Defining the EMR Selection Process

In most situations, a physician will decide to purchase an EMR and then call other physicians they know that are currently running an EMR system.  After determining which vendors are being used, the physician may call the particular EMR vendors and request a demonstration.  This method may work for some physicians, but also consider that the national average of a successful EMR implementations are about forty percent.  When considering the average EMR system cost is around $50,000 or more, a phased and systematic approach should be taken to select the right vendor for your office needs. 
The EMR selection process begins way before a vendor is called for a demonstration.  Remember, the EMR system should make your office more efficient.  With that said, the very first task that should be completed is a detailed workflow analysis of your practice.  This analysis should start with the patient’s first step in your practice.  For example, if the patient is a new patient, what forms are given to them by the front desk to fill out?  If the patient is a worker’s comp patient, are there additional forms that need to be completed?  Take each and every one of these forms and place them in a binder and label them “New Patient” documents.  At this point, you have already identified a potential way to make your office more efficient.  How long does your staff spend keying this data into your system or attaching it to a paper chart?  Many EMR vendors provide the ability for a patient to key in data either online or in a Kiosk type environment.  Most of the time, the data keyed by the patient is demographic related but some vendors take the process to the next step by collecting past family social history and history of present illness.   Some may argue that patients would not be willing to complete these forms or enter the information, but HDS has personally been involved in Kiosk environments where elderly patients had no problem using Kiosk.  At this time, you have only started with the workflow process but have found the ability to significantly enhance the efficiencies in the office through the electronic capture of patient data.  The workflow documentation process should be completed with meticulous detail.  The end result should be a document that identifies the requirements for the selected EMR vendor.  This document is the beginning of the next phase.
In the second phase of the EMR selection process, a list of questions of capabilities needs to be created in which each vendor will answer either yes or no to as to the existence of that capability in their EMR application.  Each capability needs to be weighted as to the necessity to your practice.  An example of this is the ability to directly interface to an external PACS server.  This feature may be extremely important to an orthopedic surgeon but have no importance to a pediatric physician.  As such, the score for the same EMR vendor for one specialty may be completely different for another specialty. 
The third phase in the selection process is to search for EMR vendors that you would like to see a demonstration from.  This first place to start is the list of vendors who are CCHIT certified.  Each of these vendors has gone through a process that truly puts their applications through scenarios that probably occur in your office on a daily basis.  As you will see, there are over 50 vendors already on this list.  At least this narrows the process down from 300+ vendors to 50+ vendors.  Next, call other physicians that are in the same specialty who are currently using an EMR system.  Determine if any of these EMR systems are on the CCHIT certified list and start with the demonstration of these vendors.
Hughes Data Systems recommends having at least five different demonstrations from EMR vendors.  If time allows for it, ten demonstrations will really give you the ability to find the best EMR vendor that meets your specifications.  After viewing these demonstrations, you will probably NOT have a gestalt feeling of the EMR vendor you would like to select.  The reason for this is because most of the EMR vendors will show you the same basic features of an EMR system.  Each vendor will have their own nuances and attempt to show you features that another vendor may not have.  For this reason, careful documentation during the demonstration process is critical.
Phase four is the actual demonstration process.  This is probably the most important phase of the entire selection process.  What you will soon find out is that each EMR vendor will take you down a demonstration path that is “their” own path.  Some will attempt to show you a sampling of patients that may show up in your practice and others will show you just a basic demonstration of a patient being processed through their system.  In either situation, it is the EMR demonstrator who controls the demonstration.  This means the vendor’s attempts to show you what you want to see, not what you may need to actually see.  For example, most presenters will walk you through a review of system on a patient.  Notice that the presenter will only select what is on the screen.  This kind of presentation does not show how you will handle a patient that presents with something that does not show up on the screen.  This is where you need to as the physician take the presenter off the beaten path.  Ask the presenter to choose options that do not necessarily appear in the screen.  Attempt to pick something that may not even exist in the system.  This will allow you to see how difficult it is to add a clinical element on the fly.  Some EMR’s handle this requirement easily others cannot handle it at all.  While viewing the demonstration, try to attempt to mark off your questions as best as you can.  Sometimes it is easier to view the entire demonstration and then take the presenter through your list of questions and requirements.  The key is to make sure you score each demonstration accurately and thoroughly.  As you will find out, the more demonstrations you see, the harder the selection process becomes.  After you see your fourth or fifth demonstration, you begin to forget what you liked and disliked about the first two.
Phase five begins with the analyzation of your demonstration documentation.  The easiest way to score each vendor is to add up the total features / questions for the vendor and divide it by the total questions / features asked.  You should now be able to see how well each vendor did as compared to the other vendors.  What is important to notes is the way the questions are divided.  When evaluating an EMR system that has an integrated PMS system, the questions should be divided between the two systems.  Many times, you will have several EMR vendors that the EMR total is very close but when you look at the score the PMS part of the program, the scores are tremendously different.  You may find that the deciding factor of the EMR vendor is not the EMR application but how well the PMS part of the program performs for your office.
Phase six is where your office needs to narrow the EMR vendor selection down to two or three vendors.  The best way to handle this process is create three different patient scenarios.  Type the scenarios just like the patient were to walk in your office and you would go through the process manually.  Next, call the three vendors and tell them you would like to schedule a final demo with them based on three patient scenarios.  The vendor will want you to fax the scenarios to them so they can setup the templates in the system.  Try to schedule all three demos within a day of each other.  If you can see them all in one day, it makes it much easier to see the differences between the vendors.  HDS also suggest that during these demonstrations that you might have a fourth scenario that you put together and not fax to the vendor.  Have the vendor take you through this patient without a pre-configured template in the system.  By doing this, you will get to see how difficult it is to actually see patients in the system that do not meet their template specifications.  By the end of these demonstrations, you should have a pretty good idea on the EMR vendor you are going to select.  Once you have made that selection, it is time for “due diligence”.
Phase seven is the step in which you call references and make site visits.  When you call the EMR vendor, ask for references that are very similar to your practice and your needs requirements.  For example, if you have a need to connect with a hospital with a Meditech HIS system, it would greatly benefit you if you could see an actual practice who has accomplished that type of interface.  Another example would be an interface to an external PACS vendor.   How does the vendor EXACTLY interface to the PACS vendor?  Is it as seamless as the vendor tells you it is?  Or, is it even worth paying for the interface because it does not add a real value to your system.  Next, make sure the reference that the vendor is sending you to comes from your specialty.  While you may be able to see the system in use, it does little good if the patients problems have no similarity to the patient problems you may see.  The most important point to understand about this phase is not to skip this phase.  Checking reference is critical.  You might think that sense the vendor has given you names and phone numbers to contact that the reference will automatically give you a good story.  This is not the case.  HDS has personally called references that have given very bad references for the product they were using.  As stated previously, do not skip this step.
The last phase, deals with signing off for the system and making payment.  The most important part of this step is there must be a contract between you and the vendor.  Do not sign a proposal for any dollar amount.  This leaves no legal recourse if there are any problems with the software or vendor.  Make sure the contract includes the specifications you have verbally discussed with the vendor.  Make sure the contact specifies some kind of Service Level Agreement as to the level of support that will be provided to your office.  Lastly, make sure the contract spells out the training and implementation process.
The following information has been provided as a guide to the steps of the EMR purchasing process.  Hughes Data Systems realizes there is a significant amount of detailed work that must occur by your practice during this process.  Hughes Data Systems is highly skilled in these processes and would be happy to consult for your practice during your search for the perfect EMR.      ©Hughes Data System 2007