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EMR – Is It Worth It?

January 17, 2012 By 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.

How to Succeed with Electronic Medical Records:8 Tips from Real Users

January 12, 2012 By Leave a Comment

Guest Post: Katie Matlack

As I settle in to my role as Medical Software Analyst at Software Advice, I’ve begun to wonder: What separates those who realize the benefits of an EMR from those who don’t? What are the critical success factors that can help ensure a practice’s switch to EMRs is truly transformational?

To find out, I spoke with representatives of three healthcare organizations where EMRs are in place:

  • Ian Kornbluth, Licensed Physical Therapist and owner of Neurac Institute and Therapy Solutions, two private practices in New Jersey.
  •  Hal Daugherty, Practice Administrator at Mobile Heart Specialists, a five-physician cardiology practice, in Mobile, Alabama.
  • Jeanette Christopher, Information System Teams Leader; Amanda Trujillo, Quality Management, Site Manager, EHR Implementation Chair; and, Samantha Walker, Medical Records Team Leader, at Northwest Primary Care Group, a 26-physician group in Portland, Oregon.

 

 

Here are eight pieces of advice they shared with me.

1. Get Input From Your Doctors

Before you commit to switching to a particular EMR, secure buy-in from the doctors on your team. How? Solicit feedback on features they want in their EMR. Ask what’s important to them about the system they will use. In the experience of Northwest Primary Care Group in Oregon, the benefits of asking for this input were twofold. It helped them narrow-down what EMRs to even consider. And when they were later in the midst of transitioning, their doctors were on-board because the change was something that they themselves had asked for.

2. Define Who Makes Final Decisions for Your Team

While getting everyone’s input is key for garnering full support for your transition, it’s equally important to define a clear leader of the process. After the group weighs in, this leader will have the final say. The team at Northwest, whose Medical Director played this role, stressed this point. As they explained, “The doctors knew our Medical Director listened to their input, but also knew that the final decision was up to him, and they defer to him.” The takeaway? Spell out who has the final say in advance, and you’ll neutralize time-consuming power struggles and hair-splitting debates before they arise.

3. Sweat the Product Details (Then Get Them in Writing)

Before committing to buy EMR software, hammer out the details of your vendor agreement. This tip came from Hal, a practice administrator of a five-physician cardiologist group converting to a full practice management and clinicals suite. Hal, who ended up working with Oberon Medical Solutions, stressed the importance of clarifying with any vendor which modules and product versions will be included in your system. Another transaction-related tip from Hal: discuss–and get in writing–a description of responsibility for your data. If your software provider goes under, you’ll want to ensure you’ll still be guaranteed access.

4. Get Software For Your Specialty (or Plan to Customize)

Everyone I spoke with highlighted the importance of choosing a system that fits your specialty or can be easily customized to fit your practice’s needs. After all, the extent to which an EMR fits your practice will determine how much time your system will allow you to save. The Northwest team uses Vitera, a product flexible enough so a system administrator can make any changes a doctor requests within an hour. By contrast, Ian Kornbluth uses a specialty-specific solution.“The software I use, WebPT,” said Kornbluth, “was built by physical therapists, for physical therapists. Our transition process was pretty easy and painless.”

5. Phase In Hardware Ahead of Software

Learning new software can be daunting. Now imagine trying to do it while not knowing how to work a computer. For some doctors who’re new to computers, the basics of how to access files, join wireless networks, or respond to a frozen screen increases the new technology learning curve. And doctors hate to fumble in front of patients, since this might give patients misgivings about their abilities in other areas (like medicine). That’s why the Northwest team gave their doctors several months to practice at home on the specific computers they’d be using at work.

6. Have a Capable Team Create Your Records

In a paper-based office, each time a patient visits the practice there are lots of new forms to fill out. But with EMRs, you fill out a patient’s basic information just once. That places extra importance on getting the data in perfectly the first time. As Kornbluth did, you might have one staffer responsible for entering patient data and another there to check the data is accurate. It’s also important a qualified team is scanning in your documents when you’re creating those records. The team in Oregon has their regular staff members handle scanning, stressing that only staff with highly specialized training would know where to store information from a paper chart within the new record.

