About the Author

Sheldon Needle is President of CTSGUIDES.COM, a free web site offering reviews, ratings, tools, and expert advice to help companies select software. Sheldon is a former CFO, consultant and software designer who has published more than 20 guides on software selection.

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By Sheldon Needle

You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?

Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:

1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?

Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?

Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!

2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support

3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.

4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.

The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.

Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.

Many EMR experts — both on the user side and the training side – agree that comprehensive training in the specifics of EMR software — or the absence of it, can be one of the most costly aspects of the transition from a paper based medical practice to an EMR /EHR.

Making the move to an EMR, and failing to train your staff adequately, can sour your entire staff, top to bottom, on the use of the EMR. You certainly need to avoid such a situation.

Here are some considerations and precautions to keep in mind and to discuss with your EMR vendor when evaluation the purchase or leasing of an EMR / EHR: Some of them will surprise you:

1. Your youngest and least academically sophisticated employees will probably have the least trouble learning to use your EMR. That is because they are computer savvy, and are used to texting, apps, and intuitive computer use. Your most sophisticated applications may be used by your least computer-savvy users: older doctors and nurses. Do not assume that they will know what to do without training. Do not allow your vendor to talk away the need to train your most senior employees.
2. Make sure your implementation schedule is reasonable. Do not allow your vendor to move the implementation along too quickly. Allow people time to practice functions before you go live, and don’t forge ahead with the next module’s implementation until most employees achieve a comfort level with the first.
3. Stagger your training schedule to match your implementation schedule. Training in the use of an EMR system is something that cannot be boxed off into a space of time. If you are staggering your implementation into stages (that is, implementing different modules at different times) makes sure that your training schedule is staggered to accommodate the different implementation phases.
4. Training is never one-size-fits-all for a medical practice. There is no point in offering all of your employees the same nature and level of training. Carving up the training pie carefully is critical. Careful implementation planning will, in the end, save you money.
5. If some of your staff needs training in basic computer skills, have someone less expensive than your vendor offer such training. Get a skilled college student to teach a class, or find an adult education class for your computer illiterate employees. Save the expensive training for more sophisticated applications.
6. Never rely on memory to keep track of training lessons. Request formally prepared training material to be distributed to your staff. Record the training sessions – audio and visual — for later use. If there is no prepared training material available, appoint a staff member to gather notes, handouts, etc. in a binder that can be used for reference.

Watch as Software as a Service (SAAS) for EMR / EHR becomes Cloud Computing: And Cloud Computing becomes a Valid EMR Choice

By Sheldon Needle

A few years ago, the idea of SAAS computing services for the medical EMR / EHR industry was still on the vanguard, a little risky: a kind of out-there medical solution for medical groups who wanted a cheap, automated solution.

Today, many large Practice Management Vendors are offering cloud-based Practice management software alongside their client hosted EMR – and sometimes instead of client hosted EMR.

After all, if we do so much of our IT work on notebooks that don’t have much in the way of a hard drive, and are writing our personal papers on Google Docs that are out there in the ether world, why would we not consider similar solutions for our practice management software? Even client hosted software has its own mini-version of cloud computing when it offers physicians tablet-based drug prescription software (tied in to their own remote server) or patient portals that can be logged into remotely.

The difference between cloud-based EMR and client hosted EMR is really this: Who is doing the system maintenance? In the case of client hosted EMR, it is your own employees; in the case of cloud-based EMR, it is a contracted IT team. The question becomes one of reliability, and that is a hard question to answer.

If you are large enough to hire your own full time IT people to be available 24/7, well and good. It might make dollars and (good) sense to have your own client hosted server; if you are a smaller practice, or a large practice that doesn’t want to get involved in IT management, cloud computer based EMR / EHR begins to make more and more sense as medical software management application get more sophisticated.

Some of the risks associated with cloud computing for EMR need to be discussed and evaluated. Most are valid, but are equally applicable to client hosted systems as well:

1) Who controls the data?

If your secure data is in a cloud, it means that someone else has access to your data. But companies that offer software as a service are likelier to have more secure encryption and control of the data than you are in house with a personal server, because security is such a large part of their business. In-house ignorance of data control rules, even in data associated with patient billing, or lack of enforcement thereof, is just as likely to be part of the company culture. Benign neglect of rules because you trust your fellow employees makes a system even more vulnerable than leaving security issues to a third-party whose integrity and reputation will be based on careful security maintenance.

