EMR – Denial Not an Answer

There is a lot happening in the healthcare sector today. The government is aiming to redefine healthcare with the help of ACOs and performance based compensation methods. Physicians are getting edgy about the meaningful use stage 2 objectives that their current EMRs may not posses. Recent EMR surveys and studies are producing variable results. Some display significant post-implementation gains while others show distressing productivity losses.

It’s a mess! The healthcare system is going through a transformation and such transformational phases are often complicated. With that said, the question here is whether one believes in the healthcare reform or not. If one believes in the healthcare reform, then it is easier to accept the change and adapt accordingly. However, if the answer is no then one probably shouldn’t vote for Obama in the upcoming elections.

Every change takes time. When hospitals first started record keeping, was it organized? No. Was it efficient? No. But was it necessary? Yes. The paper based system that physicians have perfected and feel comfortable with is likely to have received a similar response when it was mandated. Nobody likes to be told what to do. On the other hand, when it becomes common practice in the industry, it ceases to be a major concern.

EMR documentation is likely to be cumbersome in the initial stages as physicians familiarize themselves with the new system. What most physicians have a problem with is standardized data entry. Although most EMRs can be customized to suit user preferences, physicians tend to associate electronic medical documentation with clerical workload. However, the modern EHRs facilitate evidence based practice methods and adhere to industry best practices.

Physicians have been able to improve documentation time with regular use, familiarization and training. Practices have also been able to optimize administrative workflows and operations through continuous assessment and planning. Patient Portals let patients update basic clinical, administrative and financial information without leaving their home or visiting the doctor’s office. This saves valuable time and enhances productivity whilst minimizing the possibility of human error. These patient portals also maintain a connection between physicians and their patients, which allows simplified synchronization of information and health management.

General opinion suggests that EMR systems with voice recognition further expedite the process of clinical documentation for physicians while an optional transcription service makes the process nearly effortless. However, physicians using transcription and dictation often describe them as costly and inefficient while various surveys indicate reduced quality of clinical outcomes for these physicians.

To conclude, denial is not a solution. EMR adoption is a choice right now and not a compulsion but the future may dictate otherwise. Physicians often choose to push back EMR implementation and hope to join the race when the usage of such systems is no longer a choice. However, physicians already embarking on this journey will be accustomed to improved clinical outcomes and care quality through the use of EMRs. Only physicians know the answers to these questions and while some may continue to resist adoption, there is no denying that EMRs are a pathway to the future.


EMR – The Untold Story

The last few years have been monumental for the healthcare in the US. With the introduction of the American Reinvestment and Recovery Act (ARRA), the government laid down the foundation for a new structure in order to improve healthcare delivery. EMRs have always been on the forefront, taking most of the fire. The government along with numerous healthcare professionals believes in the value of healthcare automation. However, EMRs are merely facilitators while physicians are still responsible for delivering quality healthcare.

Improved Healthcare with EMR

With an estimate of $6600 in healthcare costs being spent on an individual per annum, the effectiveness of the ARRA is instrumental in re-shaping the future of healthcare. “The government cannot afford any hiccups. We are all too far invested in this for it not to work.” comments a healthcare IT executive. “$6600? I don’t see it. Where is it going? You step out right now and look around you tell me if you can spot one individual that had 6600 spent on their health, one individual.” remarked a construction worker from New Jersey, during an independent survey.

The Meaningful Use requirements provide an effective road map for delivering quality healthcare. Its objective is to ensure that physicians learn how to effectively utilize EMRs and improve healthcare delivery. CMS introduced this exercise to help physicians realize what an EMR is capable of and how it adds to their care quality.

Likewise, the Affordable Care Act reforms have resulted in better EMR adoption rates. The government believes that there is at least $300 billion to be saved through standardization of health information technology. However, despite the expected benefits, there is still lot of skepticism surrounding EMRs. Many physicians believe that EMRs in fact do not add to practice productivity, but instead slow them down while increasing their overheads.

