‘One size fits all’ does not apply to EMR implementation

When it comes to the daunting task of adopting an electronic medical record, healthcare facilities should identify their information needs before making an EMR purchase, according to a health information management consultant.

Often, clients simply ask what product they should buy or what vendor they should choose, Margret Amatayakul, president of MargretA Consulting, said during a Monday morning HIMSS education session.

Her advice to these clients is not to buy anything until they have determined exactly what they want to accomplish with an EMR. The end goal isn't the EMR; it is what you want to do with the EMR, she said.

Questions clients should answer include whether they want to become a part of a regional health information organization, whether they will remain part of a corporate structure, and whether they expect to focus more on ambulatory or quaternary care. The responses to these questions will shape the direction facilities take in deciding on an EMR technology, Amatayakul said.

Facilities should also determine whether their implementation route will focus on managing images or on processing discrete data, said Michael R. Cohen, president of the MRC Consulting Group.

The image-focused route may be used as a bridge technology to a final EMR, but it may not provide sufficient support for interactive clinical decision support, he said. The discrete data route would allow for robust clinical decision support but would require continual maintenance and structured data entry. Facilities might also decide to choose a hybrid of the two strategies.

Once an implementation route is selected, the facility can choose from four vendor strategies, Cohen said:

• Single source - one core vendor meets the majority of a facility's medical record needs. This works better with smaller, less complex institutions and may require the addition of niche products to supplement the single vendor.

• Best of suite - the use of more than one vendor. These vendors would have strengths in some areas, such as financial or clinical, and would complement one another. The intent is to minimize the number of vendors used.

• Best of breed - the use of products from a variety vendors that best meet specific medical record needs. This system is often employed in larger organizations where geopolitical battles are frequently fought, and it assumes that there will be an information technology integrator to meld the different products being used.

• Integration - a slight variation on a single-source strategy that is more flexible in adopting other products if they integrate well with the core products. It differs from the best of breed strategy in that ease of integration with the core vendor is taken into account.

Cohen reiterated that the end game is not the specific EMR product but the ability to translate information into knowledge.

"Facilities need to figure out where they are today, where they want to go, and then figure out what steps they need to take to get there," he said.