-ups?2.    How can we manage denials efficiently and expeditiously?

Revenue Acceleration

Experts believe that effective Account Receivables (AR) Follow up and AR Management are the most important areas requiring attention to ensure optimum revenue recovery. The average profit margin of US hospitals is less than 2% of Net Revenue while lost revenue due to denials accounts for an average of 6% to10% of net revenue, nationwide.  In fact, take a look at these powerful facts:

•    14% of all claims submitted to payers are denied and have to be resubmitted, appealed, or written off by Providers. •    50% of denied claims are never re-filed. •    90% of denials are preventable. •    50-70% of denied claims are recoverable.

This can cost a clinic or practice thousands of dollars every year. Aside from the direct impact from the loss of revenue, there’s an additional impact on resources because of the expense associated with reprocessing denied claims. A judicious combination of process, technology and people skills must be effectively used to follow up with the payers to identify, address and rectify the identified problem and accelerate your revenues so that you can get money in your bank – faster.

Denials Processing

Accurate coding speeds up the reimbursement process and results in fewer rejected claims from insurance companies. Sophisticated denial processing solutions can captures claims, payments, and denials and addresses your denial management issues with an effective denial management plan.Here are some of the tools used to achieve high rates of denial reversals:•    Continuously update denials database •    Immediate identification of the root causes of denials, and use the experience and knowledge to address each denial trend•    Utilize denial data to generate custom reports •    Better feedback to the coding and billing team

Conclusion

The many benefits enumerated in this article can be experienced by all Physicians, however, the payback period (ROI) will vary from Practice to Practice. In most cases, Practices experience increased cost in Year 1, and then, begin seeing increased revenues and, decreased administrative costs and overhead from the second year onward.  The key ingredient for success lies in the willingness of the Practice to critically examine their existing workflow and make recommended adjustments to optimize workflow efficiency. If these efforts can be supplemented with other revenue acceleration and denial management techniques, the Practice can see significant improvements in each and every revenue cycle Key Performance Indicator (KPI).

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EMR Software – Improving Medical Care

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Guidelines for Choosing the Right Medical Practice Emr Software

Suggestions For Buying The Correct Medical Practice EMR Software

When it comes to EMR and medical practice software programs, it’s critical to really dig in and find out what they can offer. Many demos are structured to emphasize particular abilities or features. It’s important to keep in the mind each of the specific requirements that your medical practice has. Are you in the market for electronic medical record software, an entire medical practice management system, medical scheduling software or medical billing software?

When you’re trying out medical practice management software, you always should find out as much as you can about each of its abilities or features. Cases that are highlighted in the demo versions often are easy and simple. Look at some of your patients and how intricate your operations are and try to use the demo with them.

How does the medical practice management system perform with your particular patient cases? Try working with a couple of basic ones and a few complex ones and see if the software consistently performs with each case. Does it work well with easier cases but become hard to use and inconvenient for cases that are more difficult? Will the medical practice management system handle reminders, e-mail capability, patient bills, and appointment scheduling? Does it have regular backup, keep track of family histories, allergies, prescriptions, etc, and assist with diagnosis and trend/pattern recognition? These are only a couple of the things you will need to have in mind when looking into which medical practice software to pick up.

Basic Design Attributes

What are the data elements? This means: patient identifiers, historical information and databases, family histories, patient activity status, vitals information, problem lists, patient notes, risk indicators, lab data, allergy lists, blood drawings, tests, immunization records, medication lists, consultation notes, reports, hospital records and more.

Good EMR software really should be user-friendly. What’s the user-interface like? The information must be easily understood. Several systems come with voice recognition software. This is a feature that should really be included in every medical practice management system.

A lot of EMR systems come equipped with medical practice management capabilities. Its important that you are aware of whether the practice management system includes software for appointment scheduling and finances. An investigation of the design and arrangement is imperative.

It is also important to do a little research on how easily accessible the system is. There are some EMR systems that are web based and others aren’t. There are some that allow multiple users, and can be accessed remotely. All software solutions need to support email.

Is the EMR compliant with privacy standards and confidentiality? It has to be compliant with HIPPA. There should be continuing support and training available to you and your staff.

These design characteristics are important since they cover a lot of the usability factors involved in medical practice management software.

All these criteria may cause you to feel confused and overwhelmed. It’s important to take the requirements and purpose of your practice into consideration, and choose a medical practice software system that accommodates it. A lot of EMR companies allow you to sample a demo of their practice management software to see if you like it before making an investment. After doing some checking it’s important that you check out a number of EMR systems and see by experience which vendor is appropriate for your practice.

