Sunday, August 10, 2008

Evaluating Electronic Medical Records

I can summarize the state of medicine and electronic medical records (EMR) in the U.S. today in one word. Disconnected. I have investigated and evaluated a number of EMR systems because I am simply interested and because our allergy practice needs a better EMR. Below, I summarize what I know about some EMR systems.

1) St. Francis Hospital selected Epic as its EMR for both inside the hospital and in its medical practices. I had my first look at Epic on 5/7/08. The system appears pretty good for general medicine, but I am waiting to see how this will operate in medical offices.

2) We interviewed GE's Centricity EMR last summer. Despite the vendor knowing we were a specialty practice focusing solely on allergy, no once did they mention they did not a special module for allergy. I had to ask them. Disappointing. Vendor had mild difficulty navigating through the system. when I put some mild pressure on him. After all, an experienced user should be able to go through the system and get what he wants quickly and accurately.

In fairness, our specialty is small and no other EMR system has a special module for allergy of which I am aware. Allergists are interested in having electronic records for extract making, giving of allergy injections, and billing for these services.

3) Misys. We have used Misys in our office or its predecessor Compusystems since 1993! Specifically we still use the DOS-based version, not the Windows-based version, called TIGER. Currently, we are having problems with billing and collections. We use their electronic prescription writer. It appeared to me to be written at the time we had the system installed in our office. There are problems. Namely too much time is spent clicking through extra windows. In August 2008, Misys was bought by Allscripts, which now has an EMR 1/3rd of all physician offices in the U.S. Note, these are not the same systems. Until they get everyone on the same line, there will be no economy of scale in savings or profits.

4) Eclinicalworks is a well-known and well rated system by TEPR. Locally, Eclinicalworks is used by Greenville Hospital Systems (GHS) and its practices. Once again, one system does not fit all. Practices I spoke with had difficulty with the billing component.

5) PMR is reportedly the name of the EMR used at Spartanburg Regional Health System (SRHS) in South Carolina. This EMR is not shared with other office practices they own currently. On one hand, this may make it easier to manage the system. On the other hand, there is loss of synergy, once you leave the hospital. I am sure they will extend the system to its practices at some time. I have no first hand experience nor could I find any information online about this EMR system.

6) I could not obtain information about Mary Black Hospital's EMR, but I do know it is used only in the hospital.

7) We used Dr. Notes' electronic prescription Dr. First for about 2 years. I evaluated the top 8-10 systems available at the time and selected this system. It's not bad, but it is very dependent on Internet connection speed. We had a 5 MBPS cable modem connection. It was still sluggish, which was an annoying waste of time. In fairness, I thought other than the speed, the actual flow was very efficient.

8) We have an appointment with a Nextgen vendor. I do know that they do not have a module for allergy at this time.

9) Medical Manager is owned by WebMD. I got experience with this system as a fellow in Chicago and then again in private practice. The vendor's support was variable and a big factor in whether or not the practice was happy with it. Whenever any EMR system even hiccups, you are dead in the water if all the records are stored electronically. This has contributed to our reluctance to go completely paperless. The nearby practice I am aware of at times functions more like a walk-in clinic, when there is any problem with the EMR system, from power to monitors.

To summarize, there is no one best EMR system yet. Some sources note thee are over 300 marketed EMR. The surviving EMR have very big challenges, because there are no standards as of yet for medical records, scheduling, billing and dealing with the innumerable insurance companies' own software. Once and (a gigantic) if standards are established, there will be consolidation. Their biggest problem will be dealing with billing and collections. Physicians and staff will whine about the system, but when cash flow is affected, the company goes on critical, red alert. This has been the back breaker, for our practice too. After all, the medical records component is really just a fancy word processor with text files and stored images. The scheduler component is also pretty uniform. How many different ways are there to schedule people?

How is an individual or organization even going to evaluate an EMR system? Some organizations or people have generated checklists and their own evaluations, much like this one here. Some EMR trumpet their endorsement from other organizations or hospital systems. Towards Electronic Medical Records is one such organization to wants to serve as the storefront and evaluator of EMR. Some companies ranking vendors based on reported feedback KLAS. Investment companies ranking companies based on units sold or dollars of revenue. To summarize, it is a free-for-all and there is nothing objective.


houston-mirth-users said...

Your summary that there is nothing objective in the EHR industry is right on.

My family business was one of the ones damaged by Medical Managers financial games. We decided that we would only use Open Source software as a result.

The top Open Source EHR in the US is ClearHealth, we sell it as MirrorMed. Even if you go with my competitor (ClearHealth) you will be happier in the long run with Open Source software. Otherwise, you have not control.


Barry said...

There is another, almost unknown yet uniquely intuitive and web-based EHR that runs on open source which I consider unique among its peers: WaitingRoomSolutions. The sea is vast and marketing is difficult. We all know that a better mouse trap does not cause a stampede to your door - but this product deserves a fair look-see by any thinking physician or PM in the market.

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