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EHR update: Choose the right electronic health record system for your practice


In the absence of industrywide standards for electronic medical records, an expert advises carefully matching system costs, benefits and capabilities with the distinctive needs of one's practice.

Key Points

Orlando - With no widely accepted guidelines available for electronic health record (EHR) installations, dermatologists must carefully evaluate these systems through the prism of their own practice's needs and capabilities, an expert says.

As such, he says there are no hard-and-fast guidelines for these systems.


In this environment, dermatologists must consider everything from software and hardware purchases to staffing decisions.

Questions dermatologists should ponder include whether their EHR system will reside on a server or with an application service provider (ASP), whether the system will send data over the Internet, how many workstations to purchase, and whether to hire a scribe to follow behind a physician entering data so the physician can focus on patient care, Dr. Siegel says.

"Every successful EHR implementation I am aware of uses scribes to input data. The doctor does not touch a computer in the course of the workday," he says.

Physician goals

In his own practice, Dr. Siegel's EHR goal is to enter data as fast as he presently can dictate - or faster.

He also values one-time data entry and a logical information flow through the system.

According to a 2005 American Academy of Family Physicians EHR survey, quick access to patient records tops most physicians' wish lists. In the survey, 85 percent of physicians identified this capability as most beneficial to their practices.

Physicians' practical priorities, in descending order, also included managing medication lists (51 percent), managing clinical documentation and notes (around 40 percent) and searching for data and E-prescribing (both around 35 percent).

Costs and benefits

System costs and benefits also figure heavily into one's choice of an EHR system.

"The cost-benefit picture will be different for every package, depending on the software-hardware combination, the cost of implementation and cost of staffing," Dr. Siegel tells Dermatology Times.

Overall, costs and benefits of EHR systems are difficult to quantify, largely because different vendors use different pricing schemes and hardware requirements, Dr. Siegel adds.

Dr. Siegel believes that price comparisons frequently understate the realities of EHR adoption.

For instance, http://EMRUpdate.com/ estimates that for a two-provider office with five support staff, six exam rooms, five desktops and two tablets or laptops, costs for the first two years of EMR implementation range up to $78,000.

However, "I believe training costs are underestimated. And losses due to inefficiency are not discussed," Dr. Siegel says.

The voice of experience

Dr. Siegel offers his own experience in setting up a new three-Mohs surgeon practice. "When we went electronic in the new practice," he says, "we decided we wouldn't have a transcriptionist - the doctors would do everything ourselves."

This move immediately eliminated a transcriptionist's $25,000 salary and benefits.

About six months later, however, Dr. Siegel says he added back a half-time transcriptionist plus benefits because the system (eClinicalWorks/ECW) proved cumbersome for physicians.

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