If you talk to anyone who is involved in the electronic medical records (EMR) industry, one of the biggest points of discussion is what is known as “Meaningful Use of EMR.” What started as a well-intentioned (by some) effort to establish standards for EMR software systems has morphed into political jockeying by corporations, consumer watchdogs, and others.

The US Dept of Health and Human Services (HHS) outlined these criteria for Meaningful Use of EMR:
1)    Improve quality, safety, efficiency, and reduce health disparities
2)    Engage patients and families
3)    Improve care coordination
4)    Improve population and public health
5)    Ensure adequate privacy and security protections for personal health information

And although each of these has defined goals followed by specific objectives and measures for the years 2011, 2013, and 2015, these still sound a bit ambiguous. Many industry experts, however, expect these to be more fine-tuned as the dates approach, but medical practices will have to stay informed to keep ahead of the curve.

Financial Incentives

As part of the ARRA (American Recovery and Reinvestment Act of 2009), financial incentives will be given to those physicians whose practices demonstrate “meaningful use” beginning January, 2011.

The incentive payment, according to CMS, is equal to 75% of Medicare-allowable charges for covered services in a given year, and maxes out as follows:

• Year 1 – $15,000
• Year 2 – $12,000
• Year 3 – $8,000
• Year 4 – $4,000
• Year 5 – $2,000

For those practices who are early adopters of the technology and hit the threshold for meaningful use in 2011 or 2012, the first year payment would be $18,000. Note that this only applies to Medicare; there are additional incentives for healthcare providers who have a certain threshold of Medicaid patients and/or who practice in a rural area. The threshold for office-based pediatricians is lower, and so they would be more likely to qualify for those additional funds.

[table courtesy of SoftwareAdvice.com]

Even considering the fact that EMR implementation may cost anywhere from $10,000 to $50,000 per provider, these incentives would certainly make that investment more palatable.

Those practices that procrastinate, however, will be penalized with cuts in Medicare and Medicaid payments:

• 2015 – 1%
• 2016 – 2%
• 2017 – 3%
• 2020 – 5% (maximum reduction)

So, how do you know if you qualify? According to the health IT blog NetDoc, to be a “meaningful EHR user”, a physician must satisfy three criteria:

1. Must use “certified EHR [EMR] technology”
2. Must demonstrate that the certified EHR technology is connected in such a way that it provides for the electronic exchange of health  information to improve the quality of health care, such as promoting the coordination of care (using HL7 or XML standards)
3. Must submit information on clinical quality measures specified by HHS (such as PQRI)

Some physicians have told me that because there isn’t a final definition of what is considered “certified EHR technology” they are just going to wait. Big mistake. Most health care IT experts working on and advising on this issue feel fairly strongly that the Office of the National Coordinator for Health Information Technology (ONCHIT) will set CCHIT (Certification Commission for Health Information Technology) criteria as the standard for EMR certification.

CCHIT is a non-profit organization funded by various corporations and groups such as the American College of Physicians and the American Academy of Family Physicians, and was recognized by the US Dept of Health and Human Services (HHS) as a certifying body in 2006.

Some critics, however, charge that CCHIT is a shill for the Healthcare Information and Management Systems Society (HIMSS), the healthcare industry’s membership organization focused on healthcare IT. Although made up of both corporate and individual members, these critics feel that their goal is to corner the market for certain major EMR players. Nevertheless, unless or until there is an alternative, most EMR vendors are using CCHIT certification as the benchmark.

In addition to the EMR certification criteria, the ONCHIT is expected to adopt an initial set of standards and implementation specifications by the end of the year 2009.

Timeline

So, is too late to implement EMR in your practice and still qualify for the financial incentives? Well, that depends on the size of your practice, type of specialty, and how motivated your doctors and staff are to go paperless. Just don’t expect to run down to Office Depot, buy an EMR program and launch it the next day (although there is talk about WalMart getting into the EMR business, but we’ll leave that story for another day…)

According to MBA HealthGroup, these are some reasonable time frames to expect for EMR Implementation:

• Stage 1 – up to 6 months – researching vendors, getting buy-in, setting up an EMR committee, checking out demos, and making a final decision on the EMR system
• Stage 2 – up to 5 months –  time it will take to actually ‘go live’. In the meantime, adapting workflow to EMR system you chose, ordering hardware, and standardizing processes
• Stage 3 – between 6 and 12 months – amount of time it will likely take to achieve “meaningful use”, which includes ePrescribing, documenting electronically, and ability to report certain items (which are still being determined)

[timeline courtesy of MBA HealthBlog]

Smaller groups and solo doctors may be able to purchase a more basic, “out-of-the-box” EMR system and more quickly adapt their workflow to the system, rather than vice versa in the case of larger medical practices. But, the one thing you can count on with EMR implementation is that you can’t count on anything – that is why some sort of timeline is important [see EMR Implementation Rollout].

What this boils down to is that those practices that have already started implementing EMR will have a good shot at getting those higher financial incentives. On the other hand, physicians who have been wishing that the whole idea of EMR was just a fleeting fad may not only miss out on these incentives but may also face cuts in their reimbursement.

