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The Next Major Healthcare Product – Care Management System

Posted on May 1, 2015 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.

While meeting with a lot of people at HIMSS I started to think about what would be the next “must have” IT system that a healthcare organization would look at purchasing. When you look back at the history of IT purchases in healthcare, the Practice Management System (PMS or PM depending on your preference) was one of the first systems that most practices purchased. It was an easy buy for most people. They saw a lot of value to digitize the billing side of their practice. Adoption of practice management systems was widespread. Everyone was and is using one.

After the practice management system came the Electronic Health Record (EHR, but many could argue that EMR came before EHR, but that’s semantics in my books). Over the 10 years that I’ve been blogging about EHR software, we’ve seen the evolution of people asking if they should buy an EHR software to everyone realizing that they needed to go electronic but were trying to figure out which solution was best to $36 billion of government money which basically had the vast majority of doctors choose to hop on board EHR. While we don’t have 100% EHR adoption, we’re getting there. The market for EHR purchases is quite mature now.

With that as background, I’ve been thinking about what system or platform would be purchased next by a practice. I asked a number of people at HIMSS about this. Dr. Tom Giannulli from Kareo suggested that Care Plan Engagement could be an interesting next step. With the coming ACOs and value based reimbursement, you can see where Dr. Tom is coming from in his thinking. Plus, his term mixes the meaningful use term of patient engagement with the care plan approach that’s likely going to be required in future business models.

When I sat down with Carl Ferguson from CTG, he called the next product a Care Management System. When I heard it, I thought that this term could have staying power. The practice management system manages the practice (ie. billing). The electronic health record stores the records electronically. The Care Management System is going to be centered on the patient and the care that a patient receives.

What do you think of the term: Care Management System? There were probably a hundred products at HIMSS that have started to build a product like this. Although, I think a care management system would probably have to be a combination of a number of products out on the market today.

Regardless of what we call it, I think what will set apart the next big healthcare IT product offering is that it will be centered around the patient. A care management system by its very nature would have to be interoperable since the care is being given across multiple organizations. A care plan would make since because the patient’s at the center of the care management system and everyone could be involved in creating the care plan and ensuring that the care plan is being followed. At first take, I really like this terminology and I hope it gains some traction.

One challenge with the term Care Management System is that the abbreviation is CMS. That abbreviation is already quite popular with the government organization (CMS) and also the popular Content Management System (CMS). Although, if that’s the biggest problem with the term, then I feel pretty good about it. Although, this does make me wonder if we’ll go back to the age old integrated PM/EHR debate again when it comes to an integrated EHR/CMS. Will EHR vendors see this opportunity and offer a Care Management System module for their EHR? Some probably think they already are doing that.

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 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.

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.

Around Healthcare Scene: The mHealth Summit, DentiMax PM Software, and Getting Physicians Onboard with mHealth

Posted on January 15, 2012 I Written By

Here is a quick look at some of the other articles recently posted on some of the other HealthcareScene.com websites:

EHR and EMR Videos

David Collins of HIMSS Discusses the Course of Global Health at the 2011 mHealth Summit– David Collins, Senior Director of Professional Development at HIMSS, speaks at the 2011 mHealth Summit about HIMSS’ involvement in this year’s Summit, and about how HIT X.0 is affecting the course of Global Health.

Cerner Smart Room Technology Overview Video– An updated view of Cerner’s Smart Room technology. The Cerner Smart Room incorporates technology and workflow software to improve consumer care and clinician efficiency. The Smart Room is powered by CareAwareTM device connectivity architecture.

EHR and EMR Screenshots

These three posts provide numerous screenshots from the DentiMax Dental Practice Management Software.  Are there special considerations for a dental practice as opposed to a regular medical practice when it comes to EHR/EMR/PM?

Screenshots from the DentiMax Dental Practice Management Software
More Screenshots from the DentiMax Dental Practice Management Software
Appointment Book Pro Screenshots from the DentiMax Dental Practice Management Software

Smart Phone Health Care

How to Get Physicians Onboard with mHealth- No matter how great an app or device may be, it will be difficult for any developer to be successful if they don’t get some level of buy in from physicians in general.  People will always resort back to their physician when it comes to the quality of medical products.

