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Part five of our five part series on the benefits of an EMR or EHR consultant is improved clinical buy-in.

Improved Clinical Buy-In

Hiring a proven EMR consultant alleviates fear and increases clinical buy in. However, more importantly, EMR consultants are able to provide a clinic the tools needed to show an EMR implementation’s ROI. EMR consultants should do a comprehensive analysis to show how an EMR implementation will reduce costs, increase revenues, and better care for patients. Quantifying the potential returns on an EMR investment generates significant buy in at all levels of a clinical organization.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part four of our five part series on the benefits of an EMR or EHR consultant is comprehensive technology support.

Comprehensive Technology Support

By providing a comprehensive set of technology support, a technical EMR consultant can alleviate doctor’s concern over the implementation of new technology. An EMR consultant’s proven track record of implementing these health care related technologies in doctors’ offices allows them to do it in a robust, efficient, and cost effective manner. Doctors save time searching through the numerous technology choices because EMR consultants can point them to the best brand of technology or even to technologies the doctor didn’t know existed.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part three of our five part series on the benefits of an EMR or EHR consultant is clinical process mapping.

Clinical Process Mapping

One of the hardest things for a doctor new to EMR to do is see how their current clinical processes will work electronically in an EMR. To alleviate this fear, EMR consultants can first map out a doctor’s clinical processes. They can then use their experience with other EMR implementations and show how current clinical processes will be done using an EMR. This will save doctors a lot of time mapping out these processes. It also provides a clear understanding of what a doctor’s clinic will look like electronically. However, the most important part of this process is that it provides a way to find problems that may occur with an EMR before you’ve actually implemented.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part two of our five part series on the benefits of an EMR or EHR consultant is EMR Training.

EMR Training

Using an EMR consultant’s experience in successful EMR implementations, they have a strong ability to train doctors on EMR and other related technologies. Some of this training occurs in an initial meeting where they discuss challenges related to EMR selection and implementation. EMR consultants also provide ongoing training on how to best use their EMR in their clinic. Furthermore, EMR consultants can train clinical staff on using the various technologies associated with using an EMR.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

A while back I wrote something about why having an EMR or EHR consultant could be beneficial to a doctor looking to implement an EHR. Here’s the first part of a five part series on reasons why I think a well qualified, experienced EMR or EHR consultant is valuable. The first part is how an EMR or EHR consultant helps with the selection process.

EHR Selection Process

By first evaluating a doctor’s needs and preferences EHR consultants are able to eliminate a majority of the EHR companies and provide doctors with a short list of high quality EHR vendors to evaluate. By providing a smaller pool of EHR vendors, doctors are more comfortable with the selection process and don’t get discouraged seeing hundreds of EHR vendors that don’t meet their needs. EHR consultants also help doctors through the evaluation process. EHR consultants often provide a list of questions that can be used to evaluate EHR vendors. These questions have been designed to tease out information which will better enable doctors to select the right software. EHR consultants also assist doctors that need help negotiating with EHR vendors. These services include requesting enhancements to meet doctor specific needs or even ensuring that EHR vendor pricing is comparable to other EHR implementations.

When it comes down to it, a good EHR consultant can save a doctor large amounts of time and money that would have been wasted looking amongst the hundreds of EHR companies. It’s not hard to say that doctor’s most precious commodity is time.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

I’ve been working with John Deutsch of EMR Experts, Inc. and I invited him to be a guest blogger on my blog. Here’s an article John sent me about the Free Vista EMR offered by the government. While I think the news about Vista being free came out about 2.5 years ago, the information about adopting it is still VERY relevant. Probably because the EMR adoption level is so low.

Enjoy John’s take on the government’s “Free EMR.”

Is anything ever free these days? Maybe so.

Instigated by the incredibly slow adoption of Electronic Medical Records (EMR) by doctors across the nation, Medicare is announcing it will begin offering doctors free electronic medical record software solutions.

Both upfront and ongoing costs have been critical factors in the lagging EMR adoption rate. Medicare hopes that by providing doctors with a free or very low-cost system, doctors will readily adopt EMR putting healthcare providers in America on a common system, thereby, providing Medicare and the general public with obvious, health, reporting and billing benefits.

