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Bonus Resource – The Techie’s Guide to EHR Implementation

September 1, 2010 By Peter Polack 1 Comment

For those of you tasked with the actual implementation of electronic medical records in your practice or business – CIO, Director of IT, Administrator – here is a nice guide to EHR implementation courtesy of CHIME (College of Healthcare Information Management Executives).

CLICK HERE to download the PDF

Although it does present the topic from a technical perspective, it does also cover issues important to the CIO or Director of IT such as assessing the financial incentives weighed against implementation costs and a discussion about the importance of the ‘people factor’ as I have previously discussed: (see How to Prepare Your Team for EMR Implementation and The Right People for Your EMR Implementation)

E-Book PDF: Download (1.0MB)

Overview of the Meaningful Use Final Rule

August 31, 2010 By Peter Polack 2 Comments

From the folks of AHIMA (American Health Information Management Association) comes a nice and concise overview of the final rule of the Meaningful Use provisions for electronic medical records implementation. AHIMA is one of the largest associations of health information management (HIM) professionals and was founded in 1928 – which I am pretty sure pre-dates the use of electronic medical records.

This first in a series of white papers offers a basic description of the final rules. We covered some of the specifics in previous posts CMS Final Rule Part 1, Part 2, and Part 3.

But if you are new to all of this and just want to get your feet wet, here is a good place to start:

CLICK HERE to download the PDF

E-Book PDF: Download (154.1KB)

Hospitals Wooing Doctors with EMR

August 26, 2010 By Peter Polack 2 Comments

A report from American Medical News reports that hospitals are increasingly courting local physicians with free or subsidized EMR systems. Why?

A recent report by the American Hospital Assn. on the effects of the recession found that 72% of hospitals reported a decline in the number of elective procedures, and 70% reported a drop in patient volume from 2009.

A major criterion of meaningful use is proving the ability to communicate and share health information electronically. For hospitals, this means demonstrating that they are sharing this information with physicians. And the quickest way to achieve that is to help doctors get up-to-speed with EMR. Experts say that this also a good way for hospitals to strengthen relationships with the very physicians they count on for referrals.

Other experts urge caution on the part of medical practices. Hire a consultant and make sure the potential system fits in with your overall EMR implementation strategy. As J. Ryan Williams, a healthcare attorney from Cleveland points out:

You could be in a position of accepting the donated technology, share in that cost, then one, two or three years down the road that technology, God forbid, doesn’t allow you to meet your meaningful use criteria. [Then] what good have you done?

Patients Cite Costs for Not Keeping Appointments

August 25, 2010 By Peter Polack 1 Comment

Is your practice business a bit slow these days? It might not be your fault. The AMA reports on a study by Deloitte Center for Health Solutions that found that a patient group they surveyed had fewer doctor visits this year than last year (79% vs 85%). And the main reason they cited for skipping their appointments – cost- was more likely to be the deciding factor (40% vs 38%).

Insurers are noticing this as well. According to the article, Aetna President Mark Bertolini told analysts:

We are seeing it everywhere, in every segment of the business at this time. There are a number of impacts, but the economy does definitely have an impact here.

And a BlueCross BlueShield of North Carolina survey…

… found that 15% to 17% of those surveyed were skipping routine checkups and preventive care….[and] twice as many were taking fewer prescriptions, skipping prescription doses or not filling prescriptions because of cost.

Eligibility for EMR Incentives Could Be Widened

August 23, 2010 By Peter Polack 1 Comment

The AMA reports that new legislation is proposing to extend the eligibility for EMR incentives to include licensed psychologists and clinical social workers.

The Health Information Technology Extension for Behavioral Health Services Act also would expand the Medicare hospital incentive to include inpatient psychiatric hospitals, and extend Medicaid hospital bonuses to community health centers, mental health treatment facilities, psychiatric hospitals, and substance abuse treatment facilities. The bill was introduced on Aug. 5 by Sen. Sheldon Whitehouse (D, R.I.), and a companion bill was introduced in the House by Rep. Patrick Kennedy (D, R.I.).

Whitehouse said his legislation “will give mental health professionals access to comprehensive and up-to-date medical histories, enhancing the precision of diagnoses and reducing medication errors.”

