11 Questions to Ask A Potential EMR Vendor About Their Software

Software demos are notoriously biased. EMR representative will generally show you the stuff that works really well. They will show you the stuff that will make you say, ooh, aaah.

Nothing wrong with that. When I’m showing something off, I want to share the best of what I have too.

But one of our main jobs as leaders of our medical practices, is to shift through the nonsense and get to the nitty gritty.

So how do we know, from a practical stand point, that the software we are evaluating can handle real world examples?

The best way to understand if a piece of software will work for you is to see it in action. Not from a representative’s point of view, but from a practice point of view.

I know what you are thinking… but I don’t know what questions to ask the EMR rep that will help me get a practical sense of how the EMR works.

Wonder no more. Suzanne Berman, MD, SOAPM member extraordinaire, wrote down 11 Questions that I think will really put an EMR through a ringer. As you will see from her questions, she emphasizes the importance of seeing  how the system performs extracting data.

Take a look at these questions and have them ready the next time you meet with an EMR vendor.

  1. “Show me how I recall all asthmatics who haven’t had a spirometry in >6 months.”
  2. “The next time this family calls or comes in, SOMEONE needs to get a correct mailing address. Please mark the chart on all the siblings so it will alert the next time someone opens the chart.”
  3. “Show me all patients who are behind on their checkups.”
  4. “Which of our patients don’t have a current Framitz Flopulitz form on file?”
  5. “I need to pre-order my flu vaccine for next year. I need a breakdown of how many VFC vs payable kids, 6 to 36 months vs big kids we had last year and how many shots/mist we gave; then I need this year’s numbers to extrapolate.”
  6. “I saw a kid with something like this last year — the specialist recommended a great treatment regimen, that I’d like to try again. Nuts, can’t remember that kid’s name. I do remember charting “Spoke with Dr. Matheson” — the specialist. How can I look through all the charts for a teenage girl seen in 2011 where the phrase “Spoke with Dr. Matheson” appears?
  7. Me, Dr. Speedy, and Dr. Talksalot are all vying for a limited number of shared exam rooms. Which of us a) has the most visits; b) runs on time vs. behind; c) has the most patients in the office at once [i.e. does the most double/triple sib appts]?”
  8. “How many active patients do I have? Exclude cross-cover patients, patients who’ve transferred, patients who we discharged, and patients we haven’t seen in X months. Oh yeah, and please show age distribution.”
  9. “How do I mark this kid’s chart as “African-American child adopted by Caucasian couple — do not ask “are you mom?” when family comes in — sensitive issue” so my receptionists stop putting their foot in their mouths?
  10. “I’m doing a sick and a well visit on the same day. Where do I chart the different bits?”
  11. “How can I find all kids who got vaccinated with Lot X? The mfr is recalling that lot.”

Of course you are free to add your own questions based on situations you’ve encountered. Oh, and don’t assume this is all the due diligence you have to do. Search the web. There are tons of articles that can help you with this process as well.

Lastly, I’d like to mention that data input is also important. The program ought to feel intuitive and easy to input data into. But don’t forget the data output. This is often an overlooked aspect of the EMR evaluation.

What question or request would you add to this list?

Dr. Suzanne Berman is a general pediatrician in private practice in Crossville, Tennessee.   Her family works, lives, goes to school, worships, and buys stuff from Walmart all within the 38555 zip code. Dr. Berman is a regular contributor to the Survivor Pediatrics blog. To read all her post, click here.

Does your Medical Practice Charge for Medical Records?

We don’t charge for medical records. And here is why:

When people ask for their records, nine out of 10 times, it is because they are leaving the practice. And the way I look at it people leave for two reasons.

  1. They are upset at the practice
  2. They are leaving as a result of a situation beyond their control (eg insurance, moving, etc).

Collecting payment from somebody that is upset at you or your practice is very uncomfortable and somewhat difficult. People don’t like to pay people they don’t like, regardless.

So what is our approach?

We kill’em with kindness and put as little barriers as possible for them to leave the office. Trying to collect 30 or 40 bucks from someone that is on their way out is a battle not worth fighting. What is the upside?

For those in group number two, as a customer service gesture, we print their records for free as well. We express how sad we are that they are leaving and wish them the best of luck in finding a great pediatrician. No need to penalize them for changing insurance or moving.

I know, there is a cost to printing and mailing the records, and it is also a bit of a hassle, specially if you don’t have electronic medical records.

But unless you have a mass exodus on your hands, it shouldn’t be too much of a burden. And if it is, deciding how much to charge a patient is the least of your worries. You need to address why you are having a mass exodus.

For the records, I’m not suggesting that you are doing something bad if you charge patients for their records. I understand each office is different and each has their own way of doing (justifying, just like I justify) things. All I’m doing here is explaining why WE don’t charge for medical records.

Do you charge for medical records? Why? Why Not?

What is the Benefit of an EMR in a Medical Practice?

Today, I have another guest post. This time it’s from Dr. Suzanne Berman MD, FAAP. Dr. Berman is also a contributor to Survivor Pediatrics. In this post, she gives insight into the real benefit of having a EMR. For example, many docs believe that a EMR will help them chart faster. But as Dr. Berman points out, that is not always true. 

The real benefit of an EMR isn’t being able to put data in/chart faster – this is great if you can do it but not everyone can point/click/type faster than they can check boxes–

…the real benefit of an EMR is getting practice-wide data quickly OUT of it.

When docs test drive EMRs, they want to see “How do I put in the vitals?  How do I issue an Rx?”  As far as getting data out, they want to see patient-specific, single-patient data: “Show me the kid’s growth chart.”  “Show me their pattern of no-shows.”

But the real ROI is learning how to get data OUT – report writing and so on.  Most docs never learn this, or expect the administrator to do it all.

I’ve posted on SOAPM before about how we found $3K/month in lost revenue in labs we weren’t billing for by cross-checking the number of, say, strep tests documented in the chart vs 87880’s billed for – at a cost of $100/month.   Is $3K/month a huge cash cow? Nope, but it’s something we wouldn’t have had otherwise.

We get another perhaps $1000/month for running reminders on missed E&M, 99050, etc.  and we already run a pretty tight ship.  Other practices have found similar results from cross-checking vaccines, etc.

By reporting on how many different days I saw kids at our local hospital (place of service 21 or 22) I can give our practice’s accountant a nice list of work-related mileage from our office to the hospital.  This is maybe $500/yr in tax savings for me and my husband.  Is this ginormous? Nope, but since the report is already there and it takes 2 minutes to run and print, $500 earned in 2 minutes work is pretty good.

Having the computer do the various annual reports that are required of the various programs we participate in saves my nurse administrator time.  How many VFC vaccines from a certain lot did we give between date A and date B to self-pay vs. Medicaid patients? How many H1N1 vaccines did we give during a period?  Point, click, print, fax, move on.  No hand tabulating.  No adding up long columns of numbers by hand.

There’s a new Framitz machine that’s now CLIA-waived!  It’s on sale, $5000, and the cost per test is $3.  Insurance reimbursement is $8.   Is it worth it? Depends on how many Framitz tests we sent out last year — and with a couple clicks, I can see what the ROI on a new Framitz machine would be.

I don’ t expect everyone to be the data mining geek that I am – but I posit that you will never reap the rewards of an EMR if you don’t know how to get practice-wide data intelligently OUT of it.

And that’s the trouble with spending a lot of time on scanning old data into the EMR – it’s clunky and time consuming, and you have to do it, but the data you’re putting in can’t be extracted in any meaningful way (unless you are doing some really awesome indexing) to do the cool things I’m talking about.