The proposed system is VistA, (Veterans Health Information Systems and Technology Architecture) the widely popular system built by the Veterans Administration.

The adoption of VistA has resulted in the VA achieving a pharmacy prescription accuracy rate of 99.997%. Due to the implementation of VistA, the VA also outperforms most public sector hospitals on a variety of criteria.
The VistA system is public domain software, available through the Freedom of Information Act directly from the VA website or through a network of distributors.

Installed in over 1300 inpatient and outpatient facilities, the system is well-established and quite successful by EMR standards.

But can a system designed for a large organization like the VA also work for a solo practitioner family practice office?

A doctor in a New York Time article writes:

“It is one thing to use a system that someone else installed and someone else maintains. It is another to get a set of disks in the mail and do it yourself.”

Those who have tried to install VistA on their own would agree.

“Giving out a version of VistA is a great idea,” said Dr. David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians, a group that has been working on the project. “But at the beginning, there was a lot of wishful thinking. They said, ‘We’ll just release it.’ I said, ‘Where’s the fairy dust?’ ”

The problems with the healthcare sector and its slow adoption of electronic medical records are much deeper than some would like to admit, and viable solutions have been hard to come by.

The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows.

Building a one-size-fits-all system has failed in the past and will likely continue to fail. The fact that over 300 different vendors currently develop and market EMR software attests to the need for customization.

The need for pre- and post-sale customization is a reality in every practice since every practice operates differently. Even practicing physicians within the exact same specialty do things differently and run their practices differently.

A key challenge for systems with large installation bases is often that the system becomes rigid simply due to the vendor trying to please too many different practices. Customization gets repeatedly delayed or shelved altogether.

Another concern is that when medical records are stored on servers that Medicare can access and control as they please practices may be hesitant to use the system regardless of the benefits to the practices and their patients.

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

Even if Medicare did make it 100% free, a free EMR is not free if it fails. The costs involved with a failed implementation can far outweigh the costs of purchasing an EMR at market price due to productivity losses, and hardware and implementation costs.

Maybe Medicare could focus more of their resources in the development and promotion of better standards for integrating already proven EMR systems and integrating EMR systems with electronic personal health records, managed by the patient

Why not offer patients a free electronic health record which can easily interface to all the major EMR vendors in the market? Wouldn’t a record they control, that can communicate with all their health providers, and be accessed by any other provider in the event of an emergency be more beneficial?

After all, isn’t the patient’s best interest the goal of healthcare in the 21st century?

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For more information about EMR Experts, Inc. and their Medical Software solutions, please visit www.emrexperts.com

I get quite a few emails from people that are interested in having me write something about their company or website. I always welcome those emails as long as they are not spam to hundreds of websites. I must get 100s of emails asking me to buy lists of doctors. Do they really think if they keep sending me spam emails that I’ll finally change my mind and buy one of their lists. Never. I already have thousands of doctors reading my blog. I don’t need some snail mail method of communicating with doctors. I digress, but my point is that if someone wants to contact me, then they better use something that doesn’t look like spam and looks like they took time to look at my website.

Once such email did just that. I could tell it was more than the average spam. How many other people include EMR and HIPAA in an email subject line and body. No spammers I know. They asked me to review a new website that is suppose to help with software selection. I’m not sure if people realize this or not, but asking me to blog about your website doesn’t mean I’m going to say nice things. In fact, you can properly assume that I’m going to be as critical as possible. Sure, I’ll point out great things too, but my readers expect to get it straight from me. So I’m going to comment on whatever I see. Let me guarantee you that EVERY website has good and bad points.

It turns out that the afore linked to website called Software Advice has a really simple 3 question form you fill out and then it gives you a list of EMR software vendors. Wouldn’t it be nice if it was all that simple? Turns out that EMR selection takes a little more than 3 questions and a click of the submit button. This medical software advice website is nothing more than a nice way for them to gather referral fees from EMR software vendors. I’ll give them credit for that. It’s quite lucrative to refer people to EMR vendors. However, I think that it would take a pretty uninformed person to use this well presented website to start demoing EMR software. Here’s just a few of the problems I see.

