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Study: Doctors Favor Integrated EMR, Practice Management System

Posted on September 13, 2013 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.

While large institutions may not be jumping onto cloud-based technologies — or admitting it, in any event — the majority of doctors in a new Black Book survey are gung-ho on cloud solutions to their revenue cycle management dilemmas, according to a new piece in Healthcare IT News.

A new Black Book study, “Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors,” surveyed more than 8,000 CFOs, CIOs, administrators and support staff for hospitals and medical practices.

The research has concluded that 87 percent of all medical practices agree that their billing and collections systems need to be upgraded, HIN reports. And the majority of those physicians are in favor of moving to an integrated practice management, EMR and medical software product, Black Book concluded.

According to Black Book rankings, the revenue cycle management software and services industry just crossed the $12 billion mark, pushed up by reimbursement and payment reforms, accountable care trends, ICD-10 and declining revenues.

Forty-two percent of doctors surveyed said that they’re thinking about upgrading their RCM software within the next six to 12 months. And 92 percent of those seeking an RCM practice management upgrade are only planning to consider an app that includes an EMR, Healthcare IT News said.

It’s no coincidence that  doctors are trading up on financial tools. Doctors are playing catch-up financially in a big way, with 72 percent of  practices reporting that they anticipate declining to negative profitability in 2014 due to inefficient billing and records technology as well as diminishing reimbursements. (On the other hand, it’s not clear why doctors aren’t still seeking best-of-breed on both the EMR and PM side.)

While selecting an integrated PM/EMR system may work well for practices, it’s going to impose problems of its own, including but not limited to finding a system in which both sides are a tight fit with practice needs. It will be interesting to see whether doctors actually follow through with their PM/EMR buying plans once they dig in deep and really study their options.

The EMRs You Don’t Hear About

Posted on September 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.

Cutting Down On EMR Clicks

Posted on August 16, 2013 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.

Few things frustrate clinicians more than having to engage in a long string of clicks to get their EMR work done. But according to a piece in Health Data Management, medical practices can take a series of steps that will gradually reduce the number of clicks practitioners need to execute to do what they want to do.

Contributing writer Katherine Redmond offers a list of changes practices can make which can address some problems with excess clicks without having to get programmers involved:

* Change administrative settings

Many independent ambulatory practices retain significant control of administrative EMR functions, which allows them to tailor some functions to their needs, Redmond notes. For example, she says, most EMRs let users select defaults for specific fields, saving users from  having to pick an option each time.

* Change system configuration

After the practice has used the EMR for a while, and identified areas in which workflow is less than ideal, it’s time to find ways to save time and energy. One way to do this, she suggests, is to develop pick-lists which allow the most commonly selected items to appear at the top. Another possibility is to research the availability of user-defined or custom fields, which can make information accessible that might have otherwise only been available on a distant screen.

* Schedule regular training

To optimize practice workflow, practices should take advantage of  the training resources that come with the EMR, which often include webinars, live chat sessions, videos or customer service calls, she points out. To maximize the benefit of training time, she suggests, there are several options, including pre-scheduling an hour a week or every two weeks to have a call with the vendor, asking the vendor to demonstrate new features, and asking vendor reps to brainstorm methods of streamlining workflow.

In this blog item, I’ve given you a taste of the recommendations Redmond made, but the article has several more to share — I recommend you look at it directly. The bottom line seems to be that practices have more power than they might think to customize their EMR experience and workflow to minimize clicks. Good to know that you don’t have to develop your own EMR to get more of what you want from your system.

Things Your EMR Will Never Do

Posted on August 15, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMRs can be powerful tools for building practice efficiency.

But they can’t do it all.

Ruth Sara Hart-Schneider, sales and marketing director for Cincinnati-based Salix, says health care providers are still paying too many people to move too much paper. Her firm helps them to fill the gaps left after even the most successful EMR implementation.
Ruth Sara Hart-Schneider is sales and marketing director for Salix
Salix specializes in workflow automation, business process outsourcing and litigation support. Health care makes up about 30 percent of its workload.

Hart-Schneider works with physician practices, hospitals and a variety of other health care clients, such as durable medical equipment firms and clinical research organizations. She deals with 26 EMR systems.

Note: If you catch her hanging out by your fax machine, don’t be alarmed. It’s part of her job.

Here’s what Hart-Schneider had to say:

Can you explain more about what your company does in health care IT?

We support health care companies in leveraging the electronic data they already have. We help them to avoid having redundant systems or people hand-filling forms or electronic systems generating paper systems. We work around the electronic systems in an office, like EMRs and practice management systems. Usually an office will have both, but there are all these other functions that have been left on the table.

What are some examples?

Most EMRs we deal with are not set up for prior authorization requests. And every state has its own forms for different programs — Medicaid HMOs, workers’ compensation. Particularly for practices dealing across state lines, it becomes cumbersome for the staff. EMR companies don’t want to program all these forms for all the states, and they change constantly anyway. That’s a sweet spot for us. Prescription monitoring is another one if the practice is giving many narcotics. Also, EMRs don’t interface with many of the tools the carriers have out there for eligibility, benefits and claims status. Some other areas are disability, return-to-work forms, immunization logs for pediatrics and certificates of medical necessity for things like wheelchairs and oxygen.

