Worth the wait: the choice of an EMR is one of the biggest a physician practice will make. C. Kerry Stratford, M.D., of St. George, Utah, performed the weighty due diligence necessary to make the right decision

Health Management Technology, Jan, 2005 by Robin Blair

When it comes to big-ticket items, selection can be arduous. For physician practices, selection of an electronic medical record (EMR) is one of the biggest decisions a practice can make, and it can't be made by the practice administrator. An EMR must be tried and tested by the physicians who will use it; it must be selected with their preferences and technology savvy in mind; and it must deliver the benefits they want.

C. Kerry Stratford, M.D., president of St. George Clinic in St. George, Utah, and chairman of the Utah Medical Association's technology committee, took nearly two decades to make the right choice, and he's glad about that. It wasn't for lack of interest or knowledge. Stratford was fascinated with information technology as a college student with an engineering background, before entering medical school. Twenty years later, as a family doctor, he remains focused on what's practical, usable and affordable in an office setting.

For years, Stratford followed the maturation of healthcare information technology, waiting for the majority of his EMR requirements to be met. He used the pre-purchase interim to help grow the medical practice, refine his list of EMR requirements and assess each physician's readiness to adopt IT.

Functionality was a huge issue in Stratford's selection of the eClinicalWorks EMR from eClinicalWorks, headquartered in Westborough, Mass., but it wasn't the only issue. Maturity of the supplier marketplace was also important, right along with price, speed, user interface and system integration.

"The right electronic medical record allows me to get the information I need anytime and anywhere I need it," says Stratford. "Physicians have been promised this for years," he said, but earlier systems, especially DOS-based systems, failed to deliver. Even as technology matured, Stratford says the functionality he wanted was eventually created, but earlier systems were still too slow for him. "You can't have technology that will slow doctors down," he says. "This can't be your father's EMR."

Serious Shopping

By the time he went seriously shopping, Stratford knew exactly what he wanted in an EMR.

Integration with practice management. There's a big difference between interface and true integration, according to Stratford, and he knew that he wanted the latter for St. George Clinic. Throughout its growth stage, the practice had used a big-supplier billing system, but didn't always find vendor support satisfactory. When the clinic moved to a larger office several years ago, Stratford believed it was an opportune time to reassess all systems.

At that point, he grappled with the practice management (PM) system and the EMR--and which came first. "Office staff are more flexible than physicians," he says, "and can adapt more easily to new software. At that point, I decided to de-emphasize the PM system features and concentrate the search on the best EMR product, keeping in mind that we needed robust systems for both that worked together for maximum financial efficiency."

Price. Naturally, price was an issue. Stratford says that throughout his research, many large vendors offered huge discounts on EMRs, but final costs were still two or three times what he paid for the eClinicalWorks product. Price was important for more than just the clinic's finances. Stratford plays a leadership role in professional medical association activities in Utah, and he knew that the system St. George Clinic implemented could be a model for other physician practices that might follow suit.

Vendor strength. Bigger isn't necessarily better, but neither did Stratford relish charting new territory. Some of the vendors he considered were headquartered in the East without much visible presence in the West. While he didn't necessarily want a big-gun supplier, he did require a vendor with national presence, one with some longevity, a proven track record and a good reputation for support.

Tablet technology. Stratford has been a tablet advocate for years now, acquiring one as early as October 2002. With the tablet PC, he became involved in using and customizing templates as preparation for how he wanted to use an EMR. In May 2003, he was named a first-place winner in a Microsoft Corp.-sponsored competition for healthcare providers making innovative use of Microsoft Office technology, using his tablet PC.

Live Lessons Learned

Much of Stratford's serious shopping consisted of travel, site visits and hands-on experience. "I got intensive about it," he admits. A couple of years ago, he attended an American Academy of Family Physicians conference which featured an exhibit floor with "dueling EMRs," and that was "a good place to start," he says.

In the fall of 2002, he began searching with an eye toward purchase. "I spent a lot of time on the Internet in doctors' forums," he says, "to determine what my peers liked and didn't like. As sites went, I liked EMRUpdate the best because it allowed for comparison of EMRs by actual users. Visitors to the site must state whether they are a physician or a vendor. I also used the TEPR awards and KLAS reports and looked at other rankings such as those from the AC Group."