Many EMR vendors casually toss the term "customization" around when describing their software, as if to say that it's easy to tailor their products to your workflows and replicate your facility's paper charts. But can you really, truly tailor your electronic medical records to fit your facility's unique way of doing things? "Ask what exactly is customizable. You may enter into it thinking you can customize a lot of things, but you really can't," says Jan Kleinhesselink, RN, CPHQ, chief quality officer of Lincoln Surgical Hospital in Nebraska. Or at least, not without an added cost.

Define 'customize'
Make sure you know what vendors mean when they use the word "customize." Transitioning to electronic medical records is difficult enough without having to learn a whole new set of forms on top of it, says Jeanne Allman, RN, BS, administrator of The Pain and Surgical Center of Langhorne (Pa.). But don't worry: Most vendors offer at least some pieces of the EMR package that are customizable. Don't expect a completely "out of the box" system that's going to do everything you need it to do without any customizing whatsoever. Achieving an EMR product that essentially mimics your paper documents "under the glass" requires good communication and understanding between your facility and prospective vendors.

Ms. Allman's facility learned that lesson the hard way. When the 2-OR, multi-specialty ASC first contracted with an EMR vendor 4 years ago, the vendor sounded great on paper, but wasn't able to fulfill its promises of delivering forms customized to the facility's needs. "They never went to see their record in use, never spoke to anyone at length about the reliability of the company," says Ms. Allman. When the initial product came back, "we really were not happy with what we saw." The facility ended up abandoning that contract and did an extensive reference check before signing on with a second EMR company. That vendor shared sample forms and flew ASC staff members out to see its EMRs in practice at similar facilities in other states. "I highly recommend that you talk to other facilities that have used" the product you're considering, says Ms. Allman. Websites such as klasresearch.com are another resource you can consult to see how users across the country are rating various EMR products.

A good time to purge
Use your digital transition as an opportunity to not just replicate, but also improve upon your current processes. "Attempting to automate your current processes can be a recipe for failure," says Ms. Kleinhesselink. Use this opportunity to assess which processes are worth keeping, and which are worth adjusting to suit a digital recordkeeping environment.

Start by designing a flowchart that illustrates your current workflow, says Stephanie Diem, RN, BS, clinical director of the Washington Square Endoscopy Center in Philadelphia, Pa. Are you completely happy with it? If so, share it with your vendor and see what they can do to tailor their product to your existing workflows. If not, "design a flowchart of your ideal workflow, and have the vendor try to achieve that."

Cost is a huge concern in the push to go digital, and likely a big reason many facilities are slow to jump on the EMR bandwagon. Ambulatory surgery centers, in particular, are not eligible for any financial incentives from the government to go paperless by 2014. While vendors may wow you with promises to make the transition as smooth as possible by offering "customizable" solutions, be aware that customization often comes with a price. Any conversation you have about customizable elements of your EMR should be accompanied by a discussion of cost, says Ms. Kleinhesselink. "Ask what's included and what's going to cost extra. You're going to run into it with every vendor, so you want to know up front." For example, Ms. Allman's facility gets charged by the hour each time it wants to tweak its EMR forms. In the end, getting an EMR that's truly tailored to your facility's needs may require a bigger investment, but Ms. Diem says it's worth it. "With EMRs, you definitely get what you pay for."

Your role in the process
Once you've figured out what can and can't be customized, and how much extra it's going to cost, the next question is, "Who's going to customize it?" Will the vendor simply take your paper records and replicate them in electronic form? Or do they require you to go in and create customized forms and pages or make changes to existing forms? It will probably be a combination of both approaches, but most EMRs will entail a certain degree of data entry up front to load the system with information specific to your facility, such as materials databases. "The data entry can take quite a bit of time," says Ms. Kleinhesselink. Find out how much of that responsibility, as well as ongoing support, will rest on your facility's shoulders, and how much the vendor will provide (and at what cost).

The time you invest in building your customized EMR, like the money you spend on it, is significant, but it should pay off eventually if done right. "It's a very long process, about 3 to 6 months," says Ms. Diem. To ease the transition, Ms. Allman recommends starting with one specialty and then expanding your paperless transition from there. Whether you go all-in or take a piecemeal approach, expect to go through several drafts and revisions before you get it just right. "If you want to make it fit your workflow, that's what it entails," says Ms. Diem. "If you want an EMR that's going to be your EMR, it's really challenging."