Electronic Medical Record - What Features Are Important In a Purchase Decision?

Physicians are being pushed toward electronic medical record keeping.  That is a fact of life.  Not only is the government pushing toward electronic medical records but also physician groups themselves are pushing toward sharing of data.  For your practice, you might want to look at electronic medical software for the purpose of streamlining your operation and making your note-taking easier.   If you are considering the purchase of an electronic medical record software program, what should you be looking for? 

Definition of Terminology

Note-taking or recordkeeping involves two sides of notes: the patient's side and the doctor side.  When the patient comes into the doctor's office, they are usually given a clipboard on which to record their demographic information and medical history.  A software program that gathers information about a patient's medical history, diagnosed conditions, family history, and previous problems is called a personal health record (PHR).  There are only a few personal health records that are online at this point in time.  Most personal health records store data on a USB drive and are not capable of sharing the information with physicians’ offices.

Software that allows the doctor to record his/her notes is called an electronic medical record (EMR) or electronic health record (EHR).  Those terms seem to be used interchangeably.  There are numerous software programs available that feature an EMR for chiropractors.

The Functionality That Is Important

Almost all of the EMR programs available use templates - a set of predefined choices or options that are available to you.  As a chiropractor, you need to make sure that the EMR has templates that are customized for chiropractic.   Once you are certain that the templates are built for chiropractic, you need to determine whether the templates can be customized to suit your particular practice style.  No two chiropractors practice alike.  No two chiropractors adjust alike.  In order to accommodate your particular style, ask the software vendor to show you how it can be customized for you.   If you have particular terminology that you like to use to describe your adjustments or your examination findings, ask the vendor to show you how that terminology can be incorporated.  Many of the programs that claim they are customizable limit the areas that can be customized.  You need to make sure that the results that are important to you can be customized to your liking.  If the vendor mentions that a system is hardcoded, you know that very little customization will be allowed.

Level of Integration

Another issue to consider is the level of integration with your current practice management software.  In other words, will the EMR share data with your practice management software and vice versa?  There is nothing more frustrating than having to enter the same patient data in two different systems.  At a minimum, the EMR should be able to access the scheduler in your practice management system and list the patients that have arrived for their appointments.   A higher level of integration involves the ability for the doctor to enter procedures performed and diagnosis changes from the EMR.  This information should be used to update the practice management side of the software so that the electronic billing is updated.

One feature that is particularly useful is the ability to send intra-office messages, somewhat like instant messaging.  For example, the doctor might want to communicate to the staff to schedule a new patient orientation for a particular patient.  The doctor might want to indicate that a re-examination or new x-ray should be performed at the next visit.  Using an instant messaging system that is within the EMR itself allows the doctor to communicate tasks that need to be performed and receive feedback that these tasks have been completed.

Speed of Use

A frequent complaint from doctors who are switching from travel cards to paperless note-taking is the speed of entering a note.  “I can do it faster on my travel card.”  While the report looks great and so much more professional than a travel card, it takes a doctor much longer to generate a note.  One thing to consider when evaluating EMR's is the type of data entry required.  Do you have to use a keyboard?  Obviously, this will slow down data entry.  Do you have to use a mouse?  Some EMR's are based on option boxes or combo boxes.  In other words, they have a drop-down list from which to make a choice.  Whenever there is a drop-down, it requires eye- hand coordination to select the appropriate option.   Choosing from multiple options in order to record a note can slow down the process.

The touchscreen environment seems to address the speed issue and the eye-hand coordination but requires a larger investment in hardware.   Touchscreen monitors would be required in every treatment or exam room.  As an alternative, touchscreen tablet PCs could be carried from room to room.  In any case, the touchscreen environment requires more hardware with the trade-off of increased speed.

Accommodation for Repetitive Entries

Let's face it.  If a chiropractic patient is being adjusted three times a week or twice a week, there is considerable repetitive entry.  When you are evaluating EMR's, look at both methods of entry - new patient and established patient.  The new patient entry should include all the common chiropractic examinations, chief complaint, case history, and treatment goals.  The established patient entry should include a shortcut that allows you to see the last visit, make the appropriate changes for this visit and save this encounter with today's date.  In other words, the previous encounter should be displayed for modification and allow a new record to be created with the changes.  If the system requires a complete new entry every time for established patients, considerable time will be wasted in keystrokes or mouse clicks.

Patient Check-In

One of the options in some EMR's is the ability for the patient to check themselves in.  As we all know, patient sign-in sheets have been considered to violate patient confidentiality through the HIPAA rules.  Having a kiosk (a computer system set up specifically for patients) in the waiting room saves time.  Patients can indicate that they have arrived. Some kiosk systems are set up to elicit information from patient questionnaires, watch patient education videos or sign forms digitally.

The method of patient check-in varies from one software to another.  Some systems use a card that has a bar code for scanning.  This is a very quick way to perform a patient check-in.  Its disadvantages are also obvious: you need to buy the materials for the cards and spend time printing them.  If the patient forgets or loses the card, they have to go through a manual check-in process anyway.  Another method of patient check-in is biometric.  Using this method, a copy of the patient's thumb or index finger is recorded and used as a method of checking in.  The advantage of this method is obvious: the patient cannot forget to bring their thumb or finger.  In more advanced systems, pupils can be scanned and used as a check-in device.  This type of validation system can be expensive.

Kiosk

Another feature available in some software programs is the kiosk system itself.  Doctors can decide to ask patients to watch a video on their second visit.  They can get signatures on forms through the kiosk.  They can ask patients to fill out pain scales and other outcome assessment forms.  If the EMR software has the ability to incorporate a patient kiosk, there is usually an increased charge for the software itself and for the hardware to run it.  Each office must decide whether a kiosk fits into their style of practice and yields enough benefits to outweigh the cost.

