EMR Product Comparison Scorecard
How to use:
1. After determining EMR goals and completing work flow analysis, use "EMR/Work Flow Needs" list and other resources to create a high-level sketch of the desired future work flow
2. Based on EMR goals, work flow analysis and sketch of desired future work flow, add any other "EMR/Work Flow Needs" to this scorecard that are not already listed
3. Consider each "EMR/Work Flow Need" and check one of the boxes: Critical, Desired or No Need
"Critical" means the EMR must meet this need or it will not be considered for purchase
"Desired" means that it would be nice for the EMR to meet this need, but it is not an absolute essential
"No Need" means that the EMR product does not have to meet this need
4. Qualify the degree of impact (high, medium or low) that meeting this "EMR/Work Flow Need" will have on Work Flow, Quality and Revenue Cycle in the practice
5. Numerically rank the importance of each "EMR/Work Flow Need"
Alternatively, determine what your "Top Ten" priorities are from the list of EMR/Work Flow Needs
6. Use this scorecard to facilitate your comparison of EMR products
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
Example: The XYZ Functionality and Process
Description of the functionality and/or work flow √
Example High Medium Low 7 √ No √ √
CCHIT-Required EMR Functionalities
The EMR at a minimum has all the functionalities that are
required for CCHIT-certification (see the full list of certified
ambulatory EMRs and the functionalities that are required on
the CCHIT website: www.cchit.org)
Practice Management System
The EMR includes an integrated practice management (PM)
system (NOTE: an integrated EMR/PM system is important for
several reasons such as streamlining clinician work flow and
providing internal linkages between quality data entered in EMR
with patient demographics, ICD-9 codes and other data entered
in the PM system
If the EMR does not include a practice management system,
then interface your PM system to the EMR (NOTE: the interface
will typically cost extra and is not likely provide the same
degree of functionality and satsifaction such as an integrated
system- but at least the interface will allow the clinician to work
in one system rather than an EMR to document in and a PM
system to enter a charge in)
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
Check-In Processes
Eliminate forms you give the patient to complete (EMR should
Example
provide ways to get all information either directly entered or
scanned in for the clinician to then view electronically)
Real-time eligibilty verification/ pre-authorization
Collect co-pays at check-in in EMR
Use real-time eligibility checking/verfication (allows practice to
redesign a more streamlined process with cross-trained staff to
eliminate common bottlenecks due to this process)
Track HIPAA forms in the EMR
Use an electronic notification system within EMR that alerts
physicians or staff when a patient is ready for each next step
(i.e. "ready to be seen" or "ready for check out")
Encounter Documentation Functionalities/Work Flow
EMR allows the paper chart to be eliminated completely (this
does not mean that every office note is directly entered in the
EMR, but it does mean that anything completed on paper must
be able to be scanned into the EMR)
Use documentation templates instead of dictation or written
notes
EMR vendor provides documentation templates to use or modify
as needed (to decrease the work of creating templates from
scratch)
Develop customized documentation templates (unique to the
physician's specialty and desired documentation work flow) that
streamline the documentation process
Configure the EMR documentation templates to allow for
"Normal" findings to be defaulted in for the FH/ROS/H&P/PE
Configure the EMR to "link" these documentation templates to
specific types of visits, Chief Complaints, Reason For Visits,
Diagnoses and order sets to streamline the documentation and
ordering processes
Build drop-down lists or "pick lists" within the electronic
documentation templates to streamline documentation
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
Use "preference lists" for fields commonly entered such as:
diagnosis, chief complaint/reason for visit, orderable lab tests
and other orderable procedures
Example
Incorporate a streamlined process to electronically
validate/reconcile medications and allergies each visit
Install a wireless network and use wireless devices for at least
some point-of-care documentation (for flexibility and efficiency)
Provide online forms for patient to fill out before visiting office
Use patient education material provided from within the EMR
Use automated reminders for upcoming patient appts and
preventative interventions that are due
Allow for some free text to be used within templates
Use speech recognition for free text fields
Use handwriting recognition for free text fields
Use an incoming fax server to streamline the sorting process
