The Tech Doctor: Best-of-Breed or Integrated Systems?

June 1, 2007

If you’re looking for an EMR, you’ll have to decide between scrapping your current practice management system and starting fresh, or combining your existing system with your new EMR.


Most practices in the market for their first EMR already have computerized practice management systems. As they shop for an EMR, they will need to make an important decision: Should I keep my existing practice management system and interface it with my new EMR, or should I purchase an integrated system that combines a new EMR with new practice management software? Let’s look at the pros and cons of each option.

Say you have a perfectly adequate practice management system, and it’s working very well. Now you want to add an EMR - and the vendor for your practice management system doesn’t offer the new technology. What do you do?

You have two choices: interface your existing practice management system with your new EMR, or start fresh and buy a fully integrated practice management system and EMR for your practice. In industry parlance, the former approach is referred to as “best of breed” systems, and the latter are called integrated systems.

With the best-of-breed approach, you select each software application based on its inherent qualities. If the practice management and EMR systems you choose come from different vendors and need to exchange data, you build an interface that allows that to happen. When combining EMR and practice management systems from different vendors, registration interfaces are the most common. This allows your front desk to automatically send data for new patients entering your practice to your new EMR. Without a registration interface, your staff must separately enter patient data into your practice management and EMR systems.

Integrated systems share the same database. This means that when your front-desk staff enters patient data into your integrated system, the information becomes instantly available to everyone in the office, using the scheduling, billing, or EMR portion of the system.

However, it’s important to note that buying both products from the same vendor is not a guarantee that they use a common database. It’s not unusual for EMR companies to purchase practice management system companies (or vice versa), package the applications under the same name, build interfaces to connect the two separate databases, and market the combo product as an integrated system. Remember that a system is not truly integrated unless the applications share a common database.

So which is the better choice?

With integrated systems, you are dealing with only one vendor, so you have the convenience of a single point of contact for support and technical concerns. In addition, you needn’t manage the technical aspects of building and maintaining an interface between your EMR and practice management systems. And you’ll also gain from the systems’ shared applications.

This last point is probably the most important. Because truly integrated systems share a common database, they allow sophisticated interactions between your EMR and practice management systems.

For example, a feature in most integrated systems, called an electronic encounter form, is designed to replace the traditional paper superbill. Physicians complete this form with EMR software during a patient visit; it is then sent electronically to the practice’s billing department, which reviews the form for proper coding and quickly posts the claim. This type of seamless data exchange is difficult (and expensive) to achieve when interfacing between two separate systems.

Myriad tasks within medical practices require different staff members to share data quickly and accurately. Integrated systems are built with this data-sharing in mind; best-of-breed systems are not.

So are there any advantages to the best-of-breed approach?

Since most practices already have an established practice management system, choosing an EMR solely on the basis of its own merits as a separate tool allows you to keep the software you have in place. This should save you money and minimize disruption to the practice when implementing your new EMR. And if your billers are currently happy campers, they will appreciate the respite from change.

Bruce Kleaveland is president of Kleaveland Consulting, a management consulting firm focused on healthcare IT. Prior to forming Kleaveland Consulting, he was chief operating officer at a leading EMR company. He can be reached at 206 527 6633, bkleaveland@msn.com, or via editor@physicianspractice.com.

This article originally appeared in the June 2007 issue of Physicians Practice.