The Medical Practice EMR Software Buyer s Guide A Practical Guide for Physicians and Medical Practice Office Managers

Transcription

1 The Medical Practice EMR Software Byer s Gide A Practical Gide for Physicians and Medical Practice Office Managers ChartMaker Clinical Amblatory EHR + Cardiovasclar Medicine + Child Health Provided by: Valley Forge Corporate Center 2700 Van Bren Avene Eagleville, PA

2 With all of the financial incentives available to yo today, yo don t need to by a cheap EMR. Dear Healthcare Professional, Like most medical practices, I m sre yo ve heard abot the generos financial incentives from Medicare ($44,000/physician) and Medicaid ($64,000/physician) available to physicians sing Electronic Medical Records (EMR) with e-prescribing. I know many physicians had dobts on whether these incentives wold actally be paid. The good news is that some STI EMR cstomers have recently received their first incentive check from both Medicare ($18,000/physician) and Medicaid ($21,250/physician). However, time is rnning ot on these incentives. For example, 2012 is the last year that yo can receive $18,000/ physician from the Medicare Program by demonstrating Meaningfl Use for only a three month period. See inside for more details on these programs. With all of the financial incentives available to yo today, yo don t need to by a cheap EMR. In most instances, the incentives will more than cover the cost of a new STI EMR system. It s critical to prchase an EMR from a vendor with Staying Power within the indstry. Yor practice becomes dependent pon the vendor providing yo with spport and software pdates to keep yor EMR p-to-date with the latest CMS reqirements. Withot pdates the software is seless. STI sold or first physician practice in 1979 and that practice is still sing or software today. In 2007, when STI first received EMR certification, there were abot 55 certified EMRs available for the amblatory physician marketplace. Once the word got ot that physicians were going to receive large financial incentives to se an EMR, the marketplace was flooded with new companies offering EMR software, many with little or no previos medical practice experience. At last cont, there were over 700 certified EMR prodcts available. How many of these prodcts do yo think will be arond in five years? George Santayana s famos qote of those who cannot remember the past are condemned to repeat it is more relevant than ever. We saw a similar cycle dring the 1990 s when physicians were adopting electronic billing systems. Hndreds of new vendors entered the market and many were gone by Y2K and HIPAA. Don t miss these generos financial incentives. At this point, there is no time to waste. Yo can install a qality EMR from STI and the incentives will more than pay for the software. Why risk making a mistake with an nknown vendor? Call today at , extension 1188, and we will visit yor practice to show yo ChartMaker. Best Regards, Eliminate all the Paper Often, practices will employ someone whose sole responsibility is finding and re-filing the charts that are sed dring the day. An EMR completely eliminates the need for this fnction and immediately redces costs. This will eliminate the chance of a HIPAA violation, when a paper chart cold be accidentally left in a pblic place. An EMR can drastically decrease the amont of time it takes to docment chart notes and can increase the qality of the content in some cases. If yo dictate yor notes sing the ChartMaker voice recognition software, yo can save thosands of dollars each year by eliminating the need to pay a transcription service. Another benefit of eliminating the paper is redcing the costs associated with it. On average, dring the life of each chart the practice spends $15/chart on paper, stickers, binders etc. The cost of these items individally does not seem like very mch, bt the average physician maintains over 3,000 charts. So, the cost is abot $45,000 over the life of yor practice. De to legal reqirements, offices keep charts for seven years after discharging patients. If yor office is paying for off-site storage for paper charts, it is a better reason to acqire an EMR. Joe Cerra STI Compter Services x 1188 P.S. We wold like to show yo why sing the ChartMaker Medical Site will help increase efficiencies and revene. ChartMaker Medical Site v 3.7 by STI Compter Services, Inc is 2011/2012 compliant and has been certified by the Certification Commission for Health Information Technology (CCHIT ), an ONC-ATCB, in accordance with the applicable certification criteria for Eligible Providers adopted by the Secretary of Health and Hman Services. This certification does not represent an endorsement by the U.S. Department of Health and Hman Services or garantee the receipt of incentive payments. Janary 5, CC Qality Measres Certified: NQF 0421, NQF 0013, NQF 0028, NQF 0041, NQF 0024, NQF 0038, NQF 0031, NQF 0043 and NQF Self Attested Additional Software Used in Testing: cid:image001.png@01cbaca7.1ede1d60.

