The previous section of this buyer's guide offered a quick introduction to electronic health record (EHR) technology and identified some of the first steps in choosing an EHR vendor.This section lists features that providers should consider.
For those migrating from a completely paper workflow, there is much to learn. Paring a list of vendors from a couple dozen "semifinalists" to a handful of "finalists" depends on how those vendors support the important features of EHR technology. The nine features listed below provide a good starting point; as you spend more time researching EHR technology, additional features of interest will undoubtedly emerge.
Voice recognition. Some physicians learn to "train" voice recognition modules, a majority of which are supported by Dragon Naturally Speaking (from Nuance Communications Inc.). Others give up, opting instead to click through pages of a medical record, select such items as prescription drug names and diagnoses, and type notes into free-text fields. Experiment with voice recognition beforehand to see if it's right for you.
Peripheral support. Because doctors increasingly are using smartphones, it's worth ensuring that the EHR technology you like supports the BlackBerry, Android and iPhone, and even the iPad. Larger facilities also can explore unified communications, or UC, systems to enable secure messaging to smartphones.
Computerized physician order entry (CPOE). There are many ways for EHR technology to support CPOE, a bedrock tenet of the meaningful use rules. Make sure the CPOE systems on your short list handle order entry in a way that makes sense to you and don't not force you to navigate in a less-than-intuitive fashion.
E-prescribing. Practitioners use different names for the same drugs, not to mention different words and abbreviations for dosing instructions. Confirm that your EHR vendor plans to keep up with emerging standardization efforts to reap the full benefit of error reductions. Also, make sure the e-prescribing module is not so full of alert messages or other pop-up windows that users are likely to ignore them -- and thus make a potentially fatal error.
Data exchange and interoperability. Several standards are emerging around data exchange. For example, both the meaningful use and the standards and certification rules said the document for "handing off" a patient from one provider to the next can be a continuity of care record (CCR), basically a data set; or a continuity of care document (CCD), which is a standalone document. Small physician practices might want electronic health record software that supports the simpler CCR, while large hospitals might prefer the CCD, which, ii should be pointed out, is the standard the Health IT Standards Panel prefers. Make sure your EHR vendor is committed to supporting both standards.
Security. The Health Information Portability and Accountability Act (HIPAA), state authorities, and the Federal Trade Commission all establish different privacy protections for patients. Make sure your vendor understands your needs, can support secure medical records customized to your state, and will pledge to keep your system up to date as statutes evolve and HIPAA compliance needs change.
As if setting up an EHR system wasn't enough, the HITECH Act also requires health care providers to prove to CMS, via a series of quality reporting measures, that they are using their system meaningfully.
Personal health records. Consumers are not very aware of their rights to see personal health records, or PHRs, and to demand a copy of them. That will probably change as the health IT buildup progresses and patients see the benefit of all their providers -- from the family practitioner to specialists to the dentist, ophthalmologist, and so on -- knowing their health history, drug allergies and other data points. Your EHR technology needs to be able to procure these records. Some people will want their data ported to a third party site like Google Health or Microsoft HealthVault. Others will prefer to carry copies on thumb drives or other media. Most people, experts agree, see value in a hospital or physician's office hosting patient records on the Web and giving access to patients via login. EHR vendors will support most -- if not all -- of these models.
Quality reporting. As if setting up an EHR system wasn't enough, the HITECH Act also requires health care providers to prove to the Centers for Medicare & Medicaid Services, or CMS, via a series of quality reporting measures, that they are using their system meaningfully. You'll be doing this as a compliance initiative. Your EHR technology needs to collect the right data points and make the process simple, straightforward and accurate.
Coding standards. Coding is changing. EHR technology will need to support Systematized Nomenclature of Medicine (SNOMED), a set of descriptions physicians will use to describe patients; the Logical Observation Identifiers Names and Codes, or LOINC, the standard language for describing clinical and lab results in EHR systems; and International Classification of Diseases, Tenth Revision, or ICD-10, the back-end coding system payers use. Few providers are using SNOMED, and even fewer are testing ICD-10. Make sure your EHR technology is ready to flip the switch when these new systems go online -- and that your employees can be trained to make the transition.
The next section of our buyer's guide takes a quick look at Web-based EHR technology, which could be a low-cost alternative for smaller health care providers that cannot afford the infrastructure necessary to maintain a client-based EHR system.