You may be surprised that we haven't told you which electronic medical records (EMR) software you should implement at your practice. At our practice, the plan was to first establish a foundation and infrastructure in order to later implement an EMR product of our choosing.

Now we'll outline the considerations to make to select an EMR system vendor. These guidelines are what we used to select a particular vendor and arrive at the solution which fit the needs of our medical practice. I should stress that other large and small practices currently contemplating EMR may have completely different needs, and should make their own choices with these needs in mind.

Our practice used an electronic practice management application, Fiscal, until the late 1990s. In 2000 we made a choice to go to a hospital-based system, meanwhile ceasing to service practice-based systems. The Fiscal version we were using wasn't ready for Y2K. At that time there weren't plans to move to EMR from paper records, although we knew that Medical Manager was developing their own EMR system.

Many doctors tend to be interested in new toys and gadgets. Ophthalmologists often must resist the temptation to bring a flashy EMR product home after learning of it at the latest Academy meeting. When we remind ourselves of the actual plan, we give this sort of information over to the electronic medical records committee. This committee is comprised of both administrators and members of the technical, business, and IT departments. The primary goal of the committee is to select the main criteria for the EMR system with suitability to the practice in mind.

Selection Criteria

To begin, our committee established some guidelines for what they needed from an EMR system vendor. The short list only mentioned businesses with at least mid-level market presence. The vendors for consideration also had some existing EMR program, as well as experience working in the field of ophthalmology.

The committee selected four main criteria on which to base our ultimate decision:

1. We wanted a system that could be fully supported on both thin and fat clients, to accommodate the low bandwidth of our satellite offices.

2. We wanted a system which would give us the ability to create, modify and design powerful graphically-based EMR templates with normalized data (not text).

3. We wanted a robust ACID-compliant relational database for several key reasons: a) we wanted the data to be protected and able to recover fully from failure, not just restore from backup; b) we wanted a database back end that would scale well as we grew; c) we wanted something with an open interface that we could report on. By the way, ACID-compliant means that the database has the desired features of atomicity, consistency, isolation and durability.

4. We wanted a product and company with a strong practice management product that integrated with EMR. We did not want to install a system with duplicate data entry, or one in which patient information isn't accessible from both the EMR and EPM.

After we reviewed the products of over a dozen EMR vendors that fit the parameters, we trimmed the list down to just four. We then invited these vendors to make presentations to our committee. After we analyzed their abilities and checked their references, we went with NextGen Healthcare Information Systems, from Quality Systems, Inc.

Reasoning and Choices

NextGen not only had an award-winning product, but a better EMR interface as well. We found that NextGen met our need for EMR template customization, as well as a solid database and total support for both fat and thin clients.

Today, NextGen doesn't use an interface. Instead, both the EPM and EMR share a common database. Rather than send patient data between products, it's native to the application because of the database. As a bonus, the application claims engine is HIPAA ANSI X12N-compliant. This facilitates direct electronic data interchanges with complete HIPAA compliance.

We chose to drop our clearing house, which saved $11,000 each year. Meanwhile, we saved time on our accounts receivable by removing the middle man. NextGen has been easy to work with, even growing into a positive element in the success of the project. The company is receptive to suggestions and has a helpful user group which practices throughout the country, meeting occasionally for training and discussion.