EMR & EHR Blog for Physicians

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I was reading an interview with the CEO of a company which offers EMR Software on SaaS (Software as Service) basis. The CEO of that EMR vendor company mentioned that theirs was the only real SaaS EMR, others who claim to be SaaS are really only ASP EMRs. I have seen this term used interchangeably in the past and therefore thought that it would probably help to clear the air a little bit.

In a hosted solution (whether ASP or SaaS), the customer does not have to buy the software or the server infrastructure. The EMR vendor hosts the application on a server that is securely hosted in a data center that is accessed over the internet by the users. These are low-cost ways for businesses to obtain rights to use software as needed. Also known as 'on-demand' licensing, the customer does not have to deal with the associated complexity and potential high initial cost of licensing the application, installing it on expensive hardware and paying for annual maintenance.

We have known many EMR Software solutions that have been offered on a hosted basis for many years.

So what excatly is the difference between ASP and SaaS offerings?

SaaS applications differ from ASP applications in that SaaS solutions are developed specifically to leverage web technologies such as the browser, thereby making them web-native. The database design and architecture of SaaS applications are specifically built with 'multi-tenancy' in mind, thereby enabling multiple tenants (customers or users) to access a shared data model.

An ASP application on the other hand in most cases is a typical Client-Server application (meant for a single client) that is accessed over the internet and therefore includes an independent instance of Database that is specifically meant for your medical office.

So, as a physician, does it really matter to you if the solution is offered as an ASP or as SaaS? Really not. As an end customer, it has no impact on how you interact with the EMR application. It does not matter to you that from EMR vendor's perspective, it is expensive to create multi-tenancy based SaaS solutions but at the time more cost-effective to host and support them.

However as a customer of hosted EMR solution, you need to unambiguously understand as to who owns the data and whether the vendor of the hosted EMR software has the right to sell the patient and physician data (howsoever anonymized it may be) to third parties like data mining vendors. Also, if and when you decide to move on to an alternative EMR solution, how easy it is for you to get access to 'your' data (including all master data) in a format that can be imported into the new EMR database.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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Top EMR / EHR Vendors

There are 300+ EMR and EHR companies catering to different specialties and clinical requirements. EMR Vendors are constantly innovating and adding new features and functionality to their Electronic Medical Records solution. When EMR prospects are looking for ‘Top EMR' or ‘Top EHR' or 'Top 10 EMR' on the internet, what are they really looking for? Are they looking for an EMR System that will meet their current needs in terms of the feature set or are they looking for top EMR Systems in terms of number of installations or net sales revenues?

Top EMR Software Features

It would not be an exaggeration to say that the EMR market is fast becoming commoditized and EMR vendors must often be differentiated on the basis of quality of service that they provide rather than any basic EMR features. The perceived differentiating feature (as portrayed by the EMR vendor) may either cease to be a differentiator (as other EMR vendors quickly add that feature to their offering) or it is a more bells and whistles kind of feature not relevant to a large cross section of physician community.

Characteristics of Top EMR vendors

I therefore believe potential EMR prospects need to go beyond EMR features, number of installations, net revenues, etc., and must look for EMR vendors who will go the extra mile in providing exceptional service from sales to post implementation period.

a. Does the top EMR vendor truthfully disclose all the features of the Electronic Medical Records solution that are fully functional and not just on the drawing board?
b. Does the top EMR vendor disclose all the components of EMR implementation costs in a fair manner?
c. Does the top EMR vendor take responsibility for things that go wrong during implementation and not lay the responsibility at your doorsteps?
d. Does the top EMR vendor clearly define the roles and responsibilities of different parties involved in EMR implementation along with dependencies and timelines immediately after sale is made?
e. Does the EMR vendor ask you to buy more training because its trainer was not able to complete the required training in allotted time for reasons beyond the control of the Physician and Physician's staff?
f. When the top EMR vendor says that it offers a free interface, does the interface really come free of all costs (with the EMR vendor bearing costs of configuring the EMR interfaces at both ends)?
g. Does the top EMR vendor work with you and your staff in reengineering your workflow and guide you in EMR implementation best practices or the vendor is only interested in selling and then declaring that "the EMR is live' even though there are obvious things that the vendor could have done to make things more efficient from both clinical and administrative purposes.
h. Does the top EMR vendor provide you with dedicated training sessions involving realistic test patients or the training sessions are theoretical in nature intended to complete standardized training sessions and move on?

