EMR & EHR Blog for Physicians

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Is the EMR software you recommend CCHIT Certified?  This is one of the most common questions physicians ask me during a first EMR Software Consultation.  My answer is, “of course” that is, until HHS recognizes another organization accredited to certify EMR Software. So while being CCHIT Certified is a good requirement to strongly consider in your search for a good EMR, it should not be used as the all encompassing endorser of every EMR Vendor you come across in making your final decision.  So what else can one do to go beyond the certification process?  Well, you can take it to the streets, so to speak.  That is, where do you go to find out how well an EMR software you may be considering is working or what are the most common criteria being used to grade EMRs in the real world of Medical Practice?

There are several well recognized grading or ranking organizations that compare EMR features and functions, survey and interview end users, and conduct performance tests of EMR Software. These results can be used by physicians as a practical “Report Card” to assist them in evaluating EMR Software and EMR Vendors.

Essentially, physicians in Ambulatory Practices of all sizes can use this information as an additional screening tool to further narrow down their selection list to include EMR Software that has earned excellent scores for their unified Electronic Medical Records (EMR) and practice management (PM) solutions as it pertains to their individual requirements.  

Here are a few of the well recognized EMR Software rating or ranking resources and examples of the information they can provide:

IDC Health Industry Insights

This IDC Health Insights report discusses ambulatory EMR functionality for small and midsize practices with 20 providers or less and presents an assessment of the offerings of 10 vendors that serve this space. This report considers the requirements and cost relief provided by stimulus payments under ARRA, alongside additional assessment criteria that consider results from EMR including the migration from paper charts to electronic documentation, electronic ordering, charge capture, and improvements to patient safety and the quality of care.

TEPR

TEPR Awards identify outstanding health information technology and electronic medical record (EMR) innovations and solutions.  Physicians can use this information to identify EMR Software that has received the highest scores available in important areas including pricing, implementation cost, features and functions, references, support and maintainence, and overall customer satisfaction.

The TEPR Documentation Challenge is one that you may hear many vendors touting about and that ranks their EMR Software for their charting abilities and speed compared to manual charting.

 KLAS

You have probably heard this phrase used a lot: "Best in KLAS" Awards. This is an annual competition amongst EMR Vendors to determine the “Top 20 Best in KLAS” awards report.

KLAS helps healthcare providers make informed technology decisions by offering accurate, honest, and impartial vendor performance information. KLAS independently monitors vendor performance through the active participation of thousands of healthcare organizations. KLAS uses a stringent methodology to ensure all data and ratings are accurate, honest and impartial. Research results are offered to healthcare providers through:

• A free directory of vendor and product information

• Free online access to vendor ratings for participating providers

• On-depth published reports, discounted for participating providers

AN IMPORTANT CAVEAT to mention here, is that not all EMR Software on the market are evaluated and therefore, even this information should not be wholly relied upon as the "super-list " of EMR Software options available to you. There are many EMR Vendors that have not been evaluated by one of these organizations, but if they were to be put to their tests,  they would rank high and pass with flying colors.  So, if you are considering an EMR Software that may not be on the “A” list of one or more of these reports, the more important take-away from these evaluating organizations is to make good note of the major  categories and criteria that are being assessed and make them a part of your evaluation process when comparing EMR Software and interviewing EMR Vendors. 

Also worth mentioning, in a majority of cases, EMR Vendors actually pay to have their EMR Software included in thsee independent assessments.  Now you can make your own conclusions here but, that does not necessarily mean there is anything under-handed going on. 

So, to the extent that an EMR Vendor is being evaluated by one of these reputable organizations, use this information more as another good reference resource throughout your EMR screening and selection process.

My best advice, find a good EMR Consulting company to help guide you in the right direction for finding and comparing EMR Software.

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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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1. List of "meaningful use" criteria that healthcare providers must meet to qualify for federal IT subsidies based on how they use their electronic health records. 
2. The standards and certification criteria that those EHRs must meet for their users to collect the money.

Phased Approach to Meaningful Use

What has been proposed is a phased approach that encompasses reasonable criteria for meaningful use based on currently available technology capabilities and provider practice experience, and builds up to a more robust definition of meaningful use, based on anticipated technology and capabilities development.

