What is an electronic health record or EHR software? And what’s the difference between electronic medical records (EMR) and electronic health records (EHR)?

EMR refers to an individual clinical record of a patient, whereas EHR refers to a system or platform that’s capable of storing, transmitting, and sharing that individual electronic medical record with hospitals, physicians, and other clinical record systems. EMR is a record, EHR is a system.

INTEGRATED SYSTEMS VS STAND-ALONE

Examples of stand-alone EMR programs are: Amazing Charts, Praxis EMR, PracticeFusion. These provide the means to chart the clinical record and they rely on other software vendors to provide revenue cycle management and practice management.

But surprisingly, the #1 functionality requested in almost every EHR purchase is not a clinical feature, it is an integrated billing system. The #2 feature asked for is also a practice management item: Appointment reminders. Finally number 3, 4, and 5 are clinical features: e-prescribing, document scanning/faxing, and medication tracking.

WHOLE PRACTICE PLATFORM

All-in-one, integrated, whole practice solutions are the topic of this EHR Buyer’s Guide for 2017. Our comparison focuses on end-to-end systems suitable for small to midsize medical practices. After redacting hospital systems, single-specialty programs and niche systems, or systems that don’t offer a native integrated billing system, the choices for an affordable, state of the art whole practice system boils down to just a handful of EHR choices. Here are the top 12 systems we’ve found that offer the total package of what doctors need in today’s practice of medicine:

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#1. PracticeSuite

Is our top choice because this Clinical platform does everything, and it does it elegantly. it’s affordable, and it includes top-tier support at no additional cost. Charting and ordering are easy, plus, there’s a genuinely free single-user version of their practice management system (scheduling, billing, and patient portal) that you can use as long as you want.

Additionally, PracticeSuite offers all the features you could need in an EHR platform. You get a patient portal, physician charting, scheduling, e-prescribing, medical billing, and top of the line revenue cycle management features. (Read our full review here.)

EHR Companies That Make Certified EMR Software

We love HealthFusion’s full-service EHR system and its no-contract policy that allows you to cancel the service at any time. It’s also easy to use and offers support for numerous specialties. Larger facilities and hospitals might find HealthFusion ideal. (Read full review.) The mobile version of the software works with Apple mobile devices.

This EHR’s impressive customer retention rate and streamlined revenue cycle management functionality put AdvancedMD near the top of our list. (Read full review.)

As one of the most customizable EHR systems on this list, athenahealth earns considerable praise for its flexibility in a variety of practice settings. It offers advanced code-checking and simple installation. (Read our full review here.)

If you’re looking for an affordable EHR system that can work for practices with up to 25 users you’ll want to consider Acrendo. Customers praise its customer support and ease of use and some of the advanced features found in robust EHR systems. (Read full review.)

Developed more than 15 years ago, e-MD has laid a track record of accuracy and diversity. (Read full review.)

MacPractice gets excellent reviews for customer service. The company responds promptly to complaints and questions, so you don’t have to worry about sitting on hold for hours on end.

CureMD is reasonably priced and easy to use. It’s a full-featured EHR system.

Vitera is more of an EMR than an EHR. It’s affordable, though, so it might work for smaller practices that want to dip their toes into the digital records pool.

This cloud-based EHR solution MicroMD comes with a free trial and many features. However, it’s not compatible with multi-physician practices, and you can’t use it for e-prescribing or patient registration. It also lacks a patient portal function.

We like many CareCloud features..

Even though PF is a stand alone EMR rather than an all-in-one system, we’ve included it because it’s popular, it’s free, and the doctors using are small enough that they don’t mind outsourcing their billing or relying on multiple software vendors to manage their practice.

BUT WAIT – (There Were Giants)

When it comes to evaluating any electronic health record software system a rush of names can jump to mind: Cerner, Epic, Allscripts, NextGen, GE Centricity, Athenahealth, McKesson, and Merge, just to name a few. But not all EMR/EHR systems are suitable for small to mid-sized physician practices. In fact when it comes to a doctor’s choice of EMR, it is names like AmazingCharts that come up more often than the Big 10.  In fact our study revealed that the #1 most popular system eClinicalWorks, which boasts a whopping 810,000 users, had the lowest customer satisfaction rating (57%) of any EHR system in our Buyer’s Guide.

