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ous choices during hardware failures, communication or power interruptions. ICs help EPs document their specifi c work-fl ow-related issues and how the EHR fi ts into overall offi ce work fl ow, which transcends EHR work flow. ICs help EPs understand EHRs with user- accessible, work-fl ow engine versus EHRs that impose static work fl ow. ICs show


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EPs how to access work-fl ow fi t during EHR product demos and how to conduct site visits to determine prod- uct satisfaction, ease of use, vendor support quality and training required. ICs help EPs decide if using an EHR with an integrated practice-management system (PMS) is a viable fi rst step for their practice versus keeping their current PMS.


This preliminary groundwork is usually completed before candidate EHR products are evaluated, since it bears on EHR functionality needed. That may not be the case with most RECs, particularly if they are in need of that second ONC payment, which requires a deployed and functioning EHR. For EP do-it-yourselfers, follow processes outlined in books such as “Successfully Choosing Your EMR: 15 Crucial Decisions,” by MSP (Wiley Press); or “Elec- tronic Health Records,” by Margret Amatayakul. A little time and $120 is far less expensive than using an IC, or REC-referred consultant. Such differences in planning approaches have real implications on EP satisfaction with their deployed EHR.


Of the more than 600 EHR products actually avail- able, RECs may have started with 160 or so with Certification Commission for Health Information Technology (CCHIT) certifi cation and have received request-for-qualifi cation (RFQ) responses from only a subset of these. They then typically select three to 10 EHRs to offer to EPs. Many ICs can recommend two or three times that number. EPs can use the Web-based MSP EHR Selector to do their EHR product research and comparisons, just as many ICs do. Some RECs now also offer the same tool to their EPs, others don’t. Check with your particular REC.


What are RECs looking for? According to Monica Arrowsmith of I-HITEC, in Indiana, EHRs were prequalifi ed that included inte- grated practice-management-system (PMS) solutions, but many EPs won’t need (or be able to afford) these. Web-based, software-as-a-service EHRs are preferred, perhaps because this REC believes in-offi ce solutions are too diffi cult for smaller EPs to manage. The Louisiana REC, however, didn’t rule out in-offi ce EHR solutions (according to a recorded July 2 RFQ clarifi cation call). So these two RECs have inconsistent approaches based


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on their opinions of what every EP will need in an EHR. Here are other choices the Indiana REC made for its EPs: integrated EHR+PMS solutions; signifi cant installed base in Indiana; minimum training required; each EHR cov- ers all primary care specialties (not just a single one like pediatrics); and meets current CCHIT certifi cation. While generally good choices, they nonetheless elimi- nate many viable EHR products that would be good fi ts for individual EPs. Some larger EPs can manage in-offi ce EHRs, and with an in-offi ce approach, the EP controls whether to upgrade to the newest EHR-software version. With an Internet-based EHR, the EP has no choice but to accept the newest version, in most cases. If a practice can’t replace its current PMS now, why should it only consider more expensive EHRs with integrated PMS? If a practice wants its EHR to interface with its current PMS, but none of the REC-approved EHRs do, what then? How are length of training and ease of use related? Do any prequalifi ed EHRs include user-accessible work-


About the authors and Medical Strategic Planning


Formerly manager of market research for Siemens Corporation’s electro-medical division, Arthur Gasch has spoken extensively on EMRs. He was contributing editor for Biomedical Business & Technology newsletter from 1992 to 1996 and is publisher of Industry Alert, a publication on emerging technologies to the U.S. hospital market. Gasch is co-author of “Successfully Choosing Your EMR: 15 Crucial Decisions” and in 1992 founded Medical Strategic Planning (MSP), a New Jersey-based medical market research fi rm offering the MSP EHR Selector as the only interactive, Web-based, critically vetted EMR product comparison tool that includes MU, HIPAA and PQRI criteria and the latest KLAS Research EMR product-satisfaction scores. Learn more about MSP at www.medsp.com. Art can be reached at art.gasch@medsp.com. Bill Andrew was the fi rst HIMSS Lifetime Member, executive VP of the MSP EHR business unit, founder of Andrew & Associates, and creator of the EMR Survey, which became the MSP/Andrew EMR Benchmark, the most comprehensive EMR product compendium of the North American EMR market. Andrew established Andrew & Associates to provide EMR consulting services to the industry, prior to joining MSP. The EMR Survey was established by Andrew in collaboration with Dr. Richard Dick, Ph.D., and Dr. Robert Bruegel, Ph.D. Andrew also established the fi rst industry-wide survey on EMR work-fl ow management systems, data that has now been incorporated into the MSP/Andrew EMR Benchmark. Bill can be reached at bill.andrew@ medsp.com.


HEALTH MANAGEMENT TECHNOLOGY August 2010 15


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