Axial’s Care Transition Suite Wins “Ensuring Safe Transitions from Hospital to Home” Mobile App Challenge– In a recent online discussion I had concerning an article I recently wrote, the point was raised that for an app or device to be successful it must fulfill a need.  While I don’t think that it is absolutely essential to success, it certainly makes the path to success much more realistic.

Jan Patterson, Office Manager of West Broadway Clinic – Force Behind its MU Implementation and Attestation Process

Posted on June 29, 2011 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.


West Broadway Clinic has three physicians and two PA’s – all three physicians successfully attested to Meaningful use on April 20, 2011. The practice encompasses multiple specialties including family medicine, internal medicine, endocrinology, diabetes, women’s healthcare and offers onsite x-ray, dexa scan and vasectomies. The following interview is with Jan Patterson, the Practice Manager who drove the MU process and attestation.

1.    How did you learn about and select Cerner as your EHR?

At West Broadway Clinic in Council Bluffs, Iowa, we learned about Cerner Corporation through a local hospital. After extensive research into Cerner and several other vendors, we made the decision that the integration of Cerner’s Practice Management System and Ambulatory EHR would be the most beneficial to our organization.

2.    What’s your take on EHR certification and did that influence your EHR selection process?

The EHR certification is a vital piece for being able to meet the CME incentive requirements, and we feel that we are practicing better medicine and using our EHR solution more efficiently after receiving certification. We selected our EHR well in advance of the reporting process, so it was not a major influence in the selection process. Still, we have been very pleased with how efficient our EHR solution has been with assisting us in reaching certification.

3.    How long has your office been using an EHR?  Is this your first EHR?

West Broadway Clinic started using an EHR in May of 2008 when our office opened. Prior to the clinic opening the providers were not using an EHR – but the providers made it an initiative to start the clinic on an electronic solution. We knew we would be up and running with an electronic solution on day one. This included an EHR and practice management solution.

4.    Would you walk us through the process you followed to meet the meaningful use requirements and how did Cerner assist you in the process?

In order for West Broadway Clinic to be able to meet the Meaningful Use requirements an extensive amount of time was spent by the practice administrator attending webinars provided by Cerner Corporation regarding Meaningful Use, as well as researching the CME website and examining materials available through Medical Group Management Association, MGMA. In addition, Cerner arranged a Meaningful Use summit at our office for our office along with several of the Cerner user groups in our area – this consisted of several Cerner associates highlighting important parts of Meaningful Use, answering questions and making suggestions to assist with the process to successfully attesting. Upon compiling the requirements, time was spent one-on-one with both the providers and the clinical staff to ensure that everyone fully understood the requirements and how to use the EHR to meet the requirements.

5.    How many of the meaningful use requirements were you able to meet with little or no effort because you were already doing them? Did the Cerner EHR affect this?

West Broadway Clinic was able to meet 9 of the meaningful use requirements with little or no effort since as were already conducting several of these requirements through the use of our EHR. The use of the Cerner EHR and the elements that were already built into the EHR were the major factor we were able to meet these requirements so easily. Additionally, as we ran into any issues – we were able to contact Cerner’s Meaningful Use team (a group of designated associates) to assist, which eased the process.

6.    Which meaningful use requirements did your clinic find most challenging to meet and why?

Probably the most challenging Meaningful Use requirement for our clinic was encouraging all of the providers to use the electronic prescription function. However, once they understood the necessity of using electronic prescriptions and became comfortable with the function they have continued to increase the number of electronic prescriptions they are sending to the pharmacies.

7.    How long did the actual process take for you to fully comply with the meaningful use requirements?

West Broadway Clinic worked in earnest to be fully complying with the Meaningful Use requirements as quickly as possible after the beginning of 2011. These efforts allowed us the opportunity to be able to attest on April 20, 2011 – two days after attestation opened.

8.    Is meaningful use of a certified EHR helping your patients receive better care? Why or why not?

West Broadway Clinic has seen many positive changes in patient care with the use of a certified EHR. With the use of Cerner’s Ambulatory EHR our staff has the ability to have the most current visit information and patient history at our fingertips. Patients receive more continuity of care due to the fact that regardless of what provider they are seeing within our office the provider can quickly and easily track what services and/or medications a different provider has provided the patient. We deliver a better quality of care and we’ve enhanced safety measures through our use of the EHR. Components such as eprescribe, medicine/drug interactions, allergy checks, complete documentation, immunization schedules, growth charts, etc., have made us more efficient throughout the office from billing to practice management to prescribing medications and providing more thorough care in the patient’s room.

