1 ELECTRONIC MEDICAL RECORDS Selecting and Utilizing an Electronic Medical Records Solution A WHITE PAPER by CureMD CureMD Healthcare 55 Broad Street New York, NY Overview United States of America Phone: Toll Free: GET EMR
2 Health IT received a major boost in 2009 with the introduction of the Meaningful Use program. Launched under the HITECH Act (Health Information Technology for Economic & Clinical Health), the program aimed to improve efficiency and care quality of the Healthcare system through adoption of Electronic Medical Records (EMRs). Anticipating long term benefits of Electronic Health Records, media and academics alike hailed this legislation as an instrumental achievement by the U.S government and health policy makers. It is expected that the adoption of EMRs will improve the quality of care, patient doctor engagement and make health care accessible for a greater number of people. The Meaningful Use Program is an initiative through which providers can qualify for up to $44,000 for Medicare and $63,750 for Medicaid in incentives, over a period of five years by utilizing approved and certified systems. How has the medical community reacted to this change? Over the years, the adoption of EMRs has gradually increased, as more and more care providers have realized the benefits of EMRs. Currently, an increasing number of providers are in the process of endorsing health information technology and/or planning to implement it in the future. Objectives of this White Paper The aim of this white paper is to facilitate understanding of EMRs, so that readers know what these systems do, how do they relate to them and the benefits that they can expect. Furthermore, it provides a step by step guide to simplify the transition from paper.
3 ALL YOU WANT TO KNOW ABOUT EMRs Understanding the technology Q: Difference between EMR and EHR? An Electronic Medical Record is the record of patients derived from medical information and history in a single practice. An Electronic Health Record is a patient s record designed to be interoperable among different entities so that information can be shared to increase care quality. An Electronic Medical Record (EMR) is a digital version of a traditional paperbased medical record. EMR software allows patients health information to be stored and exchanged electronically. Through EMR software, care providers can view a patient s medications, allergies, lab results and social history. When the history of a patient is available to a provider electronically, they can easily determine patterns of illness and decide what needs to be done before patient s health deteriorates. Myth 1: EMRs are suitable only for large scale practices EMRs create value for practices of all sizes as they allow for scalability and customizability to suit the existing administrative and clinical workflows of any practice setting. Small (1 4 MDs) Mid sized (5+ MDs) Large (20+ MDs) or Multi Specialty Practices supported by Hospitals Academic Medical Centers Management Service Organizations Integrated Delivery Networks Federally Qualified Health Centers Myth 2: Paper based Medical Records are easier to handle Using paper has always been the traditional way a medical practice does things. It is difficult to let go of your comfort zone. However, when deciding on whether to make the transition; you must bear in mind how both methods of documentation compare. Paper Based Medical Records Time consuming Susceptible to inaccuracies Physical storage required Difficult to find relevant documents Increased overheads Electronic Medical Records Time saving Accurate Electronic storage Simplified search Cost savings Myth 3: EMRs are only made for some specialties Like most things in life, there is no one sizefits all perfect solution. Anticipating this need, health IT organizations have created solutions that come in different versions for different practices depending on their size and the number of specialties involved. Single specialty: Single specialty specific EMRs will not be developed according to the specifications of different specialties. They are configurable to suit the specialty specific workflows of physicians. Multiple Specialty: Multi specialty EMRs are developed for practices which employ
4 more than one specialty. If a practice employs a dermatologist, an oncologist and a cardiologist, then the use of multi specialty EMRs would be highly beneficial for it, since the software is customized to specialty specific usage. Myth 4: A costly investment with slow returns Today, there are free EMRs available in the market as well, though they have limited functionality as compared to established health IT vendors. The table below compares the features for both systems. Free EMR Limited features No customization Annoying pop ups (Ad supported) No specialty systems Limited training and support No Practice Management Limited or no backups No clinical Decision support Paid EMR Enhanced features Highly customizable No advertisements Single and multi specialty specific Dedicated team of support Yes on all accounts Secondly, EMRs contribute both towards improvement in the clinical and administrative management of the practice. Some of the widely recorded improvements that EMR users have reported include the following: Greater Patient Safety and Care Quality Usage of Electronic Medical Records promotes patient safety and care quality by minimizing risks associated with manual errors such as illegible handwriting, no follow up alerts, drug/allergy interactions, With Electronic Medical Records that are in compliance with HIPAA (Health Information Portability and Accountability Act) Security and Privacy Rules, entities are able to safeguard patient health information. Reduce Time and Cost The cost of paper along with costs associated with maintaining software, hardware and storage space are considerably reduced with the usage of Electronic Medical Records. The need for data entry with every patient visit is also minimized since the data is entered only once, saving valuable time. Swift & Informed Decision making The ability of EMRs to match patient s medical history with known allergies, drugs and diseases for reactions allows for better decision making, minimal errors and accurate diagnosis, while saving time for doctors and patients alike. Accessibility of Medical Records Access to the patient s medical records through EMR is important for doctors to ensure quality care delivery. For clinicians, ordering and receiving test results or prescribing medication can be done from anywhere. Data Mining Electronic Medical Records allow tracking of data to determine trends and patterns pertaining to population health and preventive care measures against diseases, using artificial intelligence, machine learning, statistics, and database systems.