7. Be Systematic About Scanning Documents and Phasing-In EMR Use

Practices typically set a date to start using their EMR with active patient files. This usually means that after that date, patients have their files entered into the EMR as they come in. Most files are created through a combination of manually-entered data and scanned files accessible through the EMR. Your phase-in process might mean doctors use paper charts during patient consultations while nurses later input information from those charts into the EMR. So you’ll need to agree on a practice-wide way you’ll denote what has already been captured in your EMR and what hasn’t. A low-tech way to track what’s been scanned: “We put a diagonal line in highlighter across the front and back of sheets after they had been scanned into a patient record,” said the team in Oregon.

8. Involve Your Patients in the Switch

Patients are likely to be pleased about a system that can free up more time for you to spend with them. They’ll probably also be happy to hear an EMR can help you provide better care. It’s a definite marketing benefit if you get the right information to your patients–just be sure you tell them how their data will be secured, since one of the biggest patient concerns related to EMRs is data security. Finally, it’s also worth planning for how the new system will impact the way your doctors interact with patients. Will doctors need to turn their back to them or look away to use the EMR? Try to set up your machine so it doesn’t interfere with doctor-patient interactions.

(To read the original post, please go to SoftwareAdvice)

Older Doctors More Tech-savvy Than Most Think

December 22, 2011 By Leave a Comment

According to an article on the AMA Med News online, increased age of a physician is not necessarily correlated with resistance to EMR use. A study at Brigham and Women’s Hospital in Boston published in JAMA found that physicians who were at least ten years out of training and busier than their younger counterparts were actually more likely to adopt electronic medical records.

Although in general doctors who were older were less likely to be using EMR it was not because of their age, according to their research. Rather, many of these physicians were not as busy as their contemporaries and less apt to take a chance on a new technology. Their conclusion: It seems to be more about attitude than age.

Practices who are implementing EMR should take this into account. It only takes one resistant doctor to scuttle an EMR project. Don’t assume that the oldest partner is the one who is going to give you trouble. Au contraire, it might be the youngest whipper-snapper who turns out to be your saboteur.

The Ten Commandments of Successful EMR Implementation

November 22, 2011 By 1 Comment

ten commandments of emr implementationMost practices breathe a sigh of relief after their new EMR software is installed and running. But now comes the hard part: getting the staff and the doctors to accept and use it. The following is a list of ten “Commandments” borrowed from our practice administrator, Don Cushing M.Ed. MBA, who has years of experience with EMR adoption with multiple practices.

(1) Thou Shalt Have a Plan. As Benjamin Franklin stated, “If you fail to plan, you are planning to fail.” But a plan is worthless if it doesn’t have a defined goal. For most practices this goal will be a successful EMR implementation – a somewhat vague goal, at best. Success should be defined in relevant, realistic, and measurable terms. These can include such things as: physicians will have the information they need when they need it, physicians will have the support needed to adapt to the new EMR system, the EMR will not interfere with the doctor-patient relationship, etc.

(2) Thou Shalt Honor the Three W’s:

  1. The hardware and software have to work.  There should be enough hardware, in the right places, and with just the right amount of capacity. Trying to be too cheap with your equipment can bite you in the end, but it is also very easy to go overboard, so get good advice. Regarding the EMR software, make sure you create a list of needs and wants before you go looking for a product. Most practices rush out and get the software, then figure out what they need – wrong move. For many smaller practices, expenses can be significantly reduced by using web-based EMR systems or cloud computing, but these tend to be less robust systems.
  2. The process has to work. If you have inefficiencies in your workflow already, an EMR system will make them more obvious (see number 3 and 4). Now is a good time to ask why you are doing things the way they have always been done.
  3. YOU have to work. Buying an EMR system is neither your first step nor your last. Most of your work should occur before your purchase but you’re not off the hook entirely after the software has been installed either. EMR implementation is a process, and it will need continual feedback and improvement to ensure its success.

(3) Thou Shalt Make Flow Charts. A critical way to make sure that everyone is on the same page is to map your processes out visually using flowcharts. There are several inexpensive programs that make it easy for your staff to collaborate and fine tune your workflow (see article on Convenience Applications). If you don’t spell this out in detail you are bound to have inefficiencies, and an EMR system will just compound them.

(4) Thou Shalt Not Expect EMR to Fix Bad Processes. A corollary to number three is that even the best EMR system cannot fix your bad workflow processes. Many times a failed EMR project is blamed on the software when in fact the problem usually lies elsewhere, but by then it is too late.

