Check out our Specialty-Specific EMR section for more information or to find companies that provide these solutions

So once you have an Electronic Medical Records (EMR), you'll be ready to go paperless, right? Unfortunately, that probably won't be the case. At least not right away. I've been involved in a number of recent healthcare projects with organizations that have been using EMRs for several years, and they're still plagued by paper. In fact, one small multi-specialty clinic not only hasn't been able to get rid of the paper charts—it still doesn’t have all the doctors using the EMR system. It really has two challenges: the EMR system itself and the strategy for capturing documents.

Being a multi-specialty clinic is one reason the EMR rollout has taken so long. The general practitioners, internists and records staff were using it relatively quickly. However, like many "enterprise" products, the clinic’s EMR software didn't have all the out-of-the-box templates, integrations and other functionality needed by specialists ranging from ophthalmologists to podiatrists.

Ensure the Templates Can Adapt to Your Practice

EMR systems have predefined templates that reflect the routine aspects of patient encounters, the kinds of conditions a physician treats and the common workflows for these conditions. These conditions and workflows vary widely, so each specialty needs very different types of templates. For instance, an adult physical doesn't require vaccination tracking, growth management and medical dosing like a pediatric physical does.

EMR software vendors offer templates for common workflows that can be modified to fit the way you practice and your patient demographics. The fewer physicians who practice in your specialty, the less likely an enterprise EMR system will have well-defined templates for your needs. If you don't have trained IT resources, you'll need to pay an EMR vendor or consultant to create and modify templates for you. In the case of the clinic I mentioned earlier, its small EMR vendor, though competent and customer-service focused, didn't have the resources to build templates as quickly as the customer had hoped.

When evaluating an EMR system, ask what templates are included, how a template can be modified and how much those services cost. Templates will need to be modified. Different practices handle workflows slightly differently, and the template shouldn't force you to adapt to the software. Your practice and treatment plans will change over time. Will you need to call a service provider every time there is a small change to the treatment plan for a particular condition?

An enterprise-class EMR workflow template must accommodate specialty processes. Consider the things your practice requires that other specialties don't. For instance, a timer is needed for specialties in which a patient is given a treatment and must be seen after 30 minutes or some other set period of time (e.g., a shot from an allergist, a test by an endocrinologist or a diabetes screening for an OB/GYN patient). This functionality may not be available in all templates.

Your professional organization and peers may be a good source of information about which EMR systems have the appropriate functionality. The American Academy of Pediatrics, for example, offers a website with EMR reviews and feedback from pediatricians.

Open Standards Increase Efficiency, Support Meaningful Use

Interoperability is important for all EMR systems, but specialty practices must be especially diligent. Don't assume the software can share information with specialized diagnostic equipment or practice management software. It may not be able to handle specialized image formats, codes for various kinds of billing and unique chart formats. If not, physicians and support staff will need to go to multiple systems to get a complete view of the patient. Administrative staff may spend too much time doing duplicate data entry into multiple systems, increasing overhead costs and the likelihood of errors.

Niche-specialty EMR systems aren't a good option for a multi-specialty clinic, because maintaining continuity of care across multiple systems would be a nightmare and a huge burden on IT staff. Even specialty practices may be taking on too much risk with a niche product if it doesn't share data with other systems. For instance, a surgeon gets information from the referring physician and generally sends back a report about the procedure. If their systems can't communicate using common standards, both physicians will spend staff time printing/faxing/scanning information. Or they will need to refer to a paper chart as well as the EMR, increasing costs and inefficiency.

The Integrating the Healthcare Enterprise (IHE) initiative establishes frameworks for healthcare applications to share data using established standards like HL7. More than 300 manufacturers support one or more IHE profiles, providing benchmarks for providers who are evaluating EMR and other technologies. In addition to improving patient care, information sharing is a critical component of the meaningful-use criteria, whether it's sharing summary data with another provider or uploading information to a health information exchange (HIE). 

Products that are CCHIT Certified® 2011 by the Certification Commission for Health Information Technology, including  Electronic Health Record (EHR) systems for a number of ambulatory specialties, have been tested for functionality, security and interoperability. CCHIT also has been authorized to certify that EHRs can support meaningful-use criteria. It's important to note, however, that neither IHE nor CCHIT evaluate attributes like usability or vendor support and viability, which are as important to success as the technology itself.

Eliminate the Remaining Paper with Document Imaging

Like so many other healthcare providers with EMRs, the clinic still won't be paperless when all the physicians are using the EMR system. Currently, they print documents, put them in paper charts and note them in the EMR, which means the EMR system created more steps than it eliminated. Some incoming documents, like lab reports, eventually will be electronic and compatible with the EMR system when it's used universally. However, clinic staff will still need a method for capturing faxes, paper documents and various electronic formats received from other providers—and for making those documents available in the EMR system.

The clinic also needs to evolve its strategy for historical information that pre-dates the EMR system, including how and when to scan the data and how to index it so it can be retrieved efficiently afterwards. Many providers phase out paper files by scanning them as they are pulled for patient care and making them part of the EMR system.

Document management fills in other less obvious EMR shortcomings to increase efficiency. For instance, many EMR systems generate referrals or correspondence, filling in patient demographics and making a note of the communication. However, many EMR systems don't pull information from multiple data sources, archive the referral/correspondence or automate ticklers for follow up, as a document management system can.

With ARRA  reimbursements beginning this year, the pressure is on for vendors and providers to implement EMR solutions. Before you get started, make sure you're satisfied with the vendor's ability to provide templates, interoperability and document capture, because it's going to be a long-term relationship. Choosing carefully will improve patient care and satisfaction, reduce staff frustration and reduce your overhead costs.

Check out our Specialty-Specific EMR section for more information or to find companies that provide these solutions