Benefits of implementing an EMR outweigh barriers

Electronic medical record systems can reduce overhead and eliminate need for chart materials, storage, transportation and destruction.

Issue: December 2004

(This is part two in a five-part series on the paperless, electronic practice environment.)
Part 1: [The paperless office: Taking the plunge]
Part 3: [ More orthopedists using filmless technology]
Part 4: [The paperless office: Taking the plunge]

In the first installment of the Orthopedics Today series on creating the paperless electronic practice environment [“The paperless office: Taking the plunge,” November issue, page 16], advantages of shopping around before buying an electronic medical records system, the selection process, and implementation and training were discussed. In this installment, the electronic medical record discussion continues with a review the benefits, barriers and timing of purchase.

According to the American Journal of Medicine, “The estimated net benefit from using an electronic medical records (EMR) [system] for a five-year period was $86,400 per provider. Benefits accrue from savings in drug expenditures, improved utilization of radiology tests, elimination of undercoding, better capture of charges and decreased billing errors.” In addition to this positive financial return on investment (ROI), EMR systems improved the quality of patient care, decreased medical errors and facilitated workflow.

Although this study involved primary care physicians, orthopedists can experience similar benefits.

Herbert Alexander, MD, chairman of the American Academy of Orthopedic Surgeons (AAOS) Internet Communications Committee, told Orthopedics Today, “After having a totally electronic office for two years, I would never go back to using paper charts, as EMRs have improved my efficiency and quality of care. Life is better with an EMR.”

Benefits of EMRs

EMR systems can reduce office overhead by decreasing transcription costs, the amount of letterhead, paper and postage, and eliminating the need for chart materials, storage, transportation and destruction.

“We saved more than $240,000 a year and opened up about 3000 square feet for additional clinical space,” said Don Trexler, CPME, former executive director of Bienville Orthopedic Specialists in Mississippi, in an interview for MDNetGuide. Trexler is now CEO of the Southern California Orthopedic Institute.

Patrick Culley, vice president of marketing for eTrauma, told Orthopedics Today, “The ROI for our electronic patient charting system can be seen in as little as 12 to 18 months due to reductions in coding errors and elimination of paper chart costs, coupled with increased receivables from co-pays and recouped missed charges.”

Revenue is also enhanced through increased patient volume and satisfaction, according to the makers of ChartLogic. Insurance companies may reduce malpractice premiums for physicians using EMRs, as patients’ progress and visits are automatically documented, providing a clear audit trail. EMRs also help to decrease malpractice exposure due to misdiagnosis, treating outside of current clinical guidelines, lost charts or improper documentation, according to Eric S. Fishman, MD, orthopedic surgeon and owner of EMRconsultant.com.

“An EMR will also allow a physician to apply for enhanced revenue from various payers associated with higher quality care,” Fishman said. Pay for performance, quality bonus initiatives, incentive pay plans and the Centers for Medicare and Medicaid Services’ physician-focused quality initiative called the Doctor’s Office Quality Information Technology Project are quickly gaining popularity. They offer financial incentives for physicians who meet specified standards in areas such as information technology implementation; however, these programs are only available in limited areas.

May help improve patient care

“You can talk about money all day long, but money’s not what drives doctors — patient care does,” Trexler said. EMRs may allow physicians to provide better patient care by preventing medication errors due to improper dosage, illegible handwriting or adverse drug interactions, as well as help doctors treat patients according to current clinical guidelines.

EMR systems are also useful in tracking patient follow-up, compliance and progress. Most EMRs will prompt physicians to complete missing information and allow test and lab results, EKGs and X-rays to be automatically entered, thus minimizing the risk of improper data entry or omission.

“The government and labor unions have publicly espoused patient safety benefits with EMRs,” Culley said. “Health care professionals may retrieve and access electronic records, assuring complete information and immediate access for emergency situations.”

Guaranteeing complete information

Improving the quality and completeness of documentation is a key clinical benefit, especially with customized templates.

“The biggest problem I see is picking an EMR that just doesn’t work for you.”
— Jim Strickland

“You need to decide whether or not doctors customize their own templates,” said Jim Strickland, MD, a member of the Orthopedics Today Editorial Board. “You don’t accommodate for the EMR; it should accommodate for you and match your personal workflow. Some doctors prefer the point-and-click method over dictation through voice recognition, typing or handwriting.”

Culley added: “Orthopedic surgeons prefer software written specifically for the rapid throughput of patients in their clinic; they want software function choices to be specific and ‘customizable’ for their daily tasks. Orthopedists using our patient charting system experienced over 15% improvement in clinic efficiencies, which provided time for additional patients or activities outside the office.”

Other administrative benefits include reduced costs and time for employees pulling, copying and filing charts, the elimination of lost charts, expedited in-office communications and access, and assurance of confidentiality, security and compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

“The marketability of your practice increases when you use EMRs,” Fishman said. “Your reputation in the community and with your patients will improve as they see you as a leader in technology. Providing quick and comprehensive referral reports will impress other health professionals.”

Cost is most often cited as the biggest impediment to investing in an EMR system. Practice size, location (i.e., urban/rural), computer phobia, time commitment and physician age are additional factors. Immature vendor products, legal and regulatory issues and the required infrastructure and standards necessary for the interoperability of some systems may also be barriers.

Nevertheless, “You can’t afford not to be a part of the EMR trend,” Strickland said. “EMRs are affordable and greatly improved, and we will be held accountable for maintaining better records for managed care organizations and improved patient safety.”

“Expense is only a roadblock if you let it be,” Alexander added. “There will be a significant time commitment from physicians and staff to make this switch.

“The biggest problem I see is picking an EMR that just doesn’t work for you. Is it just too new and takes some getting used to, or is there an inherent problem requiring an upgrade or different EMR? Fear of the unknown and resistance to learning something new can be abated by taking a proactive stance, performing due diligence and seeking advice from others,” Alexander said.

Consultants and independent companies such as EMRConsultant.com and HIMSS Selector are available to make the process easier. Consultants recommend writing a Request for Proposal and submitting it to various vendors to see which one will meet your needs. Three health care information technology groups are sponsoring an initiative to develop criteria to enable physicians to compare EMR products.

Buy now

“This country is committed to moving in the direction of EMRs,” Alexander said. “President Bush challenged health care providers to implement paperless records for Americans by 2014.”

Health and Human Services has created a strategic plan outlining four goals to promote the use of health care information technology and is offering financial awards to encourage doctors and hospitals to quit window shopping and start adopting EMR systems. “There is a significant tax benefit for purchasing, so the time to act is now,” Culley said.

However, the Physicians’ Electronic Health Record Coalition (PEHRC) recommends that physicians keep apprised of industry news regarding EMRs and wait to purchase until PEHRC releases its recommendations within the next 12 months.