electronic medical records Articles - Medical Practice Trends

6 Best Practices for Implementing EMR for Meaningful Use

April 17, 2012 By Peter Polack Leave a Comment

An article on Becker’s Hospital Review discussed how Montefiore Medical Center was able to achieve 100% implementation of EMR and computerized physician order entry (CPOE).

Jack Wolf, Montefiore’s vice-president and CIO, lists these 6 best practices that they attribute to their success:

Meaningful Use is not an IT project
Physicians need to take ownership
Educate all hospital employees, physicians and staff
Use a diverse implementation team
Create an optimization team
Do not underestimate the power of system availability

IT Services for Your Practice – In-House or Outsource?

April 4, 2012 By Peter Polack 1 Comment

Previously I wrote about outsourcing your IT services support as well as how to hire an IT director. But one question that I am commonly asked is, “How do I decide whether to keep IT services in-house or whether they should be out-sourced?”

Electronic medical records systems have become an integral part of the practice of medicine and having someone with IT expertise in your corner is no longer a luxury but a necessity. But for most medical practices, this decision is strictly a monetary one. Still, there are more issues to consider than just budget.

Why you should have IT in-house

You are completely clueless about technology and need someone at your beck and call
You want someone with particular expertise in your specific EMR software
You want someone who has specific knowledge of your medical specialty
The physicians in your practice want their daily IT needs handled on an expeditious basis
Your practice can afford to pay a market salary and benefits for a full-time IT person

Why you should outsource IT services

You cannot afford to hire a full-time IT person
You have a small practice and you consider yourself ‘tech-savvy’
You are using a web-based EMR system and have a minimal IT infrastructure
You need or require 24/7 support
The complexity of your practice demands redundancy in the support services
There is a large volume of basic, mundane tasks that have to be handled on a daily basis

Why you should do both

Another option to consider: the hybrid model. Whether you decide to out-source IT services or bring in your own full-time person, a concern in either case is the transfer of knowledge. If you have a full-time IT employee, that person’s fund of knowledge – about your practice, about your EMR system, about your processes – walks out the door with him or her. Even if they are meticulous about documenting all of their processes, this can still be a devastating loss. While this risk can be lessened with an out-source firm, there is still the potential for loss if their services are terminated and you have to hire another firm.

By having both, you could build in enough redundancies that your practice can be protected in the event of a staffing change. The out-sourcing can provide around-the-clock monitoring of your IT infrastructure and handle basic, day-to-day operational issues such as computer trouble-shooting, password resets, and printer repairs. Your IT employee can oversee the out-sourcing firm while at the same time looking out for the best interests of the practice, providing physicians with prompt, personalized attention, and concentrating his or her efforts on more specialized work such as EMR templates, Meaningful Use issues, and the like.

Deciding to Go Paperless

April 3, 2012 By Peter Polack Leave a Comment

Most medical offices today are using an electronic practice management (EPM) system. This software is a far cry from its paper-based ancestors, the appointment and ledger books. The EPM market has expanded over the last twenty or so years to include a variety of products on several platforms. And increasingly we are witnessing the digital revolution in electronic medical records (EMR). Unfortunately, while many such systems have been implemented, to this day a truly paperless office seems like a pipe-dream.

For subjective-objective-assessment-plan (SOAP)-based patient care, the first generation of electronic medical records (EMR) systems worked well. Medical specialties which are primarily text-oriented tended to fare better, as compared to graphic-oriented specialties such as ophthalmology. At our practice we have used an EPM since 1983. But although this software met our needs for billing and scheduling, we were still accumulating stacks of paper records which required an increasing expense just to store the paper.

As we considered a change to an electronic medical records system, our practice compared the expected costs for paper records storage to the costs of converting to a new system. We fully understood that we’d have to become more efficient to make the transition cost-effective.

System Implementation Costs include:

Infrastructure
Consulting
Software
Hardware
Tech Support

We also included the cost of additional work-hours which will be spent training people on the new system, along with data entry. In most cases a practice uses both the old and new systems concurrently until the entire conversion is complete. In the meantime, there could be some redundant tasks.

The primary factor in our decision to switch to EMR was based on the need to reduce the growing mass of paper we were storing. And it didn’t hurt to hopefully ride the wave of financial incentives from the government for EMR implementation. Meanwhile, there was the opportunity to proactively implement new HIPAA privacy and security guidelines in a way that would work best in our practice.

