Written by: John Lynn
This is the next in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Ho can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.
After completing a family practice residency at the University of Rochester in 1989, Dr. Ho worked in a variety of settings before making her decision to open her no-staff “micropractice” in 2004. Ho defines micropractice as being “a small, low overhead, no staff, hightech-high touch practice.” Because Ho believes the current financing model of delivering primary care by cranking up the volume of visits in order to meet overhead and salary is broken she wanted to move to a model that would be better for patients and give her more professional satisfaction.
Ho realized that one of the keys to running a successful micropractice is maintaining a low overhead. Her overhead is 25-30% of gross collections instead of the typical 60% that arises from paying staff salaries and for multiple work stations.
Amazing Charts was her choice of EHR and she has found the company very responsive to user requests. All of the software pieces needed to integrate well with her EMR, both via formal interfaces and in her informal workflow.
Ho has been able to make her office completely “paperless.” She accomplished this by having all patients send her their clinical histories using Instant Medical History from her website. She also has all new patients sign a laminated “HIPAA consent, for both billing and emailing, with one signature. Then she scans the page along with a copy of their insurance card to a file. She erases the patient’s information from the laminated sheet and reuses it for the next patient. She uses EDI interfaces for most labs and some x-rays and consults. Most consultants fax her their information electronically.
Dr. Ho had no formal training in using a computer and, in fact, had only used a Mac for accessing her email prior to opening her practice in 2004. She felt that with a laptop, an all-in-one, an internet connection and an EHR as the centerpiece of her technology stable, she was set for life. She was unaware of what her technology configuration would evolve into and she became mindful of just how many of her devices would have to successfully interact to properly implement the EHR system. As of the writing of this article she was in the process of attesting for Meaningful Use and was on course to achieving MU within three months of starting the process.
She updated her EHR to the latest version (Amazing Charts version 6) in order to use the “wizards” that would count the necessary data. Ho commented that it was taking only 2-5 minutes more, per encounter, to include the required documentation. Although she would prefer not to have to spend the extra time filling in the boxes, Ho did admit the MU wizard in her EMR makes it rather simple and not too painful to collect the necessary data.
She had the following thoughts on whether MU certification is proper for any given practice. “If you are already leveraging your EMR to help you in your practice in a meaningful way, then depending on your Medicare/Medicaid revenues/patient mix, it may be worth it to apply”. She felt the questions to be asked “are the monies received – or the penalty that you would incur, worth the time it will take you to: 1)learn about the MU program, 2) learn how to use the MU features of the EMR, and 3) actually do the documentation?” She also feels that a provider needs to consider his or her payor mix and practice volume. However, if a provider doesn’t use the EMR to collect demographic data or to E-prescribe, there will be additional work to adopt these processes into one’s workflow.
Dr. Ho feels that attestation is not proper for everyone. Smaller practices with very tight profit margins which lack breathing room may not be able to succeed because the benefits of certification may be outweighed by the efforts necessary to becoming schooled in MU deployment.