EMR & EHR Blog for Physicians

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This time I decided to write this post about a slightly different topic - Coding Compliance. As we discuss below, when physicians implement EMR or EHR, the need for a good compliance plan will not disappear contrary to what some physicians may believe.

While most physicians would like to avoid an coding audit, it is a fact of life in today's healthcare world. To lessen the stress and potential penalties, preventive maintenance is the key. Regular internal and external audits should be part of every compliance plan.

The OIG (Office of the Inspector General) states: "The best evidence that a provider's compliance program is operating effectively occurs when the provider, through its compliance program, identifies problematic conduct, takes appropriate steps to remedy the conduct and prevent it from recurring, and makes a full and timely disclosure of the misconduct to appropriate authorities." To identify problem areas, utilization of internal and external audits is key.

As most EHR Vendors proclaim, Electronic Health Records help physicians maximize billing in the following two ways:

1. When using paper charts, to be on the safe side of the law, many physicians down code (use a lower billing code), rather than use an appropriate level of code. Providers who use EHR software can increase revenues by using System recommended E&M billing codes that are based on the service accurately documented within the EHR, without the fear of an audit, or if an audit occurs, being confident that their coding is compliant with their documentation. Medical Economics magazine has estimated that physicians, who routinely down-code to avoid audits, lose an average of $40,000 annually.
2. EHR software allows physicians to produce adequate supporting documentation that complies with CMS guidelines and supports the appropriate level of service to be billed. Accurate coding speeds up the reimbursement process and results in fewer rejected claims from insurance companies. Even better, an EHR Software helps produce clean claims the first time, significantly reducing the number of rejected claims!

The question that often arises when we talk to Physicians is: We are investing money in an EMR or EHR. Do we still need to have a Coding Audit or Coding Compliance program? The answer is "YES".

February 2010 edition of American Academy of Professional Coders' (AAPC) Coding Edge magazine states, "The goal of the EMR is to improve the efficiency of the physician in documenting services and ensuring all work performed is capture in the record." While EMRs can help with speeding up reimbursement, they will not prevent a physician from receiving denials. EMRs can improve coding and documentation, but physicians need to take the time to document services in order to meet medical necessity standards.

Physicians sometimes fail to realize that coding is more than just code selection and needs to consider items like Commercial payer rules, local coverage determinations, mitigating circumstances, government health programs and numerous other variables introduce rules, exceptions to the rules, and more. How many EHR Solutions can automate all the aforementioned complex rules which are forever in a state of flux and keep changing frequently? My guess is that by pareto's principle, EHRs can probably code 80% of the encounters accurately while balance 20% of the encounters need to be reviewed and/or coded appropriately by experienced coders. An example of this would be modifier selection and proper use of modifiers. These would need to be manually entered by either the physician or a certified coder.

Our experience reveals that when a Practice implements an EHR, the extent of coding audit required may decrease but nevertheless every Practice still needs to implement coding audits. You can choose to conduct the audits internally or use external auditors. Internal audits are a valuable tool, but are limited by the auditor's knowledge and expertise. Internal auditors may already be overwhelmed by their daily duties of running an office. They may not have the time between scheduling patients, ordering supplies, etc...to conduct a thorough audit. Regulations change constantly, which means a designated employee must be assigned to read publications, attend seminars and share this information with physicians and coders in their practice. Auditors should be certified and competent. An auditor is not just a Certified Coder. It takes many years of experience and education to be a thorough auditor. It is a separate skill from coding.

For these reasons, an annual external audit is invaluable for objectively analyzing billing and coding operations. It can uncover documentation deficiencies that an internal auditor may overlook and identify missed revenue in the process. Professional billing companies with dedicated teams of auditors can provide this service in a cost effective manner.

It takes physicians years of education to successfully practice medicine and even more to specialize in one area, plus stay abreast of changes and advancements in medicine. With the billing and coding requirements of today, it takes a specialist in that field to provide the same level of expertise. External auditors will also take the time to provide one-on-one feedback to individual physicians utilizing their own charts as examples and can pinpoint precise documentation deficiencies.

In closing, while implementing an EHR is a giant step in automating clinical processes, a good compliance plan that utilizes internal and external auditors shows your offices' desire to operate within the guidelines is equally important. If discrepancies are found, penalties will be less severe because you are showing due diligence to be in compliance.

(Parts of this blog post have been contributed by Kathy Husted, CPC, CPC-H, CPC-I, who works for Professional Billing & Management Services, an Affiliate of RevenueXL Inc.)

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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 world of healthcare is changing especially so in the light of an estimated 30 million new patients that will be added to the healthcare system. Most of them will be tended to by Family Doctors (including internists and pediatricians). Primary care practices typically measure productivity according to the number of visits, which also drives payment (which is less than half the money earned by specialists).

Besides the low salaries, there is tons of work that does not involve a visit from a patient, is invisible to those who support and purchase primary care and is therefore uncompensated.

In a recent study documented, each internist handled 18 visits per day in addition to the following unpaid tasks:

• 24 telephone calls (80% handled directly by Physicians; 28% resulted in writing of prescription and 8% ended in ordering of new tests)
• 12 prescription refills processed
• 20 laboratory reports read - they frequently trigger a review or adjustment of a medication, which requires access to accurate, current medication lists with doses.
• 14 consultation reports from specialists examined
• 11 X-ray and other imaging reports reviewed which may require updating problem lists or further referrals
• 17 e-mail messages including interpreting test results (59%) or responding to patients (22%)

The above numbers reveal phenomenal quantum of uncompensated work that is performed by primary care providers. If the metrics used for compensating these providers is not changed quickly, then it is easy to predict that the shortage of family doctors will increase at a rapid pace and the complete primary healthcare ecosystem will start crumbling.