As you can see from the list above, it is difficult for any Physician to get the complete and true picture of what to expect from a limited set of interactions with the sales staff of the perceived top EMR vendor. You can spend several weeks of your precious time in visiting conferences and user group meetings and learning first hand from the experience of other EMR users (like yourself). At the same time, you could work with select EMR Consulting companies to guide you along the way from initial consultation, requirements gathering, short listing, demo and selection right up to implementation phase. The choice is yours!

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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With the experience of working and speaking with hundreds of physicians behind me and reviewing dozens of EMR Software options, here is my list of top 10 must-have features that every physician would do well to require when evaluating the 300+ EMR solutions available in the market today (not listed in any particular order of importance as the sum of their value in whole, is greater than their value individually):

1) A fully Integrated EMR Software System as opposed to interfaced systems

Replacing an existing Practice Management application in favor of an integrated EMR Software and Medical Billing software may seem scary at first especially if a physician has been using a medical billing and practice management application for several years, but I believe that it is very important for the EMR software system to be integrated with the Medical Billing or Practice Management software application. Integration really means that they share the same database and there is no need for different data elements being pushed out from one system to another on the basis of defined business rules using an interface based on an API (Application Programming Interface). Interfaced applications work but occasionally cause for both systems to become out of sync due to buggy interfaces. Go ahead and take that desired step.

2) Integration of EMR Software with ePrescription to receive bonus payments

In 2009 and 2010 providers who use a qualified Electronic Prescribing system can earn a Bonus Payment equal to 2% of their total allowed charges through Medicare part B. By using a Certified Electronic Medical Record (EMR) which has in-built e-prescribing capability, medical practices can experience dramatic efficiency gains and enhanced patient safety. You can choose a stand-alone ePrescription application but it will mean creating yet another avoidable interface or reduced efficiency because of extra data entry operation. It is best to go in for an EMR System with inbuilt ePrescribing capabilities. Did you know that the average physician saves $15,700 a year by using their properly integrated ePrescribing feature?.

3) Electronic Medical Record Software that supports PQRI Automation

CMS continues to expand the scope of PQRI (Physician Quality Reporting Initiative) with increased bonus payments. Physicians who satisfactorily follow PQRI guidelines and report quality-measures data for services furnished January 1, through December 31, 2009, will earn a single consolidated incentive payment of 2.0% of the estimated total allowed charges for services covered under Medicare Part B in mid-2010. These requirements are complex, and different measures will apply to each practice. The EMR Software that you select should have a built-in ability that automates the additional documentation while you are examining your patients without any additional work, or creating special reports, or cost. Additionally your EMR Software should make it easy for you to modify and add customized metrics for your practice as required.

4) Electronic Medical Software with adaptive learning

Adaptive learning refers to the ability of the EMR Software to remember how each physician documents and allows previous data entry to suggest steps in treatment and documentation going forward. In essence, the EMR Software keeps track of how all users document within the system and "remembers" lists and assessments such as frequently used lists, previous patient generated lists, and prompts physicians based on previously documented diagnosis/ assessments by the physician...the system adapts to each provider's practice patterns, configuring itself automatically. The more you use the EMR Software, the more it learns and the more accurate, faster, and well documented your patient encounters become, saving you time and money.

