Discussion of Issues


When selecting a system a medical practice should begin with planning and research. The goal is to identify a system that meets all the needs of the health center. Three important considerations when selecting a new system are a whether to utilize a single source provider or a hybrid developed from two vendors, application service provider or client-server model and finally a wired or wireless system.
RCHC already uses computerized billing but does not use electronic medical records. For this reason, it is important to consider whether to continue using the current electronic billing system or to purchase an entire package that combines electronic medical records and practice management. A solid argument for purchasing an entire solution from one vendor is the fact that the software will communicate more efficiently if designed by one company. Otherwise, special programming and database bridges will have to be created to facilitate the communication of the two systems. The term “integrated” is used to describe a system that incorporates practice management and electronic medical records in one application suite. When systems from multiple vendors are used they must be interfaced in order to transfer data from system to system. This interfacing of systems can be costly and time consuming and even create an opportunity for data loss or corruption during synchronization. Interfaced data transferred from the practice management system to the electronic medical record system consists of demographic information such as name, address and phone number. Data that travels only from the practice management system to the electronic medical record system is transferred using a one-way interface. In contrast, data that travels back to the practice management system is said to utilize a two-way interface. Data that travels back to the practice management system usually consists of billing information, diagnosis and procedure codes and general encounter information. This interface method can be a bottle neck for system problems. Any errors in coding can create a loss of data or data corruption during the data transfer process. For this reason many health centers choose to purchase an entire solution from one vendor, which decreases the chance that data is lost or corrupt while moving through the system.

A second solid argument for selecting an entire solution from one vendor is the perceived level of support that is provided by the product vendor. Technical support is often difficult to coordinate with even one vendor let alone multiple. It is much easier to troubleshoot a problem with one support help desk rather than trying to communicate with multiple help desks. In many cases, one company will state that a problem is related to another vendor’s product rather than theirs. This can lead to a wild goose chase just trying to determine the source of the problem. The last thing a member of medical staff wants to hear from a help desk is “that’s not our problem”. The best solution to technical problems with these systems is a staff member on-site that is familiar with the system and the hardware that is able to be a point of contact between the health center and the help desk of the application vendor.
Questions to consider (Hartley, 2007)

Is it time to change the current practice management system?
Many health centers have had great success with their practice management system and there may not be a need for replacement. If this is the case, it may be more practical to purchase only the electronic medical record system. Ultimately if the users of the system are happy with it there is no reason to change. If it is necessary to change, a convenient time to make the transition is with the introduction of the electronic medical record system.
The practice management system currently being used at RCHC is new but not completely effective. There have been many issues with the functionality of this application and the subsequent support. Basic data entry is often hindered due to sub-standard programming in the form of improper validation. This causes users to lose productivity trying to perform routine functions within the system. Problematic terminal server issues and printing configurations also cause lost productivity within the RCHC environment. The vendor of this product frequently makes programming changes and releases various service packs and patches in attempts to address these issues. More often than not, these changes create more problems within the system. It has become apparent that this particular vendor is supporting a product that has not been thoroughly tested in a real working environment. For this reason, RCHC has chosen to select an entirely new practice management system.
Does the current practice management system software company also make an electronic medical record system?

If a clinic utilizes a practice management system vendor that also offers electronic medical records it may be a wise decision to purchase the electronic medical record portion from the same vendor. This can save time and money during implementation and allow the users to work with a company that is already familiar.

RCHC’s current practice management vendor does offer an electronic medical record system. Due to past performance with the current system it has been determined that an entirely new vendor is necessary. There have been many support issues related to the current system. This particular product was released without proper testing and subsequent support is lacking. RCHC will have to cut its losses and choose a new system.

Is the electronic medical record system offered by the practice management software company satisfactory for this health center?

Many companies offer a complete software suite that facilitates practice management and electronic records. Some of these companies have created the electronic record portion of their suite long after the development of the practice management system. As a result, many software vendors have created an electronic medical record system on top of an antiquated practice management system. This type of patchwork can create a system that lacks features, is difficult to use and is built on obsolete technology. In a rush to enter the market, these companies have created systems that are released too soon and not designed to be the most efficient. This inefficiency can cause a health center to replace the entire system again once they realize the functionality is not up to par; this can be very costly and time consuming.
Can the health clinic use the existing network and computer hardware?

The existing network architecture is such that very few pieces of equipment will need to be purchased in order to implement a new system. The current system is composed of two terminal servers, two domain controllers, an exchange server, a report server, a print server and numerous workstations. This equipment can be used with almost any new system. Very few hardware purchases will need to be made for a transition to a new system. One technology that will need to be purchased for the health center is wireless connectivity. Providers will enter data directly into the system during the encounters. For this reason, providers will need access to the network within all exam rooms. The easiest way to achieve this connectivity will be wireless access points throughout the building (Gururajan, 2005). This wireless infrastructure will facilitate seamless connectivity regardless of the provider’s location within the building. This wireless connection will also require workstations that support wireless connectivity. Each provider will be given a mobile tablet PC to use during encounters in the exam rooms.

Questions to be answered

What are the organizations needs?
RCHC is a federally qualified health care center ant it serves members of the population who have very little or no medical insurance. For this reason, it is necessary to charge patients on a sliding fee scale as mandated by the federal government. Many practice management systems do not have or must make special accommodations for the sliding fee system. It will be necessary to include only practice management systems that do incorporate this scale.

The chosen system must function more reliably than the currently implemented system. Currently, many support issues go unchecked for many months and it is the responsibility of the vendor to address these issues. Application support must be ongoing and must not fade out shortly after the implementation (Ovretveit, 2007). It is often necessary to address practice management issues immediately in order to accommodate the patient. In these cases members of management at RCHC must have access to technical support at any time during the business day.

The selected system must function within a windows based environment. Much of the existing information technology hardware can be used for a new system. It would be costly and very wasteful to replace the currently implemented equipment. RCHC currently owns and manages a windows based network consisting of two domain controllers, two terminal servers, a Microsoft exchange server, a print server and a report server. This existing topology should support most all new practice management and electronic medical record systems with very little hardware upgrades.

What systems meet these needs?

Three systems will be evaluated and a selection will be made on the system that best fits the organization. Current providers and members of senior management have chosen to evaluate GE Centricity, AllScripts and NextGen.