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EMR Implementation Rollout

September 18, 2009 By Peter Polack 5 Comments

Do you plan on implementing electronic medical records (EMR) at your medical practice? If so, you’re taking on a sizable project. Something this large must stay on a time-line or it may never reach completion. At our practice we experienced some setbacks including back-to-back hurricanes, construction of two new buildings, and hiring of a couple of partners -calendar-pushpin.jpg all of these events pushed the date of launch back over a year. Even so, having a firm date to ‘go live’ helps get everyone on board, allowing them to team together to engage in what could be one of the more challenging changes in their career.

Choose someone to be the project manager in charge of implementing the project. It could either be someone from staff such as an IT person or supervisor, or you could hire an outside consultant. Next, you want a comprehensive plan which covers the how, who, what, where, when, and why of the project from start to finish. Before going forward on your EMR plans, be sure your assets are ready. It just takes one poorly-prepared component to send well-laid plans down the path to failure.

Regardless of the practice, physicians’ attitudes towards EMR will range from gung-ho optimistic to downright resistant. Whoever is in charge of leading the project must decide when all of the physicians will roll-out on EMR, whether in unison or staggered on various launch dates or locations.

Some doctors may be quite comfortable allowing colleagues to test the waters first; but this may lead to more work and stress for the staff. If one doctor sees a patient using EMR, and the patient returns on a follow-up visit with another doctor using a paper chart, how will the patient’s chart be reconciled?

If there are multiple locations at your practice, you may want to implement EMR at one office before going on to the others. However, if your employees rotate between locations, your training plan must take this into account; if too much time passes between the launches at different locations, training may suffer.

Again, a project this large requires a firm commitment from the top authority at your practice, typically a physician ‘champion’, along with buy-in at all levels. One single voice of negativity from someone in a power position can drag down the entire campaign. A managing partner may have to intervene if the practice discovers that a doctor is actively working against the project – your administrator should not be put in this no-win situation. It’s also important that patients are well-informed of  the practice’s goals, so that they are more likely to tolerate the expected delays and hiccups while your team is working out the kinks in the system.

If you’d rather not make the big switch to digital all in one day, you may prefer to see only some patients using EMR. At our practice, we began with new patients requiring complete exams only, to prevent our clinics from grinding to a halt. As these patients gradually return for follow-ups, they continue to be seen using the EMR system. In this way, we were able to launch all locations simultaneously so clinics would not suffer from disparities in employee training and skills. This has also allowed us to gradually ramp up EMR with little effect on productivity.

Other items which shouldn’t be left to the last minute:

  • Are your desktop machines or wireless tablets configured correctly?
  • Has the software been installed and tested?
  • Is there a proper disaster recovery plan in use?
  • Is your infrastructure (wiring and wireless networks) ready to go? Adequate bandwidth?

Your schedule should include at least a month of intensive training for staff, which concludes well before the launch date. You may have to rotate staff during the day, or train people after hours at the usual overtime rate. Supervisors must have the ultimate word to ensure that the employees are trained to work with the EMR system in a live clinical setting. Naturally, they will need to practice to keep their skills sharp.

Will Google Health Influence Health System Reform?

August 31, 2009 By Peter Polack Leave a Comment

Although written two years ago, a post by Vince Kuraitis on the e-CareManagement blog seems timely:

“Google Health promises to simutaneously create and dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.”

What follows is an extensive analysis [Read more...]

Evaluating the Effectiveness of Your EMR Training Process

August 24, 2009 By Peter Polack Leave a Comment

In order to implement an electronic medical records (EMR) system, you must have ‘buy-in” from your staff. This means you’ll need firm commitments from the influencers at your medical practice, along with cooperation at all organizational levels.

One Bad Apple

Since one single naysayer can drag down everyone else down, computer-class.jpg it is important to intervene early. A managing partner may have to interject if it turns our that another physician is working to prevent project implementation. It’s also a good idea to tell your patients about the practice’s upcoming move to electronic records; they’ll be more patient when the practice hits the expected little bumps along the road.

