What’s Behind EMR Software

Guest Blogger: Richard has over 15 years of experience as product manager and public policy analyst. He is currently researching the use of technology to improve health care access. You find more of Richard’s writing on his blog.

No doubt, electronic medical record (EMR) buyers would love to wave their hands and clear the fog that envelops the EMR software purchase process.  Buyers’ uncertainty and distrust combine to create angst and skepticism that their purchase will be the correct one.

One tool to navigate this process: Like a doctor taking a medical and family history, the history and heritage of an EMR vendor can tell you much about the direction and competency of offerings.

Vendors for large customers (hospitals over 250 beds and physician groups over 100) have a historical software competency much like a DNA thread of a virus, with many of the distinct markers carried down to descendents. In the case of software, it is the concept of how the software is built that is carried through each revision and new product.

Prior to EMRs, software was created to register and bill patients and to reconcile financial transactions and records. That is their core competency and strength. To leap to EMR is a complete anathema to the financial paradigm. While orderly in the financial side, the EMR side is counterintuitive to them and their software shows that monolithic belief that once a design has been settled, little else can be done to customize it for future use.

Like their larger brethren, smaller EMR vendors who specialize in the primary care medical market have difficulty in accommodating subspecialties.  That’s because primary care tends to be more uniform in their approach than subspecialists who are much more fragmented than primary care. That fragmentation creates numerous requests for special features that may not be economically feasible for a small EMR vendor.

In summary, the heritage of an EMR vendor won’t ensure that you will be satisfied with your purchase. It will, however, make you aware of the bias and alert to how that may translate to functionality and support.  Vendors can change, but it’s difficult to break that “DNA lineage” unless there is an abrupt break from the past. The next time a sales representative hails you for a sales presentation, look a bit closer at the history and values of the vendor. It might just save you money.

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  • I believe what Richard states is somewhat true, and it is the exact reason I developed Media Spiders. I think that a lot of quality record keeping is lost in the efforts to try to fit into somebody’s concept of what an EMR should or shouldn’t do. I think if your practice has great organized procedures the transition should be pretty simple and basic. If you are trying to take a disorganized office and fit it into a “canned” EMR solution you are in for a rough patch of road.
    I think the real solution is to work with a vendor who has credible background, who takes a personal interest in your practice and offers a custom solution for you.
    The most common misunderstanding is these are expensive. If you are working with someone who bundles this as a combination of software as a service along with support in programming, you can get this done for less than the cost of the hardware most practices have to purchase to accommodate a new EMR.

  • Bill,

    Thanks for your blog post.

    Your comment brings up a timely issue of how to make an EMR “relevant” to a buyer. I think a formalized and mature work flow is one. The other is reconciling broken work flow process with either new requirements or new work flow.

    But my blog brings up the much larger issue of core competency and heritage of the software vendor. In your circumstance, do you feel that the heritage of a vendor has significance to the buyer?

  • I do believe it is important, but what I see as the problem, is that it is ignored in most cases. Everyone from Walmart to Qwest is developing and intending to sell their product based solely on market saturation. I think makes for confusion, not only in which to use, but in why and how it should be used. My company, Media Spiders created, developed, and managed the first Online Medical waste manifest archive for Stericycle. And we did it before anyone was really offering web based solutions. As much as I would like to think it was my genius that propelled this, a lot of its success was from having a good client vendor relationship. We were allowed to work with our client in field, train them on how to use our tool effectively and in the end, it was a huge win for our client. We were the first online archive to be approved to eliminate the mailing back of the manifests to their generator in 38 states.

    We were in charge of almost 3 million records and 30,000 registered users trusted us to deliver their manifests through the archive, saving postage and handling costs of $40,000.00 per week to our client. The larger companies claimed these results were not possible.

    It is for these reasons I am frustrated by what is happening in this sector today.
    I think my credentials are sound and my history is good but the doctors are so worried about the changes in rules and who might not survive, that they seem to continually choose the big guys and spend more money, with less support and less overall success.
    I think most EMRs are probably acceptable. The issue is, how do they fit into your work flow and budget? A lot of the practices I have spoken with have no idea how poorly they are being run due to no work lfow checks and balances.
    We just finished a practice that had over 6000 patient files without corresponding chart numbers in their database. This would mean they were not billed. Just as important, they data from the database they provided in many cases did not match the actual text on the patient folder, and in a lot of cases used the same chart number several times. If some of these patients came into the practice looking for records, they probably have less than a 50% chance of finding them in paper or electronic form. No EMR could fix this, only a change in procedures and someone who cares enough to look for these issues can fix it. I don’t think the People at Walmart or Qwest would have the time or inclination.

    I apologize for being so long here but it is frustrating to see all these doctors getting lead around by all the hoopla being written when the real issue is just being responsible, and working with a vendor you trust.

  • Thanks, Bill for your timely and well-thought of response.

    Give the audience 3-5 bullet points on how best to work with a vendor when they coming knocking on their door?

  • 1) keep an open mind.
    I am sure the practice we just finished had no idea they were in such disarray.

    2) Any good vendor will ask you to evaluate the condition of the records and the process of how they are stored and collected.

    3) Remember we are not like pharmaceutical reps, all things we offer not not basically the same, give us an audience.

    4) Bigger is not always better.

    5) Keep in mind this is a requirement, not an option and time is not your friend. 82% of the practices have not made any motion yet.

    6) Just because you move forward with an EMR does not release you from your retention requirement. Have a plan for the paper.

    7) Web based does not mean “not secure”

    8) Evaluate if you want to be records manager, or a doctor, and how the system will affect you and your practice.

    If you keep these pionts in mind, you cant really get too far off course.

  • Thanks, Bill for your timely and well-thought of response.

    Give the audience 3-5 bullet points on how best to work with a vendor when they coming knocking on their door?

  • Good article. I have recently started looking for an EMR myself and i find reading through blogs and articles such as yours really helpful. Can anyone tell me what is a cloud emr? I have recently seen a few demos for web based emrs, i found curemd to be very reasonable, any experience with their product?

  • Frank,
    I’ve found curemd to be pretty terrible. They send someone out without much knowledge of EMR social media to make similar spam comment over and over on many blog posts as a way to promote their product.

    If you want exposure on these EMR sites, there are ways to get it: https://www.healthcareittoday.com//advertise-on-emr-and-ehr/ Or you could try to engage in a real conversation as the actual company instead of trying to create some fake conversation about the company.

  • Richard,
    Interesting take on the cloud. I think as uncomfortable as it is for many doctors, the convenience of the cloud is growing stronger and stronger. Particularly for the smaller doctors like you mention in your post.

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