Guide to EHR Selection

LEARN ABOUT: ■

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Reasons why you need an EHR

May 2003 Federal Vol. 5, No. 4 Incentives and ARRA

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What is meaningful use?

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EHR Roadmap to Implementation

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Compare Systems

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Delaware Health Information Network (DHIN)

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Interfaces

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Where to get help?

INSIDE: ARRA Meaningful Use

Guide to EHR Selection Electronic Health Record Overview The decision to select and implement an EHR should be undertaken with great seriousness, because the process is both complex and costly; it will involve most processes and almost everyone who works in the office. There are few off-the-shelf software solutions (e.g., Microsoft Office) because each practice is slightly different.

On the other hand, an increasing number of vendors will provide basic functionality, so a practice can get started and gain experience before undertaking a major customization.

specific disease states (e.g., ensure that diabetics have regular foot and eye exams). The ability for software to run clinical decision support (CDS) based on physician-defined rules makes it much easier to ensure that care provided through an EHR is compliant with best practices than care provided with paper records. For example, if a diabetic is due for a foot exam or a Hemoglobin A1C measurement, the EHR system can issue a reminder. It’s similarly easy to run reports for patients over age 50 who have not had a colonoscopy or other required screening tests.

Basic software packages provide the ability to perform drug/drug and drug/allergy interactions when medications are ordered. A problem and procedure list history can be maintained, as can online documentation of progress notes and phone notes. Many software packages have the ability to track preventive measures or manage

No one-size-fits-all software package will be perfect for everyone. The time dedicated to selecting the proper software will ensure that the system serves your needs. This brochure is designed to provide a starting point for those who are thinking about selecting a system. We hope it will be helpful in your endeavor.

EHR Comparison Readiness Assessment Implementation Benefits and Quality Measurement DHIN

Quality Care and Patient Safety Studies have shown that EHR reduces errors because no one has to decipher handwriting. The system also reduces length of stay and repeat tests as well as the turnaround times for laboratory, pharmacy and radiology requests.

But change is challenging and there is a distinct learning curve for the doctors, pharmacists and laboratory technicians who will use the system. Critics say the system could make physicians overly reliant on technology.

Still, doctors can expect to benefit from improved billing and coding, in addition to fewer callbacks.

Hospitals that use EHR have fewer malpractice suits, which ultimately results in lower insurance premiums.

EHR provides such conveniences as smart med pick lists, with usual doses and routes. It provides real-time patient identification, adverse drug dose reactions and test or treatment conflicts.

Operational Efficiency Telephone calls and messages can be easily handled with an EHR; prescriptions and orders can be transmitted electronically to labs, imaging centers and pharmacies.

Online documentation can be simple or complex.

It can be a form that the physician completes or the nurse starts, or it can be a menu-driven pick list that generates a textual note. Unlike paper, the online documentation can suggest appropriate evaluation and management codes for billing purposes, and can ensure that all documented charges are presented to the billing clerk or billing system. While it’s important to note that EHR implementations are associated with a short-term reduction in efficiency, good EHR software allows

ARRA is an economic stimulus package enacted by the 111th Congress in February 2009 and intended to stimulate the U.S. economy in the wake of an economic downturn.

physicians to rapidly compensate for the learning curve and results in long-term efficiency and effectiveness.

During the early days of implementing an EHR system, when physicians and staff are learning, overall efficiency will slow down temporarily.

Don’t be discouraged. Many physicians say they are back to their previous pace within 2-3 weeks.

The best way to ensure that your implementation goes well is to avoid using features that are more complicated than you need. Do you really need to automate your notes on day 1, or can you start with electronic prescribing or other simple functions? This type of decision will improve your learning curve.

American Recovery and Reinvestment Act (ARRA) The HITECH component of the American Reinvestment and Recovery Act (ARRA) provides financial incentives to encourage physician EHR adoption. Physicians are eligible for charge-based reimbursement based on retrospective Medicare or Medicaid revenue. Under the Medicare reimbursement schedule, HITECH will not reimburse physicians until 2011, although the cost incurred may

begin in 2009 or earlier.

Physicians who qualify under the Medicaid schedule will receive reimbursement beginning in the year in which the cost is incurred.

The maximum financial benefit will be realized for each physician who implements an EHR in 2011 (fig. 1, Medicare Incentives for Physicians.