3 Compterized Practice Management Byers Gide STI offers this gide as a service to help yo make an informed decision when prchasing yor Practice Management (PMS) or Electronic Medical Record (EMR) System. We believe that the more yo know abot the choices available to yo, the more likely yo will be to select the ChartMaker Medical Site for yor practice. Althogh there is a great deal of variation among the different types of software ot there today, there are really only two main components of modern medical office software systems: Practice Management Systems (PMS) and Electronic Medical/Health Records (EMR). Both components of an p-to-date medical software soltion shold address three very simple goals: 1. Increased Efficiency 2. Increased Prodctivity 3. Decreased Cost Many practices pt too mch emphasis on the cost of the system as the sole bying criteria. A medical system is a complex combination of compter eqipment, software, training, software pdates, telephone spport, and hardware maintenance. The following sections will illstrate that cost is jst the tip of the iceberg. However, when yo do compare costs, compare all of the costs, not jst the initial prchase price. Common Sense vs. Nonsense It is nwise to pay too mch, bt it s worse to pay too little. When yo pay too mch, yo lose a little money that is all. When yo pay too little, yo sometimes lose everything, becase the thing yo boght was incapable of doing the thing it was boght to do. The common law of bsiness balance prohibits paying a little and getting a lot it can t be done. If yo deal with the lowest bidder, it is well to add something for the risk yo rn, and if yo do that yo will have enogh to pay for something better. John Rskin ( ) Increased Efficiency One major goal of office atomation is to redce the tedios, timeconsming work that is below the optimm work level of yor staff. For instance, time spent by office personnel looking for a lost file is time taken away from patient care. The compter shold help yo and yor staff work at yor highest, most creative level. In every indstry there remain tasks that are nothing more than time consming tedim. And sadly, this means that there are people that are paid to pnch in day in and day ot to complete these tedios tasks. The modern medical practice is no different. Bt as advances are made in medical software technology, these tasks are slowly bt srely being phased ot. An p-to-date software system can redce or eliminate tasks like calling insrance companies to check eligibility or manally finding and re-filing paper charts. Increased Prodctivity The ability to do more work in less time is a primary goal of office atomation. A corollary to that, and in some ways a more important one than prodctivity, is the goal of elevating the level of work of yor medical office staff. Everyone divides their workday between work of different levels. For instance, some part of yor day is devoted to high level work, sch as decision-making, analysis, patient interaction, development of new resorces, etc. Conversely, some part of yor day is low-level work, sch as time wasted looking for lost charts or missing information, doing repetitive tasks, clearing p mistakes, etc. Finally, some work lies at any one of varios middle levels. The objective of improved work in office atomation is to have the compter redce the amont of low-level work each employee mst perform in a day. It is important to recognize that this theory applies to the receptionist or billing secretary as well as to the physicians and office manager. Yor employees will work better and with greater work satisfaction when they spend the majority of their work hors at their highest level of work. And, of corse, the practice benefits becase overall better, more creative work is done. Withot these monotonos tasks, staff members will be able to devote their time and creative energies towards mch more prodctive goals. Software soltions can help enhance these goals too. Office staff members will perhaps be able spend their time chasing down npaid debts or rnning detailed financial reports, ths gaining more control over office billing practices. Similarly, with p-to-date software, doctors will be able to create more comprehensive chart content in less time than it takes to handwrite, type or dictate a note. Decrease Cost Finally, an p-to-date medical software system shold help decrease the cost of rnning yor practice. Whether it is completely eliminating transcription costs, or decreasing something as simple as money spent printing enconter forms, a crrent software system shold redce the amont of money needed to rn yor practice. Two Components to an Up-to-Date Medical Practice Software System When yo consider compterizing yor medical practice there are two eqally important components that yo need to consider. There is a clinical side and a bsiness side to yor practice. Yo need both to rn an efficient medical practice. Each piece is eqally important if yo want to rn a profitable medical practice. Obviosly yo became a physician to practice medicine not to rn a bsiness, bt withot revene from yor medical practice, yo can t contine in private practice. So when yo investigate medical software yo need to careflly evalate both aspects. Since the clinical side is sally of more interest to a physician, natrally more attention may be paid to that aspect. However, yo need to have yor office staff involved to investigate the billing fnction as well. A good analogy is the SAT score. If yo want to go to a good college yo need to have a high SAT score. Traditionally the SAT score was made p of two parts math and verbal. If yo had a high score in math, bt a low score in the verbal side, most likely yo wold not get into the college of yor choice. The colleges are looking for stdents with the highest combined score. 3

