Free EMR Consulting

Subscribe by Email

Your email:

EMR & EHR Blog for Physicians

Current Articles | RSS Feed RSS Feed

Electronic Health Records – Bringing Efficiency to Primary Care

  | Share on Twitter Twitter | Share on Facebook Facebook | Submit to Digg digg it |  Add to delicious  delicious |  Submit to StumbleUpon StumbleUpon |  Share on LinkedIn LinkedIn |  Share On Technorati Technorati | Submit to Reddit reddit 

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

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).
This study provides an idea of the direction of changes needed if family practices are to flourish and more effectively improve the health of patients and contain costs. It also shows how Electronic Health Records can support clinical processes and bring efficiencies in a primary care setting. EHR or EMR is not just a progress note generation tool as some Physicians erroneously believe!

________________________________________________

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.

0 Comments Click here to read/write comments

Top 12 EMR Software Selection Blunders

  | Share on Twitter Twitter | Share on Facebook Facebook | Submit to Digg digg it |  Add to delicious  delicious |  Submit to StumbleUpon StumbleUpon |  Share on LinkedIn LinkedIn |  Share On Technorati Technorati | Submit to Reddit reddit 

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

When you take on the onerous task of selecting the right EMR Software (aka EHR Software) for your clinic yourself, you may unknowingly do many little things that will surely lead to selection of EMR Software that is not right for you. They will result in costly and frustrating mistakes that can come as a surprise and hit you hard when you least expect them.

1. Not taking the staff into confidence before starting the EMR selection process.

Your staff will be most impacted by the changes in your clinical environment. Hence it is imperative that you help remove the fear of the unknown from the mind of your staff by explaining how implementation of the selected EHR Software will make them more efficient and effective in their day to day operations.

2. Not drawing up the criteria for your decision making process that is objective with a measurable metric rather than basing it on gut feeling.

Criteria should be EMR Selection Mistakesappropriately grouped and weighted so that you can arrive at a weighted score for each EMR being evaluated. If you are evaluating three or four EMRs and do not have the criteria well defined, chances are huge that some irrelevant issues will cloud your vision and impact your decision making.

3. Not following through with the references or not doing a thorough job with the references.

You may often believe that all references are going to speak highly about the EMR since they have been handpicked by the vendors. However, as we all know, physicians are a closely knit community and it is not difficult for you to validate or repudiate what the references told you about their experience with the EMR Software or Vendor.

4. Accepting at face value what EMR vendors tell you about all their EMR Software features and functionality.

For example, we have found some of the key differentiators claimed by some vendors had actually been decommissioned because they did not work as intended and were back to the drawing board for a re-work.

5. Assuming that larger and well known EMR vendors will be technology-wise more advanced, and customer-support-wise friendlier to your individual needs and situation.

This assumption could be quite misplaced because bigger is not always better as many of these vendors are too busy working on tying up bigger alliances with hospitals and IPAs trying to rope in hundreds of providers in one scoop. Thus, ramping up customer support for small practices almost always takes a back seat and therefore you may be left out in the cold when you need help right away. Larger vendors are less likely to hear you out in regards to your individual needs and even more importantly, make changes to the software to meet your genuine requirements.

6. Selecting a vendor who says that their EMR Software does not need much training and it is easy to pick up.

If you and your staff do not get adequate training, you will not be able to utilize the software to its full extent. There are no plug and play systems that can be implemented in a few minutes, few days, or even few weeks. Negligible amount of training built as part of initial implementation proposal is nothing more than a contrived method to win your business.

7. Being too focused on price early-on in your search or believing that there really is such a thing as Free EMR Software rather than focusing first on what you need for optimizing your clinical processes and workflow.

A lowest cost approach does not typically translate into saving a lot of money and a lower Total Cost of Ownership. Once you determine what you want and need, you may start drilling down into pricing the EMR Software alternatives you are considering. Don't get pushed into making a decision, be patient.

8. Selecting an EMR on the basis of current requirements alone and not considering your foreseeable or possible future needs.