(5) Thou Shalt See the Examination Room as the Command Information Center. A common bottleneck in a practice trying to become “paperless” is an unnecessary conversion from electronic to paper (and often back again). From the exam room, all necessary tests, labs, and instructions should be able to flow with simple clicks emanating from the EMR system, and without the need for writing on a paper router, filling out paper requisitions or barking orders down the hallway.

(6) Thou Shalt Know What an EMR Is. A common cause of EMR project failure is the lack of physician buy-in, and a major reason for this is that they see it as just a digital version of a paper chart. A paper record does not have the ability to cull clinical information and transform it into actionable data, nor does it allow for enhanced communication such as sending tasks and reminders instantaneously to multiple users. On the other hand, many physicians have become accustomed to experiencing things a certain way when they use a paper chart and this does not always translate easily to an electronic one (see number 9).

(7) Thou Shalt Not Confuse Templates and Documents. Templates are the data entry forms of an EMR system and what most users see. The documents are the forms that are generated from the templates and what really constitute the official medical record. Templates are also the sexy side of the EMR and what sells the EMR to customers. And customization of the templates can make life easier, especially for less tech-savvy physicians. But customization of the templates is not as important as that of the documents, which are potentially subject to the scrutiny of an outside auditor. All to often, practices concentrate on the former to the detriment of the latter resulting in a potential liability (see number 8 and 9).

(8) Thou Shalt Consider the Inputs in Terms of the Outputs. When looking at EMR systems or customizing the one you have, it’s important to begin with the end in mind. It is easy to get bogged down in detail regarding what minutiae needs to be included in a document. Who is the reader? An associate in your group or a referring doctor? What pertinent information is needed? Long-form exam or brief clinical summary? Does it help justify the level of coding? Ensure that the critical elements are present. Everything else is probably extraneous.

(9) Thou Shalt Not Use Templates Out of the Box. In general, the easier an EMR system is to use out-of-the-box, the less flexible it will be. This may not be as critical to a new or solo practitioner who can easily adapt his or her processes to the software. But for most practices, this is like trying to fit the proverbial square peg in a round hole. Most doctors have acquired a certain gestalt when they’re looking at a paper record and much of this is lost when staring at a busy computer screen. So it’s important to approximate this is much as possible. If a prospective EMR does not have customizable templates, keep shopping. If they are customizable, then figure out a way to make them fit the way you practice medicine. Otherwise, you’re in for a lot of frustration.

(10) Thou Shalt Not Confuse Paperless With Paper-Appropriate. Some practices are so intent upon becoming paperless that they actually throw logic out the window. For example, such things as drawings and signatures are not data that need to be mined for analysis. Rather than spend a lot of money on an expensive tablet and software that allows patients to sign forms electronically, why not just have them sign a paper and scan it? The practice has what it needs and the patient keeps the paper copy – everyone’s happy.

Have you been through a successful EMR implementation (or not)? Do you have any of your own ‘commandments’ to add to the list?

EMR News Roundup 11/15

November 15, 2011 By Leave a Comment

Is Your Practice Ready To Go Paperless?

There’s no doubt that the meaningful use incentive money, made available by the ARRA HITECH Act (American Recovery and Reinvestment Act’s Health Information Technology for Economic and Clinical Health Act) is drawing a boatload of attention. Under this legislation, the Department of Health and Human Service (HHS) Center for Medicare and Medicaid (CMS) have set requirements for the meaningful use of healthcare information technology (HIT). If these requirements are met by eligible providers, they qualify for HHS meaningful use incentive money up to $63,750 over the next six years.

For many practices the question is not whether to go paperless to qualify for ARRA HITECH meaningful use incentives but rather, when. However, there are many factors to consider when determining whether a practice will be successful at taking the leap to 100% electronic.

A Few Questions to Consider

Is the physician practice primarily interested in receiving incentive money available through the ARRA HITECH Act?

Is the practice primarily interested in going 100% electronic, and the incentives are just a nice bonus?

Does the practice have the upfront capital to invest in a meaningful use EHR? Or does the practice require the CMS meaningful use incentive money to fund the investment?

Are the practice staff ready and eager to make the switch? Are they tech savvy?

Would the practice staff benefit from taking a slower, more measured approach to adding technology piece-by-piece into the practice?

Is the office practice prepared to scan in all patient folders to include in an EHR and devote staff time for EHR training?

