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Tips for evaluating electronic medical record software

Many groups flub the software selection process by not taking the time to figure out what they really need

From the April ACP Observer, copyright © 2004 by the American College of Physicians.

By Jerome H. Carter, FACP

When it comes to electronic medical records (EMR) systems, there are literally hundreds of products on the market. Choosing one among them can be an overwhelming task unless you establish a well-defined, comprehensive process for comparing products.

Unfortunately, most physicians looking at EMR systems have only a vague idea of how to go about identifying the system that best meets their needs. Too many physicians make the classic mistake of beginning with a product demonstration and following up with a site visit.

While these two steps may seem like obvious starting points, they are not the right way to launch your search for one simple reason: At this point in the selection process, you still have no idea what you're looking for.

Consider the following example. You've just had another child, and the two sports cars you and your spouse are driving no longer meet your needs. But before going to an auto dealer, you'd first do a lot of homework.

You'd decide, for example, which car you're going to trade and how much it's worth. You'd also decide how much you can afford to spend, what safety features you want, and what make and model has the best repair record. Taking a test drive or talking to car dealers wouldn't be helpful until you have a clear idea of what you need.

Evaluating EMR software is no different. The size of your practice, the specialty of the physicians, their typing skills and computer literacy, and the group's budget and practice habits all play a role in determining which EMR is best for you. Put simply, one size does not fit all.

How can you manage the daunting search for EMR software? The following six-step process can help.

1. Create a policy to review products. Before you even think of contacting a vendor, you need to create a formal procedure for evaluating EMR software.

Start by setting up regular meetings with providers and staff. This gives everyone a chance to discuss their needs, fears, unresolved questions and budget concerns.

Create guidelines and ground rules for everything from contacting vendors to reviewing products. Use a notebook to record all information concerning meetings and tasks.

If done properly, the evaluation process should take a few months. Detailed, orderly notes will not only make the process go more smoothly, but make it much easier to create a request for proposal.

2. Define the problems you want to solve. You then want to find all the products that contain the features you need. I refer to this as a problem-based selection process.

During this step, ask and answer the critical questions that establish your practice's needs. Will you, for example, need remote access to records, the ability to write prescriptions and track referrals, or help identifying patients who need preventive medicine?

At this point, you should list in as much detail as possible every single feature you want in an ideal EMR. While this wish list should be comprehensive, you also need to make it specific.

Listing "prescription-writer" as a required feature, for instance, doesn't provide enough detail to help you decide later between two systems. Instead, you might decide that an ideal system will provide drug interaction information with user-controlled severity alerts; allow physicians to record a reason when stopping medications; provide patient education materials; and automatically check for allergies for specific classes of drugs. This level of detail lets you make much more precise comparisons.

This step should take at least a month. If more than three or four providers work in your practice, it could easily take up to six months. Once your list of required features and functions is complete, you are ready to take your first look at available products. (See "Resources to help narrow the search for EMR software.")

3. Identify appropriate vendors. While the market for EMR software is huge, winnowing the field can be relatively easy. For example, vendors often target practices by size and specialty area. Eliminating products that do not fit your specialty or practice will remove a sizable portion of products from consideration.

When you're getting started, it's critical to determine the economic vitality of the vendors. (This information is available from surveys, vendor Web sites or by contacting the vendor directly.) Make sure you include the following key questions when talking to vendors:

  • yearly sales in dollars;

  • years in business;

  • total number of systems sold to date (systems, not licenses);

  • geographic spread of customers; and

  • number of employees designated for customer support.

Eliminate any company that will not answer all questions fully. Vendors' response time could help you eliminate a few more. The remaining vendors should be asked to submit detailed product information and a working demonstration copy of their software.

4. Get a demonstration copy of the software. A demonstration copy will perform exactly like the real product, but the vendor will either limit the number of patients you can enter or the amount of time you can use the system. Avoid "canned" demonstrations where vendors walk you through a database populated with hypothetical patients. These types of demonstrations are useless at best and are often misleading.

Typically, a demonstration copy will not let you enter more than 50 patients or use the system for more than 60 days. In my experience, rarely do more than five to 10 vendors survive this step, because they are either incapable or unwilling to provide a demonstration copy of their software. (If a vendor won't provide a demonstration copy, I'd suggest eliminating that company from your consideration.)

Once you have working copies of products and accompanying literature, you can start to assess how each product meets your needs.

It's important to quantify how each one measures up, so assign a numerical score for important features and functions or use some other objective scoring system. Set a cut-off score and eliminate all products that do not exceed your scoring threshold.

5. Compare features directly. If you have completed the problem-based selection properly, you should have no more than three to five potential systems to evaluate. It is now time to compare the products side by side to see which works best for you.

This step requires you to spend time working through each of the product's features. Check the prescription-writer in each. Which one best suits your practice habits and style? Which is easiest to learn or correct mistakes?

At this point in the process, you should narrow the field to three or fewer candidates. Now you are ready to conduct a site visit.

6. Go on site visits. Site visits, when conducted by educated consumers, are quite helpful. Request a list of customers from each vendor and contact the practices yourself. Do not visit sites suggested by vendors.

List the questions you'll ask about how well vendors respond to requests, training time, implementation difficulties, upgrade frequency and specific features. Ask to be allowed to see the system in use, and try to determine how well each system would fit into your practice.

Jerome H. Carter, FACP, is director of informatics at the 1917 Research Clinic in the division of infectious diseases at the University of Alabama at Birmingham. He is the former Chair of ACP's Medical Informatics Subcommittee and edited "Electronic Medical Records: A Guide for Clinicians and Administrators," published by the College in 2001.

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Resources to help narrow the search for EMR software

Several resources can help you narrow the field of vendors selling electronic medical record (EMR) software. Here are some sites to help you get started.

ACP resources

  • "Electronic Medical Records: A Guide for Clinicians and Administrators" discusses EMR selection, contract negotiation and other topics in depth. The book, published by ACP and edited by Dr. Carter, includes a checklist of EMR features and a template to create a request for proposal.

  • The EMR Feature Check List 1.0 is an itemized form available on ACP Online to help you evaluate different software products.

  • Evaluating and Selecting Electronic Medical Record Systems from the College's Practice Management Center gives an in-depth explanation of how to evaluate EMR software.

  • The Computers in Medicine section of ACP Online has links for the above references and other EMR resources.

Other resources

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