2) Poor training and associated data vulnerability:

Poor training in the use of patient-related data is a risk in any EMR environment. Ignorance of security procedures is a more likely culprit in confidentiality breakdowns than is deliberate security violations. Most providers of quality EMR software will provide enhanced training, either as part of their regular contract, or as an enhanced feature option available with your contract for a software package, whether it is SAAS or client hosted. Don’t skimp on training, because it can make the difference between a relatively easy migration to new software and a nightmare situation. IT can also make the difference between security slips due to ignorance and a safe and secure data situation.

3) Catastrophe and backup procedures:

Isn’t it wonderful to have someone else worry about backup procedures? This is something that must be part of any cloud computing contract. If it is not, you are not dealing with a provider who is aboveboard.

If you are managing your own backup and catastrophe procedures, be vigilant: no one wants to dream of the worst-case scenario, but as we have seen in the macrocosm, and in the microcosm, such things happen readily enough. Assign this critical catastrophe management and precaution role as an integral part of your daily workload, and assign it to one person or group; the buck must stop somewhere on security issues.

In summary, we are not preaching the virtues of cloud computing, but we are saying that cloud computing is a very valid and reliable choice for some practices today. Security and flexibility of design are issues in any system. Ultimately, someone is hosting your system, whether your server sits in your back office or half a world away. The real issue is responsibility for your data. Someone has to be in charge. And you had better know who that is.

How do I know whether the EMR and EHR products I am considering are truly certified by the US government as Certified Health IT products? And, if I am not confident of receiving incentive payments for my practice, why should I care whether they are certified? Isn’t it most important to have a system that digitizes my information well and makes it easily retrievable for diagnostics, information, and billing purposes?

As most medical providers understand by now, the purchase of and /or implementation of EMR and EHR software is becoming a necessity. Not everyone is convinced of immediate efficacy of EMR and EHR systems in each of their individual practices, but it is the way the medical industry is headed. So for most of us, this means biting the medical software bullet and choosing an EMR / EHR system sometime very soon making sure that it will work with the specs of your practice or medical group.

Certified EMR and EHR systems, and submitting proof of their meaningful use, can bring financial incentives and payments for medical practices. Conversely, by 2016, lack of implementation, may result in penalties for practices.

How do you know which Software Products are certified Health IT Products, and qualify for incentive payments?

The US Government maintains a Certified Health IT Product list at: http://onc-chpl.force.com/ehrcert/CHPLHome.

According to the site, “The Certified HIT Product List (CHPL) provides the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC). Each Complete EHR and EHR Module listed below has been certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) and reported to ONC. Only the product versions that are included on the CHPL are certified under the ONC Temporary Certification Program.”

It should be noted that different modules of different packages can be certified independently. One should not assume that a brand name of X means that every module of product X is EMR certified. Excellent medical software reviews by companies such as CTS, Inc. online from reputable companies to review different modules of EMR packages.

Using the online listing of the Certified Health IT Product list, which is maintained by HHS should offer an authoritative listing of products. Even if you are not particularly excited by the financial incentives because you do not believe they will bring you great return, or if you feel that because of your patient base you would not qualify for many incentive payments (very few Medicare or Medicaid patients, for instance) there are other reasons you might want to buy a Certified Health IT product:

1. Because companies that want to compete for this large audience of buyers are eager to sell the quality of their product, they are often more aggressive about good training and problem rectification. They are eager not to have complaints lodged against them, or to receive bad reviews for their products.
2. Because EHR certified systems are eager to be able to upload their material to CMS, they are eager to have good reporting capabilities and interactive modules that communicate information with each other and with of EHR systems easily.
3. Because standards and rules for certification are still in flux, certified packages and their various modules need to be responsive to changes in rules and in the law. So if your practice buys into an EMR / EHR that is certified, you are likely buying into a product that will stay current and be reviewed and regularly updated.

Many business reasons drive companies to select new software, including the need for greater efficiency and the desire to gain a competitive advantage. If your company is in the market for new software, it is helpful to understand why other companies chose various solutions, and the positive or negative outcomes of those choices.