Source: Advisory Group, from

ARRA 2009). The benchmark to receive financial benefit under ARRA is the achievement of “meaningful use” as defined by the proposed CMS rules. It is perfectly acceptable to complete the implementation in later years, but the amount of financial benefit that accrues to the physician will be lower for each year after 2011 in which the practice achieves meaningful use.

ARRA Medicare Incentive Payments

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ARRA Medicaid Incentives Physicians can collect incentives for meaningful use of EHRs from Medicare or Medicaid, but not from both.

EHR Adoption by 2015 or Penalties Compared to incentives for EHR adoption, there are equally compelling penalties: Physicians failing to demonstrate meaningful use of EHR by 2015 will have their fee schedules reduced to 99% in 2015, 98% in 2016, and 97% in 2017. If proposed incentives and penalties fail to raise physician EHR adoption rates to 75%, the ARRA authorizes the HHS Secretary to further reduce physician payments by 2% in or after 2018.

Meaningful Use Medicaid Services published final meaningful use requirements for ambulatory EHR users on Dec. 30, 2009.

Appendix A lists the meaningful use criteria for Stage 1 (2011); Appendix B summarizes the proposed meaningful use criteria for later years. Criteria for 2013 and 2015 criteria are not clearly defined.

attestation is unknown). Reporting requirements will be extensive.

Payments based on meaningful use for software implemented in 2011 will begin in 2011.

MEANINGFUL USE FUNCTIONS (see Appendix A for comprehensive list) ■

The responsibility for certifying that a specific EHR supports meaningful use criteria falls on the vendor. A physician purchasing an EHR should always request a contractual representation that the software is certified for meaningful use.

The physician will be required to attest to the software’s meaningful use in the practice in order to receive incentive payments under ARRA (although the exact method of this

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CPOE Clinical Decision Support (CDS) Problem, medication and allergy lists E-prescribing Demographics Vital signs Smoking status Lab results Patient lists Quality measures Medication reconciliation

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Readiness Assessment When you’re thinking of acquiring an EHR,

efficient and effective processes instead of

ask: Do I need it? Why? A forthright

adapting old methods.

response will enable you to clearly understand and measure value and benefits from the software implementation.

A staff skills inventory is usually performed as part of a readiness assessment. It’s important to understand which personnel will welcome the

An important part of the

changes associated with automation, and to

readiness assessment is a

learn who might resist. Staff members who are

workflow evaluation, where

involved early in the decision-making phases

each major process from phone

are likely to embrace these changes.

calls to clinical encounters is defined and analyzed. Review current policies and procedures and other processes. Some practices institute patient and staff surveys to understand what works and what does not.

The goal is to automate new,

The readiness assessment also includes a general timeline. Questions such as, “What is the best time of year to go live with an EHR?”, “What is the best method to train the staff?” and “Do we implement the entire EHR at one time or bring it up in phases?” can help generate a workable timeline.

System Selection and Purchase First and foremost, two iron-clad requirements must be met by all EHR systems under consideration: the ability or plan to interface with the Delaware Health Information Network (DHIN), and the current or planned “meaningful use (MU) certification” by CMS. The ability of the EHR to interface with the

DHIN will allow for a single point of connection to carry information from many sources, including labs, imaging centers, hospitals, etc.

Once the requirements of MU certification and DHIN interaction are satisfied, the choice among systems becomes one based on practice size and system functionality.

Implementation EHR ROADMAP • Readiness Assessment • System Selection • Implementation • Benefits and Quality Realization

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Implementation primarily will be driven by the vendor.

The duration of implementation can last from several weeks to several months.

During implementation, required interfaces (including ones to an existing Practice Management System and DHIN) will be configured, customizations will occur,

Guide to EHR Selection

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decisions made and a go-live scheduled.

Training and support for office staff will be defined and executed during implementation.

Although consultant services may be helpful, the vendor will usually provide sufficient staff support.

The most visible aspect of implementation is the go-live

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event. Without exception, this will be associated with a productivity loss that may take months to accommodate.

Thus, you should plan to reduce patient volume during the week or two after go-live.

Good vendors that have significant implementation experience will minimize the long-term productivity loss.

Benefits and Quality Realization After go-live, measurement of benefits or negative effects must take place; in order to qualify for meaningful use incentive payments, practices must provide standard quality reports.

Vendors should provide report templates that track patient call

and visit volume, compliance with screening guidelines and quality metrics. The software should provide the ability to customize reports as needed.

