Featured Article - Medical Practice Trends

Why You Need to Worry About Computer Security

May 17, 2012 By Peter Polack Leave a Comment

Along with the widespread use of computers in medicine comes a greater need for security measures. Apart from being a good business practice, these security measures are also part of the Meaningful Use (MU) standards. But make no mistake, computer security is more than just changing your password now and then. In fact, recent legislation has explicitly spelled out what is expected of any person or entity dealing with personal health information (PHI).

The HITECH (Health Information Technology for Economic and Clinical Health) Act not only spells out specific computer security requirements that were first mentioned in the HIPAA (Health Insurance Portability and Accountability) Act but also describes penalties for not doing so. Additionally, all of this has extra teeth in the form of an enforcement agency, the Office of Civil Rights, under the Department of Health and Human Services (HHS).

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IT Services for Your Practice – In-House or Outsource?

April 4, 2012 By Peter Polack 1 Comment

Previously I wrote about outsourcing your IT services support as well as how to hire an IT director. But one question that I am commonly asked is, “How do I decide whether to keep IT services in-house or whether they should be out-sourced?”

Electronic medical records systems have become an integral part of the practice of medicine and having someone with IT expertise in your corner is no longer a luxury but a necessity. But for most medical practices, this decision is strictly a monetary one. Still, there are more issues to consider than just budget.

Why you should have IT in-house

You are completely clueless about technology and need someone at your beck and call
You want someone with particular expertise in your specific EMR software
You want someone who has specific knowledge of your medical specialty
The physicians in your practice want their daily IT needs handled on an expeditious basis
Your practice can afford to pay a market salary and benefits for a full-time IT person

Why you should outsource IT services

You cannot afford to hire a full-time IT person
You have a small practice and you consider yourself ‘tech-savvy’
You are using a web-based EMR system and have a minimal IT infrastructure
You need or require 24/7 support
The complexity of your practice demands redundancy in the support services
There is a large volume of basic, mundane tasks that have to be handled on a daily basis

Why you should do both

Another option to consider: the hybrid model. Whether you decide to out-source IT services or bring in your own full-time person, a concern in either case is the transfer of knowledge. If you have a full-time IT employee, that person’s fund of knowledge – about your practice, about your EMR system, about your processes – walks out the door with him or her. Even if they are meticulous about documenting all of their processes, this can still be a devastating loss. While this risk can be lessened with an out-source firm, there is still the potential for loss if their services are terminated and you have to hire another firm.

By having both, you could build in enough redundancies that your practice can be protected in the event of a staffing change. The out-sourcing can provide around-the-clock monitoring of your IT infrastructure and handle basic, day-to-day operational issues such as computer trouble-shooting, password resets, and printer repairs. Your IT employee can oversee the out-sourcing firm while at the same time looking out for the best interests of the practice, providing physicians with prompt, personalized attention, and concentrating his or her efforts on more specialized work such as EMR templates, Meaningful Use issues, and the like.

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.

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.

EMR – Is It Worth It?

January 17, 2012 By Peter Polack 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 Peter Polack 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)

Debunking The 7 Myths of Concierge Medicine

January 2, 2012 By Peter Polack Leave a Comment

Guest Post, John T. Kihm MD

Myths abound concerning concierge medicine (CM). Unfortunately these myths prevent good doctors from converting their practices to CM. Let’s look at those myths—maybe you need to work on yourself and your own beliefs. If you practice quality medicine your patients will value you and your work and will pay a fee to join your CM practice. CM is a value story. If you provide solid value, you needn’t believe these myths–value trumps myth.

The myths:

My patients are not wealthy/can’t afford CM. I have a lot of Medicare/Medicaid patients.
My patients will not like this concierge idea.
My patients can’t do without me.
I have bad practice demographics. I am rural. My patients are too old. My patients are too young.
24/7 coverage sounds too hard.
Is this legal? What are the ethics?
The conversion process will overwhelm me.