4 4 When yo select a practice software system, yo shold look for the vendor with the highest combined score in bsiness (billing applications) and clinical (EMR) applications. Don t make the mistake of concentrating yor effort on only one side of the eqation, or it s very possible that yo will be investigating software again in the ftre. Average Score Think SAT Score Yo want the Highest Combined Score 0 Critical Reading Math Bsiness (PMS) Clinical (EMR) Yo need Both Look at Both & Involve Medical and Office Staff When yo investigate practice software, many vendors may excel on the EMR side or the billing side dring a demonstration. However, the very natre of the software indstry is that recently designed software is typically not as robst as more matre software. Software gets better as more people se it and reqest enhancements to make it better. Becase the EMR component is newer, some practices that have prchased very good EMR software from newer, primarily EMR vendors complain of poor billing components. Some practices have had to replace the software becase the billing component was not adeqate. STI first introdced or billing software in 1979 and or EMR software in 1995 so we have had the time to properly develop both components. Benefits Of An Up-to-Date Practice Management Software Practice Management Software is the financial component of medical software systems. Practice Management contains the nts and bolts of the bsiness side of any medical practice. The fnctions of Practice Management software can vary by brand of software, bt a complete program that addresses all of yor practice reqirements shold have most if not all of the following fnctions. Electronic Claims Sbmission Electronic Claims Sbmission is vitally important in accomplishing the three goals listed above. If yo are not already sbmitting yor claims electronically, yo cold be losing a lot of money withot realizing it. The Center for Medicare and Medicaid Services (CMS) reports that claims sbmitted electronically experience 21% fewer rejections than those sbmitted on paper.(1) Five Reasons to Bill Electronically 1. Less likely to be rejected 2. Notification of accepted (clean) and rejected claims 3. Faster payment 4. Better tracking of claims 5. Atomatic posting and checking contracted fees Frthermore, if yo sbmit yor claims electronically, yo will typically be notified within hors if a claim has been accepted or rejected. That way, if there is a problem, it can often be addressed within the same day so little time is lost between sbmission and payment. Also, with electronic sbmission, yo will get paid almost 2 weeks faster. By law, Medicare mst pay claims sbmitted electronically within 14 days, whereas the average pay period for a paper claim is 26 days. (1) And let s not forget the most basic of expenses: labor and postage. With paper claims, yo not only have to pay for the paper and ink needed to print the claim, yo also have to pay for the stamps and envelopes to get them to the insrance company and the time to sort and stff envelopes. It may not seem like a lot, bt each paper claim costs $1.00- $1.50 to send. (2) Electronic Transmission of Insrance The Health Care Financing Administration now called the Center for Medicare and Medicaid Services (CMS) has reported that it rejects 26% of the claims it receives. While that nmber is astonishing, more astonishing is the fact that 40% of those rejected claims are never resbmitted. These rejections and lost claims confirm that there are significant billing problems in many provider organizations. Using Medicare s statistics, the lost revene per physician is abot 10%. On a per physician basis, this ranges from approximately $25,000 to over $50,000 per year. (1) Electronic billing provides practice benefits to avoid the type of reslts shown in the above CMS stdy. First, electronically sbmitted claims are not manally keypnched or reviewed and therefore less likely to be rejected. Stdies show that practices that bill electronically experience 21% fewer rejections(2). Second, typically within hors, yo will be electronically notified that the sbmitted claims have been accepted or rejected. If rejected, they can be qickly corrected and resbmitted the same day. Third, electronically sbmitted claims are typically paid faster. By law, Medicare mst pay an electronic claim in 14 days. The same paper claim woldn t be paid ntil day 26. (2) Forth, electronically sbmitted claims can be atomatically tracked with the proper software. If a claim is not paid within the agreed time frame, a report can be generated, the carrier contacted and the charge reviewed before atomatically resbmitting the claim. Fifth, after yo are paid, yor contracted fees can be checked to ensre that yo are being paid correctly, and then the compter will atomatically bill yor secondary carrier or patient. In some cases, Medicare payments can also be posted atomatically. ANSI 5010 Progress Between Janary 1st and March 31st 2012, the Centers for Medicare and Medicaid Services (CMS) as well as varios insrance companies will reqire yo to send electronic claims and receive yor payment remittance files in the ANSI 5010 format instead of the crrent ANSI 4010 format. STI has added spport for ANSI Most of the changes related to ANSI 5010 happen seamlessly, behind the scenes within the ChartMaker Medical Site. Here are a few important isses that we wold like to share with yo. 1. P.O. Boxes are no longer accepted for the billing provider addresses with this new format. The billing address, whether yo bill by Practice or Provider, cannot contain a P.O. Box. There are no changes to yor enrollment sign ps, or where the checks are sent. 2. The fll nine-digit zip code is reqired for billing provider and service facility addresses. The nine-digit zip code shold be entered for all practices, providers and facilities. Contined on page 6

5 In-Hose or Otsorce Billing? A sccessfl billing process starts with the right practice management and electronic billing software. Once yo ve chosen yor compter technology, the next step is to decide whether to assign the billing fnction to yor own office staff or otsorce it to a professional medical billing service. The billing process relies on getting the correct patient and insrance information into the system. Errors in data entry reslt in rejections, and it s possible that a claim can be electronically sbmitted bt immediately denied withot ever entering the payer s system for processing. Often, staff in the physician s office forget or don t have time to retrieve the next-day reports that will tell yo if yor claims were accepted. A rejection on this vital report means that yor claim was not in fact sbmitted. If yor staff doesn t catch the error in time, the claim may be rejected for timely filing with no appeal possible. A professional billing service can insre that charges entered by yo or yor office staff are done correctly and completely, or even enter the charges for yo. They will sbmit yor claims, retrieve the next-day reports, and resbmit any necessary corrections. They will record payments and follow p on denials, rejections, and low payments. Skilled staff at a billing service can review yor aging reports for slow pays, ncover npaid claims that have been prged by the insrance companies, and send bills to secondary payers. Patient bills