Kirk Voelker, MD, has already spent over a year trying to find an electronic medical record (EMR) for his practice. He became so stymied by the process that he started a Web site (www.elmr.com) to help his practice, Lung Associates of Sarasota in Florida, and others find the right system.

Voelker isn't alone in feeling frustrated. As more physicians consider EMRs, more are confused by the seemingly endless array of choices, none of which seem, at first glance, to be terribly different from the others.

In fact, shopping for an EMR can be like shopping for a good merlot, as David Bond sees it. "You're looking at a shelf with 500 merlots. You don't know whether to buy the one on sale or the one with the Wine Spectator listing," says Bond, executive vice president of the ambulatory division of A4 Health Systems, in Cary, N.C.

"I don't know of anybody who has found a quick path" to picking an EMR, confirms Jeff Blair, vice president of the Medical Records Institute, a Newton, Mass.-based organization that promotes the development and acceptance of electronic healthcare.

In short, picking out an EMR is not going to be as quick and simple as you might have hoped. But there are some methods for easing the process.

Know what you need

The first and most crucial step, before you look at a single brochure, is to define internally what the system needs to do. What made you decide to look into an EMR to begin with? Many physicians simply feel they want to get rid of paper records, but that explanation just scratches the surface. What, really, is so bad about paper? Is it that a physician can't find a chart when he needs it? That it's hard to mine paper charts to find all diabetics who need a foot exam? Be very clear about your objectives.

Often, physicians working within a group will have different motivations in mind. Any product search will fail unless there is some consensus on what you hope to accomplish. "All physicians are focused on 'what will this do for me?'" says Blair, but how they define what they want an EMR to do for them can vary.

For example, some physicians want software that will make documentation easier. "Unless it helps them perform their data capture responsibilities faster, they may not be interested. Other physicians with a lot of repeat visits may find value ... in being able to quickly look over lab tests, so their priority is more on retrieval of information," says Blair.

Still others need to share data with physician colleagues or are focused on quality of care issues. Physicians in a multispecialty group may need to incorporate radiology images or charts of an eye; others will just need a way to chart office visits. "These priorities compete with each other and you almost never find a group where they all share the same priority," Blair warns.

Voelker's experience is typical and matches Blair's description. "It's a difficult decision. For us, we have not found anything that works well for the group as a whole," Voelker says. For example, he wants to be able to send notes to referring physicians but finds the template-driven notes created by most EMRs too obviously machine-built.

"The perception of the standard of care I'm giving is decreased," he worries. It's only because he knows sending high-quality notes is important to him that Voelker is able to recognize the drawbacks of templates – at least for him. He finds it better to have no system at all than to invest in a system whose output would embarrass him.

As Voelker is doing, a good first step is to get as clear a picture as possible of the sort of functionality you need to fit the culture and goals of your practice.

Don't buy for brand

Setting a group goal will also help you avoid a common mistake in EMR shopping – just buying what everyone else is using. It's tempting to shop for an EMR the same way one might shop for a dishwasher or a lawn mower – look for the market leader or famous brand name and purchase that product.