EMR 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

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”

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.

Current Trends in EMR

November 30, 2011 By Peter Polack Leave a Comment

Guest Post: Emily Matthews

Electronic medical records (EMRs) in the medical office setting are growing at a faster pace than ever before. With rapidly advancing technological features and integration capabilities, it doesn’t take a master’s degree to see that using EMRs allow for more efficient and profitable management of today’s medical practice. EMRs benefit you and your patients by improving the quality of care, reducing administrative costs and allowing you to focus your time and management skills on patients and not paperwork.

Projected Growth

Analysts predict 12% annual growth in the use of EMRs in physician practices each year for the next five years. This growth and change in attitude about EMRs is mainly due to technological advances in EMRs as well as increased financial incentives for their utilization through federal and state programs. CMS currently offers incentives for the use of EMRs in both Medicare and Medicaid billing.

Technological Features

Today’s EMR is not the same as EMRs of a few years ago. Recent technological advances and added features make EMRs more useful to the efficient and expanding medical practice, especially those within medical networks. EMR interfaces are now compatible with mobile or handheld devices. This allows you or any physician or assistant in your practice to access a patient’s complete record no matter what the location or time of day. Integration features allow you as a physician to access all aspects of a patient’s chart, including pharmacy orders, radiology results, laboratory results, discharge and transfer orders and allows you to communicate electronically with payers as well. Advances in interoperability between EMRs are at the forefront of healthcare technology and are high on the priority list at the federal level. The cost of implementing EMRs has decreased, especially for practices that join as a group or within a network or health system.

Benefits to Practice Management

One of the greatest advantages to implementing EMRs in your medical practice is the reduction of cost of operating your business. By entering into an EMR system as a partnership with other physicians or practices or as a partnership with a health system, this reduces the cost of implementation and purchase of the software. While EMR software may cost an average $6,000 per physician in your office, even with a practice of ten physicians, this is less than the cost of hiring a single employee to manage hard copies of medical records for you. As your office implements an EMR, you might experience a temporary decrease in productivity as records are scanned or transferred into the system. However, this short-term loss of efficiency more than makes up for itself as the nurses, physicians and other staff in your practice familiarize themselves with the new system.

Your patients will benefit from improved quality of care as your practice implements EMRs. Improved communication between your office, coordinating facilities and payers improves the technical aspects of managing a medical practice. EMRs are at the forefront of healthcare and computing technology, and bringing this advantage into your medical practice readies you for the future.

[Emily Matthews is currently applying to masters degree programs across the U.S., and loves to read about new research into health care, gender issues, and literature. She lives and writes in Seattle, Washington.]

Blame-free System Increases Medical Error Reports

November 29, 2011 By Peter Polack Leave a Comment

According to an article on Reuters Health, “Flagging medical errors through a system that emphasizes a lack of punishment and maintains anonymity yields more reports than a traditional method of reporting errors, a team of doctors has found.”

After introducing the new system at a pediatric clinic in North Carolina, the number of reported mistakes jumped from five to 86 per year on average.

“Getting reports doesn’t mean we’re in an unsafe practice, it means we’re addressing flaws to make us a better practice,” said Dr. Daniel Neuspiel, the lead author of the study and the director of ambulatory pediatrics at Levine Children’s Hospital in Charlotte, North Carolina.

10 Things You Hate About EMR

November 23, 2011 By Peter Polack Leave a Comment

From the HealthcareIT News blog comes an article on the top 10 things that readers hate about electronic medical records via a Twitter thread:

It doesn’t measure up to paper
It’s hard to use
It doesn’t provide the basics
It’s cumbersome
It’s ineffective
It doesn’t allow for patient interaction
It doesn’t protect patient privacy
It doesn’t have a viable, rapid feedback loop
It’s not patient-friendly
It’s outdated

And then came responses from other readers who had these six reactions to those complaints:

Re: It’s outdated. Most software systems are based on programming that is “outdated.”
Re: Paper vs electronic. You really cannot compare the two, especially given the advantages that EMR has over a paper chart.
Re: It’s cumbersome. You don’t have to live with these issues. Get educated and choose a system that does what you need it to do.
Re: It’s hard to use. You had to learn how to use an iPhone the first time you used it.
Complaint about using Twitter to solicit comments.
Complaint about how EMR systems are not ready for prime time.

Bottom line: a lot of whining from physicians who probably didn’t perform enough due diligence and now are suffering from buyer’s remorse.

Any things you have to add to this list? Responses to the responses?

Medical Practice Trends Podcast 27: How To Tell If Your Practice Is Well-Managed

September 20, 2011 By Peter Polack Leave a Comment

MPT Podcast 27 – How To Tell If Your Practice Is Well-Managed, with guest Mary Pat Whaley of ManageMyPractice.com

This Issue (8:04):

Warning signs that your practice has management issues
Why hiring your spouse as your manager may cost you in the long run
Standard benchmarks that typical practices should be aware of
The importance of being a ‘calm’ practice

Click the play button to hear the podcast

Right-click to download

Medical Practice Trends Podcast 26: Social Media and the Medical Practice

September 13, 2011 By Peter Polack Leave a Comment

MPT Podcast 26 - Social Media and the Medical Practice, with guest Joseph Kim MD, President of Medical Communications Media Inc.

This Issue (9:41):

How specialty social media can be valuable for physicians
Should you engage your patients on a social media site?
How to stay on the right side of the law
Patient portals and communicating safely with patients

Click the play button to hear the podcast

Right-click to download

EHRs are Easy Prey, But All is Not Lost

September 7, 2011 By Peter Polack Leave a Comment

According to an article on NetworkWorld.com, the EMR/EHR market in the US will reach $6 billion by 2015. And where there’s money, there is crime. In recent years there has been a surge in data breaches, and as medical practices move into the digitized world more and more of these cases will involve patient data.

Christopher Burgess, an expert on IT security, says that most of these breaches occur at a base level: stolen laptops or lost some drives. Some practices feel they can avoid any problems by using Web hosted EMR systems, but even this is not a sure bet. While companies that run their software in the cloud do have more sophisticated hardware and security measures, they are not invulnerable to attack. And as the covered entity, the medical practitioner has an obligation to understand just how safe his or her patient information is.