can be sbmitted for yo, and if yo choose, yor patients can call the billing service with qestions instead of interrpting yor bsy staff. The advantage of sing an otside billing service is that yo redce internal labor costs and a professional billing service most likely will have more experience dealing with the insrance carriers than yor own staff since this is all that they do. That frees yor staff to provide better patient service and not sit on the phone talking to insrance carriers. Since billing services only get paid a percentage of yor collections, they need to work yor acconts to get paid. For example if a billing service receives 7% of collections, this means for every dollar that they collect, yo receive $0.93 and they receive $0.07. To evalate a billing service yo need to determine yor internal cost of collections and compare that to the cost to otsorce billing pls any additional collections that an experienced billing service can provide. If they can collect an additional $10,000/month yo receive an additional $9,300 and yor staff is available to do more important work on patient care. STI has independent billing services companies that have been trained to work with the ChartMaker software. These companies can provide yo an option of either a clodbased or client-server version of ChartMaker. With a clodbased model, yor data resides at the billing service location and they are responsible for software, back-p and server costs. With a client-server version the ChartMaker software is installed in yor location and yo control the billing information and the billing service comes into yor system. The combination of the ChartMaker PMS and EMR system with a professional billing service to verify the accracy of billing information and to follow-p on claims can provide any practice an advantage. With the ChartMaker EMR a physician can enter charge and diagnostic information directly from the patient chart. That information can be accessed and processed by a professional billing service for processing. ChartMaker software, in the hands of a trained billing service, may save yo time and improve yor cash flow. A professional billing service becomes yor back office, providing knowledgeable employees who are focsed on getting yo paid. Yo may realize lower costs, redced errors, and increased revenes when yo se one of or billing services. With ChartMaker yo have a choice of either doing yor own in-hose billing, or working with one of or independent billing service companies to process yor claims. It s p to yo. STI Compter Services, Inc Copyright 2012, EVC All rights reserved 5

6 Financial Reporting Fnctions Financial reporting fnctions work hand in hand with yor offices ability to bill electronically. What good is it that yo can find ot abot yor claim stats within 24 hors if yo are not able to view that information in a report? An p-to-date software program will give yo the ability to rn reports to get a fll pictre of what is going on with the money in yor practice. According to the same CMS report mentioned above, 26% of all claims are initially rejected. As astonishing as that nmber is, even more astonishing is that 40% of those rejected claims are never resbmitted.(1) This reslts in an average of abot 10% income loss for the physician. Why do yo think anyone wold let rejected claims go withot resbmitting them? Most rejected claims are not resbmitted becase they simply go nnoticed. With proper reporting fnctions, this shold never again be the case. Wold a Compter Help Yo Provide Better Health Care? Primary care physicians who se compters to tickle their memories are twice as likely as other doctors to administer fl vaccine to high-risk patients, a new stdy sggests. The three-year stdy involves patients who were over 65 or had chronic lng disease, asthma, diabetes mellits, congestive heart failre, or severe renal or hepatic failre. Patients whose doctors received compterized reminders had a 10-30% lower rate of hospitalization, ER visits and tests for respiratory ailments dring the winter. Medical Economics May 10, 1993 Similarly, proper reporting fnctions shold allow yo not only to realize when yo have not been paid for a claim, bt also when yo have not been paid enogh for a claim. Sometimes offices will be paid a few dollars less than their contracted amont. Again, it does not seem like yo are losing that mch, a cople dollars here and there. Bt if yo are getting nderpaid a few dollars on 20% of the 500 claims yo send each month, this can translate to several hndred dollars a month! In a year s time, yo will have effectively given thosands of dollars back to the insrance companies for work that has been done by yo. Again, this problem is easily addressed with the proper reporting fnctions in a Practice Management system. And reports do not only have to address insrance companies, (consider how mch more effective it wold be to renegotiate contracts with reports like these in yor arsenal!). Reports can also discern which provider is bringing in the most money at each location, or which procedre is the most lcrative and which ones are not worth doing. The possibilities are limitless. CMS reports that the average physician doesn t collect between $25,000 and $50,000 per year de to poor billing procedres. Enhanced Billing Featres If yo are sing an ot of date system, perhaps the most exciting new featres will lay in wait for yo within the realm of billing fnctionality. The latest systems are mch more robst and easier to se than their older conterparts. For example, in the ChartMaker s Practice Manager modle, yo have the ability to scrb the claims before they are sent ot. Whether on a claim by claim basis or on a batch at the end of the day, yo can rn a test that will generate a report detailing which claims will be denied and why. From there yo can go back and fix the problems listed and with one click send ot all of yor claims with confidence that if the claims are rejected, it sholdn t be de to a billing error. Another enhanced billing featre is atomatic payment posting. Most offices employ someone to look over insrance EOMB s, to manally match the payments to the procedres and then enter this information into the compter on a case by case basis. This is a time consming and often inaccrate process that can reslt in more lost revene to the practice. Electronically sbmitted claims can receive electronic remittance advice from carriers to atomate and streamline the EOMB posting process to redce labor cost, save time and redce errors. An p-todate system can atomatically post payments once they