Buyers searching for electronic medical records (EMRs) have hundreds of options to choose from. We've created this buyer's guide to help you understand your options and evaluate which software is the right fit for your practice.
Here's what this guide will cover:
Electronic medical records (EMRs) automate the clinical operations of healthcare providers. They provide digital storage of patient charts, and include functionality to track patient demographics, histories, SOAP notes, medications, test results and more.
Electronic medical records are also referred to as electronic health records (EHRs), digital medical records or computerized medical records. By generally accepted definition, an EMR is an electronic record of patients’ medical histories, created and stored at a single location. Meanwhile, an EHR is the comprehensive collection of patient medical records created and stored at multiple locations.
While there is a technical distinction between the two, buyers and vendors use the terms interchangeably. Review our article "EHR vs. EMR—What's the Difference?" for an in-depth look at the differences.
The following are the minimum benefits that should be realized with a successful implementation:
Improved efficiency. Physician practices should find themselves with more time to focus on patient care as they eliminate paperwork, speed up medical charting, receive lab test results electronically and prescribe electronically.
More time for more patients. As physicians and support staff spend less time tracking paperwork, they should be able to see more patients. EMRs should also allow physicians to complete and document patient encounters more quickly, further increasing their ability to see more patients.
Increased collections. Electronic patient records provide physicians with the necessary documentation to support claims sent to insurance companies, Medicare and Medicaid. Integrated features for E&M coding also help providers code visits appropriately and confidently. Of course, seeing more patients should naturally increase collections as well. This is one of the top benefits of electronic health records.
Improved quality of care. Features such as integrated drug databases, symptom checks and drug interaction verification help physicians prescribe the correct medications and dosages. EMRs can also provide prompts to physicians based on inputs of patient chief complaints and/or risky demographic factors. This is another one of the many advantages of electronic health records systems.
Software Advice is currently collecting feedback from EHR users about the top benefits and challenges of their systems. We're conducting an online survey, which displays aggregated results in real-time. You can view the results, and users can participate in the survey, by clicking here.
There are several hundred electronic medical record/electronic health record systems that collectively address the needs of just about every medical specialty and clinic size. For example, EMR vendors have customized systems for outpatient care, inpatient care, solo practices, enterprise groups, primary care, therapy, mental health, ophthalmology, nephrology, chiropractic and so on.
With so many medical EMR companies catering to so many specialties, physicians face a big challenge as they determine which medical software is right for their needs. However, we find the majority of practices we speak with fall under one of these common categories:
Primary care MDs/DOs and related specialists. These buyers work at private practices that provide internal medicine, family medicine, pediatrics, Ob/Gyn, cardiology, oncology, orthopedics, urology etc. These buyers’ various needs are addressed by broad systems with specialty-specific templates.
Specialists with other designations (DC, OD, PT, PhD, LCSW etc.). These buyers include chiropractors, psychologists, therapists, counselors and optometrists. They typically have straightforward needs that are met by affordable, specialty-specific systems.
Small practices. These buyers work at practices with one or two providers. They are usually moving away from paper charts and want to prescribe electronically and integrate with labs.
Mid-sized to large practices. With anywhere from a handful to 100+ physicians, these buyers are often looking to eliminate paperwork and improve efficiency. They may also want to integrate with other healthcare networks’ systems, track information across several locations and provide consistency of care across providers.
Inpatient care organizations. These buyers work for hospitals and acute care centers that need to manage patient rooms/beds, assigned nurses and physician rounds. They usually require robust EMR systems for hospitals that can integrate with a variety of other applications.
The expected benefits of any electronic health record system are to improve patient care, lower administrative costs and improve billings and collections. The primary measures of effectiveness are:
EMR system costs will vary widely and depend primarily on the size of the practice and the deployment model preferred (on-premise vs. Web-based). On-premise systems typically require costs for licenses, servers, implementation, training and ongoing technical support. Support costs are typically 15-20 percent of the upfront licensing cost per year. Implementation and training costs vary widely, but are often as high as the licensing costs.
Web-based systems typically have lower upfront costs that cover training and implementation. Ongoing fees paid on a monthly basis cover licensing, technical support and upgrades.
