Choosing the Right EMR System: A Buyer’s Guide

Electronic health records vs. electronic medical records

There is a difference between EMRs and EHRs. EMRs are essentially digitized paper charts for a single practice, and electronic health record (EHR) systems are more comprehensive. For one, EHRs not only replace paper charts, but also streamline critical functions like billing, ordering prescriptions and tests, managing your practice, and communicating with your patients. 

The advantage of an EHR system is that everything appears in one place – a patient’s entire medical history, the logistical aspects of running your practice, and more. Even better, EHR systems allow providers at all points of care to communicate with one another electronically. For example, if a patient visits the hospital on Saturday, their general practitioner will know all about it on Monday. 

Physicians and staff can use an EHR system to deliver more effective treatment and create comprehensive health records that circulate to every point of care. However, these days, members of the industry often use the terms EMR and EHR interchangeably, as virtually every major platform offers EHR-like functionality.

Benefits of EHR systems

These are some reasons EHR systems are increasingly common in medical practices:

• Easier note-taking. EHR systems often include medical speech-to-text tools that streamline the note-taking process. With these tools, you can prioritize hands-on patient care and let the EHR translate your conversations into notes.
  
  
• Easier chart and notes access. With EHR systems, your days of combing through overstuffed file cabinets are over. Instead, you can quickly access a digital interface that streamlines searching for and pulling up charts and notes. With this improved access comes better patient care. Medical software stores patient records in compliance with HIPAA regulations.
  
  
• Increased awareness of dangerous drug interactions. Most EHR systems will alert you if you prescribe medications that could interact dangerously with one another. This proactive safety feature isn’t possible with non-computerized charting and note-taking methods.
  
  
• Better communication with other practitioners. Whether inside or outside of your practice, EHR systems’ interoperability ensures the swift delivery of patient information from one party to another. This ensures that all medical professionals who need to care for your patient can do so without any issues.

Types of EHR systems

There are four main types of EHR systems.

1. Physician-hosted: If your EHR system is physician-hosted, then all your medical data is stored on servers within your facility. In this case, you’re responsible for buying all data storage hardware. You’ll also need to implement information security measures that keep your practice HIPAA-compliant. Although onsite hosting can make your EHR system faster, implementing it can be expensive. It’s best left to hospital-sized practices.
   
   
2. Remotely hosted or dedicated remote: The servers for a remotely hosted EHR system are based outside of your practice. This arrangement relieves your practices of the issue of data storage, but you do remain responsible for data security. In other words, it only partially relieves your IT burden. That said, remotely hosted options are beneficial for smaller practices unable to afford physician-hosted solutions.
   
   
3. Subsidized remote: When your practice uses a subsidized remote EHR, it pays another medical practice for access to its EHR. For example, if a nearby hospital provides EHR access to your practice, then you’re working with a subsidized remote system. In this arrangement, your EHR system management costs are minimal, but data ownership issues can arise.
   
   
4. Cloud-based: Perhaps the most popular type of EHR system, cloud-based EHRs don’t require onsite servers. Instead, your cloud-based EHR vendor will store all your EHR data in the cloud. This cloud access results in enhanced data security, in part because your practice’s data is available only through the EHR vendor’s HIPAA-compliant platforms. It also relieves your practice of virtually all healthcare IT concerns.

How to choose an EHR system

While the benefits of a well-functioning EHR system are clear, implementing and adapting to an EHR system can be a challenge. Before you commit to any one EHR system, consider your priorities. 

EHRs don’t just impact physicians, but every facet of the practice. This is especially true when a practice management system or revenue cycle management integrates with the system. Everyone in the practice should be familiar with the implementation goals and long-term strategy.

Explore your options before making any decisions. Shop around. Get multiple estimates, investigate vendors’ reputations, and seek recommendations.

While you’re required by the Health Insurance Portability and Accountability Act (HIPAA) to ensure patient data in any EHR system is secure, there are many other considerations when choosing an EHR system. Here are a few:

1. Cost 

The prices of EHR systems depend on the features you choose, the vendor you select, and how many providers are in your practice. When requesting an estimate, find out the initial licensing or activation costs and how much each additional component (such as a practice management system) will add to the price. Typically, for smaller practices, the price is based on a monthly subscription fee multiplied by the number of providers using the system. For our recommendations, subscription costs range from $150 to $1,100 per month, per provider, after activation or licensing costs. Those fees may cost a few hundred to a few thousand dollars. Pricing fluctuates based on the specifics of each practice and will be determined in consultation with the vendor. 

2. Ease of use 

If a system isn’t intuitive, it can grind your workflow to a halt as your staff struggles to accomplish routine tasks. Most vendors offer free trials or live demonstrations of their systems to prospective buyers, so take advantage of these options to evaluate whether the system would be a benefit or a detriment to your practice. Remember, you will use this system every day, so you don’t want one that will take you away from your patients or add hours to your daily workload. Ease of use doesn’t end at the provider; office staff and billing managers also need to understand how to use the system.

3. Cloud-based hosting 

Most major EHR vendors offer a cloud-hosted option, meaning there are no servers or hardware to maintain in your office besides your own computers. Cloud-hosted systems provide a relatively cheap way to outsource the costs of IT maintenance and technical support to the vendor. We recommend a cloud-based option unless you have a specific reason to host servers onsite.

4. Implementation and training 

The implementation of an EMR system can take anywhere from a few weeks to a couple of months, so it’s important to know your vendor’s plan for getting your system up and running. In addition, some vendors offer physician and staff training to make sure everyone in your practice is up to speed with the new software. Occasionally, a vendor will offer one-on-one support at no extra cost for a limited time after the system is implemented. 

5. Integration

Some useful features of EHRs include e-prescribing and electronically ordering laboratory tests and results. However, not every lab, hospital and pharmacy will be configured to interface properly with every EHR system. To ensure interoperability, which is a primary focus of the government’s Meaningful Use Stage III guidelines, talk to vendors about which interfaces they employ and whether or not those are compatible with the surrounding facilities in your area. Many vendors are willing to build out additional integrations upon request, so find out if that is possible and if it would be included in your subscription costs.

6. Customer service 

Acclimating to a new EMR system is no small task, so make sure the vendor will be there to support you along the way. If its customer service is difficult to reach or not particularly eager to answer questions before you buy, the service might not be helpful when you’re trying to figure out your new system later. A good working relationship with the vendor you choose is key to a successful transition to a new EMR system. 

7. ONC EHR certification

Regulations surrounding medical software continue to evolve, but a system should meet baseline requirements set out by the Centers for Medicare & Medicaid Services (CMS). These certifications are also relevant for Medicare and Medicaid reimbursement payments and whether a practice is eligible for any incentive payments or subject to any penalties based on their use of medical software.

Editor’s note: Looking for an electronic health records system for your medical practice? If you’re looking for information to help you choose the one that’s right for you, use the questionnaire below to receive information from a variety of vendors for free.

Max Freedman contributed to the research and writing in this article.