Technology and Medicine...

The New Medical Frontier...

Management of Medical Data and Processes through the use of Technology.

There are several hundred electronic medical record (EMR) and electronic health record (EHR) systems available for just about every medical specialty and clinic size. EMR vendors provide customized systems for outpatient care, inpatient care, solo practices, enterprise groups, primary care, therapy, mental health, eye care, chiropractic, etc. Along with the variety of customizations, these systems span the full range of pricing, anywhere from free to hundreds of thousands of dollars. With so many EMR companies catering to so many specialties, EMR buyers face a big challenge as they determine which medical software is right for their needs.

What you should know..

- The 411 on EMR Software
- Implementation
- Which EMR vendor is right for my business?
- Really understanding what I need from an EMR solution
- 3rd party incentives
- Benefits & Potential Issues
- Expenses & ROI

The 411 on EMR Software
Electronic medical records solutions handle the clinical operations of healthcare providers. They provide digital storage of patient charts, and include functionality to track patient demographics, histories, SOAP notes, medications, and test results. EMR systems can also be referred as electronic health records (EHR) systems.
While there is a technical difference between EMRs and EHRs, everyone will use either term as a description. By definition, an EMR is a record of a patient’s medical history created and stored at a single location, while an EHR is a comprehensive collection of a patient’s medical records created and stored at multiple locations.

The decision most buyers will need to face is whether to implement a standalone electronic medical records system or a single, integrated system with EMR, billing, and scheduling modules. Buyers who implement standalone EMRs often do so if: they have unique needs their vendor cannot meet; outsource billing with no plans to bring billing back in house; or made a large upfront investment in a billing and scheduling system they do not wish to replace. Buyers who implement integrated EMR, billing, and scheduling tools typically see the value in having one centralized system to manage all clinical, administrative, and financial information. Many popular vendors such as Allscripts, eClinicalWorks, and GE Centricity can sell EMRs by themselves or complete EMR and medical billing and scheduling systems.

Which EMR vendor is right for my business?
Before you dig in to EMR vendors and go through a formal comparison, you’ll need to figure out what type of EMR buyer you are. We believe that the majority of practices can fall into one of the following categories:

•Primary care MDs/DOs and related specialists. These buyer's work at private practices that provide internal medicine, family medicine, pediatrics, Ob/Gyn, cardiology, oncology, orthopedics, urology, etc. These buyers’ needs are addressed by broad systems with specialty-specific templates.

•Specialists with other designations (DC, OD, PT, PhD, LCSW, etc.). These buyers include chiropractors, psychologists, therapists, counselors, and optometrists. They typically have straightforward needs that are met by affordable, specialty-specific systems. •Small practices. These buyers work at practices with one or two providers. They are usually moving away from paper charts and want to prescribe electronically and integrate with labs.

•Mid-sized to large practices. With anywhere from a handful to 100+ physicians, these buyers are often looking to eliminate paperwork and improve efficiency. They may also want to integrate with other healthcare networks’ systems, track information across several locations, and provide consistency of care across providers.

•Inpatient care organizations. These buyers work for hospitals and acute care centers that need to manage patient rooms/beds, assigned nurses, and physician rounds. They usually require robust, scalable systems that can integrate with a variety of other systems.

Really understanding what I need from an EMR solution
While the EMR landscape is highly fragmented and may at first appear confusing, the available solutions are differentiated by their appeal to the different buyer types.

  • This type of buyer......
  • - Primary Care MDs/DOs
  • - Specialists (DC, OD, PT, MPhD, etc.)
  • - Small practices
  • - Mid-sized to large practices
  • - Inpatient care organizations
  • Should evaluate these systems
  • - eClinicalWorks, Allscripts, Greenway
  • - Valant, A+ Delphi, ChiroTouch
  • - eClinicalWorks, Waiting Room Solutions
  • - GE Centricity, NextGen, Sage Intergy
  • - Epic, Cerner, McKesson

3rd party incentives

These electronic medical record incentives should be considered as you select a product and vendor.

• ONC-ATCB Certification. In 2009, President Obama signed into law the American Recovery and Reinvestment Act. A major component of this bill is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes $19 billion to incentivize medical offices to adopt electronic health records. Providers that make “meaningful use” of “certified” electronic health records are eligible to receive a total of $44,000 in reimbursements in the form of increased Medicare and Medicaid premiums. Physicians have a mandate to become meaningful users by 2015. Those that fail to qualify will face decreased Medicare and Medicaid payments.