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Colonoscopy age >50

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Flu and Pneumovax rates

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Database query for specific medication in case of recall

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Hospitalization rates

Examples of Quality Reports

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Eye and foot exams for diabetics

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Diabetics with HgbA1C

Functional Comparison Appendix C contains a comprehensive list of all Certification Commission for Health Information Technology (CCHIT)–certified EHR products. For the purposes of this document, we will address in detail only popular, well-known products.

No two systems provide equivalent function or perform functions in the same way. Some applications are focused on connectivity to DHIN or other entities, some have complex documentation engines, others use forms for notes, etc.

Assistance from colleagues, consultants, hospitals and medical society recommendations can guide a practice toward the right choice. One sure-fire strategy is to engage a consultant to conduct a readiness assessment and system selection.

Quality Insights of Delaware, Beth Schindele (bschindele@wvmi.org), is experienced in system selection.

To some degree, the use of practice size as a criterion for system selection is based on the cost to implement on-site software. In general, ASP software (e.g., DHIN EHR primer, Allscripts MyWay, Cerner PowerWorks) can scale up to a large practice size.

KLAS has been performing comparisons of software, consultants and services for some time. The 2009 “best in KLAS” winners for ambulatory systems are Greenway Systems (small), Greenway Systems (medium) and eClinicalWorks (large).

Basic functionality that must be included in an ONC-certified EHR include:

Advanced functionality (not currently required for meaningful use) include: ■

Telephone messages

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e-Prescribing

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Referral management

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Medication reconciliation

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Problem, medication and allergy lists

Scanned images (for paper documentation)

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Scheduling (sometimes schedules are maintained in the Practice Management System ) and interfaced with the clinical system

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Laboratory results

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Online documentation (may include evaluation and management coding engine)

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Patient education

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Electronic encounter summary

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Health-exchange communications, including med reconciliation at transition of care and communication of immunization records to state entities

Secure patient/provider communications

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Patient portal

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Population and quality reporting

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System Comparison

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Application Service Provider (ASP) Software systems are divided into two categories: (a) on-site software and hardware are purchased by the practice and maintained in the office, and (b) remote-hosted, or “application service provider” (ASP), software and hardware are leased on a monthly basis from the vendor. The vendor is the ASP that runs the software centrally; the office connects to the ASP over the

Internet. Many practices are finding that ASP models are more easily supportable because the vendor provides technical support. Additionally, the capital expenditure for ASP software and requisite hardware is much less; sometimes there is no capital outlay. The same amount of ARRA financial compensation is available for either on-site or ASP software.

EHR Technology Components From a technology perspective, EHR implementation requires hardware, software and connectivity. Included among required components are: ■

Computers – For the exam room and business office areas. These can be stationary desktop units, computers on wheels (COWS), tablet devices, etc.

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Network – In the office so that computers can talk to one another and information can be stored centrally for future retrieval. The network can be wired (e.g., Ethernet) or wireless. If a wireless network is implemented, appropriate security paradigms are necessary.

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Internet – This is important if any part of the system is hosted (stored) from a remote location, and for e-prescribing (e-Rx), e-ordering or connectivity with DHIN.

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Server – Large machines that support the vendor software and manage the system functionality and operations.

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Printers and fax machines.

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Handheld devices – Some vendor systems (e.g., Allscripts) provide an iPhone or BlackBerry platform on which some or all system functionality can be run.

Practice Management Software (PMS) Some clinical system vendors also provide an integrated practice management system (PMS). While sometimes switching to a single-vendor system has advantages, most of the time a simple interface between the PMS and the clinical system will suffice to give the physician access to the patient schedule and the ability to communicate charges to the PMS.

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Delaware Health Information Network (DHIN) The Delaware Health information Network (DHIN) is a clearinghouse for health information generated from hospitals, commercial labs, imaging centers and other sources. Soon, information will also be sent to DHIN from physician offices. DHIN acts as the hub of a wheel in which the spokes are all the data sources in the state. Thus, any EHR you choose must be able to interface both to and from DHIN.

Many of the meaningful use criteria required to qualify for ARRA incentive payments are based on integration between the EHR and DHIN. Stage 1 examples of Health Information Exchange (HIE) communication include medication reconciliation across transitions of care and immunization history communication. ARRA meaningful use Stages 2 and 3 will make more significant use of DHIN. Physicians in Delaware are fortunate to be able to take

advantage of an HIE that is up and running.

Approximately 50 percent of physician practices in Delaware currently use DHIN for some purpose: printing reports, querying patient results, etc.