The majority of project managers would cite the ‘people factor’ as the primary cause of project failures, particularly those of the scope and magnitude of electronic medical records implementation. Usually the causes are traceable to ineffective planning and training.

A transition over to EMR can be a stressful situation for some people – this is particularly true if they’re having to learn the system while caring for patients in a live work setting. It’s usually a good idea to specify some key personnel as the go-to people, and these should always be available at the different locations and within the various departments.

Audit Your Training Process

One way to determine if your staff is ready for EMR is to conduct training audits. For example, one practice asked the office coordinator to conduct a course which taught employees to use the upcoming EMR system. These training sessions were held each week. Everything seemed to be flowing well. However, when the launch day arrived it became obvious that some employees didn’t have much skill using the new system.

Unfortunately, their training process didn’t include an audit or a way to evaluate effectiveness on the individual employees. Sending employees to EMR ‘class’ is a good idea in general, but this doesn’t guarantee they’ll understand how to use the new EMR system afterward. Tests should be conducted, and grades issued based on performance. Also bear in mind that skills fade after long periods of inactivity.

Ideally there are ample opportunities for staff to develop and practice new skills during the workday. It’s a good idea to offer after-work tutorial classes as well. Remind your staff that successful implementation is a team effort, and you understand how hard everyone is working to reach this aim. Bottom line: trust, but verify, that everyone is prepared to make the big switch to EMR, with an effective training audit process.

State Governments Also Pushing Health IT

August 11, 2009 By Peter Polack Leave a Comment

Well, several of my colleagues said it was never going to happen, push-server.jpg but not only are there federal mandates for the adoption of EMR but now the states are starting to push for it as well. If you still don’t think that EMR is going to happen….I just can’t understand where you have been living these past few months.

Anyways, according to an article in Kaiser Health News, state governments and agencies are both facilitating and enhancing the implementation of health IT through a variety of means, from incentives to loans to the creation of health information exchanges.

Of course, like a lot of things benefiting from stimulus money, on-going funding for many of these projects may be a challenge going forward. Backers of these initiatives hope that savings from enhanced efficiencies and decreasing costs will more than make up for any short-falls.

Healthcare IT Market Poised for Growth

August 9, 2009 By Peter Polack Leave a Comment

According to an article by Lou Agosta in B-Eye-Network.com, 80% of healthcare is delivered by medical practices consisting of only 1 to 5 doctors. And most big players in the EMR software system arena are marketing to larger clinics and multi-specialty institutions.

Even existing and proposed open-source systems such as OpenVistA still require significant investments in infrastructure on the part of the clients. And the government seems to be pushing for more open-source solutions, catching the attention of proprietary vendors like GE Healthcare, who may be offering some less-expensive options.

Still, there is a a lot of potential for EMR vendors who can target small medical practices, possibly with the SaaS (software as a service) or ASP (application-service provider) models.

Click here to read the entire article.

Why Medical Practices Can't Use GMail

August 2, 2009 By Peter Polack 3 Comments

Much of the new regulatory information coming out of Washington is email-envelope.jpg getting increasingly more difficult to translate into English. I was recently asked whether a medical practice could use Google’s free email service GMail instead of spending money on a mail server and its associated server software. After checking with our own head of IT, I discovered it is a bit more complicated than just picking where you want to store your emails.

Buried deep within the HITECH (Health Information Technology for Clinical and Health) Act’s Sub-Title D is the language on privacy directly related to HIPAA (Health Insurance Portability and Accountability Act). Since most of us (health care providers) are considered “covered entities”, we must ensure that not only our employees and staff abide by these rules but our “associates” do as well.

If we started using GMail for our practice’s communication, there would be patient information located on Google’s mail servers and Google would, in fact, be considered one of our associates. This would require entering into a Business Associate Contract with Google, Inc. What do you think the chances are of Google, or a similar technology firm, signing a confidentiality agreement with perhaps thousands of medical practices across the country? I thought so.