In a recent study by Danny McCormick and David Bor of Cambridge Health Alliance and Stephanie Woolhandler and David Himmelstein of CUNY School of Public Health indicated that EMRs may actually increase the frequency of tests ordered by physicians. More than 28,700 of patient visits and nearly 1,200 doctors were surveyed to determine the outcome. The study shows that physicians utilizing EHRs were 5% more likely to order imaging, rather than doctors who did not.

Danny McCormick believed that it was important to point out the contrast of the actual findings with the commonly constructed belief of EMRs decreasing health costs. However, he went on to state that it is attributable to the enhanced interoperability provided by EMRs that doctors can expect to get results faster and can easily view them on their screens.

Dr. David Blumenthal, who served as the national coordinator for Health IT at the Department of Health and Human Services from 2009-2011, pointed out that the study represents order of tests and not costs. He went on to state that the study does not take into account the overall impact of EHRs and accumulative healthcare costs. “The study doesn’t look at the benefits for quality of care at all. It’s possible that the use of tests by some of the doctors could have avoided other costs. This study has no way of assessing the overall implications of the behavior that it’s finding.”

Dr. Farzad Mostashari who is the National Coordinator for Health IT also voiced similar concerns in his reply. He believes that the study showed little evidence and did not consider the impact of EMRs in improving healthcare delivery. He also pointed out that due to the nature of the study it was not designed to answer questions about cost and quality. “Many other variables that could affect physician behavior could not be examined in this study, including having a sicker patient population, level of physician training, approach to defensive medicine, and, importantly, financial arrangements.”

The EMR is a technology that compels change and as long as it is resisted, its potential will remain muted.


EMR – The Great Expectations

The EMR technology has come a long way since its inception. Starting as a simple tool for recording information, EMRs today assist physicians through decision support systems. EMRs are increasingly becoming an integral component of the healthcare system in the US. The adoption rates have doubled during 2008-2011. However, this increase is still short of the expectations of industry experts.

As the world of technology evolves around us, expectations from an EMR continue to grow. “Most physicians today want a system that is easy to use and makes documentation quick.” says a health IT executive. “Physicians never liked documentation, even when it was on paper. But now with EMRs, they expect that computers will do most of the job as they interact with patients.” quoted another.

Technology makes our lives more convenient and EMR serves this purpose for the healthcare community by expediting clinical workflows and seamless exchange of information. Research has shown that physicians have been able to save up to 30 minutes per day with EMR for documentation. However, some physicians insist that EMRs should offer even greater value.

According to a recent study by the HSC, the expectations of the healthcare policy makers on improved coordination of patient care through EMR and the actual experiences of clinicians are quite different. The study available at the Journal of General Internal Medicine indicates that EMR interoperability is not well developed for interaction between physicians across different practices.

Physicians believe that it would be difficult to meet the proposed meaningful use stage 2 objectives with the current capabilities of their EMR solutions. ONC is also planning to release new certification criteria once the final rule is out. Established EMR vendors are already working on their interoperability extensively to comply with the proposed regulations and remain competitive.

EMR solutions will continue to evolve over time. However until a time that an EMR solution satisfies the requirements of each and every physician, is it really wise for physicians to dismiss the advantages of an EMR solution? EMRs have been proven to optimize practice workflow and reduce overheads but physicians and other end users will have to meet their respective EMR systems halfway to reap the true benefits of EMR technology.

EMR – Damage Control

Working in the healthcare industry is one of the most daunting professions in the worldEMR Learning today. Over the years, the advancement in healthcare technology has come a long way. Physicians never stop learning, as the world of medicine evolves rapidly and they have to adapt accordingly, which means that if there is a safer remedy available, they must employ it.

Clinical oversights and errors can be fatal. Hence, physicians cannot afford to make any mistakes. The traditional method of utilizing paper based records has become obsolete. There are countless instances on record where the physicians had to make critical medical decisions based on whatever information was available. This often has been the cause of adverse outcomes which have lead to litigation claims for malpractices.