receive the electronic remittance advice. The Paper Chase The system yo choose shold be able to bill commercial carriers as well as Medicare. If yor crrent practice compter is only electronically billing Medicare claims yo may be losing revene as well. Electronic billing to commercial insrance companies is as important as electronically billing Medicare since the 40% estimate of not rebilling rejected claims probably applies to commercial claims as well. As importantly, many practices face an additional labor cost in tracking hardcopy commercial claims. With hardcopy claims there is no way of knowing if the commercial carrier received yor claim or its stats withot a telephone call for follow-p. The billing staff in most practices complain abot the delay in payment from commercial carriers and the amont of time spent on insrance follow-p and reqests from carriers for resbmittal of hardcopy claims. It is no wonder that many bsy practices don t collect 40% of rejected claims, with the contining cycle of mailing hardcopy claims, waiting for payment, telephone follow-p, reqests for resbmittal of hardcopy claims, waiting again, another telephone follow-p, etc. If yo sbmit claims electronically yo have an electronic adit trail that shows when a payer received every claim yo sent ot. (3) With the appropriate software, yo will receive a confirmation and stats typically within 24 to 48 hors. If the claim was rejected it can be corrected immediately and resbmitted the same day. Accepted claims shold not reqire a follow-p call and shold be paid qickly. If yor practice is not crrently electronically billing every possible insrance carrier, yor costs can be far greater than the cost to prchase a new Practice Management System. The above CMS example claims that many providers are losing between $25,000 and $50,000 per year. This is in addition to a New Jersey Medicine article showing a fixed-cost of abot $300 per month as well as lost interest of between $100 and $300 per month for hardcopy billing. (4) 6

7 Patient Recall Many offices already tilize a system of reminding their patients when its time to retrn for an important test or procedre. An p-to-date practice management system can both enhance and streamline these systems. With technologies like mail merge and atomated phone reminder systems, compters can effectively remind patients that its time for them to call to schedle an appointment. And if jst two more patients per week schedle an appointment, for some, the revene generated from those appointments can make a sbstantial difference in the monthly income. Eligibility Checking Oftentimes, even the most responsible patients can have a lapse in insrance coverage withot realizing it. And sally, this means that their doctor will not get paid for a very long time, if at all. Most offices will call to check on the insrance eligibility of their patients the day before they are seen. No one likes to sit on the phone with insrance companies, inclding medical office staff. This process is often time consming and incredibly tedios. Lately, insrance companies have tilized the internet to speed p this process, bt only slightly. Staff members are still reqired to enter every digit of each patient s grop nmber, ID nmber, doctor s NPI nmber etc. As a reslt, this task can very freqently go overlooked. And that can spell troble very qickly for an office s income. An pto-date Practice Management system can gather all of the necessary nmbers and data, transmit them to the insrance company s website and respond with a list of eligible and ineligible patients. In some cases, it can even retrieve information abot referrals and athorizations. Electronic Medical Records Electronic health/medical records are the latest bzz in the medical software world. (NOTE: in this gide we will se the terms EMR and EHR interchangeably.) And it seems that even more information is available on all of the varied and different featres available to doctors. Bt, in choosing an EMR, the same three goals listed above apply. An EMR mst be able to increase efficiency, increase prodctivity and decrease the overall cost of rnning yor practice. If it is nable to meet these three goals, it does not matter how many bells and whistles it comes with, it won t be a practical tool in managing yor medical practice. There are featres and benefits to look for, thogh, when researching EMR software. Elimination of Paper Many people nderestimate the benefit of ridding their office of the constant paper chase. Often, practices will employ someone whose sole responsibility is finding and re-filing the charts that are sed dring the day. An EMR completely eliminates the need for this fnction and immediately redces costs. This will eliminate the chance of a HIPPA violation, in which a paper chart cold be accidentally left in a pblic place. Pls, no more lost charts. Even the most fastidios of re-filers has been known to misplace a chart from time to time. And every office can relate to the scenario of having a patient sitting in the waiting room with his or her chart nowhere to be fond. With an EMR, yo shold not need to deal with a missing chart again. THE BEST COMPUTER SYSTEM ADDRESSES THESE TYPICAL PRACTICE CONCERNS Too mch time spent plling and replacing patient charts Lost time searching for patient information Payment delays and typing redndant information Incorrect patient charges, or lost charges Not sre if all charges have been billed Complexity of insrance and government reglations Lost patient billing information, or patient records Failre to consistently bill secondary insrance Fear of patient abandonment charges No time for collections reslting in high bad debt balances Office trnover, increasing office administration costs, and poor employee morale from long hors Feel ot-of-control on the bsiness side of the practice Each provider not properly compensated No centralized control one place to find all information An EMR can drastically decrease the amont of time it takes to docment chart notes and can increase the qality of the content in some cases. Even if yo contine to dictate yor notes, sing the latest voice recognition software, yo will be saving hndreds or even thosands of dollars each year by eliminating the need to pay a transcription service. If lack of time is the problem, sally the first thing to go is the docmentation of normal findings. In most cases, the deletion of normal findings is the main contribting factor to nder-coding. Althogh most doctors will evalate patients and determine these normal findings, they only have time to docment the problems that the patient was being seen for, ths drastically redcing the evalation and management content in their notes. In 2007 when STI first received EMR certification, there were abot 55 certified EMRs available for the physician amblatory marketplace. Once the word got ot that physicians were receiving large financial incentives to se an EMR, the marketplace was flooded with new software companies offering EMR software, many with little or no previos medical practice experience. At last cont there were over 700 certified EMR prodcts available. How many of these prodcts do yo think will be arond in five years? Contined on page 9 7

