EMR Adoption and Change Resistance Management

You’re a medical practice manager with eyes on that CMS incentive program and its time to go EMR shopping. You’ve picked a product, everything looks great, the budget’s been allocated, partners & providers are with you, the vendor’s shared their magical implementation plan and you can’t wait to order the hardware.

This is where you slow down and go back to that smooth implementation plan to take a good look at it for the part that talks about “CHANGE RESISTANCE MANAGEMENT”. What! There isn’t one? Maybe you think you do not need one.  After all what can be so challenging about adopting an electronic medical record and a practice management system that will only require tweaking your business workflows while twisting arms of the back office staff. Also, don’t worry about the grumpy old radiology technician who firmly believes that technology ended with the invention of x-ray machines. The MAs’ won’t bite you just because the charts are now a few clicks away, far from that trusty old file closet.

Maybe you thought that it’s not the vendor’s responsibility to help you manage the commotion their product is going to cause at your front desk while the billers refuse to send the claims out in the back office. Your doctors probably don’t care about what product they are signing up for as long as they can still create notes on paper, slap them on scanners and beam them into an EMR.

A good EMR vendor with a mature implementation team will discuss change resistance with you; in fact they would ask you to establish all your business critical operations before sharing the implementation project plan with you. Chances are they will also share their workflows and rebuttals against each item you’ll share with them. This is usually the first step an implementation team will take with you. They should also ask you about the key staff members at the practice for establishing implementation partnerships. The chief biller at the practice can work with the vendor to facilitate a smooth deployment while acting as a key – post live communication person for his or her department. Same is the case with front desk, facility (lab, radiology etc…) and provider representatives at the practice.   A half decent implementation team will design their trainings around the concept of toning down the resistance that may surface with the adoption of their product.

Access to legacy data, adequate trainings, an established knowledge base and efficient pre live implementation communication are some of the key factors that contribute towards reducing the intensity of change resistance. Establishing a communication plan with the vendor before the start of the implementation process really pays off, since calling them every 20 minutes for the next six months is not healthy, certainly not for a practice. Find out if your vendor offers portal based communication such as e-ticketing or an action list.

Never underestimate the importance of legacy data so don’t leave any stone unturned when it comes to data migrations. Find out what you’re paying for and make sure your staff gets a memo about what information will be accessible in the new EMR and what needs to be saved in Human Readable Format on a shared network. Insist on test data migration if your vendor has not offered one already and get a consensus on it from all stake holders.  A good vendor will probably ask you to sign an approval on the test data migration before conducting a final one.

Ask for training agenda against each scheduled session and then adhere to time and staff requirements.  Insist on post live Q&A sessions and share your staff’s concerns with the vendor beforehand.

Find out what kind of online training material is offered by your vendor and promote its usage amongst your staff. Identify leaders in all the departments and establish an effective leadership that can assist you in finding and implementing solutions  while communicating with vendors on your behalf.

Finally it does not matter how new the technology may be; the same old rule of “Nobody likes change” still applies.



EMR Frauds– Issues Addressed

One of the major concerns while highlighting the drawbacks of Electronic Medical Records (EMR) has been the misuse of confidential patient information. The healthcare industry has suffered a lot in terms of reputation from such incidents in the past. All industry members have condemned these unfortunate events, though the number of reports of abuse compared to the total number of EMR users is relatively low. By and large, the statistics suggest that on the contrary, EMRs have strengthened the system.

EMR adoption has been encouraged vivaciously after the HITECH Act was passed in February of 2009. As a result, there was widespread EMR adoption across the nation. A very important note at this juncture would be to state that financial incentives introduced by CMS for meaningful use of EMRs have had a huge positive impact on the healthcare industry in the US. Processes have become much more streamlined and have been expedited as a result.

Similarly, certain statutory legislations have been passed to protect the rights of all parties involved with the entire electronic medical records user populous. However, there have been cases which illustrate the abuse of private and confidential data. This doesn’t mean that the healthcare system is inherently flawed; there are always some bad fish in the sea. Compromise on the reputation of using electronic medical records is a classic example of one bad fish tarnishing the reputation of the entire pond. Moreover, any individual who believes that the HIPAA Privacy Rule is not being complied with, has the right to file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR). Corrective actions have been taken against such fraudulent events. For instance, as per the report of HHS, a total of 92 medical practices including physicians, practice managers, nurses, and other providers allegedly used EMRs for monetary gains through fraudulent billing processes – thereby culminating in a loss of $225 Million from Medicare funds.

The above mentioned facts demonstrate how the rights of the parties in question have been protected through legislation and the system has been strengthened yet further by the use of electronic medical records. It would be ludicrous to suggest that EMRs provide a platform for abuse; yes there may be some technical slip-ups, but it’s far from being a pathway towards illegal use. That being said, it eventually boil downs to the intent of medical practitioners.

