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Healthcare IT Career Resources

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About 10 months ago, we added Healthcare IT Central to the Healthcare Scene family of healthcare IT websites. It’s been a really amazing addition to the network and I’ve been amazed at the thousands of people that have been able to find health IT jobs thanks to Healthcare IT Central. I love blogging because you get the direct interaction with readers, but there’s a really amazing feeling that comes when you play some small role in helping someone find a job.

The other great part about the addition of Healthcare IT Central is the related Healthcare IT Today career blog. If you’re not reading that site, we just added it to our Healthcare Scene email subscription lists so you can receive the latest posts in your email inbox.

Just to give you a little flavor of the type of content we’ve been posting on Healthcare IT Today, we asked the questions, “Has There Been an EHR Consulting Slow Down?” and “Who’s More Satisfied – Full Time Health IT Professionals or Health IT Consultants?” Plus, we even posted really interesting data like a look at the Epic Salary and Bonus structure. Then, since it is a healthcare IT career website, we cover things like LinkedIn tips and LinkedIn as a professional or personal profile.

If you’re someone looking for a healthcare IT job or looking for a better healthcare IT job, we have hundreds of health IT jobs available. You might also check out Cordea Consulting, ESD, and Greythorn that recently posted jobs with us.

If those jobs aren’t your style we have other jobs like this Sales Account Executive at EHR vendor, gMed, or these system analyst jobs at Hathaway-Sycamores Child Family Services and Pentucket Medical.

If you’re an employer looking for amazing healthcare IT professionals, you can register for the site and post your jobs or search our database of over 12,000 active health IT resumes.

Hopefully some of these health IT career resources are helpful to readers of EMR and HIPAA. One thing that’s universal in healthcare is the need to find a job or hire the right talent. Hopefully we’re doing are part to help both sides of the coin.

August 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Can a Client Server EHR Provide All the Same Benefits of Cloud EHR?

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One of the most popular battles discussions we’ve had on this site since the beginning is around client server EHR software versus cloud EHR software. It’s a really interesting discussion and much like our US political system, most people fall into one camp or the other and like to see the world from whatever ideology their company approaches.

The reality I’ve found is that there are pros and cons to each side. Certainly cloud has won out in most industries, but there are some compelling reasons why cloud hasn’t taken hold in many parts of healthcare.

With that in mind, a client server EHR vendor asked me to list out the reasons why someone should go with a Cloud EHR over client server. Here’s my off the cuff responses:

No IT Support Needed beyond desktop support – This is a big benefit that many like. Plus, they add in the cost of the server, the cost of the local IT person and so they see it as a huge benefit to go with cloud software

Automatic Updated Software – Not always true with the cloud, but they like that the software just updates and they don’t have to go around updating software. Of course, this also has its downsides (ie. when an update happens automatically and breaks something)

Small Upfront Cost – Most Cloud solutions are billed on a monthly charge with little to no upfront cost. We could argue the accounting pieces of this and whether it’s really any better, but it feels better even if many cloud providers require the 1-2 year commitment. In some large organizations this type of payment plan is better for their accounting as well (ie. depreciation of equipment, etc)

More Secure – Obviously this could be argued either way, but those that believe cloud is more secure believe that a cloud provider has more resources and expertise to make their cloud secure vs an in house server where no one might have expertise

More Reliable (backup/disaster recovery) – Similar to the secure argument as far as expertise and ability to provide this reliability

Single Database – There are cool things you can do with data when every doctor is on one database and one standard data structure.

Available Everywhere – At home, office, hospital, etc. (Yes, this can be done by many client server as well, but not usually with the same experience).

I’m sure that a cloud EHR provider could add to my list and I hope they will in the comments. As I was making the list, I wondered to myself if a client server EHR vendor could provide all of the benefits listed above. Let me go through each.