8 Pros and Cons of Integrating vs. Interfacing the EMR and PMS The Interface (Bridge) Dilemma In today s medical software marketplace most medical practices want a completely integrated Practice Management System and Electronic Medical Record software from one vendor. However occasionally a practice wold like to integrate (called an electronic bridge) two distinct software prodcts from two separate vendors for their practice. Althogh in some cases a practice has no other option then to bridge two prodcts, it is typically less expensive if yo can avoid this project. Before ndertaking sch an effort it is important to nderstand the complexities in creating and maintaining an electronic bridge. Bridge Between a new EMR and Yor Old Billing System Some vendors sggest that yo interface (bridge) their new EMR with yor old practice management software. The argment they present is that becase their EMR software is HL7 compliant and that yor billing software is also HL7 compliant, that both prodcts can be easily interfaced. Nothing can be frther from the trth. The HL7 standard is a compatibility index. This means that both prodcts are capable of being interfaced bt it does not mean that the interface will take effect atomatically. A good medical analogy is a blood transfsion. If one patient has A+ blood and a second patient is also A+ they may be compatible for a blood transfsion. It does not mean that the transfsion happens atomatically, and the blood atomatically flows from one patient to another. Someone needs to provide the technology, knowledge, and labor for a sccessfl transfsion. Integrated or Interfaced? When pgrading yor office software system, it is easier to prchase an integrated system (one with both a PMS and EMR from the same vendor) rather than interface a PMS and EMR from two different vendors. Interfaces are expensive and add nde stress to maintaining a properly fnctioning system. An interface reqires the continos cooperation from both companies involved. If one company chooses to pgrade their prodct, it will be yor responsibility to get (and probably pay for) the pgrade of the interface. If yo mst interface yor prodcts, have them sharing only critical information. STI has experience in interfacing the ChartMaker Medical Site with other software prodcts and vendors. We ve interfaced with medical laboratory companies, medical device manfactrer s, other practice management and EMR vendors, hospitals and specific software vendors that provide niqe services that STI feels can be better spported by another vendors. The fact of the matter is that a prodct interface (also called a bridge) has several isses that mst be considered: Interfaces reqires the cooperation of both vendors to be sccessfl Interfaces always reqires more programming effort than was originally estimated Interfaces are expensive Most importantly, interfaces are not a one-time programming fnction bt mst be maintained over the life of both prodcts. Whenever one prodct creates a new pdate or release, often times that will create a programming reqirement for the interface and it mst be commnicated and reprogrammed or the interface cold become broken. Most programmers will tell yo that the rle of thmb is that it costs three times as mch to maintain a program than to create it. With interfaces this cost cold even be higher since we are dealing with two companies not jst one. Interfaces of EMR and PMS systems are even more complicated becase often what is desired is not jst a patient demographics interface, bt an interface of patients, referral sorces, charges, and appointments which are basically every major file within the software system. Conclsion: Integrate, Don t Interface After decades of development and negotiation, the shipping indstry was ltimately able to agree pon a standardized cargo container. The healthcare indstry is going throgh a similar phase that may take jst as long involving XML, HL7 and CORBA initiatives. However, today there are no vendors offering a standardized container to pre-package all of their data so that one vendor s PMS can seamlessly share data with another vendor s EMR. Althogh the vendors may pblish the specifications, still, a significant and ongoing cstom programming effort is reqired to interface these critical applications. Relying on a fragile, cstom interface only complicates the daily sage, reliability, and performance of the two most important compter applications in a physician s office. To experience the greatest benefit and the least frstration, implement an integrated PMS/EMR. (24) 8 STI Compter Services, Inc Copyright 2012, EVC All rights reserved

9 Another fnction of eliminating the paper is redcing the costs associated with it. On average, dring the life of each chart the practice spends $15/chart on paper, stickers, binders etc. The cost of these items individally does not seem like very mch, bt the average physician maintains over 3,000 charts. So, the cost of maintaining 3000 charts is abot $45,000 over the life of yor practice. Similarly, charts do not jst take p yor money; they take p yor space. De to legal reqirements, many offices keep charts for seven years after discharging patients (longer for pediatricians). If yor office is paying for off-site storage for paper charts, its a better reason to acqire an EMR. On-Line Chart Access More importantly, the best part of having charts in an electronic format rather than paper is that yo can view an electronic chart from anywhere that yo have an Internet connection. Yo can refill prescriptions from home or finish p chart notes from the hospital. Gone are the days of staying late in yor office finishing p a stack of charts. Now yo can go home on time, have dinner and if reqired access yor charts from home when yo need to finish a note or make a telephone entry. Streamlined Chart Entry Many physicians work after the office is closed to write or dictate their chart notes. An p-to-date EMR