Electronic medical records

Dr. Alan Brookstone's top tips for EMR  selection

By Rosie Lombardi

Doctors are often advised to find a good fit with their “practice style” when they go shopping for an EMR. But what kind of analysis and footwork should be done to achieve this? Dr. Alan Brookstone (pictured), founder of CanadianEMR, an impartial EMR comparison site, offers the key questions doctors should be asking when they embark on this expensive journey.

For general practices, the first fundamental question that needs to be asked is: What is the size of the practice? “Is it a single doctor practice, a small multiple physician practice, or a multiple physician practice with specialists? When multiple people need to use the same record, the EMR needs to be flexible enough to meet all needs,” says Broookstone.

Another important question is: How much of their documentation is done in their medical office, or are they dependent on hospitals or ambulatory outpatient clinical settings? “If doctors are spending 75 percent of their time in hospital, then they’ll need a mechanism to collect and store data in their hospital system as opposed to their office system as the majority of their work isn’t done in a clinical setting. If they’re dependent on more than one system, this has implications regarding the way data flows back and forth between two different systems.”

Doctors should also investigate the functionality of the EMR system. “Does it have all the key features they’ll need to do the work they currently do? How well is it supported by the vendor? And the most important question is: What do colleagues who practice the same way I do think about the product?”

The actual features and functions that are important to doctors will vary greatly, and there are many elements to consider. “Different things are important to different people.”

For example, if many medications are prescribed in a practice, then questions will flow from this. “How well does the system handle prescription management and drug interaction checking? How easy is it for the system to allow doctors to represcribe medications for patients who are on multiple medications?”

If a practice treats many patients with chronic diseases, then modules that provide comprehensive support for this are important. “Does the system allow you to build those custom templates needed for chronic disease management? What are the reporting functions, how does the system export data? There are so many different components from the point of view of how it manages incoming data with lab data, its ability to analyze data, and then link it back to the patient profile.”

Most EMRs offer similar core functionality, so the key question is how well they handle the elements that are most important to a particular practice, says Brookstone. “This is why it’s important to check reports that rate their performances in different categories. When doctors go shopping for a system, they should do an early scan of the market to identify the systems that will meet their needs. They should then weed it down to three or four, and find out how satisfied other practices are with them. They should do site visits to see if they can live with that EMR system.”

Sniffing out a practice that is similar to a doctor’s own can be difficult. “The least unbiased way is to ask the vendor for a reference practice, but they will likely steer you to the gems, and not run-of-the-mill practices. Another way is to speak with people in the local community to find out if anyone is using a certain EMR.”

While many have attempted to create checklists that doctors can use to map out the features they need in their practices, these tend to be too long and detailed. “They’re not what your average GP is going to spend time doing. The whole concept behind the CanadianEMR site is to provide a simpler way to look at products and what their colleagues think about them. This is the key data they need to make a decision, and it short-circuits a lot of the other stuff so they don’t need to do a detailed comparison. The most important thing to do once a selection is made is to get feedback from an unbiased source using the system, and ideally, spending time at the practice to check it out.”

Last but not least, Brookstone recommends avoiding EMR systems that allow for a lot of customization unless the practice has unusual needs. “This is nice to have but it’s more expensive as you have to spend time and money on the customization. Doctors should try to find products that are already configured to meet 90 percent of their needs. Instead of finding perfection, they should try to find something that’s good enough. And if they’re moving from one EMR system to another, they really need to ensure they’ve looked at how the data will be moved over.”

Brookstone points out that the investment made in purchasing the software is a small part of the total cost of an EMR. “The majority of the costs are in all the things you have to do beyond that point: all the data that goes into the system, all the hours of physician and staff time that go into creating patient records and working with the vendor. Data has the highest value at a later point in time, so buying a cheap system at the front-end that doesn’t necessarily give you what you need at the back-end could be a costly decision. It’s not just about the dollar amount spent on system acquisition – all the effort needed to implement, manage and optimize the system over time should be considered.”

January 20, 2011