Deciding to Go Paperless

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’.

Can Your Paperless Office Go Cordless?

A physician colleague wanted to operate a completely paperless and cordless practice.  That is, his office was to operate on laptops and battery-powered devices which accessed a wireless network. This sounds like a good idea, and is - but it’s important to consider the limits of a cordless practice.

First, understand that a wireless network isn’t actually totally wireless. Something must be plugged in to something else somewhere. Also consider that a wireless system has several layers of associated expense.

You should work with a wireless consultant - preferably someone with experience installing wireless networks properly. A system that is implemented incorrectly will yield poor performance. Our practice chose to go with a Cisco-certified wireless network engineer. If you aren’t able to find someone with these rare qualifications, at least go with a consultant who specializes in network installation.

An expert consultant will use special equipment to map radio frequencies within the building. This will help to determine where to put the antennas. Our consultant’s team took several days to spread the antennas out on tripods, finally producing a map which illustrated the radio frequency overlay and a list of recommended placements.

If you plan to use cordless computers, you’ll have to use long-lasting batteries with plenty of back-ups available. Unless you’re using a special battery charger dock, this can’t be managed on the laptops. You may need to carefully plan your clinics, keeping in mind that the typical battery only holds a charge for about three hours.

Have a clear understanding of what is in your building. Is there lead in the walls? How about metal in the ceiling? These sorts of factors can either improve the signal through reflection, or degrade it overall. Are other wireless signals being broadcast in the area? Even microwaves and phones can have an effect on the signal, and most wireless networks are operating on a frequency which is on a spectrum in widespread use by other devices. The object is to prevent interference.

Be sure to keep a budget. One medical practice decided to use laptop computers connected to 24-inch monitors. This let both the patient and doctor see the monitor at the same time. However, this turned out to be costly - laptops are typically the priciest devices. Usually regular desktops are the most cost-effective solution.

Are you thinking about installing the wireless network yourself? Some network solutions on the market work well for e-mail and Internet, but might not quite cut it for operating your electronic medical records (EMR) system. There are two main reasons for this:

* Consumer wireless access points generally use a signal fixed on a higher strength than a usual laptop wireless card. This may sound good, but actually means that a laptop could detect a signal which is more powerful than it can actually return, resulting in a broken connection.

* If you require more than one wireless access point, there could be a conflict. Just walking from one side of the office to the other with the laptop could cause your session to drop, requiring another login after a possible loss of data.

Regardless of your final choice for wireless EMR implementation, make sure your team is on-board. And try to justify all purchases and keep an eye on costs. Refrain from indulging on the latest gizmos when you can - instead, stay focused on serving your patients in an efficient but cost-effective way.

EMR Software Comparison Checklist

Are you shopping for an EMR system? Before you open your checkbook, be sure to use this detailed checklist of important features your future software platform should have, thanks to the folks of Software Advice, Inc.

…{+}

The rest of this article is available to premium members only. Login or Become a member

[ Guarded by Wordpress Membership Plugin - MemberWing ]

How to Keep Your EMR Project Nimble

How long do you think it would take you to implement an EMR system in your practice?

3 months? 6 months? A year?

Of course, this is a trick question. First, you have to define when the actual project starts. Is it as soon as you make the decision to go paperless? Is it as soon as you have purchased the software? The hardware?

If you aren’t already using EMR, you are no doubt feeling some pressure from Washington to get with the program. After all, there is some serious money coming in the form of incentives in the next couple of years. Although, you can most certainly spend some serious money on the endeavor, especially if you don’t plan properly. With a reported failure rate of 30-50%, EMR implementation will be one of the biggest jobs your practice will tackle.

In our case, the timeline was more like three years. Granted, we could have pushed to meet the original goal of eighteen months. But, the arrival of two new partners - and two hurricanes - pushed this back. In subsequent articles, we will discuss the mechanics of the actual rollout. But for now, we will stick with the planning process. That’s the part that most practices fail to do, and which ultimately is the main cause of failure.

Some of these things may have been mentioned before, but I will summarize all the steps of a proper implementation of your EMR project:

1. Perform a needs/wants assessment. What exactly are you looking for in an EMR system?
2. Set up an EMR committee. This should include key players from different aspects of the practice: doctors, nurses, medical assistants, administration, billing, and of course information technology (IT).
3. The EMR committee should come up with a check list for an ideal EMR system based on #1. What are ‘must-haves’, ‘would-like-to-haves’, and ‘neato-cool-wish-list’ features?
4. Based on #3, come up with a short list of EMR systems, interview and demo them, check references, perform due diligence, and then make your choice.
5. Consult with a certified project manager. Check out the Project Management Institute . You may think you can’t afford one, but the truth is you probably can’t afford not to. Alternatively, ask your EMR vendor for some recommendations. The last option is to have your IT person or consultant to run the project - but this person should have some experience with project implementation, not just IT.

The project manager, or your staff member who has been trained to be one, will set up your project in a dynamic timeline known as a Work Breakdown Structure (WBS). This tool has the ability to adapt to changes in your schedule which will undoubtedly occur. By contrast, a schedule set up on a traditionally rigid calendar can easily be scuttled by a minor setback - this is a perfect opportunity for the naysayers to voice their “I told you so’s”.

For the do-it-yourselfers, use the tool the professionals use for producing your own WBS, mind-mapping software. The gold standard is MindJet’s MindManager. Although there are some less expensive or even free products out there, this is the most robust and the files are ubiquitous.