This report summarizes the results of a recent CTS Software Selection Survey, and reflects the opinions of 150 survey participants who visited www.CTSGuides.com, and registered for our free distribution, construction or manufacturing Software Selection Kits. Each kit includes software reviews, ratings and selection tools, along with a 10-minute Smart Shortlist™ consult with software expert and CTS President, Sheldon Needle, designed to help identify the best software options for the registrant’s shortlist. Under Needle’s leadership, CTS has been publishing business software evaluation materials since l983.

The results of the CTS Software Selection Survey are surprising at times and reaffirm that, despite the challenges in our economy, many companies are implementing new software. A summary of the survey results follows.

Why Software Buyers Choose a Particular Product

In the CTS Survey, 78% of respondents bought new software in 2010. When asking respondents why they chose a particular product, our survey listed four possibilities: Best Function, Best Price, Brand Recognition and Sales Presentation.

As Exhibit A illustrates, 60% of the respondents cited Best Functionality as a reason for choosing a particular product. (We were extremely happy to discover this because our CTS comparative ratings charts help direct buyers toward the products that have the best functionality for their needs.)

Price was the second most mentioned reason for choosing a solution. However, while 44% of the respondents cited Best Price as one of their software selection factors, only 9% chose a solution based on price alone. These price-driven buyers were generally less happy with their purchase than other software buyers we surveyed. In fact, one-third of the price-alone respondents reported being Very Dissatisfied with their software choice. This finding demonstrates that, while it’s important to consider price when choosing software, buying on price alone is certainly not the best approach.

Our survey indicates that a solid sales presentation was often an important factor in the buyer’s decision: 27% of respondents cited this as a factor in their decision-making process. Interestingly, 19% of respondents claimed that their choice was made based on Sales Presentation alone – and every one of these respondents report that they are generally happy with their decision. The takeaway here is that a well-informed sales presenter carries a lot of weight with buyers. Brand Recognition only played a role in 9% of the software selection decisions.

What’s to Like (and not Like) About New Software

While pre-defined response choices, such as Somewhat Helpful and Very Happy, helped us spot trends and establish percentages, the free-form pick-list comments gave us a deeper understanding of why a company was happy or unhappy with their software purchase.

Comments like “flexibility” and “user friendly” were fairly common among happy buyers. Good support and training, and the ability to customize the software, were other factors that routinely lead to happy buyers. Also on the positive side, integration capabilities and technology platform were mentioned as reasons for choosing a solution and reasons why a company reported being happy with their choice.

Some of the happy software buyers reported struggling with complex implementation or functionality issues. But with strong vendor support, these issues seemed to get resolved over time.
Among the unhappy buyers, “We should have done more research,” was a fairly common response. In addition, poor training and support were contributors to overall dissatisfaction. Also on the minus side, a number of respondents were surprised by the complexity of setup and use of the system they chose, and felt that more testing should have been done before the purchase. Several respondents commented that having an internal champion to manage the evaluation process and software implementation would have improved their company’s outcome.

A Note about the Non-Buyers

Our survey revealed that 22% of the respondents haven’t purchased software. While 15% of these respondents reported that economic reasons put their purchases on hold, 40% indicated that lack of interest or lost momentum among upper management stalled their technology initiative. This confirms that buy-in from top management is vital to the successful execution of a technology initiative.

CTS: A Valuable Software Selection Resource

A cautious and thorough approach to evaluating software products and vendors is the best recipe for a successful software purchase. While it is the software buyer’s responsibility to perform the necessary due diligence to make an intelligent purchase, expert guidance and quality research materials are valuable tools that lessen the chance of choosing a solution that doesn’t fit your organization’s needs and expectations. Utilizing CTS’ free published information and Smart Shortlist consult to narrow your company’s choices is an excellent step toward a positive outcome.

The big news in EMR Software as a Service right now (June 2010) is the Dell/Practice Fusion offering of  “cloud-based” free EMR software from Practice Fusion when you buy it bundled with Dell hardware to support it.  This would allow small practices that would not think of making the large initial investment in a traditional EMR or even a medium-price SAAS EMR to contemplate the great leap from paper-based offices to an EMR.

What’s more, Practice Fusion claims that its EMR  software will be certified by the right organizations and available to all medical practices that want to qualify for 2011 HITECH payments.

This means that if a medical practice is willing to jump in and make the transition to an EMR , the ramp up time will be shorter  and the money investment  much smaller than it would be using more traditional EMR systems.