No IT Support Needed beyond desktop support – Some EHR vendors will do all the IT support for the user. Plus, it’s a little bit of a misnomer that you need no IT support with a cloud hosted EHR. You still need someone to service your network and computers. More importantly though, most client server EHR vendors are offering a hosted EHR option which basically provides this same benefit to a practice.

Automatic Updated Software – More and more client server vendors are moving to this approach for updates as well. This is particularly true when they offer a hosted EHR environment where they can easily update the EHR. It’s a different mentality for client server EHR vendors, but it can be done in the client server environment.

Small Upfront Cost – We’ve seen this same offer from almost all of the client server EHR companies. It’s a hard switch for EHR companies to make the change from large up front payments to reoccurring revenue, but I’m seeing it happening all over the industry. The only exception might be the big hospital EHR purchase. In the ambulatory EHR market, I think everyone offers the monthly payment option.

More Secure – This is one that could be argued either way. Either one could be more secure. Client Server vs Cloud EHR doesn’t determine the security. A client server EHR can be just as secure or even more secure than a cloud EHR. I agree that generally speaking, cloud EHR is probably more secure than client server, but that’s speaking very broadly. If you care about security, you can secure a client server EHR as much or more than a cloud EHR.

More Reliable (backup/disaster recovery) – Similar to secure, you can invest in a client server infrastructure that is just as reliable as a cloud EHR. It’s true that a cloud EHR vendor can invest more money in redundant systems usually. However, a client server EHR vendor that hosts the EHR could invest just as much.

Single Database – This is the one major challenge where I think client server has a much harder time than a single database cloud EHR provider. Sure, you can export the data from all of the client server EHR software into a single database in order to do queries across client server EHR installs. A few vendors are doing just that. So, I guess it’s possible, but it’s still not happening very many places and not across all the data yet.

Available Everywhere – This can be done by client server as well, but the experience is often a subset of the in office experience. Although, this is rapidly changing. Bandwidth and technology have gotten so good, that even a client server install can be done pretty much anywhere on any device.

Conclusion
Looking through this list, it makes a great case for why client server EHR software is going to be around for a long time to come. There’s nothing on the list that’s so compelling about cloud hosted EHR software that makes it a clear cut winner.

As I thought about this topic, I tried to understand why cloud’s been the clear cut winner in so many other areas of technology. The answer for me is that in our lives portability has mattered a lot more to us. In healthcare it hasn’t mattered as much. Plus, new client server technologies have been portable enough.

Long story short, I’m a fan of cloud technologies in general, but if I were a provider and a client server technology provided me more features, functions, better workflow, etc, than a cloud EHR, I wouldn’t be afraid to select a client server EHR either.

Also worth clarifying is that this post outlines how a client server EHR can provide all of the same benefits of a cloud EHR. However, just because a client server EHR can provide those benefits, doesn’t mean that they do. Many have chosen not to offer the above solutions. Although, the same goes for cloud EHR as well.

What do you think? Are there other reasons why cloud EHR technology is so much better than client server? Is there something I’ve missed? I look forward to reading your comments.

August 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Where is Voice Recognition in EHR Headed?

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I’ve long been interested in voice recognition together with EHR software. In many ways it just makes sense to use voice recognition in healthcare. There was so much dictation in healthcare, that you’d think that the move to voice recognition would be the obvious move. The reality however has been quite different. There are those who love voice recognition and those who’ve hated it.

One of the major problems with voice recognition is how you integrate the popular EHR template documentation methods with voice. Sure, almost every EHR vendor can do free text boxes as well, but in order to get all the granular data it’s meant that doctors have done a mix of clicking a lot of boxes together with some voice recognition.

A few years ago, I started to see how EHR voice recognition could be different when I saw the Dragon Medical Enabled Chart Talk EHR. It was literally a night and day difference between dragon on other EHR software and the dragon embedded into Chart Talk. You could see so much more potential for voice documentation when it was deeply embedded into the EHR software.