However you do it, don’t do it alone. And take the time up front to plan properly. This way, your project can roll with the punches instead of rolling over dead.

Do Your Employees Make These 6 Computer Security Mistakes?

Now that medical practices are joining the rest of the computerized world, they are having to deal such issues as office network security policies. As in most companies with a computer network, the weakest link is usually an employee who either inadvertently, or wittingly, commits one of these mistakes:

1. Trusting outsiders too much - security experts have a name for this: social engineering, where people are manipulated into divulging sensitive information such as passwords or security protocols. This is actually the most common way that thieves hack into computer systems. Employees may share passwords with each other to try to save time or cover their tracks - or out of sheer ignorance. That makes it difficult for a practice to know who is who in an EMR system. This can violate the integrity of the medical record which is critical in cases of having to defend a malpractice suit.
2. Leaving an unattended computer or terminal unlocked - besides potentially violating HIPAA policy, leaving a terminal unlocked can allow access to sensitive information by either employees who are not authorized to do so or, worse yet, non-employees. The practice would then be left to handle damage control when information gets into the wrong hands. HIPAA violations can carry hefty fines.
3. Not changing a password periodically - there should be a password policy in place and employees should adhere to it. To be on the safe side, passwords should be set so that they automatically expire, at least monthly, and they should be complex, including numbers and symbols and different-case letters, for example. This makes them less likely to be figured out by intruders.
4. Keeping passwords or sensitive information on sticky notes - although something like this should also be part of the practice’s password policy, I mention it here by itself because it happens so much.
5. Downloading inappropriate or unauthorized software - some inadvertently-downloaded ‘malware’ programs can wreak havoc on an office network, while other “harmless” file-sharing programs can open up your network to outside intrusion. This can result in everything from damage to your hardware to HIPAA violations if patient information is breached.
6. Inappropriate use of practice equipment - this would include such things as viewing pornography, which could also make the practice liable for a sexual harassment lawsuit, or using practice email for personal uses. There is software that can allow you to monitor employees’ internet use.

A physician once asked me if it was possible not to even have internet access in his office. While it is possible, it is difficult for a medical practice not to have internet access at all because so much information travels across some sort of internet connection. It is better to have a good written internet policy and have proper oversight.

Converting Old Data From Your Existing Practice Management Software

Medical practices that are planning to get an electronic medical records (EMR) system in the near future will also need to consider whether they will be keeping their existing practice management software (EPM). Many factors come into play and we will discuss the pros and cons another time. For the purposes of our discussion, let’s assume you decided to upgrade to a new EPM that comes integrated with the new EMR system.

What do you do with all of the existing patient insurance and demographic data?

Keep it or throw it all away?

First, a little background. It is the year 1998 and businesses around the world are beginning to panic about the impending specter of the Y2K (year 2000) crisis. You remember – all computers will stop working because nobody thought to put the year in four digits instead of ‘19’ followed by two digits. Read more

You Say EHR, I Say EMR

In every industry, there are always those who seek to position themselves as the keepers of the nomenclature. Everybody else wonders what all the fuss is about. Granted, what’s in a name?

The value of standardized terminology lies in making sure that we are all on the same page, so to speak, when we are discussing complex issues. EMRs (electronic medical records) are certainly high on the awareness level of most physicians today. But what about EHRs and ePHRs?

Software Advice has a nice summary of the the difference between these and other related terms. Increasingly there are workgroups that are attempting to standardize the phraseology in an area comprised of a multitude of disparate - but interrelated - industries, from medical practices to hospitals to software vendors to insurance companies.

Soon, we will all become facile at copying our Google ePHR file and giving it to our physician for her EMR, which is linked to the RHIO’s EHR….

Training Your Staff for EMR

As I wrote in previous posts, the technical side  of the electronic medical records (EMR) implementation process, namely which EMR system to use, is probably the least critical component.

The most important things are ultimately related to the people side or what is known as ‘change management’. For EMR, this boils down to the implementation plan (which we discussed earlier) and the training plan.

The EMR training plan can be broken down into three steps:

1) Identify current skill levels. Many of your employees are probably recent high school graduates andhave grown up making cell-phone calls, emailing, and texting. These are the people you need to worry the least about.

Read more

Planning Your Electronic Medical Records Implementation

We’ve all heard the proverb, “He who fails to plan, plans to fail.”

This is certainly the case in the majority of failed electronic medical records (EMR) implementations, and usually the physicians/ administrators/ owners (circle your choice) bear the responsibility. Since this may well be the most difficult (and expensive) project your medical practice will undertake, it literally pays to have a good plan in place.

Implementation of an EMR system is truly a formidable task and the logistics can be overwhelming. We realized that we would need an integrated plan that would tie together both the technical side of the project with training in order to maximize efficiency, making the best time and use of our staff and contracted help.

So we worked with a project manager to break our EMR implementation project down into major processes and then Read more

How to Choose EMR Software for Your Medical Practice

Ask any doctor,  what is the first thing you should buy for an EMR implementation and the response will be, “The EMR Software, of course.”

Wrong! Ask any non-medical person involved with EMR implementation and his or her opinion would be that the EMR software is the last (or one of the last things) to choose.

But let’s assume that you already know that there are some basics that must be set up first, such as your building’s infrastructure, your network design, determining staff skill sets, etc. (If not, then check out this blog for previous posts on these topics before proceeding).

In this article, I¹ll discuss how to decide on both an EMR software vendor and the actual EMR software. Read more

Next Page »