In light of the enormous changes affecting medical practices throughout the United States, many physicians are updating or replacing their practice software. The age of total conversion to EHR is upon us and can pose a financial burden on physicians who suddenly find themselves having to adapt to a new style of medicine. In many cases, computer hardware will need to be replaced as well and you want to find some areas where your practice can realize some cost savings. Often, your software vendor will offer pricing for accompanying hardware in their estimate for updates to your computer programs. In most cases, these prices are not at all competitive and I believe that you can get a better deal by making a separate hardware package yourself.
Find out the specs that are required for your new program and shop around until you make the best deals. Hewlett Packard and Dell can offer bulk purchase discounts and will work with your software vendor to insure compatibility. They will also customize your systems for additional programs such as Word, Excel, Outlook and Power Point. Do a careful check of your warranty coverage and consider additional warranties that cover the machines as these systems are often subject to more use than a personal computer.
Servers should be chosen to expand with practice growth and should be stored in an air-cooled space to avoid overheating. Allow for the space for your servers prior to the completion of your build out or renovation and one that allows for the addition of programs without overtaxing the system. The servers should be housed in a locked room and should also be covered by an extended warranty.
Your phone systems should be uncomplicated and contain enough memory to add additional lines and hardware for new workstations, along with the capability to store a number of practice messages and the ability to retrieve messages from any work station. If you need a large number of incoming lines, you will want to have an employee from the phone company assigned to your account. They will be able to monitor your charges, make changes to your lines and answer any ongoing questions regarding your system. Local phone companies will also be able to offer you packages that include both phone services as well as the hardware for your office. Often their phones are more durable, so look at samples from independent vendors and your local carrier before making a final decision.
Software : It almost seems as if every computer programmer is busy developing medical practice software and the rush to develop systems for electronic medical records is being done at warp speed. Many of these programs have the same or similar features and are either hardwired into the servers directly or are internet based and the manufacturer of the software controls the hardware off site. There can be a tremendous variation in prices however and don't be surprised to find that every additional feature you may want will ultimately carry an additional price.
Many practices are already at full implementation of electronic medical records and are delighted with both their purchase and their use. Inevitably CMS and the commercial insurances will require that all practices convert to an electronic system, but EMR's are not without their own set of problems. Once all systems are paperless, what features will allow the various softwares to communicate with each other to provide a uniform patient health record? How can we guarantee privacy for medical records in systems that are internet based? What impact will the cost of conversion to EHR pose for some smaller, less financially successful practices? It often seems as if the cart is well ahead of the horse in this issue and I have to wonder about additional costs when CMS eventually requires a uniform system for health care records.... The future is certainly fraught with concerns that will shape a new face for medicine in the years to come....
In many cases, physicians who are using electronic systems will utilize some form of tablet computer, where they enter patient symptoms and treatments. Of course, in 2013 their systems will have to be updated to handle the new ICD-10 codes. A stylus is used to tap a series of pull down menus that the physician completes during the course of the exam. The tablet is especially useful during hospital visits and as long as these computers have long range capacities they can help assure that hospital charges are made at time of visit or directly after.
Doctors can also have the option of using a laptop or office PC where data is entered after the visit and can be placed in every exam room or confined to the physicians private office. Computers in the exam rooms can be utilized by the medical assistants to enter patients vital signs into the system prior to the actual exam. Some doctors feel quite comfortable entering vital data into their tablet or PC during the course of the exam. Others feel that this process detracts from the intimacy of the visit and prefer to wait until the patient is discharged before entering their findings. For simple visits such as a sore throat or cold, the tablet method is easier and poses less intrusion than for more complicated medical exams. In specialty practices, such as Cardiology, where the patient often presents with a complex history and wide variety of symptoms and past treatments, the process of entering data may be too extensive to use during the exam. In these cases, a progress note can be utilized in the exam room and entered at the end of business hours or during the course of the day when the physician has time.
Perhaps the EHR system will eventually eliminate paper and provide a more uniform system for health records, however the time you need to invest prior to implementation of your system is going to be extensive. Your software vendor must customize your package to meet the needs of your daily practice routine. Software should be created with your appropriate diagnosis and treatment options so that you are not constantly searching for a match for your patients symptoms and management. It is surely a good idea to choose a vendor that has worked with other physicians that practice the same specialty or otherwise your initial time investment in setting up your system will be overwhelming.
Exercise extreme caution prior to purchasing any EHR system. Practices can be literally crippled when the features advertised by the software vendor do not function properly post installation. This can be especially true in the present rush to market from start up companies that look great in demonstration and prove disastrous in use. To avoid this risk, it is best to choose a medical software with a significant track record in the industry. These companies have had years of experience in creating software that is user friendly and better geared for use in a specialty practice. Take the time to visit other offices that are using the software and ask how its implementation impacted billing and overall practice statistics. Finally, you must have the support and willingness of all the physicians in your group if you are going to make your conversion a success. Prior to using your new EHR, both your old and new systems should remain in place so that you can make a slow smooth transition and allow enough time for your staff to feel completely comfortable with the software. This will also allow you to evaluate how the new software meets the daily office routine.
Tomorrow: Essential Features For Any EHR System
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