The key to the ARRA HITECH Act is to increase patient safety and improve the quality of care patients receive. However, the reality is that many practices are hesitant to embark on adopting HIT. There are a variety of reasons: the belief that implementing an EHR/EMR will not provide adequate return on investment; worries that practice productivity will drop dramatically during implementation of an EHR; and the ever-looming issue of financing a new system.

Practice Options

If the practice’s long-term strategy is to go 100% paperless, this is the time to begin taking steps towards meeting CMS meaningful use requirements. Practices that adopt an EHR or EMR and demonstrate the meaningful use of the technology can be eligible for meaningful use of EHR incentive money as early as May 2011 if they are up and running with their EHR by January 2011. Eligible providers who take this route may qualify for up to $63,750 in meaningful use funds over the next six years.

Practices that wish to advantage of the ARRA meaningful use incentive money but are not prepared financially to make the dollar and time commitment required by EHR adoption can opt to install a modular EMR (electronic medical records) system which, if certified, can allow them to meet meaningful use regulations and also benefit from the incentive money. This modular approach qualifies as adoption of meaningful use EMR. As with practices that implement a complete EHR, if these practices implement their modular EMR by January 2011, they could receive CMS meaningful use incentive dollars as early as May 2011.

Providers should review and weigh all options to determine the course of action that will most greatly benefit their practice and patients. Practices that don’t pass the 100% electronic litmus test still have modular options that will keep them in the game and on their way to qualifying for meaningful use incentive funds.

By: Elinore Tibbetts

Article Directory: http://www.articledashboard.com

For more information, visit www.drfirst.com For more DrFirst news, visit us at blog.drfirst.com/

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How EMR Incentives Favor Early Adopters Of EMR Software


Electronic medical records are fast replacing traditional paper records around the globe. In order to encourage doctors to transition from traditional paper records to EMR software, the American Recovery and Reinvestment Act (ARRA) has made funds available for early adopters. This article will examine how healthcare facilities that adopt EMR software soon can receive tremendous incentives.

Beginning January 1st, 2011 the United States Government (via the American Recovery and Reinvestment Act) is offering massive incentives to physicians and medical facilities making the switch from traditional paper records to more efficient EMR software. In fact, starting in 2015 physicians who have not made the switch could start earning penalties for their failure to adopt EMR technology.

These incentives are currently being offered in order to issue in a new, more effective way of tracking patient data. Here are a few of the highlights of what a physician could receive for adopting EMR software in 2011:

1. Up to $44,000 in stimulus money from Medicare. This money can be collected over a 5 year period, with $18,000 being available the first year to physicians who meet the meaningful use standards upon initial implementation. This money is also available to each physician within a practice.
2. Up to $63,750 in funds from Medicaid. These funds can be collected over a 6 year period with $21,250 available the first year to physicians who are working toward installing an EMR system that complies with meaningful use standards. This funding is also available for each physician.
3. Avoiding penalties. Penalties will be issued starting in 2015 for physicians who have not adopted EMR software by that time. Starting in 2015 the Medicare fee schedule will be reduce by 1%, with 2% and 3% reductions to follow in 2016 and 2017 respectively. In order to avoid these penalties and receive the maximum incentive payments switching in 2011 is recommended.
4. Return on Investment. With the help of incentives EMR will also give physicians a positive ROI in a relatively short period of time. Physicians can increase their reimbursements and reduce costs associated with charts and paper records. Less clutter, more organization, and greater efficiency are just a few of the other benefits of implementing EMR software.

The earlier physicians switch, the more money is on the table. It is just a matter of finding the right company to help integrate the right software for your practice.

By: Jamie Hanson

Article Directory: http://www.articledashboard.com

Electronic Health Records system funding is now available for most doctors and hospitals. EHR software systems are now being required for Medicare and Medicaid providers.

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EMR Adoption Barriers: Cost, Chaos And Culture

Electronic medical records (EMR) are seen as an optimistic advancement in efficiency, productivity and workflow throughout the entire healthcare industry. EMRs help make healthcare safer and more cost effective by lowering operating expenses, streamlining documentation and eliminating errors. Despite overwhelming evidence of the benefits of EMRs, there are still physicians and hospitals reluctant to transition into the Age of Information, with as few as 17% of physicians using EMRs today. There are three main barriers that hinder the healthcare industry from EMR adoption and implementation: cost, chaos, and culture.

