Tuesday, October 30, 2007

Doctor, or Druggist? Washington Post Asks

Today's edition of the Washington Post examines the growing trend of physicians who dispense prescription medications at the point of care. We thought our readers would want to read the story, since we recently highlighted a national study that found most Americans would prefer to receive their medications directly from their doctors instead of the local pharmacy. The story is thorough, but it doesn't exactly discuss the role of technology in safely dispensing drugs to patients.

Read the story and let us know what you think about this practice.

Tuesday, October 16, 2007

Presidential Candidates and Health Care Information Technology: Where Do They Stand?

Election day is more than twelve months away, but the contest for president of the United States is already shaping up to be a fierce one. Many presidential candidates have either released or announced their intention to release a comprehensive plan for health care reform. Following is an attempt to summarize each candidate's position on health care information technology such as e-prescribing and electronic medical records. You are encouraged to visit each candidate's Web site on your own, as their positions may change in the future.

Joe Biden (D): His home state of Delaware is a leader in adopting new health information technology, and the candidate notes the Delaware Health Information Network (DHIN) is a state-wide health information and electronic data interchange network for public and private use. Biden says the potential savings to the health care industry from full adoption of electronic medical records is substantial. He notes that researchers at the RAND Corporation estimated that full adoption of electronic medical records could save $77 billion annually. RAND also determined that by 2004, 15 to 20 percent of U.S. physician offices had adopted electronic medical records systems.

To get to 100 percent adoption of EMR/EHR software, Biden says he would invest at least $1 billion dollars per year in moving to electronic health records systems, provide grants to states to develop electronic medical records and other health IT systems, and assist hospitals, medical facilities and doctors in upgrading to electronic record systems and implementing them in their practice.

Electronic Medical Records Information and Resources

Sam Brownback (R): Brownback advocates for lifetime electronic medical records. On his Web site, he notes that he is " ... the sponsor of a bill that would offer patients both ownership and control over their personal health information and ensure that personal health information is not used by third parties without the consent of the patient. This proposal would also offer patients debit-like cards containing their private and portable personal health information."

Hillary Clinton (D): In her comprehensive plan for health care reform, Clinton pledges to ensure that all health care providers and insurance plans use privacy-protected information technology. She says her proposal will give doctors financial incentives to adopt health information technology and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded. Clinton also notes on her Web site that the Business Roundtable, SEIU and AARP estimate that “widespread adoption [of such IT reforms] raises the potential savings to $165 billion annually.”

Chris Dodd (D): In his plan, Dodd says health insurance premiums will be affordable based on leveraged negotiating power, spreading risk, reduced administrative costs and incentives for adoption of information technology and savings from better care. He implies that technology such as electronic health records and practice management software systems will help integrate clinical information tools, monitoring technologies and care management such that chronic diseases are kept under control.

John Edwards (D): Edwards advocates for universal health care, and healthcare information technology will be critical to ensuring his model delivers high quality care without breaking the bank. On his Web site, the presidential candidate notes: "Many insurers and hospitals still rely on cumbersome paper systems and incompatible computer systems. The outdated 'paper chase' causes tragic errors when doctors don't have access to patient information or misread handwritten charts. It creates needless administrative waste recreating and transporting medical papers, performing duplicative testing, and claiming insurance benefits. Edwards will support the implementation of health information technology while ensuring that patients’ privacy rights are protected."

Edwards pledges to support new technologies, such as handheld devices and electronic medical records, to give doctors the latest information at their fingertips. Edwards also promises to support public-private collaborations that reduce medical errors through electronic prescribing (e-prescribing).

Rudy Giuliani (R): Giuliani has pledged to invest in health information technology to reduce medical errors, improve efficient and detect health threats, noting that thousands of hospital deaths each year are attributed to preventable medical errors. He sais public-private partnerships to improve and set standards for health IT but without overbearing regulations can play a major role in improving quality of care and reducing health care costs.

Mike Gravel (D): It does not appear that Gravel has a position on the role of information technology in health care reform; if he does, we were unable to find it.

Mike Huckabee (R): Huckabee is famously known for losing 100 pounds after being diagnosed with diabetes, and for his steadfast support for preventive health care. He has not released a comprehensive plan for health care reform, but he does note that health care can be made more affordable by adopting electronic record keeping, among other strategies such as medical liability reform and health insurance portability.

Duncan Hunter (R): There's no mention of health care on his Web site, let along discussion of electronic medical records.
Kucinich's proposal is for universal, single payer health care plan completely funded by the government.

Dennis Kucinich (D): Kucinich has proposed a universal, single payer health care plan completely funded by the U.S. government, called the United States National Health Insurance Act (H.R. 676). In his proposal, he calls for the creation of a "standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy," and that "notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record."

John McCain (R): He says that reforms to federal health care policy and programs should focus on enhancing quality while controlling costs, but we were unable to find any references to health care information technology in his campaign materials.

Barack Obama (D): In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging that paper-based medical records make it difficult to coordinate care, measure quality and/or reduce medical errors. He also says processing paper claims costs twice as much as processing them electronically.

Obama pledges to invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT, and promises to "commit the necessary federal resources to make it happen." He also pledges to ensure that these systems are developed in coordination with providers and front line workers, including those in rural and under served areas.

Ron Paul (R): He's a Medical Doctor, but he has not proposed a plan for health care reform, and makes no mention of electronic medical records in his campaign materials.

Bill Richardson (D): To achieve health care for all, Richardson proposes streamlining health care administration by using "21st Century Health Care Bonds" to invest in health information technology, thereby saving the system $22 billion per year.

Mitt Romney (R): In August, Romney shared his health care reform plan with physicians in Florida, where he underscored the importance of bringing market dynamics and modern technology to health care. In his presentation, Romney supported the idea of federal incentives to foster more widespread adoption of electronic medical records technology.

Tom Tancredo (R): He has announced a very basic plan for reform, but there's no mention of electronic medical records or other types of information technology.

Fred Thompson (R): Thompson says he is committed to a health care system with five key attributes. One of those five guiding principles: "Modernized delivery and administration of care by encouraging the widespread use of clinical best practices, medical information technology, and other innovations."

For more information on each candidate's health care ideas, visit the Association of Health Care Journalists.

An EHR Implementation Checklist

When implementing an electronic health records (electronic medical records) system, you will need to perform the following tasks. Adapted from "EHR Implementation in Ambulatory Care," a 2007 white paper from the Healthcare Information and Management Systems Society, this list is intended to give practices a better idea of how to allocate staff and whether you'll need to hire a project manager when implementing an electronic medical records (EMR) software system.

1. Develop an implementation plan. Establish the plan, which might include having the most computer-savvy physicians "go live" until the EHR's idiosyncrasies are identified and resolved, and then adding the remaining physicians.

2. Develop a scanning and abstraction policy. Convert paper records to electronic format. This might include having physicians review charts and select files important to patient care for scanning into the EMR.

3. Analyze workflow. With input from the practice's whole staff and help from the vendor, map how the practice's work will flow using electronic records. Use the study to train the entire practice.

4. Facilitate third-party interfaces. Set up the EMR system to communicate with several devices and entities, including: labs, hospitals and pharmacies; picture archiving and communication systems; diagnostic devices; and practice management systems. Consider paving the way for e-prescribing, patient e-mail and patient portal access.

5. Develop templates. Get input from all physicians on the template for physician note entry. Typically, these "electronic charts" are modified vendor templates or are designed by the practice.

6. Conduct training. Develop training material for all existing and future staff. In a sample workflow system from HIMSS, medical assistants enter simple patient history and vitals directly into the electronic medical records software, and physicians enter data from a patient worksheet into exam-room EMR terminals.

Monday, September 17, 2007

Mississippi Medicaid Program Considers Expanding E-Prescribing Program

An electronic prescribing program shown to save the State of Mississippi some $1.2 million per month in medication costs could be expanded, according to several news sources. The Mississippi Division of Medicaid is discussing expanding its successful e-prescribing program by equipping 225 doctors with handheld e-prescribing devices.