9.    What was the driving motivation for your clinic to show meaningful use?  And why be one of the first to show meaningful use?

West Broadway Clinic is committed to providing excellent patient care and providing patient’s with the opportunity to benefit from the latest in technology. With meaningful use of an EHR our patients are afforded these opportunities. By being one of the first groups of providers to meet the Meaningful Use requirements and report on them successfully, we are further able to show our commitment to our patients and their healthcare.

10. As a practice manager, what techniques did you use to get your physicians on board with meaningful use and EHR?

As a practice we had been discussing Meaningful Use for over a year and as the time grew near to implement the process the physicians were fully aware of the expectations and requirements and the benefits that would be provided to our patients. A lot of communication went into ensuring that all of the physicians were on board.

11.  Would you recommend that every health clinic show meaningful use and adopt an EHR? Why or why not?

After being on an EHR for more than three years I cannot imagine trying to function efficiently with a paper system. While the training period was stressful at times and it took the physicians a while to adjust, the benefits far outweigh any of the pain points. In addition, the opportunity to be able to transmit and receive patient information from other facilities in the future will only continue to enhance our patient care and the delivery of quality patient care is why we are practicing medicine in the first place.

12.  For all healthcare professionals reading this interview, what advice would you give them in starting the meaningful use process?

For anyone starting the Meaningful Use process, my advice is to first gather all of your information and facts. It is vital to be clear on the direction you need to take in order to ensure that all of the requirements are being met. In addition to thoroughly explaining all of the requirements to your physicians/staff and gaining their buy-in communicate with your staff and ensure that they fully understand the benefits and the necessity of meeting the Meaningful Use requirements, which is primarily to use your electronic records in a successful, meaningful way that will enhance the delivery and quality of care that your office provides. Remember the main reason why you are attesting, the money is a great incentive – but the biggest factor in successfully attesting is the benefit to your patients. Anyone can purchase an EHR and use it unsuccessfully or at its minimal functionality – to use it to it’s very best ability and to meet the requirements set forth by the Meaningful Use standards is to practice better medicine for your patients and to encourage others in your field to make quality care the highest priority.

13.  What remains your greatest EHR challenge post EHR implementation and meaningful use?

The greatest challenge for EHR and Meaningful Use continues to be the necessity to ensure that all the physicians and staff are continuing to maintain their high level of entering the correct and necessary data in patient’s charts to enable us to increase our reporting requirement levels far after successfully attesting. I have continued to monitor my staff’s levels after attestation and I’ve found that their numbers continue to increase – which is a positive realization for our staff and for our patients. It will also be imperative that we continue to monitor any new information coming out of CME and Cerner regarding meaningful use requirements especially as we gear up for Phase 2.

14.  What’s been the biggest benefit to your clinic of having an EHR?

West Broadway Clinic has benefited from having an EHR in multiple ways from never having to track down a paper chart to the continuity of care it provides for our patients. Having an EHR that integrates with our Practice Management System has reduced the amount of time it takes for charges to be entered and then forwarded to insurance companies. The adoption of an EHR has enabled West Broadway Clinic to become more efficient and be able to focus more upon the patient as a person. The increased benefits of safety cannot be undersold. With the assistance of the EHR, we are practicing better, safer medicine than we could on paper records.

Demo of the Acrendo AI MED EMR

Posted on May 3, 2011 I Written By

This is a 5 Minute Demo of Acrendo’s AI MED v9 EMR and Practice Management System.

 

Replacing an Existing EMR

Posted on August 17, 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 received the following email from a reader of this blog:

I am the manager of a 2 physician, 2 nurse practitioner practice with an 11 bed sleep lab. We purchased our EMR in 2006, without much research, because it was compatible with our billing/scheduling program. It is grossly time consuming. Just entering a problem list takes 5 steps (for each disorder we are entering). It will not create notes as many EMRs do. We dictate notes to a transcription service and they are uploaded as documents. Basically it is a non-interactive storage unit, much like our paper charts were, except more time consuming. The company has basically told us that they will not be changing the system. The doctors and NPs are nearing revolt at this point because of the time that they spend trying to use this system.

