Emr/ehr

We are currently looking to implement EMR in our office. Any suggestions? Does anyone have any pros vs. cons about using EMR?

Emr/ehr

Following is an article I wrote about EMRs. I hope it helps. I strongly suggest using an ASP model that you can have work with your Practice Management system and any other application you need. Let me know if you have questions after you read it...

The 5 Most Important Things To Consider When Looking at EMRs
By Sue Irwin, CHBME, MCS-P


As Electronic Medical Records/Electronic Health Records keep gaining the interest of physicians, other medical providers, the government and insurance companies; it is important to know what to look for so that your practice doesn’t become a statistic. We have all heard the horror stories of practices spending a lot of money only to give up on the new technology within a few months; a lot of money spent and nothing in return.

If the following points are addressed, the chances of a smooth transition and one that will ultimately save and make you more money are very good.

1. ASP capability – Using the internet to have someone else host the software, take care of the upgrades, handle the support, manage the back-ups all for a monthly fee which won’t change for up to three years is an amazingly smart way to go to EMR. A good product that allows you to use basic hardware, since they are hosting the server, means that you don’t have to have an IT (Information Technology) person on your staff. The software will also need to have HIPAA compliant back-ups in multiple locations so that if a disaster such as a flood, fire, or even a hurricane occurs all you need is to replace your hardware and you are up and running immediately. The EMR should not lead you to document more than you do. For instance, if it wants you to automatically to document something on each system don’t buy it. If the EMR has you use your own standard procedures to set up your patterns based on the chief complaint of the patient, this is a much more efficient manner of documentation and much more defensible in an audit.

2. Ease of use – The software should have the physician’s input in establishing his/her own templates and patterns. It is a bonus to have the software company already having dealt with your specialty. If the physician actually contributes to the formation of his own patterns, by using the chief complaint as the source of the pattern, then when he/she is treating the patient he/she will be able to just make changes to his/her normal way of treating patients. This also makes it so the physician is not documenting systems or work that wasn’t done because the software says you have to check each item off as you do a chart/record. The ability to chart only what you do makes auditors very happy. Many of the EMRs at this point will also let you know what level of E&M you performed according to the documentation in the record. We have found that since most doctors actually under-code for what they do but also under-document due to lack of knowledge of what the insurance companies want, using a good EMR can help to increase your gross charges and therefore income, in a compliant manner.

3. Flexibility – Any EMR you decide to use should have the ability to connect with most practice management systems so that you aren’t captured by any one system. Being able to use HL7 protocols for transferring information should be a must. It is the gold standard in the healthcare field. If the software has this capability, then if you are also wanting to change your EMR system, that can also be accomplished. We have always been a huge advocate of not being “forced” to do anything. If you are forced to do something, in the long run, that usually costs you more.

4. CCHIT certification – This is an absolute must. This certification, while not the “be all and end all” of requirements to have a good EMR, ensures that the government has reviewed it and it has passed the minimum requirements the federal government wants to see. It also shows, since the price is substantial, that the software probably has enough financial backing to be in business for a long time.

5. Help in increasing Patient Satisfaction – Even though patient care is the main focus of a practice, patient satisfaction means they keep returning to see you… a mainstay of any practice. If you are able to increase their satisfaction with the experience of being your patient, you are able to keep a patient for life as well as have them help you market. If, you are able to print up patient education forms while the patient is in the room with you, you are able to send prescriptions to the patient’s pharmacy electronically so that they just show up and pick up without any wait, and you can get an immediate notification that there is an adverse reaction to any drug you are contemplating prescribing… you have made an indelible impression on the patient that not only are you “cutting edge” in technology (and therefore probably in medical knowledge, too) but you also care about them personally. Remember, an unhappy patient tells 10 people, who tell 10 people, etc. Whereas, a happy patient tells 2 – 3 people. The downside of an unhappy patient can be exponentially disastrous to a practice.

Of course, there are several other things to look for. Top most is getting references and if those references are from your specialty, all the better. You also want to be sure that they have at least a decade of experience. You really don’t want a new company “practicing” on your practice. Working out kinks in any software is a major pain and while it is a given that there will be kinks; you want all the basic areas already taken care of for you.

Some of the EMR programs while not only having E-prescribing are also able to link-up to other vendors for your convenience. They can hook-up with pathology companies, hospitals so you can get results of labs and radiology tests on line, immediately. This helps to decrease the expense of paper in your office, time spent finding the chart, filing the results and re-filing the chart after you have checked over the results. You are electronically notified that a new test result has come in; you “click” on it and read it. Therefore you have a seamless integration into the patient’s chart with all information needed to treat them.

The E-prescribing benefit of an EMR has a couple of other benefits not mentioned above. Many states as well as the federal government are starting to require “tamper-proof” prescription pads. All of their tamper-proof requirements will of course cost you more money to fulfill. The good news is that E-prescribing is exempt from the new “tamper-proof” requirements. If the pharmacy that the patient uses does not accept E-scripts, the system should be able to fax over the prescription which will also circumvent the new requirements. Now the really exciting piece of E-prescribing is that your staff won’t necessarily need to field phone calls from patients concerning their prescriptions. I have seen some EMRs that have the staff train the patient to call their pharmacy about a refill or renewal. The pharmacy then sends you an electronic notice into your EMR and you can go through all the requests, at one time, using your mouse to click yes or no on each patient/drug. This can be done at the office, at home, or even when on vacation. This is another huge patient satisfying benefit.


I have even seen some EMRs that have a mobile solution that you can take into the hospital when you are doing rounds. That way, the minute you have finished seeing the patient and of course filled out the chart for the hospital, you can “click” on the level of E&M you performed and notate any other procedures done with the date of service. As you leave the hospital, you “close” the encounters and they are automatically up-loaded into your practice management system to be billed. This has three inherent benefits: 1. you bill patients for the proper date of service, 2. you don’t lose any charges that should have been billed and 3. your bill goes into the insurance company quickly. Often when a physician waits until the end of the week, when they have time, to note E&Ms and procedures that were performed in the hospital they forget a patient, they bill for a date of service that could be after the patient passed away or another physician has gotten his/her charge in first and the physician needs to fight a denial.


If you are a one man/woman office or if you are a group, there must be a “champion” in your office that will lead the way into the use of higher technology and therefore better patient care. This person must work closely with the vendor and the education specialists of the vendor to be the “go to” person for the practice. The higher position in the practice that is held by this person the better; physicians tend to listen to each other better than they do to anyone else. You want to be sure that you have total “buy-in” when you start up EMR in your practice. Otherwise, the chance of it not working and therefore just being an unwelcome expense to the practice is highly possible.



Editor’s Note: Sue Irwin, president of NCEB – Practice Management Solutions, has been in the health insurance reimbursement field since 1976 and has owned her own billing and practice management consulting firm since 1992. She is a CHBME (certified healthcare billing and management consultant) as well as an MCS-P (Medicare Compliance Specialist – Physician). She can be reached at 440/934-6135, 800/795-1794 or sairwin@nceb.net.

© 2007 NCEB – Practice Management Solutions, All Rights Reserved.

Emr/ehr

Thanks for the advice, Sue. I will pass your article/advice on to my doctor.

Emr/ehr

Glad to be of help. Good Luck!