System Benefits Include:

Improved Communication
Better Efficiency
Improved Compliance
Enhanced Documentation
Justifiable Coding
Improved Integration

At our practice, the business choice came down to the belief that we could recoup our investment in approximately five years. This calculation was based on the savings of projected storage space costs, along with reduced needs for printing expenses and services. The journal Health Affairs found that the average primary-care practice recovered its costs in 30 months.

It is more difficult to measure the value of change to job efficiency and changes in staffing patterns, but we are monitoring these factors to accurately measure returns on our investment. Some studies have shown reductions in medical records staffing of 0.25 – 0.5 full-time equivalents (FTEs) as well as significant savings in dictation costs.

The overall trend seems to be toward a world where EMR is the norm. Insurance companies and government are placing more pressure on health-care providers to standardize medical records, and EMR could soon become obligatory. Costs are dropping as more businesses adopt the technology; soon even the smallest practices may find it cost-effective to ‘go paperless’.

[Update 2012] We now have just over 3 years’ experience with our EMR system. We started with a gradual rollout and now see 100% of patients on EMR. Even our original naysayers are happy since they each have their own templates and can’t imagine going back to paper charts. Is it perfect? Are we hiccupfree? No. But the efficiency gains we have seen are real and practice wide. If you hear about a practice that laments their conversion to EMR, they have probably failed along the way in their implementation process – it’s usually not the fault of the EMR system but a people or planning problem.

Paper Has Healthcare Spoiled

March 20, 2012 By Peter Polack 1 Comment

Now that electronic medical records implementation is on the rise, some are waxing nostalgic for their old paper charts.

On the EMR and HIPAA Blog, there is a great article on the advantages of paper records over electronic ones, including:

Immediate response to open
Never a delay when flipping pages
Instant on
No training needed
Multiple page view
Fast page switching
Flexible to an infinite number of documentation methods
Easily supports text and graphic input

Then there was a great comment that posted this humorous video “Medieval Helpdesk”

The Ballad of Go-Live: A Music Video

February 29, 2012 By Peter Polack Leave a Comment

Robert Schwab, M.D., chief quality officer at Texas Health Presbyterian Hospital Denton and Texas Health Presbyterian Hospital Allen, sings “The Ballad of Go-Live,” a wry chronicle of exasperation and ultimate success in implementing the CareConnect electronic health record at Texas Health Denton.

CareConnect is now fully integrated into operations at all 13 wholly-owned facilities in the Texas Health Resources family of hospitals.

Need to Know: 5 Women in Health IT

February 23, 2012 By Peter Polack Leave a Comment

Guest Post, Katie Matlack

You want irony? Try this: the Kaiser Family Foundation reports that we women are the ones make the health care choices for the kids in 8 out of 10 families. Yet women are far and away the minority gender in the world of health IT leaders. Health IT is one of the most important segments of health care, during a time of great change. If women are the ones who’ll be where the rubber hits the road when it comes to the future of health, why aren’t more of us, more involved, in determining what that future of health looks like? [to download the report CLICK HERE]

While this is by no means the definitive list, I’ve done some research on the women who ARE making their mark in HIT. I list five to know below. They’ve been included both for their individual accomplishments and for the attention I think that’s due in the areas of health IT where they’re active.

Regina Holliday – The Patient Advocate

Regina uses art to lobby for attention to be paid to patients; she became a patient advocate after witnessing her late husband’s struggle to receive appropriate care for kidney cancer. She paints at big-time medical conventions, reminding attendees that Meaningful Use (MU) requirements of new electronic medical records programs–oft discussed today in the context of government payouts–were created with the intent to improve patient care and save lives. And she reminds us that electronic health records (EHRs) should be clear and transparent. Why does an artist get top billing in a piece on information technology? Because her point–the that the goal of the technology is to make it easier for people to be and stay well–is, well, pretty important.

Judith Faulkner – The Veteran

More than three decades ago Judith Faulkner started a small company, Epic, that has today grown into the provider of the EHR software for most of the largest hospitals in the US. Epic is also the system used by Kaiser Permanente, the biggest care provider in the country that’s not an arm of the government. And it’s in the running to be the solution used by the Veteran’s Administration (VA). Given that Faulkner is staunchly against an effort to have all EHRs move towards becoming interoperable with one another, this last fact has some folks mighty alarmed. Faulkner is still involved in any major company decision and drives the company’s unique corporate culture, and she’s got a seat on President Obama’s Health IT Policy Committee that’ll be making recommendations on “development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information.”

