WISE CHOICE With all the EMR vendors out there, satisfaction may just be a matter of finding the right one.

The potential benefits of EMRs have been touted for years, but a recent survey of 255 Outpatient Surgery Magazine readers shows clearly that the medical community is in the throes of a love-hate relationship with electronic documentation. Some administrators effuse about how easy it is to share data, about how they can generate detailed reports with just a couple of clicks, about improved efficiency, about additional case loads and increased revenue — some even rave about how much their surgeons like their systems.

Unfortunately, many readers also didn't hesitate to complain about the technology taking focus away from patient care, about it slowing down charting, about it being difficult to adapt to changes in documentation needs and about it containing user interfaces that are more irritating than intuitive.

Why the disconnect between the purported potential of EMRs and the technology's real-world performance? And what can you do to make sure your facility takes advantage of healthcare's paperless future?

SCREEN SAVERS EMRs offer a wide range of benefits if you tap into all they offer.

Looking for support
Many vendors are competing for your EMR dollars. Make the right choice and you're on your way to virtual happiness; make the wrong one and misery awaits — maybe, that is, until you acknowledge failure and try again.

"Our first system was too cumbersome and really not friendly at all," says Kathy Hummel, RN, manager of the Gateway Surgery Center in Edwardsville, Pa. So it was back to the drawing board.

"Then the second was a nightmare," she says. "It was so slow. You'd click on something and then literally count the seconds, waiting for it to respond." Had Ms. Hummel's center stopped there, it might still be among the miserable. But good fortune and increased awareness struck when a new corporate partner brought in a different system. "The one we have now is absolutely amazing," she says, ticking off a long list of benefits. "Each area is so easy to put in information. It's beautiful. Oh, and another thing: It codes ICD-10."

Of course even the best systems aren't just plug and play, which points to another key issue. An EMR will likely be only as satisfactory as the support and training that comes with it. And most folks say they're somewhere below thrilled when it comes to what they're getting. A thin sliver of respondents (11.2%) rate their vendors as excellent in training and support. And only 28% are willing to say their support is good. That leaves more than three-fifths who say it's either only fair (35.6%) or downright poor (25.2%).

For Ms. Hummel, training and support with the new system set the tone. "It was so easy," she says. "There was a tutorial for everybody to go through at their own leisure, and (the vendor) had staff here for 2 days after we went live."

Strong backup also factors heavily into the overall satisfaction that Kathy Tafoya, RN, clinical nurse manager at Saginaw Valley Endoscopy Center in Saginaw, Mich., has with her system. "We have support 24/7," she says. "If someone can't get on the EMR at 6:30 in the morning, I call them and they get on remotely and fix it. We also have a company that takes care of our server. They have to be able to communicate and resolve issues, and they do. That's important."

Patricia Keenan, RN, CASC, administrator of Safety Harbor Surgery Center in Clearwater, Fla., echoes that enthusiasm. "Technical support is just a phone call away," she says. "They can log on and assist us with any problems we have and usually resolve them before the phone call is over."

Compare those experiences to the support nightmares others describe, and it's easy to see why opinions diverge so dramatically. "Our EMR consultants have the worst customer service," says Jill Crump, RN, CNOR, director of surgical services at Howard Memorial Hospital in Nashville, AR. "They never follow up on resolutions. They never call back. We have to take all the initiative."

Plenty of pluses
If you're among the dissatisfied, disillusioned or poorly supported, it's fair to assume you're missing out on some substantial benefits associated with EMRs.

For example: "Once we schedule a patient in our management system, it automatically prepopulates into our EMR," says Ms. Keenan. "Whether you're in pre-op, the OR, a procedure room, or in PACU, information is immediately accessible to everybody at any time. Pre-op information is available, allergies have already been pre-populated, the medical history is in there." She says no matter what area of the facility you're working in, you can see everything that's taken place with that patient.

Customized reports are also easy and helpful, says Denise Wilson, RN, BSN, patient care clinical coordinator at Parrish Medical Center in Titusville, Fla. "We can see any trends we're having that might be leading to delays," she says. "Is it because we're having issues with instrumentation, or maybe because the H&P isn't being done right? Block utilization is another report we run a lot. Physicians like to have that data in front of them instead of us just telling them. Now it's a lot easier because it's all in one system."

Even physicians, probably the toughest critics, can be made to love and appreciate EMRs if their lives are made easier.

"I sat down with our physicians and showed them how to set up favorite order sets," says Ms. Wilson. "We do a lot of lap choles, and a lot of general surgeons have their favorite post-op instructions. Or they might have their standards for post-op hip fractures or total knees. Now they can just click on their preferences and get exactly what they need."

The same goes for physicians at Saginaw Valley, says Ms. Tafoya. "They can make their own templates and personalize a lot of their own areas," she says. "If they have something they would always dictate, now they have it in the EMR and can just grab it and pull it down. It takes them less than 3 minutes to do a complete chart and sign it off and be done." That is boosting the facility's bottom line. "I could not imagine being able to do the case volume that we do if we had to go back to dictation or the old way of practicing," says Ms. Tafoya.

If there's anything in the EMR the doctors at Safety Harbor Surgery Center don't like or want changed, says Ms. Keenan, the vendor is "able to work through everything on the phone and update it right then and there." Her docs, she says, push a button and get a personalized dropdown menu that can be pre-populated, so they "only have to hit a couple of checkmarks, unless there's something unique about the case."

HELP LINE Most readers say they could use better training and support from EMR vendors.

Consider the possibilities
If you can imagine it, there's a good chance your EMR can do it. But only 16% of our respondents say they're "very confident" they're using their EMRs to their maximum potential. Sound familiar? What benefits might you be missing out on?

"We worked with our vendor on lab work requisitions," says Ms. Keenan. "Now if we need a biopsy from an endoscopy case, the complete demographic information is already there — the patient's name, the procedure, the date of the procedure. You just open up one little screen, put in one bit of information and click a button. It prints out your lab request, your demographics and your labels to put on your specimen container. We used to have hand-write all that."

Billing has also gotten faster and easier, says Ms. Tafoya. "We don't have any outstanding orders or dictations that need to be signed," she says. "So we can bill immediately, the day of. We send out our report to the billing company and they bill right off of the report. And the primary care provider gets the report electronically that day."

What else can you imagine?
"I had a case where one of our docs was interested in buying into the center," says Ms. Hummel. "He needed to know how many patients he'd done here since he started. There are 35 or 40 different kinds of reports I can do like that. I just look down the list, see 'patients by provider,' entered his name and the date range, and click, it gave me the number."

And there's always room for improvement. Several upgrades are coming soon at Saginaw Valley, says Ms. Tafoya. "If a patient has been here within the previous 30 days, the system will automatically transfer their data from their last visit to their new record," she says. "Then we can just make adjustments if needed. Currently we have to enter all that data again. The EMR will also be able to generate a BMI where we just had height and weight previously. It's also going to be able to report on the yearly audits for Medicare."

Hate it or (at least eventually) love it, EMRs are here to stay. "We have to keep up with advances in technology," says Ms. Wilson. "That's the way we're going. We need to be able to keep up with other facilities, both in our area and nationally." OSM