Making electronic medical records work in private practice

Hundreds of products are available to help get organized and compete for contracts, but costs remain high

From the June 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

By Jennifer Fisher Wilson

PHILADELPHIA—Electronic medical record software can help physicians better manage patient care and compete for managed care contracts, but most doctors remain wary about actually purchasing and implementing these systems.

At an Annual Session presentation on the pros and cons of electronic medical records, speakers explained that electronic records allow physicians to quickly gather and analyze patient information, easily examine population health status, patient satisfaction and track performance outcomes.

"Outcomes are the major reason why you want an electronic record," said Jerome Carter, FACP, a medical informatics expert from the University of Alabama. "Once you get this information, it's a snapshot of what you do every day, how good a doctor you are."

Despite the advantages that electronic record software can bring, however, Dr. Carter said that fewer than 5% of physicians currently use computerized record software in their daily practice.

One reason is cost. Implementing a computerized record system can run approximately $1 million for a 20-doctor group and $40,000 to $50,000 for a two- to three-doctor group. Physicians who have little experience with computers fear sinking so much money into a product they don't know much about.

That hasn't stopped vendors from flooding the market with computerized record products. Physicians now can choose from approximately 700 practice management packages, about 30 of which have strong electronic medical record components, Dr. Carter said.

So what should physicians interested in buying commercial software to computerize their records look for? Dr. Carter recommended physicians approach purchasing a medical records system as they would buying a car. "You wouldn't buy a car without researching it first, finding out how to get the best car to suit your needs and your budget," he said. He suggested researching electronic record software for at least a year before making a purchase.

Patricia Hale, ACP Member, an internist in private practice in Gansevoort, N.Y., another panelist at the session, said that before looking at programs, physicians should identify what they like about their current records system and try to find software that can duplicate it. Then they can pinpoint what doesn't currently work-tasks like finding charts on the fly or digging through piles of papers to find lab reports-and try to use the computer to improve it.

Dr. Hale also suggested testing electronic record software to determine how different programs function and how they can help fill a practice's needs. "To evaluate an electronic record program, construct a patient scenario of the most common patient seen," Dr. Hale said. "This is the acid test."

Five questions to help make sense of medical records programs

According to Patricia Hale, ACP Member, an internist in private practice in Gansevoort, N.Y., physicians should ask computer vendors and consultants the following questions about their electronic medical records software:

• What support is available? (Ask about response time, after-hours support and local support personnel certified to work on the operating system, network and equipment.)
• Does the system charge for software updates and special reports (a list of all patients over 60 who have had a mammogram, for example)?
• Does the system have error correction features that prevent users from trying to enter wrong ages—a 165-year-old-man, for example—or lab values?
• Does the system keep an audit trail so that unauthorized access attempts can be tracked?
• Can the system import and export data?

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