With so many electronic health record (EHR) systems on the market, it can be difficult to decide which one to choose. You may want to ask your peers for recommendations, visit practices that are using a system you’re contemplating and consider advice in trade journals.
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Jeffrey G. Lawson, MD, physician, Piedmont Arthritis Clinic, Greenville, S.C., recommends using a vendor that has operated for more than 10 years. “In the early days of EHRs, not all of them had comprehensive medical records. Some didn’t offer billing capabilities,” he says.
Alan K. Matsumoto, MD, FACR, FACP, partner, Arthritis and Rheumatism Associates, Wheaton, Md., says the practice already used and liked the practice management portion of one vendor’s system, so that weighed heavily in choosing its EHR system as well. “We thought this would be a seamless way to integrate them,” he says.
The IT person at Dr. Lawson’s practice researched EHR systems on a healthcare IT consulting firm’s website. The site tells you what EHRs are available for your medical specialty, ranks their user friendliness and tells you how many practices use it.
When considering an EHR system, Dr. Lawson advises attending a potential vendor’s annual meeting to ascertain an EHR’s effectiveness. “Talk to customers using the EHR system and ask if they like it,” he advises. “Find out what its capabilities are. Ask if they get a rapid response from the company when they have problems.”
What to Look For
When choosing an EHR system, make sure it has the ability to capture and report Physician Quality Reporting System (PQRS) measures. Seek out a vendor that will offer support across the continuum—from initial training, to when you go live and when you have problems down the road. “Find out if it offers staff training and whether the training is onsite or online, and how much help the vendor will provide in getting your system to go live,” Dr. Matsumoto says. Ask any potential vendor these basic questions regarding support:
- What happens if your system goes down while you’re seeing patients?
- What is your response time?
- What are your back-up solutions?
- Do you back up in real time?
- Can you see patients if the Internet goes down?
- Is there a way to pull up a paper back-up system?
Dr. Lawson says you should seek out a vendor that offers online educational sessions on how to input data for new users. “Usually someone in-house will train them, but online education is helpful as well,” he says.
An EHR system should be usable on all types of electronic devices. “I use a tablet, another doctor uses a desktop computer, another one prefers an iPad, and another one has a scribe input data,” Dr. Lawson says.
Software should be adaptable, too, to accommodate different physicians’ preferences. One doctor may describe heat, swelling or tenderness for each joint, while another physician may want to write out this information. “The program needs to be adjustable, so each rheumatologist can enter the information [in their own way],” Dr. Lawson says.
Information should be easily accessible, as well. “Evaluate how many clicks it will take to view certain pieces of information,” Dr. Lawson says. “Is it easy to find laboratory test results, and can you move imaging results into the present EHR note results category?” You’ll also want to choose an EHR system that will allow scribes to enter data while the physician interacts with the patient. And it should be Meaningful Use certified.
Additionally, it’s nice to have an EHR system that enables you to evaluate your practice’s progress and generate reports showing how many of your patients have a certain condition or take a particular type of medication.
It’s also good to be able to examine the business side of your practice. “Ideally, an EHR will be able to interact with registries so you can evaluate your practice’s performance compared [with] other practices,” Dr. Lawson says.
Dr. Matsumoto suggests examining how the EHR system records information and what will best fit your clinical style and needs. Consider your answers to these questions:
- Does it use templates, free text or both?
- Does it allow for the use of scribes, outside dictation or Dragon speak?
- Can you customize the notes or templates to capture rheumatology-specific information, such as joint counts, pain scales and functional questionnaires?
- How does it incorporate patient-reported outcome measures or other information provided by the patient before the visit?
- What does the final note look like?
Finally, thoroughly read an EHR system’s warranty and terms of service; make sure it will work for you.
“You get what you pay for, but make sure you get what you pay for,” Dr. Lawson concludes.
Make the Most of Your EHR
The ACR’s Rheumatology Informatics for System Effectiveness (RISE) Registry can help practices optimize whatever system they choose. All ACR members can participate in RISE free of charge. Participants can seamlessly connect data from their EHR system to the registry and compare their performance to their partners, as well as to national and CMS benchmarks.
“This allows users to find out where gaps exist,” says Salahuddin Kazi, MD, chair of the ACR’s Registries and Health Information Technology Committee, which is in charge of RISE. “Sometimes, gaps occur due to improper documentation, not necessarily because a provider is delivering poor quality of care.” When gaps occur, the RISE team will view screenshots of provider notes and templates, and then help them redefine their workflow and documentation so they can meet clinical quality measures.
What’s more, having an EHR that can connect to a registry is a Stage 2 measure of CMS’s Meaningful Use requirement. “All Medicare incentives and penalties are tied to Meaningful Use, so while practitioners want to provide good care and accurate documentation, they also want to make sure that third-party stakeholders and payers are appropriately satisfied,” says Dr. Kazi, who is professor of internal medicine, Division of Rheumatic Diseases and vice chair of education, University of Texas Southwestern Medical Center, Dallas.
Another focus of the committee has been to develop quality measures that are relevant to rheumatologists and provide them with the capability of reporting these measures without creating extra work. The committee can also advise rheumatologists on best practices.
RISE launched in the summer of 2014 and, as of August 2016, has more than 600 users and data on more than 3 million patient encounters involving 653,000 patients. Currently, 663 providers are participating at various stages in the registry. “That’s at least 13% of the ACR’s clinical membership,” Dr. Kazi says. “RISE can connect to more than 80 different EHR vendors, which represents the majority of vendors in the marketplace.”
Karen Appold is a medical writer in Pennsylvania.