EMR Implementation – The Expert Advice (Part 1)

With the government’s initiative to take healthcare into the new era of technology, practices of all sizes are vying to make the transition from paper to electronic documentation. For any practice seeking to make this conversion, a thorough analysis of their operations is required in order to assess how the implementation of an EMR solution should begin. Various operational aspects of the physician’s office have to be factored in prior to the beginning of the EMR implementation phase. Ray Parker, an EMR implementation specialist at a major health IT organization, gives us his take on the subject matter explaining the approach that practitioners should take in order to ensure a smooth execution of the system within their offices.

First and foremost, general practitioners and specialists alike have to identify the specific needs of their practices, while fully comprehending the reasons for conversion from paper to electronic medical records or a switch to a different EMR vendor. They have to ask whether they are looking to expedite documentation and reporting, and whether their existing solution inadequately equipped to handle these needs. Regardless of the motives driving physicians towards adoption, their eventual goal may well be common i.e. complying with Meaningful Use measures. If they are conforming to the standards set by CMS, the practice efficiency and expedition of operational processes is expected to improve by leaps and bounds. A significant determinant while finalizing your selection of the vendor should be the qualifications of the vendor organization (with special emphasis on the quality certifications) and subsequently judging the capability of the vendor in terms of meeting your practice requisites.

During the process of ascertaining the clinical and administrative requirements of the practice, some fundamental questions need to be answered and communicated with your vendor. For instance, how many clinicians are based within the practice, the workflows they follow, how many staff members need access to the system and what will be the corresponding training requirements etc? The practice has to be prepared beforehand to convey the entirety of its needs to their chosen service provider preceding a demo of the vendor system. For example a practice might want to stop getting paper faxes and want to receive their faxes electronically instead, or a practice may want to opt for an electronic lab interface with a local lab company. To help the vendor understand specific practice requirements, it’s very helpful to ensure that providers share their existing clinical data templates and specialty specific workflows before scheduling a demo with the vendor.

With respect to implementation, it’s of utmost significance that communication between physicians and vendors is crystal clear regarding data preservation requirements of the practice. Keeping into mind the legal ramifications of maintaining historical data (which varies from state to state), a provider has to aptly determine how much data has to kept and migrated. The vendor must be able to meet these necessities or propose appropriate alternatives to avoid unwarranted outcomes. Size and nature of their data plays a huge role at this stage, as clinical and billing data from older/outdated EMRs is very tedious to extract and even more complex to migrate. Apart from the data requisites of the practice, the clinician should also communicate any specific hardware requirements with their vendor. This provides an opportunity to the vendor to deal with any hardware compatibility problems that may arise at a later stage.

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.


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.


What to Ask About Your EMR Vendor?

Collecting EMR references has to be one of the underutilized methods of evaluating and selecting an EMR solution. If you cannot buy a laptop without asking around first, how would you want to get into a contract that spans over multiple years? Relying simply on what was promised is not a wise choice. User feedback can help physicians get a holistic view of the product along with the possibility of identifying various tips and tricks to better utilize such systems, particularly important for providers with no prior EMR usage experience.

Work can be split between staff members for better productivity and ideally physicians should participate with their administrative staff. This would help in establishing peer to peer level communication, allowing participants to gauge questions and responses better. While the practice may adopt multiple ways of communication, visiting the reference site in person or conversing over the phone may help in providing a more personalized outlook.

Another key is to not be limited to the contacts provided by the vendor. Physicians can find other practices by joining user communities or professional societies. Once you have established a reference sheet, the next step is preparing a questionnaire.

The most important questions to include in this questionnaire are:

  1. How long has the practice been using the EMR solution?
  2. How long did it take for the implementation to complete?
  3. How was the implementation experience?
  4. How long was the training process?
  5. Were the allocated training hours adequate?
  6. Did the application appear to be as easy as seen in the demonstration?
  7. How much of the annotation process is templates driven?
  8. Has the documentation process improved since implementation?
  9. How many patients were seen in a day before and after the implementation?
  10. How would they rate the quality of the exam note? Pre and Post implementation.
  11. Has the use of paper charts been completely eliminated?
  12. Did they consider or use scribes? If yes, what about the cost and quality?
  13. How would they rate their overall experience? And would they recommend the EMR to another practice?

Although this list is not by any mean exhaustive, but by asking the above questions most physicians will be able to gauge how suitable the EMR would be for their practice.