This could be because ease of use (usability) and simplicity are the #1 consideration when shopping for an electronic health record system. Support is important, but after implementation, usability rises back to the forefront as time and productivity become the make-or-break factors.

OUR CRITERIA
The difficulty in evaluating any clinical system is arriving at a universal baseline of required features. Fortunately Meaningful Use levels the playing field here, but MU also brings some drawbacks, as due to MU, now most clinical systems contain features that are not needed by many physicians and so go unused. In fact CMS has recently retracted a number of Quality Measures as a relatively small percentage of doctors attested for Stage 2 MU. The ones that did were largely part of bigger groups where greater resources were available. Some other findings:

PLATFORM DEPENDENCE
Platform dependence plays another significant role in EHR  purchase decisions, as 61% of doctor offices are still on PC’s (Microsoft/IBM); 17% are currently using cloud based systems, which are by definition platform independent; 13% of practices use Apple; and 9% are on other platforms such as Linux and open source.

PRICE & AFFORDABILITY
Calculating the cost of acquiring and maintaining a clinical documentation system can be complicated. Cloud-based systems simplify this, but less than 20% of all EHR adoption is cloud. Once you leave the paradigm of the cloud-based EHR, many factors rise to consideration. Costs such as licensing, annual upgrades, networking, security, remote access, and ongoing support add up. Then the costs of the ongoing maintenance of all of these items accumulate quickly and can escalate out of control if salaries for network engineers and helpdesk get factored in.

After usability and cost, medical specialty––practice size––and type of practice/facility (ambulatory vs. non-ambulatory) comprise the final dividers.

MEDICAL SPECIALTY
Less than 12 software companies support above 20 medical specialties, which means many medical specialties are underrepresented and have fewer options to select from when shopping for a clinical documentation system. The deeper the sub-specialty, the fewer the choices, and the more costly the systems.

THE EHR MYTH
When purchasing or replacing an EHR  system, one may step back and ask the thoughtful question: “That’s all nice, but do I really need one”.

EHR DISADVANTAGES
30 years after the original dream of electronic medical records, the proof that software makes any improvement in clinical outcomes is at best underwhelming. In fact there is a reliable rumor circulating that EHR has become the #1 factor to physician’s wanting to end it all. But while EHR might be the dream of only CMS, there is clearly a favorite in the physician’s corner: E-prescribing. Electronic ordering has solid data supporting improvements in the reduction of allergic reactions, missed contraindications, and drug to drug interactions––and it only takes a minute or two.

TRADE OFFS––While large groups often see productivity gains with the implementation of enterprise-wide clinical systems, the opposite is true for small practices. The increased difficulty of daily charting patient encounter in an EHR, the decline in physician productivity, and the ensuing impact on cash flow are more than enough evidence to demonstrate that today’s clinical systems have not yet improved on the sheer simplicity of paper charting. But still there are trade offs and some advantages can make the negative impact worth tolerating.

EHR ADVANTAGES
As mentioned, larger groups that are able supply their physicians with a support team such as medical scribes and medical records specialist see the greatest benefits; often demonstrated in 3 main areas: The facilitation of team/staff care and task assignment, improvement in group efficiency, and the facilitation of peer to peer multi-specialty coordination of care. In other words software significantly aids in group collaboration (which everyone already knew).

LESS IS MORE
The requirement of support teams to prove the EHR model, of course argues that the less a physician touches the software the greater the productivity gain. But I don’t know a doctor who wouldn’t say –“amen to that brother”. Still, a future with young more technically adroit doctors, and the emergence of new healthcare delivery methods: Telemedicine, home care, and Uber care––all rely on EHR to happen. So EHR’s are here to stay.

PURCHASING CONCLUSION
In our 2017 EHR Buyer’s Guide, we’ve boiled it down to the top 12 systems suitable for small to medium size practices: From solo practitioners, up to a 50 doctor multi-specialty, multi-location group practice. In the end it is usability that makes or breaks EHR adoption. If you cannot afford medical scribes to follow you around throughout your day, then your choice of clinical documentation system can ensure or imperil your implementation, your future productivity, your cash flow, and affect your quality of life. The right EHR can be heaven, and the wrong one can make you feel like your living in the other place.