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E-Patient Update: Don’t Give Patients Needless Paperwork

Posted on July 6, 2016 I Written By

Anne Zieger 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.

Recently, I had an initial appointment with a primary care practice. As I expected, I had a lot of paperwork to fill out, including not only routine administrative items like consent to bill my insurer and HIPAA policies, but also several pages of medical history.

While nobody likes filling out forms, I have no problem with doing so, as I realize that these documents are very important to building a relationship with a medical practice. However, I was very annoyed by what happened later, when I was ushered back into the clinical suite.

Despite my having filled out the extensive checklist of medical history items, I was asked every single one of the questions featured on the form verbally by a med tech who saw me ahead of my clinical appointment. And I mean Every. Single. One. I was polite and patient as I could be, particularly given that it wasn’t the poor tech’s fault, but I was simmering nonetheless, for a couple of reasons.

First, on a practical level, it was infuriating to have filled out a long clinical interview form for what seemed to be absolutely no reason. This is in part because, as some readers may remember, I have Parkinson’s disease, and filling out forms can be difficult and even painful. But even if my writing hand was unimpaired I would’ve been rather irked by what seemed to be pointless duplication.

Not only that, as it turns out the practice seems to have had access to my medication list — perhaps from claims data? — and could have spared me the particularly grueling job of writing out all the medications I currently take. Given my background in HIT, I was forced to wonder whether even the checkbox lists of past illnesses, surgeries and the like were even necessary.

After all, if the group is sophisticated enough to access my medications list, perhaps it could have accessed my other medical records as well. In fact, as it turned out, the primary care group is owned by the dominant local health system which has been providing most of my care for 20 years. So the clinicians almost certainly had a shot at downloading my current medical data in some form.

Even if the medical group had no access to any historical data on my care, I can’t imagine why administrators would require me to fill out a medical history form if the tech was going to ask me every question on the form. My hunch is that it may be some wrongheaded attempt at liability management, providing the practice with some form of cover if somebody failed to collect an accurate history during the interview. But other than that I can’t imagine what was going on there.

The reality is, physician practices that are transitioning into EMR use, or adopting a new EMR, may end up requiring their staff to do double data entry to one extent or another as practice leaders figure things out. But asking patients to do so shows an alarming lack of consideration for my time and effort. Perhaps the practice has forgotten that I’m not on the payroll?

Major EMR Vendor Consolidation On The Verge

Posted on June 14, 2012 I Written By

Anne Zieger 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.

Note: This is a post by Katherine Rourke. Tomorrow watch for a post by John on EMR and EHR where he discusses some of his views on this discussion.

While it may not be immediately obvious, the EMR industry is at a major turning point in its history. Any day now, we’re going to see a bunch of mergers and acquisitions go off like a string of firecrackers, some of which may have a direct impact on your business.

Now, I don’t know how many EMR companies there are out there. In fact, I’m not sure anyone has a precise count. But can we agree that we’re looking at 1,000 or more, no?  And, heck, there’s probably thousands of companies pitching practice management + EMR,  medication management systems, clinical decision support, apps, mobile health plug-ins to EMRs and so on. Just visualize it all — you’ll get a headache but you’ll doubtless agree that we’re dealing with a raging flood of technology.

And most of it won’t stand alone forever. Every vendor likes to say that their product line has all the solutions, but even the most green sales rep doesn’t really believe that. Smart EMR tech firms and their natural allies are already beginning the mating dance, and quietly but inexorably, hooking up.

Since this isn’t the Wall Street Journal, I’m sure we don’t need to dig into deep financial discussion over this. And anyone who’s a regular reader of this site knows why software companies often buy rather than build the technologies they need to fill out their portfolio.

But I thought it was still worth noting that within, say, 18 months, the EMR world could look fairly different in the following ways:

* EMRs aimed at doctors are overabundant, to put it mildly. I predict that there will be a dozen or so well-publicized failures or buyouts in this space within the next year.

