I have been working with electronic medical records (EMR) for many years, having first become interested in 1996, when I was looking for a tool to collect data for pediatric sinusitis. As we designed a product to collect this data, our scope expanded into developing a subspecialty-specific EMR. I have since learned a great deal about developing and codifying information and am currently participating in my third and largest implementation of an EMR at Boys Town National Research Hospital in Omaha, Neb. In this column, I would like to discuss what to look for in an EMR and give some initial thoughts on implementation.
Explore this issue:August 2011
EMR vs. EHR
There is often confusion regarding the nomenclature of electronic-based records. In general, EMRs are designed for smaller practices. They may or may not be integrated or interfaced with a billing system. The system is integrated if both the EMR and the billing system operate from the same database. It is interfaced if the system has separate databases for the EMR and billing systems and the two databases "talk" to one another. Electronic health records (EHR), on the other hand, are generally designed for much larger health care systems and usually incorporate multiple specialties and settings. EMRs are more practice centric while EHRs are more patient centric. Ideally, information in a health record database would be available for all facilities and caregivers at the time of the patient encounter. This is a tall order for both systems; however, the EHR is designed more for this type of process.
It is important to understand that implementation begins with the selection process.Most otolaryngologists practice in two to three-person groups. They are usually independent from hospitals and, therefore, have autonomy in selecting the programs they use. If you practice at a larger system, academic or multispecialty, you will likely have little to no input into the selection of the EHR you will use. These larger systems are driven by the needs of primary care physicians, which are quite different than the needs of a surgical subspecialty. You will have to adapt that system and perhaps even create your own knowledge base. The likely advantage, however, is a large IT staff that will help with support and implementation. For these reasons, I am going to focus primarily on the EMR needs of independent otolaryngology groups.
Transitioning Your Practice
The first step is to seriously assess the practice’s physician commitment towards the implementation of an EMR. Unfortunately, implementation of an EMR often leads to dissatisfaction. I have seen several practices split because staff and physicians could not commit to full adoption of the EMR. It is crucial that all physicians in a small practice be completely engaged in the selection and implementation process.