Computer Consult

How to get the lowdown on EMR software

A little digging will uncover the recommendations and warnings you'll need to buy the right program.

Robert Lowes

Shopping for electronic medical record software? The wide range of choices can make you dizzy. According to a survey by Healthcare Informatics magazine, almost 400 companies offer an EMR product.

Don't look for a buyer's guide that analyzes all your options and recommends what to select, either. That's too tall an order, given that practices of varying sizes and specialties need different kinds of EMRs (also called computerized patient records and electronic patient records). However, there are ways—some inexpensive, others free—to gain vital intelligence about EMR software that will help you pick a winner.

Do some general homework before you start kicking the tires of specific EMRs. Peruse Medical Economics articles on the subject at www.memag.com (click on "Information Technology" in the library section). Or read Electronic Medical Records, from the American College of Physicians-American Society of Internal Medicine (www.acponline.org/catalog/books/emr.htm; $36 for members, $45 for nonmembers). Then decide what kind of EMR suits you. Are you looking for the low cost of a Web-based product? Do you prefer entering data through a touch screen or a keyboard?

Once you know what's most important to you, the following sources can help narrow down the field of options:

Product directories. These list features and capabilities of individual programs. Health Informatics posts such a directory on its Web site (www.healthcare-informatics.com ; click on "Spotlights" and then "CPR Systems"). There, you'll learn, for instance, that EncounterPRO software from JMJ Technologies offers a touch screen but isn't Web-based. Access to the magazine's Web site is free.

One caveat: Information on software in such directories generally comes from vendors themselves, who may overstate what their products do or attach different meanings to their answers, says computer consultant Rosemarie Nelson in Syracuse, NY. So you'll need to balance the information in product directories with evaluations from independent outsiders.

KLAS reports. A company called KLAS (www.healthcomputing.com) publishes online reports on EMR programs and other medical software. KLAS asks software customers to rate vendors from 1 to 9 in 41 categories, including "Good contracting experience," "Quality of training," "Quality of telephone support," and "Would you buy it again?" KLAS also collects comments that don't fall under their category headings. So you might see praise for a vendor's response time to problems or a complaint about its disinterest in custom programming.

Basic reports (called "First KLAS") on individual vendors are free if you participate in a survey that asks questions about medical software you use. More comprehensive "Platinum KLAS" reports compare vendors side by side and track customer ratings over time. Payment for platinum reports depends on practice size; those with no more than 10 physicians pay $100 to $300 a year, says Kent Gale, the company's chief executive officer. Survey participants pay half price, but at the platinum level, KLAS may not survey you. That's because it focuses surveys on large software vendors, and your current vendor may be too small to warrant KLAS' interest—and the report discount.

The company's preference for market leaders explains why KLAS reports on only six EMR products: EpicCare (from Epic Systems), the most highly rated in the pack; Logician (GE Medical Systems); HealthMatics EMR (A⁴ Health Systems); NextGen EMR (NextGen Healthcare Information Systems); Misys EMR (formerly AutoChart, from Misys Healthcare Systems); and TouchWorks (Allscripts Healthcare Solutions). However, the KLAS Web site links you to another database called POMIS, which provides customer satisfaction ratings on dozens of EMR vendors. Individual company reports cost $85 apiece. POMIS creator Vinson Hudson acknowledges having culled out companies with ratings below "good," which may hamper your investigation.

Medical Software Reviews. This bimonthly newsletter (www.civicresearchinstitute.com/mi5.html) contains detailed, candid evaluations of EMR programs by computer-savvy physicians. A one-year subscription costs $159.50 and entitles you to look up archived reviews online.

Online and e-mail discussion groups. You'll also find EMR recommendations in online communities focused on medical computing. If you belong to the Medical Group Management Association, you can post questions on the Information Systems discussion group at www.mgma.com . The American Academy of Family Physicians offers members an e-mail discussion list at www.aafp.org/fpnet.xml.

Anybody can inquire about EMRs on an e-mail discussion list called Fam-Med (www.fpen.org/fam-med). The same is true for a discussion group on a Web site just about EMRs (www.elmr.com). It was launched by a Sarasota, FL, practice as a way to research its own EMR purchase.

Information swapping in these forums is brutally honest. "This is one of the worst companies to deal with," wrote one participant about a vendor. "I have not been able to use the system efficiently. The service and support is pathetic. Biggest financial mistake I ever made."

However, customer complaints may be misleading, notes FP David Kibbe, AAFP director of health information technology. An outstanding EMR program may garner criticism because a "value-added reseller"—a company that provides sales and service on behalf of a vendor—did a poor job installing the program or training staffers. "Users sometimes can't tell whether the problem is with the product or the reseller," says Kibbe. So don't rule out a promising product solely on the basis of one or two disparaging comments.

Conferences. Consider doing EMR research in person at your specialty society meeting or conventions held by health care organizations such as the Medical Group Management Association and the Medical Records Institute (www.medrecinst.com), which sponsors an annual meeting called TEPR (short for Toward an Electronic Patient Record). Roam the exhibit hall, where EMR vendors abound. Talk to salespeople, collect literature, try out demos.

At least two conferences—those for the Medical Records Institute and the AAFP—feature an EMR charting competition. Physicians using various programs document a mock patient encounter. You'll see not only which doctor charts his encounter the fastest, but which one produces the most thorough documentation. The winner at this year's TEPR conference was EpicCare.

The Medical Records Institute also gives awards to products considered tops in their market niches. In 2002, NextGen EMR won first place in the category of comprehensive ambulatory care EMR. The Medical Records Institute says that judges base their decisions on information from vendors and customer testimony.

These awards aren't the final word on what to buy, but they may add to the body of evidence you're collecting. By poking your nose in enough places, you should be able to reach an EMR verdict that you can live with.

The author, who is based in St. Louis, is a Senior Editor of Medical Economics.

 

Robert Lowes. Computer Consult: How to get the lowdown on EMR software. Medical Economics 2002;19:42.