R. Lorenzen is an independent writer. Check out a demo version of http://www.chartlogic.com’s medical practice management software or EMR software. They’ve got the most user-friendly medical management software in the industry.

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Increase Your Revenues by Implementing EMR Software!

You may have heard of electronic medical record software reducing overhead costs and minimizing wasteful expenses.  Is it really true though that you can actually increase your revenue using EHR software?  Yes, because the same measures that allow you to streamline your operation also help facilitate new patients and new business, not to mention retain your patient base.  How is this possible?

Electronic health records software improves charge capture for one.  When regular paper charts are used many services can be easily lost.  If they are never billed, you lose out on that money.  Erroneous data can also be entered into the system that will cost you some much needed income.  An EMR solution increases revenue because it is capable of capturing charges for all services.  This is thanks to highly advanced computer equipment that can track every individual service and payment.  Automated charge capture is one of the most important features for guaranteeing income.

An EMR system can also maximize billing.  When you use a paper chart system, it’s customary for physicians to down code (use a lower billing code) just to ensure they stay within legal limits.  They do this instead of using the appropriate level of code, which gives them more money.  You can easily use E&M billing codes which are programmed to stay within legal limits.  (And this feature is constantly updated, since your system connects to the Internet)  You can make more money and not have to worry about the threat of a lawsuit, an audit or rejected claims.

Medical software can help you to improve office productivity, since it saves physicians literally several minutes a day that they would spend dictating and reviewing transcripts.  With this specialized EMR software, you can automatically generate progress notes and save several minutes a day for each session.  In the end, such effective time management can let you schedule in another patient.  

Web-based EMR software can help you with health maintenance reminders so you can better keep track of patients due for annual check up.  This software can also provide computerized checks so that you can minimize bank charges.  Lastly, the software can increase your sources of income as it allows you integration with higher quality payers and organizations. 

There are many EMR incentives to look into.  Even if you can’t justify the expense of a program for time management sake, don’t overlook the potential for increased profit.  Certified EMR software may give you that competitive edge you need to excel in business.

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E-Prescribing Through EMR Software

One of the greatest advantages of Electronic Medical Records (EMR) software is that of the e-prescription feature.  Certified EMR programs (or certified HER programs) can integrate with e-prescriptions, which can increase your income while also helping to maintain more accurate records.  What is an e-prescription?

This refers to computer-generated prescriptions that you can print out and send directly to your patients or pharmacy.  Instead of having to write out prescriptions on a piece of paper you simply enter it into the EMR system.  The prescription then travels from your office to the pharmacy’s computer.  This is done through a private, secure and closed network to ensure that the information is never just sent over the Internet or through email, sources which may be compromised.

The benefits of using EMR software for e-prescriptions include less waiting time by the patient, which will in turn increase the patient’s satisfaction and loyalty to your office.  You no longer have to worry about legibility, as EMR systems have advanced handwriting and speech recognition features.  The pharmacist won’t even be dealing with your handwriting, as he will be receiving all prescription information via computerized message.  Using EMR medical software is also the more economic choice, as it will help you to streamline your business and pass the savings onto your customers.

Currently, over 75% of all pharmacies in the country accept e-prescriptions.  Moreover, in the year 2009 and in the upcoming 2010, practices that use a qualified electronic prescribing system are eligible to earn a bonus payment of 2% of the total allowed charges through Medicare Part B.  Using certified EMR medical billing software you will have access to e-prescribing features.  You will be able to experience dramatic gains in enhanced productivity, additional income and reduction of time and monetary expenses.

The average physician spends an estimated $15,000 a year on nothing in particular—and it all results from using a paper file system or a basic computer record system.  Using an EMR system with e-prescribing capabilities enables to you take advantage of e-prescription programs along with increased bonus payments made possible by PQRI (Physician Quality Reporting Initiative).

EMR practice management software simplifies the prescription process, protecting you legally as well as helping you financially.  You will be surprised at how much more efficient your office works thanks to a comprehensive electronic document management system.  Remember that you can modify and add customized features for your practice as you need them, and you don’t have to be a computer expert to make these changes. 

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How Does EMR Software Improve Staff Productivity?

