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Electronic Medical Records: Advice For Physicians


Electronic Medical Records are coming.  The economic stimulus bill (furious spinning kittens notwithstanding) assured this.

Under the terms of the bill, CMS will offer incentives to medical practices that adopt and use electronic medical records technology. Beginning in 2011, physicians will get $44,000 to $64,000 over five years for implementing and using a certified EMR. The Congressional Budget Office projects that such incentives will push up to 90 percent of U.S. physicians to use EMRs over the next 10 years.

Practices that don’t adopt CCHIT-certified EMR systems by 2014 will have their Medicare reimbursement rates cut by up to 3 percent beginning in 2015.

(From Fierce Health IT)

There will be even more money for implementation.  We look forward to our checks (and are not counting on them yet).

Now it is time for the flies to start gathering.  Wherever there is lots of money, “experts” pop up and new products become available that hope to cash in.  Doctors, who are never lauded for their business acumen, will be especially susceptible to hucksters pushing their wares.  It seems from the outside to be an simple thing: put medical records on computers and watch the cash fly in.

Anyone who has implemented EMR, however, can attest that the use of the word “simple” is a dead giveaway that the person uttering the word in relation to EMR is either totally clueless or running a scam.  It’s like saying “easy solution to the Mideast unrest,”  “obvious way to bring world peace,” or “makes exercise easy and fun.”

Run away quickly when you hear this type of thing.

Just like becoming a doctor is a long-term arduous process, EMR implementation happens with time, planning, and effort.  It’s not impossible to become a doctor, but it isn’t easy.  With EMR adoption, the most important factor in success is the implementation process.  A poorly implemented EMR isn’t simply non-functional, it makes medical practice harder.  A well implemented EMR doesn’t just function, it improves quality and profitability.

How do I know?  Our practice ranks very high for quality (NCQA certified for diabetes, physicians are consistently ranked high for quality by insurers), and we out-earn 95% of other primary care physicians.  EMR allows us to practice good medicine in a manner that is much more efficient.

So how’s a doc to know who to trust?  What product should he/she buy and whose advice about implementation should they follow?  There are many resources out there.  Here are a few I think are especially worthwhile:

  1. Buy a product that is certified by Certification Commission for Health Information Technology. CCHIT is a government task force established to set standards for EMR products. Its goal is to allow systems to communicate with each other and enable more interfaces in the future.  The bonuses for docs on EMR are contingent on the system being CCHIT certified (think of it as something like the WiFi standard).
  2. The American Academy of Family Physicians’ Center for Health Information Technology and the American College of Physicians both have tools to help member physicians decide on an EMR. Your own specialty society may, too.
  3. Several professional IT organizations have programs to improve EMR adoption, including HIMSS and TEPR.
  4. Austin Merritt has written a good article of advice on his website Software Advice that underlines the importance of implementation.

The best advice I can give, however, is to visit a doctor’s office who is using an EMR successfully.  This office should be as close in make-up to your office as is possible.  You should be able to look at how they do it and see yourself in that situation.  Never buy a product before visiting at least one office like this (no matter how good the sales pitch).  When you visit, make sure you ask them about the implementation process.  How did they do it and how hard was it?

Which EMR do I recommend?  Remember, I have been on EMR for over 12 years, so haven’t had much of a chance to shop around.  You hear raves and horror stories with every product.  Here is some basic advice:

  • Get a solid CCHIT-approved brand that has been around for a while
  • Don’t pay as much attention to price as you do function.  Since the EMR will be absolutely central to the function of your office, it is a dumb mistake to overly-emphasize cost.
  • Realize you are paying for a company, not just a product.  It is not like buying a car, it is more like having a child or getting married.  REALLY research that side of things.  A good EMR with a bad company behind it should be avoided like the plague.
  • See how connected the user-base is as well.  A solid user group will do much to make up any deficiencies in the product and/or company.

So much time is spent shopping over EMR products, but buying an EMR is like being accepted into Medical School; your work is just beginning.  That’s OK, because like medical school, the effort put in gives a very worthwhile product.

**This post was originally published at Dr. Rob’s blog, Musings of a Distractible Mind.”


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3 Responses to “Electronic Medical Records: Advice For Physicians”

  1. EMR says:

    This is a very interesting post onIT and health care joining together for maximum efficiency. I still believe that our private info should not be transferred digitally, only stored digitally and not connected to the web in anyway.

  2. EMR says:

    This is a very interesting post onIT and health care joining together for maximum efficiency. I still believe that our private info should not be transferred digitally, only stored digitally and not connected to the web in anyway.