Digital Business Law Group has an analysis of the language found in HITECH’s Sub-Title D – Privacy section that makes it a bit easier to comprehend.

E-Book PDF: Download (38.0KB)

Stimulus Plan Will Stimulate EMR Adoption, CBO says

July 26, 2009 By Peter Polack Leave a Comment

According to a recent report from McKinsey, congress.jpgthe US Congressional Budget Office (or CBO, always described by the media as “non-partisan”) predicts that the stimulus incentives for EMR adoption will have a significant effect on medical practices in this regard, as compared to projections without the incentives.

Part of this is due to the fact that the incentives, which may amount to as much as $44,000 per physician, would more than cover installation costs of an EMR system, particularly for web-based type systems. These systems, known as ASP (application service provider) or SaaS (software as a service), generally incur less up-front costs since they do not require on-site hosting servers and their associated infrastructure but rather reside on the vendor’s servers.

The CBO also predicts that adoption rates under the stimulus incentives will climb to 90 percent by the year 2019. The slice of the stimulus pie earmarked for healthcare IT is $40 billion. And while physicians will realize many benefits from the use of EMR, the main beneficiaries are expected to be medical payers, since the expected decrease in both healthcare costs and medical errors will improve profitability.

McKinsey expects hospitals and physicians to spend about $170 billion on EMR over the next ten years. This is good news for information technology vendors and medical equipment manufacturers. So, rest well, knowing that the money you spend on your EMR system will not only help insurance companies keep a better eye on you but will also be good for their bottom line.

The Right People for Your EMR Implementation

July 24, 2009 By Peter Polack 1 Comment

In order for your electronic medical records (EMR) implementation to team-players.jpgbe successful, you need to get buy-in from your employees. And for that to happen you need some key personnel involved from the get-go. It’s not possible for just one person to handle this task alone, no matter how talented he or she is.

The employees will well understand that a new EMR system will have a profound effect on the practice. They’ll also realize the pressures they are facing at work, and some anxiety is to be expected. Administrators and doctors should understand the top concerns which staff will raise when discussing EMR implementation. And sometimes staff will present with some resistance to the plan.

In our practice we use an integrated EPM/EMR platform but we didn’t switch on the EMR module until we were humming along with the EPM system. Only after the staff were well trained and we had converted all of our useful data from our old EPM system did we attempt to go live with EMR.

We created a group of ‘super-users’; these people were the first trained on elements of the new system, and had the responsibility to bring  the rest of the staff up to speed. Peer-to-peer learning is the most effective, even among physicians. Your super-users should be representative of the various departments, including IT, office staff, compliance, front desk, administration, and clinical.

At our practice we also created an EMR committee that was authorized to hold meetings when necessary – these individuals had run with the project since its inception, and some had put in long days and weekends. They ended up with some decision-making power, as well as the added responsibility that comes along with it. Confidence in the project began to grow from that point on.

Some of the most important staff players include:

Coding/Billing Specialist

This person should have a voice in the initial software selection process. Having their expertise helped to minimize the hiccups we experienced when we switched from our old practice management (EPM) system to the new one. On their recommendation, we performed a trial run on the new system prior to completely abandoning our old system. This allowed our IT specialist to verify that the posting and billing were being performed correctly. Someone technically proficient with coding and compliance issues will be invaluable when your EMR  system goes live – to prevent under- or over-coding and ensure HIPAA compliance.

Clinical Staff

Although not as vital during conversion of your EPM system (unless you are using an integrated system), their participation will be key to the success of the integration of the EMR into the practice. Therefore, it is important to for them to be involved in the early stages of planning; it is helpful for them to have an appreciation for what the non-clinical staff does on the EPM side and how the EMR will fit into the scheme of things.

IT Specialist

This person should be involved from the beginning, even prior to choosing the EMR software. If a practice cannot initially justify the expense of a full-time IT specialist, at the very least an IT consultant should be retained. Because we knew that conversion to EMR was just part of our overall strategic technology plan, we felt we could easily justify hiring a full-time IT specialist. In fact, due to this person’s expertise in such areas as software licensing, internet communications, and hardware networking, the changes that were incorporated into the practice saved enough to cover part of his salary.

