Newbies Introduction to EMR Acquisition !!!

Originally posted by Contrarian:

Questions Come Before Answers

The buzz over electronic medical records is incessant, and the array of choices widens all the time. If you fear that you’ve fallen behind your colleagues in introducing this new technology into your practice, rest assured that you haven’t.

There’s no question about the direction in which medical records are moving—away from paper and toward the electronic gathering of health data from a variety of physicians and other sources. The question is how fast? Concerns about the quality of care, patient safety, privacy and the cost of care have stimulated both public and private initiatives. Walk into any professional trade show and you’ll find exhibits by vendors that either offer a stand-alone EMR product or that have added EMR capability to previously existing products. Specialty societies such as the American Academy of Family Physicians (AAFP) are aggressively promoting EMRs.

Physicians should not panic into buying a system in haste and making a poor decision. Step back and ask the right questions in the right order before moving ahead with EMRs. The best place to start isn’t the federal government, specialty societies, vendors or payers, but your own practice. Physicians should revisit their practice mission and goals, take the pulse of the practices information technology readiness, conduct an operational assessment, develop a good understanding of EMRs and other information technology that is currently available and then look at specific vendors and their products.

Mission and Goals

It’s essential to know your mission and goals before investing in supporting information technology. If you’re a small practice in one location, do you plan to remain that way, or will you expand by increasing the number of physicians and/or locations? At how many hospitals and ambulatory surgery centers do you practice at, and will that situation remain the same or change? There are always a number of practices that can’t answer these questions, or that have multiple opinions but no consensus among the physicians. Put rather bluntly, if you don’t know where you’re going, EMRs aren’t going to take you there.

Technology Readiness

Most physicians who have recently completed their training set up their new practices with EMR support from the outset. If your practice is currently dependent on paper records, however, you’ll need to think not only about which EMR is right for you, but how to transition out of your current situation. Several physicians respond to the potential introduction of EMRs into their practices with what I call the “over my dead body” speech. They are concerned because the physicians in their practice lack consensus on the EMR question, and they don’t know that smart EMR vendors will accommodate differences in physician readiness and preference by allowing multiple options for inputting data. For example, some physicians prefer to continue dictation, while others like hand-held devices.

Operational Assessment

All practices have strengths and weaknesses. Do you know yours? Look at every aspect of your practice operations, including, but not limited to, medical records. Here’s my reasoning: EMRs and other information technology solve problems, and you want to know what problems exist. Your chances of selecting solutions that address your vulnerabilities are better if you know where you’re starting.

Operational assessment should start with your patients. Some questions to ask yourself and your staff are:

· How do patients contact your practice to make appointments – only by phone, or electronically as well?

· How do you collect demographic information form patients?

· Can you verify insurance before patients arrive, so you minimize your claim denials?

· How do you transfer demographic and insurance information into the patient’s medical record?

· Do you ask patients for the same information at multiple points in the office so they must repeat themselves?

· After you see patients, do your visit notes require transcription?

· How do you enter test results into you medical record, and how do you convey information to patients?

· If referrals come form other physicians, how does that information get into the record?

· How do you handle information from hospitals where you admit

· How do you deal with patient requests for prescription renewals?

Use these questions to walk yourself through different patient interactions. As you see, the suggested list of questions is long, but I think they help to make the point clear. You must know what currently happens in your practice if you want to make a good decision about the future.

Understanding the Options

Many physicians request advice on selecting a vendor before they have a good understanding of the EMR functions. The question goes beyond EMRs to an understanding of how other forms of information technology can help you. The boundaries between the products are blurry, and you need to review not only EMRs, but also ways in which all technologies, including your practice management system and website, can work together to meet your needs.A good website can be a great benefit to your practice and deserves consideration. Your practice’s website, if constructed carefully, can bring you operational efficiencies, financial gains and improvements in quality of care and documentation without the high cost and difficulty of transition that EMRs involve. If the physicians in your practice are technology-shy, starting with an interactive website can help them become comfortable with IT.

Many physicians have a limited idea of the value of a practice website. They think of it as a resource for information about the practice such as locations, physicians, services that you provide, and contact information. A website that contains this important information is a good start. By adding HIPAA-compliant interactive features that allow patients to communicate directly with your practice, you can do even more. Examples of such features are pre-registration pages that collect patient demographic information prior to a visit and verify insurance information prior to the appointment, features that allow existing patients to request appointments and/or prescription renewals, on-line bill paying, and provision of on-line advice to existing patients.