Implementation costs are a big hurdle to overcome in the current economy, especially for smaller practices. In addition to the price of purchase, a practice’s revenue stream may decrease temporarily due to the slowed productivity associated with physicians learning the new system. It is tempting to focus on the system’s up-front cost, rather than how much revenue it will generate for the bottom line and save the practice in the future. Efficient and properly applied systems will pay for themselves in the first one to two years of operation.

The chaos of choosing a vendor can easily deter an interested physician. There are hundreds of vendors and systems available on the market and trying to decide on one can be overwhelming and frustrating. It is difficult for many physicians to determine which specific EMR system is the best fit for their practice. Another disincentive associated with EMR implementation is the change of operations and training neededfor implementation. It is recommended to invest in a customized system that works according to the physician or facilities’ specifications, so that a potentially chaotic change is minimal and training is cost effective.

History demonstrates that culture is hesitant to change. Medicine is often referred to as the second oldest profession and since inception, physicians and doctors have used paper records. Furthermore, news of security breaches in electronic patient information encourage skepticism in physicians, wary of privacy concerns and Health Insurance Portability and Accountability Act (HIPAA) violations. It is important to remember that computer systems are usually very well protected, while filing cabinets, desks or paper charts are physically accessible to anyone.

The future of the healthcare industry relies on technologies like EMRs to efficiently manage practices or facilities to succeed in the Age of Information. However, there are still physicians and hospitals that are reluctant to make the transition. There are three main barriers that are holding the healthcare industry back from EMR adoption and implementation: cost, chaos, and culture. e-MDs offers a host of affordable solutions for physicians and facilities looking to modernize or enhance their services with the latest EMR technology. e-MDs is committed to providing operational solutions and delivering the clinical tools needed to succeed in today’s medical field.

By: Michael.Young

Article Directory: http://www.articledashboard.com

Ethan Luke. e-MDs powerful software can help manage your electronic medical records

 

 

 

 

 

Improving Practice Efficiency With Convenience Applications

November 8, 2011 By 1 Comment

Computerized practice management systems appeared about thirty years ago. Their major selling point? To automate humans out of as many processes as possible to reduce error and improve efficiency. Medical practices are attempting to achieve those same goals through the use of  electronic medical records (EMR) systems. But trying to eliminate humans entirely from the practice of medicine is a fool’s errand. Relying increasingly on technology without acknowledging the human element is a recipe for failure.

People will always be an integral part of the practice of medicine but there are ways that technology can leverage their effort for the better. Known as ‘convenience applications,’ these software programs range from free to under a couple of thousand dollars – compared to tens of thousands of dollars for your typical EMR or practice management system. And in contrast to the latter, convenience apps are specifically designed to assist humans to be more productive and profitable doing those tasks which can’t be completely automated. They help your staff do the right things (effectiveness) and do the things right (efficiency).

Due in large part to the ubiquity of such devices as mobile devices, these apps can be found in a multitude of areas from time and task management to collaboration and communication. If you own an iPhone or other smart phone, you’re probably using several of these already.

So how can these help you in your practice, you may ask? Let’s just take two areas of interest as an example, process documentation and project management.

Process documentation

Your medical practice is nothing but a bunch of processes. But, as W. Edward Deming, a pioneer in quality management, once said, ” If you can’t describe your process you don’t know what you’re doing.” Simply having well-trained, knowledgeable employees doesn’t help you very much if these employees leave and take their knowledge with them. By documenting all of your processes, you can standardize them, squeeze the variability out of their execution, and ‘clone’ your A-teams by ensuring the transfer of that knowledge.

If you are a solo practitioner with a handful of employees, you may think this is overkill. You are constantly teaching your staff how to do various tasks, so what’s the use of writing things down? But what happens when employees leave and you find yourself repeating this process ad nauseum?

A slightly bigger practice is more likely to document things (once) in a written employee training manual, but this is of little use in the middle of a busy clinic day. This is what is known as “just-in-case” learning, and it relies on filling workers’ minds with tons of information that they may or may not ever need to use. It also requires constant retraining and reinforcement so that, should that knowledge ever be needed, the employee will hopefully remember it.

On the other hand, documenting your processes, ideally in a digital format, employs “just-in-time” learning. All that a new or temporary worker would need to know is how to access your process flow maps and follow the specific steps as illustrated. And an existing worker could fill in for an absent one without having to formally cross-train for that position – she can merely consult the documented processes and get the job done. Another great feature of digital process documentation is the ability to use employee feedback to constantly tweak processes for improvement. In contrast, an employee manual merely tells workers what to do but not necessarily how to do it better, and is only updated infrequently.

