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IdeaLab: ‘How I got Over My EMR Excuses’


Steve Ryan, MD, rebuts the most common “reasons” many physicians give for sticking with paper.

When my partner and I opened our family practice five years ago, our goal was simple: to give our patients the highest quality of care available. By then we had 16 years of practice experience, and so we recognized the costs and problems associated with a paper-based documentation system. We wanted to open our practice - Carefree Family Medicine is a two-physician, one-nurse practitioner practice in Colorado Springs, Colo. - with the best technology available to improve efficiency in communication and documentation.

Our providers see about 6,500 patients a year. In our EMR search prior to opening, we had the same concerns that most practices have as they consider a switch from paper to electronic records: Will using an EMR make that much of a difference in the way we practice? How do we even begin to choose a system? How long is the learning curve once we’ve selected and installed a system? In terms of the care of our patients, our practice satisfaction, and our return-on-investment, is the benefit worth the cost?

These questions (and so many others) are daunting, and can quickly become excuses for delaying indefinitely or eschewing altogether the transition to electronic records. My partner and I hired an outside consultant who helped us get beyond our excuses; we eventually settled on HealthMatics EMR by Allscripts. But every physician has an “EMR excuse” at one time or another, and I have heard them all.

Here are my favorites:

There is no EMR that fits my specialty.” With the growth in the EMR industry over the past several years, this simply is no longer true. There are systems with built-in knowledge to fit practices of just about any specialty.

Yet even with per-specialty knowledge, it is important to find a system that you and your staff can customize to fit individual needs. Yes, it may be more work up-front for you to do this customization, but it’s worth the effort. It is vital to find an EMR that allows such customization.

I’m just not into all that technology stuff.” That’s OK. It is not important for physicians or staff to have computer or networking skills to use an EMR. It is important to find a vendor with an outstanding training program and a proven implementation process. A good company will have training and implementation processes in place to make your practice’s transition as easy as possible.

The best way to learn if an EMR vendor can back up the promises of training and implementation is to ask for references. Speak to previous physicians and staff to learn more about their training process. More often than not, these practices will have their own EMR tips to share with you.

I’m waiting for someone else to pay for it.” Many practices have been waiting for months or years for insurers, hospital systems, the government, or some other group to announce that it will fund an EMR purchase. In the meantime, they forget about how much money they could have been saving. We saw a return on our investment immediately after implementing our EMR system at Carefree Family Medicine. We eliminated the costs of materials to create and maintain paper records, file storage costs, and costs associated with copying requested medical records.

Human resource costs were significantly reduced. We no longer had the need for full-time employees devoted to maintaining and retrieving paper medical records. Think of all the time you spend pulling, disassembling, reassembling, filing, and looking for charts. Monthly, we save thousands of dollars in transcription and dictation costs and communication efficiencies.

Revenue also increased due to more accurate coding. EMR systems help to calculate and recommend proper coding and even assist with Medicare compliance. The Center for Information Technology Leadership recently stated that if every practice and hospital in America had an EMR, savings would total more than $78 billion a year. While waiting for someone else to take care of the initial expense of an EMR system, practices are losing a significant amount of money.

I’m waiting until they refine the system.” While there are some novel EMR vendors that are still making major changes to their systems, most vendors are in the stage where they are tweaking, not reinventing, their technologies.

You should ask vendors many questions. For instance:

  • Does the vendor use physician expertise to refine its system? Any vendor you choose should work with your practice to take into account your suggestions and desires.

  • How many physician offices currently use the vendor’s EMR? While it isn’t imperative to sign on to a larger or longer-established vendor, it may be beneficial to know that your implementation will not be a “trial run” for a vendor. A vendor who has worked with numerous practices may be better able to assist you during training and implementation.

  • How long has the vendor been in the healthcare business, and is it financially secure enough to take you into the future? While nonmedical software companies may be developing and selling their own EMRs, I think it’s better to look for a vendor that understands the nuances in our industry. Vendors that have employed physicians and healthcare industry experts are more likely to know what it takes to keep a practice running smoothly.

Searching for the right EMR system for your practice is no easy feat. However, through proper due diligence, and by asking the right questions, we had a successful implementation at our practice, and we are now seeing the multiple benefits that healthcare information technology can reap. Remember, while some degree of growing pain may accompany the initial change, the long term benefit of providing better, smarter care for you patients is well worth the effort.

Steve Ryan is a family physician and a founding partner of Carefree Family Medicine in Colorado Springs, Colo. He can be reached via editor@physicianspractice.com.

This article originally appeared in the January 2008 issue of Physicians Practice.

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