Questions? Comments? Post them below

Tweet This Post

There are many benefits associated with having a computer office network, regardless of whether you are ready to implement electronic medical records (EMR) or not. For example, what may begin as a helpful suggestion from an employee can blossom into a practice-wide tool which can improve overall productivity.

ProtoQue is a program which was developed in response to a problem we were having with our phone triage: we noticed that many patients were not called back in a timely fashion. This program, which is web-based, lets operators register calls automatically. The patient is then subsequently passed off from there to either medical records or a medical assistant. This program manages the ‘chain of custody’ so that the patient doesn’t slip through the cracks. The issue remains open until the problem is resolved. Every time a patient receives a return phone call, a time stamp is created, so our attempts to contact them are documented. The supervisors can use this application to monitor information flow, delegating calls to additional staff if the team falls behind, regardless of where they are located. We no longer have patients waiting until the next day to have their concerns addressed by our staff. Even though our EMR system, like most, has a messaging feature, we still find this program to be more robust and have continued to use it for over three years.

In addition to the phone triage program, we have designed some in-house programs that help us manage specific tasks, and which would not be possible without our computer network:

• The first helps calculate our eyeglass prescription capture rate, which is broken down by location and individual doctor.
• We also have an optical lab tracker program, which tracks jobs in real time, so an optician can tell a patient precisely when their order will be ready.
• Another custom application completes work-orders, and is located on a network that is accessible by IT, Human Resources, and Facilities. If supplies are needed, or a piece of equipment is damaged, an employee can complete a work-order and send it on to the right person. This facilitates full accountability while the chain of custody among the departments is being managed.
• Our Human Resources staff is working on an application that will let new employees enroll using our own electronic interface.
• A new PQRI Tools program which resulted in a significant federal incentive bonus. It attaches to the practice management system and identifies missed reporting before billing.

If you have any comments, please post them here. You can also post any questions you might have about some of our software tools.

Tweet This Post

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’.

Tweet This Post

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.

Tweet This Post

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. (more…)

Tweet This Post

In Part 1 of this topic, I discussed the key issue your practice must resolve before purchasing a phone system: what are your needs? Now let’s review the questions you need to ask yourself and why they are so important:

1. How many people and devices need to be on the phone at one time? Don’t forget that voice calls are not the only things which tie up your phone lines. Take an inventory of any peripheral devices which could possibly be in use concurrently with your staff: modems, fax or postage machines, credit card machines, or your security system.
2. How many calls at each location do you need to receive at one time? You don’t want to limit the number of lines you have and then have patients unable to get through. This will also help you determine if you need to have an actual call center set up. (more…)

Tweet This Post

I wrote previously on disaster recovery planning for the medical office (and we have an audio teleseminar coming out in the near future on just this subject). If you connect to your office from home, it’s a good idea to have a disaster recovery plan in place for your home office as well. I had a chance to personally put a plan into effect when my house was struck by lightning – for the second time in three years.

Well, it wasn’t actually a direct hit. I was awakened early one morning last week by what sounded like a mortar going off in the back yard. There was no loss of power but several electronic devices were affected: a wireless router, two switches, a satellite receiver, a digital phone, the alarm system and, oh, yes, my desktop computer. (more…)

Tweet This Post

An article posted on ZD Net discusses a new online service that helps patients avoid being “non-adherent”, i.e. to take their meds. The American economy loses $177-300 billion per year because people don’t take their medicine properly.

Sean Teare is president of InnovationRx, a Massachusetts-based unit of a British company which aims both to cut the cost of nagging people to take their meds and improve the rate at which they do.

Will this new service work?

As to their business model, “We’re a subset of disease management. If you don’t improve adherence you can lose the impact of other changes. Health plans are looking for short term ROI, and we can show that.”

Tweet This Post

Shopping for network hardware can be like shopping for a used car in a foreign country. There a lot of decisions to be made and one of the toughest is choosing a brand. The natural instinct is to shop for the lowest price, and although price is a very important factor, others play a big role in the decision making process.

Choosing a Hardware Vendor
Most large vendors negotiate pricing based not only on what you are immediately purchasing but also what you anticipate purchasing in the future, so it’s important to communicate your long term order goals. Often, you can achieve better pricing on a purchase today if your vendor can count on your purchase tomorrow as well.

Repair service and warranty options are critical with network hardware. Make sure you understand
(more…)

Tweet This Post

When I first joined our group about 11 years ago (jeez, it’s been almost 12 years!) we had some 80 or so employees and a big collection of PC computers connected in a patchwork of a network – not exactly state-of-the-art. Our phone system, however, was relatively sophisticated – or so we thought. A multi-line phone system with several custom features and a message-on-hold device. What we didn’t realize until much later was that we were paying for each and every line coming into the building as well as for each and every custom feature on each and every one of those individual phone lines.

Another drawback to this type of system is that the staff needs to keep track of multiple phone numbers – this can get chaotic when you start adding multiple locations. If you needed to get hold of a particular doctor, for example, first you would need to find out where he or she is (more…)

Tweet This Post