Wednesday, December 7, 2011

Book Review: Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, second edition, by Ronald B. Sterling, CPA, MBA, Greenbranch Publishing, 2011,292 pages, $139,1- 800-033-3711

It ain’t over until the Fat Lady sings – until the EHR is installed, functioning, supported, useful, and showing positive results with patients and doctors.

Veteran Physician EHR User

December 7, 2011 - Among technology advances, none is more complicated or uncertain than selecting and implementing electronic medical records.

In 2004, President Bush committed the nation to universal EHRs. The aim, then, as now, was to develop electronic tools to pay physicians based on outcomes, quality, coordination of care, and wellness, rather than just on volume.

According to John Hamalka, MD, CIO at Harvard Medical School, EHRs are essential if the nation is to address “waste”- overtreatment, insufficient coordination of care, excessively complicated administration, overly burdensome rules, and fraud (“The Promise of Electronic Health Records,” Health Care Blog, December 6, 2011). One way to do this, asserts Hamalka, is to compare physician performance electronically.

Unfortunately, a 2011 CDC survey indicated that in 2010 only 10.1% of physicians had “fully functional EMRs/EHRs.” Margalit Gur-Arie, an HIT expert, speculates fully-functioning EMRs will double to 20% in 2012, but no one knows for sure.

One factor driving EHR adoption is the federal government’s “meaningful use” initiative. This initiative will pay physicians a 2% bonus for implementing EHRs and impose a 2% penalty for not adopting EHRs, if doctors comply with a series of complicated rules.

Whatever transpires, selecting an EHR, implementing, living with it, and maintaining it remains a complicated, prolonged, and expensive process.

Enter the book Keys to EMR/EHR Success,Selecting and Implementing an Electronic Medical Record, by Ronald Sterling President of Sterling Solutions, Ltd (www.sterling – The author’s goal is to help physician practices capitalize on technology to improve patient service, clinical operations, and financial results.

The book’s thesis is that physicians underutilize computer systems. At the same time, Sterling recognizes that installing EHRs is a complicated process requiring checklists, understanding of what’s involved, meeting staff, physician, regulatory, and procedural requirements, and negotiating fine print issues.

His message is: nothing worth doing with EHRs is easy. It takes hard work and systematic analysis.

The complexity of the EHR task is reflected in the book’s 12 chapter headings.

1 – Should I Invest in an EHR?

2 – Evaluating an EHR Investment

3 – Your Practice Management System and an EHR

4 – Compiling a Practice Focused List

5 – EHR and Malpractice Risk

6 – Selecting Products to Review

7 – Reviewing Products for Your Practice

8 – Making a Final Decision

9 – Negotiating a Contract

10 – Implementing an EHR

11 – Activating an EHR

12 - Supporting an EHR

Appendix: List of EHR Vendors.

The list of 186 EHR vendors contains vendor phone numbers and websites. The list will be useful to physicians considering purchasing an EMR system.

Readers will find the chapter on “Negotiating a Contract” fundamental and essential, It addresses the nitty-gritty of what can go wrong in a practice of your size and characteristics. In a 17 page table, the author recommends what to ask for and to specify.

My suggestion for the next edition would be that it more fully discuss physician negative experiences with EHRs and obstacles to EHR use, and that it highlight recent advance and refinements – such as speech recognition entry into EHRs; new business models, such as EHRs made “free” through advertiser’s support, and EHR support for physicians facilitating meaningful use adoption.

Keys to EMR/EHR Success is a useful book for physician considering installing EHRs in their practices.


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Every healthcare provider should switch to an EMR solution. Paper based records and prescriptions are a thing of the past now and it would be best for both doctors and patients to take advantage of their features and accessibility.

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