Welcome to EMR and HIPAA

Some people have asked me how I rate the EMR I work with every day. I can’t bring myself to do it. It’s unfair to me and the people I work with. It’s not that I don’t have strong feelings about my EMR. I really do. I know the pros and cons, the ins the outs, and everything in between. However, it’s just hard rating my EMR and hopefully I can help you understand why.

My job is to implement this EMR the best way possible. That’s what I do. It doesn’t matter if it’s good bad or ugly. It’s counter productive for me to rate how good my EMR is. It is what it is. I haven’t been assigned the task of selecting an EMR. I’m not paid right now to see what other EMR vendors might be better than the one I have. I’m paid to do my very best at implementing the EMR that was chosen.

I don’t want to sound harsh here, but I think that many of the EMR failures are due to people worrying too much about what other EMR software can do and not enough about what their EMR software can do. The question shouldn’t ever be, can our EMR software do this? Instead you should ask, “how can we do this with the EMR software we’ve chosen?” This is two very different perspectives that reap very different results.

I’m not talking about someone who is in the process of selecting an EMR. I’m talking about someone who has already selected an EMR. It reminds me about one of my favorite quotes about marriage that says, “When you’re dating keep both eyes wide open, when you get married keep them closed.” You could just as easily say, “When selecting an EMR keep both eyes wide open, but once you’ve chosen an EMR keep both eyes closed and make the most of it.”

Of course, one thing I can’t help doing is answering people’s questions about EMR. I’ve had dozens of people call me about my EMR and I just love talking to them about the benefits, challenges and hassles of my EMR.

I just completed my very last class of my educational career (I’ll graduate with my Masters in IS on Saturday. Yeah Me!). My last class was a Business Intelligence class. While I wasn’t necessarily fond of this class or the teacher, I am definitely interested in business intelligence.

Business Intelligence to me is really just about being able to look at large amounts of data in really cool ways. EMR is basically synonymous with the concept of large amounts of data. Each and every day thousands of really interesting pieces of information are being entered into an EMR. Many times this data is organized in such a way that in can be easily accessed and reported on.

For my class, we’ve been using SQL Server 2005’s business intelligence components. While Microsoft may have its downfalls, they really have put some thought and effort into SQL Server 2005’s BI components. For my final project, I decided to extract some appointment data from my EMR (yes, I guess it’s really my PMS, except for things like the room for the appointment) and run some BI analysis on the EMR data.

I actually had to anonymize all the EMR data before using it, because I was working in a group where they weren’t allowed access to all the HIPAA related information. However, it wasn’t too big of a deal in the end. Although, it does lose some of the reporting ability when you do that.

Since we ended up only pulling out simple appointment data from the EMR database, we could only really run reports about appointments. Don’t get me wrong. There is some really cool stuff you can report on appointments. We reported on appointments by date (this includes day, month, quarter, year, etc), provider, gender, birthdate, ethnicity, etc. We also uploaded the room number that an appointment used so that we could measure the utilization of our exam rooms. Luckily our EMR stored all the information about exam rooms. We also pulled in the data that described when a patient arrived at the clinic, when the nurse started the intake and when the provider finally saw them. We haven’t actually built any reports on that time study data, but it would be really interesting.

That’s really just the beginning of what we were able to do with the EMR data, but I think you get the point. The real question at this point is what other EMR data could benefit from some quality BI analysis? Here’s a few of my thoughts:

-Blood pressure - Depending on how this is stored will determine how easy it is to report. However, it would be really interesting to see trends in blood pressure across our entire population. Add in a few filters for certain medications and you could see some amazing results
-Average Charge per Patient - Could be interesting to look at this and identify which patients are the most profitable. Wait, doctors aren’t about profit are they?
-Average Number of Visits per Patient - Would be interesting to see this grouped too.

Those are just a few off the top of my head. I’m sure there are a hundred more that could be done with diagnosis, prescriptions, charges, procedures, referrals, etc etc etc. Which reports would you find interesting from the data in your EMR?

The best part of this all is that in the next couple weeks I have planned to upgrade my EMR from SQL Server 2000 to SQL Server 2005. That means that I could really easily use all th SQL Server BI tools to create the various BI reports with all the data in my EMR.

Has anyone else done this type of EMR reporting before?

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’m currently attending the PCCHA conference which is basically the college health association conference for the west coast. The conference has been quite interesting. A few of the sessions ended up being quite useful, but more than anything it was just fun for me to talk to all of the various people working in the college health community. Most of my conversations centered around EHR and EMR implementation, but it was also fun to see these other college health professionals jealous of the really state of the art facilities we have on our campus.

My presentation on EMR went quite well and I think that many of the people in the audience got some useful information. At least that’s my hope. It was fun to present on EMR and the things we’ve learned. The interesting thing for me was that as I talked to people about EMR and EHR and using it in college health, I realized that over the past two years I’ve really learned a lot about what it takes to implement an EHR into a clinic. It can certainly be a daunting task if you look at all the intricacies.

In the end, my message to most of the people that I talked to was that while implementing an EHR can be overwhelming, it’s important to take small bite size pieces of it and accomplish those. Then, move on to the next problem and the next. The reality is that 2.5 years after implementing our EMR system, we’re still adding, modifying and changing our processes to be more effective.

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.

The day is fast approaching for me to present at the Pacific Coast College Health Association conference in Hawaii. In fact, I have less than a month to finish my preparations. I feel pretty good about my ability to present and also my knowledge of EMR, but presenting something always gets my nerves going. I think once I get started talking about EMR, then I won’t be able to stop. My real hope is that the people that attend my session will be interested in what I have to say, find it useful and ask good questions. Honestly, a part of me really wishes that I was a member of a panel where I just answered questions about EMR. I think that would be a lot of fun.

Since it’s not a panel, then I’d love to hear any feedback from people on things I should include in my presentation about “Lessons Learned from EMR Implementation.” I have a ton of things already planned about EMR implementation, but I’m sure there are some important things that I’ve missed. Time has a way of doing that to you.

Either way, I’ll be happy if one person in my session on EMR goes away saying they were better prepared to implement an EMR system, then I’ll be happy.