What EMR Buyers Need To Know

By Dr. Terra Caudill

Q: Why don’t EMR companies list their prices on their website?
A: I have no idea. Every other thing that I buy online lists their price and has a method for me to pay for it online. I got so tired of being asked to sign up so they could waste my time by calling me so they could decide who they wanted to call me back. I just want a price to start with. If a company keeps their pricing a secret, then I have to assume that they are charging everyone a different price, or that they are going to charge me one price today and increase it dramatically next year.

Q: What is a live demo?
A: It is a sneaky way of wasting your time and forcing you to listen to their sales pitch, usually for 45-60 minutes on the phone. Any EMR company that really wants you to buy their product will respect your time, and at a minimum have demo videos of the EMR on their website, but ideally offer a 30-day free trial so that you can explore all of the features on your own time and find out if it is a right fit for you.

Q: What is the difference between an EHR and EMR?
A: This is a controversial topic with no clear sides, and many people use the terms interchangably without knowing the difference. Do physicians need an Electronic Health Record (EHR) or an Electronic Medical Record (EMR)? One little letter, why does it matter? It really doesn’t, since we are all now required to use one. But the people that wrote these computer algorithms to build these programs were hired by somebody, so it is likely that their system is biased to help the entity that paid to have it built. So, the real question is what is this computer program going to use your time to do? You only have 24 hours in a day. You can’t get more.  I don’t want it to be biased by a health insurance company that wants to lower their costs and use as much of my time documenting useless information as possible. It should be a tool that physicians (that went to medical school, not health school) use to allow us to focus our time on providing quality care to patients. Yes, if you accept insurance, you have to document enough “useless” information that is not focused on patient care to meet Meaningful Use guidelines if you want to get paid for your services. If your EMR is biased to help you do that efficiently, you now have more time to utilize the critical thinking skills that you need to use to make the best decisions for patient care.

Q: How are an EMR, PM, PHR and Patient Portal different from each other?
Q: An EMR is the Electronic Medical Record that physicians use to document their interactions with patients. PM stands for Practice Management and encompasses office billing and scheduling. A PHR “Personal Health Record” is a not widely used tool that is managed by patients alone. A Patient Portal is a variable entity that is managed by both the patient and physician and can be an extremely important tool if it allows patients to enter their intake information before their first visit, physicians to be alerted that prescription refills are needed and patients to pay their bills online.

Q: What is white label?
A: White label means that none of their branding is on the product (EMR) that you are purchasing from them. Why should you buy something and then be forced to promote their company by advertising for them when you paid for the product? We don’t let pharmaceutical companies force us to write with their pens, so why do we have to let EMR companies do it?

Q: Why use your own URL?
A: There may be no branding on what the patient sees of your EMR (i.e. the Patient Portal), but the EMR company may require that you use their name in the website link after the patient clicks on your website. If you are allowed to have a customized URL with your practice name on it, you are not forced to pay money to promote their company and it looks like a more professional site.

Q: Why is mobile responsive important?
A: If at least the Patient Portal part of your EMR is not mobile responsive, run away… All modern websites should be mobile compatible without having to download an app. This means that when you look at a website on your phone, it automatically shrinks to your phone’s screen size and you do not have to resize it or scroll to see the entire page. Everyone surfs the web on their phone. Patients expect this too. If your EMR is not mobile responsive, it is a dinosaur.

Q: Why is CCDA export important?
A: There are several different formats that are used to export data from EMRs. It is pretty complicated, but this is what I understand of it. In 1999, the CDA (Clinical Document Architecture) was birthed as a methodology to create documents and templates. In 2004, the CCR (Continuity of Care Record) was utilized to create a Word document of patient summary information (using non-CDA technology). In 2007, the CCD (Continuity of Care Document) was created as a slightly fancier document that could support user-defined fields (based on CDA technology). In 2011, the CCDA (Consolidated Clinical Document Architecture) began to be used as the new version of the original CDA programming to create modern templates that can include audio and video to create standardized documents that physicians can look at and quickly know where on that document to look for which information they need for any patient.

The bottom line, though, is that if your EMR exports your patient information via a CCR, CCD, Excel, .CSV or .PDF file, it is highly likely that this information will not be able to be imported into any modern EMR. You have to be able to export your information via a CCDA file if you want to switch to another EMR. Don’t let your EMR company hold your patient information hostage. It’s your information, not theirs.

Q: Why do third party apps matter?
A: If an EMR includes all of it’s functionality, they are guaranteeing that every function in it works. If they require that you use third party apps for specific functions that you need, they are not guaranteeing that the interface between the two will work, and it is likely that both companies will refer you to the other one when that function is not working. Don’t get caught in the middle.

Q: Why don’t you just rate the #1 EMR?
A: There is no #1 EMR. Different factors are important to different practices. Until enough time has passed that the largest few companies buy or crush all of the other ones, we have hundreds of choices. Some of the factors to consider are things such as:

• Price: If you want a free service, Practice Fusion is your choice. If you want the most expensive EMR, then Cerner is your choice. My opinion is that this is my business and I will pay as much as it costs to have all of the features that I want, but I don’t want to be overcharged unnecessarily.
• Total Cost: I found out that the price quoted (whether or not they list it on their website and even after you have listened to their sales pitch for an hour) is rarely the price that you will pay. The check you end up writing is going to be higher. If you do not have a complete list of all of the extra fees that could be incurred, you do not know how much it is going to cost you if you purchase their product.
• Customer Service: If you want an EMR that has the most short tutorial videos that you can figure anything out by yourself, Kareo is your choice. But, you may prefer phone, live chat or email support. You may only need it during normal business hours or you may want access 24/7.
• Speed: If you want your EMR to become smarter and faster as you use it, Praxis EMR is the one for you. Similar to how Dragon learns what phrases you use the most, this EMR will learn to predict what you want to type in your note, allowing you to finish your note faster.
• Established Companies: If you are worried that your EMR will tell you tomorrow that they no longer exist and all of your data is gone, you probably want to go with a well established company like Cerner.
• White Label: If you want your patients to stay on your website and not leave to go to  their website, you may want to have no EMR branding on your patient portal and to customize the url of your patient portal such as Praxis EMR or Advanced MD.
• Risk Adverse: If you worry that you will get stuck using an EMR that you don’t end up liking, you need to know how long their required contract is (if any). My theory is that any company that offers a month-to-month contract is confident that you are going to like their product enough to keep using them. Also, if they do not offer CCDA export, you cannot ever leave them, they are holding your patient information hostage. If they store your patient information outside the US and don’t back it frequently on multiple servers in different locations of the country, you could lose everything if a natural disaster hits their one location. If they are using an established storage service like the Amazon cloud, you can put more trust that they are not going to lose your data.
• Modern Technology: If you want to leave an ancient EMR, you need to consider modern factors such as mobile responsiveness, and allowing patients edit enter their medical information and having the ability to pay online.