How to Choose the Right EMR System



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With approximately 500 vendors selling EMR and EHR systems, it’s easy to get overwhelmed with choosing EHR software. While each practice has unique needs, many health care providers have used the following criteria to narrow down the list of preliminary EMR vendors to ones that are suitable for their practice. Use this list to help when choosing EHR software.

Certification for Federal EHR Incentive Payments
Virtually all health care providers want to make sure the EMR system they install will qualify for federal EHR incentive payments under the American Recovery and Reinvestment Act of 2009 (ARRA). These EHR incentive payments require providers to make “meaningful use” of an EMR system accredited by a proper certification authority. It’s important to note that there are several stages to meaningful use, all of which must be met for ongoing EHR incentive payments.

Accreditation of EMR systems (or individual software modules within an EMR suite) is made by the Office of the National Coordinator for Health IT (ONC) Authorized Certification Body (ONC-ATCB). As of October 2012, there are six such certification bodies, with Drummond Group, Inc. and the Certification Commission for Health Information Technology (CCHIT) being the most widely known. EMR systems do not have to be certified at the time of installation, but will need to be qualified before EHR incentive payments can be received.

Practice Specialty & Size
Choosing EHR software based on the workflows and EMR system requirements of your practice is important because they vary widely for different medical specialties. While there are similarities across specialties and not every particular need can be matched exactly, it’s important to choose an EMR system that has the functionality you need for your practice and has demonstrated acceptance in the marketplace for practices in your specialty or one similar to it.

Systems needs can vary widely depending on practice size, as well as on client population. Again, look for vendors with experience in practices with needs and characteristics similar to your own, to get the best EMR or best EHR system.

System Architecture
EMR systems can either be built using an on-site computer server or via internet-based access to a “cloud” service. Choosing EHR software with the systems architecture that fits your practice is important.

EMR systems can be built using an onsite computer server providing central storage of records, and some providers find this preferable, since they feel more comfortable meeting their HIPAA security obligations when they are in control of the underlying data and storage systems. However, a client /server system such as this requires that providers maintain and upgrade these systems as needed to keep them fully functional.

Web or cloud-based architectures are often referred to as Software-as-a-Service (SaaS) systems, since the application logic, programs and patient data are accessed remotely via the internet. In these EMR systems, security provisioning and system maintenance is assumed by the SaaS vendor, and many health care providers prefer the fact that these tasks are taken care of remotely. The quality and consistency of internet access can be a determining factor for these systems, since they provide limited functionality when disconnected from the web-based server.

Other Features
The most common additional EMR feature that is requested by health care providers is automatic transcription of medical notes, since it can be significantly faster than typing. Meaningful Use includes a Stage 1 requirement, for example, that more than 50% of patients receive a clinical summary within three business days after office visits. Many providers find it easiest to dictate using a transcription system and conclude an office visit by handing the patient a hard copy of the clinical summary or electronically transmitting it to them. Medical terminology makes many general purpose systems inappropriate for a medical environment, and Dragon Dictation has the lion’s share of the market.

For most practices, EMR help, installation, setup, training and maintenance will also be important items to review when choosing EHR software.