Practice Fusion has a set of suggested Dell hardware support requirements for a solo practice, smaller practice, and medium small practice.  This is an extremely interesting development for a small practice, and will certainly not come free, but will still be reasonable. And since the software and hardware suppliers will be working in tandem, a practice ordering this package will probably get good guidance on their hardware purchases.

This medical software/hardware bundling will certainly be the first among many such offerings from other suppliers.   It will offer a small practice the opportunity to get its feet wet in the world of EMR with decent hardware and technical support promised from the vendors.

Of course, the cloud-based free software will not be as customized and tailored as “bespoke” EMR built for a proprietary server.  But since cloud based computing is becoming such a popular, if not dominant way to go in the industry, a potential user can be confident that cloud-based software, and its ingenious promoters, will find ways to become more customized as time goes on and as competition for this very large market segment, small to medium sized practices, becomes stiffer.

What about CCHIT certification and “meaningful use?” Must every small practice worry about that?

If your practice is small enough that you would not otherwise consider purchasing or leasing an EMR, or if your only other option is to install open-source software, a bundled offering like this one is probably a good bet and an excellent risk: both the hardware and software manufacturers want this bundled offering to succeed, and they are promising good technical support.

Watch for competing offers from other companies.

We all know the advantages of  the electronic medical record – improving access to critical information, eliminating errors, automating tasks, improved accuracy and legibility of documentation and improving coding for better billing and reporting. The government is offering financial incentives to physicians that implement EMR software soon.

There are over 330 electronic medical record software systems for physicians to choose from today.  To complicate the decision process further, in order for physicians to qualify for the financial incentives promised by the HITECH act, “meaningful use” of such a system, (to be defined by the end of 2009,) must be achieved by 2011 for the incentives to be realized to their fullest.  In addition, there is the threat that penalties will be levied  against practices if a compliant system is not implemented by January 2011.

The latest Health IT Policy Council Recommendations to National Coordinator for Defining Meaningful Use Final  
( http://health.state.mn.us/e-health/standards/mufinalrecs102609.pdf ) stipulates that EMRs must maintain problem lists in either ICD-9 or SNOMED.  As of today, the meaningful use definition does not include compliance with the two final rules to continue the transformation of the US healthcare delivery system to an electronic environment through adoption of the next generation of diagnosis and procedure codes and updated standards for electronic exchange of healthcare data announced January 15, 2009 by the U.S. Department of Health and Human Services (HHS).

The first rule adopts the ICD-10 medical data code sets standard for use in exchanging diagnoses and inpatient hospital procedures information replacing and greatly expanding the ICD-9-CM code sets, developed nearly 30 years ago effective 10/1/2013.

The second rule replaces the 4010A1 standards for electronic health care transactions with Version 5010 on 1/1/2012.

The American Medical Informatics Association (AMIA), American Health Information Management Association (AHIMA), and AdvaMed, have issued a summary of their joint position on the adoption of the International Classification of Diseases, tenth revision (ICD-10) which includes the following points:

1. The ICD-9 CM (International Classification of Diseases, ninth revision, clinical modification – a U.S. version of ICD-9 developed by the World Health Organization) is obsolete. Its continued use will adversely impact the value of healthcare data as well as hinder medical decisions based on imprecise data. Further delay adds to the cost of modification and the investment in electronic medical records (EMRs).
2. CD-10 is needed to improve the quality of health information. It is designed to provide better data to meet the needs of today’s electronic healthcare environment and of an increasingly global healthcare system. ICD-10 will enable more accurate and improved information to be captured. ICD-10 will provide better data to support improved public health and bio-terrorism monitoring, more accurate reimbursement rates, patient safety improvement, medical error reduction, quality measurement, and pay-for-performance initiatives.
3. ICD-10 is needed to support interoperable EMRs and a National Health Information Network (NHIN). EMRs and NHIN networks require a modern classification system in order to accurately summarize and report healthcare data. EMR system benefits cannot be achieved fully by utilizing the 30-year-old ICD-9 classification system. ICD-10 must be incorporated into medical software systems with SNOMED-CT in order to realize the benefits of a NHIN and interoperability. SNOMED-CT and ICD-10 will allow data to be shared between EMR systems in their common medical language.

