Dr. Ron Garcia, an internist at Premier Physician Centers in Cleveland, OH, faced a challenge becoming ever more common. As the team leader in selecting an electronic health record (EHR) for their 75-doctor multispecialty group, he had to look beyond the superficial demos provided by vendors and determine how well each product would actually perform in daily practice. To fill in the picture, Dr. Garcia decided to do more detailed evaluations of the EHRs deemed finalists in typical patient visit scenarios, so that he could compare their usability in the real world. After a very thorough review, eMDs Solution Series™ emerged as the clear choice.


Prior to the head-to-head evaluations, Premier Physician Centers’ selection team had already spent a year and a half shopping for EHRs and reviewed numerous products. The group had decided to buy an EHR to improve patient safety and quality of care and to take advantage of the government’s health IT incentives. The key criteria of the EHR selection committee, which included internists and family physicians, were ease of use, functionality, security, and the ability to interface with the information systems of labs, hospitals, and other providers. But even after final demonstrations from key principals at each company, it was hard to separate some of the salesmanship from the reality of what physicians would be working with after signing a contract.

Garcia and his colleagues arranged for eMDs and the other EHR finalist to grant Premier access to demonstration websites where they could try out the two systems in real-life scenarios. Garcia immersed himself in the project, carefully evaluating and comparing both systems against a series of real-life scenarios. “I wanted to really make sure that the system we selected was right for our doctors from a daily workflow perspective” he recalls.


After completing the analysis, Garcia concluded that eMDs was significantly more usable than the other EHR. There were a number of specific reasons. “When I entered a chief complaint in the record, eMDs linked to the patient’s diagnosis, history, and the plan. The other EHR did not provide a direct linkage.”

Garcia also noticed that eMDs prompted him to ask questions directly related to the chief complaint. The competing EHR, on the other hand, did not tailor the questions to those symptoms.

“Let’s say a person comes in with a complaint of fatigue. If you put that in as the chief complaint, when you opened the history of present illness (HPI) in eMDs, there were some questions related to what might be causing the fatigue, such as infection, anemia, or depression. In the other system, no matter what symptom you entered, it asked the same questions all the time.”


Another “smart” feature of eMDs that was lacking in the other EHR, Garcia notes, was the “hint” box at the bottom of the HPI screen. This listed the various diagnoses that a physician should think about while he’s doing the differential diagnosis based on the patient’s condition. Garcia was impressed that the diagnoses cited by eMDs were highly relevant to the specific complaints. “There was clearly a significant amount of input by doctors to build this program. The other system seemed like something that a bunch of software guys put together with minimal doctor input.”

The narrative notes produced by eMDs were significantly easier to read and more pertinent to each patient than the notes that the other EHR generated, Garcia adds. “The other system’s note was fragmented and robotic. The eMDs note looked more individualized, whereas the competitor’s note seemed to be generated by a computer.”


Another advantage of eMDs, says Garcia, was the ability to order tests or other services on the fly during a patient visit. Instead of having to wait until he progressed to the plan section of the EHR, he could jump to the plan, enter his order, and then jump back to the place where he’d been in the documentation template. Garcia views this as a big time saver because it’s consistent with the way he and other physicians think and work as they gather information and contemplate treatments for the patient.


“With eMDs, the clinical content is part of the software. It’s loaded with lots of preconfigured templates and other things, so it’s a lot easier to use. It’s not a bare-bones thing that you have to do from scratch.” Garcia was also impressed by the eMDs physician community and access to templates developed by other practices.

“The doctors who use eMDs contribute a lot of their own templates to eMDs for them to share. There are many templates you can choose from to tailor the EHR to your specialty, and to your practice.”


Garcia also praises eMDs’ E&M coding advisor, which helps physicians choose the appropriate code for each visit. If the physician doesn’t agree with the code it suggests, the EHR will show them where documentation needed to support a higher coding level is missing. “You can see on one screen the documentation that you’re lacking to make the CPT code the appropriate one, and that you’ve met all the criteria for that code.”


Overall, what makes eMDs stand out from its competitors, says Garcia, is that it was designed to work the way that doctors think. “It’s not just a documentation tool, where you enter your observations without any other feedback. In this EHR, there’s feedback and guidance when you’re writing your note. That’s the main reason why we chose this product.”

While vendor demonstrations can be useful and site visits to practices that use the EHR are essential, Garcia recommends the kind of in-depth examination of EHRs that he did in the final stage of selection. “You’ve got to do your homework,” he says, “because you’re going to be using this product every day for a long time.”

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