When practices invest in EMRs, do they realize how much they’ll still need to do on paper?

They’re trying to meet meaningful use. When they choose a system, they know what it will do. It’s not a tool to manage your office. Still, people get frustrated with how many repetitive tasks their employees have to do even after all this money has been spent. For example, a group had a pulmonary function testing machine that wouldn’t talk to the EMR. They would print the report and then walk over and scan it into the EMR. A lot of equipment is like that.

How do you identify the inefficiencies in a practice?

If you stand by the fax for 10 minutes and watch what comes through, you’ll have a pretty good idea. You can also look around at the stacks of paper. You can ask people what they’re behind on.

How do you help?

Salix will work with an organization to help them identify their biggest pain points and then customize a solution that will free up staff time and save them money. We look for the best tools for each application. We like FileBound, which has an ASP model product that meets all the HIPAA security requirements, has a very reasonable price point and allows unlimited users without user fees.

Among our services: We can help with the auto-population of forms, we can provide data-entry services for labs and test results that are faxed in and we can help provide interface solutions for equipment that’s not hooked to the EMR. For a surgery practice, as one example, we can help design and implement systems so that the manager can look at tomorrow’s schedule and ensure that all pre-certs have been completed.

How important is it to address these areas?

Most often, there are higher-level tasks that aren’t getting done because staff is bogged down in some very menial, basic and repetitive tasks. You don’t need your nurse spending time on data entry or filling out school forms.

Is it realistic for a practice to go completely paperless?

Yes, but not in the near future. You couldn’t do it yourself. Vendors and everyone else that you deal with would have to be paperless, too, and that’s not happening. Many of the nursing home and hospice operators I talk to say they’re not going electronic because they don’t have the money. I think some things will always come in on paper.

Is The Cloud The Best EHR Model For Small Practices?

Posted on June 5, 2013 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.

Over the last few years, the use of EMRs in medical practices has grown dramatically, with over 50 percent of office-based physicians now using such systems.  However, physicians still face major barriers in adopting EMRs, including costs, usability issues and impacts on doctor productivity.

One way of reducing the complexity of EMR installations — doing more for less — is to go with a Web-based model of EMR  use, argues “The Cloud: The Best EHR Solution for Small Practices.”

This model, also known as “software as a service” (SaaS) stores patient data in the cloud, accessible from any secure device connected to the Internet.

Not only does the cloud/SaaS model make it easy to access patient data,  it saves practices having to come up with a large up-front installation fee to set up software on site. Instead, practices pay a monthly fee which is predictable (and usually, manageable).

The price difference is very striking. The average cost of a client-server implementation over five years ranges from $30K to a whopping $80K per provider, not including the cost of training, interfaces, patient portals and conversions from other systems, the white paper notes.

But cost isn’t the only reason for small practices to go with a cloud/SaaS EHR. Increasingly, physicians are going mobile with care, via smartphone and tablet. As the Bring Your Own Device phenomenon explodes, practices are going to want an EHR which can easily be accessed and used via the Internet.

Read this paper to learn more about mHealth and how a cloud/SaaS solution can support your small practice’s mobile strategy while protecting critical data offsite in the event of a disaster; being sure that your data is encrypted at rest as required by Meaningful Use; and even how doctors can use voice to chart notes.

Of course, there are many who still argue against a cloud based EHR. They have their reasons that are worthy of consideration. An in house client server EHR does have its advantages over SaaS EHR. You have to weigh the pros and cons of each. Then, you can make a great decision for your organization.

Problems EMRs Don’t (Necessarily) Cause

Posted on January 29, 2013 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.

In publications like this one, we spend a lot of time and energy clubbing EMRs and EMR vendors for the problems they cause.  That’s all well and good, but it’s also worth remembering that some of the big problems surrounding medical operations may not be due to EMR use:

* HIPAA carelessness:  When someone shouts private medical information across a room, or loses a flash drive or tablet with records on it, or leaves patient records in a public place, you’ve probably got a nasty HIPAA violation. But the EMR almost certainly had nothing to do with it.

* Clumsy office workflow:  Sure, introducing an EMR into a clinical setting can screw up existing workflow. But was it working well in the first place?  For those whose business falls apart post-EMR, I’d argue “no.”  Businesses that don’t do well after an install had jury-rigged processes in place already, I’d argue.

* Patient care slowing down:  As with staff workflow, clinical workflow can be discombobulated — badly — by an EMR installation. Learning to fit practice patterns to the system is a big job for most clinicians, and they may slow down significantly for a while. But if the patient care flow stays “broken” it’s likely that there were aspects of the pre-EMR system that didn’t work.

I realize that I might get flamed for saying this, but I’m pretty confident that a goodly number of problems that are laid at the feet of dysfunctional EMRs don’t belong there.  And that’s not a good thing.

After all, there are enough poorly designed, trouble-ridden EMRs out there to keep us busy critiquing them for a century or two.  Why distract ourselves by adding more to the pile when the real issues may be elsewhere?

