101 Tips for purchsing your EMR: 79-60 Quality Tips
Posted Jul 13 2010 10:30am
Safety and Quality are the two key drivers for EMR adoption. Quality improvement is incredibly difficult, but an EMR gives you a real leg up. You will be able to obtain data that can guide strategic thinking and keep your overall practice continuously improving. Quality information is also a key for many components of reimbursement in today and tomorrow’s world. More and more payers are looking for a component of “how well” a patient was cared for, not just that they were cared for at all.
101 tips for purchasing an EMR is just a scratch of the surface. Purchasing a new EMR can be very complicated and will have a long lasting effect on the service, quality, safety, efficiency, and finances of your practice. This table shows you the first segment of tips and questions to think about when you engage an EMR vendor.
The 101 tips are broken down into Support, Quality, Safety, Finance, and Efficiency. Some questions will have more or less relevance to your practice based on the size and electronic maturity of your environment.
Tips & Qs
Evaluate the Process FIRST!
Remember the mantra, CRAP PROCESS + TECHNOLOGY = FAST CRAP!
Make certain reporting is easy and flexible.
Quality reporting is essential for so many things. You need to report everything from meaningful use, to state medicaid, to specific chronic disease guidelines. Make certain you can run your own reports without having to get the vendor on the phone all the time. You don't want to spend the time, or the money having to call them constantly.
Find out which Enterprise Content Management (ECM) systems integrate to the EMR.
Let's face it. We really wish the EMR actually made us paperless, but it just isn't true. Patients have all sorts of paper, as will the clinic or hospital, even with an EMR. You will need to know which ECM systems are available to close that gap and make paper available in the EMR.
Do site visits
Get some references and put some feet on the ground. You will want to look at other site's implementation of the EMR product to ensure what you THINK you know is accurate. Ask the tough questions.
Find out how easy it is to do process improvement
If you are a LEAN shop you will be excited about the process improvement options an EMR can have on a practice. The problem is that most EMR systems aren't horribly flexible. You may have to work with the vendor to see how well you can manage the screens and work flows.
Predictive analytics are a huge benefit
Everyone wants to know what volumes are going to like like next year. How many encounters will I have? How many admissions? If the analytics are built straight into the EMR you will have a much easier time trying to estimate the costs and resources necessary for the upcoming years. This improves your ability to do strategic planning, and should lower your costs from 3rd party applications or consultants.
Automatic trending with graphing is a huge help
Clinicians have trends they need to pay attention to. Whether it is a single patient's coumadin dosages or a population of patients diabetic interactions, those trend numbers can be invaluable. Try to find a system that generates the trends instead of just dumping out data points.
Evaluate process flows that come directly from the application
You have already evaluated YOUR process first (#79), but you will also need to evaluate the EMR vendor's hard coded processes. Make certain you can live with them before signing a contract.
Are we integrating or interfacing
The overall smooth transition of patient information throughout your practice is a must. There are subtle differences between integration and interfacing. You will want to understand the difference and understand what it means to the clinical data.
Hard coded work flows CAN be your friend
Many vendors try to add flexibility to their application by giving you many open text fields. The problem is that you can't do quality control on that type of field. Additionally, it makes reporting near impossible. Hard coded work flows can be useful, but they are even MORE useful if you can pick whether they are hard coded or not.
Social Media integration - the way business is done today
Many sites haven't realized the benefits of social media yet. Many are still afraid of SM. However, this is the way of business in the 21st Century. SM integration can be a huge advantage for your organization, especially if you are in a situation where you have to be concerned about market share.
Determine how the EMR vendor encourages innovation
This question may get a lot of babbling and deep breaths from the vendors. Few of them like to give access to their customers to actually change code or enhance the system. But if you intend on innovating, your application needs to be able to support you.
Determine how innovation is actually put into the practice
Encouraging innovation is a little different than actually performing with it. Once the vendor explains how they encourage innovation, you will want to know how you can actually use it. Often the answer is "it will be in the next release". You will have to decide if that is good enough.
Is the patient portal comprehensive
Thanks to the ARRA Meaningful Use dollars, the question of "do you have a patient portal" is going away. Now it is much more of a question of "what can the patient get to?" Just seeing labs and refilling prescriptions won't be enough in the long term.
Don't forget LEAN and Six-Sigma
I have put two or three tips around these topics, but I want to call them out specifically. Efficiency and Quality go hand in hand for this tip. Don't forget to embrace LEAN and Six-Sigma and push the vendor on how they embrace it too.
Remember the EMR is not the end-all, be-all of quality
The EMR is a tool. Nothing more, nothing less. And like any other tool, it is only as good as the people that use it and manage it. Make sure to continue to partner with your community and regional health leaders to ensure your EMR is put to full use.
Ensure the product has expandability for other service lines
If you have no intention of ever adding services, you can ignore this item. Otherwise, make sure that new specialties or clinic programs can be handled by the product.
What are the reporting skill sets necessary
Reporting can differ greatly from system to system. It may be done in a very simple front end that anyone could learn to use, or it may be done in a cryptic proprietary language that only a half dozen people on the planet can speak. If it is the second, reporting will be slower and much more expense.
Don't be afraid of low cost or open source products
Quality does not = expense. Several very high quality systems are low or no upfront costs. That being said, make sure the support structure is strong.
Reporting, reporting, reporting, reports
Most of the aspects of quality and quality improvement will circle your ability to easily get data out of the EMR. Reports are necessary everywhere, not only for you, but for all the agencies and public health areas that govern your practice.