SAN DIEGO — A consulting group enlisted by the American Academy of Neurology evaluated more than 100 different vendors of electronic health records for their suitability for neurology practices and has provided detailed ratings of the strengths and weaknesses of the top eight performers.
“By 2009, if you don't install [an] EHR [system], you might be out of business,” warned consultant Mark R. Anderson of the AC Group Inc. of Montgomery, Tex. Anderson cited several reasons for this prediction, including government and health plan pay-for-performance subsidization of EHR use, the expectation that providing quality medicine according to standards of care will depend upon information generated through EHRs, and reduced malpractice rates for clinicians who use the systems.
Mr. Anderson's group provides third-party independent evaluations of EHR systems and has done so for other medical associations.
For the current evaluation, Mr. Anderson collaborated with the academy's EHR Search and Selection Committee, a group of eight neurologists experienced with EHRs. The first step in the evaluation process was asking approximately 100 EHR vendors to answer 2,700 questions about the capabilities of their systems, and these claims were validated by the committee. To allow head-to-head comparisons, eight of the top-performing companies were then asked to follow a predetermined series of challenges, which was broadcast via Webcasts to the judges.
The EHR systems were assessed on a spectrum of neurology-related practice needs, ranging from first contact to billing. The criteria included the following capabilities:
▸ E-prescribing. The systems should be capable of handling prescription requests and pharmacy orders.
▸ Incorporating laboratory and test data. This should include radiology reports and images, and the system should assure that the data are collected, alerts responded to, and patients informed. Consideration must be given to who will input the data and how.
▸ Charting. Ideally, a system should accept handwritten, typed, or dictated input.
▸ Data access. Each physician should be able to readily access his daily schedule and individual patient records, including summary sheets and compilations.
▸ Document management. This should include both current data and old records, which must be quickly and easily accessible and must adhere to legal guidelines.
▸ Security. The system needs to adhere to HIPAA requirements and provide confidentiality, privacy, and audit trails.
▸ Networking. The ability to communicate both within and outside the practice should be available.
▸ Reporting. Systems should be capable of reporting to insurance providers and government agencies.
▸ Information access. The ability to access practice guidelines, clinical alerts, published materials, and Internet sources of information should be available.
The neurologists' ranking of the selected EHR vendors is shown below. For more information, see www.acgroup.org
One of the biggest mistakes a physician can make when choosing an EHR system, Mr. Anderson said, is to allow the vendor to demonstrate the product, showing you what they can do—and omitting what they can't do. Another mistake is failing to insist that the vendor configure the system for your practice, train your personnel adequately, and follow up on how well the system is working for you. But the biggest mistake, said Mr. Anderson, is purchasing the cheapest system. “You will not get the clinical and financial return that some more expensive systems have,” he said.
Neurologists have been slow to adopt EHR systems, according to Mr. Anderson. The top eight vendors reported that they have supplied systems to 100 neurology practices, representing about 200 neurologists. He estimates that due to shortages in skilled labor, vendors will be able to add only about 8% more practices per year in the next few years, so physicians may experience delays in obtaining systems once they are ordered, and the delays may worsen temporarily as demand grows.
At a symposium held at the AAN annual meeting, Dr. Michael A. Lobatz and Dr. Jack D. Schim of The Neurology Center, Oceanside, Calif., shared their experiences of having an electronic, paperless office for the past 4 years. They found that EHRs increased the quality of services, increased efficiency, contained costs, improved continuity of care, and increased the complexity of medical care that could be provided to patients.
For instance, Dr. Lobatz said that having an EHR system saves an average of $9 to $30 in costs just to retrieve, replace, and locate misplaced charts. Transcription costs are reduced by typing consultation notes into a laptop computer during the patient visit, and off-site access to patient records is available through a PDA.
Dr. Lobatz and Dr. Schim offered the following advice for physicians making the transition to electronic health record keeping: