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

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.