First, Medical Software Advice is missing a TON of EMR software vendors. In fact, they’re missing some of the very best EMR software companies out there. Let me help them. Here’s a list of EMR software companies. Once you have all of these companies in your database, then you might get close to something. Until then, stop showing us a short list of EMR software companies that really just seem like they are the ones that are going to pay you to refer people to them. I did say seem, because I don’t know. I guess it’s also possible that you just hope to one day have relationships with these vendors, but even more reason why you shouldn’t have such a limited list.

Second, increase the number of criteria that you are using to determine a proper EMR software company. Three criteria can barely even be called a filter. However, even if you add more criteria, there are a ton of subjective elements that will make it hard to filter down to a small set. I think it’s possible to do a pretty good job, but you’re not even close. I have about 0 confidence looking at your initial offering that you’ll be able to create a quality filter using serious criteria. For the industries sake, I hope I’m wrong.

Third, I love how each of your EMR software products has a couple big buttons that say Free Demo and Pricing. First, I can guarantee that any commercial EMR software product is going to have a Free Demo and Pricing available to you. In fact, many will bend over backwards to get your business. They’ll do multiple demos, site visits (if you’re large enough), and entire RFPs to get your business. Just contact them directly and you’ll get all the attention you want. So, if Software Advice wanted to offer a good service, they’d stop linking us to forms that we could fill out at the EMR vendors website and start giving us actual information on EMR pricing (already partially done) and links to actual online demos of EMR systems (like this one).

I’m sure I could go on about a lot of other things, but I think that’s enough for now. I appreciate people who want to help increase the number and success of EMR selection and implementation, but as their website stands now, it seems much more like a referral engine to me.

For those of you who can’t afford a skilled EMR consultant to help you wade through all the litany of EMR companies, I’d suggest using the EMR selection tools at EMR Consultant. They are certainly far from perfect, but they have a hundred times better product offering than the website I list above. They actually include EMR’s that don’t pay them for referrals. What a novel concept.

Sorry if this post is a little harsh, but it gets under my skin when people try to act like something they’re not.

When I was replying to a comment made on my previous post, I came up with an analogy that was so good that I decided to make it into a post.

Here’s what some people might say about an EMR:

An EMR isn’t nearly as good as a paper chart, because I can’t draw my cute male and female symbols. (*This was an actual quote from someone I worked with)

Hearing something like the above made me think of this analogous statement:

A car isn’t as good as a horse, because a horse can go into tight places.

Of course we could come up with a number of reasons why a paper chart is better than an EMR. However, the same could be said about why having a horse was better than having a car. However, no one is wishing that we were riding horses around instead of cars.

There are pros and cons to everything we do, but I am certain that an EMR has more benefits than a paper chart just like cars have more benefits than horses. I don’t find people complaining about wanting to go back to the horse and buggy days. So, let’s stop wishing we were back in the paper chart days.

I personally have a theory on doctors selecting an EMR system. I call it “My Theory of 5.” It goes like this.

I believe that after a short discussion with a doctor’s office, I could give them a list of 5 EMR systems to evaluate. My guarantee is that Any of the 5 suggested systems can work for their doctor’s office. Furthermore, I also guarantee that every one of those 5 EMR systems will cause them a certain number of headaches and challenges. However, in the end if they are willing to adapt and learn the new system, they will be happy they decided to use an EMR.

It’s a pretty simple system that I’ve only used one time. That’s why I call it a theory. It worked well for the doctor that used it. I gave him a list of 5 systems to evaluate. We talked a couple times about the advantages and disadvantages of each system and he selected the system that he liked best. I didn’t personally care which system he chose, because I knew people who had successfully implemented all 5 systems. Therefore, he was just choosing which system he thought would best fit his style of practice.

Many people may note that this isn’t revolutionary. These people aren’t the ones that are just starting to evaluate the 1000s of EMR vendors out there. I guess the other option is to spend a year and countless hours evaluating hundreds of EMR systems just to have most of those people probably end up choosing one of the 5 EMR systems I would have recommended in the first place.