My patients are not wealthy. If your patients value you and your work, you can devise an affordable program. Patients will find the money to keep you if they value you. Be creative with pricing if necessary. You can make it work. Amazingly, I have patients who live in housing projects who joyfully belong to my practice because they see the value. Conversely, all of us in CM practice have wealthy patients who say the fee is too high, do not see the value, and do not join. Patient income generally does not predict CM success or failure. Perceived value predicts success. Focus on value and the rest will follow

My patients will not like this concierge idea. Do not project onto patients negative beliefs, as those beliefs may become unnecessary self-fulfilling prophecies. Patients’ enthusiasm will mirror your own. Patients possess a survival instinct and will recognize your opportunity for better care, along with your belief in providing that care. Moral: be enthusiastic! Believe in yourself and your patients will follow. Above all, emphasize value and opportunity in your CM practice.

My patients can’t do without me. Primary care doctors are famously codependent. Get over it. Patients not seeing the value in your practice can and will vote with their feet. You do not decide who can live with or without you—patients decide. Patients who truly “can’t live without me” will see the value and stay with you. There is nothing unethical about letting patients decide who they need. Do not project your own needs onto your patients. Patients who do not wish to stay with you are responsible for their own lives. Let go of your codependency.

I have bad practice demographics. You can overcome demographic obstacles by providing great value to your patients. Patients of all stripes, ages, and locations will stay with you if you take excellent care of them. For example, farmers in my practice understand, respect and value hard work. All of my farmer patients signed my contract. The elderly do tend to value their care more that the youthful, but the health-conscious young will sign-up as well. Meet demographic challenges by making sure your patients see value.

24/7 coverage sounds too hard. 24/7 sounds impressive, and it does demonstrate value. Taking call has never been easier for me. First, with fewer patients in the practice, the calls decrease in proportion to number of patients. Second, the very patients who respect and value me enough to contract with me demonstrate discretion in calling after hours. Mutual respect is the norm in CM. Inappropriate calls come few and far between, so 24/7 call is not hard.

Is this legal? What are the ethics? Concierge medicine is legal and is ethical. In CM, you provide a service for which patients pay. If you elect to file insurance, your CM practice needs to provide a non-covered service. Some argue that by charging a fee, you limit access to patients, hence CM is not ethical. Your response should be, “I need to see fewer patients to practice a high level of care. I cannot take care of all patients who need a doctor. It is not my responsibility to see all patients or attempt to cure all of society’s ills. I just focus on my own patients.” Explain this truth to your patients. They will understand you. It is ethical for you to stay alive and in business by practicing concierge medicine.

Conversion process will overwhelm me. Conversion to a concierge practice is do-able, and challenging. You have one chance to do it right. We do not recommend going it alone. Conversion need not be overwhelming. Simply ask for help.

If you know in your heart that you need a better alternative than hamster treadmill high volume medical practice, consider concierge medicine. Do not shoot-down CM based on any of the above myths. Focus on value. If you can provide value to your patients and if you want a better life for your patients and yourself, bust these myths and get going. Contact us, we can help.

Dr. John T. Kihm blogs on ConciergeMedicineDirect.com – the original article can be read at Debunking the 7 Myths of Concierge Medicine

The Ten Commandments of Successful EMR Implementation

November 22, 2011 By Peter Polack 1 Comment

Most 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:

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.
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.
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?

Improving Practice Efficiency With Convenience Applications

November 8, 2011 By Peter Polack 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.

How to Attest for Meaningful Use: 3 Tips from a Meaningful User

October 26, 2011 By Houston Neal Leave a Comment

Guest Post: Houston Neal

According to an August 3 report, 2,246 eligible providers and 100 hospitals have successfully attested to meeting Meaningful Use (MU) criteria. Among these early adopters was Premier Family Physicians, a family practice here in Austin, Texas. We recently had the opportunity to speak with Dr. Kevin Spencer, a board-certified family physician with Premier Family Physicians.

