It’s breathtaking how much money some EMR systems cost.  I’ve seen quotes for a seven-ophthalmologist practice that range between $250,000 and $380,000.  That’s pretty astonishing for a piece of software.

So what happens if you purchase your system and you don’t like it?  Most vendors will refund your money if it doesn’t work, or if there is some other failure to perform.* But they probably won’t give you a refund just because it slows you down and you hate using it.  What then?

Your choices at this point are to…

1.            Stop using it, curse the government for forcing you to get involved in EMR, and go back to paper (hundreds of thousands of dollars poorer).

2.            Grin and bear it for every one of your patient encounters for the rest of your career, seeing fewer patients per day and spending your time chained to a system that progressively drives you crazy.

Clearly, either choice is horrible.

I’ve unfortunately met a few pioneering ophthalmologists who’ve purchased EMR systems and either uninstalled them or just stopped using them.  Most spent over $100,000 on their system.  They’d installed the software and hardware, tried to use the EMR with patients, and wound up going back to paper.  Why?  Their system looked good in the showroom, but it wasn’t useable in the clinic.

All of these poor docs had researched their systems, done the demos, visited competitors at conferences, and done all the due diligence that is possible for a busy eye surgeon to do.  They had gotten references and tried out the system, and still they wound up with the big dollar disaster.

This is the scenario that keeps many of us from adopting EMR.  The government is pushing us to spend huge amounts of money to buy an EMR system and use it in our clinics.  They’ll pay us once to defray the costs, but if we choose the wrong one we’re stuck with it.  Most of us have almost no experience using EMR systems in the clinic, and really don’t know what will work and what won’t.  No one taught us in residency about networks and servers, or HIPAA security standards, or e-prescribing, or useability, or any of the many, many issues we have to sort out when deciding which system to buy.  We’re being asked to lay down a huge amount of money for a system that will be hard to back out of if we choose the wrong one.

Pretty scary.

Fortunately, I think there are ways to avoid making a big dollar mistake like this.

The one thing I’ve heard in talking to ophthalmologists who’ve uninstalled or stopped using their system is that they did not choose it based on usability.  Often they’ve let their practice manager or some administrator choose the system for them, or been swayed by “features” that they initially thought impressive or essential.  They didn’t realize the importance of seeing how the system performed with patients.

When I’ve shown our EMR to colleagues, the number one question I get is “will it import data directly from my diagnostic machines?”  Yes, it will, but that’s not the first question I would ask.  In my opinion their question is valid, but the fact that they ask it first reflects their inexperience with EMR.  After these guys have used EMR for a while I bet that won’t be the first thing on their mind.  A year or two after using EMR they’ll be asking:

“How fast is it?”

Very soon after you start using EMR you’re going to have a waiting room full of patients who don’t want to wait.  The lady in room three has talked your ear off and blocked the exit to the room as she told you about all eight of her grandchildren.  You’ve finally escaped but you’re three patients behind and have several procedures coming up.  That’s when you’re going to learn whether you’ve bought a good EMR or not.

Your EMR has to be fast.  Not just faster than other EMRs, but faster than paper.  Fast to learn, fast to use, fast for you, and fast for your staff.  If it’s not faster than your current paper-based system you’re going to see a decrease in the performance of your practice, lower revenues, and patients who are unhappy they’ve been waiting so long.  If it is faster than paper, you’ll be doing more ophthalmology, having more fun in the clinic, and you’ll see your EMR pay for itself.

So here’s my advice: when you are choosing an EMR system, don’t ask the salespeople to demonstrate the bells and whistles.  Ask them to document a routine encounter with the typical patient you see.  Tell them you don’t need them to talk, just document the encounter, code the visit, and sign the chart note.  While they do this, time them.  If they can’t document a routine encounter faster than you can do it on paper, don’t buy their system.**

There are of course other factors than speed.  In my next blog I’ll be talking about some essentials of any system, like security, reliability, certification, interoperability, and flexibility.  Most systems will satisfy these requirements, but usability is the single factor that separates the happy EMR user from the miserable one.

*You can view an example of a vendor’s money back guarantee at:  http://www.nextgen.com/offers/guarantee.aspx.  Notice that they guarantee performance, not satisfaction!

**I raced one of my colleagues on our system.  We each documented an encounter with a patient with refractive error, cataract, and possible glaucoma.  We created glasses prescriptions, entered an assessment and plan, ordered baseline glaucoma testing, coded the visit and signed it.  The computer beat the pen 45 seconds to 51.  I did this with a couple of vendors at ASCRS and no one came in under five minutes!