Growth is generally inevitable and you may take on new providers (multi-specialty?), offer new services, or use devices that need to interface with the EMR.

9. Believing that you or an appointed member of your practice has all the time, knowledge, and experience to handle almost a monumental responsibility for undertaking the research, screening, selection, negotiating, and implementation of the best suited EMR Software for your practice without guidance from an experienced EMR consultant. There are too many decisions to be made and if you stop and think about it, you may realize that you truly do not know all about the good, the bad and the ugly, about EMR selection, implementation, price negotiation, hardware selection and more. Engage with an EMR Consulting company to assist and work with you.

10. Not having a true picture of how the EMR will help create a true paperless office and what components will or will not be addressed by the vendor directly as part of implementation.

You must ask the EMR vendor to adequately demonstrate that their EMR Software will in fact increase efficiency and translate into increased revenues.

11. Not taking enough time to discover and evaluate the initial and recurring costs of implementing EMR.

This also includes understanding the technology underpinnings required to support the selected EMR. It would also greatly help if you define and require the line items expected on the proposal from every EMR vendor you are considering so that you can make the best apples to apples comparison between different EMR Software.

12. Not clearly understanding what the vendors always mean by that or this is included at no additional charge.

A good example of this is not clearly defining what they mean by a bi-directional interface with labs. There are actually two costs involved in setting this up and usually EMR Vendors mean that their side of the cost is included and that they can accommodate the connection but, someone (you) will have to pay for the other side of the connection.


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

We would like to keep revising this list for the benefit of our future readers. Hence if you believe that there are other blunders made often by Physicians in EMR selection process, please do leave your comments. We will have an updated list avaialble for free download soon.

 

 

 

 

 

Learn about the top 10 EMR Software features that you should be looking for. Download our free article on Top 10 Electronic Medical Records features for every physician.

RevenueXL can not only help you select the right EMR Software, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.


________________________________________________

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.

2 Comments Click here to read/write comments

Free EMR Software - The truth behind ‘Free' Electronic Medical Records?

  | Share on Twitter Twitter | Share on Facebook Facebook | Submit to Digg digg it |  Add to delicious  delicious |  Submit to StumbleUpon StumbleUpon |  Share on LinkedIn LinkedIn |  Share On Technorati Technorati | Submit to Reddit reddit 

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

Did you know that there are 1000's of searches every month on Google from people interested in ‘Free EMR Software' in different forms:

Free EMR  2,900
Free Electronic Medical Record  480
Free EMR Software  480
Free Electronic Medical Records  390
Free EHR  320
Free EMR download  260
Free Electronic Medical Record Software  140
Free Electronic Medical Records Software  91

However, economists tell us that "there ain't no such thing as a free lunch" which essentially means that it is impossible to get something for nothing. Yet people search for ‘free EMR' in the hope of finding something which may work for them and that would not cost them several thousand dollars to implement and support.

IMHO, there are at least three flavors of ‘free EMR':

a. Open Source EMR
b. Low end versions of full fledged EMR Systems offered at zero cost
c. Commercial EMRs supported by ads and selling of anonymized data (data which has been stripped of identifying attributes) offered at zero cost

Open Source EMR

It is well known that open source software movement is gaining ground. Wikipedia maintains a list of open source EMR / EHR software.

When you opt for open source EMR, you get full ownership of the code under GNU General Public License which gives you freedom to share and change all versions of a program to make sure it remains free software for all its users. You do get the license at zero license cost. So what is the catch? While the software may be free, you have to consider the following:

1. What is the total cost of ownership of an EMR / EHR solution? You will find that the cost of license is only about 20% of the cost of implementing a Client Server version of EMR.
2. What is the size of the community supporting ongoing development and enhancement of that EMR?
3. What is the guarantee that the open source EMR will continue to meet ever changing Governmental regulations?
4. What is the support structure of the company to help implement, train and support the EMR?


In a survey conducted by Computer Economics, 44% of the users quoted ‘less dependence on vendors' as the leading advantage of using open source software. Note that lower TCO was not the main advantage cited by the respondents.