The Office of the National Coordinator (ONC) for Health Information Technology, part of the Department of Health and Human Services (HHS), is the department responsible for heading up this initiative. They have selected six organizations to certify electronic health records from medical vendors. These organizations (e.g. CCHIT) have been titled “ONC-Authorized Testing and Certification Bodies,” or ONC-ATCB.

• Mobile device support. Mobile devices are gaining momentum very quickly and healthcare providers are eagerly adopting them. As practices aim to accomplish more from outside the office and improve mobility within the office, iPhones, iPads, and Android devices are becoming more apparent in the workplace. Some of the top EMR vendors are moving on to this increased demand and we expect to see more iOS and Android-compatible systems coming to market. Several EMR Providers already offer tablet PC EMRs. For example, MediTouch is a leading company in mobile healthcare IT.

• Software as a Service (SaaS). Surveys have found that roughly 25% of buyers are interested in only web-based systems, while another 50% of buyers are open to the model during early stages of their research. As cloud computing catches on in other industries, it is emerging quickly in healthcare as well. Developments in HIPAA compliance, data security and encryption, server reliability, and data backup make web-based EMRs viable alternatives in medicine. Furthermore, many healthcare providers are avoiding large upfront costs required for client-server systems and preferring monthly payments for hosted systems.

Benefits & Potential Issues
EMRs are designed to benefit both healthcare providers and administrative staff. The following are the minimum benefits that should be realized with a successful implementation:

• Improved efficiency. Physician practices should find themselves with more time to focus on patient care as they eliminate paperwork, speed up medical charting, receive lab test results and faxes electronically, and prescribe electronically.
• Increase in patient visits. As physicians and support staff spend less time tracking paperwork, they should be able to see more patients. EMRs should also allow physicians to complete and document patient encounters more quickly, further increasing their ability to see more patients.
• Increased collections. Electronic medical records provide physicians with the necessary documentation to support claims sent to insurance companies, Medicare, and Medicaid. Integrated features for E&M coding also help providers code visits properly and upcode when necessary. Of course, seeing more patients should naturally increase collections as well.
• Improved quality of care. Features such as integrated drug databases, symptom checks, and drug interaction verification help physicians prescribe the correct medications and dosages. EMRs can also provide prompts to physicians based on inputs of patient chief complaints and/or risky demographic factors.

As with all healthcare technology, there are potential issues to consider as well. The most common concern we hear is in regards to data security. Patient privacy and HIPAA compliance are typically on the front of providers’ minds, so buyers will want to make sure that the EMR is implemented properly and that standard security measures are in place. Most vendors are well aware of this concern and have proper data encryption technology for both on-premise and web-based systems. A second consideration is user adoption, primarily among providers. Some providers find EMRs difficult to use, often because they are so familiar with working with paper charts. Most user adoption issues can be solved with adequate training. The amount necessary typically depends on the user’s level of tech savviness. The final consideration is vendor viability. Such a fragmented market is bound to undergo consolidation as vendors get acquired or go out of business. As a result, buyers will want to make sure they select a viable vendor whose products will not be discontinued.

Expenses & ROI

The goals for any EMR implementation is to increase revenue, lower administrative costs, and improve the quality of care. The primary measures of effectiveness are the claims collection rate, the number of patient visits per day, the amount of time spent managing faxes and paper charts, and the direct costs of paper charts (cost of materials, storage, destruction, etc.).

EMR implementations have traditionally been very expensive, often beyond the budgets of most small practices. However, increased competition among vendors has applied downward pricing pressure on the market. Furthermore, technology developments such as SaaS have led to alternative, more budget-friendly pricing models. Government stimulus programs such as ARRA will likely make EMR investments even more feasible for small and large practices. EMR system costs will vary widely and depend primarily on the size of the practice and the deployment model preferred (on-premise vs. web-based). On-premise systems will typically require costs for licenses, servers, implementation, training, and ongoing technical support. Support costs typically range 15%-20% of the upfront licensing cost per year. Implementation and training costs also vary widely, but are often as high as the licensing costs. Web-based systems typically have lower upfront costs that cover training and implementation. Ongoing fees paid on a monthly basis cover licensing, technical support, and upgrades. In both cases, buyers need to be aware that integrating a standalone EMR system with an existing billing and scheduling system can often be equal to or more than the cost of implementing one system for both electronic medical records and practice management.