5 Queries About Software Print
1. Does it offer ophthalmology-specific and subspecialty-specific content, features and templates?
Treatment plan descriptions, decision support tools, medication lists and other items unique to eye care should already be banked into the system. "Ophthalmologists frequentlymake annotations and draw pictures. So, when you look at an EHR system, make sure that it has all the critical capabilities for your practice. Although some features may intuitively seem standard, not all systems will allow for freehand drawing on an electronic form, for example," said Mr. Daigrepont.
"Look for a system that has both depth and breadth with regard to ophthalmology installations because even within ophthalmology there are different needs among the subspecialties," said Ms. Lee. "Find out if the ophthalmology templates allow for customization and how much work such customization involves. Ask for a demonstration of the product and find out if tehre is a live site nearby that you can visit. Go to a practice that as closely approximates your practice as possible in terms of size, number of providers and subspecialties."

2. Will the EHR system be interoperable with current patient management system and practice software?
Most practices already have a patient management system (PMS) in place for billing, scheduling and other administrative tasks. If the EHR product that you are going to buy won't work with your existing PMS, then you will need to upgrade to a compatible PMS system. "This can really change the scope and complexity of your conversion, but make sure the two systems will work together," said Ms. Lee. Bundling services together with one vendor can simplify the integration process and make both systems easier to maintain.
"The Academy sponsos a standards-based effort to integrate different systems," said Lloyd Hildebrand, MD, who is chairman of the Academy's Medical Information Technology committee. "This effort is know as Integrating the Healthcare Enterprise (IHE) Eye Care initiative. If both the EHR and PMS are IHE Eye Care tested, then they should be able to work together."
Furthermore, said Mr. Daigrepont, "find out the basic programming language of the system. If it uses a proprietary database or programming language, you may have more difficulties working with the database as opposed to an Oracle- or Microsoft-based program, which has countless people who can help you."

3. Will the EHR system interface with your current diagnostic devices and equipment?
When meeting with a vendor, take a list of every device in your practice that will require integration. Some devices will integrate on one side, and others may need bi-directional integration - one on the vendor's side, and one on the device side - which may mean extra fees.
"Your should also take the basic statistics about your practice," said Ms. Lee. "For example, the total number of providers, useres and practice locations. This will give the vendor an idea of the scope of the installation."
"Again, a standards-based approach - as pioneered by IHE Eye Care - saves you money by alleviating the need to create custom interfaces for all your devices and equipment," said Dr. Hilbebrand. "The VA went from writing 700 different devices interfaces to writing just one because they were using a common standard. This year, even old equipment can be integrated through software know as 'middleware.'"

4. What are the vendor's plans for the product in the future?
An EHR systems is a long-term and costly investment. You therefore should make sure that it is not at the end of its life cycle. "Do not take the chance of becoming technologically isolated. Even if the vendor continues to support the software, it will become outdated because market research and development on the product ceases," Mr. Daigrepont said.
"Find out who they are hiring. If they are hiring a lot of Windows programmers and the product was Unix driven, chances are that is not where they are headed in the future."

5. What are the terms for upgrades and new realeses? At what frequency?
Expect to receive a new realease approximately every six months as a part of your maintenance agreement. To ensure delivery of these enhancements, "your contract should explicitly state that the vendor is required to provide you with future upgrades, new versions and releases at no additional charge. And, these improvementes should be in compliance with federal requirements," said Mr. Daigrepont.