5) Secure Portability and access to your electronic medical records even without an internet connection

Typically, physicians should have access to patient data anytime, anywhere either by using their own laptop or tablet pc, or an off-site desk top by accessing a server over a secure internet connection. However, there may be many instances when the physician is making trips to hospitals, satellite clinics, at a conference, or traveling where internet access may not be available or you lose internet connectivity at your Clinic, or your server goes down. Thus, your EMR Software application must be able to save selected data including, charts for that day's or the next few week's appointments and your most active or recent patient records, on the provider's tablet pc or laptop. This critical function allows you and your medical staff to continue working and seeing patients, charting, writing Rx's, review patient records, and then, once you return to your main Clinic, or your internet access is restored, your portable device should easily or automatically synchronize right back up with your server. Essentially, you never skip a beat. As an added note, it is imperative that you have the appropriate security measures in place in order to safeguard access to all of your portable devices.

6) Integrated patient portal - Keeping more in-touch with your patients

Your EMR Software needs to provide your practice with an integrated patient portal that allows patients to connect with your practice in ways that will improve their loyalty and compliance, and have access to key personal health information. Patient portals (or secure patient access to information you authorize) have been traditionally thought of as just allowing patients to provide access to their medical records to other consulting physicians but now, you need an EMR Software that supports a patient portal that also allows for appointment scheduling, re-fill requests, exchanging secure messages with physicians and other clinical staff, patient education and other health information, and much more. Your patient portal should also be able to be extended and integrated with a website that is customized to your specific needs and helps you to generate new patients on a daily basis.

7) Electronic Medical Record Software that does not box you into rigid templates

Many Electronic Medical Record Software solutions provide pre-defined templates that can only be changed by the vendor or IT personnel. However, a growing number of EMR solutions are now template free which is because they are driven by 'Chief Complaint(s)' . Since the system is "CC-driven", it allows the doctor to "chart at the speed of thought" without being tethered to a template or form that may not fit the particular patient that is being charted. This is proven to offer significant speed in charting over template based systems, especially at point-of-care since the physician can navigate to any screen or function at anytime without having to leave a template.

Look for Electronic Medical Record Software that offers the best of both worlds : it is template free but can also use templates, known as COMMON PROBLEM PALETTES. This allows physicians to use predefined templates or forms to document very common and repetitive procedure and visits.

8) Document and Image Management

Your EMR Software should go beyond simply scanning and attaching documents and make sure it provides a complete records management system built into the application. Your EMR Software must be able to either copy documents into the EMR database or link to files without copying. This can be particularly helpful with PACS images and other very large files. Your EMR Software must also enable attaching documents and images to a patient chart at the click of a button and then, make sorting and searching for any kind of document, image or even video as simple as using your email or cell phone.

9) Integrated with voice recognition and handwriting recognition

Integration of speech recognition technology in the EMR Software is not an option anymore. When we talk about speech recognition, we implicitly talk about compatibility with Dragon NaturallySpeaking software. With advancement in technology, it is possible for a physician to achieve 98%+ accuracy rate which is at par with the accuracy that is achieved by a human medical transcriptionist. Speech recognition is traditionally utilized to capture the historical portion of the medical health record since pre-designed templates can not anticipate the full spectrum of facts presented by the patient.

Your EMR Software must also allow the physicians to follow their own preferences for documentation method - handwriting recognition, point and click with stylus, typing or a combination. As you become more comfortable with using your stylus, you will find that it is much easier for you to write on your tablet PC (just as you would scribble on a writing pad) and the handwriting recognition capabilities of the EMR Software converts natural handwriting into ready for use digital information.

10) Meets all regulatory and compliance requirements

Your EMR Software must satisfy all mandatory Federal and State regulatory and compliance reporting, general reporting requirementsg, and appropriate coding documentation.  The other upside of requiring that these features be built-into your Electroni Medical Records Software, is that this is extremely important to qualifying each provider in your practice to receive all the incentives available for EMR from Federal and State agencies.  Additionally, many malpractice insurance carriers offer Physicians a substantial discount for having an Electronic Medical Record software with these functionalities.  

11) OOPS! One more important point. If all you did was to require these top 10 must-have EMR Software features from a vendor, you can rest assured that you will also get all of the other essential, most up-to-date, and easy to roll-out and use functions, found in the leading EMRs today, as well.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.