Examples of Process Apps: SmartDraw, Google Docs, Microsoft Visio, Gliffy.

Project management

Anything that takes two or more steps and has a beginning and an end is called a project. This can be anything from a simple remodeling of an exam room to something as complex as implementing electronic medical records in your practice. Keeping true to the concept of knowledge sharing, project management should not take place in someone’s head but in a tool specifically designed to promote collaboration.

Project management apps can display timelines with dependencies, task staff members with automated reminders, and allow managers to display the progress of the project at a glance. They keep everyone on the same page at all times. And they are more flexible than calendars. Just try scheduling a multi-step project in a calendar and see what happens if one of those steps has to be postponed: chaos.

Examples of Project Management apps: MindManager, Basecamp HQ, Microsoft Project, ProjectPlace.

Smart practices are efficient ones. By using “convenience” apps, your practice can match the productivity and profitability gains an EMR system gives you at a fraction of the cost.

EMR By The Numbers – A Video Infographic

November 7, 2011 By Leave a Comment

 

Yes, it is a commercial for GE Healthcare, but it is still cool to watch. And for those doctors trying to convince their partners about the benefits of electronic medical records (EMR), this video does list some additional points to consider.

How much does an average doctor get to keep out of every dollar they earn? How much time is spent on non-billable activities? See why using an integrated electronic medical records (EMR) system that incorporates scheduling, billing, insurance claims management, and patient records goes beyond just proving ”meaningful use.” Watch this entertaining and informative vinfographic (video infographic) from GE Healthcare´s Centricity Advance.

Medical Practice Trends Podcast 31: Why Everyone in Your Practice Needs to Know Coding

October 18, 2011 By Leave a Comment


MPT Podcast 31 - Why Everyone in Your Practice Needs to Know Coding, with guest Mary Pat Whaley of ManageMyPractice.com. Ms. Whaley explains why it is important for all employees and doctors need to be on the same page when it comes to medical coding.

This Issue (7:32):

  • Why everyone in your practice needs to be well-versed in coding
  • How ICD-10 will impact your practice
  • Training staff the right way from the start
  • Pros and cons of coding ‘wizards’

Click the play button to hear the podcast

Play

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EMR News 10/17/2011

October 17, 2011 By Leave a Comment

The Latest EMR and Meaningful News from Blogs and Social Media 10/17/2011

From Jim Tate, Meaningful Use Expert:

Do Specialists have to meet all meaningful use objectives …

There are two questions from Eligible Professional specialists about the CMS EHR Incentives that I’m asked over and over again. Today, let’s answer one of them and hopefully put it to rest. Do specialists have to meet all of …

From Channel Intel:

The ABC’s of Meeting Meaningful Use

If you’ve looked into implementing an electronic health record, or EHR system, you’re probably familiar with the term “Meaningful Use.” But do you really know what it means, or more importantly, the benefits it may provide you in the short and long t…

 

From the Twitterverse:

RT @ahier: NCVHS says it’s too soon to add #EHR metadata to #MeaningfulUse http://t.co/dlzAuxL8 (via @HDMmagazine)

By HITAdvisor at 10/13/2011 18:29

Data Capture Pen Gets Meaningful Use Certification http://t.co/tZN0phat #healthIT #EHR

By stevez at 10/13/2011 18:25

Advice From Early EHR Adopters

October 10, 2011 By 2 Comments

 

 

Our practice went live with our own EMR system in late 2008. For the most part, this was uneventful. The reason for this was mainly due to proper planning. And credit for our implementation plan goes primarily to our administrator, our IT director, and staff members of our appointed EMR committee. Although some of the physicians were an integral part of the committee, we tried our best not to micromanage the process. We also made the decision to gradually roll out EMR, instead of trying to convert all our patients overnight. As a result, there was no loss of productivity for the entire practice. And these days especially, every dollar counts.

It is estimated that no more than 20 to 25% of medical practices in the US are using EMR as of this writing. Why? Practices site cost, waiting for the right EHR, and concerns about recouping their investment as some of the reasons why they’re holding off on their decision. For practices that are not yet using EHR, here are some words of advice that hopefully will guide you along the way.