The same study also dealt with implementation of Electronic Health Records and the changes in practice design that this brought forth in a Primary Care setting. Primary Care Physicians play a number of roles in the course of discharging their daily duties - from making diagnoses and providing treatment to ordering tests and filling out forms. How and by whom the work is done is dependent on both the skills of available support (non-physician) staff and the extent of information-technology support.

When EHR Software is implemented in a Primary Care Clinic, roles played by Clinic personnel often change. In this documented case study, the following changes were recorded:

1. The job profile of the registered nurse changed significantly after implementation of Electronic Health Records. While the nurse's work could be handled by personnel without any nursing skills, new duties of the nurse included doing "information triage" of incoming laboratory reports, telephone calls, and consultation notes.
2. Additional front-desk staff and medical assistants were hired to handle the increased tasks associated with the comprehensive management of chronic diseases like diabetes, etc.
3. Productivity metrics of the Physicians were changed from just using total charges (or number of visits) to including telephone calls and e-mails handled.
4. Doctors now rely on availability of comprehensive, contemporaneous structured data when responding to telephonic calls and lab results.
   
5. The purpose of documentation has shifted from billing to ongoing clinical care, and the EHR is now used more for 'information management' and 'active support of clinical-practice activities' (rather than mere progress note generation).

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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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To give you some perspective of what this means, here are some numbers from the report to ponder about:

Claims:

Presently 75% electronic utilization
Provider cost savings electronic vs. paper: $3.73
Payer cost savings electronic vs. paper: $0.73

Eligibility:

Presently 40% electronic utilization
Provider cost savings electronic vs. paper: $2.95
Payer cost savings electronic vs. paper: $1.38

Claim Status:

Presently 40% electronic utilization
Provider cost savings electronic vs. paper: $3.33
Payer cost savings electronic vs. paper: $2.56

Claim Payment:

Presently 10% electronic utilization
Cumulative Provider and Payer cost savings electronic vs. paper: $4.80

Claim Remittance:

Presently 26% electronic utilization
Provider cost savings electronic vs. paper: $1.49

TOTAL:

Total unrealized industry savings: $29,718,502,500
Present transaction types by percentage: 57% paper / 43% electronic

This begs the questions: aren't billing and payment transactions already electronic? Didn't HIPAA simplify administrative aspects of healthcare years ago? If so, what really happenned?

According to the report, these are common misperceptions about the business side of healthcare. The facts are quite different indeed. While Health Insurance Portability and Accountability Act of 1996 (HIPAA) addressed administrative simplification, and it was hoped that this would provide the mandated framework necessary to unify the system in transition to automation, it did not provide any detailed operating rules, leading to significant operational variances from payer to payer. It not only resulted in inconsistent formats but has also mades it almost impossible to create interoperable and fully electronic systems.

The Administrative Simplification provisions of the healthcare reform legislation are designed to accelerate the standardization of transactions and solidifying a set of operating rules that will eliminate these kinds of inconsistencies.

Healthcare industry can accrue these benefits irrespective of whether or not the perceived benefits of EHRs are realized. As we have seen the meaningful use of EHR definition and certification process has ben dogged by political controversies and / or clinical concerns. I have no doubt in mind that they will get resolved in the mid to longer term timeframe, but surely they will not get resolved in the short term.

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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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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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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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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.

If you like this post, please subscribe to our Email Subscription to read our new posts in your email.

Medicare payments to physicians not qualified as “meaningful users” of Certified Electronic Medical Record software will be reduced by 1% in 2015, then 2% in 2016, 3% in 2017, 4% in 2018, and by as much as 95% in subsequent years.

To avoid this situation your timing is critical. Experts predict that by mid-to-late 2010, the demand for Electronic Medical Record Systems may far exceed the number of qualified sales and support staff that companies with Certified Electronic Medical Record software will have to meet the last minute rush of physicians suddenly realizing their forthcoming financial misfortune. Therefore, now is the time to take action and give serious attention to the 2 to 4 months of lead-time required for planning and selection, set-up and training, implementation and “go live”. Then, add an additional 6 to 8 months to ensure physicians and staff are proficiently up and running as “meaningful EHR users”, so that each physician in your practice is eligible for the up to $44,000.00 in Medicare Incentive Payments beginning in January 2011.

Late adopters can surely expect huge delays or worse, being placed on a waiting list (at least by the best and most popular EMR software vendors).  In this case, your options may become very limited, and prices may even increase.  So, instead of receiving Bonus Payments, you may wind up being penalized through reduced payments.  Don’t be surprised if you find yourself on a “hotchpotch” path of trying to force-fit poorly matched EMR and Practice Management software together from different vendors. This predicament will cost you a lot of time, frustration, and money.

There are over 300 EMR vendors on the market, and only a few are CCHIT Certified and qualified take on the question, “Which EMR has the smoothest transition and implementation that meets the requirements of your practice and, ensures each physician in your practice receives the maximum Medicare Incentive payments?” The answer, find a good Independent Consultant who, at no cost to you, can help you find the best-fit Certified Electronic Medical Record software, which has all the answers “built-in”.   

It’s not everyday the government imposes new laws, regulations, costs, and penalties upon your business and then, turns around and pays you, to become compliant and avoid being penalized. Now is the time to start positioning each provider in your practice to leverage every Bonus Incentive dollar available. After all, the right-fit Electronic Medical Record software will make running your practice easier, more profitable, boost morale, improve patient care and, enhance your quality of life and that of your patients.  Everyone will “feel” the difference.

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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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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.