Essential Insights On Electronic Medical Records

Bruce Werber, DPM, FACFAS

Which EMR Server Is Best For Your Practice?

   Bring your staff into the process of choosing a system. First, figure out what you can afford. (At this stage, do not necessarily add into the equation the potential revenue that the system could save or generate.) Set an amount that is comfortable for you. Just like buying a car, buy what you can afford but consider the potential of improving the efficiency of your practice by automating many of your repetitive tasks.

   As far as the type of EMR server, consider the two models available: application service provider (ASP) or an on-site server.

   ASP model. With this model, the practice pays the software company a monthly fee. The software company maintains the server at a distant location to which the practice connects via the Internet. The practice needs to have a fast Internet connection such as T1 line, fiber optic, cable or digital subscriber line (DSL).

   With this type of setup, the advantages include: a low entry cost (typically one month upfront); training cost for your staff; and any terminals/laptops you will need for the treatment rooms and front desk. The system is offsite and offers a secure backup. This keeps the records safe should there be a disaster at your office. There is typically no maintenance fee or upgrade fees. You can access the system anywhere in the world that has an Internet connection.

   You may be able to negotiate a long-term contract to ensure the stability of the monthly cost. If you opt to switch to another EMR company, it is possible to convert data to a new system. However, this usually proves to be a very difficult and expensive process. You can get a copy of your data but it may be useless if you do not have the software to read it.

   There are some disadvantages with the ASP model. If the Internet connection goes down, your server access in many cases will not work. In these situations, some systems, such as eClinical Works, will allow your staff to continue to work but with limited functionality. For example, you can write a note or make a tentative appointment but none will be confirmed until the system reconnects with the server. The monthly fee for ASP type set-ups ranges from $400 to $800 per month per doctor.

   On-site server. For larger practices, an on-site server may make more sense. For several smaller practices that want to share a server and use the same software, this may be a great option.

   Upfront costs are higher. Maintenance is required for equipment, the server software and the server operating system. Maintenance includes ensuring backups, virus protection, licensing the software and yearly maintenance of the software. These all have recurring costs plus the time to do the maintenance and upgrades. You can rent space at a server farm such as Rack Space. That way, the server is offsite and for a monthly fee, professional technicians maintain the server and provide protected backups.

   The choice is personal. Some practitioners prefer having total control and being able to know the server and data are in their possession. Personally, I am in favor of the ASP model for safety and lower upfront expenses for the small solo practitioner or small group. For larger groups, the cost may be spread out and it may make more sense to bring everything in house.

Shopping Around For The Optimal EMR Model

   After deciding on the type of server, first make sure the prospective EMR model is certified by the CCHIT or another agency deemed appropriate by CMS. Then ask a successful, well managed practice what system that practice is using. Ask the staff if they are happy with the system. Ask if they would change the setup if they could and which setup they would switch to.

   Seek out online product reviews and read the blogs about each product. Check out customer service complaints and ask for references in your specialty. Ask for the names of practices that may have abandoned their product if that information is available. Look for testimonials and call the people giving testimonials to ask if they still feel the same way and what they would do differently.

   Go see the product in use at a local practice. Send your staff to talk with that practice’s staff. Usually you will find out from staff if there are any problems, which the doctors may not share as easily.

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