In April, seven of Premier’s eligible providers (EPs) attested for MU. After the mandatory 90-day tracking period, six providers were reimbursed the full early-adopter amount of $18,000. In total, the practice has received $108,000 so far. After their seventh EP attests, the office will be on schedule to receive $308,000 in Medicare reimbursements over the next five years. Not bad for meeting just 15 criteria.

Sure, meeting those criteria does have its challenges. But it’s possible, and there are 2,246 case studies to prove it. That’s why we are running a series to profile physicians that have successfully attested. Throughout our series, we hope to shed light on the best tips and tactics for other providers. At the same time, we want to give recognition where it’s due. Dr. Spencer and the rest of the providers and staff at Premier Family Physicians have worked hard to meet MU criteria. Here are the three key factors that helped them succeed in attesting for Meaningful Use:

1. Choose the Right EHR Software Company

Choosing the right electronic health record (EHR) software vendor is one of the keys to attesting. This is one of the first lessons Dr. Spencer shared inadvertently during the interview. Dr. Spencer and the other providers at Premier use Greenway PrimeSUITE. Not only has Greenway developed a Meaningful Use Dashboard that makes it easy for providers to track compliance, but they also offer a really good training program.

“It was excellent,” said Dr. Spencer. “They put on a MU seminar right at the beginning of the year. We were trained on the things that the Centers for Medicare and Medicaid (CMS) wanted to measure, and how to utilize our EHR to capture the right data.”

Greenway offers support beyond training seminars. Gina Scalapino, the Director of Operations at Premier, shared a few anecdotes about her training experience. She informed me that a Greenway rep shadowed her and provided instruction on how to change her information workflow to document into the Meaningful Use Dashboard.

Of course Greenway is not the only EHR vendor that offers this level of support. There are others taking extra measures to ensure their customers meet MU criteria. But again, the key lesson is to identify one of these vendors right from the start. It will mitigate risks and challenges of the attestation process

2. Approach with the Right Mindset

Dr. Spencer really gets it, and talking with him was like a breath of fresh air. There are many Luddites still complaining about the shortcomings of EHR technology and the government’s carrots-and-sticks plan forcing them to “adopt or else.” It was refreshing to speak with a practicing physician that understands the benefits of EHRs and that is willing to work hard to reap the benefits.

Call it a sharpen-the-saw attitude. Dr. Spencer and Premier have used the MU attestation process to improve patient care and track and grade their performance.

“We’ve used this process to be an organization that [focuses on] process, workflow and measurements so that we can really attack clinical outcomes, look at our data and grade ourselves to be better physicians going forward.” – Dr. Kevin Spencer

In addition to the post-bootcamp outcomes, Premier’s patients are also benefiting from the practice’s EHR and MU attestation process. They are more educated about their disease state; they have more information available to them, and; they can be more involved in their health care. Patients can also sign up for Premier’s patient portal and check their medication lists, drug allergies, diagnosis and treatment instructions. Currently, more than 10,600 patients have registered, which is a significant level of engagement.

However, while Premier is seeing great returns from attestation so far, Dr. Spencer anticipates most benefits to come from Stage 2 of MU attestation, which is expected to be implemented in 2013.

“I think the next phase will be where we really see great benefit,” said Dr. Spencer. “Where we have information being exchanged with immunization registries between hospitals, specialists and primary care offices. Where we can avoid duplication of services and really take care of people at the right price point.”

3. Embrace the Process

Every practice needs a physician champion to take ownership of MU attestation. Someone to “embrace the process,” as Dr. Spencer and Scalapino suggested. Attesting for Meaningful Use will require behavioral changes, and practices need a campaigner to engage others and drive organizational changes.

Call it “change management” or whatever moniker you’d like to give it. But, it is important to have an individual or team to ensure providers and administrative staff understand the process and take the necessary steps to track MU criteria. They should be the central correspondent with the EHR vendor; the coordinator organizing training sessions, and; the manager articulating the importance of the process and ensuring individuals follow guidelines. It’s critical for a successful EHR implementation and similarly, for MU attestation.

Combined, these three factors helped Premier Family Physicians attest to Meaningful Use.

(To read the original post please go to SoftwareAdvice)