Needless to say, I was intrigued when I was approached by the people at NoteSwift. They’d taken a number of EHR software: Allscripts Pro, Allscripts TouchWorks, Amazing Charts, and Aprima and deeply integrated voice into the EHR documentation experience. From my perspective, it was providing Chart Talk EHR like voice capabilities in a wide variety of EHR vendors.

To see what I mean, check out this demo video of NoteSwift integrated with Allscripts Pro:

You can see a similar voice recognition demo with Amazing Charts if you prefer. No doubt, one of the biggest complaints with EHR software is the number of clicks that are required. I’ve argued a number of times that number of clicks is not the issue people make it out to be. Or at least that the number of clicks can be offset with proper training and an EHR that provides quick and consistent responses to clicks (see my piano analogy and Not All EHR Clicks Are Evil posts). However, I’m still interested in ways to improve the efficiency of a doctor and voice recognition is one possibility.

I talked with a number of NoteSwift customers about their experience with the product. First, I was intrigued that the EHR vendors themselves are telling their customers about NoteSwift. That’s a pretty rare thing. When looking at adoption of NoteSwift by these practices, it seemed that doctor’s perceptions of voice recognition are carrying over to NoteSwift. I’ll be interested to see how this changes over time. Will the voice recognition doctors using NoteSwift start going home early with their charts done while the other doctors are still clicking away? Once that happens enough times, you can be sure the other doctors will take note.

One of the NoteSwift customers I talked to did note the following, “It does require them to take the time up front to set it up correctly and my guess is that this is the number one reason that some do not use NoteSwift.” I asked this same question of NoteSwift and they pointed to the Dragon training that’s long been required for voice recognition to be effective (although, Dragon has come a long way in this regard as well). While I think NoteSwift still has some learning curve, I think it’s likely easier to learn than Dragon because of how deeply integrated it is into the EHR software’s terminology.

I didn’t dig into the details of this, but NoteSwift suggested that it was less likely to break during an EHR upgrade as well. Master Dragon users will find this intriguing since they’ve likely had a macro break after their EHR gets upgraded.

I’ll be interested to watch this space evolve. I won’t be surprised if Nuance buys up NoteSwift once they’ve integrated with enough EHR vendors. Then, the tight NoteSwift voice integrations would come native with Dragon Medical. Seems like a good win win all around.

Looking into the future, I’ll be watching to see how new doctors approach documentation. Most of them can touch type and are use to clicking a lot. Will those new “digital native” doctors be interested in learning voice? Then again, many of them are using Siri and other voice recognition on their phone as well. So, you could make the case that they’re ready for voice enabled technologies.

My gut tells me that the majority of EHR users will still not opt for a voice enabled solution. Some just don’t feel comfortable with the technology at all. However, with advances like what NoteSwift is doing, it may open voice to a new set of users along with those who miss the days of dictation.

August 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Giving Email Addresses to Patients Who Don’t Have Them

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In my post, 4 Things Your Patient Portal Should Include, I talked about the thing patients want most in a patient portal is the ability to communicate with someone in the physician office. I still think that’s the most powerful part of a patient portal.

In response to that post, the people at Engaged Care sent me an interesting way that they’re approaching engaging the patient. Their efforts are focused on those patients who don’t have an email address. Check out this video which demonstrates the workflow they offer.

I’m not sure how many patients don’t have an email address, but this is a pretty slick solution to get them signed up for an email address. The other challenge is getting those patients who don’t have an email address motivated and skilled enough to check the newly created email as well. However, maybe access to a well done patient portal might be motivation enough for them to get involved.

The other benefit to these physician provided email addresses is that they are secure. You might remember that native email is not HIPAA secure. The email addresses that Engaged Care provides are HIPAA secure.

I’ll be interested to see how this company does. How many patients actually use the new email addresses and where they take it next. Although, I found the idea of giving patients a secure email address quite interesting.