Susannah Fox – The Researcher

She’s responsible for studying what goes on at the crossroads of technology, health and the interwebs, as the Researcher on Health and Health Care for the Pew Internet Project. So Susannah Fox brings us some mighty interesting data about the habits of Americans when it comes to how many of us look online for health information (59 percent), what specific kinds of health information we seek (specific diseases or conditions, treatments or procedures, and doctors or other health professionals), and who we seek it from (increasingly, from other people who might have conditions similar to ours). Fox blogs regularly on e-Patients.net [http://e-patients.net/] and is helping researchers understand the habits of patients so that health IT can better meet those needs.

Halle Tecco – The Connecter

The company she co-founded has yet to celebrate its second birthday. Yet Tecco’s Rock Health –an accelerator “powering the future of the digital health ecosystem” by providing capital and mentorship to health startups–has funding from giants like Microsoft and Quest Diagnostics, and two of its “graduates” have secured additional funding from other investors. Tecco was chosen because of the power of her idea: that innovators could put tools and systems out there that could rejuvenate healthcare, make it not “just okay” but make it really rock. She was also chosen because she shows you don’t need to have gone to medical school to make a big impact in medicine: Tecco’s background is in tech and business.

Amy Sheng – The Inventor

Sheng also co-created CellScope, Inc., with Erik Douglas, less than two years ago. CellScope uses optical attachments to transform smartphones into diagnostic-quality imaging systems. In the right hands, this technology has the potential to transform lives: in the developing world it can be used in village clinics, while here in the US consumers can use the CellScope to access expert diagnosis and advice. Sheng’s work demonstrates the great potential for telehealth solutions to break down the barriers separating developing countries from high quality health care.

Katie Matlack is the Medical Analyst for Software Advice, a company where she blogs regularly about health IT.

Paperless Registration – What You Need To Know

February 13, 2012 By Peter Polack Leave a Comment

Guest Post, William McClain, MBA

If you are a practicing physician today, your world is being buffeted and reshaped by a dizzying confluence of disparate external forces. The federal push for EMR adoption, HIPAA security rules, practice needs for greater operating efficiency and productivity, “retail consumerism”, increasing market competition and the steady advance of medical and information technology are just a few of the influences changing the profession as you know it. Practicing the noble calling of medicine has never been more complex or challenging.

These forces of change touch virtually every aspect of how your practice operates, including how patient information is captured, entered, stored and exchanged. The combination of federally mandated security rules, Meaningful Use requirements, the need for greater productivity, efficiency and patient convenience, plus innovative new software technologies is now making the age-old clipboard and paper registration process a dinosaur. Add to that list the fact that 90 million e-consumers in our country are projected to be tablet users in the next two years, as reported by eMarketer.com.

So what does all of this “background noise” mean for you and your practice? Clearly, there are compelling, manifold reasons for migrating your practice from the risk-laden and inefficient pen and paper registration process to a secure, integrated electronic solution.

Paperless registration can provide substantial benefits, including: secure and exchangeable patient information; elimination of costly, redundant and error prone data re-entry; HIPAA-compliance; and enhanced patient convenience for initial registration and periodic updates.

Virtually all paperless registration software programs offer benefits for your practice. However, it is important to understand that not all paperless systems are created equal. Your evaluation of the software options available today should be as evidence based as your clinical decision making.

When you consider a paperless registration system for your practice, be sure to look for key “differentiators” that will optimize functionality and value to you, your staff and your patients.

Below are some important attributes you should look for:

Is the software “system agnostic”, i.e. can it interface seamlessly with any existing electronic medical record (EMR) system, or are you forever tied to a single EMR product?
Is the software totally customizable to your practice, i.e. can it precisely replicate the paper registration forms you use now, or must you and your staff change your normal processes to accommodate the software’s “cookie cutter” template?
Does the software provide your patients with the convenience of secure off-site registration from home, office or laptop to reduce their time in the waiting room?
Is the registration software internet independent, i.e. can it continue to function smoothly during internet failures, or does it fail when your internet service fails?
Does the software provide secure data encryption both at rest and in flight, i.e. while stored and while being transmitted or exchanged?
And finally, does the software provide additional functionality that can add value to your practice and your patients, such as in-office flat screen messaging to your patients and revenue-generating promotional capabilities to attract paid advertising by commercial interests such as pharmaceutical companies, retail drug stores and home medical equipment providers?