Front Desk Staff

They provide valuable input from the perspective of the end-users of the EPM. Their tasks include check-in, check-out, posting of charges, and scheduling. Their critical job prior to the EMR rollout was to help test the design of the posting process at the time of patient check-out. Once we went live with EMR, they had to learn to post the charges electronically in real-time. Having time to get the bugs out of this process helped support our decision to postpone implementation of EMR until the staff was well acclimated to our EPM system.

At our practice the doctors empowered the EMR committee with authority to manage and plan the EPM/EMR integration. Managing partners continue to meet regularly with the administrator for status reports. They also meet with IT to continually tweak the system to improve efficiency. Bottom line: the overall success of the project will depend on the cooperation and involvement of everyone at the organization.

Putting Meaningful Use in Your Practice

July 20, 2009 By Peter Polack 2 Comments

A recent article in the AMA news discussed some of the continued drown-in-paper.jpgambiguities of the “Meaningful Use” prerequisites handed down by the Health IT Policy Committee. Nevertheless, it does give everyone an idea of where they are headed. Generally speaking, meaningful users are defined as healthcare-providers who are using E-Prescribing, that their EMR technology is connected in such a way that there is an electronic exchange of health information, and that clinical quality measures are submitted to the government via electronic means.

For practices that fail to have meaningful use by the end of the set timelines, not only would there not be incentives, there would actually be penalties in the form of reductions in Medicare reimbursements – unless the practice could demonstrate some type of financial hardship that would prevent adoption of EMR.

If you don’t think the financial incentives are worthwhile, thing again. SoftwareAdvice.com has a nice explanation of what medical practices have to gain by getting the ball rolling and not waiting until the perfect EMR solution falls out of the sky and hits them in the heads (note: it ain’t gonna happen).

To give you an idea of the timeline we are talking about, here is a graphic from a committee report (courtesy of Digitized Medicine). So, what are you waiting for?

meaningful-use

Legal Issues of the Electronic Medical Record

July 19, 2009 By Peter Polack 4 Comments

When medical practices change over from paper to electronic medical records (EMR), gavel-and-scale.jpgsteps must be taken to ensure that the records remain legally sound. The change to electronic medical records brings up some issues with compliance, privacy, and security. Below you will find some important considerations to make when switching your practice over to EMR.

When writing an exam on a piece of paper and signing it, you create a legal document. You are most likely familiar with the problems that can result from changes to medical records, and the importance of good documentation. The Healthcare Information and Management Systems Society (HIMSS) asserts that electronic medical records must be stored legally. Otherwise, these records can be challenged as hearsay and deemed invalid.

This is important, because when electronic medical records do not meet the legal requirements, a payor can sometimes deny a claim. Also, you could create the risk of an adverse outcome in litigation. In addition to being sure your electronic records aren’t altered, you must also be able to demonstrate the procedures which are used to ensure this.

How, then, can you make sure your electronic records can’t be altered? The ideal system lets users make updates and correct errors while keeping the record’s legal integrity intact. Ask yourself the following questions:

* Does the system keep a record of who is accessing and writing to the record? You wouldn’t want your name appearing as the author of another user’s entry.

* Does it contain a security protocol which is strict but not too time-consuming? Features could include an automatic time-out after a period of inactivity, and periodic changes to the alphanumeric passwords.

* Does the system prevent access to certain critical features? For example, an employee working the front desk shouldn’t be able to edit a patient’s clinical findings.

* Does it use a secure ‘lock-out’ feature? Perhaps you want the doctors to be able to make changes at the end of the day, but after a certain amount of time has passed the record should lock. This sort of feature helps protect you by preventing unauthorized changes.

* Does the system write time stamps on all entries, to show an audit trail? For example, the system could write an unalterable draft of each event and entry.

By paying attention to these important considerations, you’ll be on your way to ensuring your electronic medical records system is legal and defensible.

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