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EHR Benefit – Eligibility for Pay-for-Performance

Posted on May 9, 2013 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.

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Eligibility for Pay-for-Performance
I think that this is a really scary topic for most doctors. It’s not that a doctor is afraid of being reimbursed for the way they perform. The problem with pay for performance (ACO if you prefer) is that we have no idea what that’s really going to look like. The unknown is scary and a real problem. A change as dramatic from fee for service to pay for performance is an enormous shift and we still have very little idea how that shift is going to happen.

However, as one person told me, “That train (the shift to pay for performance) has already left the station.” In fact, I was talking with the former CEO of a major EMR vendor and he suggested that the shift is going to happen a lot faster than most of us realize. If we assume that this shift is going to happen, then doctors and healthcare better be prepared.

I believe having an EMR will be the only way a clinic can participate in pay for performance.

I make this assertion, because how else are payers going to measure your performance if they don’t have the data on how you’re performing? I’ve never thought of this before, but the EMR could become the performance measurement tool for doctors. Trying to flintstone your performance in a paper world is just not going to happen. The data collected in an EMR (and possibly other software) is going to drive the performance metrics which will drive the payments.

Think about what that means to a clinic. If you don’t have an EMR, you will miss out on the pay for performance payments.

I imagine many that read this will discount the shift that’s going to happen. That’s a fair position to take, but one that I think will come back to bite you. If the shift in payments doesn’t happen, then you won’t have to worry. However, if the shift to pay for performance has left the station, then you’re going to be at a tremendous disadvantage.

Healthcare data is going to drive a lot of things in the future of healthcare. Pay for performance is one of those things. Physicians who don’t have that data available in an EMR or other electronic format are going to face stiff challenges.

EHR Benefit – Eliminate Staff

Posted on April 30, 2013 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.

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Eliminate Staff
The idea of eliminating staff is a really hard one to talk about. Often the staff in a medical office becomes a family and so it’s really hard to think about losing a staff member in order to pay for the EMR. In fact, it’s incredibly common for staff in a clinic to fear an EMR implementation because they’re afraid that their job is in jeopardy.

From my experience, it’s incredibly rare for any existing staff to lose their job during an EMR implementation.

There are two main reasons why it’s unlikely that someone will lose their job because of an EMR implementation. The first is that most healthcare organizations have a natural employee attrition. When this happens the organization can just choose to not replace the departing employee. This is one way to save money on staff without having to actually fire any employees.

The second reason that people don’t lose their job to the EMR is that those people get reassigned to new jobs. For some people this can be nearly as bad as losing a job, but for many it’s basically a shift in job responsibilities. This shift can often be welcome since the EMR implementation can free them up to do work that they always wanted to do and never were able to do before.

The areas of healthcare that I’ve seen most affected by an EMR implementation is medical records, transcription, billing, and the front desk. We’ve already written previously about transcription and EMR. The front desk and billing can be affected, but generally stays close to the same from what I’ve seen. A lot of this depends a lot on what type of staffing you had before the EMR. I have seen some organizations implement an EMR and save money on front desk and billing staff.

Medical records (or HIM if you prefer) is usually the most impacted. Certainly they still have an important place in the office for things like release of records and other records management functions. They also have to continue to deal with the legacy paper charts. However, their days of finding, organizing and filing charts are over when an EMR is put in place. In some cases the chart organizing and finding gets replaced with things like scanning into the EMR. In other cases, there isn’t as many medical records staff needed.

Many who are reading this post are probably balking at the idea of eliminating staff being a benefit of an EMR implementation. They’d no doubt point to the EHR backlash that we see from many doctors who complain that an EMR makes them much slower and takes up too much time. This is an important item to consider when evaluating the benefits of an EMR in your organization. It’s not much of a benefit to save other staff cost if the doctor spends twice as much time per patient.