Many of these practices enjoy interfaces between DHIN and their EMR that make paper results unnecessary. It can’t be stressed strongly enough that the ability to work with DHIN should be your #1 system selection criteria.

The Delaware Health Information Network (DHIN) is a public-private partnership that provides the organizational infrastructure to support a clinical information exchange across Delaware. DHIN is a collaboration of physicians, hospitals, commercial laboratories, community organizations and patients, designed to provide for the secure, fast and reliable exchange of health information among the many medical providers treating patients in the state. DHIN provides one source and one format for all clinical results.

DHIN/EHR Data Integration and Flow The functional purpose of DHIN is to receive and send clinical results and orders to and from all clinical locations of care. DHIN’s current and future functionality includes: ■

Results from all sources, including lab, radiology (including links to the image), pathology and others reports.

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eOrders – the clearinghouse for EHR orders. For example, a lab order generated from an EHR will be routed through DHIN to the lab.

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Transition of care records – hospital-dictated documents and EHR visit summaries will be sent to DHIN for distribution to hospitals, practices and other sources.

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Immunization records – DHIN will receive immunization updates from EHRs, hospitals and clinicals to maintain a comprehensive record that is available to the EHRs and others.

DHIN current and future functionality begins to paint a picture of system independence. No longer is a single system needed to ensure excellent data communication between a hospital and an affiliated physician’s practice. Data will flow among different vendor systems via DHIN as a data hub.

Consequently, when selecting an EHR system, consider the robustness of DHIN connectivity first, then evaluate the vendor system based on functionality, price, ease of use, etc.

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DHIN is a Health Information Exchange

Information is flowing through the DHIN health information exchange in two directions: to and from the practices, labs and hospitals. A document (e.g., discharge summary) that is generated from the hospital will flow through DHIN into an EHR. Similarly, immunization records will flow from the physicians’ offices through DHIN to public health agencies and hospitals.

DHIN’s integration status means there is no limit to the number of different vendor systems that can share systems. As long as the EHR you select is certified by DHIN for full integration, your system will be able to access any information that comes from hospitals, other DHIN-integrated physicians’ offices, commercial labs, public health agencies, etc.

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Frequently Asked Questions What is the deadline for my EHR to be installed?

Ambulatory EHR systems must be installed 90 days prior to the end of calendar year 2011 so that data collection and reporting can be performed for at least 90 days in that calendar year.

When can I expect to receive my incentive payment?

A payment will be made for the year in which meaningful use reporting occurs. For example, if meaningful use reports are generated for calendar year 2011, payment will be made for that year.

What is the maximum financial incentive I can expect for EHR implementation?

The lower of 75 percent of allowed Medicare charges (if using the Medicare formula) in the payment year or the set limits established in ARRA (a total of $44,000 over five years for most physicians).

What if I decide not to install an EHR? The last year in which incentives will be available is 2014. Starting in 2015, penalties will be levied based on a percentage of Medicare or Medicaid revenues, and these penalties will increase with each year. Additionally, the Secretary of Health and Human Services has been authorized to increase the penalty amount above the current legislation if EHR adoption is deemed insufficient.

How long does it take to get an EHR up and running?

This is highly variable; it depends on the degree of customization, whether software and hardware is on site or remote, and other factors. For remote-hosted software applications (ASP model), the range is 90 days to six months.

Are there any sources for financial help to obtain an EHR?

An EHR is an electronic medical record that exchanges data among systems. An EMR is a stand-alone isolated system

Some companies provide deferred payment plans, until ARRA incentive payments are made, or other financing plans. The Stark anti-kickback laws have a safe harbor that allows hospitals to donate up to 85 percent of the cost of a new EHR for medical and dental staff members. Christiana Care is closely evaluating these regulations.

What is the difference between an EHR and an EMR? An EMR is an electronic medical record that is used by a practice or clinical provider but does not integrate/interface with other systems. An EHR is an electronic health record that is integrated with a Health Information Exchange (HIE).

How many of my colleagues in Delaware have an EHR? Most practices have been using an electronic practice management system for billing and scheduling for some time. The penetration of clinical EHR systems in Delaware is 30-40 percent of clinical practices; most of these are large group practices. Most practices of fewer than three physicians do not yet have a clinical EHR.

Where can I get help?

Various consulting companies will be happy to help with system selection, training, implementation, etc. Quality Insights of Delaware (302-521-6928) can be retained for assistance.

