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EHR products. The entire process is hidden, in spite of the published RFQs. Can EPs trust that their REC has made the best choices for them? It’s a very large expen- diture for 100,000 EPs at $44K to $64K per EP, if they all adopt and achieve MU status.

The right EHR for you EPs can procure and deploy EHRs from a non- prequalifi ed EHR developer, but doing so puts them on their own. Some EPs will be reluctant to do that, and want to just be told which EHR to buy. If you are among these EPs, the REC approach is probably best. If you want to be more involved because you have to live with the results, use an alternative method to evaluate viable alternative EHR solutions. The more involvement EPs have in their own EHR planning, the more likely they are to be committed to making the EHR work. No IC or REC can make the right EHR decisions for an EP. There is offi ce work-fl ow variation across 1,000 to 2,000 different EPs. EPs must ask, “Can my total offi ce work fl ow be easily accommodated by the EMR I am considering?” Without a RFQ requirements crosswalk, no one can determine what coverage of work-fl ow issues was included across the universe of REC RFQs. RECs differ in approach; some are empowering their

EPs to decide what EHR best meets their needs and won’t negatively impact work fl ow after deployment. Kudos to those RECs; they take seriously the ONC mandate: “… to offer technical assistance, guidance and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of electronic health records (EHRs).” The REC program is also intended to “establish a national health information technology research center, funded separately, to gather relevant information on effective practices and help the regional centers collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use and provider support.” EPs need to educate themselves in order to do this, and some EPs feel that takes too much time and effort. The national implications of EHRs with poor work

fl ow are profound. If an EP using paper documentation is currently seeing 30-35 patients a day in three to four exam rooms, and that drops to 25-30 per day using an EHR, what will the national loss of productivity mean to patient care delivery in this country when multiplied by up to 100,000 EPs? If EPs can’t see their current patients as quickly after adopting an EHR, how will they fi nd the capacity to see any of the 33 million newly insured patients under healthcare reform legislation? The implication of improving versus crippling EP productivity is therefore very important when scaled to the national level. Every EHR has some impact on productivity. The time to evaluate work fl ow impact on

productivity is before the EHR is chosen, not after its deployed. It will be a couple years before we know what effect the REC process has collectively had on EHRs.

EP education

EHR adoption is paradigm change – from an un- structured, page-oriented, paper approach, to a highly granular, observation-structured, database-driven ap- proach. Pages are replaced by computer screens, which also replace reports. Organization of information fl ow is critical, and different users have different presenta- tion needs. Charting in more detail is forced. Data fi eld choices are therefore directly related to speed of entry and ease of use. It’s a big change. And EPs need to ponder it and not be rushed by anyone. EPs should be wary of accelerated adoption pro- cesses, or REC/EHR vendor relationships that seem a bit too cozy. Whether EPs choose their own EHR or go through a REC or an IC, they need to keep their eyes open wide and ask a lot of questions. Failure will be expensive. EPs only win if they choose an EHR that is cost effective, inexpensive to maintain and at least work-fl ow neutral.


The Electronic Medical Record (EMR) is the essential underpinning of any signifi cant health- care reform. This book clarifi es the crucial deci- sions that result in successful EMR adoption and avoidance of expensive EMR mistakes. It provides timely insight in leveraging ARRA/ HiTech, meaningful use, Stark Safe Harbor, CPOE and PQRI incentives and understand- ing current HITSP, HL7, ASTM, ELINCS and other interoperability standards.


YOUR EMR: 15 Crucial Decisions



This book provides practical guidance on: evaluating EMR ease-of-use, determining in-offi ce vs. Web-based vs. blended EMR deployment; deciding which user-interface approach to adopt; understanding structured vs. unstructured charting approaches; assess- ing EMR developer stability; and obtaining legal advice about RFIs, RFPs and contract negotiations.

The 13th MSP/Andrew EMR Benchmark™ product feature summary will be showcased in Health Management Technology magazine. More results will appear in the V12N2 issue of MSP’s Industry Alert™ newsletter. Data abstracts will also be provided to all state re- gional extension centers (RECs) and 46 medi- cal specialty organizations.

The 2010 HMT reader survey indicates al- most half of respondents are involved in the purchasing process of an electronic records system. Since purchasing or upgrading EMRs/ EHRs is on the horizon for so many, we’ll continue our coverage with exclusive supple- ments in HMT looking at the 2010 MSP/ Andrew EMR Benchmark and EMR Construc- tor, which helps practices navigate the EMR adoption process.


August 2010 17

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