EMR frauds – the Issue Needs Attention!

Fraudulent use of Electronic Medical Records (EMRs) is under a lot of scrutiny within the healthcare industry. From health IT consultants to healthcare professionals to government’s regulatory bodies, almost everyone has taken the matter seriously. After all, EMRs were designed to ensure precision and quality in care delivery and never to encourage any fraudulent occurrences.

Considering the extent of fraudulent use of electronic medical records, it would not be difficult to proclaim that some healthcare professionals have deviated from the axiom of transparent provision of quality care at low cost. Moreover, it would certainly be “unreasonable” to blame the CMS’ financial incentive programs for instilling the urge of cheating and greediness amongst physicians.

It is important to realize that the financial incentives were offered on the basis of Meaningful Use of certified EMRs and I quote, “in a legal manner”.  According to official reports of HHS, 92 defendants including doctors, nurses, and other healthcare providers have been alleged for fraudulent use of EMRs related to billing purposes – resulting in $225 million for the Medicare funds. (For more details visit HHS).

According to the billing reports of the past decade, it becomes evident that physicians have been biased in submitting medical bills. The clinical procedures that resulted higher in monetary benefits were significantly given more priority, while the ones with negligible benefits were ignored. (Source: Fierce EMR)

Furthermore, it would also be absurd to blame the EMRs for these fraudulent occurrences. When it comes to IT products, some glitches and technical errors do exist but that doesn’t mean that they create a gateway to illegal usage. At the end of the day, the idea of usage, by all means depends upon the intent of use of healthcare providers.

Farzad Mostashari, the national coordinator for Health IT, says that there have always been people who commit frauds and there are always going to be enforcement against these frauds. In addition, lauding the significance and not blaming the EMRs, he proclaimed that it is such technology that constructs the base of stronger investigations and enforcement.


EHR – Does certification matter?

As part of the healthcare industry, the providers, health IT consultants and other healthcare bodies are well aware of the CMS funded financial incentives for complying with Meaningful Use requirements in regards to Electronic Health Records (EHRs). More importantly, they are also familiar with the need for EHR certification that would serve as a helping hand in achieving the aforementioned target. So, at the end of the day, it is the Meaningful Use of certified EHRs that would help physicians get their hands on the incentive funds.

Today, with millions of physicians in the U.S, not every physician is comprehensively acquainted with the concept of EHR certification. Many believe that a certified EHR is the one that comes with the seal of Certification Commission of Health and Information Technology (CCHIT). However, it is not the CCHIT’s approval seal that meets the certification criterion for incentive funds. It is the set of minimum standards and that needs to be complied with.  This set includes the review of various functions and parameters like storing patient demographics, security parameters, integration, computerized order entry, information exchange and specialties, etc.

“The biggest dilemma amongst physicians, today, is the failure to understand the concept of Certified EHRs. Be it any industry, certification of a certain product comes by meeting the minimum requirements set by controlling authorities”, says an Ohio based Health IT Consultant.

Considering the financial incentives and benefits that EHRs have brought to the providers, it should not be difficult to think of EHRs as a long term investment. Therefore, before choosing an EHR, it is essential for physicians to make sure that they get their hands on the right product and the right vendor. With more than 700 EHR vendors, almost everyone claims to provide a certified solution. However, it is only until the solution is implemented that the physician is exposed to the realities.

“I can recall several so called “certified EHRs” which have caused disappointments amongst physicians. It is not always a one sided game, where vendors need to be careful while marketing their products. Physicians shouldn’t be negligent either while purchasing the product”, says a Nebraska based Health IT consultant.

Since physicians are the sole beneficiary of CMS incentives, it is their responsibility to make sure that the EHR being implemented is not only certified but also being used meaningfully.


EHRs – Breaking the Constraints

The developmental pace of the health IT industry has been astounding. With numerous innovative products making their way into the market, the healthcare industry is headed for an extreme makeover. Healthcare reforms are the need of the hour considering the current economic crisis of the country, as they aim to bring affordable and quality care to every household in the US. The first step has obviously been the promotion of electronic health records. Serving as a cornerstone of healthcare reforms, EHRs will eliminate paper based medical trails while increasing efficiency through clinical decision support and electronic data interchange.

While EHRs have existed for a while now, their objective is significantly different from what it was two decades ago. Created only as a digital repository, EHRs had minimal functionality. Defining features were limited to input control and basic reporting. Today, the EHR is defined by its data mining capabilities. With the healthcare industry focused on population health management, the importance of ‘big data’ utilization is now more than ever.

Keith Smith, a health IT consultant explains that electronic health records (read more) are the platform for change in healthcare, “We are talking about re-inventing the system, introducing performance incentives for physicians and inducing a culture of accountability. We are talking about coordinated care and patient connectivity. We are talking about better care, lesser mistakes, population health and affordable care. To truly be able to transform to such an extent we must digitize healthcare. We must improve information accessibility and enable connectivity. We must move to EHRs.”

