Buying an EMR is like buying a car: The best way to check it out is to test drive it and talk to other people who have the same model. Ask your vendor rep for references. Then, go to those centers, watch how they use the system and ask questions. Here are 9 that can save you hassles and headaches in getting an EMR up and running.

Can I run my facility's data in the demos? When reps demonstrate their systems, everything works perfectly. But remember, they've done that demo 100 times. They've already fixed what went wrong in previous demos. Only when you input your own information will you get a truer picture of how the system will work in your setting. Test the interfaces with your data and see how they exchange the data between software.

How does the interface work? How an EMR works with your existing systems is vital because you'll most likely want to keep your existing software. Just about every system speaks the HL7 language. Reps will tell you, "Don't worry, it's HL7, it'll talk." But, will it transfer all the information you need? How easy is it to migrate the old data to the new system? If you can't get your data into an EMR or if you have to key it in, that can cause unplanned headaches, delays and costs.

What happens if the interface drops? Can you key in information until the interface is back up? Does the system hold all the information it has already exchanged? Can your system run at all without the interface? This is basically your disaster plan for a system shutdown — but you need to know what that involves before, not after, it happens.

What are the data storage requirements? A vendor will give you basic specifications for a system, but will that accommodate practice growth? Obviously an ASC with 1,200 patients a year won't grow as fast as one with 8,000, but you have to think about raw storage and backups. I recommend redundancies between off-site and on-site backups. After a server failed last fall, we started doing bare metal backups. Bare metal lets you load all your server information on a new server and it doesn't care what version of the operating system or type of server you're running. As a smaller ASC, you may have to take what you can get for a server just to get back up and running again. Backups and data expansion are an expense that you might not think about when purchasing a system, but if your system is a memory hog and you didn't plan for expansion, it'll cost you.

What are all the recurring costs? Some systems might offer a low purchase price but high down-the-line costs for maintenance, service and upgrades. Know your recurring costs. Many surgical centers don't have a formal IT department, so what does the vendor expect you or your IT person to know? Determine how much database maintenance your own team can do so you're not paying the vendor or local IT consultant for everything.

Can I customize input screens? Being able to customize your input screens is critical, especially with the pending Medicare quality measures. We don't know what they'll be, but we have ideas. Having the flexibility to add a question or a check box to your input screens to track measures could be important for meeting those Medicare requirements. Not all systems give you complete autonomy with customization. Ask how much it costs to make adjustments to input screens, who can do it, and how complicated it is to do.

Can I customize reports? Usually a system has a canned set of reports with a selection of customizable reports. But what happens a year or two later when you want to generate more types of reports or capture another data set? Can you do that? And if you can, how easy is it? Can you drill down to the information you need?

How often do new versions come out? This is not a deal breaker, but it's helpful to know if you can expect updates a few times a year with tweaks or less frequently with significant upgrades. Find out how easy the updates are to install. Some releases launch from the server and you are done. Other releases install on each work station individually. Because of the burden we don't install every release, and instead wait to get a bunch of releases to do them all at once.

Can we stay in touch? I learned the most about our own system just by talking to my peers at other facilities. It's amazing to find out how other institutions have figured out workarounds for the same problems you've had. Talking with our peers also provides feedback to the vendor for tweaks and fixes in the newer versions. There's strength in numbers. If vendor reps hear the same complaints enough, they'll find ways to make the EMR better for everyone.