What EMRs Do

When you look at EMRs, consider their evolution, common functions, and potential benefits so you are well informed before you make a decision to purchase a particular product.

• Evolution. If you were practicing medicine a decade ago, you’ve probably heard of the term CPR (computerized patient record). CPRs were longitudinal records that captured paper records for later use. EMRs go one step further, and capture structured and unstructured data from both paper and disparate computer systems. Most EMRs are owned by a single organization such as a medical practice or hospital. Right now, most information that’s entered into EMRs is done at the point of patient encounter.

Just as CPRs evolved to EMRs, EMRs will evolve into electronic health records (EHR) that capture information from multiple health-care providers, from a variety of other databases and from patients themselves. Eventually, patients will be able to control their own document, called an electronic patient record (EPR).

• Functions. EMRs have many functions, and most physicians use some but not all of them. The major functions, in order of common use, are:

• view information such as problem lists, medications, and adverse reactions;

• document what happens during a patient visit; identify clinical issues such as drug allergies;

• decide clinical issues using comprehensive, up-to-date, and reliable databases and references;

• manage prescriptions by accessing formularies and routing Rx orders and renewals directly to pharmacies;

• order tests, imaging, & other studies;

• communicate securely with medical colleagues within and outside of the practice;

• code by matching ICD and CPT codes with details in visit notes;

• comply with privacy, security rules;

• aggregate data on individual patients into longitudinal records;

• manage chronic disease/conditions of individual patients;

• standardize disease management goals for groups of patients;

• query the system for reports on clinical issues for individuals and groups;

• conduct research; and

• incorporate information that comes directly from patients. When you’re talking with vendors, make sure you know what functions are important for your practice so you can be sure that the product you buy meets your needs.

• Benefits. EMRs have three important benefits. First, they can increase your operational efficiency by streamlining the ways in which you gather, organize and use patient information. Second, EMRs can improve your financial management by methodically and accurately documenting all that you do and by verifying the appropriateness of your coding. Third, EMRs can improve the quality of patient care by helping you document and retrieve accurate information on both individuals and groups of patients and by accelerating the accurate and secure exchange of patient information between you and other parties in the health-care system such as providers, pharmacies and other organizations that collect relevant information.

Selecting a Vendor

Once you are clear on your practice mission and goals, technology readiness, operational strengths and weaknesses, and general technology options, you can begin to contact vendors. Many vendors will encourage you to purchase everything from them, but don’t limit your thinking to just them. I think smart purchasers buy what they need and then deal with the interconnectivity among the vendors. Eventually, there will be standards for interoperability.

Successful Implementation

The technology aspect of EMRs is only half the story. Successful implementation depends on people, and EMRs that are a phenomenal success in one practice may be a costly failure in another. There are six keys to successful implementation:

• Set realistic expectations about your time frame and the difficulty of implementation. If you’re transitioning away from paper, allow 18 months from the start of your investigation until implementation and expect a bumpy road.

• Identify a physician champion who is not only interested in introducing EMRs, but who is willing and able to coach his peers through the process.

• Enlist the commitment of all physicians in the practice, including those who are comfortable with information technology and those who are not. EMRs should be a practice enhancement, not a tool that one or two technologically savvy physicians use while others retain their dependence on paper.

• Agree on timing that suits your practice. Some vendors permit practices to purchase a comprehensive EMR software package and phase-in the implementation of different modules. Others allow the separate purchase of each different module. Still others are inflexible and require all clients to purchase and implement their products in a way that meets the vendor’s, not the purchaser’s, needs.

• Pay attention to relationships between EMRs and other systems. Interconnectivity between EMRs, your practice management system, Web-based communication, lab and other systems isn’t automatic.

• Purchase the level of support that is suitable for your practice. Even if you have your own information technology specialist, you may need outside help from one or more vendors. Ask about initial installation, availability of the help desk, software fixes and upgrades, and special deals on hardware, software and Internet connectivity.

With so many efforts on both government and private fronts to get electronic medical records up and running, in one form or another, EMRs are the wave of the future. By getting started now, learning about all of the information technology systems available, you’ll be able to take your time and get there in a way that suits your specific practice.

