Electronic Medical Records – Seeing is believing

By injecting huge amounts of funds within the health IT industry, the US government is successfully automating healthcare. Roughly, $370 million was allocated to different

healthcare departments including the office of the National Coordinator for Information Health Care Technology, Department of Commerce for health care information integration activities, and Department of Health and Human Services. This huge funding explains the seriousness of the situation and the extent to which government is trying hard to modernize health care, with implementation of Electronic Medical Records (EMR) as the stepping stone.

Moreover, government will be providing incentives to the physicians who will be meaningfully using the information technology.  ‘Meaningful use’ is a relative term and different physicians take it differently. However, it is best described as the clinically correct way of using technology that will bring significant improvement in health care. The aim is to have physicians demonstrate healthcare in a meaningful manner in order to get the best health care results by bringing the errors to a mere low. Adoption of Electronic Medical Records will ensure that the medical community is following industry best practices and justifying it as well.

There are many studies that support the idea of having Electronic Medical Records. Recent studies indicate that EMR adoption doesn’t only improve the quality of health care provided, but also reduces the malpractice claims done by physicians and insurance companies. Equally important, it reduces the hassle of documenting everything on paper, brings down cost, and access health information from multiple locations. According to a study by Harvard, malpractices of physicians dropped from 11% to 6% once they implemented Electronic Medical Records.

However, this idea of electronic documentation was opposed by many physicians as they thought the application would require more bug fixing. For this reason, EMR Vendors are trying hard to make it user-friendly and usability oriented. Therefore, leading Electronic Medical Records Vendors have come up with all-in-one Cloud EMR technology that integrates Electronic Medical Records, Patient Portal, Medical Billing Services, and Practice Management Software. In most cases, these services are compatible with each other and therefore, could be accessed simultaneously from the same server.

Cloud EMR technology gives physicians the ease of always staying connected with their patients. This technology complies with the industry standards and ensures the protecting of the data. Certainly, Cloud EMR technology will bring about the expected changes in the way practice taken.

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.


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.


EMR – The word on the street – Part 4

I concluded my last post (EMR – The Word on the Street – Part 3) on meaningful use and patient engagement. Although my first session had concluded with patient portals, I had a chance to revisit my group last weekend. Luckily, during the time since our last meeting most of the group members had managed to experience healthcare automation first hand. Our discussion had sparked an interest and increased their curiosity. One member even admitted visiting his primary care physician just to experience the new exam room dynamics. “I just called in and scheduled a physical. I knew they had converted to an EHR some time back.”

However it was pertinent to note that a few of them had learned about the government incentive plan and they were quite intrigued when I mentioned the meaningful use program and its objectives. The initial phase seemed to go well with the group. They unanimously agreed that it was a good idea to incentivise the adoption, while most of them agreed that setting EMR objectives should also benefit the healthcare sector. One member though keenly pointed out that such objectives could prove to be a distraction for the physician. “Wouldn’t this make the physician more concerned about his checklist?”

The recent feedback on meaningful use has been somewhat similar in this regard. Many professionals are now questioning ‘the carrot approach’ to meaningful use. Some even going as far as to regard it as unethical. However, personally I believe that meaningful use serves a purpose in its own right. The program has brought a method to medicine. While standardization may not be good for free flowing innovation, meaningful use has brought a purpose and direction for electronic medical records today. Without it, I doubt we would have seen this much progress in terms of interoperability and health information exchange. I also feel obliged to point out that the meaningful use program is completely voluntary, and physicians who feel as though such measures may affect their care delivery process are free to operate without them.

The meaningful use objectives though are likely to become more challenging with time. With the final rule for stage 2 out now, ONC has made its intentions clear. EMR vendors may have been given a lifeline this time around with some relaxation in interoperability requirements but ONC has made it clear where healthcare is headed. Electronic medical records would need to evolve with the requirements as stage 3 is unlikely to be as forgiving. Stage 2 sets up the practice for health information exchange while increasing its responsibility towards population health management. The group seemed to share a similar opinion on population health management and I think the following quote from a participant sums it up quite well, “Sure, I mean I can see how it would help in disease management, hospitals will be able to respond quickly and there would be a shift towards preventive medicine, but then again I have seen too many movies to know how this could all go wrong, very wrong.”