E-prescribing refers to an electronic prescription order/fulfillment route that directly connects physician workstations with mail order or retail pharmacies. Many electronic medical records (EMR) systems include an e-prescribe function, and some companies sell programs independent of an EMR.

Physicians can use the Informed Decisions devices to access patients' medication histories, avoid dangerous drug interactions and see if patients are filling and refilling their prescriptions. Doctors who use the devices write fewer prescriptions on average, and those prescriptions are likely to cost the state less, state officials say.

The state pays $35,000 per month for the program but is saving nearly $27,000 per month on hospitalizations because the physicians receive real-time alerts about the dangerous drug interactions, according to Mississippi officials.

The state Medicaid program is looking to expand the initiative because it consistently has been saving money for 18 months.

The devices also help detect fraud. Kurt Bruckmeier, a physician for about 200 Medicaid beneficiaries in Hattiesburg, Miss., said the system has "helped identify drug abusers who would very likely have gone undetected were it not for our ability to evaluate the full scope of prescriptions they were taking."

Mississippi officials said they did not know of any negative aspects to the program. Florida has launched a similar program with comparable results.

Friday, September 14, 2007

Malpractice Insurance Carrier Announces Unusual Policy Credit for Physicians Using Electronic Medical Records

In an unusual and what appears to be unprecedented announcement by a medical malpractice carrier, Midwest Medical Insurance Company (MMIC) earlier this week announced it will offer a premium credit to any solo physician or physician group policyholder who implements and uses electronic medical records software. The credit begins January 1, 2008.

Why the special discount? According to a press release, the MMIC board of directors strongly believes that EMR software improves the quality of care through better patient safety. "As a physician-owned insurance company, our goal is to help our physicians reduce loss frequency and severity," their CEO said. "Offering the premium credit just makes good business sense."

We agree, as countless studies have shown electronic medical records software reduces errors and improves overall quality of care when the EMR is fully utilized.

To receive premium credits of 2% to 5%, a physician group must meet the following requirements:

* The EMR system must be certified by the Certification Commission for Healthcare Information Technology (CCHIT), the recognized certification authority for EMR systems.

* The physician group must have implemented or plan to implement the latest vendor updates for their system. (No old school EMR systems, please.)

* At least 75% of the physicians in the group must be using the EMR or EHR.

* The group must have been using the EMR or EHR for at least a year.

* The group must be using at least two of the six EMR's functions listed on the application.

What do you think about this announcement? Will a 2-5% discount on malpractice insurance encourage physicians to implement electronic medical records in their practice, or is this yet another plastic carrot promising to boost healthcare IT adoption rates? Share your comments.

Note that electronic health records are the same as electronic medical records here - we use them interchangeably.

Thursday, September 13, 2007

Physician E-Mail: How Many Doctors E-Mail Patients?

We know the adoption rate of electronic medical records software is low among physicians, but what about e-mail? Are doctors e-mailing their patients?

It turns out there's not much difference between the percentage of physicians who use an EMR and the percentage of doctors who regularly e-mail their patients. Thirty-one percent of physicians in 2007 said that they communicate with their patients via e-mail, up from 24% in 2005, according to a January 2007 survey by Manhattan Research. However, the remaining 69% of physicians said that concerns -- such as liability, lack of reimbursement and technology integration -- still remain barriers to adopting the technology.

The survey also found that most physicians approve of patients bringing information that they found online to an office visit. Sixty-five percent of physicians said it is a good thing when patients bring in information they found on the Internet, while 34% of physicians said it was a bad thing, according to the survey.

Many more physicians (50%) reported using a personal data assistant (PDA), most often relying on the device to store a prescription drug reference database, according to the survey.

Results are based on a telephone survey of 1,353 physicians in Q1 2007.

Wednesday, September 12, 2007

New Rules for E-Prescribing Faxes Generated by Computers?

E-prescribing - a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care - is an important element in improving the quality of patient care. In an effort to encourage the adoption of e-prescribing (also known as e-rx), the U.S. Centers for Medicare & Medicaid Services (CMS) has proposed eliminating the exemption for computer-generated faxes from the e-prescribing standards by early 2009.

In the earlier rule, the U.S. government adopted e-prescribing standards for use by physicians and suppliers in connection with prescriptions under Medicare Part D. They included the SCRIPT standard for communications between physicians and pharmacies regarding prescription information, but provided that entities that transmit prescriptions via a computer-generated fax were exempt from the SCRIPT standard. SCRIPT is a data transmission standard intended to facilitate the communication of prescription information between prescribers and pharmacists.

Will Your E-Prescribing Software Pass the Test?

Many older electronic medical records (EMR) systems have a computer-generated fax function, whereby a fax is generated on a physician's computer and sent to a pharmacy's fax machine. Think of it as the halfway point between the old fashioned paper system and the "new fashioned" electronic system. CMS anticipated that physicians using computer-generated fax software would adopt the SCRIPT standard over time, but this hasn't occurred. In the words of CMS, developing e-prescribing standards "is one of the key action items in the government's plan to expedite the adoption of electronic medical records and build a national electronic health information infrastructure in the United States.

So, what's "wrong" with computer-generated faxing? In short, it retains some of the disadvantages of paper prescribing. For example, the pharmacy must key the prescription into the pharmacy system, where data entry errors could jeopardize patient safety. It's better than the old fashioned paper prescribing system, but in the minds of Medicare, it falls short of true electronic prescribing.

Tuesday, September 11, 2007

Advice for How to Purchase the Best Electronic Medical Records Software for Your Physician Practice

Every now and again, we stumble across an exceptionally well-written piece of advice for physicians looking to select, purchase and implement the best electronic medical records (EMR) system for their practice. We recently found one such article, effortlessly outlining practical advice and straightforward steps for choosing the best EMR software system. Following is a summary of this EMR advice. To read the entire article, see the link at the bottom of this post.

The idea of Electronic Medical Record (EMR) software has commanded significant debate lately. Physicians are hearing about the benefits of EMRs, and the approaching federal mandates for converting to an environment of electronic medical records. Unfortunately, physicians make a common mistake when they over-rely on the EMR vendor to make the best hardware or implementation recommendations. It's important to consider the product, its appropriateness for your specialization, its cost, its ease of implementation, realistic Return on Investment (ROI), and the long term non-financial benefits that an EMR will deliver: for example, improved quality of care and increased automation. Prakash Chakkunny, a favored industry expert, offers a few tips you can use to help ensure that you can make the right software choice.

Selecting the best EMR system boils down to six important steps: planning, vendor selection, request for proposal, support, client/server versus Web-based EMR, and final considerations. We'd like to take this opportunity to emphasize the importance of two of these EMR research steps: planning, and client/server versus Web-based EMRs. To be sure, the other four steps are also important.

Before you hop onto the EMR or EHR bandwagon, take the time to consider the entire picture. Examine your motives ("why do I want an electronic medical records system in my practice?). Physicians make the transition to information technology for a variety of reasons, which can include saving time, improving quality of care or saving money. Every one's reasons are a little bit different, but you'll never pick the best EMR system for your office if you don't know exactly what you want to accomplish with the medical software. Electronic medical records can do many things for many people, but certain EMR systems tend to do certain things better than others.

The Most Important Questions to Ask EMR Vendors

You should also give considerable thought to the potential pros and cons of a client/server EMR versus a Web based (or ASP) EMR. There are advantages and disadvantages to each electronic medical records model. The Web based EMR is a remotely hosted software system accessed via an internet web browser. It is usually accessed by paying a monthly fee to the EMR vendor. Because the server (that hard working backend computer hardware)is not located in your office, an ASP software system dramatically reduces upfront expenses, and effectively eliminates the need to hire an IT professional to run your system. With a Web based EMR, you also tend to have access to the latest and greatest software enhancements (usually automatically updated for you), and the benefit that comes along with storing your data in a safe, off-site location. (If a burglar breaks into your office, s/he won't be able to steal your server. You don't have one.)

