EMR & EHR Blog for Physicians

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Is the EMR software you recommend CCHIT Certified?  This is one of the most common questions physicians ask me during a first EMR Software Consultation.  My answer is, “of course” that is, until HHS recognizes another organization accredited to certify EMR Software.  So while being CCHIT Certified is a good requirement to strongly consider in your search for a good EMR, it should not be used as the all encompassing endorser of every EMR Vendor you come across in making your final decision.  So what else can one do to go beyond the certification process?  Well, you can take it to the streets, so to speak.  That is, where do you go to find out how well an EMR software you may be considering is working or what are the most common criteria being used to grade EMRs in the real world of Medical Practice?

There are several well recognized grading or ranking organizations that compare EMR features and functions, survey and interview end users, and conduct performance tests of EMR Software. These results can be used by physicians as a practical “Report Card” to assist them in evaluating EMR Software and EMR Vendors.

Essentially, physicians in Ambulatory Practices of all sizes can use this information as an additional screening tool to further narrow down their selection list to include EMR Software that has earned excellent scores for their unified Electronic Medical Records (EMR) and practice management (PM) solutions as it pertains to their individual requirements.  

Here are a few of the well recognized EMR Software rating or ranking resources and examples of the information they can provide:

IDC Health Industry Insights

This IDC Health Insights report discusses ambulatory EMR functionality for small and midsize practices with 20 providers or less and presents an assessment of the offerings of 10 vendors that serve this space. This report considers the requirements and cost relief provided by stimulus payments under ARRA, alongside additional assessment criteria that consider results from EMR including the migration from paper charts to electronic documentation, electronic ordering, charge capture, and improvements to patient safety and the quality of care.

TEPR

TEPR Awards identify outstanding health information technology and electronic medical record (EMR) innovations and solutions.  Physicians can use this information to identify EMR Software that has received the highest scores available in important areas including pricing, implementation cost, features and functions, references, support and maintainence, and overall customer satisfaction.

The TEPR Documentation Challenge is one that you may hear many vendors touting about and that ranks their EMR Software for their charting abilities and speed compared to manual charting.

 KLAS

You have probably heard this phrase used a lot: "Best in KLAS" Awards. This is an annual competition amongst EMR Vendors to determine the “Top 20 Best in KLAS” awards report.

KLAS helps healthcare providers make informed technology decisions by offering accurate, honest, and impartial vendor performance information. KLAS independently monitors vendor performance through the active participation of thousands of healthcare organizations. KLAS uses a stringent methodology to ensure all data and ratings are accurate, honest and impartial. Research results are offered to healthcare providers through:

• A free directory of vendor and product information

• Free online access to vendor ratings for participating providers

• On-depth published reports, discounted for participating providers

AN IMPORTANT CAVEAT to mention here, is that not all EMR Software on the market are evaluated and therefore, even this information should not be wholly relied upon as the "super-list " of EMR Software options available to you.  There are many EMR Vendors that have not been evaluated by one of these organizations, but if they were to be put to their tests,  they would rank high and pass with flying colors.  So, if you are considering an EMR Software that may not be on the “A” list of one or more of these reports, the more important take-away from these evaluating organizations is to make good note of the major  categories and criteria that are being assessed and make them a part of your evaluation process when comparing EMR Software and interviewing EMR Vendors. 

Also worth mentioning, in a majority of cases, EMR Vendors actually pay to have their EMR Software included in thsee independent assessments.  Now you can make your own conclusions here but, that does not necessarily mean there is anything under-handed going on. 

So, to the extent that an EMR Vendor is being evaluated by one of these reputable organizations, use this information more as another good reference resource throughout your EMR screening and selection process.

My best advice, find a good EMR Consulting company to help guide you in the right direction for finding and comparing EMR Software.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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I cam across an interesting article on a very important topic that is very relevant in the light of recent discussion and legislation on 'meaningful use' of Electronic Medical Records (aka Electronic Health Records).

It was a survey that involved sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. There were 6 major findings:

1. EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging;
2. EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange;
3. Managing information overflow from EMRs is a challenge for clinicians;
4. Clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination;
5. Realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes;
6. Current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).