Under this phased approach to meaningful use, the criteria of meaningful use would get updated through future rulemaking. The initial meaningful use criteria have been referred to as "Stage 1."

(Stage 2 criteria are expected to be proposed by the end of 2011 and the Stage 3 definition may be proposed by the end of 2013.)

Stage 1 Meaningful Use Criteria

The Stage 1 meaningful use criteria focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.

Stage 2 and Stage 3 Meaningful Use Criteria

Stage 2 meaningful use criteria shall expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease).

Stage 3 meaningful use criteria shall focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.

Stage 1 Meaningful Use Defined in Detail

Goal 1: To further the care goal of improving quality, safety, efficiency and reducing health disparities.

1. Use CPOE (which entails the provider's use of computer assistance to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device. The order is also documented or captured in a digital, structured, and computable format for use in improving safety and organization. For Stage 1 criteria, it will not include the electronic transmittal of that order to the pharmacy, laboratory, or diagnostic imaging center)
2. Implement drug-drug, drug-allergy, drug-formulary checks.
3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®. It also includes past diagnoses relevant to the current care of the patient.
4. Generate and transmit permissible prescriptions electronically (eRx).
5. Maintain active medication list.
6. Maintain active medication allergy list.
7. Record the following demographics: preferred language, insurance type, gender, race and ethnicity, and date of birth.
8. Record and chart changes in the following vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI.
9. Record smoking status for patients 13 years old or older.
10. Incorporate clinical lab-test results into EHR as structured data.
11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
12. Report ambulatory quality measures to CMS (or, for EPs seeking the Medicaid incentive payment, the States).
13. Send reminders to patients per patient preference for preventive/follow-up care. Patient preference refers to the patient's choice of delivery method between internet based delivery or delivery not requiring internet access.
14. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.
15. Check insurance eligibility electronically from public and private payers.
16. 16. Submit claims electronically to public and private payers.

Goal 2: Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health

1. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, allergies) upon request. Electronic copies may be provided through a number of secure electronic methods (for example, personal health record (PHR), patient portal, CD, USB drive).
2. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the EP. Electronic access may be provided by a number of secure electronic methods (for example, PHR, patient portal, CD, USB drive). Timely is defined as within 96 hours of the information being available to the EP either through the receipt of final lab results or a patient interaction that updates the EP's knowledge of the patient's health. 
3. Provide clinical summaries for patients for each office visit.

Goal 3: To improve care coordination by enabling exchange of meaningful clinical information among professional health care team.

1. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
2. Perform medication reconciliation at relevant encounters and each transition of care.
3. Provide summary care record for each transition of care or referral.

Goal 4: To improve population and public health by having the patient's health care team communicate with public health agencies.

1. Capability to submit electronic data to immunization registries and actual submission where possible and accepted.
2. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Goal 5: To ensure adequate privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law and provide transparency of data sharing to patient.

1. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

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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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________________________________________________

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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Medicare payments to physicians not qualified as “meaningful users” of Certified Electronic Medical Record software will be reduced by 1% in 2015, then 2% in 2016, 3% in 2017, 4% in 2018, and by as much as 95% in subsequent years.

To avoid this situation your timing is critical. Experts predict that by mid-to-late 2010, the demand for Electronic Medical Record Systems may far exceed the number of qualified sales and support staff that companies with Certified Electronic Medical Record software will have to meet the last minute rush of physicians suddenly realizing their forthcoming financial misfortune. Therefore, now is the time to take action and give serious attention to the 2 to 4 months of lead-time required for planning and selection, set-up and training, implementation and “go live”. Then, add an additional 6 to 8 months to ensure physicians and staff are proficiently up and running as “meaningful EHR users”, so that each physician in your practice is eligible for the up to $44,000.00 in Medicare Incentive Payments beginning in January 2011.

Late adopters can surely expect huge delays or worse, being placed on a waiting list (at least by the best and most popular EMR software vendors).  In this case, your options may become very limited, and prices may even increase.  So, instead of receiving Bonus Payments, you may wind up being penalized through reduced payments.  Don’t be surprised if you find yourself on a “hotchpotch” path of trying to force-fit poorly matched EMR and Practice Management software together from different vendors. This predicament will cost you a lot of time, frustration, and money.