It is important to realize that EMR purchase is quite sticky and it is not easy to change the EMR that you implement in your clinic. Therefore, I would not recommend smaller clinics to stay away from open source EMR or EHR for many reasons:

a. None of the currently known open source EMR systems are commercially proven unlike other vendor systems.
b. Implementing any open source EMR will need customization or upgrade services which will add to the cost of implementation.
c. What is the current and forecast future availability of required technical expertise at reasonable prices? Will you have the time, patience and expertise to find the right talent at a later date to support your changing requirements?

If the open source EMR, on the other hand, is procured by a hospital which has invested significant amount of money in information technology and therefore has the expertise to customize the open source EMR to meet its current and foreseeable charting requirements and governmental regulations, the hospital will stand to benefit from open source EMR / EHR in the long term.

Free versions of full-blown EMR Software

There are many vendors that offer free EMR products (like eMDfix) while at the same time offering full fledged EMR products which are paid products. As you will figure out soon, there are costs involved with implementing a new EMR which will put it in pretty much the same price range of a non-free EMR. You will also find that the free version of the software lacks some important features that are important for you to work efficiently. As I mentioned before, EMR purchase is sticky business and if you have been using the free version for some time, you will be forced to upgrade to a paid version. To top it, it has been our experience that providers (barring a small minority) need a lot of hand holding in order to make an EMR work. When you sign up for free EMR, you essentially sign up for ‘no obligation' from the free EMR vendor's end. Guess what - it means that you are pretty much on your own even though you may get some email based support which will, in most cases, not be sufficient.

Free EMR Software? What is the financial model?

Let us talk a little bit about the third kind of free EMR software systems like Practice Fusion which recently received investment from Salesforce.com (the leading name in SaaS based CRM software). What is the financial model behind this EHR? There are two aspects:
(1) This is an advertisement supported EHR System. It essentially means that you will see advertisements from vendors interested in selling to the medical community. Will you get distracted by such advertisements? I will leave it to you. (They also offer an ad-free subscription for an additional $100 per month per physician.)
(2) The vendor reserves the right to sell the data that is collected in the course of hundreds of physicians charting patient visits. Of course, the data is sanitized (anonymized) so as to remove any and all attributes that help identify a patient. This is a sensitive topic and at this point of time, I will leave it for you to decide if you are comfortable with this model.

What are the other issues with this free EMR? It does not come with an integrated billing module. You will need to export the billing information on a periodic basis and send it to your billing company or system. You will have to check out the compatibility of your billing system to receive the billing information from your new free EMR system. If you use a PM system in-house, you will find that your patient scheduling information is now split between the EMR and PM system with no way to synchronize them.

It claims to allow you to start charting in 5 minutes after signing up. I find this statement hard to swallow considering the amount of training that most providers and their staff need before they can start using the EMR. In most cases, we insist on an onsite training component from 3 to 5 days to adequately prepare the physician and staff. Will the vendor of the Free EMR Software work with you until you successfully implement EMR Software?

If you found this blog interesting or helpful, please do take a moment and register to subscribe to our blog at the top right of our page to keep active or current with our present and upcoming blogs. Your comments (whether or not favorable) are encouraged!


Download Now

Learn about the top 10 EMR Software features that you should be looking for. Download our free article on Top 10 Electronic Medical Records features for every physician.

RevenueXL can not only help you select the right EMR Software, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.



________________________________________________

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.

1 Comments Click here to read/write comments

How much does an EMR Cost?

  | Share on Twitter Twitter | Share on Facebook Facebook | Submit to Digg digg it |  Add to delicious  delicious |  Submit to StumbleUpon StumbleUpon |  Share on LinkedIn LinkedIn |  Share On Technorati Technorati | Submit to Reddit reddit 

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

How Much Does Electronic Medical Records Really Cost Your Practice?

