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	EHR questions? We have answers ...

	The electronic health record is moving into mainstream medicine. President Bush wants doctors to go paperless, and insurers are beginning to reward them financially for heeding his call. Last summer, almost one-quarter of primary care doctors said they were going to buy an EHR in the next 12 months, according to a Medical Economics survey. Not surprisingly, physicians are asking lots of questions about the EHR. And who wouldn't? Implementing one means spending tens of thousands of dollars and changing basic office routines like how you renew prescriptions. Nobody wants to make an ill-informed decision, and the best way to avoid that is to seek as much information as possible. We've collected some of the frequently asked questions and invited healthcare IT experts to provide answers. The first grouping follows. Look for another round of FAQs in next month's column.

	Q: Should I hold off buying an EHR until the government finalizes national standards? What if I buy a program today and later the federal government says it's unacceptable? Will I simply be out of luck? A: If you buy smart, you can buy right now and not have much to worry about. It's true, though, that the federal government wants a certification process for EHRs that will help doctors identify effective programs and help Medicare and private insurers identify those worth subsidizing. So standards are coming. They'll revolve around core EHR functions: Can a program freely exchange information with another EHR? Does it allow you to e-prescribe? Does it have decision-support tools that will prevent a prescribing error? But these standards won't come from Washington. Internist David Brailer, the Fed's healthcare IT czar, wants instead to put private industry in charge of this vetting. Taking that cue, several trade organizations, including the Healthcare Infor-mation and Management Systems Society (HIMSS), created a commission last year to certify EHRs. They hope to have a pilot program for a basic certifica- tion process in place by the end of the summer. Because standards are likely to evolve over the next 10 years as the EHR matures, there will be no particularly safe time to buy, says internist Mark Leavitt, medical director at HIMSS. "The key to success will be choosing an established vendor that has a large customer base and a commitment to meeting whatever standards materialize," says Leavitt, who chairs the certification commission. "There's safety in numbers." Leavitt anticipates that his group will avoid setting perfectionistic standards that today's major EHR programs won't be able to meet. "We don't want to send the market backward," he says. "If any program is at risk, it's an EHR developed by a doctor or his brother-in-law. Will they be able to upgrade their programs to satisfy the standards. "Some doctors are finicky and argue that commercial programs can't meet their unique needs. That may have been true 10 years ago, but since then these pro-ducts have evolved a lot, and many have tens of thousands of users," adds Leavitt.

	Q: How can I be sure that an EHR will interact with my existing practice management system? A: If the EHR vendor is different from the one that made your practice management system, you'll have to connect the systems with a software interface. Your EHR vendor may need to create the interface from scratch, but you probably can obtain one off the shelf if both systems come from established companies. So while you're shopping, ask a prospective EHR vendor to direct you to a customer who uses not only their EHR, but your practice management system. Then visit that practice and see how the interface performs. Does information flow freely between the two systems? Do users have to enter patient demographic data twice? "Check—or at least ask about—how often information fails to cross from one system to another, and if there's an audit tool in place to catch those mistakes," says Rosemarie Nelson, a computer consultant in Syracuse. "Patient demographic information from the practice management system might not make it into the EHR, for example. Or, charge capture data from the EHR might not transfer to the practice management side." Interfaces can be a pain in the digital fanny. Every time you update either your EHR or practice management system, you also need to update the interface, which means additional expense. Otherwise, the two systems may stop talking to each other. The alternative is to buy an integrated system in which the EHR and practice management modules share a single database. "That's ideal," says Nelson, "but only if your EMR and practice management modules have all the features you want. I'd rather interface two good systems than own an integrated system with a subpar EHR module."