Disaster Planning and HIPAA

Posted on November 20, 2012 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.

When talk turns to HIPAA, most of us are focused on privacy compliance.  After all, privacy is a complex, expensive nightmare, and few hospitals or medical practices feel up to the task, so talking through those issues makes sense.

But as blogger Art Gross points out, the HIPAA Security General Rules require more than protecting a patient’s privacy. They also require that ePHI remains available even in the face of disaster. From the rules (courtesy of Gross, emphasis his):

§ 164.306 Security standards: General rules.
(a) General requirements. Covered entities must do the following:
(1) Ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.

Apparently, far too few healthcare providers are paying enough attention to this part of the rules. Gross, who is a HIPAA security consultant, says that when he audits organizations, few have disaster recovery or emergency operations procedures in place.

Now, big enterprise IT departments aren’t going to leave disaster recovery out of their planning; it’s simplly part of the drill for any large installation. But the smaller the provider group gets — particularly when you zoom down to one to three-doctor practices — the story changes.

As people who read blogs like this one know, smaller practices aren’t likely to have so much as a single IT staffer on board. Keeping their EMR up and running is enough of a burden. I’m not at all surprised to hear that they aren’t prepared for disasters like Hurricane Sandy, which brought down even large medical centers.

But with HIPAA demanding immediate access to ePHI, doctors won’t have a choice much longer. And hospitals will want to make sure independent doctors aren’t the weak link in the availability chain.

Yes, it’s asking a lot of small practices to make intellligent disaster recovery plans for their EMR, and even more of their hospital partners if they want to keep access to disparate EMRs out there.  But there’s just no getting around the problem.

Clinician Adoption of Healthcare Tech, Patient Satisfaction, and Safety: #HITsm Chat Highlights

Posted on November 3, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: What are keys for successful, sustained clinician adoption of healthcare technology?

Topic Two: How can we improve patient satisfaction? #patientexperience

 

Topic Three: What is #healthIT’s role in patient safety?

 

Topic Four:  When is a low-tech solution better than high-tech?

A Smart Approach To Medicine And Social Media

Posted on August 29, 2012 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.

It’s always a pleasure to touch base with the thoughtful blog  (33 Charts) written by pediatric gastroenterologist Dr. Bryan Vartabedian. This time, I caught a piece on how Dr. Vartabedian handles social media communication with patients, and I thought it was well worth a share.

While your mileage may vary, here’s some key ways Dr. Vartabedian handles medical contact online with consumers:

* He never answers patient-specific questions from strangers

As he notes, people generally ask two kinds of questions, patient-specific and non-patient specific. While he’s glad to answer general questions, he never answers patient-specific ones from strangers, as it could be construed that he’s created a professional relationship with the person asking the question.

* He guides patients he’s treating offline

If an existing patient messages Dr. Vartabedian, he messages back that he’d be happy to do a phone call. He then addresses their concern via phone, while explaining to patients how both he and they could face serious privacy issues if too much comes out online. Oh, and most importantly, he documents the phone encounter, noting that the patient who reached out in  public.

* He flatly turns down requests for info from people he loosely knows

The only exception he makes is for family and very close friends.  In those cases he arranges evening phone time and spends 45 minutes getting facts so he can offer high-quality direction.

I really like the way Dr. Vartabedian has outlined his options here — it’s clear, simple, and virtually impossible to misunderstand.  It’s hard to imagine anyone being offended by these policies, or more importantly, having their privacy violated.  Good to see!

If you’re a doctor how do you handle your social media interactions with patients?

Where is the Value in Health IT?

Posted on August 10, 2012 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 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

What a powerful question that I think hasn’t got enough attention. Everyone seems to be so enamored with EHR thanks to the $36 billion in EHR incentive money. I seem to not be an exception to that rule as well. Although, at least I was in love with EHR well before the government started spending money on it.

While so many are distracted by the government money I think it’s worth asking the question of where the value is in healthcare IT.

Practice Management software has a ton of billing benefits. Is there a practice out there that doesn’t use some sort of practice management software? I don’t know of any.

Health Information Exchange (HIE) has a ton of value for reducing duplicate tests. Certainly we have challenges actually implementing an HIE, but the value in reducing healthcare costs and improving patient care seems quite clear. Having the best information about someone clearly leads to better healthcare.

Data Warehouse and Revenue Cycle Management (RCM) has tremendous value. RCM is not really sexy, but after attending a conference like ANI you can see how much money is on the table if you deal with revenue integrity. I add data warehouse in this category since they’re often very closely tied together.

Since this is an EHR site, where then does EHR fit into all this? What are the really transparent benefit of using an EHR. I know there are a whole list of EHR benefits. However, I think it is a challenge for many doctors to see how all of those benefits add up. EHR adoption would be much higher if there was one big hair benefit to EHR adoption. Unfortunately, I don’t yet think there’s one EHR benefit that’s yet reached that level of impact. I hope one day it will. Not that it matters right now anyway. Most practices wouldn’t see the benefit between the EHR incentive weeds.