There are over 300 EMR vendors on the market, and only a few are CCHIT Certified and qualified take on the question, “Which EMR has the smoothest transition and implementation that meets the requirements of your practice and, ensures each physician in your practice receives the maximum Medicare Incentive payments?” The answer, find a good Independent Consultant who, at no cost to you, can help you find the best-fit Certified Electronic Medical Record software, which has all the answers “built-in”.   

It’s not everyday the government imposes new laws, regulations, costs, and penalties upon your business and then, turns around and pays you, to become compliant and avoid being penalized. Now is the time to start positioning each provider in your practice to leverage every Bonus Incentive dollar available. After all, the right-fit Electronic Medical Record software will make running your practice easier, more profitable, boost morale, improve patient care and, enhance your quality of life and that of your patients.  Everyone will “feel” the difference.

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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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Stories abound about botched EHR System implementations and providers uninstalling EHR Systems in Arizona. But at the same time, there are many case studies which prove that achieving ROI with EMR or EHR is very much possible, provided there is right focus on training, transition and implementation.

Computation of ROI with EMR Software is a complicated business, based on many assumptions and unquantifiable and intangible benefits. I personally like the definition: ROI = Increase in Revenues - Decrease in costs. I recently come across another definition: ROI = EMR - FTE based on the consensus that automated systems alleviate support staff needs. You can choose whatever definition appeals to you most.

According to "The formula for EMR: ROI=TCO?", if the average physician needs 4 assistants, implementation of an EMR can reduced that number by one or more. In a fast growing practice in New York State, which implemented an EMR, it was able to grow from 20 to 120 doctors in just two years because they only had to hire two or three FTEs per doctor instead of four or five.

In a recent case study published by HIMSS, Glynn Medical Associates, comprising of four internists, two rheumatologists and a physician's assistant, which implemented an integrated EMR/PM system with every provider using the system as of the first day, experienced savings conservatively estimated at $200,000 per year. But the ROI did not come easy. The first three months of going paperless were stressful. Also, one physician in the practice was seeing 33 percent more patients daily with use of the EMR system helping to increase patient satisfaction.

Some of the quantitative benefits included:

• Reduction in transcription costs.
• Reduction in medical records personnel
• Reduction in billing department personnel
• Possible downsizing of facility

In another case study, according to Wellesley, Mass.-based Nuclear Research, a 76-bed hospital in Bolivar, Mo achieved a 1,321 percent ROI in its first year after implementing an EHR Software solution, besides reaping other intangible benefits. Over three years, the hospital's ROI came in at 2,912 percent.

Here are two EMR Calculators that you can use:

1. Physicians Practice EMR ROI Calculator
2. HIMSS EMR ROI Calculator 

Experts say that an EHR implementation project is not a sprint but a marathon. Moreover, the race does not finish on the go-live date. You will see reduced productivity during period immedialtely followng post-activation followed by "stabilization" and then "optimization".  If everything goes right, you can achieve stabilization within 90 days. After that, the financial benefits will materialize gradually as staff increasingly utilizes the EHR Software and associated workflows. 

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There are many opportunities for revenue enhancement as well as cost reduction which will yield Return on Investment. Download our free article on 'Does EMR increase Revenues?'.

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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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What is the difference between an EMR and EHR? Aren't they essentially the same?

It is easy get confused by the inconsistent way these terms are bandied about in the industry.

• Nextgen mentions both EMR and EHR in its home page title, but the product is called Electronic Health Records.
• GE Healthcare calls its product as Centricity EMR.
• Greenway characterizes its PrimeSuite product as an EHR.
• Aprima's PRM product was initially labeled EMR but is now described as EHR.
• eClinicalWorks continues to refer to its product as an EMR.
• Allscripts mentions both ‘Electronic Medical Records (EMR)' as well as ‘Electronic Health Records (EHR)' in the title of its home page, but their solution is called ‘Electronic Health Records'.
• CCHIT certifies EHR (Electronic Health Records) products, but the list of CCHIT-certified EHR products includes a number of ‘EMR' products.

As is clear from the above, vendors have been using the two terms - Electronic Medical Records (EMR) and Electronic Health Records (EHR) - interchangeably in their communication even though these two terms are technically different with different sets of features and capabilities.