The client/server EMR model sits on the other end of the spectrum. In some cases, these systems are faster than a Web based electronic health records software system, because patient data doesn't need to be transmitted from a remote server to your office. Client/server users also have complete control over their data - no one stores the information on your behalf. Remember, though, that with great power comes great responsibility! You need to take extra steps to safeguard this information from theft or fire. Finally, although the upfront costs are much higher as compared to an ASP EMR system, the long term multi-year EMR costs can be (actually, tend to be) lower.

For these reasons, we believe that smaller physician offices (1-9 physicians) should give serious consideration to a Web-based EMR, and that larger offices (10+ physicians) should give serious thought to a client/server EMR. Of course, both types of electronic medical records will work well in both settings, but few smaller physician offices can afford the significant upfront costs (expect at least $50,000 for a small office, and potentially as much as $250,000) that comes with a client/server software system.

We recommend you read Ckakkunny's entire article. There's a lot we didn't cover here. Click here to give it a look.

Monday, September 10, 2007

Tools for the Exchange of Health Information

You can't discuss the electronic medical records (EMR) software industry without discussing the need for a more standardized exchange of patient health information. Some industry experts go as far as speculating EMR software adoption will remain suppressed until these standards are ratified.

Last month, the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) has released a set of reports titled Privacy and Security Solutions for Interoperable Health Information Exchange. The reports review 34 state Health Information Exchange plans and identify the challenges and feasible solutions for ensuring the safety and security of electronic health information exchange. This work was funded under a contract with AHRQ, the Office of the National Coordinator for Health Information Technology and RTI International.

All states followed a standard core methodology, but each was provided an opportunity to tailor the process to meet their needs. As a result, states varied on several key dimensions, including degree of adoption of electronic health information exchange (from electronic medical records or electronic health records), health care market forces in the state, legal and regulatory conditions related to health information, demographic composition of the state, and financial status of the state.

“These reports address one of the greatest concerns that Americans have about health information technology: Will their personal data be safe?” said AHRQ Director Carolyn M. Clancy, MD. “This work presents information on how to develop privacy and security solutions that allow for the exchange of information safely and securely.”

“Work at the state and local levels is integral to our success. The number of stakeholders involved in this initiative demonstrates the magnitude of this work,” said Robert Kolodner, MD, National Coordinator for Health Information Technology. “The report findings and recommendations will provide ongoing guidance for local, state and federal governments as we move toward greater interoperability.”

Some of the key findings point to the need for additional research and guidance on:

* Identifying different interpretations of the HIPAA Privacy Rule among states and increasing awareness among stakeholders.

* Addressing variations regarding the potential intersections between federal/state privacy laws.

* Evaluating the technologies available to protect security and privacy of individuals as well as the associated administrative processes and liabilities.

* Developing a system that accurately and consistently matches individual patients with their electronic health or medical record information — one that is created and updated by various health care providers/organizations.

* Developing a standard set of definitions and terms to facilitate sharing of health information. For example, terms such as medical emergency, current treatment, related entity, and minimum necessary do not have agreed-upon definitions and may increase variation as organizations attempt to meet compliance.

EMR Business Case and the Three Stages of Economic Return

Is there a business case for electronic medical records? Will an upfront investment in an EMR produce a return? If so, how long will it take for an electronic health records system to pay for itself?

These are common questions when physicians evaluate EMR or EHR software vendors. As noted in the white paper, "Implementing Ambulatory EMR Enterprise-wide: Critical Success Factors", an EMRs return on investment (ROI)can be anticipated to build in several stages. The following three stages of economic return should help you decide whether there is a business case for a particular electronic medical records system.

The first stage is characterized by operational efficiencies and workflow automation achieved through process re-engineering and faster access to accurate information. The benefits gained in this stage include reduced overhead costs and professional liability rate reduction.

In the second stage, benefits are derived from increased clinic productivity and decision support at the point of care. As more information is entered into the EMR, standard care protocols, order management, and outcomes analyses can be supported. EMR customers experience quality improvements, compliance with regulatory requirements, and reduced exposure to risk.

In the longer term, investments in EMR software systems can provide health care organizations with a distinct competitive advantage. Looking forward, physicians should anticipate using an electronic medical records system as a tool to manage the business of delivering care efficiently and cost-effectively, and to provide more responsive care to an increasingly selective consumer.

Sunday, September 9, 2007

The Importance of Change Management to EMR Implementation

What do the tasks of electronic medical records (EMR) implementation and the principles of change management have in common? Quite a bit, according to experts in the implementation of EMR software systems.

According to Harvard Business School professors Michael Beer and Nitin Nohria, PhD, 70% of all change initiatives fail. (Remember that installing an EMR system is essentially one large change initiative.) Beer and Nohria attribute this failure rate to the way in which organizations approach change. Their research indicates that organizations, based on their culture, choose an “either-or” approach. Some organizations choose an approach that tries to create a quick return on investment based on economics. Others approach change in an open, trusting culture based on results over time. While the professors recommend a blend of the approaches as most effective, some organizations do not consider change management strategies as part of the transition to the electronic medical record (EMR).

Moving to an EMR requires a change in employee attitudes and behaviors. Healthcare organizations that address change management issues and help their users prepare for the impact of an EMR may increase their odds of being part of the 30% who complete successful change initiatives.

Want to learn more about how change management influences EMR implementation? Read a more thorough discussion of this topic by clicking here. You'll give yourself the best chances for success.

Top Reasons to Implement an Electronic Medical Records Software System

Implementing an electronic medical records (or electronic health records) software system can be a daunting task for smaller physician practices - so daunting, in fact, that it's easy to lose sight of all the reasons why making the transition is worth the trouble. There are countless benefits of electronic medical records (EMR) systems. Here are a few of our favorite reasons why you should ditch the paper and add an EMR to your office practice.

EMRs Give You Better Access to Data

Pull a patient chart within seconds, not minutes. Even the most basic electronic medical records systems mean no more wasting time searching for charts.

Open a patient's chart on any computer in your office. With many EMR systems, you'll be able to open a patient's chart from anywhere in the world! Medicine isn't always practiced in the office. Duty sometimes calls at home or on vacation - usually late at night, right?

It helps that more than one person can work with a chart at the same time. In most cases, that means greater efficiency and reduced costs.

An EMR Facilitates Better Charting

With an EMR, you'll stop worrying about chicken-scratch handwriting. You might be able to read what you wrote, but your local pharmacist (and your malpractice carrier!) will appreciate the improvement in your notes.

Let your patients complete a computer guided medical history at home or in your office. Many EMR or EHR systems facilitate this process, and allow the information to be automatically uploaded into the electronic medical record.

Effortlessly (well, relatively effortlessly) import diagnostic images, lab results and hospital discharge summaries into the patient record. Almost all EMR software systems will also let you update medication and problem lists with every visit.

Build flow sheets and create graphs for all kinds of data. Visually analyze blood pressure, HbA1c, weight ... the list goes on. An EMR/EHR system also puts thousands of procedure and diagnostic codes at your fingertips.

Electronic Medical Records Improve Care Management

Use an electronic medical records system to track pending orders for lab tests and diagnostic imaging. Those that are long overdue may signal lost reports or patient noncompliance. In many cases, you can use your EMR system to spot trouble before it's really trouble.

Affordable EMR Software Options: Is ASP Right For You?

Use your EMR to receive automatic reminders in the exam room when a patient is due for preventive or disease-management services. Even the best physicians won't remember everything. Let the software help you. For that matter, use the EMR to remind you of evidence-based guidelines for diagnosing and treating conditions while you talk to the patient. With most electronic medical record systems, you'll be able to quickly produce a list of all patients due for a preventive test; in some cases, the EMR software will print reminder letters that can be mailed to patients.

Print a copy of the progress note and give it to the patient at the end of the visit. Or put his entire record on a mini "thumb" drive that he can take home. Don't want to get this advanced with your software system? Use it to print patient education handouts in the exam room, or before the patient leaves your office.