Doctors tend to like gadgets so their inclination is to focus on the software. This is usually a mistake. As in many technology implementations, sometimes the who is more important than the what. The following is a list of implementation steps from a guide I wrote, Navigating the EMR Jungle. Notice that the software itself is not mentioned until step 5.

  1. Decide you need to do something. Why are you doing this? The financial incentives? That’s very nice, but you need more than that to motivate your organization and see the project through to its successful end. Some other good reasons would include improving patient care, improving coding and reimbursement, improving practice efficiency.
  2. Assess your needs. What kind of system you need? Does it have to be wireless? Does it have to work between multiple offices? Other things to consider: how much you want to spend, whether or not have an in-house IT person, whether or not you want to control your own data or let it be hosted elsewhere, and what your timeline is.
  3. Form an EMR committee. This should include key members from different departments including billing, clinical, and administrative. You should also involve an IT specialist early in the process, even if it means hiring someone from the outside. Just make sure it’s someone with medical IT experience, not your nephew the tech geek.
  4. Involve the doctors. All of the doctors, especially those who are resistant to change. I’ve written previously on the dangers of naysayers; it only takes one person in a position of power to scuttle your entire project. Bottom line: grease the squeaky wheels first. This means spending extra time with them on training, answering concerns, and getting their templates up and running first.
  5. Create a short list of vendors. By this point, your EMR committee should have whittled down the plethora of software vendors to some key players. Now is the time to get the key decision-makers involved in performing demos, checking references and interviewing the companies on the short list before you ask for proposals and ultimately purchase one. Don’t rush this decision.
  6. Plan your implementation. This is a critical step in the one where many practices fail. You must find a balance between easing into a new way of doing things and not disrupting your revenue cycle unnecessarily. It’s best to allow for a gradual rollout so that the clinic and the billing office can work out the kinks. Converting all patients to EMR overnight is usually ill advised yours is a very small practice (and you only have yourself to yell at if things go bad).
  7. Organize a training schedule. With about 150 employees, it wasn’t practical for us to train everyone at the same time. We put a dozen old computers in a spare workspace and created a classroom. Staff members were rotated through training as their schedules permitted and after hours (yes, this was an overtime expense). Supervisors were tasked to audit their training and send any employee back to the process if they needed to improve upon certain skills.
  8. Run a simulation day. We credit this for uncovering some key problems that otherwise would not have been detected until we went live. We brought all of the doctors and clinical staff in on a Saturday and ran other employees through simulated check-in, work up, exam, and check out. Everyone complained about having to do this, but was thankful when the big day finally came.
  9. Go live! If you’ve done everything right up until this point, this should be anti-climactic. Nevertheless, it still stressful, especially when there is a hiccup (and hiccups should be expected).
  10. Assess current set up and plan next steps. EMR in your practice is not so much a project as a process, so constant assessment and feedback is critical. As such, there is a huge potential for improving the way you practice medicine.

I recently had the opportunity of asking members of the Large Practice Interest Group (LPIG), a workgroup comprised of 18 large ophthalmology practices that are early adopters of new technology and  management trends, for their words of wisdom for practices considering the EHR. Here’s what they had to say:

Keith Casebolt, CEO of Medical Eye Center of Medford Oregon, advises practices to “plan for training, more training, then add 25% !” His practice adopted Medflow’s electronic medical records system about six years ago. Another word of advice: there must be a specific person who “owns” the EHR, someone to stay on top of upcoming changes and who has the authority to make decisions. “Essentially [the project manager is] a new job and you need to recognize and budget for that.” He also stresses the importance of spending a lot of time in due diligence, making site visits, and attending user meetings. Lastly, make sure that you have properly assessed the level of support for this important project. “You need a lot of people rowing in the same direction, with no anchors.”

Andersen Eye Associates, in Saginaw, Michigan, is a NextGen EHR user. Kurt Beuthin, the practice CEO, says practices should get their EMR vendor to project what IT expenses are expected to cost given the size of your organization and the scope of the implementation. “Ongoing IT support costs have been more than anticipated,” he says, “and it would have been nice to have had this information from the beginning.”

Donna Davis, administrator of Atlantic Eye Physicians, in Long Branch, New Jersey, is currently involved in her second EMR conversion (and fourth practice management system conversion). She stresses the importance of keeping entire staff motivated. “We brought all key staff into the selection process and at every meeting I made sure to state what benefits the new system would give us operationally.” In contrast to other practices that I spoke with, they are planning to convert 100% of their patients when they go live upon the recommendation of their EMR vendor, IO PracticeWare.