Chris Hobson in a article published in ‘Advance for Health Information Executives' says that the difference between the two terms more than semantic and is crucial for health IT decision-makers to understand the difference.

So what is the difference between EMR and EHR? Let us review the distinction portrayed by three authorities in their own rights:

1. Chris Hobson:

The essential difference between EMR and EHR lies in how the (electronic) data will be used or shared - within the confines of a single office or practitioner or will it be shared across a wide range of different providers, such as specialists' offices, labs, insurance providers and government agencies?

Chris relies on the definition advanced by HIMSS and accordingly, an EMR is a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information "within the confines of a single organization". It may touch clinical data repositories, lab applications and patient information management systems, among others -- but all within the reach of a single organization.

EHR, on the other hand, is a longitudinal, complete and unified view of electronic record of patient health information produced by clinical assessments in one or more care settings drawn from across a wide region corresponding to all the providers who are seeing the patient -- the totality of his/her personal data, state of health and delivered care.

According to Chris, while both EMRs and EHRs provide some similar benefits -- cost savings through improved workflow and paper reduction, improved delivery of care accuracy -- EMRs provide those benefits only within a single organization. EHRs, because they are shared across the irrelevant geographic or otherwise defined region, increase the efficiency of patient care and improve patient outcomes, disseminate information rapidly between care providers, help with research efforts, and cut costs throughout the entire system more promptly and reliably.

2. National Alliance for Health Information Technology (NAHIT):

NAHIT while offering the following definitions, generally supports a similar distinction between EMR and EHR:

EMR (Electronic Medical Records) is an Electronic Record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.

EHR (Electronic Health Records) is an Electronic Record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.

3. Healthcare Informatics:

EMR is a computerized legal clinical record created in Care Delivery Organizations (CDOs), such as hospitals and physician offices, and used and owned by the CDO. It becomes an EHR (Electronic Health Record) when:

• Reports and histories (labs, pharmacy, radiology, consults, etc) are electronically added;
• Items in the record are electronically exchanged with other providers, and
• There is a personal health record (PHR/PMR) component which allows patients to participate in documenting and creating their medical history and communicate with their provider.

EHRs represent the ability to easily share medical information among stakeholders and to allow it to follow the patient through various modalities of care from different CDOs. Thus EHR offers a holistic approach to patient care where continuity of care is emphasized.

EMR vs. EHR - What does it mean to you?

Regardless of whether vendors call their products EMR or EHR, what should your first priority be?

When selecting an EMR or EHR, ask your vendor to explain how its solution will support your vision for interoperability and rapid exchange of data between care providers, in order to provide a holistic perspective on delivering health to your patients. It's that simple. You can safely make this your criterion for choosing a system, and forget about what the vendor calls its product. For your purposes - providing efficient, effective care - the name is totally irrelevant.

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Read our related blog on Top 12 EMR Software Selection mistakes often committed by Physicians.

Contact Us for free no-obligation EMR / EHR Selection Consulting and Demo.

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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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Web-based EMRs have been touted as a nice way to implement EMR solution with low initial investment. Web-based and client/server EMR systems have unique advantages and disadvantages. Which model you should choose for your practice will depend on your special requirements.

Despite the obvious advantages of web-based EMR (access from anywhere, remote hosting, etc.), there are some important points you should consider when deciding whether to implement a web-based system:

1. Don't imagine that a "high-speed" Internet connection is all you need to run a Web-based EMR. It's important to find out if you'll actually have the bandwidth required to send, receive, and exchange data efficiently. Consult the EMR vendor about its requirements, and talk to your Internet service provider about its available bandwidth options.

How much bandwidth you need will depend on the number of users and the volume of data flowing between your practice and the hosted Web- based EMR. If the data increases, you may need additional bandwidth, and you'll need to be prepared. Carefully review the EMR vendor's recommendations before you sign up for a bandwidth plan.

2. How reliable is your Internet connection? This is critical - and also, your upload and download speeds may vary depending on the time of day and how much bandwidth is being used by nearby businesses. You'll want to plan for extra bandwidth to avoid slow-downs in charting your patient encounters.

