By Eric Fishman, MD
There is a lot of discussion concerning which is the “best” Electronic Health Record
(EHR) for any individual entity. There are a variety of parameters which should be
considered prior to embarking upon what will undoubtedly be one of the most important
decisions in the life of a healthcare organization.
One of the most important issues is “Should I purchase an EHR designed for my
specific specialty?” We will attempt to address some of the pros and cons of each
If you are involved in a multi-specialty clinic I would strongly advise against purchasing
multiple different EMRs, one for each specialty. One of the major difficulties with this
plan, and it may be all but insurmountable, is the inter-connectivity between the various
programs. Yes, they may all be HL7 compatible, but you will find yourself in an almost
endless quagmire of interfaces.
The question is a bit more difficult to answer if you practice in a single specialty
environment. There are a large number of specialty specific EMRs for a variety of
specialists, including Oncology, Ophthalmology, Orthopedics, Cardiology, etc. In
this instance, if you have a very sophisticated workflow, often seen in larger single
specialty medical groups, then a specialty specific EMR may be most appropriate.
I find that Oncologists, in particular, do well with EMRs designed specifically for their
specialty. This is, in part, because many of their workflow issues are entirely foreign to
almost all other specialties. This would include, of course, dosing issues concerning
their cancer treating pharmaceuticals.
At the other end of the spectrum would be Internal Medicine and/or Family Practice.
Most “general” EHRs are fully capable of handling most of the workflow and reporting
issues found in those practices, and therefore a more general Electronic Health Record
program would be most appropriate.
Cardiology, Ophthalmology and Orthopedics, and many others, fall somewhere in the
middle. If you find yourself using a substantial number of activities that are not
performed by any other specialists, such as in office arthroscopy for Orthopedists, you’ll
likely find generic EHRs to be lacking in functionality. If, however, your office based
practice is more standardized, by which I mean closer to the activities performed by
other specialists, then the problems which may be associated with single specialty
EHRs may not be worth encountering.
What are some of these problems? First of all, many single specialty EHRs are provided
by companies which are both small and unlikely to grow much larger because of their
limited potential user base. Certainly this is not the case of all single specialty EHRs,
and there are some multi-billion dollar companies producing fine software in this arena.
However, many of them are products which were started by a physician in that specialty.
Their longevity in the marketplace must be considered when acquiring software of that
So, in short summary, I would encourage you to take a careful look at the workflow in
your office and consider how similar or different it is to other physicians of different
specialties. If it is not extraordinarily different, I would go with a more general EHR. If, on
the other hand your specific installation is that of a multi-specialty clinic, I would strongly
recommend purchasing a general EHR from a company which is large enough to have
developed the different workflows for each relevant specialty.