Better Prescribing with EMR Software

Almost every EMR software system includes an e-prescription function. E-prescribing means less time talking to pharmacists and answering questions about what you've written. Use the extra time however you please - spend more time with your patients, or more time with your family.

Does Your E-Prescribing Software Pass the Test?

E-prescribing software also lets you fax prescriptions from your computer to the pharmacy. This EMR function minimizes the chances a patient will lose or alter the prescription you've written. When it's time to reissue a script, simply give the mouse a few clicks and move on to the next patient.

Electronic medical record (EMR) software systems also tends to reduce the number of prescribing mistakes, alerting physicians to potential drug interactions, allergies or other situations that require extra caution. In the event of a drug recall, your EMR will let you immediately identify all patients taking the recalled drug. Many electronic medical records systems will print our reminder letters, and some will even telephone patients and play a pre-recorded message!

Boost Efficiency with an Electronic Medical Records System

No more flipping through pages upon pages of written notes. Use your EHR to review a concise (and real-time updated) summary of the patient's health information at a glance. Less time in the chart means more time with the patient.

The Most Important Questions to Ask EMR or EHR Vendors

Stay on top of your work with an electronic to-do list that includes incoming lab, radiology, and pathology reports. Most EMRs also collect and triage your in-office messages and telephone calls.

Don't like a good old game of phone tag? When patients call, answer their questions right away by pulling their record from the software. No more pulling the paper chart and calling them back.

Produce referral letters, school and work excuses, and other documents with a few clicks. You can also send messages to your nurse(s) without leaving the exam room.

Reduce staff downtime at the copy machine. When you need to share records with someone, transmit them electronically using your EMR software. Your copy machine will thank you.

Send claims faster by sending encounter information, including diagnostic and CPT codes, straight to your practice-management software.

Use an EHR to Lower Costs

How might you use an extra $10,000? That's how much you could save (per doctor, per year) on dictation and transcription costs. Let your electronic medical records system do the work for you at no additional charge.

Save several thousand dollars a year on paper chart supplies, not to mention several hundred trees, with your electronic medical records software system. While you're at it, save your stamps and use your EMR to electronically transmit charts.

Higher Income with Electronic Health Records

Qualify for "pay for performance" bonuses by tracking the care you provide and the outcomes you achieve for various groups of patients. True, those pay for performance incentives aren't particularly generous, but they'll help you pay for your electronic medical records software.

Automatically capture all your charges while you record what you do. While you're at it, reassign your transcriptionist and file clerks to help collect accounts receivable. You won't need a full time transcriptionist or file clerk with a decent EMR.

Medical Billing Software Option Includes Free EMR System

No more defensive coding! Confidently code for higher levels of service based on thorough EMR documentation. Use the software system's automatic E&M coding suggestions that are based on your documentation.

Of course, we'd be remiss if we didn't give thanks to Medical Economics for many of the ideas cited here.

Note: On this blog, the terms "electronic medical records" and "electronic health records" are used interchangeably.

Thursday, September 6, 2007

Most Important Features of Payer-Offered Electronic Medical Records

A new survey by the Healthcare Information and Management Systems Society (HIMSS) finds a majority of respondents believe electronic medical records systems (EMRs) offered by health insurance plans should have robust privacy and security features.

Survey respondents were most likely to believe that EMRs (also known as electronic health records, or EHRs) offered by insurance plans should include insurance company data, such as claims data. However, about two-thirds of respondents also said they believed that payer-offered EMR systems should include clinical data derived from hospital and ambulatory visits, as well as consumer-generated data, writes iHealthBeat.org

Twenty-four percent of survey respondents said they thought payer-offered EHRs would boost patient safety, while 21 percent said they expected them to verify insurance eligibility and benefits. Improved billing collections and improved quality of care each were selected by 18 percent of respondents.

The results were based on a survey of 101 physicians in July, 2007, by HIMSS.

Thursday, August 30, 2007

Six Tips When Searching, Evaluating Electronic Medical Records Software Options

There are hundreds of electronic medical records systems on the market today, leaving physicians with the daunting task of reviewing dozens of medical software systems in their "free time" (as if physicians really have free time), often with little or no expert help. It's no wonder so many doctors are leery of buying an EMR and using it in their medical practice. Choosing the right EMR system doesn't have to be so difficult.

Jerome Carter, FACP, offers six tips for evaluating and selecting the right electronic medical record software, writing in the American College of Physicians' ACP Observer.

1. Create a policy to review EMR products. Don't begin contacting an EMR vendor until you've created a formal procedure for evaluating EMR software.

Carter recommends setting up regular meetings with both physicians and office staff in order to give everyone an opportunity to discuss their needs, fears and budget concerns, and to present unresolved questions to the group. Then, invent guidelines and ground rules for everything from contacting software vendors to reviewing their EMR or EHR products. Record everything you learn for future reference. You won't be able to remember all the information.

Saving Money with Electronic Medical Records: Cost Savings Tool

Carter says the EMR software evaluation process should take a few months if done properly, and allows that detailed and orderly notes will make the profess go more smoothly. It will also help when you're ready to submit a request for proposals (RFP) from EMR vendors.

2. Define the problems you want to solve with the medical software. Then, find all the EMR systems that contain the features you need. Carter calls this a problem-based selection process.

Ask and answer the critical questions that establish your physician practice's needs. Need remote access to electronic medical records? Want the ability to write prescriptions or identify patients who need preventive medicine? This is the time for these important questions.

You should list in as much detail as possible every single feature you want in an ideal EMR system. Your "EMR wish list" should be comprehensive but also specific. Listing "prescription writer" as a required feature, for example, doesn't provide enough detail to help you decide later between two systems, Carter notes. Instead, you might decide an ideal electronic medical records system will provide drug interaction information with user-controlled severity alerts. This level of detail lets you make much more precise comparisons between EMR systems.

Strategies for Implementing an EMR System

Carter warns this step should take at least four weeks, and up to six months if you're in a large physician practice. Once your list of required features and functions is complete, you are ready to take your first look at available EMR products.

3. Identify APPROPRIATE vendors. Yes, the market for electronic medical records EMR software is huge, but narrowing the field is not very difficult. Many EMR vendors target practices by size and/or specialty, and some vendors only sell their electronic medical records in certain parts of the country. Eliminating systems that do not fit your specialty or practice will remove a long list of EMR systems from consideration.

Don't forget to determine the economic vitality of the EMR vendors! Although there are many stable and profitable companies in the electronic medical records or medical software space, there are also many "fly by night" vendors hoping you won't ask hard questions about their financing and future prospects. You can measure the economic vitality of electronic medical records companies by reviewing industry surveys, asking how long they've been in business, examining the geographic spread of customers or reviewing financial statements.

4. Ask for and receive a demonstration (or "demo") copy of the EMR software. If you're considering an ASP (or web-based) electronic medical record system, ask for a live software demo. A demonstration copy will perform exactly like the real product, but the vendor will either limit the number of patients you can enter or the amount of time you can use the system.

Be careful when watching canned demonstrations where vendors walk you through a database with hypothetical patients. These types of EMR software demos can be valuable, but they can also be misleading. Stay on your toes - if you're paying

Helpful Advice When Selecting an Electronic Medical Records System

Once you have seen for yourself how the EMR software performs and you've received its accompanying product literature, you'll begin to assess how each software product meets your needs. It's important to quantify how each EMR system measures up, so assign a numerical score for important electronic medical records features and functions or use some other objective scoring system. Set a cut-off score and eliminate all products that do not exceed your scoring threshold, Carter advises.

5. Compare software features directly. If you have completed the problem-based selection properly, you should have no more than three to five potential EMR systems to evaluate. It is now time to compare the electronic medical records side by side to see which software system works best for your office.

You should narrow the field to three or fewer EMR systems at this point in the process. You're now ready to conduct a site visit.