The idea is to remove the constraints of paper based system and enable better communication amongst healthcare professionals. Care quality is often determined by the information available to the attending physician. “There have been countless examples whereby physicians had to treat patients in emergency with little or no information, jeopardizing both the patient’s health and their own professional careers. It is a shame we have to go through these dilemmas in the 21st century,” explains a retiring physician from New Jersey. EHRs are designed to bridge this gap in healthcare by creating self sustainable digital health records, accessible to patients and providers across the care continuum.


The EMR Triangle – Physicians, Vendors, and Demos

Gathering relevant product information and knowledge should be the first step before deciding to buy a certain product.  Considering the healthcare industry, providers usually request the EMR vendor for a demonstration of the product. Although providers are aware of certain functions that Electronic Medical Records (EMRs) are designed to perform, however in order to thoroughly understand any application, they always prefer to schedule a demo.

Despite the fact that spending long hours in learning the application is a tedious job for physicians, it is the only way they can comprehensively evaluate and understand EMRs. Before spending thousands of dollars, they need to make sure if the solution is worth their time or not. However, providers can save plenty of time by informing the EMR vendor whether an on-site or an online demo suits them, and of course, by doing their homework beforehand.

Considering the above mentioned points, physicians should generally prepare a set of questions and send them to the demonstrator before the demo starts, and during the presentation they can easily communicate if the concerned aspects have been addressed or not. Moreover, they should always make notes and share them with colleagues to see if further queries could be brought up.

It is indeed true that the more you ask the more you learn. This is one of the reasons why EMR demonstrators encourage physicians to ask as many questions pertaining to the application as possible. After all, being a passive learner could certainly put a cap on the amount of extractable, relevant information.

“Before going into a demo, we are well prepared to answer a good deal of questions. We don’t expect the providers to know everything about the product before they have even seen it, and this, primarily, is the most important reason why we always encourage equal participation from the other side”, says an EMR demonstrator.

Once a demo has been completed, it is always advised to go through the notes and see if all concerns have been duly addressed or not. Has anything been missed out? Always conclude a demo with feedback, as it matters to the vendors since they can design the system according to such feedback. In the end, if you are content with the demo, simply signup!

Given the amount of competition in the market, providers are exposed to a wide array of EMR vendors to choose from. Hence, taking the needs of their practice into account, providers should know beforehand which EMR vendor to opt for. According to recent surveys, providers today prefer “All-in-One Solutions” for their practice, which includes Practice Management and Patient Portal. These solutions help them with not only the clinical side of the practice but also with administrative side.


Practice Management – What’s Missing in EMRs?

Considering the daunting competition among Electronic Medical Records (EMR) vendors in the market today, various vendors are trying to innovate healthcare technology as much as possible. It is certainly not difficult for them to realize that in order to influence the consumer market and to generate revenues, they need to focus on the need of the hour – the integrated HIT application suite.

Besides efficiently maintaining clinical records and documenting patient encounters, managing practice operations is yet another challenge that physicians face on a daily basis. To resolve such issues, physicians prefer practice management software, which helps them to record “non-clinical” information of patients. It simplifies the administrative and financial workflow management and also eliminates the hassle of re-entering patient information. This means that once the information for a particular patient has been stored into the system, next time the provider simply needs to use the click of a button to access the entire data.

“I remember how many hours it would take to manually enter patient information, maintain the records, and retrieve them when needed. With practice management software, however, it just takes a few clicks and there you go”, says a New York based physician.

Having established that, there are several other reasons behind the increasing demand of integrated practice management software. Physicians prefer such systems because they help them in reducing the levels of stress amongst their staff and also saves valuable time. Moreover, it is more convenient and prolific to have all the essential workflow management components on a singular platform.   While the internal benefit of Practice Management software is to increase practice efficiency, the external benefits include a safer environment through the reduction of paper use.

“With health IT application suites, apart from saving lives, physicians today also serve in protecting the environment. This is clear evidence that green technology is the future”, says a New York based Health IT consultant.

The above stated facts illustrate the significance of practice management software in the world of HIT. Unfortunately, the absence of practice management systems within an EMR increases the difficulty level of maintaining administrative and financial workflows of the practice. It is essential for EMR vendors to realize that although technological advancement aids in optimizing managerial process, incomplete packages might deteriorate the consumer interest in a particular technology. Nevertheless, there are some vendors that understand the consumer demands and offer an “All-in-One” EMR package with integrated practice management software.

Read more: EHR & Healthcare automation: Are patients better off?