  3. quiact says:

    Computerized Medicine
    Electronic Medical Records (EMRs) are essentially digital treatment platforms that contain significant patient variables, such as their own medical history. This and relevant knowledge and data relevant to the individual patient assure to a higher degree that the treatment they receive from their health care provider when it is needed is reasonable and necessary.
    EMRs have the potential to prevent medical errors that occur, unfortunately. Such errors are believed to cause nearly 100 thousand deaths every year.
    Present medical records on documents are digitized and integrated into the EMR easily. And EMRs are desirable in the medical community for a number of reasons that fill unmet needs to restore the health of others. These health care provider assets provide evidence-based clinical information contained in this knowledge system.
    In addition, EMRs provide additional patient safety, regulatory and reporting needs. These needs, as well as confirming reimbursement requirements, provide a strong ROI for those medical facilities that have quality EMRs at their location.
    The first large demonstration of the effectiveness of EMRs was with the VA Hospital’s Vista System. The code was written by doctors for doctors, and has about 18000 pages within Vista. Author Phillip Longman wrote a book about this system and the quality it allowed for superior health care, which was entitled, “Best Care Anywhere.” The Vista is the largest EMR in the United States
    In addition to EMRs storing patients’ medical history and present treatment regimens, EMRs make others aware when ordering ancillary testing for patients. The awareness is to make sure the testing ordered is not repeated, or does not already exist. In addition, and of particular importance to the health care provider, the need for transcription of patient notes is eliminated.
    With some debate, there seems to be a good possibility for the development of increased profits for both health care providers and medical institutions. This is due to EMRs offering the most appropriate and accurate codes. These are diagnostic and procedural codes allowable for a particular patient as they are determined to be needed for this patient. These codes are used to seek reimbursement from health care payers, and are required for reimbursement from third party payers for certain patients.
    The continuity of patient care improves the care of patients and reduces the need of additional patient staff that was needed before EMRs arrived at the medical facility. Historically, there is often a lack of needed staff at medical institutions due to the shortages of professions that exist in the health care field, such as nurses.
    The EMR provides flexibility of architecture to meet individual workflow requirements at each location. Preventative medicine and compliance with treatment regimens are more assured with EMR utilization as well.
    Again, evidence-based medicine as well as a higher degree of patient-centered healthcare is now possible and improved by EMRs. The many benefits perceived by others that are based on fact has resulted in the utilization of EMRs by various managed care companies and pharmacy benefit management companies.
    However, health care providers who are in solo practice are understandably reluctant to acquire an EMRs because of cost. The cost of an EMR may approach 40 thousand dollars, as well as several thousands of dollars paid annually to maintain the EMR. A complete EMR package would include hardware, software, installation, maintenance, and training.
    One of the primary functions of EMRs often includes electronic prescribing, which is more reliable in reducing prescription errors, which are believed to cause over 5 thousand deaths a year. Electronic prescribing also lets the health care provider know if there is a generic version of the drug available, and if the patient’s pharmacy insurance benefit covers the drug chosen by the health care provider.
    Additional functions of EMRs would include the ordering diagnostic tests, and retaining the results of these tests. Also, the documentation from the health care provider about the health and well-being of their patient after a visit with such a provider is placed directly upon direction from the provider into the EMR. This thankfully improves patient data availability for other health care professionals may have a need to retrieve regarding these patients.
    Aside from having great ability to store information and data, as well as the EMR having user-friendly navigation, the EMR should have the following core functionalities: Health information and data about disease states and patients that have been treated, the, ability to manage results, the features to allow order entry, the ability to provide decision support, and the EMR should have good communication with other devices.
    As far as the plan of implementing EMRs within a medical facility, this would involve the EMR’s hardware, software, EMR installation, maintenance of the EMRs as determined, and training of the medical staff.
    Additional patient benefits because of the ability and function of EMRs is the reduction in mortality, according to some studies. Mortality has been concluded to be reduced by around 40 percent. Equally impressive is that the EMR makes patient care much more efficient, including where efficiency may be needed the most. That would be those many patients who have at least one chronic disease. Chronic diseases consume around 80 percent of health care spending. The EMR facilitates a medical home for those patients who are chronically ill..
    Surveys have shown that most people surveyed favor EMRs more than they do a health care provider visit. The EMRs allow and encourage written dialogue between the health care provider and their patients. When this is done, visits between these patients and their providers are significantly decreased.
    Presently, those who have access to EMRs range in ages of those in their late teens, to those in their early 90s. Utilization of EMRs by others is not limited because these records are very user-friendly for most people. And utilizing EMRs may also be used to enhance one’s medical knowledge regarding a particular topic or disease state. With those who are with medical problems, this knowledge often will improve their health and their medical issues because the patient is now an advocate in their own treatment of their medical problem.
    EMRs are certainly not flawless, and there are those that oppose the integration of this digital advance into the U.S. Health Care System. There are privacy concerns, as well as more valid concerns about EMRs becoming dysfunctional without notice. Presently, those who make EMRs in this 20 billion dollar a year industry are not regulated, and no uniform standards regarding their durability have been established. So likely, some EBMs are overall better than others,

    Dan Abshear

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