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Create a working plan, budget before seeking EMR system providers
Investments of $25,000-$55,000 per provider can result in up to $30,000 yearly profit per physician.
Orthopedic surgeons and practice administrators who are considering implementation of an electronic medical record system in their clinic should first do their homework and draft a work plan and budget that realistically reflects the goals of their clinic.
These will serve as a blueprint for your electronic medical records (EMRs) system, said Debra J. Wiggs, FACMPE, senior project manager for Maxwell IT Company in Seattle.
Wiggs, who is also a member of the Medical Group Management Association, detailed her experience working with orthopedic surgeons, family physicians and other doctors in electronic as well as traditional paper-based medical records systems in a presentation at the BONES 38th Annual Conference.
EMR: Still a budding field
During her talk, Wiggs surveyed the audience to see how many actually integrated an EMR system into their orthopedic clinic. More than half said they didn’t even start comparing different systems yet.
“The reality is, the future of health care in this country will be focused on the data, and to capture and compare data from paper documents is fairly cumbersome and complex. And getting the information you need to meet pay-for-performance requirements is a huge puzzle.
“The sooner you can switch [to an EMR system], the sooner you’ll get that necessary information,” she said.
The question on everyone’s mind, though, is what kind of EMR system works best for my specific practice.
To answer that question, she said orthopedic surgeons and practice administrators should first:
- identify current “bottlenecks� your practice faces in delivering services to patients;
- identify care delivery processes that need to be “redesigned” to create greater efficiency, perhaps via an EMR system;
- understand how paper and electronic processes differ; and
- assess what hardware and infrastructure your practice will need to sustain an effective EMR system.
Not entirely paperless
Although the ultimate goal is to transition to a completely electronic record system, Wiggs urged surgeons to consider how they plan to handle paperwork that will continue to stream into their practice even after the transition is complete.
Examples of this include faxes coming in from patients and doctors as well as reports from hospitals, she said. Physicians must consider where that paperwork will go and how it will be added to the electronic system.
Wiggs also advised orthopedists “not to lowball on your hardware. You don’t need to have the ‘queen-of-the-fort’, top-of-the-line system, but if you don’t buy at least what is recommended by your application provider, you will pay for it over and over again in lack of productivity and function as you wait for things to happen,” she said.
And don’t worry if you think you bought too much. “If you get more [memory or storage] than you think you’ll need, you will probably use it up eventually,” she added.
Although it isn’t crucial to have a wireless system, “They are good systems to have because they offer a lot of flexibility” in terms of their mobility, she said.
Budgeting wisely
When allocating your finances for an EMR system, “Don’t forget that you have to make room in your budget for the implementation process,” Wiggs said. “It can be a career-altering event if you don’t plan for it.”
She said orthopedic clinics should expect to spend approximately $25,000 to $55,000 per physician on training and equipment, but the return on that investment could be as high as $25,000 to $30,000 per physician annually if the EMR system is used to its full potential.
“Cost savings are seen in terms of what you save in transcriptions medical records, changes in coding and documenting for coding, and an overall reduction of paper records,” Wiggs said.
Also, be cognizant of hidden costs that many times are not apparent for a few years. For example, many people don’t add software maintenance and support costs to their estimates.
“We pay for it twice in 5 years, so if you can do that well or better, great,” she said.
Likewise, “You will also experience reduced revenue during the period of initial implementation of your EMR system, when your practice is trying to get up to speed in learning the program. No one tells you about that.”
No “plug and play”
Likewise, if any company tells you they have a “plug-and-play” program, don’t believe them, Wiggs noted.
“There really is no such thing as a plug-and-play system, I don’t care how much they talk about it,” she said. “Someone in your office really has to become proficient in configuring the system, and it shouldn’t be the doctor in most cases. It should be someone else in the office who enjoys the technical aspects of such a program, leaving the doctors to do what they do best, which is care for their patients.”
Although Wiggs has spent many years checking the potential of such EMR systems, she can still appreciate the benefits a good EMR system offers patients.
“I just went to my family doctor, and he has been using [an EMR system] for 2 years, and not only was he able to give me a printout of my health record to take home as well as a reminder of some things I needed to do, but he ordered my labs for the next visit, contacted the pharmacy and scheduled my appointment. He also ordered all of my medications at the pharmacy, and I have a prompt in my e-mail system that will remind me of my next visit. All of that was done in one doctor’s visit.”
She added: “I had 20 to 25 minutes of total face time with my doctor, and he only spent 5 minutes on a computer, so I was very happy.”
Wiggs predicts that this ability to be more interactive and connected with patients will reap long-term benefits in terms of patient loyalty.
“It’s come to the point where physicians are asking, ‘Do we have to do this?’ but patients are asking more and more, ‘Why aren’t you doing this?’”
Editor’s note:
Look for the next installment of this occasional series in the January issue of Orthopedics Today.
For more information:
- Debra J. Wiggs, FACMPE, can be reached at 317 N. State St., Suite 206, Bellingham, WA 98225; 360-224-0913; e-mail: dwiggs@maxwellt.com.
Reference:
- Implementation kick-off to go-live. Presented at the BONES 38th Annual Conference. May 6-9, 2007. Chicago.