How to Choose the Right Software for Your Practice

Our practice was able to find a provider who met our individual needs.

We've waited until now to discuss the actual process of how we determined our electronic medical records (EMR) software provider. The plan, which started over two years ago, originally was to establish an infrastructure and foundation to make a successful transition over to whatever product we would eventually choose to use.

Here we will outline the particular criterion which you should use to select an EMR vendor. We'll even discuss the exact reasons for determining and selecting the appropriate vendor for our five location, 140-person practice.

I'd like to stress the fact that other practices, both large and small, may be currently contemplating this same choice, but also probably have different needs. They should make the choice of vendor with these needs in mind - this article presents the overall process, offering examples of the things that should be considered when matching your practice to a vendor.

A medical practice, Ocala Eye, has used an application called 'Fiscal' for its electronic medical practice (EMR) solution up until the late 1990's. The practice later made the choice to concentrate on hospital-based systems, choosing to no longer service practice-based systems (beginning in 2000). The Fiscal version wasn't ready for the year Y2K, and at that time there weren't plans to switch from paper records to EMR.

Most physicians, and ophthalmologists in particular, tend to become highly-interested in new kinds of toys and gadgets. Often we must resist the temptation to bring a hot new product back to the office after discovering it at the recent Academy meeting. When we do remember the true plan about new technology, we simply turn the relevant info over to the electronic medical records committee, which is comprised of certain administrators and specific members of the IT and business departments. One primary goal of the committee is to set up the criteria for selecting an EMR system that is specifically suited to our practice.

Criteria Selection:

The committee first established some general guidelines of their expectations from an EMR system vendor. The committee decided that they would only consider vendors with at least a medium-sized presence in the market, expected to survive into the foreseeable future. Vendors would also have an EMR system in use in some other area of ophthalmology.

Next we agreed upon the primary criteria upon which to form our final decision:

1. We wanted a robust ACID- compliant relational database for several key reasons: we wanted the data to be protected and able to recover fully from failure, not just restore from backup; we wanted a database back end that would scale well as we grew, and we wanted something with an open interface that we could report on. By the way, ACID-compliant means that the database has the desired features of atomicity, consistency, isolation and durability.

2. We wanted a system which would give us the ability to create, modify and design powerful graphically based EMR templates with normalized data (not text).

3. We wanted a product and company with a strong practice management product that integrated with EMR. We did not want to install a system with duplicate data entry and where all patient information isn't accessible from both the EMR and EPM. After reviewing the products of about a dozen or so EMR vendors that had some experience with ophthalmology, we narrowed these down to a short list of about four. These vendors were then invited to make a presentation to our EMR committee. After analyzing their capabilities and checking references from not only ophthalmology practices but also practices of other specialties, our choice was NextGen Healthcare Information Systems from Quality Systems, Inc.

4. We wanted a system that could be fully supported on both thin and fat clients (remote control and direct control, respectively) to accommodate the low bandwidth of our satellite offices.

Reasoning and Choices:

In addition to a solid database and total support on both thin and fat clients, we discovered NextGen meet our need to customize EMR templates. In addition to an award-winning product, NextGen had a superior EMR interface. Today, NextGen doesn't even use an interface; instead both the EMR and EPM share a common database. So, instead of sending patients' data between the two different products, the information is already native in the application because of the database.

With this application, the added bonus of having a fully HIPAA ANSI X12N-compliant EPM claims engine is included. This facilitates a direct electronic data interchange (EDI) with complete HIPAA-compliance. We were then able to drop our clearing-house, meanwhile saving $11K annually while providing ourselves with the ability to save time on accounts receivable and eliminating the middle-man.

NextGen has been excellent to work with as a company, even developing into a positive element in the success of this large-scope project; they are receptive to suggestion and have a user group that forms into practices throughout the country, meeting occasionally for helpful training and discussion.