Electronic Medical Records

Implementing EMR in a medical office

"EMR can improve patient care and practice efficiency in the small office setting. But if you decide to go to EMR, you must use it all the time, for everything. If you don’t, you defeat the purpose, waste money, and end up with the headaches of both EMR and paper systems, but the benefits of neither." So learned Dr. Sarah Corley when setting up her office in Arlington Va.

There are several ways to implement EMR in a primary care office.

1. Desktop PCs for each of the Doctor, the Nurse, and the Front desk
2. Desktop or Notebook PCs in each exam room
3. Desktop or Notebook PCs in each exam room hardwired into an office server
4. Notebook or Handheld PCs plugged into wall jack into an office server
5. Notebook or Handheld PCs used remotely, then downloaded into office PC
6. Notebook, Tablet, or Handhelds with wireless connection to an office server.

Physicians’ needs from EMR

• Templates and Wordlists for chart summary, progress notes, consultations
• Image utility - store and retrieve
• Summary screen
• Progress Notes
• Medication Lists
• Laboratory results
• health maintenance
• Search options
• Reports, letters, graphics
• Automatic Code insertion for diagnosis (ICD) and office visits/procedures (CPT)
• Billing Link
• Allergy and Dose warnings
• Links to Fax, Internet, Lab, Images
• Patient information sheets and medication handouts
• Drug/disease and drug/drug warnings
• remote access
• Ease of use and learning curve
• import/export
• prescription logging, printing, submission
• chronologic data tracking and graphing of labs, vitals, etc
• Patient recall, reminders, tickler file
• Patient tracking system
• upgrades
• Confidentiality and security
• search and sort by clinical parameters (ie all pts with DM, all pts on Inderal, etc)
• multiple report formats for encounters, procedures, and diagnoses
• automatic letter outputs

The year 2000 seemed like the perfect time for the Family Practice Management journal to conduct its third survey of electronic medical record (EMR) vendors. The market and products have changed considerably since the last survey was conducted in 1997. The most noticeable change has been the migration of EMRs from the desktop to the Internet. Titled Electronic Medical Records: The FPM Vendor Survey by Susan Rehm, MBA, and Susan Kraft, MD, it is a report on 23 conventional systems and five Internet-based ones.

The previous article appeared in the December 1997 edition of Family Practice Management entitled Computerized Patient Record Systems: A Survey of 28 Vendors by Steven M. Ornstein, MD, Ruth G. Jenkins, MS, and Robert L. Edsall. It gives a good overview of how well the major software packages meet the needs of the office based physician. If you're thinking of computerizing your records, here's the data you'll need to know.

Some Requisite Software Capabilities

1. Workflow Management · patient tracking · autofax
2. Clinical Data Repository · prior pat visit notes · patient history · uptodate labs, vital signs, etc · QA analysis tools · full database search capability
3. Patient Documentation · Clinical Notewriter · Prescription writer · RM prompts · Automated drug/drug & drug/allergy alerts · automated ICD & CPT coding · reimbursement prompts
4. Medical Decision Support · Knowledge Base · Patient Instructions · Drug formulary with dosage/usage guidance

EMR software that I have looked into

· SOAPware ($300, DOCS, Inc, www.docs.com) A very economical, simple solution to the majority of my needs. Very amenable to customization according to my preferences. Currently selected for use in my office.

· Powermed ($500, Powermed, Inc, www.powermed.com) More robust set of features than SOAPware, slightly more complex interface than Practice partner. I liked the fact that it would automatically screen for reminders that were due each day at startup.

· Practice Partner ($1800, Physician Microsystems, Inc, www.pmsi.com, 800-770-7674) Well-suited to primary care medicine, with a well-organized chart with separate sections for progress notes, H&Ps, letters and consults. It has a great health mainteneance section, a good summary screen and excellent search capabilities.

The American Academy of Family Physicians maintains a list of Software Vendors of Electronic Patient Records (Alphabetized by Vendor)

Other stand-alone EMR software

· PAL/MED

· ChartWare ($995, 1800-571-5444)

· Health Probe Patient Information Manager ($1295 single/$4995 multiple users, 1800-571-5444)

· Welford Chart Notes ($2000, MEDCOM Information Systems, Inc, 800-213-2161)

· Praxis (InforMed Medical Information systems, Inc, 800-985-6016, www.infor-med.com)

· STAT! Clinical ($2000, STAT! Systems [formerly QD Systems], www.statsystems.com)

· ChartWizard ($600, Wizard medical systems, 206-313-5690, www.wizmed.com)

· S-O-A-P ($400, Patient Medical Records, Inc, 800-285-7627)

· PocketChart ($1000, Physix, www.physix.com, 713-797-1199) EMR software integrated into medical office systems

· AMS Medical Office System offers the EMR alone ($1995) or their Practice Management PLUS system is an integrated version of both the EMR and Medical Management software programs ( retails for $7,995.00 for a 5 user license). American Medical Software 800-423-8836 www.americanmedical.com

· ClinicaLogic (Medicalogic, www.medicalogic.com, ranked #72 in Healthcare Informatics 1997 survey of HIS software revenues)

· CHARTstation (Datamedic Corp, www.datamedic.com, ranked #40 in Healthcare Informatics 1997 survey of HIS software revenues)

