When you click  This is a difficult question to answer. EMR's come with a variety of features and are somewhat dependant on the size of your practice, the number of practice sites involved and the nature of your specialty. Most users will tell you that the cost of the EMR is rapidly recovered by the improved billing and collections features of the programs.

The EMR is a computer-based medical record that is specific to one physician, practice or organization. It is the record that a doctor maintains on his or her own patients, detailing personal information, medical history and diagnosis. It is often integrated with the medical business software that manages activities such as billing and scheduling.

Physicians have always looked for ways to improve the delivery of care to their patients. An EMR system, carefully selected and wisely implemented, can help in many areas and offer a good return on investment. Unlike paper records, the EMR rapidly and efficiently preserves critical medical information. This is important, as the art and science of medicine is practiced within an information driven environment and most of the information in a clinical setting is based on patient charts and related records. Physicians talk about the tyranny of paper, and problems such as not being able to locate a paper chart or the "front sheet" not being up-to-date.

In addition to eliminating many of these concerns, the EMR can improve management of chronic diseases by making patient data more easily accessible. The physician can program reminders about periodic tests or checks that need to be completed in chronic illness management.

There is an expectation that to provide quality care physicians should comply with increasingly complicated clinical guidelines. Computer hardware and software are good enough now that the EMR applications should not impede the provision of care, but in fact help the physician meet expectations with respect to quality care by, for instance, linking clinical support tools such as guidelines with care for specific patients. An EMR also permits a physician to show patients specific test results in comprehensible formats. Patients who see their lab results drawn in a graph, for example, demonstrate markedly improved understanding when compared to those whose test results are relayed verbally or just written on a piece of paper.

The EMR can also help reduce medical errors, especially medication-related errors. As more new drugs come on the market, it is increasingly difficult for physicians to be aware of all the potential adverse effects. The very low rate of reporting adverse drug events is also a concern. An EMR with a drug interaction module could be expected to reduce adverse events, and offer an easy means of reporting an adverse drug reaction. Generating prescriptions by computer will reduce medication errors, result in fewer inquiries from the pharmacy and save time in the physician's office.

Yes. By the judicious use of interfacing your EMR with hospitals, lab testing companies and so forth you will be able to share appropriate health information so as to provide the best possible patient care.

If your practice management program is different from the EMR you install, it will be possible to interface both programs. If you do not have either an electronic practice management program or EMR consideration should be given to identifying the same vendor for both. However, connecting two different programs can be accomplished.

A common mistake when looking at EMR systems is to underestimate the power and complexity of the functions that physicians require. Physicians do a lot of things during the patient encounter; the difficulty is in recording everything that transpires. When you assess an EMR application check if the workflow of the program suits your practice style. It takes several hours at least to work through different scenarios to assess how the EMR system works. Dont discount a program because it looks too complicated; users who work with these programs on a daily basis soon appreciate the extra features that looked complicated at first.

Ideally the computer system should be designed to be one step ahead of the user. Functions you want should be in plain sight, and you should not have to search through multiple screens to find them. The ability of various parts of the EMR to work with each other or the integration of different components is key to a high-level EMR. Avoid programs that require data to be re-entered for separate modules; data entered during the physician encounter, for instance, should pass through to the billing application. Such integration depends on how comprehensive the system's reference coding is. When evaluating systems, determine how exceptions and changes are handled.

Are there enough codes to allow your staff to capture the necessary information without having to shoehorn data into a limited number of fields? It is common for users to say they do not want a lot of codes, but this comment reflects not so much the wish for as few codes as possible but bad experiences with poorly designed interfaces.

Select a system that can communicate with others, and consider how well the system imports and exports data. It is also important to learn about the vendors' demonstrated ability to provide service to clinics similar to your own.

Even though EMRs are still at the earlyadopter stage, there is a good understanding of the costs involved. Service agreements will cover hardware concerns, but you should also factor in replacement costs since it will be a stretch to keep the same hardware longer than three or four years. One approach is to get more capacity in terms of speed and hard disk storage than you need; then the system may meet your needs for a longer time. The other approach is to get an EMR that is just fast enough and has barely enough storage space. You will need to upgrade sooner. Remember that as the office gets more proficient in using the computer system people will want to do more and more on the computer. This could include photos, telemedicine, messaging with patients, patient access to the system and other functions that you did not consider at the time of the initial purchase. A big decision is whether to have your own server or if the server function should be housed at a remote location. Each approach has benefits and costs.

There will be costs related to training you and your staff and you should consider having extra staff during the transition period. Once the staff is trained, turnover will be a concern; in addition, there will be a continuing need to keep staff trained and retrained as new versions of the application are released. Expect to see lower productivity for about six months as you get used to the EMR, but this will be followed by increased productivity. Other hidden costs can include wiring changes and subscription services. These could include access to Internet and subscriptions for medical reference and drug interaction programs. When making comparisons, bear in mind that paperbased systems also have hidden costs.

Daily routines should change to maximize the use of the computers. Paper routines should be rethought, not just automated. The main EMR functions that physicians want are lab results and prescriptions. Visit notes are the hardest part for physicians to get started with, and it is a big day when charts are no longer pulled for each office visit. At the outset some effort should be made to populate the database with as much historical data as possible. One year of lab results, prescriptions and visit dates with the billing diagnosis would be extremely useful. In addition, the office computers will need to be networked so that the physician can use the computer at the same time as the staff. Make sure there is enough desk space for all the required hardware.

Security relates to corruption of the data and the ability to access the patient information in the future. Privacy relates to controlling access to the patient information, making sure that only those with legitimate reasons can access patient information. The federal governments new Personal Information Protection and Electronic Documents Act (PIPEDA) establishes a set of rules that must be complied with when collecting, using, disclosing and retaining patients personal information in the course of business. It is still uncertain how PIPEDA applies to health data. Work with a security expert and your EMR vendor before and after purchase to ensure that your chosen system has the necessary safeguards. Once operational the system should be backed up at least daily. If you are using tapes you need to have more than one backup tape. It is probably wise to make CD-ROM copies that can be archived for years. An alternative is to do backups over the Internet to a server in an offsite location. Physical security is important, for someone could walk off with hardware such as a notebook computer. Wireless security is another major issue that requires expert advice. You should have a backup power supply for the main computer in the office. Redundancy in computer hardware becomes more and more important as the office depends increasingly on the computer, and it will be necessary to have a contingency plan for a sudden and unplanned computer shutdown.

The general opinion is that it is not worthwhile to convert all existing paper records into an EMR. However, it is worthwhile and probably necessary to bring forward selected information of enduring interest from the paper record, such as data about allergies, current medications, problems and past surgeries. When EMR records are created on an as-needed basis, it may take about a year to convert most of your patient charts. The other option is to hire someone to do this from start to finish. One person can usually do this in about three months per physician. Scanning the old charts is of value for archival purposes, but they are difficult to integrate into the EMR for day-to-day use.