Nurse Practitioners often ask me “which EMR should I choose”? The answer to that question is dependent on an infinite number of variables, but it all boils down to using the one that is right for you, and thus the answer is “it depends”. Finding and using the right EMR can have far reaching implications for your practice, both today and in the years to come. Having recently gone through my own version of “EMR purgatory”, here are a few tips you’ll want to keep in mind when you make this important decision.
1. Do not be an early adopter! I have this side of me that itches to have the newest gadget and play with the newest software and EMRs are no exception. The problem is, all the bugs are not yet worked out. While that’s okay on that gadget you are playing with, it’s not okay in your practice. You’ll also want to make sure that there is enough input from clinicians and not just software engineers.
2. Meaningful use certification is not enough. Don’t be fooled into thinking that because the software is MU certified that it will meet the needs of your practice. MU certification only tells us the software meets the needs and can do the appropriate reporting for meaningful use attestations.
3. Look for more than one way of inputting information. For example, can you type, use templates and dictate? Can you input data from your computer, tablet or phone?
4. What kind of reports can you pull out of the system? Can you export your entire patient database if needed? Pull reports that will tell you who needs an A1c or a flu vaccine? Will you be able to tell who is due for a pap smear? Think of the different ways in which you’ll want to access patient information and see if you’ll be able to do that.
5. How easy is it for you to use? What about your staff? Will it fit into the flow of your practice? Ideally you want an EMR to support you in the work you do, not one in which your entire workflow needs to adapt to it.
6. What kind of support is available? Is it available during the times you are in the clinic, or even for a bit after hours when you might need some help while completing charts?
7. Assuming you are looking at an online solution, what is their uptime? How often is the system updated, and are those update done at a time that will not interfere with your practice? (I once used a system that updated its software at 7PM my time. This was not good for the folks who were in an earlier time zone!)
8. Is there a way for staff to communicate you with regarding patients (and thus “attaching” charts), or even just interoffice communication (not attached to charts)?
9. Is there a patient portal available? This is going to be more important as we move forward, especially if you are attesting for MU. You’ll see more and more practices offering online appointment scheduling, (secure) email communication, as well as access to medical records.
10. Cost. As practice reimbursement changes (shrinks), controlling overhead becomes critical. The most common cost of EMRs tenders to be per month per provider. While I’ve seen as low as $100 (including eRx), I’ve seen that number jump to $500+/month per provider. There are also some EMR’s that are free and will provide many, if not all of the same services.
11. Is there integration with labs, imaging or services and others? Ideally, you’ll want to be able to order services as well as receive reports directly into your system.
12. Practice Management. You want to be able to generate your billing or at least be able to complete your note and finish off the “superbill” for your biller to be able to pick it up and bill the visit. Having an integrated system will cut down on cost, time and potential errors.
13. Ability to generate your notes and send them out from the system to referring providers, specialists and the like is an added bonus!
An often requested, and yet to be seen feature is for flow sheets. Many of us who have been “old school” miss the tried and true flow sheet where at a glance we can see trends or outlier information. While I’ve heard of many work-arounds, I’ve yet to hear of something completely integrated.
This list of 13 is far from exhaustive. It’s up to each person to do their own homework. Make sure you demo any software as much as possible. Better yet, see if you can get your own copy of the software to try out just as if you were seeing patients in real time. Talk with other users, check the user and support forums and look around for problems as well as positive reviews. Remember, there is no perfect EMR out there, and the best one for you is the one that is best for you!
What’s worked (or not) for you? Your colleagues want to know! Leave your comments below.
Barbara C. Phillips, NP, FAANP is a professional speaker, author, clinician and business owner who provides business education, resources and support to Nurse Practitioners, Physician Assistants and other Advance Practice Clinicians — both for the employed and self-employed clinician. Additional information about Ms. Phillips is available at www.BarbaraCPhillips.com.