When prospective EMR clients ask me "so how much does Electronic Medical Records or EMR cost?", the immediate answer to this somewhat of a thought provoking question is, "well, how much time do you have on your hands today to listen to the answer?" Meaning, are they looking to just find out about the cost of the EMR Software itself, or are they really interested in understanding the Total Cost of Ownership (TCO) as it relates to implementing an Electronic Medical Records solution in their practice successfully.

Stethescope on MoneySo, what are the true total costs of implementing Electronic Medical Records (EMR) Software?

For the purposes of this blog article, I will confine myself to a Client Server kind of installation where the EMR Application Server is installed on a Server (typically a Windows Server 2003) located within the premises of a medical clinic. Total cost of implementing an Electronic Medical Records system can be divided into two main groups: Product Cost and Services Cost.

Let us explore these two main cost components and then dive down further into their respective sub-components.

I. Product Costs

a. Software costs

i. EMR / Practice Management Software License Cost (for Provider and other staff like PA, RNs, etc,)
ii. Procedure, Diagnosis & HCPCS codes
iii. Drug Interaction Database (with or without dosing)
iv. Patient Education Advisors
v. Code scrubbing software
vi. Recurring annual maintenance and support costs

(Complete list available in the downloadable Excel Template below.)

b. Interface(s) and Conversion Costs

i. Lab interfaces (may be offered free from the EMR Vendor side but, there usually will be a charge for the lab side of the interface, which the lab may pay for)
ii. Medical device interfaces (as required)
iii. Practice Management interface (if required to interface with an existing Practice Management application)
iv. Data conversion
v. Electronic Remittance Set up
vi. Other compatible third party interfaces

c. Hardware Costs

i. Windows Server
ii. Windows workstations / Laptops with flat screen monitors
iii. Scanner
iv. Scanner and OCR for Drivers license and Insurance card
v. Insight Scanner and Docuscan from Scantron
vi. Tablet PC

(Complete list available in the downloadable Excel Template below.) 

II. Services Costs

a. EMR Implementation and Training Services Costs

i. Onsite implementation and training costs
ii. Travel costs (Flight, hotel, boarding, commute, etc.)
iii. Remote training (using software like Webex)
iv. Project Management
v. EDI Set up and training

(Complete list available in the downloadable Excel Template below.) 

b. Installation, Configuration and recurring IT Services Costs

i. Installation of Windows Server, workstations, printer, fax server, scanner, tablet PC, etc.
ii. Network setup (Router, Switches, etc.)
iii. Configure outbound and inbound fax services
iv. Configure VPN and / or RDP for remote access
v. Installation services for EMR/PM client software (if required)

(Complete list available in the downloadable Excel Template below.) 

c. Electronic Billing Costs (recurring monthly costs)

i. e-Prescribing via Surecripts, re-fills, etc.
ii. Electronic Medical Claims processing
iii. Medical Paper Claims processing
iv. Electronic Remittance processing
v. Statement Service
vi. Credit Card processing service
vii. Appointment reminder service

Does this seem staggering? Does everything listed here apply to your practice? If not, what things are must have and what's optional? Which costs are one-time upfront only, or monthly or annually recurring? My answer is really quite simple, find and work closely with a good independent certified EMR consultant that will provide you with these answers throughout your EMR selection process and do so, at no cost to you. Yes, you read that right. 

So, when an EMR vendor quotes you a price for an EMR solution be sure to ask them to address and clarify as to what components are really included in their proposal and quoted price? I am certain that you will be quite surprised and taken back by the responses you get.

Well, enough for now, but I promise to provide more detailed explanations about these popular components and their related costs and variations, that you should be aware of throughout your EMR selection process. Keep an eye out for more of my articles on this topic and others.

Total Cost of Ownership of an EMR

EMR SoftwareLearn more about different cost components of an EMR and break them out into one-time and recurring costs. Download free template on EMR Implementation Cost Computation.

RevenueXL can not only help you select the right EMR csetificate, but also help to get handle on total cost of implementing EMR Software a.k.a. EHR Software.

 

 


________________________________________________

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.

0 Comments Click here to read/write comments

All Posts