Dr. Terri Steinberg, Christiana Care CMIO, is willing to help with general questions pertaining to EHR system selection and implementation or to provide information about specific Christiana Care Health System plans.

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Appendix A: Meaningful Use Criteria CPOE

80% of orders by clinician into CPOE. Orders do not need to be sent electronically to department (lab, pharm, etc) Use CPOE for meds, lab, rad, referrals

Clinical Decision Support (CDS)

Real time clinical checking (d/d, d/a), formulary check, user ability to maintain screening rules, track user response to alerts

Problem List

Longitudinal PL in ICD-9 or SNOMED 80% of unique pts must have at least one coded problem/diagnosis (‘none’ is an allowed entry)

e-Rx

75% of non-controlled substance Rx’s

Med List

80% of unique patients must have at least one coded entry (‘none’ is an allowed entry)

Med Allergy List

Longitudinal with allergy history 80% of unique patients must have at least one coded entry (‘none’ is an allowed entry)

Demographics

80% of unique patients must have demographics as follows recorded as structured data: Preferred language, Insurance type, Gender, Race, Ethnicity, DOB

Vital Signs

Height, Weight, BP, BMI, Temp, Pulse, Growth Chart for children 2-20 80% of patients >/= age 2 must have BP and BMI

Smoking Status

Must be recorded for 80% of patients Record if current smoker, former smoker, never smoked

Lab Results

Display results, translate LOINC codes; Allow maintenance based on new results Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format

Patient Lists

Allow user to sort, retrieve, and output patient lists based on demographics, medications, and conditions

Quality Measures

Calculate, display, and submit quality measure results to CMS and States

Patient Reminders

Issue practice reminders based on patient preferences, demographics, conditions, and medication list

Rules

Five CDS rules beyond d/d or d/a; based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track responses to alerts

Eligibility

Must cover 80% of unique patients; Allow user to record and display based on eligibility response from insurer

Submit Claims

80% of all claims submitted electronically

Electronic copy of health Must provide an electronic copy of health information to requesting patients within information to patients 48 hours Includes: test results, problem list, medication list, medication allergy list, immunizations, and procedures Patient Access to health info

Within 96 hours of availability to 10% of unique patients: diagnostic results, problem list, medication list, medication allergy list, immunizations and procedures

Office Visit Clinical Summary

Must provide for 80% of office visits Diagnostic results, medication list, procedures, problem list, immunizations

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Appendix A: Meaningful Use Criteria Information Exchange

Must conduct at least one test of exchanging information. Electronic sending and receiving: test results, problem list, medication list, medication allergy list, immunizations, and procedures

Med Rec

Must be performed in 80% of encounters and care transitions. Compare and merge two or more medication lists into a single list that can be displayed in real time

Immunization Registries Submit data to immunization registries.

Must conduct at least one test of submitting information Syndrome Surveillance Data to Public Health Agencies

Must conduct at least one test of submitting information

Protect Electronic Patient Must conduct a security risk analysis and implement security updates Information Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures

Appendix B: Meaningful Use Stages 2 and 3 Adoption Year

Improve Quality, Safety, and Efficiency

2013

Evidence Based order sets Clinical Decision Support at the point of care Record family medical history

2015

Meet performance baselines on quality, safety, efficiency measures

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Engage Patients and Families

Improve Care Coordination

Improve Population and Public Health

Ensure Privacy and Security for PHI

Access for all patients to PHR with real-time health data

Produce, share electronic care summary at care transitions

Receive health alerts from public health agencies

Secure patientprovider messaging

Reconcile meds between care settings

Use summarized or de-identified data for population health data reporting

Self-management tools

Access comprehensive patient data from all available sources

Electronic reporting on care experience

Medical Device

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interoperability

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Provide anonymized electronic syndrome surveillance data

Clinical dashboards Automated realtime surveillance

On-demand accounting of treatment, payments and operations disclosure to patients Access comprehensive patient data from all available sources

Appendix C: Ambulatory EHR Products Source: Certification Commission for Health Information Technology (CCHIT) ABEL Medical Software Inc.

AbelMed EHR-EMR

Abraxas Medical Solutions

Abraxas EMR

Advanced Data Systems Corporation

MedicsDocAssistant

Agastha, Inc.

Agastha Enterprise Healthcare Software

Allen Systems Group, Inc. (ASG)

ASG Medappz Isuite

AllMeds, Inc.

