Before implementing EMRs, heed words of warning

May 1, 2010

Some time ago, I wrote an editorial in this magazine describing my early experience with the use of an electronic medical record. In the article, I indicated that this technology was a valuable addition to the medical office, but there was a fairly steep learning curve and some difficulties in creating a coherent and understandable document. After three years of using an EMR, much of what I said before remains valid.

Key Points

After three years of using an EMR, much of what I said before remains valid. However, recent experiences have allowed me to evolve my thinking about this office tool. I would like to share this with you.

I use an EMR that is relatively simple in its structure and is in many ways suited for a small, medically oriented dermatology practice. It works well for my associate and me, and definitely improves the care that we deliver to our patients. I intended to continue with this program for as long as our practice existed; that is, until the company that developed the software sold its assets to a larger competitor. Several things happened soon thereafter:

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.

The new software company conducted a series of Web-based seminars to convince the owners of the old software that its product would suit our needs. After viewing the presentation, it was clear to me that the product was designed for use in a large, primary care practice, and that the needs of the dermatologist were not considered when developing it.

So, I am now in the market for a new EMR system. Since I last shopped for this software, the number of vendors has increased substantially; many are claiming to be just right for the dermatology specialist. A common slogan seen on the advertisements goes something like this, "EMR system designed for physicians by physicians." A few have substituted the word "dermatologist" for the word "physician."

I have started the process of viewing the demonstrations of a number of these companies. This is often done one-on-one with a representative of the developer, using the Internet and a telephone connection simultaneously. These are valuable and often enjoyable sessions. However, we are not talking about objective presentations from disinterested parties. These are sales people trying to demonstrate that their creation is terrific and the competitors' products are worthless.

Migration challenges

For those of us already using an EMR system, there is the added complication of moving thousands of patient records to the new software system. Many programs have the capacity to receive this data from other programs, but it can get very expensive and time-consuming to complete this task, and there may be glitches when two different systems attempt to interface.

The other option is to keep one's old system and move patient data only as the individual is subsequently seen. It is not yet obvious to me which method is best, but I can tell you that the cost of this transfer is negotiable. One vendor has even offered to make this transfer at no extra cost.

All of this threatens to be a major disruption to my practice, if only for a few weeks while the new system is installed and implemented. I do not plan to conduct business as usual during this time. It would not surprise me if the volume of patients seen in the month after the new program is implemented will decrease by 50 percent. This must be calculated as an additional cost of acquiring this technology.

The government is encouraging all physicians to adopt EMR technology. The financial incentives are attractive. For a practice with substantial Medicare and Medicaid patients, incentives could total up to $60,000 if the EMR program is used appropriately, as defined by Medicare.

Some software vendors are confident that their programs will lead to incentive payments and are willing to guarantee in writing that this will happen with their system. This type of guarantee will be one of the factors that will help me decide which system to purchase.

My parting words of advice:

1. Be very careful in selecting an EMR system. If possible, go with a big, established company with a track record of providing programs for the dermatologist market.

2. Confirm that customer support is available and capable. Talk with other dermatologists who already use the particular brand to get an assessment of the level of support. I will guarantee that you or your office staff will have many encounters with customer support teams in the first few months that you own the software.

3. Don't buy more than you need. For example, don't pay for the capacity to track a woman's mammography history if this is not part of your normal practice.

If you are contemplating a switch to an EMR, absolutely take the plunge. This is the only way that medicine will be practiced in the future. You might as well get on board now.

Norman Levine, M.D., is a private practitioner in Tucson, Ariz.