One Final Note: The theory of 5 will not work if a doctor isn’t fully committed to implementing an EMR. I’ve told a couple doctors that they weren’t ready for an EMR and so I wouldn’t work with them. Thankfully I have the luxury to do so. I could tell their hearts weren’t in it and so it wasn’t worth my time and effort to drag them kicking and screaming through the EMR process.

As I pointed out in my previous post on patients filling out forms electronically, it is absolutely essential that your EMR software supports a robust set of preferences for determining which forms a patient should fill out.

Let’s take three example forms to illustrate most of the needed options: HIPAA privacy form, Health History form, Consent for Pap Smear. All of these forms need to be filled out in different intervals.

HIPAA Privacy Form
I think that in most cases, the HIPAA privacy form is something that just has to be filled out one time. Once I’ve filled it out, then I don’t want to have to ever see that form again. What does this mean for the EMR self check in kiosk? That means the computer has to check my account and know if that form has been filled out already or not. Easy enough right. I check in for my appointment, the EMR checks to see if I’ve filled out a privacy form and presents the form to me if one doesn’t exist. No sweat…or is it.

Of course, you can’t forget about the case where the government decides to change HIPAA laws and so now you have to change your HIPAA privacy forms. Let’s assume you change this form on January 1, 2007. This now means that your EMR self check in kiosk needs to now provide the new HIPAA privacy form to anyone who has not filled one out since January 1, 2007. Can this be done? Of course, and it really isn’t that hard. However, it’s an important difference that must be planned for.

Health History Form
How often do you make your patients fill out a health history form? Some may only do it once and then never ask again. If that’s the case, then you can see my comments above on HIPAA privacy form. In our clinic (and I think most others), a health history form should be filled out every year [Emphasis Added]. My clinicians tell me it’s just good practice to get the history if it’s been more than a year, because you never know what else might have happened to them or their family in that time. Is this really possible with a paper chart? Not very easily. However, with a computer it’s no problem.

When a patient checks in for the appointment, the EMR self check in kiosk checks the patient’s notes for the last time they filled out the form called “Health History.” If the form is more than a year old, then the patient is prompted to fill out a new health history form. Of course, we’ve previously set a preference that the Health History form should have be filled out every year. Again, it’s not rocket science, but an important difference from the HIPAA privacy form.

Consent for Pap Smear
This form is even more difficult. Unless of course your EMR is like ours and requires you to use specific appointment reasons when scheduling an appointment. When scheduling an appointment our front desk will choose appointment reasons like Pap Smear, Wart Removal, etc. This makes it easy for the EMR self check in kiosk to quickly check the reason for the patient visit and require patients to fill out forms like the Consent for Pap Smear.

A few other points of note:

Minors: I could easily see an EMR self check in kiosk determining a patient’s age and displaying special minor consent forms for those that are under 18. We’ve solved this problem using conditional questions on our forms which I think I’ll leave for a future post if people are interested. Minors is another good reason to capture the electronic signature as opposed to just using some sort of individually identified login for a signature.

The Unseen Procedure: Often you won’t know if a patient needs to fill out a consent for treatment form until after they’ve seen the doctor. This is obviously a problem since they can’t just fill this form out when they check in for their appointment. We’re still working through this problem, but we’re either going to go with scanning a paper form or possibly some sort of portable workstation with signature pad. I sure wish that UMPC’s were a little farther along. I’ll let you know how it turns out. This could also apply to forms like birth control and the unplanned pap smear.

One thing that’s important to understand is just because you could sign the form electronically doesn’t mean that it’s always beneficial. Does it really matter if you have your consent for treatment or HIPAA privacy form in your EMR immediately? It’s certainly nice, but it’s not like someone’s going to go looking for it in the EMR the next day to see what was done. The EMR notes contain the time sensitive information. As long as it’s eventually scanned into the EMR, then some forms can wait. Of course, don’t forget to weigh the cost of scanning to the cost of signing it electronically.

In the end, there are a bunch of business and operational decisions that are required to make using an EMR self check in kiosk work properly.