The third goal of 'meaningful use' focuses on improving care coordination by enabling exchange of meaningful clinical information among professional health care team by requiring the EHR to possess the following capabilities and functions:

1. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
2. Perform medication reconciliation at relevant encounters and each transition of care.
3. Provide summary care record for each transition of care or referral.

Given the survey findings listed in the earlier part of this blog, I am personally skeptical how many of the current versions of EHR Software solutions can pass the three capability tests (as above). The jury is out and we will better know which EMR / EHR Solutions will effectively meet the goal as far as co-ordination of care is concerned in the next few months.

If any EMR / EHR vendors or current users of EMR / EHR solutions would like to share their understanding, knowledge or perspective on this topic, please feel free to leave a comment.

We will continue exploring different aspects of 'meaningful use' over the next several weeks.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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Now that the HHS has issued two sets of long-awaited and much-anticipated federal regulations on list of "meaningful use" criteria that healthcare providers must meet to qualify for federal IT subsidies and the standards and certification criteria that those EHRs must meet for their users to receive the EMR incentives, one is left wondering what is the real value of CCHIT certification and do those EMR vendors who went in for CCHIT certification and spent over $40000 each for the certification without waiting for the meaningful use get any headstart?

Here is a summary of an article that was published by Modern Healthcare today:

CCHIT may have had close ties to HHS in the past but that is history. David Blumenthal, the current head of the ONC, in a meeting was responding to a question about existing CCHIT certifications of Electronic Health Records and HHS' prior recognition of CCHIT as a certifying body.

Blumenthal mentioned that to qualify to receive incentive payments, the EHR would have to be certified by a body certified by the Office of the National Coordinator and that ONC is working towards creating a process to recognize that body.
Blumenthal mentioned that even though CCHIT was recognized in the past as a certifying body, its future status will be governed by the regulatory process that is ongoing right now. He termed as premature the talk about the implications of any particular set of certification criteria that CCHIT or anybody else has put forward or will put forward.

Mark Segal, Vice Chairman of the Electronic Health Record Association of HIMSS said the stimulus law, gives the ONC the authority to go ahead and retroactively accept any EHR systems certified under the old CCHIT process as certified under the new stimulus law provisions.

The ONC rule-makers explained the rationale behind this decision to scrap the previously accepted certification criteria and process. HHS, they wrote, decided not to accept CCHIT certification criteria due to "our approach of aligning adopted certification criteria with the proposed definition of meaningful use."

Segal said there still are "a reasonable expectation that CCHIT will be one of those" organizations that will again be recognized by the ONC. He also mentioned that CCHIT certification criteria come quite close to matching those new criteria being developed by the ONC. As a result, if an EHR is already certified up until now means it already has a lot of the functionality in place.

I do believe that the EMR Vendors who spent the time and financial resources in advance of the recent formal release of regulations, they are at an advantage as compared to a large number of vendors who do not have any certification, whatsoever. A number of smaller EMR vendors got certified in 2006, but as the competition is heating up, are already on the way to getting their EHR certified under the CCHIT 2011 Certification Program.

As I have earlier mentioned in another blog of mine, just because a Physician implements a Certified EMR does not mean that it is used in a meaningful manner, one of the EHR selection criteria must therefore include the ease with which the EHR allows demonstration of meaningful use to CMS.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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1. List of "meaningful use" criteria that healthcare providers must meet to qualify for federal IT subsidies based on how they use their electronic health records. 
2. The standards and certification criteria that those EHRs must meet for their users to collect the money.

Phased Approach to Meaningful Use

What has been proposed is a phased approach that encompasses reasonable criteria for meaningful use based on currently available technology capabilities and provider practice experience, and builds up to a more robust definition of meaningful use, based on anticipated technology and capabilities development.

Under this phased approach to meaningful use, the criteria of meaningful use would get updated through future rulemaking. The initial meaningful use criteria have been referred to as "Stage 1."

(Stage 2 criteria are expected to be proposed by the end of 2011 and the Stage 3 definition may be proposed by the end of 2013.)

Stage 1 Meaningful Use Criteria

The Stage 1 meaningful use criteria focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.

Stage 2 and Stage 3 Meaningful Use Criteria

Stage 2 meaningful use criteria shall expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease).

Stage 3 meaningful use criteria shall focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.

Stage 1 Meaningful Use Defined in Detail

Goal 1: To further the care goal of improving quality, safety, efficiency and reducing health disparities.