(instead of printing faxes, reviewing them and then scanning
them into the EMR, the fax server allows you to go straight to an
electronic review of the information and then electronically
sending the document to the EMR)
EMR Display
Configure reminders in the EMR for Preventative Care items
that are due (and fit the reminders within the work flow of an
office visit)
Implement a remote access tool and/or web-based smart phone
tool that allows on-call physicians to use home computers or
smart phones to display EMR
Labs can be displayed graphically
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
EMR displays a problem list based on ICD-9 codes Example
Problem list configuration can be activley managed by the
clinician (i.e. when an Active problems needs to be changed to
a "Chronic" or "Past Problem" or a problem not based on ICD-9
needs to be entered
Growth Chart measures can be electronically entered and
displayed
Immunization Record can be configured by practice and data
electronically entered and displayed
Interoffice messaging
Capture all phone messages in the EMR
Be able assign and forward messages entered in the EMR to
the physician or staff who are responsible for follow-up
The interoffice messagiing tool provides a "message board" for
each individual in the practice
Tasks can be entered and assigned in the EMR messaging tool
Tasks can be prioritized when entered in the EMR
Work flow is built into the interoffice messaging tool to allow
tasks to be completed, forwarded/assigned and tracked
Patient-Doctor Messaging
The following methods of patient -doctor messaging may be
included or be "add-ons" to the EMR:
Patient Portal
Secure messaging between doctor-patient
Answering phones/messaging
Encrypted email
Orders and Results (Lab, Radiology, Other)
There is an interface between the EMR and the major
laboratories and radiology centers used by the office to reduce
paperwork/faxing/routing/manual reviewing/filing
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
Electronic results coming in can be flexibly routed to the
ordering physician, the primary physician or to others in the
practice's redesigned review process for electronic results
Example
Configure a structured template screen in the EMR that allows
the staff to enter lab results done at the office
Configure the EMR to auto-collect charges based on the
lab/radiology orders
Configure the EMR to enable tracking of specimens that are
sent to an outside lab that is not interfaced (and be able to view
a list of pending results)
Order sets/protocols can be linked to specific types of visits,
Chief Complaints, Reason For Visits or diagnosis to streamline
ordering
Use a new electronic process to audit and track pending results
EMR should facilitate the creation of a "lab letter" to send to
patient
Scan all paper lab and radiology reports into the EMR
(preference, however, is to interface with labs)
The scanned results preferably get indexed into the regular Lab,
Radiology or other "Results" screens of the EMR instead of into
a different "Scanned Documents" screen
Similar to paper-template order sets, develop sets of evidence-
based order sets based on the physician's specialty and with the
consensus of all physicians in the group (reduces clutter when
looking for order sets and streamines the ordering process)
Create order sets that include not only the usual orders but also
a small number of optional orders that are sometimes but not
always included (if possible create the order set with a default
selection of the usual orders and a required "check mark" or
other active selection of the optional orders)
Create order sets for orders commonly ordered together and link
them to Chief Complaint or Diagnosis (i.e. abdominal pain order
set and CHF order set)
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
Link order sets to Reason For Visit, Chief Complaint and/or
diagnoses where possible to streamine ordering
Example
EMR stores video or pictures produced by the practice
Transcription
There should be an interface between the EMR and the
transcription system used by the office (NOTE: it is
recommended to use template documentation to capture quality
data for quality reporting purposes; OCR transcription may be
considered if a free text reporting tool also purchased for data
extraction and reporting
Prescriptions and Rx Renewals
Use e-prescribing (your EMR sends Rx directly to pharmacy's
Rx system) to reduce time spent refilling prescriptions (pulling
charts and calling pharmacies) and decrease Rx errors
Real-time drug formulary checking and med reconciliation using
Surescripts or similar functionality
Build "order strings" for commonly ordered medications to
provide a 'pick list" of commonly ordered medication
dosages/routes/frequencies (streamline ordering process)
Reduce the number of drugs available to pick from in the EMR's
drug formulary to drugs prescribed by the practice (i.e.