If you share an Internet pipe with other businesses in the same complex, your data transfer speeds may fluctuate dramatically, depending on how the others businesses are using the connection. We recommend asking your Internet service provider for documented evidence of the uptime you can expect. Depending on the answers, you may want to consider getting a dedicated pipe for your clinic. Work with the EMR provider to develop a backup system for charting on paper if the system goes down, and develop your office processes accordingly

3. What if your EMR vendor folds its tent? Will you be able to retrieve your data from the vendor's servers? Will the data be in a format that you can use/convert/transfer?

After deciding on a web-based EMR vendor, treat the vendor as your partner. You should be able to discuss every possible scenario with the vendor's sales reps. Better yet, work with an experienced EMR consulting company who'll help you communicate with the EMR vendor. Consider asking the vendor to provide data-backup files on a regular schedule.

4. Unlike a client/server environment, where you have local control over the server and EMR software, a web-based EMR makes you dependent on the vendor's customer support. Will your vendor reliably and promptly support you and your staff by phone, IM, email, or chat? Will the vendor be available to quickly help you solve urgent or critical issues? Talk to the vendor about its support structure, especially outside normal working hours.

5. What will happen if you someday decide to move from a web-based to a server-based EMR? Does your vendor offer that flexibility? If so, how seamless will the migration be? How much will it cost? Even if you don't believe it will ever happen, it's in your best interest to discuss it with the vendor today, and get an in-depth understanding of the process.

We've seen many successful web-based EMR systems. They do work well for most physicians. By understanding the handful of caveats we've outlined above, and preparing accordingly, you'll stand a better chance of implementing a successful web-based EMR system for your practice.

Learn about the top 10 EMR Software features that you should be looking for. Download our free article on Top 10 Electronic Medical Records features for every physician.

________________________________________________

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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Did you know that there are 1000's of searches every month on Google from people interested in ‘Free EMR Software' in different forms:

Free EMR  2,900
Free Electronic Medical Record  480
Free EMR Software  480
Free Electronic Medical Records  390
Free EHR  320
Free EMR download  260
Free Electronic Medical Record Software  140
Free Electronic Medical Records Software  91

However, economists tell us that "there ain't no such thing as a free lunch" which essentially means that it is impossible to get something for nothing. Yet people search for ‘free EMR' in the hope of finding something which may work for them and that would not cost them several thousand dollars to implement and support.

IMHO, there are at least three flavors of ‘free EMR':

a. Open Source EMR
b. Low end versions of full fledged EMR Systems offered at zero cost
c. Commercial EMRs supported by ads and selling of anonymized data (data which has been stripped of identifying attributes) offered at zero cost

Open Source EMR

It is well known that open source software movement is gaining ground. Wikipedia maintains a list of open source EMR / EHR software.

When you opt for open source EMR, you get full ownership of the code under GNU General Public License which gives you freedom to share and change all versions of a program to make sure it remains free software for all its users. You do get the license at zero license cost. So what is the catch? While the software may be free, you have to consider the following:

1. What is the total cost of ownership of an EMR / EHR solution? You will find that the cost of license is only about 20% of the cost of implementing a Client Server version of EMR.
2. What is the size of the community supporting ongoing development and enhancement of that EMR?
3. What is the guarantee that the open source EMR will continue to meet ever changing Governmental regulations?
4. What is the support structure of the company to help implement, train and support the EMR?

In a survey conducted by Computer Economics, 44% of the users quoted ‘less dependence on vendors' as the leading advantage of using open source software. Note that lower TCO was not the main advantage cited by the respondents.

It is important to realize that EMR purchase is quite sticky and it is not easy to change the EMR that you implement in your clinic. Therefore, I would not recommend smaller clinics to stay away from open source EMR or EHR for many reasons:

a. None of the currently known open source EMR systems are commercially proven unlike other vendor systems.
b. Implementing any open source EMR will need customization or upgrade services which will add to the cost of implementation.
c. What is the current and forecast future availability of required technical expertise at reasonable prices? Will you have the time, patience and expertise to find the right talent at a later date to support your changing requirements?

If the open source EMR, on the other hand, is procured by a hospital which has invested significant amount of money in information technology and therefore has the expertise to customize the open source EMR to meet its current and foreseeable charting requirements and governmental regulations, the hospital will stand to benefit from open source EMR / EHR in the long term.

