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.

Sources:

[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

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.

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.

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.

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

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."

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.

Selecting an EMR/EHR Software System: Clinical Documentation Considerations

Last week, we highlighted some of the clinical management features you should consider before deciding on an EMR or practice management software system. Today, we'll outline a few important clinical documentation considerations.

1. Does the software system have a web-based patient interviewing software that can be incorporated into a note?

2. Does the EMR have an integrated transcription solution with macros, carbon copy, and distribution features, and full line-count reporting?

3. Is there a scanning solution integrated with the EHR/EMR?

4. Can the user annotate, mark-up, and sign scanned documents (e.g., ophthalmology or dermatology)?

5. Does the IT system have a demonstrated ability to eliminate transcription using templates and/or speech recognition?

6. Can the EMR user print the entire patient record?

7. Does the system have the ability to provide real-time billing updates and notification back into Practice Management System without any manual intervention (e.g., changes to insurance, situational data elements, and special billing functions)?

8. Does the EMR feature automated tasks to remind physicians of missing charges and to complete reconciliation features to the Practice Management System?

9. Can the user carry forward review of systems, problem list, medication, etc., from the patient's last visit?

10. Does the EHR have the ability to flexibly document conditions including expanding details (severity, location, etc.) for each clinical finding?

11. Can the user document the patient visit using pre-built templates?

Stay tuned for more "advice" later this month, when we'll outline some other important considerations when shopping around for your medical software system.