Peter J. Polack MD FACS
Contributing Editor
Are you in the 93% of medical practices who has yet to pull the trigger on the purchase of an electronic medical record system for your practice? Maybe you've heard horror stories from other medical practices that have tried and failed to implement EMR and you’re reluctant to do the same.
So, besides a federal government mandate requiring all medical practices to have electronic medical records within the next 10 years or so, what other compelling reasons are there to go paperless? And websites which offer individuals access to free EMR. Here's a brief look at some features that are available on some of the newer software systems, including both the clinical (EMR) and practice management (EPM) aspects.
EMR features
Drawing capability and icon stamps. One key thing that weeds out most EMR systems for ophthalmology is a good drawing function, something lacking in most of the products on the market. A great feature for drawing is icon stamping, preset figures that can be dragged and dropped onto templates of the eye. The next cool thing? Drag and drop a stamp, and the diagnosis code is automatically brought forward to your assessment page.
E-Prescribing via computer or PDA. This feature is becoming more commonplace. Scratch out a prescription on your computer or PDA, and it is either printed up at the front desk for the patient to take or it is faxed directly to the patient's pharmacy of choice.
Coding wizards. Artificial intelligence built into the EMR can suggest CPT coding based on the documentation of the exam. Although ultimately the physician is responsible for the final decision, this tool can help prevent under- or over-coding.
Patient communication portals. Some systems now have the ability to give patients access to the practice for asking questions, making appointments or downloading forms which need to be filled out prior to their visit. As more retirees are becoming computer savvy, this could really streamline your check-in process. These can also be used for patient education, allowing patients to download information about common ailments, potentially saving valuable chair time.
Central patient data repositories. Some EMR vendors are now touting the benefits of central repositories, allowing the sharing of patient data among health care providers and laboratories. Although this may be the wave of the future, there are still many issues to be worked out regarding the sharing of patient information, such as who shares in the liability if the information is leaked to unauthorized parties.
Integrated imaging scanning solutions. What to do with all those reams of paper received from your non-EMR colleagues? Some EMR systems have integrated scanning solutions that assign paper records to a patient's electronic chart.
User customization. When it comes to customization of an EMR system, you can pay now or pay later. Less expensive systems, which are less complex and ready to use right out of the box, generally allow less customization down the road. The more robust systems, while more expensive and difficult to initially set up, offer more flexibility in terms of customization, not only for the practice but also for each individual user. Don’t underestimate this - for some physicians who are set in their ways, this can mean the difference between accepting the use of EMR or not.
Handwriting or voice recognition. Handwriting and voice-recognition software have become much more accurate and sophisticated. And these are now becoming incorporated into EMR systems. For example, through the use of a tablet PC, a doctor's handwriting can be converted to printed text for better documentation.
EPM
Much of the tedium and drudgery involved in running a medical practice can be reduced or eliminated by many of the functions included with many EPM systems.
Automated tasks. Very tedious, repetitive tasks which are processor intensive and time consuming to run, such as reports and statements, can be performed automatically at night. Certain tasks such as re-billing for certain claims can also be scheduled. Tasking is another feature that can automatically delegate a job to any designated employee when a specific event happens, such as a denied claim.
Automated authorization/eligibility verification. Ask employees who are usually tasked with having to manually call insurance companies to verify eligibility of patients. Having the EPM system do the work for you is a real time saver.
Automated collection cycles. The EPM system can be set to monitor collections, including thresholds for payments which cannot be altered by employees without the proper authorization.
Patient flow/timestamps. This feature keeps visual track of patients in the office with timestamps, so nobody gets left in a dilating hall for three hours.
Other Issues To Consider
Certification. The Committee on Certification for Healthcare Information Technology (CCHIT) is a nonprofit association made up of three health IT industry and advocacy associations. EMR vendors must pay a fee and pass certain criteria to become certified, a status which is good for three years. But be sure to ask the vendor for references. It's also important to check out how many years the company has been in existence. It would be preferable to have a well-established company that is not certified, rather than a certified company that is a newbie.
Integration between EMR and EPM. There are many good standalone EMR or practice management systems on the market, and practices that have one of these may be reluctant to ditch one in order to get an integrated solution. If you are very happy with your existing EPM system and are looking at a standalone EMR product, just beware that the two may not get along. Ask the EMR vendor for references of practices that have successfully integrated their product with your existing EPM system. If there is a problem you may be caught in the middle of finger pointing between the two companies. If you do buy an integrated EMR/EPM system, certification does not necessarily guarantee a smooth and seamless function between the electronic medical records system and the practice management system. Again, check references.
Return on investment. Most physicians would like to have a simple answer to the question, what is the return on my investment for an EMR system? This is sometimes a difficult question to answer. For most practices today, the largest part of overhead is staff expenses. In the future, as EMR becomes obligatory, this may be rivaled by the cost of information technology (computer software and hardware). If you figure that it costs anywhere from $3-$5 to pull a chart, then add the costs of transporting charts between multiple offices, and EMR systems start to make financial sense. In our case, a significant portion of the cost was offset by not having to acquire more office space to hold paper records.
PQRI. The Physician Quality Reporting Initiative, handed down from the CMS, straddles the line between EMR and EPM, since both proper documentation and coding are necessary to qualify for the 1.5% bonus. This may not sound like much. However, for a large practice, this could be enough to pay for an administrator's salary.
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