Digital Signature

When you get audited by Medicare, they require that the notes that you provide are signed.  They do not, at this point in time, require a digital signature.  In fact, there are no specifications yet for the use of digital signatures by either the patient or the doctor.  It is expected that the meaningful use guidelines being developed will address the use of digital signatures and the requirements of their use.

Patient Education

An optional feature available in some electronic medical records programs is the ability to create a patient education brochure or pamphlet.  If this type of customizable patient education is important to your practice, you will want to look at EMR's that offer this feature.

Visit Plans

Many chiropractors set up their patients on a series of treatments or visits.  As the patient is being adjusted, it is helpful for the chiropractor to view the visit plan and monitor the patient's compliance with the visits.  It is also helpful to be able to communicate the visit plan to the front desk for the purpose of scheduling patient appointments.

Interoperability

Interoperability has become the buzzword for electronic medical records.  Its meaning is simple-the medical record must have the ability to share information with other medical records and/or with the patient.  Quite frankly, most EMR‘s have not met this requirement yet.  In fact, the government is still defining the standards that they consider critical for interoperability.   It is expected the interoperability will involve the import/export of data using a specific language such as HL7 or XML.  Not only is it expected that physicians will share information with other physicians, it is also expected that physicians will share information with their patients.  In most cases, the sharing of information will occur over the Internet.

Online Medical Record

In order to accomplish the interoperability standards that may be set forth in the next few years, most of the software programs will be looking at integrating data online rather than within the office itself.  In other words, the software would operate online as opposed to a network system within the doctor's office.  An online medical record has obvious advantages.  Patients can be encouraged to request appointments online.  A patient portal can be established through the doctor's website that allows the doctor to collect the case history information and import it into the doctor's electronic medical record program.  Of course, any data collected and stored online must be encrypted to meet HIPAA privacy standards.

The Best EMR/EHR Choice for You

Because every doctor is different and every practice is different, there is not a clear winner for the choice of EMR software.  You need to purchase whichever EMR software will work best for your office.  This is not an easy decision.  A doctor must decide which features are most important and which features fit into the style of his/her practice.  Then, once the features are selected, the comparison shopping and price shopping can begin. 

We have prepared this checklist of questions to help you get started with your EMR shopping.  Start by circling the features you need.  You may decide to throw out some of these questions because they are not important to your purchase decision.  As you shop, realize that electronic medical record software is currently a “work in progress” for most companies.  As regulations are communicated, there will be changes required.  You must be certain that the company you choose is committed to making the changes required in the future to meet government regulations.

  1. Is your software customized for chiropractic?
  2. Can you show me how to customize your templates with my verbiage and/or my examination flow?
  3. For my established patients, how do I view the previous encounters?  Can I change this screen to match my typical patient flow?
  4. Does your software integrate with any PHRs? Do you have plans for integration?
  5. Is the software integrated with practice management to include scheduling and procedure entry?
  6. Can you show me the typical patient flow for an established patient?
  7. Is there an instant message system to communicate information to the front desk?
  8. Can diagnoses be changed and indicated from the EMR?
  9. Do you have a patient kiosk system available?
  10. Do you accommodate patient check-in and how? What are the costs involved?
  11. Does your software operate from my internal network or use online access?
  12. What are your programming plans for interoperability?
  13. Do you have a patient education module?
  14. Do you have online scheduling available?
  15. Do you have digital signature capability and what are the costs?
  16. Can I establish visit plans from within the EMR?
  17. What are your future programming plans?  What is your timeline for the features that you are planning to add your software?

 

About the Author

This article was written by Marilyn K Gard, MBA, CEO of ClinicPro chiropractic software and ICER-2-GO LLC.  Marilyn has been involved with the chiropractic profession for 30 years, conducting chiropractic insurance seminars, writing professional articles and running a software development company.  ClinicPro software currently offers an electronic medical record program which includes patient education in partnership with the New Renaissance organization.  Marilyn can be reached at Marilyn@clinicpro.com or 928-203-0854.


  
Chiropractic software, or chiropractic practice management software, is specifically designed to run a chiropractic office. It includes chiropractic procedure codes such as 98940 and 98941. It includes chiropractic diagnosis codes for subluxation and neural muscular skeletal conditions. It is HIPAA compliant and complies with the guidelines for Medicare chiropractic coverage. In addition to providing chiropractic software, creative concepts in communication writes articles for local and federal chiropractic organizations and publications. ClinicPro chiropractic software is committed to providing the best chiropractic practice management software in the industry along with the best technical support available for Chiropractic software.
As a chiropractor, the needs for clinic software differ from a medical practice. Chiropractors primarily use two procedure codes: 98940 and 98941. In addition, electronic medical records for chiropractic practices differ significantly from medical practices. Chiropractors do not use electronic prescriptions, lab tests or immunization registries. Chiropractors need to record x-ray findings, visit plans and functional limitations. Chiropractic software by ClinicPro provides the best chiropractic practice management software in the industry.
 In a chiropractic office environment, the use of chiropractic software streamlines the functioning of the office. Chiropractic software should include an appointment scheduler that allows chiropractors to set up visit plans. It should include chiropractic procedure codes for x-rays and adjustments such as 98940 and 98941. It should include an integrated electronic medical record that allows chiropractors to record Medicare mechanism of trauma. Using an EMR to record documentation notes and physical exam findings streamlines the overall functioning of the chiropractic office.