1. Use CPOE (which entails the provider's use of computer assistance to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device. The order is also documented or captured in a digital, structured, and computable format for use in improving safety and organization. For Stage 1 criteria, it will not include the electronic transmittal of that order to the pharmacy, laboratory, or diagnostic imaging center)
2. Implement drug-drug, drug-allergy, drug-formulary checks.
3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®. It also includes past diagnoses relevant to the current care of the patient.
4. Generate and transmit permissible prescriptions electronically (eRx).
5. Maintain active medication list.
6. Maintain active medication allergy list.
7. Record the following demographics: preferred language, insurance type, gender, race and ethnicity, and date of birth.
8. Record and chart changes in the following vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI.
9. Record smoking status for patients 13 years old or older.
10. Incorporate clinical lab-test results into EHR as structured data.
11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
12. Report ambulatory quality measures to CMS (or, for EPs seeking the Medicaid incentive payment, the States).
13. Send reminders to patients per patient preference for preventive/follow-up care. Patient preference refers to the patient's choice of delivery method between internet based delivery or delivery not requiring internet access.
14. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.
15. Check insurance eligibility electronically from public and private payers.
16. 16. Submit claims electronically to public and private payers.

Goal 2: Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health

1. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, allergies) upon request. Electronic copies may be provided through a number of secure electronic methods (for example, personal health record (PHR), patient portal, CD, USB drive).
2. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the EP. Electronic access may be provided by a number of secure electronic methods (for example, PHR, patient portal, CD, USB drive). Timely is defined as within 96 hours of the information being available to the EP either through the receipt of final lab results or a patient interaction that updates the EP's knowledge of the patient's health. 
3. Provide clinical summaries for patients for each office visit.

Goal 3: To improve care coordination by enabling exchange of meaningful clinical information among professional health care team.

1. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
2. Perform medication reconciliation at relevant encounters and each transition of care.
3. Provide summary care record for each transition of care or referral.

Goal 4: To improve population and public health by having the patient's health care team communicate with public health agencies.

1. Capability to submit electronic data to immunization registries and actual submission where possible and accepted.
2. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Goal 5: To ensure adequate privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law and provide transparency of data sharing to patient.

1. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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The term "system" originates from the Greek term syst¯ema, which means to "place together" and defines a system as an integrated set of interoperable elements, each with explicitly specified and pre-defined capabilities, working seamlessly to perform value-added processing to enable a user to achieve set objectives.

An EMR System includes these basic components:

1. Infrastructure- Physical and hardware system components, for example, Workstations and Servers, Tablet PC, Laptops, Monitors, Scanners, Routers and Bridges, etc.
2. Software- Application software (EMR Software or EHR Software), Operating System software, utilities, and other applications like Instant Messaging, Fax Servers, Networking Software, Lab interfaces, ePrescription, etc..
3. People-Personnel involved in using, maintaining or managing the EMR - this includes the clinical and administrative staff, Physicians, etc . These personnel need to receive appropriate level of training.
4. Business Processes-Guidelines, instructions, and steps involved in keeping the EMR System running smoothly. This includes patient appointment scheduling, reminders, billing, etc.
5. Data-Information captured, used, and supported by a system, including documents, images and databases.

It is clearly evident that EMR software is just one component of an EMR System and is therefore a subset of EMR System. It is not good enough to assemble motley of ill-fitting components to create an EMR System since they may not work seamlessly and will certainly not perform value added processing.

So what are the implications from a Physician's perspective?

When Physicians buy EMR Software from EMR Vendors, they typically get the following:

1. EMR Software (application software)
2. Application Database
3. Configurable Lab and Pharmacy interfaces
4. Specifications of recommended commonly required and used hardware

To take the above and convert this to a fully functioning EMR System takes skills of different kinds - technical and functional. Also as you can see, unless you take the required steps to create an optimized System that performs value added processing, you shall not get the required Return on Investment (ROI).

Physicians are expert at providing quality healthcare to their patients but do not have the necessary expertise to assemble all the components to build and implement the EMR System. By working with an expert EMR Consulting company or an EMR Systems Integrator to build and integrate all required components of a customized EMR System, you can ensure successful implementation and reap maximum benefits from EMR Software deployment.