However, on the other side of the coin is those doctors who swear by the efficiency their EMR provides them. I’ll never forget this older OB/GYN I met who told me he would NEVER use an EMR. Two years later that same OB/GYN was proclaiming his love of EMR. He described how he wouldn’t be able to see nearly as many patients as he did each day without the EMR. He acknowledged the slow down that occurred when they first implemented the EMR, but once they adapted to the EMR workflow they were able to see most patients.

No doubt Eliminating Staff can be a mixed EMR benefit basket depending on your unique situation. Although, this is true with almost every EMR benefit we’ll cover in this series. This can be a tremendous benefit of EMR or it can also be an expense as you find you need to hire more staff.

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EHR Benefit – Space Savings

Posted on January 30, 2013 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.

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Space Savings
I’ve heard many clinics use the space savings as a great way to justify the cost of their EHR. This works better in the small physician office market than it does in the hospital market, but the principles are similar. However, the scale is different.

The obvious space savings is the storage of all the paper charts. While many clinics are quite creative in how they’ve stored paper charts (see the walls around the front desk of many clinics), the most common storage is a chart room dedicated to the storage of all the paper charts. Each state has its own requirements for the retention of paper charts, but its usually somewhere in the neighborhood of 6 years. 6 years of paper charts amounts to a lot of storage space. Plus, many doctors I know keep their paper charts well beyond the required retention period (the liability of doing so is a different discussion).

There are many different approaches to dealing with your paper charts during an EHR implementation. Many continue referencing and pulling the paper chart, but just start any future documentation in the EHR. Others scan the patient charts for the following day’s appointments. Others choose to only scan parts of the paper chart similar to how they use to “thin” the paper charts. In each of these situations, the space savings will start to accrue over time, but you won’t experience a big space opening up right away.

One way that some clinics gain space is by moving the charts from a very accessible place to one less accessible. As you move to EMR, there isn’t as much of a need to access the old paper charts and so you can often optimize your space in a way to free up the previous paper chart storage space and move the paper charts to a different space in your office.

Another option many clinics are doing is outsourcing the scanning of all their old paper charts to an outside company. While not the topic of this post, the cost and quality of such outsourced scanning has made it a really attractive option for many clinics. Many chart scanning companies will even do clinical data abstraction as I’ve written about before. In this case, all of your paper charts get scanned into digital form and you no longer have any paper charts storage needed at your office. It’s always amazing to see an entire room full of paper charts sitting on a little hard drive.

I’ve heard of clinics use the previous chart storage space in a variety of ways. The most interesting is when the previous chart storage space is turned into an exam room(s). This extra exam room can allow a clinic to see more patients or even hire another provider who sees patients in their clinic. In this current fee for service environment, that translates directly to dollar signs for the clinic. If you can achieve this during your EHR implementation, it’s a great way to justify the cost of the EHR and is a tremendous financial benefit to consider.

In other cases, the chart room is turned into an office for the billing staff, practice manager, nurses, or doctor. Doing so can’t easily translate to a specific dollar amount, but can also lead to valuable benefits such as employee satisfaction, quality of care, quality of billing, etc.

Saving space isn’t always a result of implementing an EHR, but it can be in many EHR implementations. So, consider how the chart storage space can benefit your clinic.

EHR Benefit – Transcription Costs Savings

Posted on January 18, 2013 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.

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Transcription Costs Savings
When I first writing about EMR (yes, it was only called EMR at the time), this was probably the biggest reason that doctors gave for implementing an EMR in their office. Doctors looked at their transcription costs and saw EMR as a great way to replace those transcription costs. Or at least the doctors could use the transcription cost savings to pay for the EMR.

This has proven true for many doctors and no doubt was the financial mechanism that many practices used to go electronic. In fact, I always wondered if the transcription world was on a final death march thanks to EMR. My view of transcription has greatly evolved over the years. In fact, I think we’re seeing a resurgence of transcription in healthcare.

The reason for the renewed interest in transcription is because a large number of providers that start using EHR are tired and overwhelmed by the “number of clicks” that are required by an EHR. When a doctor reaches this point, there immediate reaction is “EMR is so much slower than transcription” or the related “I miss my transcription.”