In June 2009 a cancer patient Fred succumbed to his illness leaving behind a wife and two children. Fred was transferred from one hospital to another without any medical records, without which Fred could not be treated. Fred’s wife Regina tried in vain to get her husband’s records transferred. She even made an attempt to transport them herself from the first hospital they had visited. Finally, she was told she could get the records, however it would take 21 days for the hospital to generate them, and it would cost 73 cents a page. This incident is a clear example of how inefficient our current healthcare system is.

The EMR was developed to overcome the limitations of the traditional record keepingEMR Development system. Through automation, an EMR removes any errors caused by illegibility or negligence on part of the medical staff. The built-in verification process ensures that the variable factors, such as allergies, are accounted for while prescribing medication along with drug to drug or drug to food interactions.

The EMR can also store large amounts of information within a few kilobytes; amounting to a size of a microchip. As a result, EMRs help physicians save up space and storage costs while eliminating paper clutter. EMRs also remove the hassle of retrieving and filing medical records by providing instant access to clinical information anytime, anywhere. Time is instrumental in most clinical situations where even seconds can make the difference. With EHRs, physicians have the access to complete medical information from immunization records to a family’s medical and genetic history. Thus, EHRs are likely to drive more informed clinical decisions, thereby reducing medical risks.

In a report published in 2011, it was suggested that a 10% increase in basic EMR usage in hospitals would save 16 babies for every 100,000 live births, while a 100% adoption would lead to 6,400 infants being saved in the US each year.

Presently, insurance payors demand procedural detail. EMRs not only ensure compliance with best practices but also help physicians to formulate claim reports based on documented information, thus removing the need for re-analyzing and creating claim reports from scratch. EMRs also allow physicians to record the complete journey of the patient from appointments to procedures; effectively creating a clinical time line.

Similarly, EHRs record any subsequent changes or additions, which provide theMedical Audit with EMR opportunity for an audit trial if necessary. However, an audit trial does not only favor the patient; it can also be used by the physician as well. Physicians can use the EMR to justify medical treatment given the situation and the relevant information. This concept is helping the healthcare industry formulate Accountable Care Organizations and is encouraging evidence based practice methods. EMRs also aid physicians and patients alike by redefining the care culture.


Making Your EMR Work

The views on EMR usability vary significantly from one physician to another. A number of physicians today think of cost and productivity benefits from an EMR, as myths. Some physicians feel that instead of improving efficiency, an EMR slows down their practice workflow and does not yield any cost benefits. Whereas on the flip side, many providers have reported that utilizing an EMR system helps control costs and increase productivity.

EMR Selection

This disparity can be attributed to two key factors, the first of which is being unable to find the right fit. However this factor has been explored in detail by many technology pundits and thus does not require much elaboration. The key is to find an EMR solution that adapts to the existing workflows of the practice as well as help providers in meeting their various clinical, administrative and even financial objectives.

The other factor is meaningful use. Many physicians believe that benefits will accrue automatically once the EMR implementation is complete. EMR is just a facilitator and the benefits are limited to how the user chooses to utilize the application. A physician that utilizes an EMR solution to simply record medical information may not be able to drive the same benefits, when compared with a physician that utilizes data mining to optimize care of patients with certain medical situations.

 “It is about your mind set really. If one believes that it works, then one tries to go the extra mile to make it work.” says a New Jersey based Practice Manager.

The meaningful use program was devised by the CMS to help providers get a feel of the real capabilities of EMR. The first stage of the program was designed to introduce EMR usability along with the built-in features that help enhance productivity and improving care quality. The government believes that there are benefits to be driven from wider EMR adoption and that is the reason that it has set up the incentive program for adoption and meaningful utilization of EMR solutions.

There are multiple case studies where practices and large hospital organizations have been able to gauge the change in performance after utilizing an EMR. In most cases, even practices have been able to quantify the positive impact of deploying an EHR solution in terms of time saved, patients treated per working day and the changes in amount of re-admittance. Only physicians that align their organizational objectives during the EMR implementation phase are able to derive the utmost clinical, administrative and financial benefits from their solution.