Originally posted by Contrarian:

A Dozen Questions For EMR Vendors

Like the diver poised at the end of the subtly bouncing board, your practice may be ready to make the leap into a full-fledged electronic medical records system. As the practice manager or physician administrator, you are charged with the task of interviewing EMR vendors and making recommendations about the best product for your practice. I suggest a dozen questions to ask EMR sales representatives, so that when you and your colleagues compare available systems, you can be sure of comparing apples to apples.

Do Your Homework

Beginning with the assumption that you have completed a thorough assessment of your practice’s needs, wants and capabilities to implement an EMR, you should now become familiar with the lingo common to EMR systems. An EMR integrates all of your internal and external documentation and communication needs. It is more clinically focused than your practice management system and your informative web site—but it can integrate with these components. Begin by reading about EMR in general—nothing that has to do with any one particular system. Armed with an understanding of the tech-speak you will undoubtedly hear, ask EMR vendors the following questions:

How does each of the EMR functions work?Having identified current trouble spots in your practice, you want to find out how the new EMR can help you solve your problems. Ask about the following functions:

• documenting patients’ visits and the rationale for clinical decisions;

• identifying with “red flags” clinical issues such as drug allergies;

• managing prescriptions and accessing formularies;

• communicating with medical colleagues outside the practice, or with patients;

• coding by matching ICD and CPT codes with details in the visit notes; and

• complying with privacy and security rules.

When the EMR sales rep visits you in your office, don’t just let him run the demo. Use it yourself, and have a staff person—someone who will actually be using the future system—come in and use it too. I’ve learned that the ease of navigation is a key to a user-friendly system.

Looking at systems at trade shows is a great way to assess what is out there and create a short list of vendors. While browsing EMR on the trade show floor may be efficient, don’t make any decisions there. Your staff and other physicians in the practice can’t be there with you to give input.

What are the methods for input of information?

Keyboard data entry need not be your only means of input. Some documents, such as pencil sketches or lab results, can be scanned into the EMR. X-rays may be uploaded. Voice recognition is gaining interest as the systems become more intelligent. Based on your completed assessment of your practice needs and wants, you will know the preferences of the physicians in your practice.

How is the transition of current records into the new system handled?

Transition is usually the most challenging and stressful part of converting to an EMR. In spite of everyone’s good intentions, a practice’s existing records may be out of order and inconsistent. One way to handle this is to decide not to load existing records into the EMR and to start fresh from that point forward. If you do want to continue existing records, though, you need to make sure that the new EMR system can accept your “old” data. Cumbersome conversion processes might easily disqualify some vendors from consideration.

Where is the data server physically located?

You may choose to house the data server on-site or share an off-site or ASP secure server with other clients. If you use the shared-server model, you will benefit from regular upgrades to the system (equivalent from moving from a 2.0 software to a 3.0 version), and the vendor handles security and maintenance. If you house the server in your office, you have complete control of your data, but you are more dependent on calling in reps for service and upgrades. Make sure to ask each vendor about the platform on which their systems are based.

How can you customize the menus, screens and categories for me?

EMR software begins as boilerplate that may be customized to your practice’s specific needs. Frequently used ICD and CPT codes can be pre-loaded into the system so they are readily available in drop-down menus or forms. Vendors can make many modifications, but the real issues are their willingness to customize and the fee (if any) they charge to make changes.

How does the EMR integrate—or not—with my existing practice management system, Web-based communications, etc?

Most EMR can be integrated with other medical office software and systems so that information can be shared in a “language” understood by all of the parts. Find out if your existing systems are compatible with the EMR that you are considering, unless you are planning to scrap all of your existing software and hardware and build a totally new system. In some cases, starting fresh might be the best thing to do.

How do we access the EMR?

If your practice has multiple sites, you’ll want equal access from each site, regardless of whether the data server is housed at one of your sites or in an outside, shared location. Physicians should be able to access the EMR remotely, whether on the road at a conference, at home or on-call at a hospital or clinic. In order to comply with HIPAA Privacy and Security requirements, you will need to know who in your office will be allowed to access certain information.

Also, physicians or others who will remotely access the EMR should give sufficient thought to their home office or laptop computer. Does it have enough memory to handle the EMR data? Is the Internet connection fast enough? New hardware purchases or installation of high-speed lines may be necessary.