What is your point of view on finding a new EMR? What would the time and mental repercussions be? Is it possible to coordinate billing systems and EMRs from different companies?

My reply was something I thought many on this blog would benefit from:
Thanks for sharing your experience. Unfortunately, it’s a common one.

The good news for you is it sounds like the notes in your current system is basically a document management system that stores your transcriptions electronically. This bodes well for you if you decide you’d like to move to a new EMR system. I say that because it is likely that you’ll be able to get these documents out of your old system and import them into a new EMR system so that your old EMR records are still available in the new EMR. Many EMR companies will work with you on doing just this.

If your current EMR system is worse than paper, then it sounds like change is likely a good choice. What I think you’ll find is the lessons you’ve learned from this first implementation will help you in your next EMR selection and implementation. It’s unfortunate you had to pay that price, but now that you’ve learned you might as well use it to your full advantage, right? In business they call it a sunk cost. It’s time and money already spent. You should base your decisions on changing your EMR on the time and money you’ll have to spend going forward and not costs which you’ll never get back.

It will take some time and money to fix it. However, those people who dislike your current EMR might be ready to commit the time and money needed to find a good EMR to replace what you’re using now. I will also say that I think unhappy workers is worth spending a lot of time and money to fix. An EMR should not start a revolt.

My only caution for you is that you need to take a real serious look at your clinic and ask an important question: Is it the EMR that’s the problem or is it something about our workflow/clinical environment/policies/culture that is the real problem with the system? Obviously, if it’s the former a change of EMR would be good. If it’s the later, then you might as well not change EMR software until you fix those other issues. I’ve often said that implementing an EMR just exacerbates any problems or weaknesses that exist in a clinical environment. It brings them to the surface and makes them hard to ignore.

Yes, there are a number of EMR companies that will work with your current Practice Management System (PMS). I’m someone who believes that if you’re very happy with your current PMS and the reimbursement that you’re getting from it, then it’s certainly a reasonable option to stick with your current PMS and interface it with an EMR company. In fact, there are some companies that are only EMR companies and then interface with various PMS systems. Their philosophy is that they should just focus their time on making an excellent EMR and not divide themselves between EMR and PMS software creation. Basically, they let another company focus on making an excellent PMS (or they’re are already excellent PMS systems out there). One example of this is Medtuity which is where I learned some of these principles. As I look at their product, I can see the advantages of focusing on being the best EMR and not being distracted.

Just know that there are costs associated with managing/supporting an interface between your EMR and PMS. Plus, there are some advantages to having the two integrated. You should weigh those out as you select a new EMR.

This was kind of fun. If you have a question you’d like me to answer, send it to me on my contact form and I’ll see about making it a future blog post.

EMR’s Affect on Medical Billing Costs

Posted on September 29, 2008 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 received an email not too long ago from a medical billing company who talks about the crazy costs associated with medical billing. In their email they offered the following statistics on the costs of medical billing.

The statistics below represent industry averages taken from the MGMA.

Claims Rejected on 1st Submission – 30 %
Underpayed Claims – 20%
Gross Collection Rate – < 60% Preventable Denials - 90% Denials that are Recoverable - 67% Average days in A/R - 52.32 Cost per claim - $5-$7 Cost per FTE physician - $30,000-$60,000 Cost of billing operations - 18-22% Cost of Billing Personnel - 58-62% Cost of Technology/ Practice Management Solution - 18-22%

Source: Avisena whitepaper

I must admit that billing is far from my expertise, but it’s a well described necessary evil for almost any practice. Plus, the better you do it, the more money your clinical practice can make.

Of course, my question is how did implementing an EMR in your clinic either help or hurt these various costs? Were you better able to process claims, because the charting was done electronically and the coding done at the time of visit? Were you able to process claims at a higher rate because your documentation was more complete using an EMR? Could you more quickly process denied claims because it was electronic? Did you need more or less employees to do your billing after implementing an EMR?

I guess it would also be important to know if you decided to go with an integrated Electronic Medical Record and Practice Management System or if you tried an interface between your legacy system and a new EMR system.