How can EMR (Electronic Medical Records) software improve your office productivity?  You may have a medical practice but still remain uncertain as to whether EMR is a convenience or a need.  These are hard times and you do need to maximize every dollar.  Is electronic medical record software really a necessity?  Consider six reasons why buying EHR or EMR software might be ideal for your practice.

More Accurate Coding: Human beings make errors, especially if there are heavy data entry requirements.  However, using electronic health records software can provide more accurate coding, resulting in fewer mistakes and thus less wasted money.

Increased Number of Patients: By taking care of logistical and technical details for you, electronic health record software can actually cut minutes of time away from your busy day.  By saving just a few minutes of paperwork or computer entry, you can actually schedule more patient visits and make a higher income.

Decrease or Reallocation of Employees: The less paperwork your office has to worry about, the less filing and data entry that is needed, the more money you can save for yourself and your core staff members.  Along with saving on unnecessary expenses, you can also decrease patient wait time.

Reduced Storage Space: Some officers grow so quickly they run out of room in the local office and have to purge and store files at an offsite location.  With an EMR system they can store all files onsite and filter through them accordingly.  At the same time, multiple users can access charts or other documents at the same time. 

Elimination of Lost Items and Illegibility: One of the major problems facing a lot of practices today is losing charts and other important written information as well as illegibility in charts.  With modern EMR solution software you are able to convert handwritten documents into computer characters, as well as scan documents and convert printed text into typed characters.  Some of the newest medical software even recognizes human speech. 

Web-Based EMR: Whether you are on the road traveling or your secretary is out of town, it’s good to know that the central EMR system is never more than an Internet web browser away.  A web-based EMR system lets you access the application and database from any location and update schedules, perform tasks or search records.  This is very efficient in improving productivity during holidays, on weekends, vacation time or after hours.

These are just a few EMR incentives that are worth thinking about as you plan your practice’s future.

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Top 10 Features of EMR Software

EMR stands for electronic medical records software and there’s no question that having a highly advanced system can help save you money and make you more money.  Let’s consider 10 outstanding features of the best electronic medical record software programs on the market.

1. A Fully Integrated System

The best feature to look for is a system that is integrated with a larger medical billing practice management application.  Integration simply means that all of these applications share the same database, so you don’t have to worry about buggy interfaces and other inconveniences.

2. Integration of Software With E-Prescription

In the last two years of practice, providers who use EHR Software along with qualified electronic prescribing systems are eligible to earn bonus payments of 2% of their total allowed charges through Medicare Part B.  You can look forward to efficiency gains and enhanced patient safety. 

3. System that Supports PQRI Automation

PQRI refers to Physician Quality Reporting Initiative.  This refers to a quality-measures policy that states that through for the 2009-2010 period physicians can earn a single consolidated incentive payment of 2.0% of the estimated total allowed charges for Medicare Part B covered services.

4. Software That is Also Adaptive Learning

Adaptive learning refers to the electronic health record software’s capability of remembering how each physician enters in data entry for treatment and documentation.  This essentially means that the software is capable of “remembering” names, lists, assessments and prompts based on previously entered information. 

5. Secure Portability Without Internet Connection

The best systems of today allow total portability, meaning you can access your software and databases from any location or computer.  Additionally, this access must not only work through a secure Internet connection if possible, but also be able to work offline.  The best software is able to save important data so that you can still keep up to date with your future appointments.

6. Integrated Patient Portal

The EMR system should be able to let your patients connect your office using an integrated patient portal.  Patients can use this for appointment scheduling, re-fill requests, messaging, education and more.

7. No Rigid Templates

Medical Software should not have pre-defined templates that can only be changed by vendors or high-tech wizards.  In fact, the best systems today are run by a technology known as “chief complaint” which allows the doctor to “chart at the speed of thought.”  This is far more convenient that dealing with frustrating templates.

8. Effective Document/Image Management

Web-based EMR software should let physicians and staff record and manage records (via copying documents or linking) with ease.  The best software is cable of reading large files, converting picture data into database form quickly and accurately.

9. Voice Recognition and Handwriting Recognition Technology

Practice management software should equipped with the latest advanced features in recognizing human speech (with a 98% accuracy) as well as handwriting.  When you get used to the system you will find that writing down a signature on a tablet PC will be far more convenient than typing words into a database.

10. Meets All Technical and Legal Requirements

There are numerous federal and state regulatory and compliance issues that you must be aware of.  Having an EMR Solution that has guidelines programmed in (and is constantly updated by the vendor’s system) will keep you legally safe all year round.