ICD-10 increases the sheer number of diagnostic codes ten fold.  There is not a one-to-one mapping between ICD-9 and ICD-10.  Adding choices and complexity can only help achieve improved health and more accurate payment if the systems and people are capable of codifying data properly.

Doesn’t it make sense to look for an EMR vendor who has a rock solid plan to remediate their EMR solution to utilize ICD-10 codes? To achieve real interoperability and, therefore, meaningful use, you must have a plan in place to train your physicians and staff responsible for coding in the use of ICD-10.  Make ICD-10 part of your criteria for vendor selection and meaningful use.

- Sandra Schafer
President, Turning Point Advisors

About the Author
Sandra Schafer has over twenty five years experience in healthcare IT.  Prior to forming Turning Point Advisors, a healthcare IT vendor consulting firm specializing in product commercialization and strategic marketing, she was Senior Vice President of Marketing and Product Direction at CareMedic, Vice President of Marketing and Product Marketing at NDCHealth, Vice President of Strategic Business Development at Healthcare.com.  Sandra began her career at HBOC, now McKesson where she spent 17 years in various management positions.  Ms. Schafer holds a B.A. degree in Business Administration and a Masters in Healthcare Administration from the University of Iowa.

Overview

The decision to implement an electronic health record (EHR) is one of the most important decisions for your health care organization or physician practice. The transition to an EHR system changes everything. Nearly every business process is impacted with the EHR implementation from registration/admission, scheduling, documentation, billing, patient follow-up, and communication within and external to your organization. Considering the profound change this implementation generates, your organization needs a clear road map to ensure a successful transition that will capitalize on the quality, safety, financial, and process benefits of the implementation.

Getting It Done Right

Successful and effective implementation requires hard work, careful planning, and diligence. In 20 years of implementing EMR and clinical information systems, we see patterns in the successful deployments. There are key elements to successful implementation from adoption approach, change management, process redesign, testing of the application, hardware, and interfaces. This article focuses on one area crucial to success, project planning.

Project Planning – What Should You Do?

Best practice in management of an EMR implementation has a vendor project manager with broad knowledge of the EMR application working with a project manager (PM) from your organization to develop a comprehensive project charter, project plan, and communications plan. Both PMs should have experience with multi-department implementations. If the PM skill is not available in your organization, often, a third-party consultant project manager is hired to plan and manage the effort. When leveraging a consultant always identify an internal leader in your organization that will be mentored through out the implementation.

At the end of the EMR project, someone in your organization will need to own the support and management of the application. A consultant project manager that mentors an internal resource puts your organization on track for success. Too often, we see organizations struggle after an implementation because much of the knowledge walks out the door with the vendor team and the consultant.

What Can Happen to Your EMR Project?

So what happens in this scenario? Your organization does not have a clear understanding of the scope of effort, complete project plan or a clear implementation roadmap. You do not understand the logical order of tasks, how your organization can most effectively prepare.

The various vendor implementation specialists connect with identified key contacts in your organization and these resources follow their plan or task list to complete configuration of functional areas. You can have multiple application specialists asking for information from many areas of the organization to complete master file and table builds. The vendor usually has an engagement manager (EM) who is overseeing your implementation. The vendor EM manages the overall effort of the various application specialists and can be the one-team member who understands the big picture surrounding the implementation. Often the individual vendor team members do not have a broad understanding of the overall EMR application or understand other functional application areas. There tend to be few team members knowledgeable about the whole application and implementation process.

You begin to wonder how the various decisions made for configuration work together. How do the decisions affect workflows? Is the vendor defining and documenting future state workflows with clinical areas? Often little attention is paid to this critical area of EMR implementation. You can be left wondering if the infrastructure, interfaces, and hardware needed will be ready at the right time. If you have an internal leader for your EMR project, they can struggle to comprehend and manage all of the moving parts of the project without a clear and complete plan and the right tools to manage the project. A well-defined project charter, project plan, and communications strategy are the best way to know your EMR initiative is on time, on budget, and being implemented using best practices.

Take Charge and Do It Right!

Documentation of a project charter defines the project. It documents the what, how, who, when, where, and why of the project. The project charter articulates scope, approach, and clearly defines measures of success that help to manage expectations for the initiative. Project risks are defined, analyzed and mitigation strategies developed and implemented. Typical EHR project risks are expectation, resource, acceptance, solution, and impact.