The importance of staff training was stressed by all of the administrators. Hayley Boling, administrator of Boling Vision Center, in Elkhart, Indiana, says, “ongoing training is essential, especially for your staff that is not computer-savvy. Having qualified staff members that are able to troubleshoot issues that arise along the way is imperative. These issues happen frequently.”

In our own practice, there was significant angst when we first proposed going paperless, but that quickly changed. Ann Hotaling, Director of ASC for Ocala Eye, says, “Rest assured that the staff and physicians will give you pushback when you start your EMR project. But within a year you will get pushback from trying to hand them a paper chart. They will adapt.” She also recommends cross training your key computer staff. It is not uncommon for a networking person to be unfamiliar with the EMR software; conversely, someone who is good with the program and templates may have trouble troubleshooting a hardware glitch. It also helps for the lead technical person to be fluent enough with the clinical aspects of the EMR program to be able to communicate effectively with the physicians.

Some practices have had major problems with their EMR implementations, but their advice can be especially valuable. One partner in a four-doctor practice, who wishes to remain anonymous, said that “Ours is a case study in how NOT to implement EMR.” Their previous practice administrator chose the software, no due diligence was performed, and the doctors did not demo it prior to going live. Over time they came to the realization that software was primarily designed for solo practices, and they have had to deal with numerous technical problems including frequent software crashes. “It has been a very frustrating endeavor.” He says the choice of this particular company was in large part to try to reduce their capital outlay, but in the end it has cost them more in the long run in terms of decreased productivity. They are more than a year out and the issues are still not fully addressed. In addition, they have noted a decrease in job satisfaction among their technicians.

Below are some more pointers from our administrators (as well as a few technical considerations thanks to Kathaliya Folds from our IT department):

Before Purchasing EHR

  • Strongly consider an integrated EMR/EPM
  • Make sure it fits your workflow – this is better than trying to adapt to the software
  • Make sure can it interface with other systems you have – practice management as well as diagnostic
  • Check references; do a site visit with the same software, preferably in a practice of similar size and in your same specialty
  • The software doesn’t have to be specialty-only, but the company should have proven experience with your specialty
  • Consider ditching an old legacy system if it is not working out/cut your losses early
  • Consider software-as-a-service versus hosted locally if you are a small practice
  • Get input early in the process from a technical person – someone needs to be able to speak the same language with the EMR vendor to avoid misunderstandings
  • Make sure the specs you get from the EMR vendor are scalable and that the system will grow as your practice grows without difficulty
  • Make sure your office infrastructure can support the EMR system you want the way you want to use it – wireless devices, video streaming, multiple locations, high-resolution imaging, etc.

Implementing EHR

  • Keep your patients informed and ask for their patience
  • Have a ‘point person’ or ‘super-user’ in each location who acts as trouble-shooter and motivator
  • Use a “train the trainer” model. Have the EMR vendor train your key employees who then train the rest of your staff – these can then become your ‘super-users’ that others can turn to with their questions or problems
  • You should definitely have an EMR ‘champion’ to see the project through to the end
  • Consider having your own full-time IT person on staff
  • If you can’t afford your own IT person, hire someone locally – the EMR vendor is usually too busy to give you rapid support on most issues
  • Budget liberally for ongoing IT/EHR expenses
  • Realize that you might have to spend a little more time with the less tech savvy doctors getting them up to speed with the software
  • Take bite-sized chunks. Employee a phased rollout beginning with certain types of patients and adding other subsets as doctors and staff become acclimated.

Using EHR

  • Get patient information into the records prior to the visit if possible
  • Take advantage of template customization by doctor, by type, by type of test
  • Use macros for quick plans – they take a little work to set up but can greatly increase your efficiency
  • Take advantage of built-in capabilities such as printing out patient instructions and educational materials
  • Realize that EHR is an ongoing process and constant tweaking is required
  • Consider an audit process to ensure you are continuing to capture key exam elements, testing interpretation and history

The best advice from all of this is to seek counsel from those who have ‘been there and done that’ – don’t try to reinvent the wheel. Most practices who have been through EHR implementation are more than happy to share their experiences or host a site visit.

(If you would like to order a copy of  “Navigating the EMR Jungle,” CLICK HERE)

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