Someone asked me what EMR to use; it depends on what would be best for you

A friend asked me what EMR to get and here’s my response (edited a bit from its original form to make it into more of an article than a chatty email message.)

Personal preferences; learn from the mistakes of others:

So much of using an EMR depends on personal preference so it is best to try different ones, even seeing if you can get different vendors to let you use them in your own office setting for a few weeks to know if it is right for you. Some people may rave about the EMR they use and it may turn out that particular one is not good for you. That being said, you also do need to try ones that people recommend, or at least ask any potential vendors for a list of their clients in your area so you can visit them to see it in action and get their opinions. Some offices may only be using one module of an EMR and had too much trouble with the rest of the EMR so gave up on it!

EMR I’m currently using (but NOT for everyone):

Optimed Software's Accuro face sheet

All that being said, I am currently using Optimed Software’s Accuro but am looking into two others that I describe in greater detail below.  Accuro is a good compromise if you are moving to an EMR as it is form-based. You have complete control over the screen layout which is a feature lacking in many other EMR systems. You can therefore make the screen look like your current paper chart. When I switched to Accuro, this was important based on the office staff I had at the time. I needed to ease the transition to a fully integrated EMR system as our previous EMR worked great for most scheduling, billing and importing ancillary test printouts, but was a bit awkward for chart notes, handling medications, and generating letters back to referring doctors. However, as you will learn with EMRs, there is ALWAYS compromise; no one system will be perfect for you. In the case of Accuro, the flexibility to create whatever fields you want, means that there are not enough pre-defined fields of data so you cannot easily generate reports or import prior data into new forms. In addition, every program handles billing and scheduling a bit differently and this one seems to require more steps than need be with those tasks as well as with generating the letters back to the referring doctors.

Other EMRs I’m intrigued by (and the decision of start-up vs established vendor):

ifa Systems glaucoma exam form

Ifa Systems AG has been doing nothing but Ophthalmology EMRs for over 20 years. Ifa is the world leader with integrating with ophthalmology equipment but requires many screens worth if data entry to do each exam. Accuro was good when my staff was afraid of an EMR but now that there has been staff turnover since I began to use it and the rest are very accustomed to an EMR, it is worth considering a change to the way more complex ifa system. The ifa system not only imports the printouts of ancillary testing devices but the raw data allowing you to

generate reports on any data. 

ifa Systems IOP graph

There are of course trade-offs if opting for the ifa system. Rather than a simple monthly fee of approximately $300 per physician with Accuro, the ifa system has a monthly fee PLUS a very big upfront cost that can total thousands of dollars per workstation, depending on how many pieces of equipment are being integrated. Also, at least in Canada, the ifa system does not yet have billing (though it has it for most of the rest of the world. Hopefully, this is just a matter of time as it is commonly accepted that you should NOT get an EMR that is not a complete package…ie if it does everything but billing, look for something else.)

TeckSoft EyeVu summary screen

A new company on the scene, TeckSoft, has created a program called EyeVu. Their initial goal was integrating ancillary testing devices as the ifa system does but they have an almost complete EMR package. They lack billing and, at least as of this past month, have stated that they have no intention of including billing as this would be too much work and suggest that there are many other billing programs out there.

TeckSoft EyeVu patient flow

EyeVu has some of the best features of both Accuro and ifa, including a robust database of fields allowing for powerful search capabilities across all records, control over the exam form with the ability to just add an extra section on the fly when seeing a patient. They also have a unique visual way of handling patient flow, allowing you to see a floor plan showing where any patient is within your office as they flow through their pre-visit screen, ancillary tests, and examination. (The ifa system has a very good traffic manager that is less visual; Accuro has a poor traffic manager that fails miserably and was an afterthought.) Their pricing is much more reasonable than the ifa system and they still have the excellent integration of ancillary testing data.

TeckSoft EyeVu advanced search

The biggest risk though with choosing the EyeVu, is that they are too new a company. Would you opt for a company like ifa systems AG with clients all over the world but a huge pricetag or a start-up with 7 clients and a lower price tag? Common sense would dictate going with the company that has the long proven track record; but the features found in TeckSoft’s EyeVu can make you through away common sense.

My next EMR article in the works:

My next EMR article will discuss the newly posted ‘meaningful use’ criteria being adopted by the province of British Columbia to go into effect in September 2010 for those seeking government funding for the right reasons: ie meaningful use.