Frequently Asked Questions/General EMR

Will using electronic medical records (EMR) really help me in my office or is it all just industry hype?
At this point it is a given that EMR is the way of the future and has the potential to really ease the day to day grind for the physician practicing in "the trenches". Unless you are within a few years of retirement, it is not so much a question of if you will be using EMR software, but rather when. You can't pick up a medical journal these days without seeing some type of article on the benefits of EMR. Rather than rehash this once again, if you need more information a literature search on "benefits of electronic medical records" will find all kinds of information on the potential benefits that EMR can offer.

I'm interested in trying EMR software in my office but am concerned that I don't know how to use computers well enough in order to be successfull. Can a computer illiterate physician successfully use an EMR?
Any physician can learn to successfully use EMR software provided they are willing to put in the time it takes to learn how to use the system. Obviously a physician that is computer literate prior to starting with an EMR will have a much shorter learning curve, but even computer illiterate physicians can use EMR software if they have the interest and the willingness to learn.

Why are so few physicians currently using EMR software in their offices? Why do I always hear and read about doctors wasting a lot of time and money on EMR implementations that fail?
The reasons for this are multifactorial, but it essentially boils down to 3 basic things:

1. Software that is written by people who do not understand the workflow and nuances of a medical office.
2. Unrealistic expectations by the user.
3. An ineffective (or nonexistent) implementation strategy.

A lot of medical software is written by programmers who are not all that familiar with the workflow of a medical office and therefore the software can actually impede rather than improve that workflow.

Secondly, many physicians have a kind of fantasy regarding EMR, in that they feel that the day they install it the EMR will allow them to see 40 patients, be out of the office an hour earlier, fire half their staff, double their charges, etc. An EMR should be treated like any other new piece of equipment in the office. Just as there is a learning curve with a new endoscope, laser, colposcope, etc. there is a learning curve with an EMR. Not realizing or accepting this up front, some doctors find themselves getting frustrated very quickly and end up not using the software at all. Unfortunately many EMR companies feed into these unrealistic expectations in order to make a sale, thereby setting the doctor up for disappointment and ultimately failure.

Why are EMR's so expensive, and why is there so much variability between the prices of different products? Are they worth the money?
EMR pricing is admittedly all over board, with programs ranging from a few hundred dollars to hundreds of thousands of dollars. Unfortunately this is a market where you don't necessarily get what you pay for. Some of the higher priced programs can turn out to be the biggest clunkers. The EMR marketplace is very immature at this point, so many companies charge what they feel the market will bear. A successfull EMR implementation should save an office tens of thousands of dollars, year in and year out. An unsuccessfull implementation can cost an office tens of thousands of dollars and at least that much more in aggravation.

Keep in mind that the market for EMR's is small compared to other types of computer software, so while prices in the range of several thousand dollars seem high compared to Quicken, or similar mass marketed software, it actually compares favorably to other industry specific specialized software. Even with this in mind however, some EMR's on the market today are outrageously priced. While price is certainly not the only issue to consider, be sure to look around and compare, because as was said before, there is a significant disconnect between price and value in todays EMR world.

I'm pretty computer saavy and want to save some money on an EMR. Is it feasable to write my own EMR?
It is certainly possible, and there are some physicians that have done it successfully. For several hundred dollars or less you can get the software necessary to write a full featured EMR. However you should realize that this is the software equivalent of building your own house. If you knew what to do with the raw wood, cement, shingles etc. you could save yourself a whole bunch of money. Sounds great, but the problem is that only a fraction of the population would have the expertise to even consider doing that, much less be able to take the time needed to complete it successfully.

Don't get me wrong. There is no magic to programming or database design. Anyone capable of becoming a physician can learn how to program, but you will not pick it up in a weekend. An EMR is a complex piece of software, on a completely different scale then writing an address book program or something to keep track of your CD collection. If you know some programming and relational database theory going in, plan on spending at least several thousand hours to get your program up to snuff with what's currently out there. Count on considerably more time if you have to learn to program from scratch. The upside is you will have a program geared to you, with features that you want and think are important.

The bottom line to all this is that the only reason a doctor should attempt to write his own EMR is if he really enjoys programming. Read that last sentence again if you are considering doing this and make sure you pay attention. If you really enjoy programming and would do it as a hobby (or more) anyway, then go for it. You'll be having fun and creating something very usefull at the same time. If you are doing it to save money, or for any other reason, you may as well forget about it now. You will not succeed. I would estimate that less than 1% of practicing physicians today would meet the criteria to see the development of their own EMR through to successfull completion.

OK, I'm interested. What's the best way to go about choosing an EMR?
The short answer is you have to try the program yourself. Simple as that. And not at a vendors booth at a medical convention or your friends office after hours. There is no substitute for being able to use a demo version over the course of a month or two. Try it at your leisure. Get comfortable with how it works and then take it into the office and try doing a few patient notes. You will soon get a good feel for how the software will work for you, and whether it will be a good fit for your practice.

The long answer is that you need to look at these programs closely to evaluate the price vs features. This will be a crucial decision, having a large effect on your practice, and it just doesn't make sense to make it based on features that sound good but aren't really important to you. Lot's of programs advertise all kinds of bells and whistles, and it is easy to get caught up in the hype. It's human nature, and the more "gee whiz" things a software company offers, the easier it is to generate more hype and charge big bucks whether it is warranted or not. When doing an initial evaluation of EMR software you need to take a step back and try to see the forest, not the trees.

So what is important then? Realize that at it's most basic level an EMR needs to do 3 things, and do them very well. They are:

1. Automate the millions of mind numbing repetitive tasks you do every day.
2. Present information in a way that can be easily, quickly and intelligently filtered.
3. Provide an easy, efficient way to enter data.

An EMR that does those 3 things well and nothing else, will be a winner for any office. On the other hand, an EMR that has every bell and whistle conceivable but does poorly at the above tasks will be a loser, and more than likely an expensive loser. When you are first evaluating programs, forget about the E&M coding, graphing of lab results, drug formulary checking, etc. and concentrate on the above 3 tasks. If it doesn't perform well in those aspects, forget about it, regardless of what else it offers. You will find yourself a lot better off in the long run. No one wants a car with every add-on known to man, but it has a crappy engine, so it just sits in the driveway. There are far too many doctors that have bought the EMR equivalent of that car and ended up with an expensive program that looks good but is so difficult or cumbersome to use that it is abandoned.

It is also worth repeating one more time that there is no substitute for trying an EMR over time. If a company does not offer a working demo or at the very least a no questions asked money back guarantee, think long and hard about whether you want to take a chance on their software. Do you really want to risk running your practice with software that you haven't had an opportunity to properly evaluate? At MindWare Medical we have designed Patient Minder with the above 3 tasks always in mind. Although it does a lot more, it excels at those critical tasks. Click the download link and try out our demo. We think you'll be very happy you did.