AllMeds EMR

AllscriptsMisys, LLC

Allscripts Professional

AllscriptsMisys, LLC

Allscripts Enterprise

AmazingCharts.com, Inc.

Amazing Charts

American Medical Software

Electronic Patient Charts

Aprima Medical Software, Inc.

Aprima 2010

AssistMed, Inc.

AssistMed EHR

athenahealth, Inc.

athenaClinicals

Axolotl Corporation

Alysium

CentriHealth, Inc.

Individual Health Record (IHR)

Cerner Corporation

PowerWorks EMR

Community Computer Service, Inc.

MEDENT 18.1

Complete Medical Solutions, LLC

MyWinmed EMR 1.2

Compulink

Advantage/EHR 10

Conceptual MindWorks, Inc.

Sevocity Version 08

Connexin Software Inc.

Office Practicum 8.1

Criterions, LLC

Criterions 1.0.0

CureMD Corporation

CureMD EHR 10

e-MDs

e-MDs Solution Series 6.3

eClinicalWorks

eClinicalWorks 8.0

Eclipsys Practice Solutions

Eclipsys PeakPractice 1093

EHS, Inc.

EHS CareRevolution 5.3

Epic Systems Corporation

EpicCare Ambulatory EMR

Gateway Electronic Medical Management Systems (GEMMS)

GEMMS ONE

GE Healthcare

Centricity Electronic Medical Record

Glenwood Systems LLC

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Appendix C: Ambulatory EHR Products gloStream, Inc.

gloEMR

Greenway Medical Technologies, Inc.

PrimeSuite

Health Systems Technology, Inc.

MedPointe

Henry Schein Medical Systems

MicroMD EMR

Infinite Software Solutions, Inc.

MD-REPORTS

InteGreat Concepts, Inc.

InteGreat EHR

Integritas, Inc.

STIX EHR

Intuitive Medical Software

UroChart EHR

iSALUS Healthcare

OfficeEMR

KeyMedical Software, Inc.

KeyChart

LSS Data Systems (Lake Superior Software)

Medical and Practice Management (MPM)

Marshfield Clinic

CattailsMD

McKesson Provider Technologies

Lytec MD

McKesson Provider Technologies

Medisoft Clinical

McKesson Provider Technologies

Practice Partner

MCS - Medical Communication Systems, Inc.

MD.net EHR

MDTablet LLC

mdTablet

Medappz, LLC

iSuite 4.0

MedConnect

MedConnect EHR

Medflow, Inc.

Medflow EMR Version

Medical Software Technology Inc.

Advance EMR MD

Medicmatics Inc.

XUMIX VERSION

MedInformatix, Inc.

MedInformatix

MediSYS for Physicians, Inc.

MediSYS EHR

Meditab Software, Inc.

Intelligent Medical Software (IMS)

MedLink International, Inc.

MedLink TotalOffice

MedNet System

emr4MD Version

MedPlexus, Inc.

MedPlexus EHR

MTBC (Medical Transcription Billing Corporation) MTBC EMR NexTech Systems Inc.

NexTech Practice

NextGen Healthcare Information Systems, Inc.

NextGen EHR

Noteworthy Medical Systems

NetPracticeEHRweb

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Appendix C: Ambulatory EHR Products OIS OIS

EMR

PracticeOne

e-MedsysElectronic Health Record (EHR)

Prime Clinical Systems Patient Chart Manager Pulse Systems Pulse

Patient Relationship Management

Sage

Sage Intergy EHR

Secure Infosys, LLC

MyEMR

Silk Information Systems, Inc.

SILK

STI Computer Services, Inc.

ChartMaker Clinical Version

SuiteMed

SuiteMed Intelligent Medical Software

Symphony Corporation

Symphony Plus EMRx

Total OutSource, Inc.

ezEMRxPrivate

VIP Medicine, LLC

SmartClinic

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This brochure was produced to provide an introduction to EHR selection and to address basic concepts such as ARRA incentive payments, meaningful use, and other important components of EHR implementation.

The information contained in this document is not comprehensive and may not serve the needs of every physician specialty practice. Please contact Dr. Terri Steinberg for further information or assistance.

Christiana Care Health System Medical Affairs 302-733-2597 James Newman, M.D. Chief Medical Officer Terri Steinberg, M.D., MBA Chief Medical Information Officer Phone: 302-327-3959 E-mail: tsteinberg@christianacare.org

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