I always found EMRs that facilitated transcription a little odd, but considering the above trend they might be well positioned to capitalize on those doctors who want to use transcription with their EHR. Plus, the transcription industry is shifting as well. They’re moving quickly away from just being simple transcriptionists to embracing coding and other ways to assist in the clinical documentation process. Considering the complexity of ICD-10, this might be an interesting opportunity.

What does seem clear is that doctors will be more and more interested in ways to streamline the EMR documentation process. I won’t be surprised if many doctors choose transcription as a way to accomplish this goal. Although, I’m not sure this will be the case with new doctors. Transcription has its own learning curve and I don’t see many new doctors who don’t have transcription experience going that direction.

In the end, it’s hard to really say whether transcription cost savings is an EHR benefit. In many cases it could be. Certainly the shrinking transcription industry would agree that many doctors are saving money on their transcription costs. Although, it depends on the clinic and whether they cut out their transcription when they implement their EHR. While we might see some return to transcription, I expect that long term the transcription industry will need to evolve or die as most next generation doctors won’t even consider the idea of transcription.

EHR Benefit – Accessibility of Charts

Posted on January 10, 2013 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.

It’s time for the second installment in my series of posts looking at the long list of EHR benefits. In case you missed the first post, go and check out the EHR benefit of legible notes.

Accessibility of Charts
The second EHR benefit is similar to the Legibility of Notes benefit in that it is easily forgotten as a benefit to EHR and it can be hard to quantify the value of the benefit in dollar amounts. Plus, it is really easy to see how nice accessible charts are to an organization.

There are a number of ways to look at the EHR benefit of accessible charts. The most obvious one is when you think about the number of times a chart has gone missing in a clinic. In most cases, the chart isn’t really missing. It’s in the clinic somewhere, but no one can find it. Remember all those special places that a chart could hide: exam room, physician’s desk, front desk, nurse’s desk, lab sign off box, physician’s car, hospital, physician’s home, etc etc etc. Oh yes, I didn’t even mention HIM not being able to find the chart because someone (probably someone other than HIM) misfiled the paper chart.

I’m sure most HIM people who read this will have a visceral reaction. I’m sure many are likely thinking, “But we do an amazing job keeping track of all those paper charts.” I agree with them 100%. A good HIM person has done an amazing job keeping track of paper charts. It would be 100 times worse if they weren’t there. The problem is that if a dozen people are using the paper chart, the reality is that charts are going to go missing.

Now think about the concept when it comes to EHR. None of those lost chart locations exist. The nurse can’t accidentally take the chart and forget to file it. The doctor can’t forget the chart at home or in his car. No one can misfile the chart.

Think about it. An EHR solves 100% of the problem of missing paper charts.

Besides misplaced paper charts, the idea of chart accessibility is an important one when you consider the idea of accessing an EHR remotely. Even if you use a less than ideal remote desktop solution, a physician can access an EHR anywhere they have an internet connection. For web based EHR, you get exactly the same experience accessing the EHR remotely as you would in the office.

I’ve heard horror stories (at least their pretty horrible to me) of doctors getting late night patient calls which require them to get dressed, go into the office, open the medical records room to access a patient chart. With an EHR, that same workflow has the doctor booting his computer and logging into the EHR. This doesn’t apply to all doctors, but for those that do it’s a dramatic difference.

The biggest fear I’ve heard from doctors in this regard is they often equate chart accessibility with their accessibility. The argument goes that if they can access the chart 24/7, that it also means they have to work 24/7. I think this is a myth that doesn’t match most realities. Just because you had a key to your office and could go and work on paper charts 24/7 doesn’t mean you had to do it. The same is true with remote access to EHR. You choose when is appropriate and important to access and work on the EHR and when not to do so.

The key difference between EHR and paper charts is that when you do want to access a patient’s record remotely you have that option available to you. That doesn’t mean you always have to do so, but it is nice to have that option available.

When talking about EHR accessibility, I think also about the landscape of connected mobile devices (smart phones, tablets, etc). All of these devices are connected to the internet at all times and could provide a doctor access to their EHR almost anywhere in the world. Try doing that with paper.