medications that are prescribed very rarely or not at all are
unecessary clutter" that make finding and selecting the
commonly prescribed medications more cumbersome than
necessary
Use EMR electronic prescriptions tool and fax prescriptions to
pharmacies (this is an option if EMR does not have e-
prescribing ability)
Referral Management
Use a referral management system to streamline tracking and
follow-up
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
EMR maintains a list of referral sites, insurance plan approval
parameters, reasons for referral and referral histories Example
Track referrals through reports based on patient, doctor,
reason/diagnosis and referral sites/providers
Appointment Scheduling
Configure appointment scheduling templates to meet each
physician's individual needs and preferences
Automatically prevent overbooking of appointments
System allows for manual override of Overbooking but can be
limited to specific staff within the office (role-based access)
Appointment scheduling is flexible enough to meet the desired
work flow of the practice
Check Out
Staff responsible for check-out verify the charges as the patient
visit concludes
Physician enters charge in EMR (replace paper Superbill)
Check out staff receive electronic communication of check out
information-- referrals, f/u appts and tests
Electronic referral management that tracks referrals
Physicians are able to communicate electronically to the check-
out staff all of the information needed follow-up needs such as
referrals, appointments,and tests as well as charges.
Patient education materials can be electronically provided
Coding and Billing
Use "intelligent charge capture" EMR functionality (this is a
decision support tool that "checks" E&M codes against the
documentation entered in EMR templates to improve the
accuracy of charge entry to improve reimbursement
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
CPT codes are pre-loaded Example
ICD -9 codes are pre-loaded
ICD-10 codes will be pre-loaded when available
An electronic Superbill is used which replaces the need for a
paper Superbill; it is customizable to meet practice's specific
requirements
An electronic "cash box" is used
Staff responsible for check-out verifies the charges as the
patient visit concludes
Reconciliation of appointments, charges and cash can be done
electronically at the close of each day
Month-end closing is performed electronically and completed
within the first three days (timeframe may vary by practice) of
the month
Population Management Reporting Requirements
Design standardized documentation templates that capture the
specific quality data needed
Use the EMR/practice management system to capture the
needed demographic data and other non-quality metrics
Use a reporting tool that extracts the needed data into a usable
report
Data entry/capture and data reports can be customized to meet
future needs
Desired data can be extracted and stored in a separate data
repository, registry or warehouse where report processing
occurs
Work
√ √ √
EMR/Future Work Flow Needs
Quality Revenue Priority Vendor Vendor Vendor Vendor
Flow
Critical Desired No Need Impact Impact Rank A B C D
Impact
Quality data can be extracted and exchanged through health
information exchanges using accepted, standardized fomats
(HL-7 CCD/CCR format or others as specified) such as
Example
immunization registries, P4P inititiaives, specialty registries,
CMS "Meaningful Use" reports as they are developed and other
future HIE uses
Quality data input from external systems can be captured for
quality reports (i.e. Pulmonary Function Test results or EKG
results from separate systems)
Other Requirements
Desired interfaces to other systems (list separately and provide
known specifications)
Data conversion of current electronic data (specify which
systems and type of data, i.e. pateint demographics in a
practice management system)
Client-server model
ASP model
Role based access provided
Electronic signature
Daily back up of data is provided
Compatible with LOINC, SNOMED CT, CCR/HL7 CDA and
other HL-7 specifcations
Disaster recovery plans are satisfactory
This Scorecard is an adaptation of work by the Doctor’s Office Quality- Information Technology initiatives as documented in a workbook entitled, "A Systems Approach to Operational Redesign
Workbook." prepared by Masspro, the Medicare Quality Improvement Organization for Massachusetts, under contract with the Centers of Medicare and Medicaid Services (CMS) agency of the US
Department of Health and Human Services (HHS) in June 2006. Accessed on July 29, 2009 at http://www.masspro.org/docs/tools/DOQIT%20WB%20for%20WEB.pdf
Office Processes Checklist
Processes
Answering phones
Making appointments
Scheduling procedures
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