system can help eliminate the need to do this. If yo are hand writing or dictating yor chart notes, an EMR can save yo time and money. Even doctors who are sed to dictating their notes will save time. The latest voice recognition software can be integrated into yor system and make the transition from paper to compter almost seamless. The only difference yo shold notice is the amont of money yo save each month that wold otherwise go to pay a transcriptionist and the elimination of the wait to receive yor transcribed notes. The trend in practice management systems is toward integration with clinical information shold yo by both components from the same vendor? Michael Wiley thinks so. (19) The Five Fnctions of an EMR 1. Storage The first fnction of an EMR is to store patient information within the compter. Each patient visit or interaction, and other related docments or correspondence that relate to that particlar patient is stored and accessed by the compter in a manner similar to storage in a medical chart rack. 2. Organization An EMR organizes basic patient medical information into sefl gropings for follow-p and decisionmaking. For example, the EMR can provide lists for all patient medications or provide lists of patients on certain medications. Telephone messages and recall lists can be maintained. 3. Presentation The EMR has also been called a strctred medical record, becase all the information is shown in a standard, strctred format to the ser. For example, with the ChartMaker EMR System, the patient s face sheet is always present on the left of the electronic medical chart with all crrent problems, medications, allergies, and recalls. 4. Virtal Data Base Althogh all of yor medical information physically resides in one, secre, compter server in yor office, the information in yor EMR can be accessed by athorized sers at different locations. Yo have the ability to access patient information remotely. An added benefit is the elimination of lost or misplaced paper charts. 5. Medical Data Inpt The fifth fnction of an EMR is to assist in the inpt of patient information into the record. ChartMaker provides yo with varios methods to add yor medical information into the EMR inclding: 1. Typing directly into the EMR 2. Dictation and transcription 3. Scanning 4. Voice recognition 5. Template based data checklists (9) 9

10 E&M Gidelines Many physicians are concerned that they are nder-coding or nderdocmenting their patient notes de to a lack of time when seeing patients. Not properly docmenting normal findings is often the main contribting factor of nder docmentation becase of time constraints. Usally the work is done bt the physician does not docment the normal findings. Electronic Laboratory Reslts Electronic Lab sbmission and retrieval can go a long way toward saving time and increasing efficiency in yor office. Many offices still employ a staff member whose responsibility is to retrieve the paper lab reslts from the fax machine and sort laboratory reslts alphabetically, find the corresponding charts, match them p and place them on the doctor s desk to await review. An p-to-date, EMR can also more accrately help yo to determine the proper E&M level by conting the nmber of items docmented in yor note as yo complete an electronic patient template for an examination. With an EMR, yo can qickly docment normal findings with the click of a btton. And in some systems, like ChartMaker Clinical, the E&M items can even be tracked in the backgrond of yor EMR to make yor life easy if yo are ever adited. E&M Gidelines ChartMaker incldes generic E&M templates inclding an atomatic, nmeric tracking system to help yo better determine the proper E&M code for each examination that yo docment. Medical histories, ROS, examination and other medical data are conted by the E&M template to help yor medical staff conform with E&M gidelines. The Evalation and Management (E&M) docmentation reqirements are designed to set specific grond rles for both physicians and aditors when medical charts are examined for compliance. For the practical physician it s important not to have yor chart docmentation pt yor practice in jeopardy of being fined. Besides the need for medical necessity and providing the reqired patient service, yo need a more detailed level of docmentation to spport a code than is needed to spport a code of So if yo provide the patient the level of service, bt do not properly docment the service in the patient s medical chart, yo do not qalify for payment. In fact, yo may be in jeopardy of a fine for frad or abse de to a lack of sfficient docmentation. The old adage rings tre, if yo didn t write it down, yo didn t do it. An electronic medical record system, like ChartMaker, can make yor job easier. That s becase most of the E&M docmentation criteria involves tracking the nmber of criteria (qantification) performed in an examination to determine a nmerical score for each category that determines the level of care spported by yor docmentation. E&M templates inclde an atomatic, nmeric tracking system to help yo better determine the proper code for each examination. Many consltants are recommending that a prdent strategy for their clients incldes the implementation of an Electronic Medical Record (EMR) System to redce their E&M docmentation liability. Some consltants even feel that a non-compterized practice has little chance to conform to the higher-level E&M docmentation reqirements. (11, 12, 18). An efficient trn arond time for this process is approximately a day and a half from fax receipt to doctor review. With an EMR the lab reslts can be sent directly to the doctor and in the case of ChartMaker EMR, the lab can be linked directly to the patients chart so that it can be filed with one click after review. HIPAA and Patient Confidentiality Confidentiality of patient information becomes a bigger concern with the implementation of HIPAA. Besides frad and abse provisions, HIPAA also has strict rles on maintaining the confidentiality of patient medical information. Now the release of patient information incldes the possibility of large monetary fines and even criminal charges that inclde the possibility of jail time. The Electronic Medical Record can help yor practice to maintain secre gidelines needed to enforce HIPAA s confidentiality provisions. The EMR shold inclde an integrated patient record password secrity system to maintain the privacy of yor patient records. Contined on page 11 10

