The decision to move from paper-based medical records and complex workflow
management to an integrated HIS/ophthalmology EMR is a prudent transition to benefit
from the advantages it offers, making hay when the high-tech sun shines. While
implementing an integrated HIS/EMR solution results in more efficient workflow, a decrease
in number of staff who create, index, file, and retrieve manual patient records, and a
decrease in time spent to complete clinical tasks such as referrals, lab, and diagnostic
orders, the process of implementation might prove to be a sticky wicket without adequate
preparation and owning responsibility on your part. It is essential to define clear vendor
selection criteria, and have a proper EMR and vendor assessment process to avoid being
bogged down in the implementation quagmire.
EMR IS NOT JUST AN EMR TODAY
In the present times all health care providers have undergone practice methodology
changes and administrative and management changes as well. This is the age of
transformation in many respects.
The earlier model of home-visiting family doctor has given way to single-physician
and general practice or single-specialty clinics. Then the practices were mostly owner
driven, with multiple visiting physicians. Hence paper-based patient record keeping
helped the owner to have the overall knowledge and control of the hospital
Gradually, multi-specialty hospitals came into existence and grew in number. Their
administration was run not by a single owner but by a group of young professional
business managers who kept abreast of latest technology developments. These
managers brought in EMR for better process management and patient care,
informed decision-making, and enhanced revenues.
Now not only big hospitals but physicians who run clinics on their own also want to
go for EMR to ease their administrative as well as workflow burden.
To go by the latest trend, detailed and accurate data capturing capability of an
integrated HIS/EMR is used for smarter business intelligence analytics and outcome
More and more hospitals are opting for accreditation to compete in the global field.
An HIS/EMR with its exhaustive and accurate documentation capabilities is a boon in
complying with the accreditation procedures, which call for regular documentation
of the organization-centered process flow and patient-centered care procedure
With the advent of technology patients are well informed. To meet their demand for
quality care and competitive pricing, hospitals are increasingly opting for EMR.
Streamlining insurance process claim submission has become imperative for
hospitals to increase patient numbers and improve collections. EMR plays a major
role in accurate data capture for complete claim submission, reducing number of
rejections to miniscule percentage.
Hence an integrated HIS/EMR comprehensively takes part in decision making, enhancing
clinical reporting, improving workflow management, increasing care coordination, boosting
collections, complying regulations, and augmenting patient loyalty. Today an HIS/EMR is no
more for electronic medical records documentation and maintenance; it has been further
expected to play multiple decisive roles in running a health care service successfully.
KEY DRIVERS TO HIS/EMR/PMS TRANSITION
Digitizing patient medical records is only a starting point for opting an Integrated
HIS/EMR/PMS package. The patient record data can launch analytics. They help in predicting
outcomes, visualizing results and sharing information aiding in diagnosis and management
decision-making. A good HIS/EMR facilitates business intelligence analytics using AI by its
data capturing and custom report generating capabilities. To put it in a nutshell, the
following are the major reasons for a hospital or a health care provider to switch over to
EMR or upgrade to an integrated HIS/EMR/PMS software solution for their daily operations.
Digitize patient records
Maximize insurance reimbursement
Improve patient care
Decrease services cost/overhead
Deploy predictive analysis in decision-making
PREPARATION AHEAD OF HIS/EMR SELECTION
Once the decision to implement/upgrade HIS/EMR is taken, preparations to that effect need
to be put in place prior to actual implementation/ upgradation. Though the selection and
implementation of a most suitable HIS/EMR is a slippery slope, having a clear-cut plan
before selecting the HIS/EMR and vendor will significantly sidestep the rocks on the way.
There are a number of key components that need to be crystallized prior to the initiation of
the HIS/EMR selection process, which have the potential to make or break the successful
transition to HIS/EMR. These include
Clarity: Be clear on the high-priority requirements that need to be addressed by the
HIS/EMR to make the transition useful and worth the efforts and cost. Differentiate
between must-have features (e.g. ophthalmology-specific modules) and nice-to-have
features (e.g. HR module).
Goal: Set practical, prudent clinical, productivity and work environmental goals, which will
result in tangible outcomes.
Time line: Decide on a time line for selection, negotiation, and implementation of EMR to
make it effective in achieving goals.
User consensus: Arrive at a consensus with HODs and end-users as their cooperation and
active participation will help in attaining the above criteria and also will result in smooth
Budget: Freeze the budget based on the size of your practice, the required add-on features,
deployment location (cloud based, remote, or on premises), and additional warranty
required, among other factors. Always allot an additional 30% for hidden charges or
customization requirements for the first year.
