EMR Electronic Medical Records (EMR) Term Paper

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Selecting the right vendor (background check)

Choosing the right vendor can be just as important as the system being setup and the software being utilized. Choosing the right vendor is just as important as choosing the right EMR software. Daniel Ray, in the article, "Electronic Medical Records (EMR) Vendors- Points to Consider," declares the following things are essential in choosing the right vendor for your business:

1. Checking the track record: evaluate the history of the company and their reputation in relation to the services being offered and the past service to other clients.

2. Evaluate your needs: start by making a detailed list of the features and services you require from the vendor. Compare this list to any services already being utilized by the practice.

3. Consultation: before deciding on a particular vendor and software, consult other practitioners that are already using EMR software, consult the references of previous and current clients, and compare the vendor with other local vendors in terms of service, price, and reputation.

4. Keep your questions ready: make a list of all the questions you can think of before meeting with the vendors. The efficiency of the vendor can be determined by the responses he gives to the questions.

5. Training Issues: for the system to operate and be maintained correctly, training must be fluent. Determine what the vendor offers in terms of training conditions and if the vendor has onsite and online training manuals and demos.

6. Manage your results: consider all information carefully and with all involved members of the office. Remember the needs of a new office being opened can be different from the needs of an established office.

Vendors sell their businesses everyday and contracts need to be in place to ensure continued customer service is received if the business changes owners. The customer should have the option of seeking another vendor in the company changes owners.

Selecting the right cost base on the needs

The experts at Emrexperts.com give the following information in relation to determining the price of the EMR for the practice:

EMR Systems generally have three price levels. The first level is your boxed systems for small one (1) to two (2) provider offices. These systems are usually older products with a large client base that will provide you with the basics. These types of products generally run below $3,000. The second level is your more customized systems for Small to Medium sized offices. These products will often require on-site installation and training because they need to be customized for each application. The prices for these products, usually run between $5,000 to $35,000 and depends on the number of providers. For example, a small one (1) to two (2) provider office can expect to pay between $5,000 to $15,000. A larger office of 5-10 providers can expect to pay around $3,000 per additional provider, bringing the total cost to around $25,000 to $35,000. You must keep in mind, however, that with most system quotes, hardware, installation and training are not included (How to Purchase an EMR, 2010).

General Challenges of implementing the right EMR

One of the greatest challenges, especially for offices that have been practicing for a number of years is the transfer of the paperwork from the previous years to the new EMR system (Levine, 2010). Levine noted the following challenges when the vendor chosen sold out to a larger competitor:

1. Customer service, which had been excellent before, became almost nonexistent, and not nearly as professional, when available.

2. The new owner made the financial decision to no longer develop the software and to seek expensive accreditation from the EMR authority, Certification Commission for Health Information Technology (CCHIT). This seal of approval is absolutely essential if one is planning to seek the incentive awards from Medicare for implementation of an EMR (see below).

3. The new owner strongly encouraged all present owners of the software to transition to the company's far bigger, more complicated and definitely more expensive product. The company even offered to move all of the data from our program to its product seamlessly, for a substantial fee (Levine, 2010).

According to Dr. Paul Smith in the article, "Implementing an EMR System: One Clinic's Experience," the challenges for the setting up of the system can be characterized as:

Work-flow analysis and redesign. One of our most important jobs was to analyze every function of every job to understand how tasks were accomplished with the old system.

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The project team spent considerable time analyzing existing work processes, looking for opportunities for improved efficiency, designing new work flows that could be accomplished with the tools available in the EMR and developing a transition plan. .

Facility modification. To avoid the expense of major renovations, most practices will have to fit the EMR system into the existing space and floor plans, as we did. With our work-flow redesign complete, we had a good understanding of what the patient and staff flow would be with the EMR system functioning in our existing space.

Hardware selection and installation. The choice of hardware for the network and servers is mainly driven by the vendor's requirements and recommendations. Considering how fast this kind of hardware changes, we made sure we had the vendor's latest recommendations before purchasing anything.

Software configuration. Good EMR software can be adapted to your practice environment without expensive custom programming.

Security. EMR software should have the ability to limit access to various portions of the record to particular users. In our practice, each user was only allowed access to the areas of the chart and functions within that area that were required for his or her job duties.

Laboratory data management. We wanted all laboratory test results to be available as soon as we started using the EMR. This required either an electronic interface with each lab or a manual method of data entry.

Templates. A template is a set of structured text elements that prompt the user to add pieces of data to document the medical encounter. Some EMRs require templates for data entry, while others, such as the one we chose, are more flexible, allowing data entry by template, direct entry (typing), dictation/transcription or voice recognition. Developing templates (and even modifying existing templates) requires considerable time and effort.

Developing a backup system. The key is to have multiple methods of backup and recovery and test them before you go live.

Entering old data. The amount of old data to load into the EMR before going live depends on available time and money, and the needs and desires of the clinicians.

Evaluating EMR

The added features of the system need to be carefully studied to ensure that all the requirements of the office are available.

There are several requirements that must be considered when choosing an EMR system and according to HIPAA, they consist of the following:

The record must be totally collaborative to allow anyone in the office to open and chart without regard to others having the chart open.

There must be security. An audit trail.

It must be very customizable for the practice. Customizing must be simple and intuitive but a template which is customized now, cannot in any way harm the documentation done previously with that template.

It must be capable of collecting that information, slicing and dicing it with great discrimination, and conveying that information to other health systems software.

It must be capable of running client-server or self-contained on a laptop.

It must be affordable. This $25,000 or more per user is ridiculous. A government funded EMR should be affordable out of cash flow -- that is, no upfront purchase of the software, but rather, turnstile pricing.

It must be intuitive.

It must be "graded" in its operational capacity. A new user can use obvious features but as they mature in their EMR awareness, more features can be accessed. There is nothing like "need" to inspire to user to learn another step. That is, filling out a lab form is too slow and so if the user wishes to switch to a bidirectional lab interface, it should be available. If they don't care, then at least give them the option of the software filling out the lab request form.

It must be easy to assist users who experience difficulty. This is one of the most important items by far. The ease of assisting a user will make or break many EMR installations. My preference is to have the ability of the user, with a single click, to show their desktop to technical support, whether that technical support is in their large facility or in another prearranged site.

It must be easy to update, including all the SQL schema changes, executable versioning, new clinical content, and so much more without the use of it staff. If for every update, someone in.....

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