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Moving to an EMR: A Checklist


Steve Rebagliati, MD, offers up a checklist for EMR buying.

Diving into an EMR is scary. Eliminate risk with a checklist. Here's one that covers the seven critical success factors for an EMR. Whether your new EMR actually works the way you need it to will be decided by choices you make in these areas:

Text-based versus graphical interface

Consider the look and feel of the application itself. Make every vendor demonstrate its EMR to you as it would work in your office. Your main concern is balancing the trade-off between graphical user interfaces (GUIs) and text-based systems.

GUIs use up large amounts of memory: you trade elegance for speed with GUI, and sometimes you'll find text-based interfaces are faster and easier to use.

What you choose depends on your computer processing power, the way your computers are networked, and the type of Internet pipeline you have. Just remember the trade-off between GUI and text and make sure any vendor demonstrations are on machines similarly configured to what you'll actually have in your practice.

Data-entry hardware

What will you use to enter data? A full-sized desktop? A mini personal digital assistant (PDA)? The trade-off here lies between mobility and utility. The most useable interface is a full-size monitor at a PC workstation, rooted to a particular desk. Next down: a wireless, networked computer kiosk with a movable workstation. Next are handheld items such as tablet-based PCs and tiny PDAs. You have to consider your patient care needs and how physician workflow takes place.


How easily will this integrate into your current business practices? How many exam rooms do you have? How fast do rooms turn over? Do you have stops for patients along the way for vital signs, lab draws, and so on? Whatever software you buy needs to be able to accommodate or, better, improve each step in your workflow process. It won't do, for example, to have physicians waiting around for lab work to be entered into the system before they see the patient.

Data structure

How is the actual data structured? You will find that lots of add-on software, including quality management and patient safety surveillance software, can only be used on specific types of data. So it matters whether the EMR structures data in flat-files like FileMaker Pro or relational databases like SQL or Microsoft Access.

Privacy and security

How does the system protect patient privacy and maintain information security? Is it compatible with your own information security policy? Does it permit graduated levels of access and privileges? Is it sufficiently modular to separate out accounting, scheduling, billing, and clinical information functions with access by different people? Can you find the right balance between water-tight "need-to-know-security" settings and efficiency-enhancing "boundary-less" information sharing?

External connections

How does it interface with external information systems such as hospital laboratories? Can your workstation's EMR access lab results through a common Intranet? Does it require some form of secure dial-up access? Do verbally dictated chart notes have to be downloaded through a dial-up electronic data interchange pipeline or e-mailed? How secure is the information exchanged with third parties and what safeguards exist in terms of resident firewall and virus scanning software?


Does it generate the kind of reports you need? Some GUIs have so much space taken up by frames for control buttons that it's hard to read a whole page of a progress note without either shrinking it down to illegibility on the screen, or being forced to constantly scroll up and down and side to side to read everything. Can you search for information you want easily? What is the directory structure of the record like, and can you sort out information on labs, radiographs, consults, and other kinds of documents by patient, date of visit, originator of consult, and so on?

Whatever EMR you choose, you'll be more likely to come to a happy conclusion if you remember these seven critical success factors.

Steve Rebagliati, MD, MBA, is a practicing physician. He offers these resources, ideas, and tips for using information technology to increase revenues, decrease hassles, and free up time so physicians like you can succeed in a changing world. He can be reached by phone at 503 502 6339 or by e-mail at or via

This article originally appeared in the November/December 2005 issue of Physicians Practice.

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