How does this system help me comply with HIPAA Privacy and Security requirements?

In addition to passwords and “internal” security, find out exactly how an outside, shared server is secured. Find out if the vendor helps you install protections such as firewalls to servers located in your office. In addition, make sure there are alternative ways to access your server; most will have more than one Internet address through which you can access your data.How does the EMR process, exchange and store graphics?Find out how images and other graphic information are loaded or scanned into the system.

How does the system handle storage and transfer of video or digital photography captured during surgery?

In today’s patient record, information comes from multiple sources, not just what is written down during the patient visit.

What can I expect from customer support?

During the transition phase, it is reasonable to expect that a vendor rep will be on site with you for several weeks. Unexpected things will always occur as you try to get up and running, and it is vital to have a tech person immediately available. Beyond the initial set up, find out if there is one person who will work with you continuously, or if you will communicate with a different rep each time you call or send an e-mail. Find out how frequently someone will come to your site for maintenance, upgrades, etc. Ask about a guaranteed response time for both routine and emergency calls.

What is the cost?

It’s probably the most difficult to get an immediate answer to this question. Much is calculated on the size of your practice and the degree of customization you desire. Here are some typical cost areas:

• software licenses (per physician)
• electronic data interfaces (EDI) priced at an hourly rate
• conversion from paper to EMR
• hardware, including on-site server and secure Virtual Private Network
• maintenance of EMR system and interfaces
• customized programming
• implementation and training

The final point about training is a particularly important one. Annual system upgrades may require training. How will new employees be trained? Beware of vendors who steer you too forcefully toward on-line training. Many people learn best or are more motivated in a classroom where someone else actually shows them what to do. Be sure to find out how much training is included in the initial price.

Are financing plans available?

What about satisfaction guarantees?Few practices can afford to pay for the entire EMR outright. Ask about financing plans, deposits and installments. Find out about any trial periods and how important customer satisfaction is to the vendor. You don’t want to work with a company that will forget or ignore you after 90 days. Importantly, determine ownership of health information when opting for the off-site secure server option. You don’t want to have to leave your data behind if you ever decide to explore new options.

Potential Benefits

Practices vary in specialty, size, and operations, so EMRs don’t produce the same benefits for all users. Studies of practices that have already implemented EMRs identify two common benefits that may result, if and only if the practice pays attention to factors other than the technology itself.

The two important benefits are improvements in financial position and in the quality of patient care. Financial position depends on revenue and expenses, and an EMR can impact both. With respect to revenue enhancement, EMRs can reduce the percentage and amount of erroneous claims submissions by flagging erroneous codes or data omissions. Coding modules can help physicians code more accurately and with more confidence. EMR screens that prompt proper coding help them code at the appropriate level.

EMRs can also improve a practice’s financial position by reducing operating expenses. For example, practices that embrace EMRs as a replacement for costly transcription can save on that item. Other common cost savings can be the reduction of staff time for chart pulls and prescription renewals and a decrease in dollars spent on paper supplies.

With respect to quality of patient care, EMRs can make a big difference. Physicians can retrieve lists of patient problems, medication lists, and preventive protocols much more easily than they can when all information is hand written and placed into paper files in random order. EMRs can facilitate the management of patients with chronic health problems, reduce medication errors and eliminate duplicate lab tests. 

http://www.emrupdate.com/forums/thread/20511.aspx

NYFP wins the award for most tenacious, dilgent research on EMR selection. He also co-shares the award with Cyath for best caption http://www.emrupdate.com/forum/topic.asp?TOPIC_ID=3688&whichpage=5

How does my hair look...? Traffic jam/log jam.

Dr. Winn, looking at the picture of the dog in your avatar, I was just remembering the cute old song.."how much is the doggie in the window?" Ever heard it?? I think it was from about 20 years ago!
Raja

quote:

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Originally posted by DrRoger

Dr. Winn, looking at the picture of the dog in your avatar, I was just remembering the cute old song.."how much is the doggie in the window?" Ever heard it?? I think it was from about 20 years ago!
Raja

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Yes, I remember. Look closely at the Avatar. Not quite the face of a dog face, not quite a human face - it's mandog!

Disclaimer: I am the founder of e-MDs - highest rated EHR in 5 consecutive AAFP and ACP physician surveys

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