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13 responses to "Clinical Process Review Before an EMR Implementation"

1. # SRM commented on October 17th, 2009:

   In order to efficiently implement any automation, it is recommended to understand the current process and put in place a new process to support the current “work flow”. This is done in every IT project with very good results.

2. # John commented on October 17th, 2009:

   I think you could have more aptly phrased it that “In every IT project with very good results, this is done.”

   Sadly, too many clinics miss these important details and their EMR implementation fails.

3. # Casey commented on October 18th, 2009:

   You know I agree. The work flow and clinical review MUST be taken in to consideration when looking to replace the current with the new.

4. # Bill Horvath commented on October 19th, 2009:

   I like the phrase “Clinical Process Review” as well.

   We go at this problem by conducting a needs analysis as part of an implementation. We need to figure out who’s doing what, and how, when, and why there doing it, before we can tell the practice’s management how implementing an EMR is going to impact their workflow, and what steps they can take in preparation in order to smooth the transition. (This is also how we figure out how to customize the software to suit the needs of any particular office.)

5. # John commented on October 19th, 2009:

   Bill,
   I’d be interested to hear more about what customizations you offer to your customers. How far will you customize the system? Honestly, the best EMR software I’ve found has customization of the EMR as a major part of their EMR.

6. # Bill Horvath commented on October 19th, 2009:

   We’ve customized the software in a variety of ways in the past to suit the needs of particular clients, from adding buttons to the Control Panel for accessing unique functions or items, to providing a treatment protocol catalog feature for an oncology group that shows up in several places in the system. Another frequent request is hooking up to lab equipment so the data can be directly imported into charts, which is something I’m sure most EMR vendors can provide.

   (FYI, a side benefit of customizing the software for each client is that we don’t have to charge sales tax. Sweet.)

   Not to get too technical, but one of the nice benefits of loosely coupling the software components and making heavy use of interfaces is that it’s easy to substitute modules on an individual-client basis.

7. # John commented on October 20th, 2009:

   The point about not having to charge sales tax if you’ve customized the software is really interesting. That’s why a good accountant is worth the money.

   Interfaces are great when they work well. It was one of the happiest days of our EMR implementation when our lab interface was complete and we no longer had to pass around paper lab results which then needed to be signed and scanned. Electronic lab results is 100 times better.

8. # AXEO SYSTEMS commented on October 20th, 2009:

   be careful with the sales tax angle here; remember you’re guilty until proven innocent; ask anybody that has fought the installation vs. fabrication issue

   if this angle worked, software vendors would charge a buck for the product and call everything else, the custom templates, and setup, etc tax free “installation” type labor

9. # AXEO SYSTEMS commented on October 20th, 2009:

   you have lots of new EMR products treading on thin trademark ice already; the sales tax penalties and interest can be murder

10. # Bill Horvath commented on October 21st, 2009:

    We modify the source code for every customer, so I’m fairly certain we’re meeting the letter and spirit of the law, at least here in Ohio.

11. # AXEO SYSTEMS commented on October 21st, 2009:

    re: sales tax

    John, you might want to follow-up this thread and add it to your inventory. Not a big issue in the greater scheme of things but nonetheless, can be a big gotcha.

    For example, in some states …

    “The vendor of the custom computer software program must pay sales or use tax on the cost of all materials used to produce the custom software.”

    Lots of pitfalls. Could even get through to the provider as a Sales AND Use Tax issue.

12. # John commented on October 21st, 2009:

    Axeo,
    I think I’ll leave this discussion to the accountants. Each state is different and so too much to consider.

    My recommendation is to get a great accountant and do what they say.

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