Free versions of full-blown EMR Software

There are many vendors that offer free EMR products (like eMDfix) while at the same time offering full fledged EMR products which are paid products. As you will figure out soon, there are costs involved with implementing a new EMR which will put it in pretty much the same price range of a non-free EMR. You will also find that the free version of the software lacks some important features that are important for you to work efficiently. As I mentioned before, EMR purchase is sticky business and if you have been using the free version for some time, you will be forced to upgrade to a paid version. To top it, it has been our experience that providers (barring a small minority) need a lot of hand holding in order to make an EMR work. When you sign up for free EMR, you essentially sign up for ‘no obligation' from the free EMR vendor's end. Guess what - it means that you are pretty much on your own even though you may get some email based support which will, in most cases, not be sufficient.

Free EMR Software? What is the financial model?

Let us talk a little bit about the third kind of free EMR software systems like Practice Fusion which recently received investment from Salesforce.com (the leading name in SaaS based CRM software). What is the financial model behind this EHR? There are two aspects:
(1) This is an advertisement supported EHR System. It essentially means that you will see advertisements from vendors interested in selling to the medical community. Will you get distracted by such advertisements? I will leave it to you. (They also offer an ad-free subscription for an additional $100 per month per physician.)
(2) The vendor reserves the right to sell the data that is collected in the course of hundreds of physicians charting patient visits. Of course, the data is sanitized (anonymized) so as to remove any and all attributes that help identify a patient. This is a sensitive topic and at this point of time, I will leave it for you to decide if you are comfortable with this model.

What are the other issues with this free EMR? It does not come with an integrated billing module. You will need to export the billing information on a periodic basis and send it to your billing company or system. You will have to check out the compatibility of your billing system to receive the billing information from your new free EMR system. If you use a PM system in-house, you will find that your patient scheduling information is now split between the EMR and PM system with no way to synchronize them.

It claims to allow you to start charting in 5 minutes after signing up. I find this statement hard to swallow considering the amount of training that most providers and their staff need before they can start using the EMR. In most cases, we insist on an onsite training component from 3 to 5 days to adequately prepare the physician and staff. Will the vendor of the Free EMR Software work with you until you successfully implement EMR Software?

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Learn about the top 10 EMR Software features that you should be looking for. Download our free article on Top 10 Electronic Medical Records features for every physician.

RevenueXL can not only help you select the right EMR Software, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.

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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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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.

Do you disagree with these thoughts? We'd love to hear it in your comments. If you like reading these thoughts and articles, please subscribe to our blog using RSS feed or email.

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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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You probably spent several months in EMR vendor selection process. Right? Did you realize that you need to spend at least as much time in planning your EMR implementation, if you want to ensure a successful Electronic Medical Records implementation.

Unfortunately, we have found that this phase is often overlooked or underestimated resulting in poor satisfaction levels with EMR implementation.

No EMR Software implementation can be successful without a close working partnership between the EMR vendor and key members of the medical office. Moreover EMR implementation involves several parties - EMR vendor, Networking technician, IT expert, Billing staff, Nursing staff, Physicians, and more. Therefore, our strong recommendation is for potential EMR customers to insist on an EMR implementation project plan with detailed tasks, roles, responsibilities and dependencies clearly defined upfront.

EMR / EHR Software implementation can take anywhere from 10 weeks to several months depending upon many factors including number of locations and number of physicians, nursing staff, billing staff etc. who need to be trained.

While some EMR vendors offer onsite EMR implementation with their staff available during ‘go-live', others EMR vendors offer a completely offsite implementation assistance. It is our experience that EMR implementation is best handled by a judicious mix of offsite (or remote) and onsite implementation effort. As expected, onsite EMR implementation effort involves travel costs and therefore adds to implementation costs. Therefore work with the EMR vendor to work out a plan that assures successful EMR implementation. Some of the EMR implementation best practices include pre-implementation workflow analysis and re-design, not scrimping on training, customized training depending on roles, responsibilities and user profile, conducting go-live immediately after EMR training, etc.

Part 1 - Are you on the path to Guaranteed Failure in implementing an EMR Solution?

Learn more about the top 5 mistakes committed by the Practices who are on the path to guaranteed failure in EMR implementation. Download free article on Top 5 Project Management mistakes that you must avoid at any cost.

RevenueXL can not only help you select the right EMR csetificate, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.

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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.