August 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Work IT! Optimize Health Technology with EHR Adoption – Breakaway Thinking

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The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
workout
Investing in an electronic health record (EHR) is largely based on the decision to improve patient safety, align with clinical guidelines, enhance revenue cycle times, and capture government-based incentives. But without a proper EHR adoption plan in place, healthcare providers risk never optimizing their investment and achieving their intended goals.

Once an EHR is implemented, healthcare organizations must continue striving toward their goals to optimize their systems. Improving workflows, establishing best practices and increasing overall proficiency of end-users in this application are all components of optimization. Healthcare organizations that are able to maintain this level of focus will see improved clinical and financial outcomes.

This process isn’t easy and requires a commitment to the initial performance metrics that drove the healthcare organization to purchase the new system. Today, nearly half of all healthcare organizations use an EHR, but many struggle to ensure it provides clinical value across the organization. They carefully select and implement systems but fail to make the tool work as originally envisioned. Just because they bought a new EHR doesn’t mean it is serving their patients, providers, or bottom line.

A parallel comparison can be made with buying a high-end, a mobile exercise device to track aerobic and anaerobic steps. Individuals seeking a healthier lifestyle invest in these devices, hoping it will help them achieve their personal health goals. After making the initial investment and adapting daily habits to wear the device, one can begin to adopt the technology to achieve improved health goals. But realizing these goals takes work and commitment. If performance is not monitored, results can plateau and, in some cases, regress. This could result in a growing waist line for the person trying to lose weight, an ironic and unfortunate twist. For healthcare organizations, their growing waistline is unhealthy organizational performance, visible through increases in adverse drug events, recurrent admissions, revenue cycle times and government penalties, all symptoms of goal misalignment. The more healthcare organizations look away from their initial performance goals and utilize EHRs for data storage only, the more noticeable the symptoms become. Both individuals and healthcare organizations can benefit from the process of system optimization to make the tool work for the betterment of the individual or organization.

Extensive research has been conducted by The Breakaway Group (TBG), A Xerox Company, to identify elements that lead to optimization. TBG reports the key adoption elements exhibited by healthcare organizations that optimize their EHRs:

Engaged and Clinically Focused Leadership
Healthcare organizations must demonstrate engaged and clinically focused leadership. Clinical leaders must align their EHR by refining workflows, templates, utilization, and reporting to meet their organizations’ clinical and financial goals. The Chief Medical Information Officer (CMIO) is well suited for this venture.

Targeted Education and Communication
Healthcare organizations must provide targeted education and communication.  When system upgrades are released, organizations must effectively and efficiently educate end users to alleviate reductions in proficiency and productivity.

Comprehensive Metrics
Healthcare organizations must be able to use EHR data.  Organizations must move past the superficial use of an EHR and begin to analyze what is entered. The EHR is of little value, if the data is neither clinically valuable nor used.

Sustained Planning and Focus
Healthcare organizations must sustain planning and focus. Change occurs frequently in healthcare, so system optimization requires preparation, adjustment and real-time communication.

With these adoption elements, healthcare organizations can make their technology work as originally intended—to improve patient and financial outcomes. To overcome the EHR implementation plateau, they must focus on their original performance goals to truly optimize health information technology systems. This process isn’t easy. It requires endurance, but the payoff is worth it. It’s time to “Breakaway” from the status quo and work IT– by optimizing use of HIT systems!

Carrie Yasemin Paykoc
Xerox is a sponsor of the Breakaway Thinking series of blog posts.

August 20, 2014 I Written By

Telemedicine A Critical New Approach To Primary Care

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Telemedical treatment has been a tantalizing possibility for many years, for reasons including a failure of health plans to pay for it and too little bandwidth to support it, but those reasons are quickly being trumped by the need for quick, cheap, convenient care.

In fact, according to research by Deloitte, 75 million of 600 million appointments with general practitioners will be via telemedicine channels this year alone.

While one might assume that this influx is coming from traditional primary care practices which are finding their way online, that doesn’t seem to be the case.

