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Navigating the EHR jungle not as daunting as it first appears
Government incentives, avoiding penalties and improved practice efficiency are benefits to implementing electronic health records.
The jungle of electronic health records has been quite controversial over the last few years, especially in terms of the selection process, implementation process, financial implications and, ultimately, true clinical value to patient care. The various vendor claims, government promises and staff resistance have fueled the fire on whether EHR is a necessary evil or realistic advantage to the bottom line of profitability, efficiency and better patient care.
Selection process
Various practices have business/administrative computer programs in place but without electronic medical record or electronic prescribing capability. I spent 2 years of due diligence in trying to find the correct system to integrate into my practice, which entailed looking at a demo of each system with all key personnel from administrator, front desk, billing manager, lead technician and optometrist, to myself the surgeon. All of us have different needs and wants from an EHR system, so trying to find the system to make all of us happy was indeed a daunting task. For the next step, I actually followed up on each EHR system’s practice reference and interviewed the same personnel as above from the various practices to find out the real story on each system. Lastly, once I had my selection down to one or two systems, I went to visit a practice with each system to see it live and followed a patient from check in to check out to see how the flow was from a patient side and from the staff side.
Originally, we had Medisoft as our business software, which would only link to McKesson for EHR purposes. I did not like that I would have two vendors plus an IT vendor, for a total of three vendors that could point fingers at each other if something were to go wrong once implemented, so my practice chose a fully integrated system requiring only the EHR vendor and my IT vendor to allow for a smoother transition. IO Practiceware was our final choice because of its easy patient exam navigation process, touch-screen efficiency and ability to handle all the government requirements for incentives and penalty avoidance. Some practices have even looked at systems that have a presence in Europe because these systems are already prepared for the ICD-10 overhaul expected on Oct. 1.
Implementation process
Before implementation on our “go live” date, all of our systems had to be in place in terms of hardware and software. Mounting secondary computer screens in each room, planning for a temperature-controlled and secure main server hub location, and transferring all appropriate data from our prior business software to our new fully integrated IO system were critical. Establishing a 24/7/365 contract with our IT vendor was completed as well to avoid any potential patient care downtime once on the new EHR system. Lastly, our IO vendor placed two to three personnel in our office for 2 weeks during our “go live” period to make sure our transition was as seamless as possible. There is nothing more valuable than a hands-on approach to a real-life stressful conversion process. Having your vendor’s team on site allows for immediate customization of the software as it pertains to a specific practice’s needs.
Financial implications
Despite the initial exorbitant costs of implementing an EHR system, there are financial incentives that can be obtained from the federal government and penalties (up to 6% per billed claim) that can be avoided. Although there are additional costs per doctor in a practice for EHR, there are additional incentives per doctor as well from the government. The digital conglomerate of meaningful use (meaningful use, or MU, stage 1 year 1, stage 1 year 2, stage 2, stage 3), physician quality reporting system (PQRS), clinical quality measures (CQM) and electronic prescriptions (eRx) is so complex and intimidating that my advice is to get a consultant involved who knows your EHR vendor well to make sure all these processes are accomplished in a timely and effective manner.
Our practice utilized the services of consultant Patricia Morris, from Excellence in Eyecare, an expert on IO Practiceware, who recommended that your EHR vendor must be ready for all the necessary changes before you can be. A few key pointers from our consultant was that the meaningful use Stage 1 Year 2 attestation period, which was typically a 365-day period, is now only 90 days in 2014, allowing for additional incentive dollars in the same year. She also advised that Year 2 of Stage 1 and Year 1 of Stage 2 only needs a calendar quarter up until Feb. 28, 2015. The key to succeeding with meaningful use, for example, is to stay on top of what your numbers are vs. what they should be, and this can be easily achieved by reviewing your data throughout the reporting period. If you can master this section, you are the “king of the digital jungle,” with maximal profitability potential and even recovery of the costs of your EHR investment in the first place. The next way that EHR will most likely minimize your pain will involve ICD-10 coding, which is scheduled to come on Oct. 1.
Clinical value
The real value of any EHR, in my opinion, is the true clinical advantages. Malpractice liability is reduced to due to handwriting misinterpretation errors. Fraud risk is reduced due to clear reporting of the core objectives of the exam to substantiate the coding that was billed. More importantly, a physician can review many diagnostic tests performed on a single visit or over a span of visits in just seconds. For example, it is simple to compare changes in visual fields without the manual flip of pages through a traditional chart to see if there is stability or not. The ability to show patients on dual screens corneal vs. lenticular astigmatism will help conversion rates to advanced toric IOL technology, helping the patient’s visual outcome and the practice’s profitability simultaneously. Comparing multiple refractions in advance of laser vision correction is much simplified in a single-page grid to assure refractive stability before performing surgery. The examples are numerous when it comes to patient care and improving outcomes with EHR. Finally, practice efficiency has improved significantly with the ability to see more patients in less time, a factor critical in a climate of reduced reimbursements.
In the end, the daunting task of bringing an EHR system into the office does not have to be the digital jungle it appears to be. Rather, proper due diligence in selecting a fully integrated system that fits your practice’s needs and implementing it correctly by the “go live” date are just the first steps in achieving the true benefits of EHR. The profitability from government incentives no matter what the lingo (MU, PQRS, CQM eRx), avoidance of penalties for lack of EHR, and improved practice efficiency with reduced clinical mistakes and maximized conversions to premium technology are the true ways to become king of the jungle.
Stay tuned for my next column on the missing link: what technologies are lacking for U.S. premium surgeons.