EMR – Business of Saving Trees

Let me start off by saying that, I am a huge proponent of green technology, be it Eco-friendly containers, hybrid vehicles, recyclable paper products, etc. We have denied our next generations enough resources, as it is. We are at the precipice of completely exhausting our natural resources and thus it is our responsibility being on top of the food chain, to help restore and preserve the planet’s resources while protecting those that we share this planet with.

The age of automation came beckoning for more efficient and effective ways of recording and processing information, but for most it was just another method to increase productivity and decrease cost.

Reduced paper consumption and deforestation was seldom acknowledged, although this is one of the biggest advantages of automation.

For the healthcare industry, EMR was the ultimate breakthrough to eliminate tons of paper flowing through the healthcare communities. Rapid innovation and tougher competition among vendors helped give birth to cloud based EMR. This architecture allows for remote backups and storage, eliminating the need for the filing and storage of paper based medical records. With reduced hassle of retrieving and filing records, the user can access relevant information from anywhere, within seconds. The cost of maintaining a dedicated file room and relevant staff is eradicated, saving up to $3 per record. EMR also eliminates the need for duplication as users can access information simultaneously resulting in further benefits in the form of better cohesion and collaboration along with significantly reduced paper wastage.

There are over 800 thousand medical practitioners serving over 300 million people in the US today. Let’s assume that every individual utilizes 100 A4 size paper sheets for diagnosis, prescriptions, test results, etc during their lifetime. If one A4 size sheet weighs roughly around 4 to 4.5 grams, the total consumption would equate to 127.5 million kilograms or 140544.7 tons of paper (907.18 kg/ton) and according to a study by Trinity College in Western Australia, it takes 17 x 20 year old trees to produce 1 ton of paper. That’s 2.4 million trees and if for some reason this does not sway you, there are millions of gallons of water to be saved from tree pulp processing along with millions of gallons of potential fuel savings through reduced doctor visitation. Add in digital imaging and we can bid riddance to tons of toxic chemicals that are used for developing x-rays and film.

The above is just a rough estimate generated independently and although actual figures may vary, the purpose here is just to enlighten readers of the numerous benefits of adopting a technology that significantly reduces our carbon footprint whilst improving quality of healthcare. Among other things, the business of EMR is also one of saving trees.


Meaningful Use – Not an IT Project

The Obama administration introduced the American Recovery and Reinvestment Act with EMR as its cornerstone. Billions of dollars were reserved as funds for the stimulus plan to reward physicians on effective utilization of digital health information with up to $63,750 in incentives. CMS has already paid out nearly 3 million in incentive payments to physicians who successfully attested for meaningful use in 2011.

The two incentive schemes fall under Medicare and Medicaid, federal and state run insurance programs respectively. Physicians that attested for meaningful use stage 1, had to complete 15 core and 5 menu objectives. The objectives for the first stage targeted effective data capturing and sharing. While many physicians successfully attested and received their incentives, a number of physicians struggled with some of the changes brought by the new EMR technology.

The reason CMS is promoting EMR adoption is not just for the sake of healthcare automation, but the whole incentive program is designed to drive appropriate usage and desirable outcomes to improve healthcare quality and productivity. The US is spending over $2 trillion each year on healthcare with mostly unsatisfactory results. The government believes that the increasing healthcare costs are not only burdening civilian families but are also detrimental to the economy.

EMR is just the first step towards the advancement of healthcare in the US. By streamlining operations and increasing accountability, EMR aims to forge a new culture of care delivery. While we are aware of some of the advantages in the form of a paperless environment, reduced clinical errors, increased efficiency, reduced cost and improved quality, the actual value of an EMR resides in its ability to compile data producing analytical reports, and its capability to interface with other healthcare entities for exchanging vital information, thereby establishing a chain of effective care delivery.

The meaningful use stage 2 builds on the requirements of the first stage. Instead of demonstrating interoperability, physicians would be required to utilize these features and explore detailed functionality of the EMR. The increased focus on connectivity and information exchange is to promote preventive care measures, rather than just improving disease management.

While we await the final rule for the next stage, it is seemingly apparent that the CMS meaningful use program is not just an embellished IT project but a meticulously structured healthcare transformational program.