EMR – The word on the Street – Part 2

Continuing from where I left off 3 weeks ago, EMR – The Word on Street – Part 1, most patients tend to have very unique perspectives about the EMR technology. Still not accustomed to the change like most physicians, patients are more intrigued and fascinated by the drift towards automated healthcare. While I have not had the chance to reconnect with the group, I had not quite finished the account of our detailed discussion on health IT and the wondrous world of electronic medical records.

I was able to establish that the patients in the group did not have any inhibitions towards the electronic medical records technology. Even when invoking the subject of privacy and health information exchange, most of the group members felt secure, citing that they ‘trusted their doctors’. Despite being an ‘awww’ moment, I was surprised at this response. One member quoted, “If my doctor is using an EMR, I expect he has gone through all the hurdles to make sure that my information is safe and secure. They are professionals and they know how to do their job.” That statement summaries what most patient feel about health IT adoption, instead of being personally concerned about the security of their health data, patients expect physicians to play that role for them, as professionals.

While providers plan for such risks and unauthorized disclosures, electronic medical records change the job description significantly. Digitized data is more susceptible to theft. Not only is data exposed in its physical environment but also vulnerable to cyber theft. However, the problem is that most providers tend to rely on basic firewalls and commercial encryption software available at economical rates, while others simply leave the security up to their hosting parties and EMR vendor. Given the amount of recent breaches, such methods are no longer acceptable. Ensuring patient safety and maintaining confidentiality should be one of the top priorities for physicians. With health information exchange (HIE) in sight, physicians should look to train their staff to work within such an environment whilst planning for contingencies.

However, despite their trust in provider professionalism, the group did not take lightly to the possibility of physicians selling their patient’s personal health information to disease control bodies, etc. even when de-identified. I had to assure one of the group members that it would be a HIPAA violation and against the ‘rules’ to sell patient information without prior consent. One patient joked about reading the fine print of every medical document from  henceforth.


Costs to consider for EMR implementation

Despite what most EMR vendors may want you to believe, there is more to budget for than monthly costs along with the initial training and implementation fees. While costs have decreased significantly over the last few years, most EMRs still require a small fortune. Many providers still rank cost as the highest in hurdles to adoption and while the government may incentivize EMR adoption through meaningful use, the initial investment is still to be paid by the provider alone.

Research and Analysis (Sunk Cost)

What most providers do not account for is the opportunity cost of researching and analyzing the EMR product. While for some it may just translate into free time and hectic schedules, for others it may require sacrificing available time slots for patients, resulting in business loss. One should also include the cost for visiting onsite references, hiring staff overtime for analysis or consultation fees.

Hardware Costs

Most EMR vendors are able to provide hardware specifications for optimum results. While Software as a Service (SaaS) model for EMRs may reduce the upfront spending, those shifting from paper will still need to set up exam rooms and nurse stations. Recognized EMR vendors often work with hardware vendors to provide their clients with discounted deals and bulk buys.

Software Costs

EMR users are required to pay licensing cost, either upfront for a client server model or on a monthly basis for SaaS based product. Physician’s assistant and Nurses may also require separate user licenses apart from the provider’s own. The upfront licensing cost for a client based server can range between $5000-25000 depending on the solution and user base while some hospital based vendors may even charge in excess. SaaS based EMR vendors usually charge around an average of $500 per license.

Training and Implementation Costs

The training and implementation costs can vary significantly from vendor to vendor.  Most EMR vendors prefer to train providers through remote desktop access, because not only is it more cost effective but flexible too. Sessions can be configured to suit the user requirements, while personal sessions can be set up at the discretion of the user, independent of location. However, most practices still prefer onsite training which may cost more but help smoothen the implementation process itself. Training hours can be billed somewhere from $100-300 dependent on the method and vendor.

Support and Maintenance 

Hospitals and large care corporations are able to hire dedicated staff to provide ongoing assistance when and wherever required. However, EMR vendors especially for SaaS based products are able to provide offsite support through telecommunication and online portals. This method is more cost effective in most cases and one of the major reasons driving the adoption of SaaS based EMRs. These costs however do not include hardware maintenance in most cases which then would have to be arranged independently by the provider if required.

Other ongoing costs

It is important for the provider to consider other miscellaneous expenditure that may or may not be required during or after the EMR implementation. These can include hardware and software upgrades, new employee training, additional feature requests and customizations.