How to choose the best Electronic Medical Record (EMR) System for your practice: a complete review for the busy provider
How do you choose the best Electronic Medical Record (EMR) for your practice? There are many choices out there at a variety of different price points. Some are great. Some are not. Choosing the right EMR for your practice needs is one of the most important professional decisions you will make. Choosing an inadequate EMR can be a costly mistake-slowing you down significantly in your day-to-day work and hindering practice growth. On the other hand, choosing the right EMR can save you valuable documentation and prescribing time and act as an effective, efficient patient communication and appointment booking tool.
When shopping for an EMR, important considerations include price, capabilities, and user support. Ideally, you want an EMR that is affordable and has ample 24/7 user support to assist with onboarding and trouble shooting. You also want an EMR that has all the basic functions needed to operate a busy outpatient practice. These include, but are not limited to, the following key functionalities: e-prescribing for medications and labs, integration with Quest/Lab Corp, ability to create and store note templates, forms, and frequently used clinical smart phrases, an easy-to-use patient scheduling tool with telehealth appointment ability that integrates with your practice website, and superbill functionality with electronic claim submission. The EMR should also contain an integrated fax line, direct patient payment capability with integration to Stripe or Square, as well as a user-friendly portal for patient and staff communication, patient form signing, uploading and storage, questionnaire completion, appointment booking, and staff to staff communication. All of these functions are essential to an EMR and your sanity as a provider! EMRs that contain all or most of these features are considered the gold standard. They are most desirable for a growing practice. In some situations, you might need to choose an EMR with more limited functionality for cost reasons, especially if your practice is new and cash strapped. Just keep in mind that choosing an EMR with limited functionality means there will always be limits if the practice needs to pivot in a new direction. In the next few paragraphs, we will summarize the most commonly used EMRs, the pros and cons of each, and “the word on the street.”
AdvancedMD: Consistent with its name, AdvancedMD is one of the most sophisticated outpatient EMRs on the market. It has many built in note templates, multi-provider scheduling tools and views, automatic benefit verification, CPT coding suggestions, and sophisticated intra-staff communication features. It has several pricing options including price per provider or price per patient appointment, called “price per encounter.” The price per provider is approximately $400/month, although there is some negotiating room for practices with many providers. It is an ideal choice for a busy multi-provider practice, although some users give feedback that it is too expensive and offers limited support.
Charm: With a free version and a nearly free version, Charm is the preferred favorite for the cost conscious, low budget practitioner looking to minimize start up costs. It has all of the basic functions, is easy to use, and can function seamlessly for a busy outpatient practice. Among users, it has a good reputation overall and is a solid choice.
DrChronos: Dr.Chronos gets mixed reviews. Users like the reporting functions, the auto posting of insurance payments, and Square integration for payment. It is very user-friendly, intuitive, and easy to personalize. The revenue cycle management (RCM) and billing features are strong. The biggest gripe among users is that the e-prescribing software is clunky and time consuming. Also, you can only get a live person for support via email-no readily available phone number or live person chat function. It is one of the costlier EMRs, at approximately $350-$400 per user.
Epic: Known as the “Cadillac of EMRs,” Epic is by far the most sophisticated and most expensive EMR on the market. It is used extensively by very large inpatient and outpatient HMO and University healthcare systems, including Kaiser Permanente and Johns Hopkins Medicine. While its patient portal, patient/staff secure messaging system, and integrated measurement-based care tools are impressive, it is likely outside the price range of most small startup practices, and has many tools and functionalities that would likely go unused on a day to day basis.
Icannotes: Icannotes is an older EMR. Many users say that Icannotes has “a dream note template” that includes everything, which is great for a beginner or someone newly out of school who needs guidance and structure on note content. While it is a cheap and affordable option geared towards behavioral health outpatient practices, its interface appears outdated and log-in is often slow and clunky. Billing is challenging. The monthly cost of Icannotes has also recently gone up due to all the add on charges for various functions. It has all of the bare minimum functionalities needed, but with a 1990s, Oregon trail-like look and feel to it. So while the note template is great and its relatively cheap, this is not always enough to overcome all of the other limitations.
IntakeQ: Known for its automated forms and easy operability, IntakeQ is a favorite among some outpatient clinicians who describe it as “user friendly” and “easy to customize,” with great customer support. There are a few drawbacks though: it is not a certified EMR so this can be an issue for some payer contracts. There are also very few templates in the template library. If you have your own forms or patient handouts that you prefer to use, you have to pay nine dollars to upload each outside form or handout to IntakeQ or recreate it yourself within IntakeQ. One clinician recounts having forty patient handout pdfs she wanted to use in the patient portal, and having to pay three hundred and sixty dollars to upload all of them for use in IntakeQ. Additionally, Intake Q is only currently integrated with Krupa for labs, which is not sufficient for what most providers need. Finally, Intake Q recently got rid of their payment integration with Square and Stripe and partnered with another third party payment processor that has multiple complaints listed on the Better Busines Bureau (BBB) website. That being said, its affordable price range, customization tools, and extensive existing usage among outpatient clinicians still make it a reasonable choice for small to medium sized growing outpatient practice. It is not ideal for larger practices.