Today, increased competition among vendors has applied downward pricing pressure on the market. Furthermore, technology developments such as Software as a Service (SaaS) have led to alternative, budget-friendly pricing models. There are even free EMR software systems that are supported by alternative revenue streams like advertising. And finally, government stimulus programs such as the American Recovery and Reinvestment Act (ARRA) make EMR investments even more feasible for small and large practices.
ONC-ATCB certification. In 2009, President Obama signed ARRA into law. A major component of this bill is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes $19 billion to incentivize medical offices to adopt electronic healthcare records. Providers that make “meaningful use” of “certified” electronic health record systems are eligible to receive up to $44,000 or $63,750 in reimbursements in the form of increased Medicare or Medicaid premiums. Physicians have a mandate to become meaningful users by 2015. Those that fail to qualify will face decreased Medicare and Medicaid payments.
The Office of the National Coordinator (ONC) for Health Information Technology, part of the Department of Health and Human Services (HHS), is responsible for heading up this initiative. They have selected organizations to certify electronic health records from medical vendors. These organizations have been titled “ONC-Authorized Testing and Certification Bodies,” or ONC-ATCBs. To see a list of certified products, visit our ONC-ATCB EHR buyer’s guide. We also have a list of CCHIT-certified EMRs. (Until January 2014, CCHIT was perhaps the foremost ONC-ATCB. They are no longer certifying new products, but previous certifications are still valid.)
In 2013, Software Advice analyzed data from tens of thousands of interactions with EHR software buyers to gauge the impact of the HITECH Act on EHR purchases. We published a three-year comparison on the motivations for software purchases. Click here to read the full report.
Mobile device support. Mobile devices are proliferating quickly and health care providers are eagerly adopting them. As physicians aim to accomplish more from outside the office and improve mobility within the office, iPhones, iPads and Android devices are becoming increasingly prevalent in the workplace. Some of the top EMR vendors are catching on to this increased demand and we expect to see more iOS and Android-compatible systems coming to market. Several vendors already offer iPad EMRs. For example, MediTouch is a leading electronic medical record company in mobile healthcare IT.
Software as a Service (SaaS). We find roughly 25 percent of medical practices are interested only in Web-based systems, while another 50 percent of are open to the model during early stages of their research. As cloud computing catches on in other industries, it is emerging quickly in health care as well. Developments in HIPAA compliance, data security and encryption, server reliability, and data backup make Web-based EMRs viable alternatives in medicine. Furthermore, many healthcare providers are avoiding large upfront costs required for client-server systems and preferring monthly payments for hosted systems.
Because these systems are accessible on any device with a Web browser, many Web-based solutions are also optimized for use on the smaller screens of mobile devices, incoroprating design elements such as larger buttons for ease of use. For more on design considerations, visit our guide on EHR interfaces.
EHR vendor market share is notoriously difficult to pin down. However, the Centers for Medicare & Medicaid Services (CMS) regularly publishes data from meaningful use (MU) attestations under the EHR Incentive Programs. Using MU attestations as a proxy for market share has limitations, but allows us to provide a valuable assessment of the current state of the market.
Software Advice analyzed hundreds of thousands of attestations to determine which vendors’ systems are most used by providers attesting to meaningful use. Epic, Allscripts, eClinicalWorks and NextGen Healthcare lead the ambulatory care market, but the market remains highly fragmented, with nearly 40 percent of providers using a system that doesn’t rank in the top 10 in terms of market share. Read the full report: EHR Meaningful Use Market Share IndustryView | March 2014.
Security. The most common concern we hear regards data security. Patient privacy and HIPAA compliance are typically on the front of providers’ minds, so buyers will want to make sure that the EMR is implemented properly and that standard security measures are in place. Vendors are well aware of this concern and have proper data encryption technology for both on-premise and Web-based systems.
User adoption. A second consideration is user adoption, primarily among providers. Some providers find EMRs difficult to use, often because they are accustomed to working with paper charts. Most user adoption issues can be solved with adequate training. The amount necessary typically depends on the user’s level of tech savviness.
Integrated software suites vs. best-of-breed solutions. The decision most doctors will need to face is whether to implement a standalone electronic medical records system or an integrated suite with billing and scheduling applications. Buyers who implement standalone computerized medical records often do so if: they have unique needs their vendor cannot address; outsource billing with no plans to bring billing back in house; or, they have made a large upfront investment in a billing and scheduling system they do not wish to replace.
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