These are just a few of the features to look for in the newest EMR software.

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The Physician’s Guide to Electronic Medical Records Software

A challenge awaits the physician who has had enough of the frustrating inefficiencies, financial penalties, and antiquated practices associated with maintaining a paper-based medical office. So the decision is made to digitize the practice. Any initial enthusiasm quickly wanes once an initial search for medical software uncovers hundreds of products and vendors. It doesn’t take long before the 300 or so electronic medical records system screenshots and feature/benefit grids begin to look remarkably similar. The sheer number of vendors occupying the EMR (electronic medical records) market is unmanageable without a basic product assessment/elimination strategy.

For physician practices with limited time and resources, the selection process can appear overwhelming. Fortunately, physicians can begin to narrow down potential systems by eliminating uncertified products, as well as those built upon dated technology architectures.

By confining research only to CCHIT-certified EHR (electronic health record) products, a substantial number of systems are quickly eliminated. As of this writing, 53 ambulatory EHR systems have successfully met the 2007 standards, while only 18 have met the more rigorous 2008 criteria. Using CCHIT certification as an initial benchmark is prudent for a variety of reasons: The CCHIT is the leading Healthcare I.T. certification organization, and is publicly endorsed by the American Academy of Family Physicians; the American Academy of Pediatrics; the American College of Cardiology; and the American Medical Association, among others. In addition, a CCHIT Certified designation ensures that a product has met the basic requirements for functionality; interoperability; and security and privacy.

A 2008 CCHIT certification warrants the product’s utilization of standard formats enabling the exchange information with other systems – known as interoperability. The exchange of patient information on a regional or national level is the underpinning of a more efficient and less costly healthcare system. Future tax incentives and Medicare reimbursements may be tied not only to utilization of digital medical records in general – but specifically benefiting practices with CCHIT-certified EHR systems.

Interfaced systems are still sold today, so it is a “buyers beware” market. In the past several years, there have been a number of mergers and acquisitions between vendors having market share in one side or the other (scheduling and billing or charting/EMR) but desired a comprehensive solution to offer physicians. As a result, there are products currently marketed as a “suite,” but were developed by disparate vendors on different platforms, tied together using a separate application. Although generally transparent to the practice, there may be questions of data integrity; patient safety (for example, a patient’s practice management/billing record does not match the clinical record and lab results get overlooked in the mess); and even the vendor’s long-term maintenance of the system.

Unfortunately, uncovering if a system is integrated or interfaced is not always straightforward and may require the buyer to conduct some detective work. The first step is to ask the vendor questions about the product’s history – which company developed it, does it utilize a common database, and is there a single login for billing and charting? Some interfaced systems require users to log in separately to access the practice management/billing and the clinical portions of the software.

Following the elimination of uncertified products with dated technology, the pool of suitable products begins to shrink and the specific needs of the practice should be defined and considered.

Finally, it is time to ask questions about the vendor’s service and support – the most ambiguous, but arguably most important aspect in the decision making process. After all, you can purchase an electronic medical records software system with every bell and whistle, but if the implementation is disorganized; the training inadequate; or the post-installation support lacking – productivity will drop; providers and staff will be frustrated; cash flow may be interrupted, or worse.

Some smaller practices opt for a web-based installation to decrease the cost of hardware and eliminate the need to maintain servers and other equipment. Web-based installations are known as SaaS (Software as a Service) and are delivered by an ASP (Application Service Provider). The electronic medical record ASP hosts the software in a secured data center, and the end-user (the practice) simply accesses the system using a web browser. All that is required is a high-speed internet connection and a workstation. Access to the data is dependent upon the internet connection, so mission-critical applications are not appropriate in a SaaS environment under most circumstances.

The alternative to a web-based installation is Client/Server, requiring an onsite server and regular maintenance of the system by the vendor. Both types of installations have advantages and disadvantages, so it is important to discuss installation with potential vendors.

To keep costs down, some practices may utilize a heavier web-based training plan for the bulk of the staff with designated superusers who attend advanced training. For practices with less technologically savvy staff, more handholding through onsite training may be the best option. In addition to improperly installed I.T. (hardware, networking, security, workstations), insufficient training or post-implementation technical support are prominent failure points in medical software implementations.

By asking relevant questions, evaluating the needs and culture of the practice, and systematically eliminating unsuitable products and vendors – practices can enjoy the host of current and future financial and patient safety benefits that an electronic health records system provides.

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