A lot of doctors are like Victor Ching, MD, an Upland urologist. His office took the technological plunge and integrated its practice management system and electronic medical records program--two essential tools that many physicians aren't particularly comfortable with individually, let alone together. The two programs talk to each other in Dr. Ching's office, meaning data only have to be put into one or the other. The practice staff is early in the learning curve, he reports, but he's optimistic about the integrated system's potential.

In many ways, Dr. Ching is past the scary parts of integration: making the decision to do it and then actually doing it. And you needn't fear taking your information technology platform to the next level either. Here's what to remember:

1. Be realistic.
"The first thing that went wrong was everything." That's Benjamin Mahdi, MPH, speaking. He is the CEO at six-provider Riverside Family Physicians and an enthusiastic fan of the Practice Partner software he used then and recommends now.

Mahdi's practice includes four physicians, a physician assistant and a nurse practitioner. The problems staffers faced were familiar to anyone who's undergone a computer conversion of any magnitude: Computers require humans to install, operate and maintain them, and humans make mistakes. Don't expect your early integration experience to be effortless.

2. Take your time.
Victorville allergist and Loma Linda University School of Medicine Assistant Clinical Professor Alan Gorenberg, MD, took the integration plunge in late 2003 and has just started using his fairly sophisticated system to its full potential. And he's delighted with his progress. "After a partial implementation for several years, we recently transitioned to digital charts," he reports. "It took that long--three years--to get the software, data systems and hardware working satisfactorily enough to make the transition."

Dr. Gorenberg adds: "I attribute our success to the extraordinary computer expertise of my colleague, physician assistant Steve Gruer, and to my own computer skills, as we do all of our own information technology for a single-physician practice with four locations."

3. Take the long view.
Dr. Ching's office is about two years into its adventure in integration and he expects it will be another year until things reach near-completion. That's as close to "completion" as he expects the IT initiative to ever get. "We have taken the trip very slowly--and not necessarily leisurely," he says. "We were even idling at times. We started with the billing system first, then added the EMR portion, and they were integrated from the beginning. But I'm afraid to give a beginning-to-end estimate because I see this as an evolving process."

4. Learn to think differently.
Riverside's integration efforts were wrapping up as Mahdi joined the team a year or so ago. He realizes now that the early problems staffers experienced were largely the result of trying to force the new technology to conform to the old processes. "We were trying to do what we'd always done, only on the computer," he says. "You have to step back and look at the whole information technology system and how it interconnects."

Everybody's familiar with what goes in and what comes out, but everything in-between is different with integrated practice management and EMR systems. "It takes a lot of time to train the staff, the physicians and all the other team members," Mahdi says.

5. Expect to spend a few  bucks, naturally.
Dr. Gorenberg's practice has been using a best-of-breed approach, including an EMR and a separate practice management system. He bought JMJ Technologies' EncouterPRO EMR in December 2003. It wasn't implemented until August 2004, although it was paid for the year before. It cost $27,000, and "implementation was fraught with technical problems related to computer hardware, operating systems, software and the EMR software allergy-shot module itself not being ready for prime time," Dr. Gorenberg recalls.

The practice management system, Per-Se/McKesson's Lytec, is integrated with the EMR by middleware called X-link, which Dr. Gorenberg describes as a "relatively expensive product that requires a full-price annual license." That adds to the overall complexity of the system, he notes, because there are three software vendors that usually do not communicate with each other--only with the client. On top of it all, his unique specialty narrows the field of available EMRs, which may account for some of the difficulties the practice experienced.

6. Be open to learning.
"I consider our story a success," Dr. Gorenberg says, "but it has been a huge education for me. The most important point to remember is implementing and using an EMR is a dynamic process that continually changes as hardware and software are updated, medical equipment and methods improve, and workflow evolves. You are never really finished with an IT project."

7. Expect good things.
"We've seen dramatic results" from implementing integration, Mahdi says. "We've definitely been through a lot of battles, but now we can measure if diabetics are compliant with office visits, for example. We can also compare how diabetics in the classes we offer are doing to others in the practice who aren't in the classes. That ends up leading us to better patient care."

8. Don't expect miracles.
Dr. Gorenberg's office is as high-tech as it gets. But he's only human. "If you came to my office, you would find that my desk is still covered with paper," he says, "although none of it is patient-chart related."