* Big vendors that pitch to both enterprises and medical practices will largely have to pick one,and it’s the enterprise side that will win. If you’re a doctor running a giant company’s EMR, stay in regular touch with your vendor and get their support promises in writing!

* There will be a flurry of mHealth activity, with EMRs that play nicely on tablets in center stage.  It’s possible the market will even support another IPO or two this year by EMR vendors if they’re offering a nifty mobile health aspect integrated with their core product.

* Doctors, in particular, risk finding that their product becomes abandonware this year as the market consolidates.  Have a Plan B available, and I mean a written plan developed by a consultant or tech-savvy senior member of your team.

So, what else do you think will happen as the market absorbs excess players and recombines relationships?

Away From Blogging Sick

Posted on July 27, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

The latest flu bug that’s been going around has hit me pretty hard. I’ll be back tomorrow (assuming all goes well) with more posts.

Until then, some interesting news items for you to consider:
SOAPware Announces Release of PMS – They’ve been working on this for a while. Plus, it’s interesting to see the pure EMR companies getting a PMS. Check out this interview I did previously with the SOAPware president.

SRS and Ingenix Collaborate to Deliver PMS and EHR – Another case of an EMR partnering with a PMS system. Plus, now SRSsoft can get to meaningful use. As expected, EVERY EMR vendor is likely going to need to be able to say, “Our EMR can show meaningful use.”

Reasons Why CCHIT Certification is an Inappropriate Standard for EHR Stimulus

Posted on March 15, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

An EMR and HIPAA reader, recently pointed me to a post on a Google Group called “Response to HIMSS ‘Call to Action’: Interoperability First.” The response starts with a short discussion of the need for government to promote and support some sort of interoperability standards. I’ve said a number of times before that interoperability should be a focus of government, because interoperability is more of a public health benefit than it is a benefit to doctors.

After discussing interoperability, the response discusses reasons why CCHIT certification is an inappropriate standard for the HITECH act to use to determine “certified EHR.” Take a look at the reasoning:

As it currently exists, CCHIT certification is an inappropriate standard for federal funding, authorization or endorsement of HIT systems:
*CCHIT 2009 certification has over 450 separate requirements, the collective effect of which tremendously increases the cost and complexity of IT solutions. Many of these requirements are “functional specifications” that should be determined by customer needs and priorities, rather than by committee. These requirements foster (if not mandate) the development of rigid, monolithic systems.

*The monolithic approach to certification taken by CCHIT does not reflect the current advances in information technology being leveraged by other industries where integrated solutions are used to support the complete “end-to-end” business process. Integration and interoperability are essential to leverage the potential of “cloud computing” and other service orientated delivery mechanisms.

*CCHIT works to the benefit of a small number of large EMR vendors that can command a high price from the relatively small segment of the market able to currently afford their products. It is essentially anti-competitive, and establishes a major barrier to entry by new vendors and open source projects (where the majority of innovation will take place).

*A quick count from the CCHIT website gives the following results for the number of systems certified for ambulatory EMR (including conditional certifications and multiple certified products from a single vendor):
i) 2006 = 93
ii) 2007 = 55
iii) 2008 = 14

*At this rate of attrition, the number of certified products will dwindle to the single digits.

*The shrinking number of vendors that are capable of meeting CCHIT certification exposes a fundamental flaw in its current organizational structure – CCHIT is funded by the very vendors it certifies. In order for it to maintain revenue, it needs to provide a reason for vendors to continue to either:
i) re-certify on a regular basis
ii) apply for new certifications

*The problem with this model is that, in order to justify ongoing re-certification, CCHIT must continue to add new certification requirements year-to-year. The driver for more requirements is not necessarily the needs of customers or the best interest of the healthcare system, but the need to have new requirements against which to certify vendors. This is illustrated by the fact that CCHIT has recently reduced the length of the certification from three to two years, and is adding numerous supplemental certifications in areas like child health, cardiovascular, etc. There is no end to the number of requirements to which this could lead, but there is no evidence it will serve anyone well in the long run, other than the few large vendors with the resources to keep up with this process, and CCHIT itself.

