In my last column (ENT Today, August 2011), I explained some of the broader issues regarding electronic medical records/electronic health records (EMR/EHR) selection, centered around the understanding that an EMR is a record that is more practice centered while an EHR is a health record intended to follow the patient through multiple providers. This article is directed toward practices with a large degree of autonomy in selecting their products; therefore, we will be discussing EMRs. If you’re part of a multidisciplinary practice or a university, you likely had little to no input regarding the EHR chosen. This is because larger numbers like primary care drive EHR selection. Don’t stop reading, however; assessment of disease-specific pathways is still applicable for the EHR you have.
The key to finding the right EMR is to make the most out of your meetings with vendors. Here’s how:
Do your research. First, assess your needs and determine what you can afford. Start by looking at EMRs that show at the American Academy of Otolaryngology Annual Meeting. These vendors are interested enough to develop content for otolaryngology. If you can’t make it to the meeting, go to vendor websites.
Delegate wisely. A practice manager could save you time by researching and setting up meetings with various EMR vendors. You and your fellow physicians need to attend the meetings. The practice manager will not be using the EMR; you will be. You need to assess the program in person to know whether it will meet your needs.
Review the company’s certification. The Certification Commission for Health Information Technology has been in the business the longest and does a good job of assessing data flow and integrity between modules, which is currently outside the scope of certification. Don’t take a vendor’s word for it. Check them out by going to the Office of the National Coordinator for Health Information Technology’s website (http://onc-chpl.force.com). Once on the site, choose “Ambulatory Practice Type.” Look up the EMR and assess the criteria and quality measures they possess.
See it firsthand. Ask vendors to show you an encounter of your choosing, from beginning to end, with any emphasis on time-saving tools and how they would recommend using physician extenders. Hold your questions to give them a chance to give you the big picture. Work on understanding how they would work their way through the encounter. Pay particular attention to how the history of present illness is laid out. Here are questions to ask:
- Are there questions appropriate to the disease, and how detailed are they?
- Is there a logical flow and are the elements counted by the Centers for Medicare and Medicaid Services for the encounter obvious?
- How do they record pertinent negatives as well as positives? How do they treat bilaterality?
- How do they handle free text?
- Is spell checking with a medical dictionary incorporated?
Don’t dwell on past medical and surgical histories at first because these will be pretty standard. Look for how vendors present questions required for meaningful use documentation. Look for good detail in the head and neck exam. They should volunteer time-saving “macros” which allow you to easily create your own normal findings and then chart by exception. Be wary of company defaults because you will no doubt enter unintentional data that, at the very least, could get you into trouble and at worst, could harm your patient. Remember: Everything you check means you did it or asked the question!
Review the plan. Ask yourself: Have the designers of the pathway taken the time to outline possible medical and surgical options? This is not to push you into a “doc in the box” modality but to assist you in choosing viable options.
Check coding. You should also look at the assessment portion of the EMR. It should be presented to you as a differential diagnosis with embedded ICD9 codes. This is important because the list will remind you of less common diagnoses. Don’t forget to ask about their strategies to incorporate ICD10 on October 1, 2013.
Get samples. Ask for a printout of the chart note and referring letter. Free text that describes your assessment and plan succinctly is very valuable when it is incorporated into the referring letter. Your referring doctor does not want to see your entire chart note, just a one-page letter that explains that you saw the patient, what you thought was going on and what you are going to do about it. This short text is invaluable at your follow-up appointment. Reading this assessment and plan will instantly tell you what you thought was going on and what you did.
If you like the initial pitch, dig deeper. Ask for a sight visit or a webinar for a more in-depth look at the product. For example, ask for references to sites of similar size that use the product. Be respectful of these practices because your visit can be disruptive and costly. Make sure you take billers, nurses, and administrators with you. Also make sure you get unchaperoned time with the users; you’ll be amazed at what comes out. Particularly important is an assessment of the company’s training and support. You will be dealing with a whole different animal after the sale! ENT Today
Rodney Lusk, MD, is director of the Boys Town Ear, Nose and Throat Clinic and Cochlear Implant Center at Boys Town National Research Hospital in Omaha, Neb. He has been working with EMRs since 1996. He may be reached at firstname.lastname@example.org.