(Research Support provided by: Om)

RevenueXL can assist you in deriving maximum ROI from your investment in EMR technology by converting your EMR Software into a fully functioning EMR System. Contact us right away for a Free Consulting Session.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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The American Recovery and Reinvestment Act of 2009 (ARRA) provides $17.2 billion in Medicare and Medicaid incentives designed to facilitate widespread implementation of certified Electronic Health Record (EHR) systems in physician practices and hospitals. Physicians, facilities, and other providers will receive money through Medicare or Medicaid programs for their "meaningful use" of EHR Software.

What constitutes "meaningful use" still hasn't been precisely defined. And there's still a lot of uncertainly. However, this hasn't prevented EHR vendors from aggressively marketing their EMR / EHR solutions to physicians and medical clinics, small and large.

What are these vendors doing to overcome physician hesitancy to implement EMR? They are guaranteeing that their EMR products will exceed, or at least meet, the requirements imposed by CMS. These warranties aim to lower one of the highest barriers to early EMR adoption: uncertainty about future standards.

Here's a sampling of the current vendor guarantees:

• ChartLogic Inc. says: "I guarantee that ChartLogic EMR users will be able to meet the "meaningful use" requirements needed to receive the stimulus money."
• eClinicalWorks similarly commits to supporting its customers' ability to meet the HITECH Act's "meaningful use" standards. In its license agreement, it warrants that its software will support the "meaningful use" criteria of the American Recovery and Reinvestment Act (ARRP).
• Athenahealth Inc. guarantees that its her users will receive Medicare meaningful use incentive payments authorized under the HITECH Act within the economic stimulus law. Athenahealth states:

"For each month for which you don't receive your qualified HITECH Act Federal Stimulus reimbursement dollars during the first year of funding, we will credit our monthly service payments, for up to six months. This offer applies to HITECH Act reimbursement payments only. Additional terms, conditions and limitations apply."

Note that the guarantee does not cover Medicaid incentive payments because of variations at the state level.

• Praxis EMR guarantees qualification under the ARRA's meaningful use guidelines within 90 days of publication, or your money back.
• Practice Fusion guarantees that physicians using its EHR will qualify for meaningful use before HITECH payments begin in January 2011.

A careful reading of these warranties reveals that every vendor pretty much guarantees that its EHR Software will qualify for "meaningful use" under the ARRA. However, the burden of proof that the qualified EHR is being used in a manner that proves "meaningful use" still lies with the physician.

Today, many physician organizations are expressing strong views about what they would like a working definition of "meaningful use" to include.

For example, the MGMA recently recommended that the federal government conduct a small pilot project among vendors and physician practices, to ensure that the process of demonstrating meaningful use will be achievable and practical. And they want the feds to complete the pilot program before any incentive programs for meaningful use of electronic health records begin. Additionally, the MGMA wants attestation and/or survey instruments to serve as primary methods for demonstration, instead of imposing arbitrary reporting thresholds on physicians. (Read more about MGMA's perspective on meaningful use of EHRs.)

According to recommendations submitted by HIMSS in April, it wants the following:

1. To ensure continuity, recognize CCHIT as the certifying body of EHRs.
2. To achieve incremental maturation of "meaningful use," adopt metrics that can be reasonably captured and reported beginning in FY11/2011, and then made increasingly stringent using intervals of not less than two years. HIMSS' definitions include specific metrics to enact, in phases, over a multi-year period.
3. To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.
4. Reconcile the gap between "certified EHR technologies," "best of breed," and "open source" technologies.

• Read the HIMSS definition for meaningful use of technology in hospitals
• Read the HIMSS definition for meaningful users of EHR technology
• Read the HIMSS letter sent to ONC and CMS
 

But where are we on the definition of meaningful use of an EHR?

HHS hasn't released a formal proposal for the final rules for meaningful use of EMRs. However, there are hints of what it might wind up including. National health IT coordinator Dr. David Blumenthal, speaking at the American Medical Informatics Association's annual symposium, said, "The meaningful use framework will be about the goals of care, not the technology." That's fairly vague, and Dr. Blumenthal didn't elaborate on the specifics.