Affordable EMR Software Packages

6. Go on site visits. Site visits, when conducted by educated consumers, are quite helpful when selecting an electronic medical records software system. Request a list of customers from each EMR vendor and contact the practices yourself, says Carter.

Decide the questions you'll ask each customer in advance, such as how well the EMR vendors respond to requests, how much software training time was provided, any EMR implementation difficulties, software upgrade schedules and specific electronic medical records features. Determine how well each EMR system would fit into your medical practice.

To view more advice from Carter, click here.

Tuesday, August 28, 2007

Majority of Patients Desire In Office Medication Dispensing, Study Finds

A new research study by Purkinje, a healthcare technology and services firm, finds that three out of four (75%) Americans would prefer to have their prescription(s) filled in their doctor's office instead of a retail pharmacy if given the choice. The research was conducted by Opinion Research Corporation on behalf of Purkinje.

The study examined consumer attitudes of an FDA-approved service known as in-office medication dispensing or point-of-care dispensing. The practice involves distributing pre-packaged medications directly to patients at the point of care, saving them a trip to the pharmacy and allowing them to immediately begin their treatment.

Overall preference for office-based medication dispensing appears to be driven by the prospect of saving time and improving quality of care, according to Purkinje. A majority of respondents (84%) said such a service would be more convenient, and 62% said it would help them better manage their health.

According to their media statement, "Thousands of progressive medical and dental offices around the nation are adding medication dispensing as a way to heighten the patient experience and create a new source of revenue," said Tom Doerr, M.D., chief medical officer for Purkinje and a practicing physician. "Patients like the comfort of having their prescription filled in the privacy of their physician's office, and the convenience of starting their treatment right away."

Purkinje says software programs are usually integrated with in office medication dispensing services to double check to ensure patients are receiving the right medicine, cross-check against known allergies and look for potentially adverse interactions. Medications arrive in safety sealed bottles, they say, prepackaged offsite under the supervision of a licensed pharmacist. Apparently, point of care dispensing can also be integrated with electronic medical records systems.

Our own brief research suggests the practice of in office medication dispensing (or point of care dispensing) has been around for more than 20 years, although it has failed to meet initial expectations. Although some 15,000 - 20,000 physicians dispense medications at the point of care, the vast majority of doctors do not offer this service.

This could mean one of two things. Either in office dispensing is a promising but untapped new service for physicians, or its promises don't hold up in real practice. Nevertheless, it appears a majority of Americans are receptive to this type of medication service in their physician offices.

Fair disclosure: Purkinje is currently a sponsor of this blog. (Note their advertisement)

Wednesday, August 22, 2007

Questions You Should Ask Electronic Medical Records Vendors

Physicians and industry experts alike will tell you it's important to ask the right questions when you're considering an electronic medical records, or EMR, system. Good questions will help you distinguish the reliable EMR vendors from the "fly by night" vendors. Here are a few important questions to ask when you're evaluating different EMR software options.

* How long have you been in business?

* How many live sites are currently using your software? If possible, learn which specialties do or do not use the software.

* Can you provide me a representative list of your clients, allowing me to randomly select which practices to contact? If not, why? (Most vendors won't give you their entire list, but the customer list they offer needs to be comprehensive.)

* Is the electronic medical records system being used in a multi-site environment? If yes, ask about their experiences to date.

* Is your product a client-server model or ASP model? Each has its own benefits, although smaller practices will probably want an ASP solution.

* What is the typical length of time between the purchase date and the "go live" date? No matter the EMR vendor or the EMR system, there will be a delay between the purchase date and the go live date. Look for vendors who can implement the EMR software in a reasonable amount of time, while still allowing enough time for implementation pre-work.

Strategies for Implementing an Electronic Medical Records System

* What is your plan for implementation? This plan should be thorough! Beware of vendors who don't offer a detailed EMR implementation plan. Even the most basic systems require a plan.

* What type of technical support is available, and how much does it cost? Beware of EMR vendors who require expensive technical support agreements, or those who advertise "rock bottom" prices with no mention of service or support. In many cases, these vendors require additional annual costs for service and support. To be fair, many vendors offer affordable electronic medical records with no expensive service or support requirements.

* What is the process for fixing bugs and launching upgrades/new versions to the EMR system? Every system will have bugs. Be less concerned about bugs and more concerned about how those issues are resolved.

* How are licenses issued? Is the license fee payable monthly, yearly, or is it a one-time fee? Some EMR companies charge a one time fee, others charge a monthly subscription, and still others charge a one time fee with monthly or yearly service fees. Do your homework.

* How much do software upgrades cost? Are these upgrades mandatory?

Does Your E-Prescribing Software Pass the Test?

* Is your electronic medical record system CCHIT certified? Look for systems that have been certified. The 2007 standards were more rigorous than the 2006 standards, although any certified system is better than a non-certified system. Again, to be fair, some good EMRs have yet to receive CCHIT certification, but a lack of certification should be a red flag for more homework.

* For ASP systems, how frequently are backups performed, and how long are data stored? The more the better. It rarely hurts to "over-backup" information!

* For ASP systems, what percent of time is the system functional and online? An ASP-based electronic medical record is of little use if it's always down. Look for systems with the best uptimes, and aim for a 98% minimum.

* Does your EMR system import and export data to and from common formats, such as .csv or .txt? If not, ask why.

* What standard clinical templates, if any, are included in your software system? How were these templates created? Look for systems with templates that are based on the most recently published clinical/medical evidence, and look for companies that routinely update these templates.

Clinical Management Features to Consider in EMR Systems

* Does your system have a single summary page for each patient?
* Are both structured and free text allowed for documenting progress notes?

* Does the EMR system generate a summary at the end of the visit that provides the patient with visit findings and discharge instructions? Most systems will do this. Beware those electronic medical records that don't.

* Does the software system provide patient education handouts? These aren't as important as the end-of-visit patient summary, but they are still an important feature.

* Is there an additional cost for transferring date from my existing EMR into the new EMR software system? Some of the most affordable systems charge you to migrate or transfer data from your old EMR system to your new software system. Others allow a one time transfer at no charge. Look for the vendors who offer a free or deeply discounted transfer.

* Can the software be accessed from remote locations? For most ASP systems, the answer will be yes. Many client-server systems can also be accessed remotely, although it can be difficult.

* Can the system send prescriptions electronically to pharmacies in my local market? Can it fax orders to pharmacies? If it does neither of these tasks, look elsewhere!

* Does the EMR feature disease-specific clinical templates? The better the clinical templates, the better the system.

* Is there a dashboard that shows the day at-a-glance? If the EMR doesn't offer a dashboard, look elsewhere!

* Can a personal health record be generated? If yes, great, but you shouldn't necessarily ditch a company that doesn't have a PHR feature. If the EMR system doesn't generate personal health records, ask when the feature will be available.

* Does the system have a built-in charge capture mechanism and automatic coding advisor? These features are important; they'll likely help pay for the system. Look for a system that minimizes defensive coding. A solid medical billing component helps, too! Some vendors will offer free medical billing services if you use their software, and others will offer a free electronic medical records system if you use their medical billing services.

A few other important notes:

Uptime: This is a critical question, especially for ASPs. If the system is down, you will not have access to patient information, scheduling, labs, etc. Most EMR vendors are capable of giving you an uptime figure, and it should be 98% or higher. ASP uptime is also dependent on your Internet connection: if your Internet connection is down, you will not be able to access your EHR. A reliable Internet connection is critical for an ASP. Look for electronic medical record vendors who will provide, in writing, the statistics on the ASP’s uptime, for both the server and the application.

Data backup frequency: This is an extremely important question. The busier your practice is, the more important it becomes. For example, if data are only backed up once a week on Friday, and the system loses its patient health data on a Thursday, all data from the previous Saturday until Thursday will be lost. Ensure data are backed up to the degree patient volume warrants, usually daily at a minimum. Your EMR vendor will be able to assist you with this task. Data archive time: If you are contracting out the maintenance of your electronic medical records system, or if you are performing it yourself, you should be aware of how long the data backups will be kept, especially in consideration of legal requirements and responsibilities. Back-up files should be kept off site in a secure location to protect data in case of fire or natural disasters. More than one site ("redundant backups") are best.