The national coordinator for health IT, Farzad Mostashari, believes that although there will always be incidents of fraud and illegal use of EMRs, there will be legal implications against such frauds. He goes on further to say that appreciating what EMRs have done to strengthen the provision of healthcare is essential. Mr. Mostashari states further that such technology constructs the basis for independent compliance audits and thorough investigations. Therefore, the environment keeps on improving and rectifies its mistakes, and consequently the healthcare industry becomes sturdier.


The Solo Provider Conundrum

With the increasing popularity of Accountable Care Organizations (ACOs), the quest for affordable care may not seem too far. Health IT has helped transform the care structure, enabling physicians to become more responsive to change. Today, almost 55% of physicians have access to electronic medical records (EMRs) helping engage other concerned parties across the care continuum. However, the support for this change is not free of personal concerns.

The healthcare reform focuses on two key elements, quality and affordability of care. While most professionals will resonate with these principles, there is some uneasiness regarding the course laid out by the government. “While the consequences may be unintended, the current healthcare reform clearly favors hospital based physicians over private practices. It is increasingly becoming difficult for solo practitioners to work independently. Reimbursements are low, costs are high and then there is the regulatory pressure.” says a Practice Manager in New Jersey.

The last few years have also shown a trend amongst large healthcare corporations of acquiring smaller independent practices. Competition is rife, and while independent physicians struggle to keep up with business expenditure, hospitals and health corps are moving on to electronic platforms with EMRs and independent health information exchanges (HIEs). “It is creating a technological gap. Solo practitioners are still struggling with EMR adoption while hospitals have started to receive their return on investments.” says one industry expert.

A significant percentile of physicians reports a decrease in overall revenue with the economic depression. Revenue cycles are drawn out with claim complexities further jeopardizing business health for solo providers. “ACOs are being slated as the next generation of healthcare organizations. Practices that fail to embrace the concept and the technology will soon become dinosaurs.” says a Hospital Administrator.

The fee-for-performance does not appease every provider. With the level of competition in the medical services market, solo providers have much to lose already. Most physicians are advocating a blended system including fee for service along with an outcome based reimbursement. George Kamajian, DO from Florida complains that the government policies do not involve the physicians in such (reimbursement) decisions. Kamajian believes that this is in fact the main reason why most patients requiring care are deprived of it, “It all comes down to government guidelines and barriers and restrictions.”


Why Physicians Prefer to Choose their own EMR?

Most physicians customarily like to associate themselves with multiple practices or hospitals. In today’s competitive environment, reimbursements are meager and costs are high. This compels most physicians to seek additional hours at hospitals or establish their own private practices. Keeping pace with the ever evolving healthcare industry is also an arduous task. With healthcare moving towards automated care, physicians must adapt accordingly or risk being left behind. While the recent report from CDC shows an improved EMR adoption rate for single providers, smaller practices are still playing catch up.

“It is not that physicians have not been exposed to the technology. Most physicians have access to electronic medical records at hospitals if not at their private practices.”, says Keith Smith, a health IT consultant. He believes that the gradual increase in EMR adoption will undoubtedly influence physicians across the nation. Keith further adds that, “Physicians are usually very sociable. If all of their friends are using electronic medical records, then they would want to use it too.”

This is one reason why most physicians tend to choose EMR solutions popular amongst their peers and colleagues. That being said, physicians tend to avoid electronic medical records being used at hospitals that they are affiliated with, while purchasing an EMR for their private practices. This may seem unusual given their level of familiarity with such systems, but hospital based EMRs are often designed to conform with generic requirements, whereas physicians prefer choosing an EMR that can provide for their individual practice workflows.

Another reason may be that most hospital based EMRs are configured to operate in a specific environment. Hospitals have more resources at their disposal compared to a private practice. Hence, while a large health organization might be able to derive efficient workflows from implementing an EHR solution, the outcomes may not be the same for a smaller practice. Therefore, unless a physician has other factors to accommodate, they would refrain from choosing hospital based systems.

“Every practice has their own unique identity and their workflows should be able to reflect that. This is why practitioners seek customizable EHRs that fit their practice structure and requirements.”, says a Florida based practice office manager.


Where are we With the Healthcare Reform?

I recently had a chance to connect with a former colleague and Health IT expert, Keith Smith. Keith is an independent Health IT consultant working closely with hospitals and private practices. He helps them manage the logistics for implementation as per their operational and technological needs. Given the recent surge in innovative Health IT solutions, I invited Keith to share some of his experiences and perspective on EMRs.

What is your opinion about the adoption numbers by CDC?

Well if you look at it from the perspective of ONC and the government, things are moving along at a decent pace. With adoption tipping over 55%, you can clearly sense a shift in tides. Moreover, according to the report, half of the physician populous that had not yet implemented an EMR solution was planning to do so within the next year.

How far do you think we have come in terms of the healthcare reform?

That’s a subjective question and I am sure there would be plenty of other opinions as well. I think the right way to look at it is to trace back from the end goals of improved health, longer life span, patient convenience, etc. Accountable Care Organizations in principle sum up what healthcare should be like. Right now we are in a transitional phase and most of the innovative solutions coming out are experimental at best. However, this year will be monumental for Health Information Exchanges and EHRs as we move towards connected care. Earlier this year, HIMSS Analytics released a 7 stage US Ambulatory EMR Adoption Model (UAEAM) that gauges the capabilities of health organizations to improve care quality through electronic medical records. According to this report, almost 11% of healthcare providers are at the third stage, having replaced the paper charts with EMRs backed up clinical decision support systems and capable of electronic messaging.