My personal perspective on 'Meaningful Use'

Physicians should be aware that simply buying and installing an EHR doesn't always bring efficiencies to a medical clinic, or even prove meaningful use of an EHR. EMR software (also called EHR software) is only a piece of the complicated puzzle - it's only an enabler. Physicians would be well advised to do their homework to determine whether the promised ROI of the selected EHR system will actually be realized. And they should also recognize that the ball will be in their court when it comes to proving "meaningful use" of the EHR.

Contact us for a free 'no-obligation' Consulting Session to address any questions that you may have with regard to 'Qualified EHR', 'Meaningful Use', EMR Costs, etc.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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Stories abound about botched EHR System implementations and providers uninstalling EHR Systems in Arizona. But at the same time, there are many case studies which prove that achieving ROI with EMR or EHR is very much possible, provided there is right focus on training, transition and implementation.

Computation of ROI with EMR Software is a complicated business, based on many assumptions and unquantifiable and intangible benefits. I personally like the definition: ROI = Increase in Revenues - Decrease in costs. I recently come across another definition: ROI = EMR - FTE based on the consensus that automated systems alleviate support staff needs. You can choose whatever definition appeals to you most.

According to "The formula for EMR: ROI=TCO?", if the average physician needs 4 assistants, implementation of an EMR can reduced that number by one or more. In a fast growing practice in New York State, which implemented an EMR, it was able to grow from 20 to 120 doctors in just two years because they only had to hire two or three FTEs per doctor instead of four or five.

In a recent case study published by HIMSS, Glynn Medical Associates, comprising of four internists, two rheumatologists and a physician's assistant, which implemented an integrated EMR/PM system with every provider using the system as of the first day, experienced savings conservatively estimated at $200,000 per year. But the ROI did not come easy. The first three months of going paperless were stressful. Also, one physician in the practice was seeing 33 percent more patients daily with use of the EMR system helping to increase patient satisfaction.

Some of the quantitative benefits included:

• Reduction in transcription costs.
• Reduction in medical records personnel
• Reduction in billing department personnel
• Possible downsizing of facility

In another case study, according to Wellesley, Mass.-based Nuclear Research, a 76-bed hospital in Bolivar, Mo achieved a 1,321 percent ROI in its first year after implementing an EHR Software solution, besides reaping other intangible benefits. Over three years, the hospital's ROI came in at 2,912 percent.

Here are two EMR Calculators that you can use:

1. Physicians Practice EMR ROI Calculator
2. HIMSS EMR ROI Calculator 

Experts say that an EHR implementation project is not a sprint but a marathon. Moreover, the race does not finish on the go-live date. You will see reduced productivity during period immedialtely followng post-activation followed by "stabilization" and then "optimization".  If everything goes right, you can achieve stabilization within 90 days. After that, the financial benefits will materialize gradually as staff increasingly utilizes the EHR Software and associated workflows. 

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There are many opportunities for revenue enhancement as well as cost reduction which will yield Return on Investment. Download our free article on 'Does EMR increase Revenues?'.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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2006 marked the beginning of an era for soaring demand at record setting paces for the adoption of Electronic Medical Records Software by Pain Management Physicians. This record growth can be attributed in part to a combination of several factors including, technological innovations, greater efficiencies caused by product innovations reducing costs and increasing revenues, market and political pressures, and now, government tax and payment incentives. Since this time, tens of dozens of EMR software vendors have been popping up everywhere jockeying for a piece of the pie by claiming that their solution can best meet the Specialty EMR needs of Pain Management Physicians and their practices.

Pain Management Physicians who are working with a good EMR Consultant are experiencing smooth, timely, and successful selection of the best Electronic Medical Records Software for their practice. At the opposite end of this EMR software selection process are those physicians trying to take on this daunting task on their own, and they are quickly finding themselves in a rather precarious situation and learning things the hard way by going through tumultuous EMR software search that engulfs a tremendous amount of their time and resources, not to mention, all of the frustration, confusion, and headaches that accompany trying to ride solo through the EMR software selection maze.

Those Pain Management Physicians who have managed to make their un-assisted way through the EMR selection maze say that, if they had it all over to do again, they would have brought in some professional help and saved a lot of time, headache, and money.

