Whatever terminology is preferred, the key decision process for selecting an EMR/EHR is to figure out your organization's requirements and methodically assess systems against what you need. Anderson says that when choosing a system, "one should focus on the system itself, its features and feel, and perhaps most importantly, the track record of the software vendor." This task is one of the hardest for most physicians since there are almost 400 vendors stating that they sell the "best" product in the marketplace. Anderson says that there are a number of debates over the real cost with prices as low as $29.95 monthly for an integrated PMS (Practice Management System) and EHR to CCHIT certified products that cost $12,000 to $25,000, plus 18% maintenance costs per year. What's the right choice? "The answer can be found by determining what your needs are and matching your needs to the suite of vendors by category," says Anderson.

How far along is the health care community when it comes to EMH/EHR?

Outside of the Veterans Health Administration system, the vast majority of health care transactions in the United States still takes place on paper and has since the 1950s. The VA health system has over 155 hospitals and 800 clinics, and represents one of the largest integrated health care delivery systems in the world. It relies on a single EHR system called VISTA, which they have used for years.

Neal believes that there will be a major effort to fulfill President Obama's promise "to ensure that within five years, all of America's medical records are computerized." "No doubt, the current stimulus spending and focus on automating medical records will drive a major EMR adoption over the next five years," says Neal. Throwing money at the project does not guarantee success because change management and proper implementation processes will be critical. Another challenge will be getting small medical practices to make that investment and change their workflows. "In five years, we'll see a lot of progress however, I imagine it will take twice as long to execute on the vision that is being painted, perhaps longer," says Neal.

Other issues involved in the smooth transition from paper to computer are interoperability, standardization and connectivity of clinical information, training and technical support. Two other key elements in successful implementation of an electronic heath records system are financing and patient acceptance.

Eric Fishman, MD is President of EHRConsultant.com and EHR Scope, a compendium of information about physician system and speech recognition, which includes a free service to help physicians choose an EMR/EHR.

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