· ChartMaxx (MedPlus, www.medplus.com, ranked #83 in Healthcare Informatics 1997 survey of HIS software revenues)

· Electronic Medical Chart (EMC, Inc)

· Medacom (Integrated Clinical systems, inc, 800-893-6504, www.imsnet.com, ranked #14 in Healthcare Informatics 1997 survey of HIS software revenues)

· Medical Master (Medical office management corp 800-887-0262)

· Medical Manager (www.medicalmanager.com, ranked #26 in Healthcare Informatics 1997 survey of HIS software revenues)

· MedTrac (Medicomp Systems, 800-765-8080)

· QSI (Quality Systems, Inc 800-888-7955, www.qsii.com, ranked #56 in Healthcare Informatics 1997 survey of HIS software revenues)

· SmartClinic ($2250, Berdy Medical Systems, 800-662-3739, ranked #97 in Healthcare Informatics 1997 survey of HIS software revenues)

· topsSuite is an integrated system that automates the three primary areas of a medical practice: scheduling, charting, and practice management. While each of the three modules (topsSchedule, topsChart, topsBill) can be purchased separately and interfaced with existing systems, a single integrated solution offers many advantages. (e-MDs, Cedar Park, Texas 888-344-9836)

The American Academy of Family Physicians maintains a list of Software Vendors of Electronic Patient Records (Alphabetized by Vendor)

EMR incorporated into enterprise-wide HIS

· PROVIDE (Cerner Corp, www.cerner.com, ranked #5 in Healthcare Informatics 1997 survey of HIS software revenues)

· SmartChart

· Logician (Medicalogic, www.medicalogic.com, ranked #72 in Healthcare Informatics 1997 survey of HIS software revenues)

· Healthpoint ACS (www.healthpoint.com, a service of Physician Computer Network, inc, 800-421-9497, www.pcn.com, ranked #11 in Healthcare Informatics 1997 survey of HIS software revenues)

· Johns Hopkins Electronic Patient Record (JHHS Ctr fot Info Srvcs) - winner of the 1997 CWSA award for leading technology application by a business

· Ulticare (HDS, www.hdsc.com, a medaphis company, www.medaphis.com, ranked #12 in Healthcare Informatics 1997 survey of HIS software revenues)

· Avicenna Systems corp, www.avicenna.com

· WAVE (Oceania, www.oceania.com, 888-462-3264)

· Novius, (SMS, www.smed.com, ranked #2 in Healthcare Informatics 1997 survey of HIS software revenues)

· Cierra solutions, www.cierrasol.com

· Lastword (Phamis, www.phamis.com, ranked #24 in Healthcare Informatics 1997 survey of HIS software revenues)

· Workstation (Microscript, www.microscript.com)

· Pathways Smart Medical Record (HBOC, www.hboc.com, ranked #1 in Healthcare Informatics 1997 survey of HIS software revenues)

· Medical RecordsPlus (Dynamic Healthcare Technologies, 800-832-3020, ranked #38 in Healthcare Informatics 1997 survey of HIS software revenues)

· The Medical Record (Database, Inc)

· Medic Vision (Medic Computer Systems, www.medcmp.com, ranked #4 in Healthcare Informatics 1997 survey of HIS software revenues)

· Health Care Information System (Meditech, www.meditech.com, ranked #6 in Healthcare Informatics 1997 survey of HIS software revenues)

· IDXtend (IDX systems, www.idx.com, ranked #7 in Healthcare Informatics 1997 survey of HIS software revenues, www.healthcare-informatics.com).

The American Academy of Family Physicians maintains a list of Software Vendors of Electronic Patient Records (Alphabetized by Vendor)

Keys to Successful implementation of System-wide technology

1. Obtain user involvement early
2. Enlist people with varying interests
3. See the process as educational
4. Simulate the required workflows
5. Consider moving system maintenance
6. Give the team autonomy, authority, and accountability
7. Count on change
8. Stagger installation
9. Employ key users in system testing

The American Academy of Family Physicians' now offers aclearinghouse for computerization resources at FPNet.

Institute of Medicine’s "Gold Standards" for EMR

A. Provides problem lists
B. Measures health status and functional levels
C. Documents clinical reasoning/rationale
D. Provides longitudinal and timely EMR linkages with other patient records
E. Guarantees confidentiality and audit trails
F. Provides continuous authorized-user access
G. Supports simultaneous user views in the EMR
H. Provides access to local or remote information resources
I. Facilitates clinical problem solving
J. Supports direct physician entry
K. Supports cost measuring/quality assurance
L. Supports existing/evolving clinical specialty needs
M. Clinical data dictionary
N. Clinical data repository
O. Point-of-care facility
P. Ergonomically designed presentation facility
Q. Intelligent care support facility
R. Supports routine multimedia/image data storage
S. Links with ambulatory and other patient records
T. Supports multiple formulary lists
U. Checks RBRVS, E&M compliance and documentation
V. Supports multiple practice management/EDI linkages
W. Supports automated history and physical
X. Supports icon-generated text
Y. Supports multiple controlled vocabularies and coding structures
Z. Supports integrated/interfaced multimedia technology via icon on the clinical workstation

If you would like to submit any information, additions, updates, or corrections that would enhance this webpage, please forward them to Philip A. Gilly, MD, FAAFP.
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