Communication planning is a critical component to the success of large projects. It involves determining what information needs to be communicated to whom, when, and how. The types and frequency of communication will vary depending on the audience, as different groups of people have differing levels of need or want to be informed. Understanding the needs of all project stakeholders and effectively communicating pertinent data is one of the keys to a project accomplishing its goals.

Communication techniques and technology will also differ based on the type of information. There will be formal documents that outline policies, requirements, and processes. There will also be informal communication via e-mail, phone, and meetings. Designing an organized approach to manage all these differences will enhance the team’s ability to make decisions, share data, educate, influence, and resolve issues.

The communications plan defines the various meetings, communications, reports and documents used over the course of the project. It is important to be clear about the intent or intended yield of the various forms of communication. Will the communication inform, educated, or influence the reader? For example, when you provide communication to a particular audience, is the communication meant to be one-way or two-way? Are you looking to inform the audience or do you want feedback? Is action optional or required by the reader? The plan should coincide with change management strategy. An effective communications plan can help to establish expectations and increase acceptance for the project and new software tools being implemented.

Project planning should be done using industry standard project management software such as MS Project, thereby leveraging many timesaving features for planning, tracking, and reporting project status. The project plan must document all of the project tasks: tasks for the vendor team, provider team, and other vendors involved in the project. The plan should encompass the entire project life cycle, from kickoff to transition of support services, and identify critical project milestones. The project plan identifies key dependencies among the various tasks. The plan is analyzed to identify risks and mitigation strategies developed. Tasks and responsibilities need to be defined within the project plan to review and manage the quality of deliverables for various project areas.

Clearly defined project governance is critical to the success of an EHR implementation and a well-managed project. A RACI diagram is well suited to identify the various project functions, roles, and responsibilities. The diagram documents who is responsible, accountable, consulted, and informed (RACI) for decision making and getting the work of the project completed in various areas. A project organizational chart clarifies who is in what role and articulates reporting responsibilities. Numerous decisions are made over the course of an EMR project, a well thought, and communicated governance structure facilitates this process. Review of successful EHR implementations point to complete and rigorous project planning as a crucial area to ensure successful implementation of your EHR. Further, building knowledge, skills, and ability in your internal resources is vital for ongoing user support and system maintenance after the implementation is complete.

About the Author
Janice Ahlstrom, CPHIMS, RN, BSN, is a partner in Wipfli’s health care practice. She has over 28 years of experience in the health care selecting, implementing and integrating enterprise information systems. She has helped a variety of organizations develop technology strategies, implement EMR applications, define business processes, enact operational performance improvements, and implement information systems. Contact Janice at 414.431.9352 or email her at jahlstrom@wipfli.com.

About Wipfli LLP

With more than 800 associates and 15 offices across the Midwest, Wipfli ranks among the largest accounting and business consulting firms in the nation. Serving businesses and individuals since the firm’s start in 1930, Wipfli has one of the region’s strongest healthcare practices, with an extensive list of clients across the Midwest.

For more information, visit www.wipfli.com.

Ease of Use is a major factor to keep in mind when choosing medical billing software.

Here are some important considerations regarding ease of use, security, and other factors when comparing medical billing software options:

1. When you start using the medical billing software, moving from one screen or one function to another should be intuitive and make sense to you, the user.  Do transitions from screen to screen proceed logically?
2. Is there a simple graphical interface between different modules of the medical billing software?
3. What about data security and HIPAA compliance?  Is it easy to make backups of your software? Can you password-protect sensitive data from unwanted users?
4. Can the medical billing software track insurance policies and data?
5. Are there customizable templates for standard functions within the medical billing software modules?
6. Can several staff members access the medical billing software program simultaneously?
7. Is there a web-based component to your system, so that users can have  password-protected access to your  system from different locations?
8. Are the templates easy to customize for a specialty practice?  For instance, if yours is a cardiology practice, you will need different types of templates than a dermatology practice: hypertension templates, cardiac cath templates, etc.
9. How easy is it to import data from outside sources, such as HHS and other government agency sites?
10. How easy is it to fill out standard forms?  Are HCFA forms easy to fill out?  What about easy access and analysis of CPT and CDT codes ?
11. Are interfaces with external sources easy to set up from within the billing and scheduling system?
12. How difficult will it be to import data from simple software sources, like Microsoft access spreadsheets (with xls extensions)?
13. How difficult will it be to import data from paper sources?  Is there any OCR facility available for scanned data?
14. Data conversion: how difficult will it be to convert data that is already on some other medical practice or medical billing system (perhaps one that you practice has outgrown)?
15. Does the software allow for multimedia attachments, such as pictures, scanned documents, x-rays, and even voicemails and files?
16. Does the software have a “free-trial” option so that you are not locked in to the system before you have seriously tried it out?
17. What are the training options that come with the software you are considering?  Is there a human tech-support contract option that comes with the software, or is training available only online?  Is there a person that is assigned to your company to provide tech-support?  How expensive is it to buy additional tech support time for you and your staff?

