CRITERIA FOR EVALUATING EMR SYSTEMS
Too often, family physicians purchase electronic medical records (EMR) systems and are disappointed with their performance. To help physicians better evaluate EMR products before they buy, the AAFP Ad Hoc Committee on Electronic Medical Records created a list of criteria that EMR systems should have in order to be "family-physician friendly." A portion of the list appears below. The complete list of criteria for evaluating EMR systems is available at www.aafp.org/fpnet/x432.html.

GENERAL FEATURES

Basic

1. Offers structured data entry for medication, diagnoses and orders.
2. Allows integration of the EMR system with scheduling and billing systems.
3. Provides adequate system availability (around-the-clock access, if necessary).
4. Allows adequate response time. Buyers need to be aware of those factors that determine response time, such as the software itself, the speed of the computers and the bandwidth of the local network.
5. Allows user to identify and manage implementation costs. An initial capital investment is required, in addition to ongoing expenses for software maintenance and periodic upgrades.
6. Supports incremental implementation of additional, more advanced components.
7. Supports multiple office locations, including connectivity between practice sites.
8. Supports multiple users simultaneously.
9. Supports working with multiple patients quickly and safely (sequentially or concurrently).
10. Supports multiple user access to a single patient record, with appropriate security.
11. Offers online user support and technical support.
12. Offers adequate data protection and backups.
13. Offers customizable fields in various locations of the EMR to support local work flow/templates.
14. Allows the buyer to assess the vendor's commitment and viability.
15. Affords a workable "exit strategy" should the need arise to export the data to a new system.

Advanced

1. Allows multiple encounter records on the same patient to be open simultaneously (e.g., phone call plus office visit).
2. Offers evaluation and management (E/M) coding and documentation support.
3. Offers remote access capabilities (e.g., from home, emergency department or hospital).
4. Offers interface options (e.g., lab, formulary, transcription and radiology), with costs and
   requirements for these options clear from the outset.
5. Supports midlevel providers and residents in collaborative practice with physicians.

Optional

1. Offers patients "patient-view," read-only Internet access to their records and the ability to request appointments, advice and refills and to learn about lab results, overdue health maintenance procedures, etc., online.
2. Allows patients to enter data.
3. Offers the scalability necessary to accommodate practice growth, additional locations and mergers.
4. Offers ability to exchange information between products.
5. Allows multiple patient records to be open simultaneously.
6. Supports encrypted e-mail.
7. Provides online access to health information.
8. Offers e-mail links to the Internet.
9. Provides dial-up support.

CLINICAL DATA REPOSITORY FEATURES

Basic

1. Uniquely identifies all patients by name, date of birth, medical record number, Social Security number, gender, address, etc.
2. Merges charts if a patient has more than one record.
3. Creates clinical data repository (CDR) from all discrete EMR events (e.g., diagnoses, pharmacologic and nonpharmacologic treatments, orders, results, charting and vital signs).
4. Allows users to query the CDR and create reports, especially for routine items such as medications, diagnoses, age and procedures.

Optional

1. Allows users to share data with affiliates or consultants, possibly via the Internet.
2. Provides security (i.e., HIPAA compliant) for sharing protected health information with affiliates or consultants, possibly via the Internet.
3. Allows access to and sharing of data from other systems (e.g., a hospital system).
4. Allows merging of family information (e.g., allows the family history for two siblings to be entered once).

Editor's note: The list is intended to be merely a resource for physicians and is not a recommendation of any particular EMR system.