Kareo/Tebra: Widely popular among clinicians and patients alike, many consider Kareo to be the best EMR on the market for small to medium sized growing practices. Full disclosure, it is my personal favorite. It is extremely easy to set up and use and also has an intuitive scheduling tool and patient portal. It also has sophisticated and easy to use electronic superbills and self-pay options. It is easy to create and save note templates and commonly used clinical phrases or use existing templates from the Kareo library. Kareo boosts an extensive library of onboarding and training videos, as well as friendly, responsive 24/7 support. Kareo recently partnered with the healthcare marketing and branding company PatientPop to become Tebra, where it offers google review integrations and extensive search engine optimization (SEO) marketing support. While it is not the cheapest EMR on the market, the extra spend is definently worth it.
NextGen: Similar to Icannotes, NextGen is an older EMR with limited features. Its interface is slow and clunky. Many providers jokingly call it “FirstGen” due to its dated interface and limited capabilities. It is ideal for a very large outpatient non-profit or Federally Qualified Health Center (FQHC) with limited funds.
Practice Fusion: This is an EMR that was initially free for its first 5 years. Now due to its growing popularity and ease of use, Practice Fusion offers a free trial, and then charges a small monthly provider fee. However, the billing function is slow and clunky and not well integrated into the EMR. Additionally, their customer support is minimal. Users also complain that the clinical note template is essentially a word document. That being said, many folks like the flexibility and degree of user customization it offers, as well as ease and simplicity of medication ordering. Overall, it is a relatively solid, cheap EMR; one that meets most of the needs of both small and medium sized practices alike.
Practice Q: In my role as a collaborating physician, I really like Practice Q. Practice Q makes it really easy for a mid-level provider to email individual patient charts to their collaborator for review and sign-off. Instead of the collaborator logging into the EMR and searching for charts by date and patient information (which is time-consuming), the collaborator receives a HIPPA compliant email with a link they simply click on to open the specific chart needed for review and sign off. Selfishly and for this reason alone, I would prefer that every mid-level use Practice Q!
SimplePractice: This EMR is popular with therapists. It offers an easy-to-use phone app for on the go work, as well as a popular email and text appointment confirmation feature for patients. Simple Practice Telehealth is a popular version of the EMR for virtual providers that also offers on demand free telehealth training classes. Simple Practice has electronic claim submission functionality with their “Plus” plan. The main complaint about SimplePractice is that they have continued to raise their prices significantly over the last year, including higher charges for swipe fees, while also moving some pretty basic functions like calendar sync into their more expensive plans.
Optimantra: For a smaller EMR company, Optimantra gets consistently great reviews. It is a fast growing EMR company with a lot of positive buzz. It has a sophisticated scheduling tool that integrates directly into your practice website for direct appointment booking. It also has many customizable forms and note templates, e-prescribing, and e-lab ordering with full integration with existing lab companies. You can also take advantage of the free Optimantra facebook group, which is run by a very experienced and friendly Nurse Practitioner. Overall, users seem to agree that it is very intuitive and easy to use, with a robust, responsive user support department.
Osmind: This less well-known EMR has a lot of great features, including automated questionnaires with alerts for customizable score thresholds, integrated intake paperwork and document signing, integrated billing and superbill generation for clients, and an electronic insurance submission tool. Users find the interface visually appealing and intuitive. The one main draw-back is there is no self-scheduling tool for patients. Overall though, there is consistently good feedback about the functionality of this EMR, although some feel that the price is too high given that they are up and coming and still in a development phase.
TherapyNotes: As its name suggests, TherapyNotes is an EMR designed primarily for therapists or providers with a largely psychotherapy/counseling focused outpatient practice. It offers integrated telehealth functionality and integrated billing, as well as additional billing support if that is not your strong suit. It is often used for therapists who run groups. Users report that the support staff is very responsive and available during off-hours. Overall, it has positive reviews online from most therapists. Some mid-level providers feel it is limited and more for therapists than prescribers, but has enough workaround tools to get the basic job done.
Valant: Valant gets mixed reviews from providers. Most like that it is very cheap. It also has a nice feature called “Knowledge Base” which has helpful clinical articles and on-demand training videos. However, many complain about the lack of integration with labs (an almost universal feature included with most competitors) as well as the patient portal which does not interface well with many web browsers. Others note that customer service becomes less responsive after you sign the service agreement contract. Due to all of these limitations, providers are starting to avoid this EMR.
As you can see, shopping for the right EMR for your practice is much like dating. There are many that have most of the features you are looking for and quite a few that have significant hidden flaws and drawbacks which would make daily provider life for you unnecessarily burdensome. Similarly, I would argue that no potential EMR “partner” is perfect. Even the very best have minor drawbacks. The take home message here is do your EMR shopping diligently and thoroughly by completing demos, reading reviews and articles like this one, and talking to as many providers as possible about their user experience. Your fellow providers will be honest with you about which EMR partners make for great long term relationships, and which ones just flat out suck. If you go through these steps, you will undoubdtly make a wise EMR choice that suits your practice needs and finances best. Best of luck in your EMR dating quest!
-Lauren