No one likes to think about everything that can go wrong, but you do need to do serious planning so that things will go smoothly with your medical software implementation.  Invest the time in comparing systems up front, so that you will eventually choose a medical billing system to fit the needs of your practice.

The type of EMR and medical software platform that will work best for you depends on the size and complexity of your medical practice or organization.

If you are a smaller practice or a solo practitioner, one of the most daunting aspects of buying and implementing EMR is the price: purchasing, licensing, implementation, and training can cost a true fortune. This outlay can make sense and save money for a large medical organization. If the system is implemented carefully, it will cut the number of man hours you need, perhaps reduce the number of employees, and help your practice comply with government reporting requirements.

However, if you are a solo-practice, or part of a small practice, this financial investment would be overwhelming. But you certainly need to make headway into the world of EMR and medical billing software, if you haven’t already. Is this feasible at a modest price?

The answer is, very feasible indeed, depending on how you make your choices.
There are two basic types of EMR software configurations available: Each software model has its upside and downside.

1. Client/server based software is housed and maintained on your own server.
Most of the large, well known EMR software packages are client/server based. This means that you and the developer – whether you buy the package customized, or whether you provide customization in-house — totally control the environment and can be tailor exactly to your needs. Most of the specialized practice packages are client/server based. Many client/server EMR models are web-enabled, meaning users can connect to their EMR via the internet on a standard web browser from a remote location – but the software will still reside in-house. Web-enabled software packages sometimes offer the option of handling security issues “elsewhere” by offloading the maintenance issues to a third-party host .

If you are not concerned about Stimulus payments, and whether the US government views you as making “meaningful use” of your EMR software, there are inexpensive client/server based options available at more reasonable prices. While these are not the CCHIT certified packages, they may be able to serve your basic EMR needs very well. There is even “open source” EMR software available free of charge, but it will require customization. If you are willing to go with a basic EMR / medical billing software package which performs basic functions reasonably well, and if you are willing to dedicate resources to customization and maintaining system and data security, open source software may work for you.

If you go with an off-brand EMR package, there is training and customer service available. If you decide to go with “open source” software, there is no customer-training or customer service division to call when you are desperate for help. You have to make your own security and backup arrangements, and there is no one to reassure you when there are data problems. If you are technically savvy, you may be able to make these arrangements yourself, but talk to others who have used this software before committing yourself to it!

2. Software as a Service (SAAS) EMR, offers a web-based model.
SAAS software does not live on your computer or server, but in cyberspace. For SAAS EMR software, you the user log onto a website from any internet-accessible computer hosted by a software provider to whom you pay periodic fees.

SAAS EMR can be accessed from anywhere. You do not need a dedicated IT person taking care of your computers, because security, back-ups, and updates are taken care of by the hosting company. Your up-front costs are usually much smaller than they would be for a client/server model since you don’t have to worry about hardware or network infrastructure. Your up-front costs are usually much smaller than they would be for a client/server model since you don’t have to worry about hardware or network infrastructure.

The disadvantages of SAAS EMR are that it may be difficult to configure specifically for your practice – sort of like buying suits off the rack instead of bespoke tailoring. Web-hosted software does not currently afford exact customer-tailored customization, although that will likely change.

Another possible problem: the smaller up-front costs may be deceptive. A host or vendor of SAAS can always up the rates. You don’t own any more of the systems two years into using it than you did on Day One, so you are basically a “renter “and the tax advantages and deductions afforded by a major corporate purchase are not there for you.

In summary, just because you are small does not mean that you cannot have excellent and extremely useful EMR software. But look carefully before you leap.

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