Instead,a growing number of entrepreneurial startups are delivering primary care via smart phone and tablet, including Doctor on Demand and HealthTap, which offers videoconferences with PCPs, and options like Healthcare Magic and JustAnswer, which offer consumers the opportunity to get written responses to their healthcare queries from doctors.

Primary care doctors going into direct primary care are also joining the primary care telemedicine revolution; a key part of their business is based on making themselves available for consultation through all channels, including Skype/Facetime/Google Hangout meetings.

To date, most of the thinking about telemedicine have been that it’s an add-on service which is far to one side of the standard provision of primary care. However,with so many consumers paying out of pocket for primary care — and virtual visits typically priced far more cheaply than on-site visits — we may see a new paradigm emerge in which victims of  high-deductible plans and the uninsured rely completely on telemedical PCPs.

Rather than being merely a new technical development, I believe that the delivery of primary care via telemedical channels is a new form of ongoing primary care delivery.

It will take some work on the part of the telemedicine companies to sustain long-term relationships with patients, notably the use of an EMR to track ongoing care. And telemedicine PCPs will need to develop new approaches to working with other providers smoothly, as coordination of care will remain important. Health IT companies would be wise to consider robust, unified platforms that allow all of this to happen smoothly.

Regardless, the bottom line is that primary care telemedicine isn’t an intriguing sideline, it’s the birth of a new way to think about financing and delivery of care. Let’s see if traditional providers jump in, or if they let the agile new virtual PCP companies take over.

August 15, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Comprehensive Patient View, Social Media Time, and Linking Millions of EMR

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You don’t really need to click on the link above. The answer is no. The answer is that it probably won’t ever happen. There are just too many source systems where our health data is stored and it’s getting more complicated, not less.


If the social media maven Mandi has a challenge getting her social media on, now you can understand why many others “don’t have the time.” It takes a commitment and many don’t want to make that commitment. It doesn’t make them bad people. We all only have so many hours in a day.


No need to read this link either. Although, I found it great that they described the challenge as linking millions of EMR. Let’s be generous and say there are 700 EHR vendors. Unfortunately, that doesn’t describe what it takes to make EMR interoperable. To use a cliche phrase, if you’ve connected with one Epic installation, you’ve connected with one Epic installation. I know it’s getting better, but it’s not there. If you want interoperable EMR data, you need to connect a lot of different installs.

August 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Power of the Cloud EHR – Hidden Technology

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Today’s post will be short. I’m hitting up the Black Hat conference in Las Vegas today and tomorrow. For those not familiar with Black Hat, it’s a hackers conference. It’s not quite as hardcore as Defcon when it comes to hacking, but they warn you about getting your devices hacked. I personally plan to play it safe and not bring my laptop and to turn my cell phone off. Anyway, hopefully I’ll do some future posts on security based on what I learn at the event. I always find deep value in going to a conference that doesn’t apply specifically to what I’m doing. Although, in the past they’ve had some medical device hacking sessions, but I digress.

The title of this post describes a concept I was recently considering. In fact, it was inspired by a comment on a previous post by Suzanne McEachron, that talked about a clinic needing to upgrade their in house EHR server from Windows Server 2003 to Windows Server 2008. Here’s the full comment:

Your statement, “While it’s sometimes disappointing to look at the old technology that powers healthcare,” must refer to an ambulatory vendor I am aware of, which installed its software onto a Windows Server 2003 just 3 years ago, and is now demanding the provider upgrade to Windows Server 2008. The provider wants to upgrade to Windows Server 2012, but the software company’s software won’t reliably work (yet) on that version. What is a poor country doctor to do?
He will be dumping his current vendor and finding a software company which uses the cloud instead of servers in his office.
Companies which continue to not keep up, will be left with few customers.

The last two lines are probably worthy of their own post. So, we’ll mostly set them aside for now. However, I was struck by Suzanne’s comment that they would be going with a cloud solution after this experience with an in house EHR vendor.