Additional equipment and software: Unless your vendor or consultant is contractually bound to provide a "turn-key" system, a new electronic medical records install will sometimes require additional or upgraded equipment. For a single computer practice, this only may be a new computer workstation, but if there are multiple users connecting in multiple ways, it may require a substantial investment in additional equipment, software such as database licenses, etc. You should ask your EMR vendor what you will need to actually use the EMR. You should ask about both software and hardware. This is especially important when considering a client-server electronic medical records system.

In the client-server model, the server, database, and all software are kept on site at the practice; the practice is responsible for doing maintenance and back-ups. (A server is a heavy-duty computer that handles the majority of the processing tasks.) If you have an IT person, this should not be a problem. An Application Service Provider (ASP) is a company or organization that provides access over the Internet to software programs like an electronic medical record. The EMR would run on remote servers not owned or supported by the end user's organization (i.e., not an in-house server). Data are usually housed at the remote location. This should not be confused with a network program, which is owned and supported by in-house staff.

Client-server models tend to work best in large physician offices (for example, practices with more than 10 physicians), and ASP models tend to work best in smaller offices (for example, practices with fewer than 10 physicians), but both types of systems can work in all sizes of practices.

Tuesday, August 21, 2007

EMR Cost Savings Tool: Use This Tool to Estimate the Expected Cost Savings from an Electronic Medical Records System

If you're concerned about the cost of an electronic medical records software system (EMR system), or want to accurately estimate your return on investment (ROI) of your EMR, this cost savings tool should help.

It was designed by a Medicare Quality Improvement Organization under the DOQ-IT program. The spreadsheet helps quantify potential monthly savings as a result of an EMR or EHR implementation. Simply answer a few questions and see whether or not your electronic health records software is worth the initial investment.

Additional benefits associated with improved clinical care process and efficiencies may or may not be represented by a dollar amount in this tool. The worksheet represents the areas of EHR or EMR use where common efficiencies and saving are realized. A full ROI request should be performed with your electronic medical records EMR vendor during the contracting phase of your EHR implementation.

Monday, August 20, 2007

Study: When it Comes to Electronic Medical Records, Osteopathic Physicians Say Cost is Biggest Hurdle

A new research study by the American Osteopathic Association and the Medical Group Management Association finds the cost of an electronic medical records (EMR) software keeps doctors of osteopathic medicine (DOs) from transitioning to electronic medical records. In some cases, the costs kept physicians from fully utilizing EMRs they had already installed.

The study shows larger medical groups (at least 51 full-time doctors) tend to have more funds available for information technology investment, and adopt electronic health or medical records systems at a rate of 55.1 percent. The rate was much lower (25 percent) in solo physician practices.

What's keeping physicians from adopting EMR or EHR systems? According to this study, a “lack of capital resources to invest in an EHR”. Researchers found that the median EHR/EMR purchase and implementation cost was $20,000 per physician, with an additional $250 per month per physician for maintenance.

Affordable EMR Software Options: Is ASP Right for You?

Of those that had moved to an electronic medical records system, nine out of ten respondents said they would not go back to paper medical records. Among AOA members, “improved access to medical record information” ranked highest as a potential benefit to their medical practices. Other high-ranking benefits with more direct impact on practice financials were “improved accuracy for coding evaluation and management procedures” and “improved charge capture.”

Overcoming Financial Fears Important When Considering an Electronic Medical Records System

This research also seems to support the theory that although these software systems can be expensive, they lower practice costs in the long run. Of those with systems, 22.3 percent said their practice costs had decreased. To be fair, an almost identical percentage of DOs claimed their practice costs had increased. The balance wasn't sure.

Is There a Business Case for Electronic Medical Records?

MGMA conducted the study of AOA members in spring 2006, although the results were released in August 2007.

Tuesday, August 14, 2007

Can Electronic Medical Records Defend, Prevent Malpractice Claims?

Do you think an electronic medical record system can help protect your physician practice from malpractice cases? According to a survey by the Medical Records Institute and Professional Risk Associates, nearly half of physicians (45% of respondents) think an EMR or EHR can make a physician practice less vulnerable to malpractice claims.

The survey of 115 physician practices of various specialties also found that:

* Some 20% of respondents said their malpractice insurer offers a discount for having an EHR or EMR system; and

* Nearly 20% of respondents said they have had a malpractice case in which documentation was based on information from their Electronic Health Records systems, while 55% of those respondents said the technology was helpful in the case.

Two-thirds of respondents with an EHR system said providers at their practices fully use the systems. Meanwhile, about a quarter of respondents said their electronic medical records systems do not have all the functions necessary, and a similar percentage said they have not been adequately trained on the systems.

The survey was conducted between March 21 and June 30 through links on both organizations' Web sites and e-mails to clients. This story was originally posted on ihealthbeat.org.

Monday, August 13, 2007

AAP Notes Special Functions for Pediatric EHR Systems

A new report in the American Academy of Pediatrics' journal Pediatrics explains that while clinical information systems, such as electronic health records, typically are designed for adult care, unique functionality requirements are needed to support pediatric care. The report includes EHR functions for pediatrics in areas such as:

* Immunization management;
* Growth tracking;
* Medication dosing;
* Patient identification;
* Norms of pediatric measurement data changing over time;
* Privacy;
* Pediatric terminology; and
* Accuracy of the data being collected and presented.

Electronic medical records functions should enable the registration of infants without Social Security numbers and support a temporary and prenatal identifier that links to the postnatal record, according to the report. EHRs also should support changes in an infant's name and the retrieval of data when previous names are searched, the report said.

The American Academy of Pediatrics has previously published a policy statement on the rationale and functionality requirements for electronic prescribing systems for pediatrics.

Tuesday, August 7, 2007

Electronic Medical Records Implementation Strategies

There are two schools of thought when it comes to implementing an electronic medical records (EMR) system.

One camp says you should take baby steps; learn to crawl before you try to run. We'll call this the incremental approach. The other group advises making the transition to electronic records all at once; face your fears, work out the kinks and enjoy your new software. Let's call this one the big bang approach.

Each implementation strategy has benefits and drawbacks, especially depending upon the size and type of physician office that will use the EMR. The incremental approach tends to lend itself best to larger physician practices, multi-specialty groups and environments where "office politics" runs high. It also works well when you're implementing a very complex electronic medical record system. The big bang approach, on the other hand, tends to work well with small (fewer than 10 physicians) practices, or offices where strong leadership exists.

Here are some of the pros and cons associated with both implementation strategies. If you're considering an electronic medical record purchase, think about which approach might work best in your practice.

The Incremental Implementation Strategy

The Pros
• Reduces "change shock" to staff and physicians
• Spreads out costs of software and implementation over a longer period of time
• Portions of EMR functionality are rolled out in phases across all units
• In many cases, the project is less likely to lose momentum

The Cons
• Total training, implementation costs may be higher
• Longer overall implementation of your electronic medical record
• ROI is not achieved as quickly
• Morale may decrease as implementation lags
• You may introduce a training lag if implementation phases are too far apart from training sessions

The Big Bang Implementation Strategy

The Pros
• Everyone goes live at once
• Paper processes cease shortly after the EMR is "turned on"
• You're less likely to end up with a dual system
• You'll shorten the parallel paper/EMR operation period
• ROI is achieved more quickly
• When it is over, it's over!

The Cons
• If you choose a complex electronic medical record system, there's a higher risk of blow up
• You'll likely encounter significant productivity reduction when you begin using the software system, and this could last for up to three months
• Inadequate planning may jeopardize full implementation
• Staff or physicians resistant to change may become overwhelmed

No matter the strategy you choose, it's important to stay focused (and committed!) to successfully implementing your electronic medical record system. Even the most affordable EMRs represent a considerable time and financial investment. With a little strategic planning, you'll get the most out of your software.

