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Investing in EMR: The Story of a Lost Employee

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Future HealthcareIt wasn't the hours; he essentially allowed her to set her own hours. It wasn't the physicians; she emphatically stated that she enjoyed working with all the partners. It wasn't the location; he had a beautiful seaside view looking out over Palm Beach and the Atlantic Ocean. Yes, she will be getting paid a bit more at the new location as an office manager instead of as a billing clerk, but more importantly, instead of pouring over scribbled notes, manually faxing billing reports, and waiting for transcription to return so the HCFA forms can be sent, she'll be working at a practice that has successfully instituted an electronic medical record system. As a result, medical records will be available immediately, coding will be done properly - the first time - and she will be working with state-of-the-art technology that will enable her to develop marketable skill sets.

A nice story from Future Healthcare.....

He, like many colleagues, is challenged with the daunting task of moving their practice to an EMR or EHR system. The government expects to spend many hundreds of millions of dollars over the next ten years to encourage the use of computer technology to modernize medical records. But with hundreds of EMRs available, each one touting its own benefits to the hundreds of thousands of physicians, how is a medical practice able to differentiate between them?

medical secretary If you have been practicing medicine for more than a year but less than 40, it should be rather obvious that you will need to acquire an EMR system for your practice in the not too distant future.

Here are some practical suggestions concerning methods of minimizing the potential for acquiring an incorrect program for your needs.

First, let's discuss the time frame for your acquisition. There are pros and cons of both immediate action and procrastination.

The benefits of procrastination include the potential that the software will be provided to you by a third party. These third parties could include health insurance plans, large employers in your community, state and/or federal government agencies, local hospitals, etc. It makes sense for many of these parties to provide the funding for you to acquire this technology since they are amongst the major financial beneficiaries of improvements such as diminished duplication of services, fewer medical errors, and improved medical care.

While there are isolated instances of funds being made available through these channels, I believe that the probability of you successfully finding yourself with an EMR and not having to pay for it because of the generosity of others remains relatively low. And, while the future remains uncertain, I do not believe that the probability of this will increase meaningfully in the near to intermediate future.

Another benefit of procrastination is allowing the marketplace to mature, thus minimizing the potential of choosing a soon-to-be-outdated program. There is currently a major initiative being undertaken nationwide which is attempting to improve the interoperability of various programs, thereby minimizing the ill-effects of an incorrect choice. Having said that, most currently commercially viable programs have adequate import and export capabilities so that if you choose prudently, it is unlikely that you would have difficulties migrating your data - even if you purchase your software now.

The benefits of more immediate action are many and include higher long-term ROI, more immediate improvement in the quality of your medical care, and higher probability of being at the right side of "inflection point EMR acquisition."

Most properly chosen and properly implemented EMRs will provide a positive ROI early on. I acknowledge that some of the claims made by EMR vendors may be inflated, and no software in and of itself is likely to increase your annual income from $90,000 to $290,000. However, the lower costs associated with staff, transcription, paper, chart pulls and chart storage, prescription refills, postage, etc. will (in most instances) more than make up for the cost of the software acquisition and implementation, as well as the costs of the hardware and network upkeep. When used in conjunction with a state-of-the-art voice recognition program, such as Dragon NaturallySpeaking Medical Version 9, the savings can add up even more quickly. Further, the financial benefits increase over time as the savings continue unabated, but the annual maintenance costs are generally a small fraction of the first year's expenses.

Also worthy of mention are the frequently discussed benefits of coding properly. Your ability to withstand an audit will go up substantially with almost any of the currently available high quality programs. However, with respect to ROI, if you wish to make more money, up-coding accurately and without fear of audit offers real potential, and can be lucrative.

Notwithstanding a few articles, which indicate correctly that new technology can introduce new classes of errors, the overwhelming majority of experts concur that the quality of medical care can, and most likely will, improve in your office when you properly utilize EMR technology. If you're going to start using it one day, delaying the improvement in your care doesn't seem like a very sensible choice.

What do I mean by the "inflection point of EMR acquisition?" There is a significant push to have various programs work interoperably. This means that when you see a patient and document your patient encounter in the EMR, other physicians taking care of this same patient will be able to electronically access your documentation. Yes, it seems futuristic, but pilot programs have been implemented in a large number of communities throughout the country in which physicians using this technology do not need to rely on faxed medical reports, but rather are able to have real-time access to the entire record. Thus, when you order a lab test, it populates your patient's database in your office, as well as your patient's database in other physicians' offices.