*Although in theory vendors can apply jointly for CCHIT certification, in practice the monolithic certification process will limit the ability for vendors to provide component solutions from which customers can choose to create best-of-breed, low cost solutions that best fit their needs. For instance, in the ambulatory arena, this might typically be a combination of Practice Management, EMR and e-Prescribing solutions.

*Certification of Practice Management systems in other markets (e.g., UK) has arguably reduced innovation and investment, increased the total cost of ownership and consolidated the market to such a point that there is limited choice and the barrier to entry for new entrants into the marketplace is unaffordable.

I think this is just the start of what could be said, but it raises some really important points about certification.

Making the Switch to Web-based Medical Practice Management

Posted on January 22, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 recently invited the President and Owner of Great Acclaim LLC to do a guest post for this blog talking about the benefits of switching to a web based medical practice management. The hope was to illustrate the increased reimbursement that can be achieved by using a well managed practice management software (or SAAS – Software as a Service).

This blog has focused a lot on EMR and EHR, but hasn’t focused enough on the benefits of an electronic practice management service. The following guest post from Dan Williams will hopefully shed some more light on the benefits of a web based medical practice management implementation.

Guest Post by Dan Williams
Physicians face an array of options linked with the decision to switch to Web-based practice management solutions. Like EMR implementation, some doctors are reluctant to make the switch, citing reasons such as fear of change, fear of commitment to a provider, or fear of investment (“it’s just too costly”). However, once practice managers understand the value of a Web-based solution, and how that solution can easily and immediately lower claim rejection percentages, the fears will be seen as unwarranted.

With an industry average of nearly 30% in third party claims rejection, a client-server model cannot keep up with the constant process and coding changes the insurance companies are introducing into the reimbursement system. There are millions of coding combinations and they change regularly. Many doctors hire out to manage the business aspects of their practices, and may not even realize how much money they are losing through poor management, security threats, or simple ignorance of the solutions available. Medical professionals are accustomed to trusting in the newest proven advances to solve medical problems for their patients. It’s time they trust proven technological advances to solve business problems as well.

After firing their previous outsourced billing providers, several Seattle-area physicians’ practices recently hired Great Acclaim, a specialized outsourced medical billing firm, to handle billing functions. The firm had selected AdvancedMD practice management software based on its Web-based model and customer average of fewer than 5% rejected reimbursement claims. Using this Web-based practice management software, client monthly deposits and reimbursements increased by 50%, as fewer claims were denied and electronic financial transfers (EFTs) now account for 75% of insurance company payments.

Practice management software simplifies staff workflow by combining billing, scheduling and EMR functions. With no need to purchase additional hardware, install server-based software or perform manual data back-ups, initial investment is low, while ROI is maximized. Many practices and billing services find that the need for human review of claims and therefore, the number of man hours required to perform office functions is reduced, leading to greater efficiency and higher profits.

After initial setup and training all of its clients’ staff with the same software, Great Acclaim has eliminated integration obstacles. Nothing gets lost in paper transfers. From a new patient’s first appointment, physicians and their staff have access to the same information as Great Acclaim does through the Web-based model – anytime and anywhere.

Not only have client practices’ workflows improved since making the switch, but they no longer face a high financial security risk, as those receiving payments aren’t the same individuals who manage the billing. The software is designed to inhibit fraud. All of this equals less risk and more rewards for physicians. Or, as Great Acclaim’s clients have concluded: 50% higher returns for the same effort on the part of doctors—a great deal.

Dan Williams, a former software industry expert, is the President and Owner of Seattle-area outsourced medical billing firm Great Acclaim LLC.