Wednesday, July 25, 2007

When Adopting an Electronic Health Record (EHR), Overcoming Financial Fears is Important

It's no secret that the majority of U.S. physicians practice medicine with paper and a pencil, and that transition to an electronic medical record (EMR) or electronic health record (EHR) system has the potential to boost efficiency and quality of care.

Why the slow rate of adoption? Many physician practices think they cannot afford an electronic medical record or practice management software system. These offices are overwhelmed by the traditionally high initial costs, including computer hardware and EMR software, installation, training, space, maintenance, support and system upgrades.

But an EMR or a practice management system can be affordable, no matter the size of the physician practice. Here are a few suggestions for how to affordably implement an electronic health record EHR in your office.

Go modular. A modular EHR system enables incremental implementation of an EHR system with a smaller up-front investment. Some physician offices are using online tools for chronic disease, e-prescribing, and registries as starting points for building a full-scale EHR or EMR. [24]

Opt for phased implementation. Purchase or rent more complex EHR components (e.g., data exchange interfaces) and hardware (e.g., notebook computers) later in the implementation phase. [13] Implement incrementally by patient, provider, module, or function.

Ditch the traditional, embrace the ASP model. Consider obtaining an Application Service Provider (ASP) based electronic health record software system. Users “rent” access to software, and vendors provide access to data applications. ASP has the potential to reduce costs associated with EHRs, specifically hardware and maintenance. [13,14]

If you're a physician, you've probably also heard horror stories about lost productivity on the heels of an EMR adoption. Many of these stories are exaggerated, although it will take some time (generally 4-12 weeks) to bring you and your staff up to speed with the new medical software system. That's the case with any change.

Physician Offices Slowly Adopt Electronic Medical Record Systems

Time savings from electronic medical records are realized in long-run. Research shows that EHR systems have the potential to save physicians time over time by enhancing clinical processes and workflow; by improving clinicians’ abilities to make sound clinical decisions in a timely manner; by decreasing documentation and dictation time; by improving patient tracking and follow up; by improving the legibility, accuracy, and accessibility of progress notes; by reducing time spent on filing, finding, and pulling charts; by using e-mail messaging; by increasing full integration and documentation of clinical information; and by reducing the time spent writing new and refill prescriptions.


[13] Meyer, M. (2004). Physician use of e-mail: The telephone of the 21st century. Journal of Medical Practice Manager, 19(5): 247– 51.

[14] Miller, R. H., & Sim, I. (2004). Physicians’ use of electronic medical records: Barriers and solutions. Health Affairs, 23(2): 116– 26.

[24] Working Group on Financial, Organizational, and Legal Sustainability of Health Information. (2004). Connecting for health: Achieving electronic connectivity in healthcare. New York: Markle Foundation. Retrieved September 30, 2005, from http://www.hsrnet.net/nhii/materials/CFH_Incentives_Summary.doc

Monday, July 23, 2007

Survey: Patients Want Doctors to Use EMR Systems

If you're a physician looking to attract new patients, you may want to think hard about buying an electronic medical record (EMR) system. Most consumers said EMR technology plays a role in their selection of a physician, according to a survey of 600 consumers and 100 physicians by Accenture, a consulting company.

Highlights of their study:

* 51% of consumers said they would be willing to pay for the service if the price was reasonable.

* Two-thirds said that an electronic health record (EHR) was at least slightly important in their physician choice, with 24% saying it was very important. Another 24% said it was moderately important.

* 77 percent of consumers said they would have greater access to and more control over their medical records if they were in electronic form. Other benefits of electronic records cited by consumers included the capacity to confirm information provided by a doctor and the ability to ask physicians better questions.

* Only 10 percent of doctors said they had electronic health record technology.

* 86 percent of doctors cited the cost of implementing and/or maintaining the system as a concern. Physicians also worried about the time it would take to implement a program and potential privacy risks for patient information.

* 90 percent of doctors said electronic medical records would make sharing and obtaining information easy. Other positives noted by physicians included more comprehensive patient information and fewer lost records.

Friday, July 20, 2007

Doctors: When Did You Adopt an Electronic Health Record System?

Of the 36% of physicians with an electronic health record (EHR) system surveyed by Medical Economics, more than half (58%) have had their EHRs for more than two years. Only a small group (6%) of respondents said their practice had adopted an EHR within the past six months.

The survey also found that of the 65% of physicians without an EHR system in place, approximately one in three (30%) said they planned to adopt an EHR system within the next year.

What were the top three reasons for adopting an EHR system? Physician respondents cited better documentation, improved access to records and enhanced quality of care, according to the survey. The ability to defend a malpractice suit was ranked as the least important reason by survey respondents.

The results are based on a December 2006 survey of 548 physicians, and were published in Medical Economics.

Thursday, July 19, 2007

Does Your E-Prescribing Software Pass the Test?

Following are key components of a solid e-prescribing system. Does your e-prescribing software pass the test?

Patient Information

* Does the e prescribing software maintain patient demographic information?
* Can it be interfaced to practice management software systems?
* Can data be manually entered by the physician or medical assistant?
* Can you upload demographic information from a file?
* Does it maintain medication history (current/discontinued)?
* Does it maintain a list of known allergies?
* Does it maintain a list of problems?
* Will it maintain patient insurance and eligibility information?

Medications Management

* Will it automatically calculate dosages based upon weight/age calculations?
* Can it maintains individualized lists of most frequently prescribed drugs?
* Does it allow for look up of drugs by different criteria, including brand name, generic name and drug class?
* Does the e-prescribing system check for drug-drug interactions, drug-allergy interactions and drug-problem interactions?
* Does it check for duplicate therapies?
* Does it perform formulary checking?
* Will it maintain multiple prescription formularies?
* Does it recommend brand and/or generic drug alternatives?
* Does it allow for alerts or warnings to be either turned off or attenuated?
* Is the software integrated with a drug reference library?
* Can the physician print prescriptions?
* Can the user fax prescriptions to pharmacy?
* Is the e-RX software able to send prescriptions electronically to pharmacy?
* Will the e-prescription system warn you if transmission to pharmacy fails?
* Does it provides patient education materials?
* Does it automate the renewals/refill process?

Helpful Advice When Choosing an EMR

There are many electronic health records and electronic medical records software packages on the market, and in some cases, the variety of software options makes the selection process overwhelming. Here's some advice: Don't choose an electronic medical record (EMR) software system before reviewing these helpful tips!

Vendor Software Licenses: When you purchase an EMR or EHR system, part of the price almost always includes a software license. These licenses usually take one of two forms - concurrent or named-based. If your EMR is one of the new ASP (monthly rental agreement) based systems, you don't really purchase a software license. Instead, you rent the license, usually for a low fee. However, the same issues exist for determining the number of ASP licenses as with a traditional EHR license purchase.

Possible Red Flags:

1. The EMR software vendor doesn't specify the type of license ini the quote.
2. Software functionality is not specified.
3. The EHR company doesn't specify the period of time the license is in force.

Interfaces: Software programs that allow data from the electronic health record system to flow back and forth between external applications. These applications can either reside outside the physician practice (think lab applications) or can be
another system within the doctor's office, such as a medical billing system.

Possible Red Flags:

1. One-way or two-way interface is not specified.
2. The EHR's data format is not specified (structured or non-structured).
3. Additional license costs, if any, not specified.
4. The EMR company promises an interface, but it is not currently available.

Clinical Documentation Features to Consider When Selecting an EMR or EHR System

Implementation Services: Consulting services offered by the electronic medical record vendor. These services will provide planning and actual implementation of an EHR software system for the physician practice.

Possible Red Flags:

1. The EMR vendor can’t commit to a project plan with milestones.
2. Only the EHR vendor can customize templates.
3. Software implementation is not broken into small enough tasks.

Training Services: Consulting services offered by the electronic health record company. They provide hands on training for how to use the EMR in the physician office.