I’d never thought of this before I read this comment, but is one of the benefits of a cloud EHR that the user has no idea what type of back end technology you’re using to deliver the software? Sure, some of them will ask some questions during the EHR selection process, but I’ve never seen anyone ask a cloud EHR vendor how they’re doing at keeping their technology stack up to date. The reality for end users is that they don’t really care what technology is being used. They only care about the end result. Does it work? Yes. Is it fast enough? Yes. Then, since it’s in the cloud, who cares what technology is being used?

Of course, this may be exaggerating the situation a little, but not much. Certainly very few if any people are asking cloud providers how they’re doing at keeping their technology up to date. No doubt some do care about this and run into this problem even with cloud providers. My favorite example of this is when a cloud EHR provider requires a clinic to use an extremely outdated version of IE (internet explorer) to run the EHR. Yes, then they start to care a lot more.

Maybe it’s a mistake that practices don’t keep after their cloud provider more. However, the reality today is that the don’t. That makes it a huge advantage for cloud EHR providers. At least it does until they’re so outdated that they can’t hide it anymore. For example, when they can’t launch an iPad app because there’s no way for their old technology to work with it. Sounds like I need to create a new jokes series called, “Your EHR might be outdated if….” The problem is the jokes won’t be too funny if you’re suffering through it.

Side Note: So much for it being a short post.

August 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Revisiting the ROI of an EHR Investment

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The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
Now that we’re well on the road to being meaningful users of an EHR, I thought it would be interesting to take a step back and look at the ROI of an EHR investment. Hopefully this will be a valuable resource for those still considering an EHR investment and those who’ve already adopted an EHR in their practice. Some of the items listed below are benefits you receive automatically just by using an EHR. Other benefits require some thought and effort on your part. Hopefully this list will remind you of EHR benefits you might have forgotten and ones you can still work to achieve.

Repurpose Space – One of the big advantages of EHR software is that you can store your entire chart room on a relatively small server. Plus, if you’re using a hosted EHR solution, you don’t even need space in your office for a server. Once your paper charts get scanned into your EHR, you can often repurpose your chart room into a revenue generating exam room. I’ve seen some cases where an extra exam room made it possible to bring on another doctor or mid-level provider. In other cases, the extra exam room was able to make existing doctors more efficient. Either way, I don’t know very many practices who say, “We have too much space.”

Eliminate or Repurpose Staff – Nobody likes the idea of eliminating staff as part of an EHR implementation. However, there are two ways I’ve seen organizations reduce staff after implementing an EHR. First, some organizations reduce their staff through natural employee attrition. When a member of your staff chooses to leave your organization, some organizations decide not to replace that staff member since many of their duties are no longer needed in an EHR world. Second, some organizations take their existing staff and repurpose them to perform other tasks. For example, I’ve seen HIM (medical records) staff who are also medical assistants switch to more of a clinical role in the organization after implementing an EHR.

Avoid Penalties – One of the best reasons to make an early investment in an EHR is to avoid the government penalties. I’ve written about the meaningful use and PQRS penalties before, but this is likely just the start of the penalties the government and private payers will implement on those who don’t use an EHR. The long term ROI of these penalties is very large for most practices.

Quality Measures and Value Based Reimbursement – Meaningful Use together with the Value Based Reimbursement Modifier (VM) are the start of a shift towards reporting and getting paid based on clinical quality measures and outcomes. EHR software is at the center of this shift and will be essential to easily document and report these measures and outcomes. While we can put a hard number on the EHR incentive payments that are tied to these measures and the VM, you can be certain that this number will only continue to grow as the government and payers require more data.

Improved Charge Capture – Eight years ago, improved charge capture was the main ROI mechanism that EMR vendors used to sell software. The idea being that the EMR could help you more fully document the patient visit and thus allow you to bill at a higher level than you were doing previously. As in most things involving money, some doctors took this too far and started using the EMR to over code visits. These EHR over code abusers aside, the majority of doctors I know are chronic under coders. Many of these doctors under code because they don’t want to spend time documenting the normal findings that would let them code at a higher level. A well implemented EHR can help doctors fully document even the normal findings in a visit and therefore allow them to bill at a higher level.