Let's consider a hypothetical, but very common occurrence in which a primary care physician refers to two specialists in the same specialty. At this point in time, the primary care physician refers approximately half of their patients to each of these two specialists. At one point in time, the primary care physician will purchase an EMR. We don't yet know when, but we do know that they will. As soon as the primary care physician's EMR is interoperable with one of the specialists' EMRs, this specialist will almost automatically start receiving a disproportionate share of the referrals. This is only natural since the primary care physician will be receiving the specialist's reports instantaneously. They will receive the results of labs tests, radiographic tests, and other information just as if it had been produced in their own office. Therefore, the physician who hesitates in obtaining the technology will be at a substantial competitive disadvantage from a business standpoint.

I am unsure when this "inflection point" will occur, but it seems rather obvious that it would be preferable to acquire your software in front of that curve rather than behind it.

While I acknowledge that procrastination does have its theoretical advantages, I believe that more immediate action is the more proper course at this point in time. This does not mean that you should look at a couple of companies at the next trade show and buy one of their products without further scrutiny. However, embarking on what will probably be a six-month process to choose the proper EMR is an appropriate action and I see no reason for a meaningful delay.

So, how does one choose from amongst over 300 different programs? Having answered that question for thousands of physicians, I have more than a few thoughts on the subject.

Some basic parameters to consider are: your budget, what specialty you practice, and hosting method of software.

Selecting a proper EMR is an art as well as a science, just as is medicine. It is important that you and your staff find it easy to use the program that you select. This is something that trial and error will assist with, but it is best to have this trial and error process occur during the demonstration phase of EMR acquisition, rather than during the implementation phase.

One of the frustrations of many physicians is that they feel they need to see demonstrations of dozens and dozens of programs before they can choose. What commonly occurs in these situations is that the distinctions between the programs begin to blur over time and it becomes difficult to differentiate between various programs.This tends not to be the case when doing demonstrations of a smaller number of software programs. However, then you risk missing the "right" program for your office.

I would strongly recommend carefully choosing the programs for which you are going to request demonstrations. It is not only a waste of time reviewing technology that is inappropriate for your office; I believe it can be counter-productive as it can lead to confusion as well as to inactivity.

You should discuss your current environment with your employees and colleagues, and make a few determinations about high-level issues so that you can restrict your demonstration time to programs that have, at the very least, the minimal qualifications for your office.

Determining your budget should be done early on, but only rather loosely. I have found that physicians commonly find that purchasing a program that is modestly more expensive than they had initially considered still ends up being an appropriate choice. Many physicians hear about the $2,000 EMR packages and believe that they will be able to satisfy their needs within this budget. While obtaining an adequate report writing program is possible within this budget, it is not likely that you will find a fully functional EMR for this amount of money. Also be aware that the total installation costs, including hardware, training, and support, will probably be close to three times the cost of the EMR license alone.

You should decide if you want a client/server installation or a web-based program. For larger groups or ones with a stable in-house IT department, the choice may be a bit more difficult as there are significant advantages to both. However, for solo practices or small practices which do not have any computer savvy physicians on staff, ASP models have some significant theoretical advantages, including their simplicity.

Determining which specialty you are in is easy. Determining if you want a specialty specific EMR is not as easy, but should still be given some thought. If your practice is one which is covered adequately by most EMRs, such as internal medicine and family practice, you should not feel compelled to carefully review EMRs which have been designed specifically for your specialty. However, if you practice within a specialty whose workflow is very different, you may wish to strongly consider a program designed specifically with your practice in mind.

I recommend looking at a variety of programs from 30,000 feet, requesting demonstrations from those that, at least superficially, appear to meet your minimum requirements, and then studying a small number of them in depth until you find the one that matches best. Hopefully, in this way, you can keep your practice and your patients healthy, and keep your employees from being "lost."

Get the full article here http://www.futurehealthcareus.com/?mc=investing-emr&page=hit-viewresearch

Last Updated ( Saturday, 31 May 2008 00:20 )  

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