Possible Red Flags:

1. There is no cost listed for future EHR training.
2. The EMR vendor offers no formal training plan.
3. There is no definition of what training expenses will be reimbursed, along with limits.

Support and Maintenance: EHR support and maintenance costs typically represent 15-20% of the software license fee. Where the actual license are often a one-time fee, the support and maintenance costs are renewed on a yearly basis. This yearly fee
basically covers two areas: 1)any upgrades or new releases; and 2)customer service and support. If you select an ASP-based (web-based) electronic medical record system, you don't usually pay a yearly support fee because those services are built into the monthly rental fee you pay for the medical software.

It should be noted that both vendor EHR software and third party EMR software will need support, so it is important to determine which components the support costs cover. Also, some EMR/EHR vendors might have more than one service level agreement representing different support options at different costs.

Potential Red Flags:

1. No support agreement from the electronic health record company.
2. No guarantees of service or reliability.
3. No cap on renewal percentage increases.
4. No software escrow costs offered.
5. The EMR company charges extra for database schema.
6. There are added maintenance costs for third party products.
7. The EHR company will not offer support for third party products.
8. No support offered for previous EHR/EMR software versions or releases.

Payment Terms: EHR implementation typically involves a number of phases and takes time. Things can go wrong. Therefore, the payment terms should reflect milestone-based payments. This means should pay the EMR vendor percentages of the total as major parts of the project plan are successfully completed.

Potential Red Flags:

1. The electronic medical records company wants all or most of the payment up front.
2. The EMR vendor is not willing to agree to final payment when system is accepted.
3. The EHR company has no policy or process for payment refunds or reductions.

A Business Case for Electronic Health Records

Service Level, Hours of Support: Most EMR or EHR companies will offer several ways to communicate and resolve software problems. Typical methods include email, telephone, and online chat. In some cases, a specialist will visit the physician office to help resolve an issue with the electronic health records software. Ask whether remote diagnostics and/or on site visits by support analysts are available.

Potential Red Flags:

1. “Normal business hours” are specified instead of detailed days and hours.
2. The company offers no "after hours" support to physicians.

Financing Alternatives: Electronic medical record or electronic health record systems can be expensive, depending on the type of medical software system you choose. (The exception is when you buy an ASP (web-based or online-based) EMR, where the physician user pays a monthly fee instead of an up-front license fee.) EHR or EMR vendors should offer you the option of leasing or financing your system.

Potential Red Flags:

1. The EMR company passes you off to a third-party finance partner and is not involved in the process.

Editor's Note: The terms "Electronic Medical Records", "Electronic Health Records", "EHR" and "EMR" are used interchangeably in this article. For more information like this, click here.

Tuesday, July 17, 2007

Electronic Medical Records: New Survey Finds Cost, Productivity Limit Adoption

Most physicians cite concerns about cost and productivity as reasons why they haven't adopted an electronic medical record system in their offices, finds a new survey by the American Academy of Family Physicians. The survey also found physicians who were most likely to use an EMR or EHR system practiced in an urban area, had practiced for fewer than seven years and worked in practices with at least two other doctors.

Affordable EMR Software Options: Is ASP Right for You?

The Academy's research into electronic health records also found:

* 53% of respondents who did not have an EHR/EMR cited cost as the reason;

* 42% of respondents who did not have an EHR in their practice said their practice was concerned about decreased productivity;

* 26% of respondents said they planned to purchase an EMR system in the future; and

* 25% of respondents said they had no plans to adopt an EMR system in their practice.

Study Finds EMRs Pay for Themselves

Friday, July 13, 2007

Electronic Medical Records: Physician Offices Slowly Adopt EMR Systems

How many physician offices use electronic medical record (EMR) systems in the United States? Data from the National Ambulatory Medical Care Survey suggest EMR medical software systems are growing in popularity, but that most physicians still practice medicine with paper and pencil.

One-quarter of office-based physicians report using full or partial electronic medical record systems in 2005, a 31% increase from the 18.2% reported in the 2001 survey, but suggesting the race to computerize physician offices has a long way to go before the finish line is in sight.

EMR use did not vary by physician age, gender or specialty type, according to the NAMCS. The data also show physicians in the Midwest and West are more likely to use EMRs than those in the Northeast.

Wrote the researchers, "Although these estimates show that progress has been made toward the goal of universal electronic health records, there is still a long way to go. Solo practitioners are the least likely to use EMRs, whether measured generally or for an EMR system with four specific features. Although solo practitioners make up about one-third of physicians, they comprise about two-thirds of medical practices. Additionally, the features of EMRs vary widely; clinical reminders and public health reporting lag behind the other features of systems in current use."

For more information, see National Center for Health Statistics.

EMRs Quickly Pay for Themselves, Study Finds

Electronic health record systems quickly create enough cost reductions to pay for the cost of the systems, according to a study published in the July issue of the Journal of the American College of Surgeons, HealthDay News/Forbes reports.

The authors analyzed the return on investment of EMR systems at five physician offices representing 28 health care providers, comparing the costs of tasks such as pulling patient charts and data transcription before and after the medical software was installed.

What did they find? Using EHRs reduced costs by almost $400,000 per year, and nearly all of the savings were associated with reducing the amount of time for manually pulling charts. The initial investment was recouped within the first 16 months.

"Health care providers most frequently cite cost as a primary obstacle to adopting an [EHR] system," the authors wrote. "Until this point, evidence supporting a positive return on investment for [EHR] technologies has been largely anecdotal."

Wednesday, July 11, 2007

Common EMR Terms, Glossary Part 2

Here are some more of the most common terms (and definitions) you'll run across when evaluating an electronic medical record or electronic health record software system.

Client Server: A form of distributed computing where a dedicated heavy-duty server computer handles most of the processing tasks while less powerful client computers access and share files, programs and computing power. A network located at the customer's site connects the server (the big computer) and the "clients" (the smaller computers). Client server systems are commonly found in larger physician office practices and hospitals.

Clinical Information System: Relating exclusively to the information regarding the clinical care of a patient, instead of the administrative data. Most EMRs/EHRs contain clinical information systems, whereas most practice management software systems contain administrative data. Many vendor solutions integrate the two types of data together for physicians.

Computerized Patient Record: The previous name for an EMR or EHR.

Data compression: A method that reduces the volume of data by more efficiently encoding the information. This process could save the user time and money by lowering transmission times, minimizing bandwidth requirements and reducing storage space.

Data Warehouse: A large database that stores information like a data repository, but also allows the user to access data for population analysis. Such a warehouse is most often used by physicians and policymakers to identify trends and support the
creation of knowledge - for example, to show a physician how many of his patients have received a flu shot in the past 12 months. Reports from the data warehouse are normally generated at scheduled intervals.

Electronic Data Exchange: A direct exchange of data between two computers via the internet or other network, using shared data formats and standards. In healthcare, the most common frames of reference of EDI are electronic claims processing and electronic prescribing (e-prescribe).

Integration: The task of ensuring that all of the elements of an information system (EHR/EMR) communicate and act as a uniform entity. An integrated system maintains one database, stores data in the same format, and utilizes the same processing features. Be wary of electronic medical record systems with poor integration features!

Operating System: The software program that controls the power and logics of all operations of a computer system. Examples include Microsoft Windows and MacOS for Macintosh.

Portal/Patient Portal: The entry point for authorized persons to access secure data using the Internet. A patient portal allows a patient to access the physician practice via the Internet for the purposes of communication, scheduling, and/or accessing health information.

Redundancy: Two computer servers that simultaneously and automatically store identical information. Each server can be used as a back-up for the other in the event of system failure. In an EHR or EMR, redundancy is a GOOD thing. Look for medical software systems that have some sort of built-in redundancy.

Registry: A software application that allows a physician to record and track information for subpopulations of patients, especially those with chronic diseases or requiring preventive care.

Workflow Automation: A type of medical software that automates workflow and re-engineers processes such that productivity gains and improved customer service are realized. Look for EMRs with robust workflow automation - that's the feature that promises to save physicians lots of time and money.