I’m looking for the right EMR, but where do I start?

By Jonathan Nelson

Enter the patient. He checks in with the receptionist, who opens an encounter using the computer terminal at her desk. Nurses in the back notice the arrival on their terminals but no one needs to pull a chart. The computer software works the new patient into the schedule and assigns an examining room. Once there, the nurse takes the patient’s vital signs and enters them on a terminal, laptop or sub-laptop. She talks with the patient about his ailment and enters that into the record.

Meanwhile, the physician can access the record from another terminal, if necessary, and view in real-time the changes made by the nurse. When the doctor enters the exam room, she searches the patient’s record and makes additions right at the point of care.

  

This patient needs a pharmaceutical, but there are a few the doctor could pick. At the push of a button, the computer searches the patient’s health plan formulary and offers a covered drug to the physician. She generates a digital prescription that is forwarded online to the patient’s pharmacy of choice.

At the end of the encounter, a bill is generated and transmitted to the patient’s health plan and the patient goes off to the pharmacy to pick up his prepared prescription. There is no paper—no lost charts, no handwriting to read, no confusion over the prescribed medication or the instructions for its use and no question that a performed task will be billed.

Could it really be that easy? Not for most physicians, at least not yet. But this is the promise of electronic medical records (EMRs), and perhaps a scenario like this is not as far off as it seems.

For some time now, pharmacists have been processing prescriptions and negotiating payment online, but physicians have been slow to follow. However, new regulations affecting physicians and the flow of protected health information may bring about a change. Doctors are keeping a wary eye on the implementation process of the Health Insurance Portability and Accountability Act of 1996, and the health care community will have to comply with the first wave of these regulations by next October.

Actually, these first regulations, which establish national standards for electronic health transactions and code sets, should make it easier for physicians and other health care professionals to join the digital age. Uniform claim formats will be accepted by all health plans, eliminating the hassle of maintaining several different forms. Privacy and security standards to come are likely to be much more onerous, but a good EMR may go a long way in helping physicians comply.

For example, to comply with the minimum necessary rule in the privacy regulations, the physician in the example above must limit access to the medical record so that the receptionist will see only the part she needs to perform her task. Obviously this isn’t possible with a paper record unless the physician denies access to the entire record, but a good EMR can discriminate between users and allow access to only the necessary portion of the record. While technology alone will not solve the problem of HIPAA compliance, it can play an important role in the solution.

Shopping for an EMR can be a daunting task. Programs range from the simplest of systems costing only a few hundred dollars to the “Cadillacs” costing tens of thousands. At TAFP’s recent Annual Session and Scientific Assembly, 14 different software vendors manned booths in the exhibit hall, each proclaiming their system as the obvious choice. Some featured voice recognition components while others used touch screen technology similar to that used in the restaurant industry. Many worked with personal digital assistants (PDAs), which have become almost as ubiquitous as cell phones and pagers among physicians.

All of these choices compound the  trouble physicians experience when making this decision. Choosing a personal computer is easy—would you like a Windows-based system or a Macintosh? In the EMR market, there are no clear industry leaders, and the technology is changing so rapidly that research articles are almost out of date when they leave the press.

For this reason, AAFP has dedicated a section of its Web site to providing up-to-date information on all aspects of health care delivery technology. FP Net, at www.aafp.org/fpnet/, is loaded with articles, comparisons and helpful links. Find out what questions you should ask and what features you should look for when shopping for an EMR and gain access to a comprehensive list of vendors and their contact information in a section called “Electronic Medical Records.” Read about the advantages and disadvantages of the Palm Operating System and the Pocket PC in a section called “PDAs and Wireless.” Learn ways other physicians have begun to use these tools in the exam room to provide efficient, meaningful care.  

Click on the “Hardware” link and get a complete guide on how to select a computer system for a general practice clinic. The “Internet and E-mail” link leads to a thoughtful discussion about the risks and concerns of using these powerful tools in the practice of medicine and how you can avoid these risks. There’s even an e-mail discussion list that allows you to cull the knowledge shared by your colleagues across the country.

There is no question that computers, EMRs and electronic communication will replace file cabinets and paper in medical clinics. The only question is when will it happen. Each physician will have to answer that question for his or herself. FP Net is a great place to start getting the information you’ll need to make it happen.

FP Net: www.aafp.org/fpnet/