The Tech Doctor: EMR Data Entry

How do electronic medical records help you make money? The key word is throughput.

If you can't raise prices - and between the strained Medicare system and commercial managed care there is little hope of that - the only way to keep up, let alone advance your position, is to see more patients faster or drive down your costs.

The right EMR helps you do both, provided you can actually get data into your system.

INPUT OPTIONS

Let's compare EMR input models in terms of their mobility, power, and ease of use. The basic options currently are:

• A single personal computer/workstation in every patient room;
  

• A tablet PC;
  

• A handheld device such as a PDA (personal digital assistant); or
  

• Voice recognition technology.

PC workstations typically have keyboards that require manual data entry. On the plus side, they permit users to access patient labs fairly rapidly via full monitor display tabbed windows. Handheld devices are most useful for specific niche tasks or for when you want to capture data in real time by working off a checklist. So you might use a PC workstation for a robust, server-based EMR, but use a PDA if all you want to do is capture enough patient encounter data to generate a diagnosis and a billing code or write a prescription.

Verbal input into medical records remains the most traditional and familiar method of data entry. While the average touch-typist physician might type as many as 50 words per minute, dictation is twice as fast. Most EMR systems will input transcriptions into patient records, allowing you to easily retrieve dictated notes. Other technologies will learn how to understand your voice, subsequently allowing you to dictate directly into your computer via voice recognition technology.

COMPARE INTERFACES

Let's evaluate some concrete examples of interfaces. AcerMed is one example of a company whose EMR interface can run on a tablet PC. It's almost as easy as carrying a clipboard and a lot more flexible than using paper.

A physician can carry a tablet from room to room, entering her chart notes in real time. A tablet PC's desktop is oriented to classic history, physical, and SOAP formats with appropriate templates for clinical charting.

With AcerMed's product, you can use a stylus to point and click on templates that fill in a note you then can print out in a narrative format. This EMR, like many, also incorporates Dragon Naturally Speaking voice recognition technology, allowing you to point your cursor to a specific part of a note and then dictate your observations in real time. The Healthmatics EMR has similar mobility. Their desktop interface resembles Microsoft Outlook's folder format.

Both products incorporate triage and workflow features that flag where patients are within their check-in processes. These are two good examples of how far EMRs have come in terms of ease of data entry. Workflow needs for ease of use and efficiency are resulting in giving users the ability to converge records, moving toward products that combine tablet PCs with Web-based interfaces. However, there remain significant differences between products' "look and feel" and their ability to integrate transcription and voice recognition options.

ASSESSING MOBILITY

Once you enter patient information into one of these devices, a key determinant of the usefulness of that information lies in a product's flexibility of output and inclusion or exclusion of certain functions.

For example, does your vendor let you download key reports to a PDA you can carry around in your lab coat? It's nice to have a list of patients scheduled for hospital rounds that includes their admission date, room number, referring physician, key clinical data (allergies, medications, past medical history, problem list), as well as a charge-coding PDA "assistant" with physician-specific coding and modifiers at hand. This makes it easier to access and modify critical patient data in time-constrained situations (such as rounding on patients in more than one hospital before rushing to your clinic to start your day).

The comparisons that follow are examples of three different approaches vendors have taken on the issue of mobility for ease of use.

• Vendors with well-defined, limited functions that translate well to PDAs. Examples include:

• iMed EMR (www.imedemr.com/keyfunctions.htm)
  

• AcerMed - This product uploads patient visit schedules and allows charge capture on its PDA portal (www.acermed.com/v2/pda.htm).

• Vendors who use larger platforms and exclude PDAs. In this case, vendors seem to have come to the conclusion that less is not more and that below a certain screen size there's not a lot of value to adding PDAs when tablet PCs are almost as portable. Examples include:

• Z-charts - These are totally paperless EMRs for ambulatory surgery centers (www.zchart.com/zCHART_hardware_techspecs.pdf).
  

• CureAccess - These are Web-based and require laptop or standalone PC and Internet access (http://cureaccess.com/download/CUREACCESS_Brochure.pdf).

• Vendors who use Web-based interfaces and claim usability in hand-held devices but refer more often to tablet PC platforms. Examples include:

• EclinicalWorks (www.eclinicalworks.com/eclinicalworks6-7.php).

In researching this subject I found more than 100 vendors claiming to have developed "the ultimate EMR" with varying degrees of mobility for ease of use. While impossible to describe each of these in detail within this space, I hope these examples give you some idea of the variability in such devices' portability.

CHOOSING YOUR SYSTEM

EMR costs vary widely in this fragmented, hypercompetitive environment. From a larger vendor you can expect implementation costs of roughly $50,000 for a two-physician group and maintenance costs that vary between $5,000 and $10,000 or more per year. Lower-end products (robust, but with fewer features) can run much less - roughly $1,000 per physician with negotiable maintenance fees.

How do you know which EMR to choose? The decision is a tough one. There are about 70 choices out there; however, the top 10 vendors make up about 50 percent of the market.

You can see how record model, data entry method, and the scale of your supporting vendor all impact your decision. I'm collating a mountain of data on this topic and will be distilling it down into a special report I'll soon make available. To review it, go to www.infotechfordoctors.com/emr.html.

Steve Rebagliati, MD, MBA, is a practicing physician. He offers these resources, ideas, and tips for using information technology to increase revenues, decrease hassles, and free up time, so physicians like you can succeed in a changing world. He can be reached at admin@infotechfordoctors.com or via editor@physicianspractice.com.

This article originally appeared in the April 2006 issue of Physicians Practice.