One thing all of those Pain Management Physicians who manage to make it through and find the right Electronic Medical Records software for their practice is that they tend to really like the EMR software that offers a operational foundation that is a combination of having pre-defined and customized templates or intuitive or "smart learning" abilities and related software design. Then comes the other key EMR software features and functions Pain Management Physicians are getting when they find the right Electronic Medical Records Software for their Practice. The vast majority of those are listed here:

• Pre-loaded pain management specific conditions and nomenclature
• The software must be well developed with Specialty templates and built-in intuitive or smart-learning capabilities, and have encounter scripts and key equipment integration points ideal for Pain Management Practitioners.
• The technology must enable plug and play integration with most Pain Management medical equipment.
• Easily accessible and interactive built-in diagrams or images for documenting precise location of pain, numbness, tingling, burning on extremities, neck, back, shoulder, face.
• Ability to upload and use additional diagram, images, and drawings specific to your practice.
• Interactive diagrams (extremities, body, etc.) for documenting pain locations
• Pain management patient education
• Pain management specific HPI complaints and ROS with systematic documentation of pain effect on daily activities, previous treatments tried and their efficacy, investigations undergone in the past, expected outcome of the present pain treatment.
• Operating Room Vitals Monitoring Integration
• Templates for Multiple Procedure, Back/neck pain, Selective nerve block, Lumbar puncture, Epidural steroid injections, Trigger point injections, Facet injections, Bursa injections, Botulinum injection, Epidural Steroid injections, Intrathecal cath / pump placement, Stimulator implantation, Opioid trials for chronic pain, Anesthesiology, etc.
• Quick glance face sheet to view patient's medical history in details including allergies, past/present medical problems, family and social history, surgery history, current medications, all previous prescriptions, stopped medications with inbuilt drug-to-drug, drug-to-allergy contraindication warnings or alerts.

There is no doubt that the search and selection process is quite an undertaking and the demand for EMR software by Pain Management Physicians is expected to continue to soar. So your best bet is to find and engage the services of a good EMR Software Consultant. This will save you a lot of time and this is important because right now the longer it takes you to find that right-fit EMR Software, the longer you can expect to wait in line for your turn to get started in implementation and then "go-live". Another important thought regards your timing has to do with being properly up and running in order to be qualified and eligible in time to receive the Stimulus Incentives.

Click here to find a good and experienced EMR Consultant who will provide you a free 30-minute EMR needs assessment, selection, and next steps Consultation for your Practice.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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Now with the Obama administration pumping in money in healthcare by incentivizing Physicians implementing certified EHRs and demonstrating meaningful use, many EMR vendors are again proclaiming the demise of Medical Transcription stating that after implementation of EMR / EHR Software, the Physicians can eliminate use of Medical Transcription services altogether.

While I agree that the role and nature of medical transcription will change in the new world, I do not believe that physicians and clinics can stop using medical transcription services altogether.

EMR solutions are based on point and click templates and capture data as discrete data elements. However, to any one intimately familiar with the nature of dictations and transcripts, it is obvious that there is a narrative part of the medical note which tells what the doctor is thinking during the patient encounter. How will this narrative be captured as part of eletronic medical records?

It has been shown that such narrative contributes to a detailed electronic medical record and supports meaningful use of the EHR. The narrative can either be produced in real-time using speech recognition software like Dragon, or it can be produced on the back end using traditional digital medical transcription services and input into the EHR by the transcription editors.

In a survey carried out, over 75% of the respondents indicated that they are interested in productivity aids that would help doctors to better document care within an EMR (beyond the standard point and click). Even though the accuracy of speech recognition software has improved significantly and it can be trained, most physicians find it a distraction - imagine the physician seeing the software wrongly transcribing and repeatedly interrupting his dictation to correct the transcript using keyboard and mouse - and do not want to take on the editing responsibilities.

Speed of charting has been one of the main sticking point with the physicians who complain that the EMR slows them down. Dictation is still the preferred method for physicians to document encounter notes. A possible solution that partly alleviates the concern of the physicians is to have the Medical Transcription Company introduce XML tags (in a semi-automatic manner), make the data elements ready for abstraction and then load the same into the EMR Software's database as discrete data elements. I would like to get feedback from readers if they have seen this technology solution successfully deployed.

According to Jay Cannon, EHR vendors need to work closely with the Medical Transcription service providers to deliver "hybrid clinical documentation solutions" that give physicians flexible choices for input, along with discrete, reportable data output for the EHR. I completely support this philosophy.