11 Electronic Prescriptions (escripts) There has been increased interest in recent years in the advantages of Electronic Prescribing (escripts). The Centers for Medicaid and Medicare Services (CMS) has advocated the niversal adoption of this technology for several reasons. First, electronic prescribing can significantly redce the nmber of dplicated prescriptions by allowing the prescribing physicians access to an entire list of medications within a pharmacy database. Second, the tilization of software to aid in the process of escripts is believed to contribte to the redction of the nmber of negative drg-to-drg interactions as well as drg-to-allergy interactions. In the United States last year alone there were over 14 million adverse drg events (ADEs), 2.6 million of those reslted in the death of the patient. Electronic prescribing cold drastically redce this nmber of events. (23) Integrated vs. Free Standalone escript Offers Althogh receiving FREE escript software may initially sond pretty attractive, it is always a good idea to identify the catch in the offer. FREE for how long seems to be the most obvios qestion? The more sbtle qestion is why is it FREE? Once yo realize that escripts software is the first step to the EMR, the answer becomes more apparent. If yor FREE software is hosted at the vendor site on their file server (called an ASP model for Application Service Provider - also called clod-based) as opposed to on-site on yor server (called Client- Server) yo may have no choice bt to prchase the EMR from the ASP vendor or lose the escript content (yor medication data in an electronic format) if yo choose another EMR. So a FREE escript software pls an expensive EMR may cost yo more than a moderately priced EMR with integrated escripts. There are several advantages of integration of escripts into an EMR as opposed to FREE standalone escript software. In a recent White Paper on e-prescribing from Covisint (23) the athor points ot that stand alone escript technology is disrptive to the physician in that it is not flly integrated with the rest of the practice software casing workflow changes to accommodate dplicate patient data entry, as well as sing a second system to view and prescribe. We wold add that the physician is also bilding valable patient content (medication history, allergies, etc) into a system that is not integrated with the rest of his patient information when sing a standalone escript system. In fact this data may reside thosands of miles away on another server and begs the critical qestion -- How do I retrieve my patient medication and allergy history and import it into my EHR when I am ready to implement this technology and at what cost? The answer may be that yo can t, so check before yo choose that FREE offer. Since eprescriptions are a reqired featre of all CCHIT 2008 or later certified EMR, a better soltion than a FREE standalone eprescription program is to prchase an entry level EMR program with escript capabilities that many vendors call EMR Lite. Many EMR vendors realize that physicians may not want to prchase all of the capabilities of an EMR initially and provide low-cost versions of their software with limited capabilities that at least can provide yo a growth path to a complete EMR when yo are ready rather than committing to an ASP eprescription prodct that may reqire yo to walk away from yor medication data at a later time. For example STI provides a low-cost (nder $5,000) EMR prodct called ChartMaker Entry Point, that can provide yor practice not only in-hose eprescription capabilities, bt also the ability to receive electronic lab reslts, maintain a patient face sheet with medication lists, problem lists, and allergies for each of yor patients, enter procedres with G-codes, qery yor medication and problem lists to find patients taking certain medications or with certain problems and medications. More importantly, it incldes docment management capability to allow yo to begin scanning yor patient notes into the EMR. So instead of an eprescription only prodct that maintains yor medication on a distant server that yo may need to walk away from in a year or two, yo have the fondation of a complete EMR in yor office with no data loss if yo choose to implement the complete EMR with template, voice or pen-based patient note entry at a later date. A mch better option! For a more thorogh discssion on the differences between a clodbased and client-server system, see the related article on page 18. Third, electronic prescribing allows pharmacies to become more efficient by demystifying the enigma that is doctor s handwriting, thereby redcing the nmber of calls made to doctor s offices for clarification. Forth, Electronic Prescribing allows doctors to receive refill reqests directly into their EMR. This allows the doctor to view the patient chart and make accrate medication decisions from anywhere at any time of day. Besides the patient safety considerations, the widespread adoption of escripts cold offer vast savings to the healthcare indstry. Savings cold vary between $27 billion (CITL 2003) and $60 billion annally de to appropriate medication se and diminished ADE s (23) escripts are so important that the CMS provides a financial incentive to send yor prescriptions electronically. Atomated Billing Entry Finally an EMR can atomate the billing process even frther. In many offices, patients are handed an enconter form or sper-bill to carry to the front to check ot. If that patient were to jst keep walking past the front desk and ot the door, many of those same offices wold not even realize that a charge was missing. An EMR like ChartMaker can send charges directly from the clinical side to the Practice Management side sing an electronic charge slip in the EMR template. When the doctor finishes the note diagnosis, procedres and modifiers can be transmitted from the EMR to the billing system with the click of a btton. No more lost charges and a redction in clerical costs as well as possible transcription errors. Since the billing staff no longer has to manally enter each diagnosis/procedre code, they can spend their time doing more prodctive work. EMR Certification Certain standards have been pt in place to certify that an EMR software program meets the highest qalifications. One sch certification program is called CCHIT (Certification Commission for Healthcare Information Technology). This seal of approval is crrently the highest level of certification an EMR program can achieve. CCHIT is designed with the intent to protect doctors from bying software that is not able to complete all of the basic fnctions necessary to keep appropriate patient records. The government is also tilizing 11