The problem here is that most EHR don’t do well on mobile devices. Remote desktop from a smart phone or tablet works, but is a pretty terrible user experience. A native mobile app provides a much better experience for users, but we’re still in the early days of EHR mobile app development. As this matures, the accessibility of charts will become an even bigger EHR benefit.

EHR Benefit – Legibility of Notes

Posted on December 12, 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.

I’ve hinted for a little while that I was going to start a series of posts talking about the various benefits of using an EHR. I think this is an important subject worth discussing in greater detail. I hope that this series of posts will also help us move past meaningful use of an EHR for the government EHR money and explore all the other reasons why healthcare should fully adopt an EHR.

Back when I first started blogging about EMR software (It was 2005, before the term EHR came to be), I made this list of EMR and EHR benefits over paper charts. I’ll be using that list as the starting point for this series of EHR Benefit posts. I love the first paragraph on that page (which I likely haven’t touched since 2005):

This list is just a starting point to list off all the possible benefits of having an EMR or EHR. Probably a poor one, but a start nonetheless. My plan is for this list to grow over time as I think of new benefits or as people suggest things I’ve most certainly missed. Also, I think that most people often focus too much on the financial benefits of an EMR and so hopefully this list will include financial and other benefits beyond the financial implications.

The list definitely did grow, but I guess I never got around to updating the intro paragraph. Although, I am pleased to see that even back in 2005 I was as interested in the non-financial benefits of EHR. Certainly the financial benefits of EHR are incredibly important, but far too many people don’t take into account the other non-financial benefits in their analysis of EHR benefits. It’s just too hard for many to try and compare or put a value on the non-financial benefits of EHR. We’ll try to point these benefits out just the same.

Now for the first EHR benefit on the list:

Legibility of Notes
I’m really glad to start with an EHR benefit that everyone can understand with little explanation. Poor medical handwriting has been a running challenge in healthcare for as long as we’ve been documenting patient visits. I did a quick search on Google for “write like a doctor” and it had about 321 million results. That’s quite pervasive.

I can’t think of anyone that would argue that healthcare doesn’t have a challenge reading physician’s handwriting. No doubt there are plenty of exceptions to this, but even those with beautiful handwriting still have to read other doctors’ handwriting from their own office or from other doctors’ notes that get sent to their office. It’s great to have the notes, but if you can’t read them then what’s the point.

While certainly illegible handwriting is a major problem in the office, it also extends outside the office as well. Think of all the times pharmacists have had to call a doctor to clarify the prescription a patient brought in. Even worse than that is the number of times the pharmacist misread a script because a doctor’s handwriting is illegible. This becomes a non-issue in an electronic world where the prescription is either printed or ePrescribed.

Of course, none of this is new territory. Every doctor understands these benefits better than I’ve explained here. However, far too often when we think about implementing an EHR, we forget about these simple and easy to understand benefits. How much time is saved in your clinic by being able to read the handwriting in the chart? How much time is saved in healthcare when referrals come in an easy to read, legible format? How much time and how many lives are saved by pharmacists getting the proper prescription to the patient? All of these are hard measures to quantify, but they are real, tangible benefits of an EHR.

I won’t mislead you into thinking the shift from paper charts to EHR solves all the legibility problems. Many template driven EHR software that creates a mass of mostly irrelevant data can be just as hard to decipher as the hieroglyphic handwriting of some doctors. However, I’ve seen a tidal wave of push back against these documentation approaches and I think we’re getting better. I think the shift to quality of care reimbursement versus procedure based reimbursement will help this to go away as well.

There are other things a clinic leaves behind with paper charts. I’ve heard many tell me how many times they looked at the handwriting to recognize who had documented something in a paper chart. Certainly that same info is available in an EHR, but you do lose the instant recognition of who charted what in the chart.

Despite not being able to put a nice dollar value on the Legibility of Notes, it’s certainly an EHR benefit that can’t be forgotten. It’s very easy to adopt an EHR and take this for granted.