Cancel Transcription – Depending on how you use (or don’t use) transcription, this may or may not be a part of your EHR ROI calculation. While transcription can still be used with an EHR, the majority of EHR users stop transcribing as part of the EHR implementation process. Once you make the switch to documenting directly in the EHR or using voice recognition, it’s easy to forget how much money you were spending on transcription.

Improved Workflows – A well implemented EHR software can improve your clinic’s workflows. The lab result workflow is a great example of how an EHR can improve the workflow in your office. The amount of time saved ordering labs and retrieving lab results in an EHR world is significant. Sure, lab interfaces aren’t perfect, but they’re a lot better than the paper model. You can see similar workflow benefits from X-rays and even a well implemented patient portal. Of course, your workflow can be negatively impacted if you’re not careful and thoughtful in how you implement your EHR. However, EHR technology can do a lot to improve a clinic’s workflow when you replace time intensive paper processes.

Streamlined Internal Communication – Related to improved workflows is improved communication. When it comes to internal office communication, most EHR software comes with a secure internal messaging service or task system. This replaces all those sticky notes, stacks of charts, or notes in boxes that would occur previously. Now messages aren’t lost and can be more easily tracked in the internal EHR messaging. Plus, you can also often report on how fast tasks are being completed.

Streamlined External Communication – We’re still early in EHR’s ability to facilitate secure communication with external providers. While some EHR software offers a provider portal for this communication, I’m more interested in the progress of Direct Project which allows the secure transfer of patient records between doctors. As these technologies mature, the time saved at the fax machine and sorting data records will be tremendous.

Eliminate Paper – Once you implement an EHR, you quickly forget how much money you were spending on paper and paper charts. Don’t forget to think about this cost savings when looking at the value of EHR. While some paper just disappears post EHR implementation, you’ll likely find that there’s still plenty of paper lingering around your office. You’ll never eliminate all of the paper from your practice, but you should ask yourself if you really need the paper you’re using or if it’s just part of an old practice that’s no longer needed. Furthermore, many EHR enabled offices print off insane amounts of paper from their EHR for no reason. This extra cost can be avoided with a little planning and awareness.

Chart Search Time – This is another one of the EHR benefits that quickly gets taken for granted. In the EHR world, it is extremely simple to find the right chart. I don’t need to outline the challenges that existed in the paper world with finding the paper charts. Medical records staff were amazing at organizing and finding paper charts, but this all required a lot of time organizing and locating the right chart. This is all but eliminated in the EMR world.

Along with the financial and efficiency benefits mentioned above, there are lots of other benefits to using an EHR like: legible notes, drug to drug interaction checking, and ePrescribing to name a few. However, even more important than all of the benefits mentioned above is how important an EHR will be to future reimbursement and care. As was mentioned, Medicare’s started penalizing non-EHR users and we’ll likely see other payers in some form or fashion follow their lead. Along with current and future EHR related penalties, there’s a real risk that you won’t be able to practice the highest quality medicine without an EHR and the future technologies it facilitates. The medical standard of care will likely require an EHR.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

August 5, 2014 I Written By

Bad Boy EMR List, EMR Apology Letter, and Direct Primary Care

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I’ve always liked the idea of a bad boy EMR list. I’ve called it a meaningful EHR certification before. Or an EMR naughty and nice list. It’s a hard thing to do well…especially if you want to make a business of it.


I’ve posted a number of images lie this before. It’s always interesting to see what they say. This one actually looks like it’s trying to help them meet their MU patient engagement requirements as much as it’s trying to explain the EHR implementation delay. I’ve seen quite a few of these signs in hospitals I’ve visited. Getting patients signed up on the portal is a challenging thing for hospitals.


I need to dig into the direct primary care model a lot more, but it’s one of the really interesting alternative care models that’s worth watching.

August 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.