Understanding HIT applications

Before tackling the details of your practice's particular needs, take a look at the basic applications on the market. After you understand which types of applications are available, learn which servers and systems facilitate them. We've briefly outlined the applications and server options below.

Practice management systems (PMSs)
Practice management systems (PMSs) are the most commonly adopted HIT products. Many providers who have not yet implemented EHRs or other HIT are already using PMSs to:

• Digitize the "business" aspects of medicine.
• Manage visit coding, billing, scheduling, registration, etc. Note: If you are already using a PMS, then you need to make sure that your EMR can "talk to" your PMS, and that information updated in one system will update the other and that your staff won't need to "double-document" information.

Read a quick explanation of practice management systems.

Electronic medical records (EMRs) and electronic health records (EHRs)
EMRs, at a minimum, replicate all the aspects of your paper charting. They are designed to facilitate all the documentation you do in your office already (lab results, visit notes, diagnostic test results, insurance information, demographics, health histories, and medication information, etc). Most, though, build substantially on these basic uses and allow for things like data exchange and messaging between physicians, the generation of reports and population lists specific to disease or medication, automatic lab reporting, or specific issue-based "templates" for patient visits.

Before a patient even steps into your office, an EMR system may have already:

• Managed scheduling, patient data registration, health history and medication lists. Depending on the vendor, these functions may be available in the EMR itself. Alternately, it may capture these data by interfacing with your existing PMS.
• Facilitated messaging between physicians (within or external to the practice) regarding a patient's specific case.
• Allowed you to electronically preview patient medical history, medications, diagnostic tests. These basic data may have been compiled for you in a "patient summary report" generated by the EMR.
• Generated reports on patients that require follow-ups, are due for physical exams, or need medication refills.

While you are seeing a patient, an EMR allows you to:

• Type your clinical documentation.
• Electronically prescribe medication, transmit these orders directly to pharmacies, and (in some systems) receive an automatic "warning" of potential drug interactions.
• Work with a pre-established "template" designed around specific disease management protocols.
• Electronically order tests, diagnostic imaging, labs, etc, as well as electronically review previous results.

After the patient leaves, you may be able to:

• Electronically communicate with consulting providers and save these messages directly to patients' charts. Messages are pre-populated with patient demographics, so callbacks and patient contact is easier.
• Receive electronic notification of prescriptions that need to be refilled.
• Electronically review lab results, and diagnostic test results, having been automatically alerted when these are ready for review.
• Group and manage specific populations of patients: all those with diabetes, for example.
• Use the EMR for billing management, claims submittal and coding.
• Have patients review test results, fill out forms, send messages, and populate records (home blood pressure and glucose readings, for example) through a patient portal.
• "Dictate" consult letters to a voice-recognizing computerized tool.

Learn more about EMR functionality.

Electronic prescribing (e-prescribing or eRx)
E-prescribing means the transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through an intermediary, including an e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions between the point of care and the dispenser.

If you choose to adopt a stand-alone e-prescribing system, you will be able to:

• Manage all your patients' prescriptions on your computer.
• Print scripts, or directly transmit them to participating pharmacies.
• View potential drug interactions and side effects. Decision support is often integrated into these systems.
• View prescription drug coverage and insurance information.
• Receive electronic notification when you need to authorize refills, approve generic substitutions, etc.
• Share simultaneous access to prescription histories and allergies with pharmacies, whether or not that pharmacy has managed the patient's previous prescriptions.

Because physicians can choose to implement an e-prescribing system without implementing a full EMR application, it is important to learn more about e-prescribing functionality.

Picture Archiving and Communications Software (PACS)
PACS are EMRs that are specifically designed to allow doctors to view digital photographs or images of diagnostic tests. With a PACS system, you can:

• Store MRIs, X-rays, colonoscopy or dermatology photographs, etc., in high-resolution formats.
• Share images with diagnostic centers and consulting physicians.
• Maintain image-related patient data in conjunction with other EMR systems.

Learn more about PACS functionality.

Personal Health Records (PHR)
PHRs are much like EMRs except that they are managed and populated by your patients. There are already functional PHRs on the market, but it's currently unclear how patient-generated PHRs will interact with physician practices' EMR systems in the future. Potentially, though, PHRs could allow providers to view:

• Patient-documented glucose levels, food diaries, heart rate or blood pressure readings.
• Detailed health histories.
• Non-prescription medication lists. Interoperability issues with these systems, however, are unresolved as of today. Although the federal government has advocated for every patient to have a PHR, these applications have yet to flood the market, since it is unclear how these records will participate with provider-created EHRs, how they will be secured, and how physicians will access them.

Learn more about PHRs and their relationship to EMRs.

Server decisions: application service providers (ASPs) v. client-server model

Application service providers (ASPs)
ASPs sell web-based applications. If you work with an ASP, you will use software on vendor-owned equipment, and your data will be located outside of your practice at a secure site or data facility. You will not have to purchase a server, hardware, or software outright. Instead, you will contract for the use of these through the ASP. Because the ASP owns the equipment and maintains the server, there is less technical responsibility for the physician practice. When working with an ASP, data backups, software upgrades, licensing and hardware servicing are usually provided as part of the cost. Costs are on-going, so there is less of an initial financial investment.

Client-server models
If you choose not to use an ASP, you will have to buy a server with adequate space and speed for your practice needs, as well as the necessary hardware for exam rooms and work stations (and the EMR software). You (or your technology staff-person) will be responsible thereafter for backing up your data, maintaining the server, and upgrading software. You may have to pay licensing costs for each workstation (depending on your licensing agreement with your HIT vendor). After the initial start-up costs, you will only pay for upgrades and maintenance.

See our section on vendor assessment to assess your practice's needs in more detail.