The Do’s and Don’ts when buying a Practice Management Software

Before getting into the nitty gritty of what a Practice Management software is all about, let us define it first. In simple words, a practice management software addresses the day to day operations of any medical practice and allows the clinical user to capture patient demographics, maintain insurance payers list, schedule patient appointments, perform billing related tasks and generate user defined reports. This implies that an ideal practice management software should make front desk operations look like child’s play, but is that the case?

Many medical experts will have their own recommendations on which practice management software should be considered, but blindly implementing a software based on someone else’s recommendation can prove be a physicians Achilles heel. What most medical experts don’t realize is that each practice has its own customs, specialty and workflows, which is why they would pick the practice management software that best suits their existing workflows. Implementing a practice management software and the subsequent transition phase is something that physicians would rather avoid. The only drawback in such circumstances is compliance issues. There are many practice management software’s which might meet the practice needs but fail to comply with HIPAA rules and regulations. The sudden change to a more compliant practice management software creates havoc and the physicians ends up de-optimizing his practice rather than optimizing it. So how does one decide what to  look for and stick to it?

here are many software’s in the industry today that offer their solutions for practice management but the key is to choose the right one. First step is classification. Practice management software’s are designed for small (1 -2 physicians), medium (5 -10 physicians) and large (10+ physicians) sized practices. A physician must identify the software’s which satisfies his requirements, decide if the practice needs a client server or cloud model, verify if the practice management software integrates with the EMR/EHR and then perform the tricky bit – schedule a product demo !

Before we get to the demo part, choosing the right model is the key. A client server model for practice management would mean that the practice would either have to acquire or finance server equipment, along with setting up workstations for its users which will have the practice management software installed on them. The primary disadvantage of running a client server model is the cost of running the server. This is where the SaaS or cloud model outshines the client server. The SaaS model decreases cost while increasing security and reliability. The only drawback is that protected patient data will be with the EMR/EHR vendor, which could raise unwarranted security issues.

Integration between practice management software’s and electronic medical records is often a key decision maker. During implementation it is considered to be one of the most challenging aspects faced by any medical practice. Few EMR/EHR vendors in the industry today offer a complete suite, which consists of both EMR and PM, but a fewer number of vendors exist whose practice management software would integrate with any EHR. The wise choice would be to identify the vendor who offers the complete suite and whose practice management and electronic medical records are top notch. Although this might seem like an impossible task, there are a few vendors out there who do provide such services. The question remains on how to identify them, and the answer to that question is simply KLAS. Recent unbiased surveys by the KLAS group have catered to this need. A quick glance at their survey will help physicians and office managers identify the leading EMR and practice management providers in the industry, and would expedite the overall selection process. Categorized by different specialties, practice size and other criteria, I would recommend medical experts to take part and review the survey to get the best value for their money.

Meaningful Use of EMR – Where to next?

Meaningful Use EMRHealthcare professionals have now become accustomed to working with electronic medical records to perform their daily operations. These systems are no longer viewed as tools to record clinical information to be viewed at a later time. Thanks to the support and rules set forth by the CMS in the Meaningful Use initiative, providers and EMR vendors have all had to incorporate positive changes in existing workflows, system design, usage and development of these systems. This has meant that the industry has grown to hundreds of different vendors, offering one thing over another in attempts to beat their rivals.

The Meaningful Use initiative has now come a long way with an advisory committee working hard to finalize its most advanced phase – stage 3. The health IT policy committee’s Meaningful Use workgroup places much greater emphasis on clinical decision support and machine-readability of data among other things. They also propose greater usage of CPOE (Computerized Physician Order Entry) along with electronic referrals in this final stage of the EHR incentive program.

The proposed rules also require for providers to have at least 10% of their patients submit information such as medical history, demographics and even information captured from home-based medical devices, directly into the electronic health records through online portals. Care coordination is also highlighted, as providers are required to create and transmit care plans across multiple sites in case of patients moving from one location to another.

Similarly, the optional requirements under stage 2 will be considered as the fundamental measures under the stage 3 rules. Also, they would become obligatory subject to the provisions of the final rule in stage 2, which is expected any to be established any day now. In February this year, HHS announced the proposed rules for Meaningful Use stage 2, set to be implemented in FY2014. Considering the present timeline, Meaningful Use Stage 3 would commence two years after an eligible provider first satisfies the stage 2 requirements, which means no earlier than 2016.

Eligible providers will be required to record potentially confidential data such as gender information or identity. They also recommend eradication certain measures such as recording the patient smoking status. As for enhancing population health, the workgroup recommends physicians to use electronic health records for creating patient lists for particular conditions in order to establish a pattern. This will significantly reduce health disparities and research. Having said that, we may have to wait till May 2013, which is when HHS would propose its final stage 3 rules, to witness the real impact of the Meaningful Use criteria on the healthcare industry.