What do you think about the meaningful use measures?

I think the purpose of meaningful use (MU) was to educate the healthcare community on effective use of electronic medical records. While it does serve that purpose, MU’s objective based incentives can distract physicians from care quality to the fulfillment of these measures. Care is a service and I do not believe in standardization of care processes. It affects the individuality of the practice and often causes an ethical dilemma for providers. However, MU is voluntary and it has been effective for a number healthcare practitioners. The stimulus has helped many practices expand and improve their care delivery processes. Hence, I believe that this program can benefit the community at large, though it may be early to start measuring its success.

Read more: Healthcare & the race between vendors to develop the best software


The Preventive Care Solution

Preventive care is far more efficient than curative care. It is also a lot cheaper. With the US economy under crisis and healthcare expenditure on the rise, a change is required now more than ever. After all, information technology has influenced several industries and while healthcare anticipates similar benefits, the progress has been relatively slow. However, as a result of the governments backing towards health IT and EMR adoption, almost 55% of physicians in the US have either adopted or are in the process of implementing an EMR. There have also been multiple developments on the health IT front, with mobile healthcare poised to make big waves, especially in consumer markets.

Consumer health IT products will definitely help in increasing patient awareness. There is an increased level of expectancy from interactive mobile applications that will help patients manage health, interact with physicians and maintain their own personal health records. Farzad Mostashari the National Coordinator for Health Information Technology said, “We all know that most of the health does not happen in the doctor’s office; it happens with the patient”. Mostashari believes that electronic reminders through patient portals and electronic medical records will influence patients to pursue recommended prevention and recovery plans, while allowing physicians to play a more prominent role in care delivery.

Dr. Ned Claxton, medical director and president of medical staff at the Central Maine Healthcare’s new Accountable Care Organization (ACO) believes that there is an increased need for the health community to shift from reactive care to proactive and health focused care. A healthy patient is a happy patient and preventative care costs less. ACOs promote a similar concept with ‘quality and affordable care’. Many medical professionals would agree that ACOs are in fact the future of care. “ACOs are outlining a roadmap for health organizations. The Accountable Care principle is not just about health IT and use of EMRs; it’s about a change in health perspective. By incentivizing quality care and collaboration, ACOs are transforming care.” Cutting costs and reducing budgets may only produce short term results, while compromising on the quality of care. This is why ACOs and preventive care are the way forward.


EMR Adoption and Health Information Exchange

The last few years have been monumental for health. Electronic medical records have flooded into the mainstream with a recent report from Center for Disease Control (CDC) suggesting that nearly 55% of physicians in the US are at some stage of adoption. The survey also indicated that most respondents felt that EMRs had improved the overall quality of care. Industry analysts view this as a huge achievement for the healthcare industry and a giant leap towards the reformation process. One industry expert says, “The EMR has the numbers now. With more than half of the physician populous already using electronic medical records, physicians still using paper will have to join in or risk becoming obsolete.”

The U.S has been quick to utilize emerging technology in healthcare and with EMR adoption on the rise, physicians are likely to respond positively to innovation. “Our objective is connecting care and to reach this goal, we require an electronic health information exchange platform. EMRs provide just that”, says a hospital administrator.

John Lynn from healthcarescene.com shared a similar opinion in his blog. He believes that most of the healthcare community is aware of the benefits of Health Information Exchange (HIE). John argues that while standardization and development costs are two main barriers, the scale of EMR adoption in the country may be the biggest impediment to growth in the sector, he writes, “We want HIE’s to be successful, but can an HIE be really successful for doctors and hospitals that don’t have an EHR? The lack of EHR adoption might be the biggest impediment to HIE.”

The transformation of the healthcare system hinges on the success of electronic medical records. Having realized the importance of EMR adoption, the government extended its support through Regional Extension Centers and other educational communities in various states. The ONC highlighted the need for outreach programs targeting the rural and underdeveloped areas. While cost is a major deterrent here, education and exposure are the other key constraints.

The CDC survey also listed solo providers as the laggards in the adoption cycle, with only 30% reporting for adoption. However, the outlook is not so bleak. An industry expert highlighted that it’s common for independent businesses to lag behind in industrial changes, saying, “The adoption may be slower for independent doctor offices but it would change in the long run. Physicians are likely to follow large health corporations and hospitals in adoption. In fact there is an increasing trend of independent doctors adopting EMR systems with an HIE interface with their local hospital.”

HIEs are a step in the right direction and should help reduce cost in the long run. The communication process will simplify and health organizations will be able improve the patient care process through coordination. EMR adoption will continue to be the top priority and the government remains optimistic as it aims to shift America to electronic medical records by the end of 2014.

Read more: Data migration: Why is it important in Healthcare?