Last year, President Bush outlined a plan aimed to ensure that most Americans have electronic health records within the next 10 years. Electronic health records, also called electronic medical records, can eliminate problems such as dangerous drug interactions, patient information being filed in the wrong chart, large amounts of time and money spent on recording and transcribing doctor's notes, staff time pulling paper charts, lack of easy access to a patient's prior medical history and storage issues. The accumulation of paper had gotten so bad at one practice, "it was just about to get the entire floor reinforced to handle all the paper charts," says Ralph Riccardi, executive vice president and COO of Birmingham-based Source Medical Solutions, which offers an electronic health records system called SourcePlus EHR. Another benefit of a good EMR system is that it can automatically compute the Evaluation and Management code for each visit, points out Gavin Ellis, vice president of sales at Birmingham-based Medisys, which markets the Encite EMR. "A lot of physicians under-code," he says. "They think it will probably be a four, but they put down a level three, because if they put down a four, and the insurance company audits it and only justifies the level three, they're going to ask for money back." Proper coding, he says, results in more revenue. Digital x-rays and other diagnostic imaging are another important part of electronic medical records. Among the benefits digital x-rays offer are getting the images in hand faster; ending the problem of lost or misplaced films; the ability to consult colleagues who may not be in your geographical region; the ability for multiple people to look at the image at the same time from different locations; the ability to lighten or darken the image via computer; saving on storage space; and saving on expenditures for film and chemistry, according to Alan Bailey with Red Mountain Imaging, which markets a digital imaging system that transmits the images over wide area networks. Electronic medical records "also can have a positive impact on a physician's lifestyle," says Medisys' Ellis. "They finish seeing patients at 5:00 and don't have to stay there an hour or so dictating. We had one physician who went to a three-day workweek, and her revenue has not gone down." Despite the many benefits, providers estimate no more than 10 percent of physicians' office currently use EMRs. One of the problems with widespread adoption of EMRs has been a lack of flexibility. "The thing that is most challenging in terms of using an electronic medical record is not necessarily the cost of the system, or the willingness of [healthcare] providers to see the value of it," Riccardi says. "The problem is most of the systems give you a set, rote series of documents in an electronic format that you must now conform your practice patterns to. There are many hundreds of thousands of dollars spent on systems that have subsequently been unplugged." Source Medical starts with a paper chart from the physician's practice and custom-develops matching electronic forms. "What a physician or nurse sees on the wireless tablet is a digital image of the same forms they have always used in their paper practice," Riccardi says. "Within 15 minutes of demonstration, even physicians that have not operated with PDAs and other types of computing devices previously are using that tablet PC the same way they would use a paper chart and a pen." Medisys' Ellis points out that EMR products run the gamut. "Some are used just to scan in paper," he says. "However, doctors may still be dictating, having to pay transcription costs every month and having to take time to do dictation. The latest generation is direct physician input into the medical record, which eliminates transcription." Medisys customizes its Encite EMR to reflect the physician's specific needs, the way he practices medicine, his specialty and how he wants to document it. In addition to flexibility and customization, consider whether an EMR system will interface with your practice management software. Proper implementation is vital for the success of an EMR system. Find out how long it will take to get up and running. Some practices have had the process drag on for months. As part of that implementation, you need to make sure you have the right hardware and the right network, especially with wireless systems. "A secure, fast network environment is probably key to satisfaction with an EMR package," says Hardie Sims, co-owner of Sunrise Technology Consultants in Birmingham, which specializes in IT consulting for healthcare organizations. "It has to be running smoothly and fast, or there's going to be some dissatisfaction with it, especially with doctors who see a lot of patients during a day — they can't afford any downtime or latency in their network." Training is another factor. Source Medical, for instance, trains the medical staff separately from the administrative staff, because they use different parts of the system. "Another thing a practice needs to do is make the decision that they're going to make the time and effort to use this system in all of its functionality," Riccardi says. "You spent all that money for it; you need to commit to really learning that system so you're going to get maximum advantage out of it." When implementing its AllMeds EMR system, Sports Medicine & Orthopedic Specialists in Birmingham discovered the importance of sticking with it. Prior to implementation, the clinical manager had contacted several other EHR users to learn about their experiences. "We were told that we would hate the system for six weeks," says Samuel Goldstein, MD. "For three months, we would dislike it, but become more tolerant. After three months, we would become proficient. At six months, we were told, we would never be able to do without EHR." In their case, Goldstein says, the learning curve was significantly shortened — even though after a week they were just hoping to survive to the next day. "We were actually proficient with the system at six weeks and knew that we could never go back to the archaic system of paper charts."