Include the EMR in Your Evaluation of a Practice

By Craig Wilkerson, MD

One of the most difficult challenges for a young ophthalmologist is to choose the right practice or partner with whom to start a career. Pearls In Ophthalmology has provided valuable insight into how to evaluate the potential partners, staff and practices. Much has also been written on how to incorporate an evaluation of practice styles and financials into making this decision. Increasingly, however, the presence and type of electronic medical record is becoming a consideration in deciding on a practice.

Electronic medical records (EMR) and practice management (PM) systems are becoming more common in medicine. Between 2001 and 2006 the use of EMR's rose by sixty percent to include nearly thirty percent of physician practices. CMS essentially is mandating the use of these systems by 2014. It is unlikely that the young ophthalmologist will be able to avoid using one of these systems during their career.

This article is not about choosing an EMR or PM system. I spent a great deal of time and effort research and using systems until I found one that had the ease of use, value and vendor support and longevity that I needed. As a solo practitioner, this decision was entirely mine. This article is for those who are joining a practice that has or is in the process of implementing an EMR or PM.

It’s probably safe to say most practices will give more consideration, time, and money to finding the right EMR than they will to finding the right partner. Most of the providers and staff will spend more time working with the EMR than they will with each other. It’s also likely that any one of them or you will leave the practice before the EMR does.

Given the amount of time you will spend working with the EMR and likelihood it’s there to stay, it becomes important to include it in your evaluation of the practice. Here are some brief observations that come from our implementation of an EMR and some tips on evaluating EMR’s in practices you may be considering.

-Is the EMR a sail or an anchor? Most EMR systems are not neutral. Either they help the practice or they hinder it. Determine if the providers and the staff feel as if it has helped them to improve efficiency and accuracy.

-Find out how long the system has been in place. Just because a practice is on the steep part of the learning curve doesn’t mean that the EMR won’t ultimately be a gem for the practice.

-Is the effect on the practice universal? Does everyone love it or are the technicians (or schedulers or receptionists) looking for new jobs because of it?

-Is it paying for itself or taking an increasingly bigger bite out of the profits? Most EMR’s will have maintenance fees, provider fees and hardware costs. Most also require IT support on an ongoing basis.

-How will it affect your interaction with the patient? Are you required to turn away and type or does it allow you to maintain your style of patient interaction?

-Can you take it with you? Most young ophthalmologists do not stay with their initial practice. If someone leaves what happens to the records? Most of the EMR databases are designed to work with their proprietary user interface. Unless you have the same system in your next practice, the data may have limited value to you.

-Is it integrated with other systems? What happens when you need to view lab results, radiology scans, visual fields, OCT’s, etc? It’s inefficient if you have to leave your workstation and travel to another part of the clinic to view this data or wait for a fax to arrive with lab results.

-What happens when it inevitably goes down? Does the clinic stop functioning or is there a backup procedure for continuing to see patients?

These are some of the more practical issues that we had to resolve as we implemented our system. I would advise that you ask the receptionists, technicians and providers if they would buy the same system again. Ask what the ideal or dream system would have that their system doesn’t. Find out what frustrates them about the system. Beware if there are no frustrations. Remember, it’s a computer system, so something will frustrate them. Finally, I would want to know how the patients like it. Do they feel it interferes with or enhances their care?

Our system has been in place for nearly three years. It is far from perfect, but has become a powerful tool in the practice. It has turned out to be a good match for us. Just as you will need to do when evaluating partners or practices, you will need to find the right match in an EMR.