When considering the transition to an EHR system, it is essential to think about more than just the software. The hardware can be just as important. All EHR vendors have minimum specifications required to ensure the proper functioning of their system, but most will allow individual practices to use existing computers or purchase new equipment on their own. When companies do suggest specific hardware, they often choose costly equipment that far exceeds the basic system requirements. Since this may not make sense for your practice and can far exceed your budget, it can be very helpful to think through the process ahead of time and truly assess your needs to maximize productivity and minimize price. Here are some issues to consider:
▸ To PC or not to PC?
Regardless of your personal preference, the majority of EHRs run under the Windows operating system. If your office is already outfitted with Macs, you might need to replace them. You could also install Windows using software such as Boot Camp, a program that ships with new Intel-based Macs.
If your office is already established on PCs, you must determine if they meet the EHR's minimum specs. It won't take long to realize that running the software on a slow computer is frustrating, so consider the amount of RAM and processor speed in each unit.
Either way, be sure to find out exactly which version of Windows the software requires, as changing the operating system can be a very costly and time-consuming experience. For example, one well-known EHR product requires Windows XP Professional. XP Home Edition and other versions of Windows simply will not work. And, not surprisingly, many EHRs don't play well with Windows Vista.
▸ Desktop, notebook, or tablet PC?
Initially, a lot of physicians wonder how an EHR will affect their documentation. Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. It is therefore very helpful to put some forethought into how you'll best be able to integrate computers into the office visit.
Some practices choose to install desktop computers in each exam room. In general, desktops are cheaper and more comfortable to navigate. On the downside, they cannot be easily moved to optimize patient interactions and take up a significant amount of space in the room. They also require power and network wiring.
As an alternative, consider wireless notebooks. They are mobile, flexible, and take up much less space, but they are typically more costly to purchase, can be quite heavy, and might be dropped and easily damaged. They may also have a small keyboard and a less-than-convenient pointing device.
For this reason, tablet PCs have become very popular in medicine. A tablet PC may or may not have a keyboard, but all are designed around a touch screen on which a digital pen serves as the mouse. While seemingly wonderful in concept, learning to use the pen to enter complicated information has a steep learning curve and can be extremely frustrating. Many EHR products address this issue by developing schemes to expedite the documentation process. Some involve a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.
In the end, regardless of the type of PC you choose, expect it to take some time to get used to the new process of documentation. You may initially find yourself in the exam room with your face buried in the computer screen. Some get around this by documenting after they leave the room, a process that can become a significant time drain. Others choose to employ dictation software that allows them to speak directly into the EHR to generate a note. Although these programs are constantly improving, they still require training and may take a good deal of time to use accurately. No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. Moving forward, the initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes and charts that are never lost.
▸ Durability, price, and options.
Inevitably, every practice will need to purchase new computers. When making this decision, consider longevity as well as price. Extended warranties and service plans may be a high priority, but given the ever-dropping costs of computer hardware, some may decline to spend the money up front and risk the cost of replacement. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be attractively priced, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs. You will find that batteries die at the worst possible times, and it is convenient to have another battery freshly charged and ready to go.