Our recommendation would be for prospective EMR customers to ensure that the EMR Software allows for an easy and unobtrusive interface for the provider to dictate and for the Medical Transcription Company to come in and transcribe right into the EMR or load final and structured documents into the EMR.

Do let us know of your comments and / or experience with implementing such a solution successfully.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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What is the difference between an EMR and EHR? Aren't they essentially the same?

It is easy get confused by the inconsistent way these terms are bandied about in the industry.

• Nextgen mentions both EMR and EHR in its home page title, but the product is called Electronic Health Records.
• GE Healthcare calls its product as Centricity EMR.
• Greenway characterizes its PrimeSuite product as an EHR.
• Aprima's PRM product was initially labeled EMR but is now described as EHR.
• eClinicalWorks continues to refer to its product as an EMR.
• Allscripts mentions both ‘Electronic Medical Records (EMR)' as well as ‘Electronic Health Records (EHR)' in the title of its home page, but their solution is called ‘Electronic Health Records'.
• CCHIT certifies EHR (Electronic Health Records) products, but the list of CCHIT-certified EHR products includes a number of ‘EMR' products.

As is clear from the above, vendors have been using the two terms - Electronic Medical Records (EMR) and Electronic Health Records (EHR) - interchangeably in their communication even though these two terms are technically different with different sets of features and capabilities.

Chris Hobson in a article published in ‘Advance for Health Information Executives' says that the difference between the two terms more than semantic and is crucial for health IT decision-makers to understand the difference.

So what is the difference between EMR and EHR? Let us review the distinction portrayed by three authorities in their own rights:

1. Chris Hobson:

The essential difference between EMR and EHR lies in how the (electronic) data will be used or shared - within the confines of a single office or practitioner or will it be shared across a wide range of different providers, such as specialists' offices, labs, insurance providers and government agencies?

Chris relies on the definition advanced by HIMSS and accordingly, an EMR is a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information "within the confines of a single organization". It may touch clinical data repositories, lab applications and patient information management systems, among others -- but all within the reach of a single organization.

EHR, on the other hand, is a longitudinal, complete and unified view of electronic record of patient health information produced by clinical assessments in one or more care settings drawn from across a wide region corresponding to all the providers who are seeing the patient -- the totality of his/her personal data, state of health and delivered care.

According to Chris, while both EMRs and EHRs provide some similar benefits -- cost savings through improved workflow and paper reduction, improved delivery of care accuracy -- EMRs provide those benefits only within a single organization. EHRs, because they are shared across the irrelevant geographic or otherwise defined region, increase the efficiency of patient care and improve patient outcomes, disseminate information rapidly between care providers, help with research efforts, and cut costs throughout the entire system more promptly and reliably.

2. National Alliance for Health Information Technology (NAHIT):

NAHIT while offering the following definitions, generally supports a similar distinction between EMR and EHR:

EMR (Electronic Medical Records) is an Electronic Record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.

EHR (Electronic Health Records) is an Electronic Record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.

3. Healthcare Informatics:

EMR is a computerized legal clinical record created in Care Delivery Organizations (CDOs), such as hospitals and physician offices, and used and owned by the CDO. It becomes an EHR (Electronic Health Record) when:

• Reports and histories (labs, pharmacy, radiology, consults, etc) are electronically added;
• Items in the record are electronically exchanged with other providers, and
• There is a personal health record (PHR/PMR) component which allows patients to participate in documenting and creating their medical history and communicate with their provider.

EHRs represent the ability to easily share medical information among stakeholders and to allow it to follow the patient through various modalities of care from different CDOs. Thus EHR offers a holistic approach to patient care where continuity of care is emphasized.

EMR vs. EHR - What does it mean to you?

Regardless of whether vendors call their products EMR or EHR, what should your first priority be?

When selecting an EMR or EHR, ask your vendor to explain how its solution will support your vision for interoperability and rapid exchange of data between care providers, in order to provide a holistic perspective on delivering health to your patients. It's that simple. You can safely make this your criterion for choosing a system, and forget about what the vendor calls its product. For your purposes - providing efficient, effective care - the name is totally irrelevant.

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Read our related blog on Top 12 EMR Software Selection mistakes often committed by Physicians.

Contact Us for free no-obligation EMR / EHR Selection Consulting and Demo.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.