5 Accountability EMRs with built in audit trails monitor every clinical and administrative process to ensure transparency, accountability and integrity of patient health information. This allows physicians and relevant regulatory bodies to identify any misuse of data or other fraudulent activities. Simplifying the Transition Step 1 Know Your Practice Step 2 Explore the Market Step 3 Decide What You Want Step 1: Know your Practice If you have decided in favor of transitioning to EMRs, you will have to undergo a series of steps to ensure that you have a product that will maximize returns both in terms of the quality of care and practice revenues. This process can take time, usually between 1 to 2 months on an average (the time period may vary depending on the vendor) starting from exploring the market to implementation processes such as data migration, trainings and generation of customizable workflows and systems. Thus, you should try to start the process as soon as possible after preliminary research and due diligence. Identify reasons for transitioning from paper. Objectively analyze the problem in the practice and take help from an HIT consultant to identify how these problems can be solved by an EMR. All EMR vendors offer comprehensive EMR demos to help you assess the benefit prior to making a decision. Ensure financial stability. You have to make sure that there is a set budget put aside to avoid unnecessary delays in acquisition. Education is the key. Every relevant person in the office should be educated about upcoming changes. Special trainings should be held on how to use the software. Provide basic guidelines to the management and how to best use EMR software.
6 Question the vendor. Ask questions about every issue you face with the software and how they think the issue may be resolved. Put in place a single person who will coordinate with the vendor and solve issues at the workplace. Test the software. Make sure that you test the software before it is actually supposed to go live. Initiate the use of EMR throughout the practice a couple of months before the go live date so that every issue that comes with operating the software is handled before and everyone gets to learn how to use the software effectively. Step 2: Explore the Market Surveys suggest that at times physicians do not ask or take interest in product details, rather basing their purchase decision on low cost or visually appealing solutions. Providers must choose an EMR vendor that can fulfill their long term practice requirements. Selecting a standalone Practice Management or EMR system, instead of an integrated system can cause compatibility and workflow related issues. Practice Management Software Integrated practice management software can help streamline administrative and financial operations of care delivery organizations providing unprecedented opportunities for productivity, collaboration and growth. Integrated access across patient demographics, scheduling, electronic billing, administrative/financial reporting and workflow management connects front and back office operations, drives efficiency while eliminating reimbursement delays and communication barriers. With integrated Practice Management, providers can do what they do best providing quality care and not worrying about managing a busy practice. insurance information while subscribing to valuable electronic tools and services. Medical Billing Functionality Electronic Medical Records with built in billing functionality can allow for quick charge capturing and claim submission directly from the EMR software. Through this integration, providers can check claim statuses in real time, so they know exactly when they are getting paid. Patient Portal Facilitate your patients to securely request appointments and prescription refills online, provide patient provider communication, receive test results as they become available, utilize educational material and update their health status, history, demographics and
7 Features of a good EMR Point and Click Reducing cognitive overload, supporting unique workflows and clinical approaches a specialty specific, template driven, point and click technology enables accurate, complete and faster encounter documentation. Computerized Physician Order Entry A CPOE backed by EMRs is extremely valuable for doctors. When doctors issue orders through CPOE, the presence of patient s medical history through EMRs is vital in reducing many possible errors. If the doctor is ordering certain medication for the patient, then the access and availability of the patient s previous drug usage and overall medical history helps the doctor decide whether the prescription was necessary or it might have caused an allergic patient reaction. The purpose of a CPOE is fulfilled when every element of clinical information is securely and efficiently integrated between different healthcare stakeholders such as hospitals, practices, clinics and laboratories. Customizability It is important for any EMR software to be customizable so that practices with different specialists can use the software. Some of the common specialties include: Cardiology Endocrinology Family Practice / Primary Care General Surgery Infectious Diseases OB/GYN Otolaryngology Podiatry Dermatology Emergency Medicine Gastroenterology Internal Medicine Nephrology Oncology Pediatrics Rheumatology Step 3: Decide what you want Q: Do I need to upgrade existing hardware and software? Not at all. With Web based technologies, you don t have to have the latest system or spend money on updating softwares. Your data will be securely stored on web based servers which you can access from any location with your identification. There are thousands of Electronic Health Records vendors in the market today, which can make decision making difficult for providers. The following should help you decide which vendor you will benefit from most. Hardware Many practices need to upgrade existing hardware to run EMRs. Vendors give out a list of items you need to purchase to get things going. This is why it is even more important to look for a vendor who offers webbased services that require limited hardware installation.
8 Maintenance Many vendors charge a percentage of the first payment to cover costs of software maintenance and updates. It is therefore important to see if the increased costs due to maintenance are worth your money. Talk to the vendor about this and consult with people who use this vendor. Is the maintenance and update service as good as they say? Web based Technology Web based technology enables providers to access EMRs regardless of location on any desktop or laptop computer, tablet and Smartphone. Such technologies reduce the cost of purchasing, maintaining and updating hardware and software at the practice. Support and Training It is imperative that you choose a vendor who provides live, online and built in software support services. Many EMR vendors now provide support services with dedicated client account managers. Demonstrations A vendor who provides detailed demonstrations for their products will further simplify your decision making. Feel free to ask them questions that come to mind. Ratings/Certifications/Alliances Google the vendor. Look for ratings from credible sources. Take a look at the vendor website and see if they are compliant with Meaningful Use, if they are certified with credible entities and follow the industry standards. Some of the important certifications to look for are: ONC ATB 2011/2012 CCHIT HIPPA compliance SureScripts Gold Certification ISO 9001:2000, 27001:2005 Some of the standards to look for include: HL7, ANSI X12, LOINC, SNOMED CT, DICOM, NCPDP, ICD9/10, CPT4 and PDF/H. Also, remember to ask for references before making a final decision. We hope these guidelines will enable you to select the best suited EMR for your practice.
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