Using EHRs to Drive Quality Improvement

August 18, 2010 By Peter Polack 1 Comment

Physicians have long suspected that part of the reason that the government and the insurance industry are so gung-ho about EHR adoption is to keep a closer eye on health-care providers. And here is an example of just that.

A Blue Cross Blue Shield provider (Highmark) is developing quality measures for its providers (internists, family practitioners and cardiologists) that are tied to financial incentives.

According to their spokesman, “Ideally, use of health information technology will transform care through access to full information at the point of care, use of decision support to assure better adherence to evidence-based guidelines and coordination of care among multiple caregivers. In so doing, we expect to see a reduction in unwarranted variation and improvement in patient safety.”

There is no doubt that the widespread use of EMR will lead to better documentation and therefore enhanced patient safety. But we must also be aware of the potential for increased control over the practice of medicine.

The Bottom Line on Dropping an Insurance Plan

August 17, 2010 By Peter Polack 1 Comment

An article on Medical Business Resources points out the potential pitfalls of dropping an insurance plan without doing your homework. They cite a report by the Medical Group Management Association that found more practices were renegotiating or eliminating low-paying insurance plans this year than last – 56% compared to 50%. Most physicians probably make these decisions based on emotional reasons – “they’re sticking it to me on this contract” – rather than a careful analysis of the numbers, a process made easier by computerized practice management systems.

Some important factors to consider are:

  • If you drop one plan, will another become your largest plan? This could make you more vulnerable if it covers more than 25%  of your patients
  • How will dropping the plan affect your most common referral sources?
  • Do you have a waiting list for new patients?
  • Will you have additional marketing costs if you have to recruit new patients?
  • Don’t burn any bridges – it is not uncommon for insurance plans to change their ways and sign practices back up again

Are Hospitals Necessary for EMR Adoption?

August 16, 2010 By Peter Polack 1 Comment

A post on HealthAffairsBlog illustrates the case of a community in Delaware where the adoption of electronic medical records was spear-headed by the local hospital system, Christiana Care. But it also brings up three challenges that any community would have in trying to reach that same goal:

  1. How to we get everyone communicating on the same network?
  2. Who is going to pay for the start-up costs?
  3. How do we ensure that all physicians benefit?

The answer to all three, according to the writer, Dr. Robert Laskowski of the Christiana Care Health  System, is the hospital. He argues that most small and solo practices do not have the resources or the wherewithal to implement EMR on their own and that if local hospitals would take the lead, it is a win-win scenario.

Do EMRs Make Practicing Medicine Safer or More Dangerous?

August 13, 2010 By Peter Polack 3 Comments

Recently I wrote about a Harvard study that found evidence that physicians that use electronic medical records systems (EMRs) are less likely to be involved in a malpractice lawsuit. But regardless of whether your charts are better documented and therefore make you less of a target for a claim, does using EMR make you practice medicine better?

According to the Huffington Post Investigative Fund, there have been several cases of EMRs gone amok. In most cases there was no harm to patients. But they quote Dr. Jeffrey Shuren of the FDA as attributing six deaths and 200 injuries to poorly implemented CPOE (computerized physician order entry). Many critics of the government’s EMR implementation plan point to these cases as examples of not enough regulation and oversight.

On the other hand, the ONC (Office of the National Coordinator [for Health Information Technology]) spokesman says the they are working closely with a number of organizations including the FDA to improve safety. Critics say that the ONC has too friendly a relationship with the EMR industry, and feel that the FDA needs to be given more authority to collect and analyze errors caused by EMR systems.

Which Doctors Are Most At Risk For Malpractice Lawsuits?

August 12, 2010 By Peter Polack 1 Comment

According to a report by Fierce Healthcare, a survey from the American Medical Association found that 95 out of every 100 physicians will be sued for malpractice sometime in their career.

In addition, their 2007-2008 survey of almost 6,000 physicians across 42 specialties found that:

  • About 2/3 of doctors aged 55 and older have been sued
  • Male physicians were twice as likely to be sued as female physicians
  • General surgeons and OB/GYNs had five times the risk as pediatricians
  • Doctors in solo or single-specialty groups had a higher risk than those in a multi-specialty group

They also noted that physicians prevailed 90% of the time that cases went to trial, although these cases can still average $100,000 in defense costs. And even the 65% of cases that are dropped or dismissed can cost over $20,00o to defend.

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