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Ten Things to Consider When Selecting an EMR System


Acquiring an Electronic Medical Records System is one of the most important decisions a practice can make. A successful selection and subsequent installation can be a boon to practice efficiency, while a bad selection can be expensive and virtually bring a practice to a standstill.

Acquiring an Electronic Medical Records System is one of the most important decisions a practice can make. A successful selection and subsequent installation can be a boon to practice efficiency after both staff and physicians become comfortable with the system. A bad selection and installation can be expensive in dollars and can virtually bring a practice to a standstill.

The following are some considerations a practice should utilize in making the decision of the system to acquire and some thoughts on installation.1. Make a wish list of what you would like a system to do. Use this list to benchmark against the software you are evaluating. These may include fax capability for scrips, image storage, ability to interface with labs or hospitals, automatic drafting of follow-up letters to patients and appointment reminders by phone or mail.2. Don’t limit yourself, however tempting, to the software that your major hospital uses. It may not be the best for your day-to-day practice activity. Bridge programs can be written at a nominal cost or the vendor may already have a bridge product available.3. Consider only systems that are designed for your specialty. Don’t believe salesmen’s promises that minor adjustments can be made to a product to make it work for your practice.4. Only software that has CCHIT certification should be considered. This body, while not a part of the federal government, certifies EHR (Electronic Health Records) systems in various categories including ease of use. Software vendors must pay $29,000 to start the certification process. The process takes three years. The certification has primarily been for vendors of primary care practices although some software vendors of specialist practices have sought certification.

There maybe software vendors whose products are a good fit for your practice that is not certified. The question to ask is why haven’t they sought certification?5. Physicians should not depend solely on the opinions of an office manager or staff. Physicians should invest the time in visiting an existing practice using the system and observe the physicians using the system. Don’t plan on an hour, but invest a least half a day. Take the physicians out to dinner and ask them what they like best about the software and what they like least. Ask for their horror stories about the installation.

A physician should make the same investment with their staff and another user’s staff.

Compare notes. If issues are discovered talk to your sales representative and see if they can be addressed and changed to your satisfaction. Often software vendors will make changes to their software that will benefit all their users.6. Determine if the software vendor has a users group. This is a good sign that there is a commitment to improve the product. Part of your IT budget should be participation in this group.7. Have your attorney review the purchase agreement, especially if changes to the software have been promised. Have a substantial amount of the purchase price withheld until all promised changes have been made.

8. Evaluate staff carefully. If a staff person is not committed to the installation or doesn’t “get it,” make a termination and hire a new employee.9. Plan the installation process carefully. Whatever time the vendor tells you it will take, triple it. Be prepared to pay for additional training time from the vendor if needed. It will help you get staff and physicians functional quicker and thus save money in the long term.10. Have a line of credit from your bank available as receipts will slow down for 30 to 60 days as the system is implemented. Physicians should not have as many appointments scheduled for the first two weeks. We typically recommend scheduling 25% fewer appointment for the first week and increase by 5% for the next three weeks and 10% for the final week.

This listing is not meant to be all inclusive. Consult with your independent practice advisor such as a HCAA member who can assist you with both selection and installation of a product.

Hal A. Shoemaker, CPA, is the Managing Member of Shoemaker & Co., a Cincinnati-based accounting and consulting firm. Mr. Shoemaker specializes in delivering assorted accounting services to physicians and physician groups.He can be reached at (513) 871-9600 or via e-mail at


Mr. Shoemaker is a proud member of the National CPA Health Care Advisors Association. HCAA is a nationwide network of CPA firms devoted to serving the healthcare industry. Members provide proactive solutions to the accounting needs of physicians and physician groups. For more information contact the HCAA at info@hcaa.com.


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