As the cost of operating an office rises and reimbursements decline, physicians must find ways to make their practices function more efficiently. Electronic health record (EHR) systems are an expanding technology with the potential to boost medical offices' efficiency while improving the safety of patients and enhancing communication between healthcare providers. Although only an estimated 20% of medical offices currently use EHRs,1 this number is sure to grow substantially in the years to come. A survey conducted by the Medical Group Management Association looked at 135 ophthalmology practices. Of these, 86% had paper charts in files, and only 12% had EHRs. Fifty-three percent, however, were poised to adopt some form of EHRs within the next 24 months.2 Here is some advice on selecting and implementing an EHR system. If the aforementioned reasons for doing so are not sufficient motivation, consider that, in 2004, President George W. Bush established a requirement that medical offices have some form of operative EHRs by 2014.3
WHY ADOPT EHRs?
At first glance, choosing an EHR system and incorporating it into your practice may appear time-consuming and expensive. In the long run, however, a properly selected and operated EHR system can save your practice time and money4 as well as increase patients' satisfaction with their care. They are also healthier and more engaged in the healthcare system, and doctors get the support and incentives necessary to help drive better outcomes.5 An EHR system can also boost your staff's morale. Once installed, it can cut down on the quantity of phone calls that the staff must handle; decrease the amount of time they spend locating, pulling, and replacing patients' medical records and laboratory results; and maximize the efficiency of internal communications. In an era of Pay for Performance policies, EHRs can help provide the documentation needed for obtaining greater reimbursement and more malpractice-free credits while reducing medical errors. You can draw on an EHR system's database of codes and diagnoses to support clinical research by defining and fulfilling search parameters.
CREATE A TASK FORCE
Put together a committee of personnel from various areas in your office—front desk staff, technicians, and billing staff—to review the available EHR systems, to determine what is needed to meet each department's requirements and preferences, and to build consensus about what would be best for the office as a whole. Be sure to include on the committee both the person in the office who is the most gung-ho about adopting an EHR system and the person who is most opposed to it. Their contrasting viewpoints will help bring balance to the meetings. The committee should list the hardware, software, and budgetary costs required of your office (Figure 1).
FIND THE RIGHT EHR SYSTEM
Currently, more than 400 companies sell a wide variety of EHR systems. The upside is that you have a lot of options. The downside is that choosing among them can prove daunting. An ophthalmic practice has specific requirements necessitating a customized system, so it is vital to conduct research before buying an EHR system.
These days, Internet searches are de rigueur before making a purchase, and EHR systems are no exception.6 A Web site worth a visit is that of the Commission for Healthcare Information Technology (www.cchit.org/index.asp), which certifies and endorses systems but does not measure how usable they are.
When assessing an EHR system, take into account its practicality. Does it mesh with your current technology, or are you going to have to replace/upgrade some components? Also, consider costs (initial and recurring), provider support, ongoing management and upgrades, privacy/security measures, and backup systems (both on and off site). Creating a spreadsheet of the different companies and their systems' features can help you make a comparison.
If you and your staff lack the time or training to conduct your own Internet research, consider hiring a qualified consultant. This person can help limit the number of companies to be reviewed and act as a liaison between your office and EHR companies' representatives. When choosing a consultant, ensure that the one you select has no biases or conflicts of interest (ie, ties to one EHR company or another).7
SELECT AN EHR VENDOR
After establishing your office's needs, select the vendors that seem to be the best match, preferably just three or four. Try to choose companies that have strong track records, accessible technical support teams, and products that are HIPAA compliant. Request a list of references from each company and contact these individuals to discuss their experience with the system, both in terms of its installation and their working with it. It is also advisable to locate people who are not on the reference lists but who have used the EHR systems in question, because they may be able to offer different perspectives. The Net servs of various ophthalmic associations can help locate such colleagues. Once you are in contact with experienced users, ask them about every aspect of a given service.
Present each potential vendor with the needs of your office, as determined by your committee, and obtain cost estimates from each. Schedule on-site demonstrations to see the systems in action.
Record-Keeping Methods
In medical offices across the country, an immense amount of time, energy, and space are consumed by the management of patient records. An effective EHR system can greatly reduce the hours and dollars dedicated to this process. Admittedly, the time investment may increase initially upon the adoption of EHRs, because staff must enter old documents into the new system. Offices with a huge amount of data to upload may benefit from the hiring of high school students who will come in on weekends, evenings, holidays, or summers to scan old information onto the EHR system. Some systems are set up for voice activation; others require typing. Choose the one that best suits your needs and existing hardware.
Upgrades
As technology changes, your system will occasionally require updating. Negotiate the fees and terms of such upgrades in advance and be sure that they include training time for your staff. The cost8 ranges from $5,000 to $15,000.
Implementation
Decide whether you want the system to go live all at once or over time (eg, over the course of 1 week, 1 month, or 1 year) (Figure 2). The initial cost for an office has been estimated at $30,000 to $50,000 per physician.8,9
The Unexpected
Understand ahead of time who is/will be the legal owner of the records stored on the system (it should belong to your practice) and establish what kind of disaster recovery plan the EHR provider offers. Make sure the system provides remote access to patients' charts, both from satellite locations and during off hours.
A PERSONAL EXPERIENCE
I chose the system (EyeDoc EMR; Penn Medical Informatics Systems, Inc., Altoona, PA) used in my office more than 10 years ago. As a glaucoma specialist, my primary requirement was the ability to integrate my existing photographs, visual fields, imaging studies, drawings, and gonioscopic details (Figures 3 and 4) into an EHR system and any future upgrades to the technology. As a physician launching a solo practice, cost was a major factor for me. A larger practice might have been able to divide the upfront costs and price of hardware more easily than my small practice. Thankfully, I was able to find an option that worked within my budget and used my existing hardware. Most EHR providers have pricing programs, including rental options, for smaller practices.
Becoming more technologically savvy over the years has proven beneficial, both in terms of using the equipment and saving money on it. It is possible to defray costs by choosing a system you can troubleshoot yourself or implement more easily without too much outside assistance.
CONCLUSION
Choosing an EHR system is much like selecting a partner or a spouse. Making the correct choice can save a lot of pain and aggravation. If things do not work out, a painful (and costly) separation may occur. In 2004, the AMA stated that online communication may be the wave of the future. Prepare yourself with an EHR system.
Mildred M. G. Olivier, MD, is Associate Clinical Professor at Midwestern University & Rosalind Franklin University and Medical Center and is CEO of the Midwest Glaucoma Center, PC, in Hoffman Estates, Illinois. She acknowledged no financial interest in the product or company mentioned herein. Dr. Olivier may be reached at (847) 882-5848; molivier@midwestglaucoma.com.