Level of automation: Decide on the level and the number of processes to be automated
depending on your budget and time line. Keep in mind that achieving 100% automation is a
phase-by-phase process, that is, complete automation doesn’t occur at the very first stage
Compliance: Finalize which statutory regulations need to be complied in toto, such as
HIPAA, HL-7, ICD-10 and NABH standards.
STEP-BY-STEP SELECTION PROCESS
1. Need assessment: Based on the above key considerations, the hospital should prepare a
2. Vendors selection: Pick five popular vendors after checking up with other practices that
have implemented HIS/EMR and any medical association of which you are a member for
HIS/EMR evaluation resources and also after searching online for suitable vendors.
3. Request for information(RFI): Design a RFI document containing relevant details you
need for EMR and vendor evaluation The said document solicits information about the
solutions and services offered by the vendor, vendor’s business profile (support
structure, team quality, skill set, experience, domain knowledge, previous experience,
financial stability), HIS modules, EMR capability, ophthalmology-specific features,
statutory compliance, interoperability, equipment integration capability and interface,
data security design, implementation and training methodology, ongoing support
services, patient tracking capabilities, warranty and extended warranty details,
estimated cost, site visit possibility, and availability for demonstrations, among any
other specific details you need.
4. Comparison and short listing: Based on the RFI, compare the vendors and shortlist a
minimum of three vendors and call for a proposal from each of them. Insist on detailed
proposal covering deliverables in no uncertain terms. The exhaustive the proposal the
better is the selection.
5. Demonstrations and site visits: Schedule demonstrations of all three shortlisted vendors
and have a face-to-face interaction with each team. Obtain two references of the
vendors’ clients where the same HIS/EMR model has been implemented. Contact both
references, discuss, and collect their feedback and reviews on the vendor. Make sure
you visit their websites too to get another angle, as these days most of the patients rate
and review their treatment encounter online. Site visit along with the development
office visit is highly recommended.
6. Negotiation: Negotiate for the total cost of EMR inclusive of HIS components. Keep in
mind hidden costs such as additional implementation charges, additional customization
charges, and support charges while working out the final cost. Arrive at the final cost
after taking into account the cost that would be incurred for next three years including
AMC, for a reasonable expenditure estimate.
7. Finalization: Finalize the best vendor with a stable financial background, solid project
management capability, and proven track record in execution that meets you half way
and ready for a long-term partnership. Make certain that the vendor is ready to do some
customization to suit your needs, at the same time remember that too many changes
will lead to distortion. So it is better to strike a balance. During the finalization freeze 15
to 20 must-have MIS reports, for example daily, weekly and monthly collection
summary, payables and receivables, and patient registration summary so as to confirm
no necessary input capture is missed by HIS/EMR while customizing.
GO THE EXTRA MILE
As the saying goes well begun is half done, but the other half of the successful
implementation of HIS/EMR rests with you. To put it clearly, 50% of the success depends on
your owning the responsibility for implementation and maintenance. For it not to be a
protracted process, the hospital must provide a conducive atmosphere for the vendor to
implement HIS/EMR seamlessly, while conceding that the process takes 3 to 4 months to
settle down. The following steps from your side guarantee a successful implementation
Allocate a dedicated resource or a team to go-between the vendor team and
decision-makers and end-users. This will ensure there is no gap in communication on
the scope that has been finalized and what is being implemented among all
stakeholders. The single-point of contact provides the vendor team clear directions
and coordination, in turn ease in implementation.
Apply the top-down approach, which is highly essential for smooth and stable
implementation. It has been found from research that the major impediment for
implementation success is user reluctance. The end-users willingness to take
HIS/EMR training has to be ensured by dispelling their misconception about
productivity disturbances, workflow changes, and level of skills needed to work on
HIS/EMR by the decision-makers convincingly. Management has to take into
confidence the end-users by enlightening them about the need for HIS/EMR and the
advantages it will bring in the realm of ease of use, productivity, and patient care.
Although going for an integrated HIS/ophthalmology EMR in this high-tech era is a wise
choice, freezing on select-featured EMR and vendor might prove to be a tricky process.
This can be handled by systematic approach. Post selection implementation also holds key
for a successful EMR transition. Joint efforts of both vendor and the customer go a long way
in seamless implementation and maintenance. To overcome the initial user reluctance and
promote user adaptation, the decision-makers should apply the top-down approach by
confidence building measures like organizing training sessions, motivational lectures,
practice sessions, etc. The vendor on their part have to provide pre-requisite training,
manuals, training videos and enough hands-on training sessions to boost the confidence of
users. Further, the management should own the responsibility of implementation and take
an active part by dedicating a team to coordinate with the vendor for the best
implementation and maintenance experience.