Article Date: 5/1/2002

Electronic Medical Records and You
Before selecting a paperless system, consider the options and features that best fit your practice.
BY KAREN RODEMICH, Senior Associate Editor

The subject of electronic medical records (EMRs) has captured its share of headlines recently, yet the concept of a paperless practice is 20 years old. Ed Crowell, founder and president of Medformix Ophthalmic, says that his company developed the first paperless office in 1982.

At the time, EMR systems didn't gain widespread acceptance among optometrists. But that's all changing. EMR vendors abound these days, each with a unique package of offerings that range from draw programs to instrument interfaces to the tracking of coding. This article will cover some EMR basics as well as provide a buyer's guide for those of you who are serious about adopting this technology.

The key is efficiency

According to experts, efficiency is the greatest benefit of an EMR system. EMRs "should allow you to enter data as quickly as you can write on a paper chart. You should notice time savings when you generate referral letters, when you supply records to an auditor, when you don't have to search for a lost paper chart and when you connect from home or from a satellite office to view a patient's chart," write Susan and David Jones in their book, How to Implement the Right Computer Solution for Your Ophthalmic Practice.

Chicken scratch be gone!

One of the greatest efficiencies comes from eliminating handwriting. A 1999 IBM study found that ". . . Poor handwriting is said to contribute to 25% of all prescription-related medical mistakes. Simply computerizing the order-writing process (making the orders more legible) reduced medication errors by 55% at one hospital . . ." EMRs provide a consistent, legible and searchable database. Records are easier to organize and alphabetize. You can also append digital exam data (digital photographs, results from visual fields, etc.) to the EMRs.

Rita Benavides, office manager at Eufaula Eye Associates, says that the greatest benefit of EMRs is the "peace of mind" that comes from a system that records each encounter with each of the practice's patients.

Paper vs. paperless

While it is easy to jot down notes on paper, paper records are easy to misplace or misfile, and the recovery process may be long and arduous. EMRs eliminate any paper chase.

Paper also comes with a lower initial cost and with paper, you can access or input data in a random fashion. If your practice cares for a limited number of patients, paper records may suffice.

The merit of EMRs is that you can quickly search through thousands of records. For example, Benavides says that EMRs save time when locating a patient's history or the type(s) of medication(s) he uses.

With an EMR system, you can input data using a number of methods (keyboard, mouse, stylus, etc.). Some software programs have word recognition, so when you type the first three letters of a patient's last name, for example, that patient's file will pop up into view.

EMRs facilitate an effective management process because you can run a wealth of reports against the patient database. They're also great if you want a profile of your practice, the relative return/recall rate, the type of patients to send a direct marketing campaign to, or if you want to pull up a list of patients who have a particular condition.

EMRs may require less physical space than paper records, but with EMRs, you have to monitor office conditions, such as humidity and temperature, because computers are sensitive to changes in the environment.


A Sampling of EMR Vendors
As this table illustrates, EMR packages can vary widely by features and prices.  As with any information system, costs and features often change.  Optometric Management recommends that you contact the vendor for the latest information.

A correction to the chart above: Charting Plus/MediNotes. The company doesn't charge per workstation -- it charges per user license. The initial optometric license is $2,295 and each additional optometrist license is $995.

What to watch for

"The number-one pitfall (with EMRs) is accidental loss because of user error, natural disasters or criminal action," says Richard Hom, O.D., F.A.A.O. He recommends a good backup and recovery strategy to ensure that you can recover the EMR system without losing data. Other pitfalls of EMRs include incompatibility with other office systems and access by unauthorized users. Some EMRs may not have a suitable security system that authenticates authorship of the EMR. However, the Department of Health and Human Services (HHS) and the Health Insurance Portability and Accountability Act (HIPAA) mandate that EMRs have a methodology in place to do just this.

Weighing the pros and cons

When considering EMRs or paper records, experts recommend adopting a system that best fits your practice. Here are some issues to consider:

Coding. With EMR systems, you can have the software check your coding for accuracy. With paper records, you or a staff member may want to double-check your coding. Of course, this is a time-consuming effort.

Storing files. While EMR records don't take up much space, the associated hardware may -- think of the computers on your desktops, servers in the closet and network cabling throughout the office. But on the other hand, storing data electronically is inexpensive and compact -- a single CD stores about 600 megabytes, or 100,000 pages of text.

Paper records also require storage space -- and if your patient load is high enough, or if you have a lot of patient turnover -- this may translate into having to rent storage space.

Going on looks. "Paper records are relatively easy to design to accommodate your individual preferences; EMR packages are less flexible and may therefore require you to change designs to accommodate the structure of the EMR package," says Dr. Hom.

Lost data retrieval. What happens if your receptionist spills her coffee on your next patient's file? Do you have a backup file you could refer to, or would you resort to trying to decipher your notes through the coffee stain?

With EMRs, once an effective plan is in place, backup CDs are relatively indestructible. Also, if anything does happen to the CD, the original file resides on your computer system.

What about costs and value?

Price is a major concern in making the decision between paper and electronic records. Here are some cost issues to consider:

Acquisition. Dr. Hom explains, "The acquisition cost for EMRs is the most significant barrier to adoption. It's a system that, combined with the software license, may feel like quite a hit to your wallet."

However, you can find some software vendors who will tie in the purchase of the license with parallel purchases of companion products. "In other cases," adds Dr. Hom, "EMR vendors that focus on large practices may require complex setup and installation, which can add to the acquisition cost."

Training. Dr. Hom tags training as the biggest cost. Most of the vendors we interviewed provided price ranges for training. Some include initial training in the cost of buying the software, others charge for initial training. You could be looking at anywhere from $85 per hour to $750 to $1,400 per day to have a vendor train you and your staff onsite or offsite.

Practice management. If you don't already use practice management software, you may also want to find out if an EMR vendor also offers both types of software. Keep it all with one company and you may minimize your headaches when it comes to training, support, systems compatibility, etc. Also, you might receive a discount by purchasing both EMR and practice management software together.

While costs are important, you must also consider value. An EMR system replaces many of the manual tasks performed by your practice. However, if you cannot place a price tag on the costs and labor associated with these manual tasks, then it becomes difficult to quantify the savings, in both time and money, of an EMR investment.

With a clear understanding of your practice's unique costs, you can then judge the costs and benefits of EMR systems. "You might find a system for the price you want, but if it doesn't offer the features you really need, it isn't worth it," say authors Susan and David Jones.

Look before you leap

Here are a few other things you may want to consider in your search for the right EMR software:

You may want to consider issues unique to your practice. Research the topic on the Internet, talk to colleagues who've already implemented EMR systems and, of course, take a look at what vendors have to offer. Your research can produce substantial benefits for your practice.


Optometric Management, Issue: May 2002