The clipboard and paper registration process is outdated, and will inevitably be replaced by more streamlined and cost-effective and secure paperless systems. Therefore, it is essential to conduct appropriate due diligence to make the best decisions for your practice and your patients going forward. Hopefully, the ideas offered here will help you to frame your evaluation process most effectively.

(William McClain, MBA, is in Marketing & Corporate Relations for DigitalPatient™, Inc. , a Dallas-Ft Worth practice-centered medical software company dedicated to providing effective, cost-saving solutions for today’s medical providers. For more information go to Digital-Patient.com)

Infographic – The Top 20 Most Popular EMR Software Solutions

January 27, 2012 By Peter Polack 3 Comments

From Capterra comes this great infographic showing the Top 20 Most Popular Electronic Medical Records Software Solutions.

For more on how they compiled the data go to Topping the Charts: The 20 Most Popular EMR Solutions

Medical Practice Trends Podcast 35: 101 Ideas to Increase Revenue & Decrease Costs Part 2

January 24, 2012 By Peter Polack 1 Comment

MPT Podcast 35 - 101 Ideas to Increase Revenue & Decrease Costs Part 2, with guest Mary Pat Whaley of ManageMyPractice.com. Ms. Whaley shares more of her many suggestions for increasing profit for your medical practice.

This Issue (7:30):

Some useful tips on obtaining Meaningful Use incentives
Why you shouldn’t purchase an EMR just for the incentives
How do PQRI and E-Prescribing come into play?
Are there any other financial incentives or grants you can qualify for?

Click the play button to hear the podcast

Right-click to download

EMR – Is It Worth It?

January 17, 2012 By Peter Polack 1 Comment

If you comb through the blogosphere on the topic of electronic medical records, you may find a surprising amount of negative commentary. And if you mention the financial incentives for meaningful use implementation, things get downright testy: anti-government sentiment, conspiracy theories, and a call to resist the temptation to go paperless. They site studies that show that EMR has failed to improve practice efficiencies or control costs, as well as high failure rates leading to many doctors losing money. Why all the controversy now?

I think what we are experiencing is the high middle of the market adoption curve of these systems. There are many early adopter practices that have been successfully using EMR for years but now we are starting to see the more conservative and skeptical practitioners jump into the game, with very mixed results: failed implementations and abandonment, multiple purchases leading to significant write-offs, or incomplete implementations which are barely limping along. The culprit, according to these unfortunate practices, is conveniently the software itself.

But the high failure rate of EMR system implementation (30-50% in most studies) is not so much a reflection of the technology as a lack of knowledge of basic change management on the part of physicians. We don’t learn anything about business in medical school and we certainly don’t learn how to integrate complex technologies such as EMR into a small business. But it is a people management issue not a tool management one.

I disagree that EMR systems are by definition inefficient and that they don’t improve productivity. We have not found this to be the case in our own practice after 3 1/2 years of EMR use – and we have only begun to realize its full potential. But what most practices don’t realize is that it is just part of an overall sea-change in the way you practice medicine. Even the best EMR system cannot fix poor workflow processes – if anything, it will make them more obvious. Our EMR implementation was planned for 3 years before we went live and the software wasn’t chosen until half way through this process. Most doctors run out and buy the first EMR they fall in love with and then make their administrator try to implement it in three months – this is like buying a new tool and then trying to figure out how to use it.

Some feel that the financial incentives from the government, with complicity on the part of insurance companies, will ultimately prove to be a clever way of controlling physicians through the lens of promoting ‘better’ healthcare delivery. And true, any time that the government and private carriers agree on something, you have to pause and think. Rather than having to cull through stacks of paper charts, auditors can now make you upload your entire file set for their bots to search through.

But EMR systems are here to stay. Electronic practice management systems replaced paper scheduler and pegboard ledger books and paper medical records will soon be a thing of the past. Physicians can be resistant and be dragged kicking and screaming into the 21st Century. Or they can get educated and informed, perform their due diligence, and realize that this will be the most expensive and difficult thing they will have to do in their career – besides raising kids.