A whopping 71 percent of our survey respondents said they expected work flow improvements as a result of implementing an EHR.
Gina Tucker, administrator of Hampshire OB-GYN in Northampton, Mass., says she has proof of those improvements. As an early adopter of EHR back in 2004, the practice of five physicians, five NPs, and a nurse-midwife now achieves every aspect of the clinical and administrative activity needed to complete a patient visit — even a coding review and CPT-to-ICD matching — by the time the patient leaves the office.
That level of integration wasn’t entirely due to the Hampshire EHR’s smooth interface with a practice management system, though that helps. What it took was a willingness to re-examine protocols for every activity, from documenting phone calls to sending laboratory orders.
“It is a big upheaval in one sense but we looked at it as a way to improve the practice and improve patient safety,” Tucker says. “You need people who are willing to accept that the way they’ve done things is going to change.”
Solverson recommends getting an office administrator and a key clinician, such as a nursing supervisor, to work with the physicians to analyze how the EHR will change work flow. Practice leaders must also take the lead in designing an implementation plan that could include, sometimes, breaking down walls between office functions that traditionally stand separate, such as the billing office and the front desk.
So what’s a physician to do? Steven Lazarus, president and founder of the Boundary Information Group of consultants in Denver, suggests accelerating your education about EHR.
“Don’t waste time getting started if you know it is something you want to do,” Lazarus says. “You will run out of time to qualify for bonuses and finding outside help will be harder if everyone else is asking at the same time.”
• Read up. Books, magazines, white papers, and reports from government, nonprofit organizations, and private sector companies are out there to help novices and experts alike.
• Get educated. The HITECH Act funds 60 federally designated Healthcare Information Technology Regional Extension Centers (RECs) across the nation. These centers will provide no-cost and low-cost seminars, summits, online education, and technical advice to help physicians quickly implement and become adept users of EHR. See a list of all 60 centers online.
• Examine vendors. Lazarus suggests looking for vendors with good track records on customer surveys and adequate capacity to handle a big influx of new customers.
• Look for help soon. Hiring qualified technical help, whether it’s a new staff member or a consultant, will be harder if thousands of other medical practices are doing the same thing at the same time as you.
• Give incentives and seek penalties. With good help in short supply, and a likely sellers’ market for EHR, Lazarus suggests writing financial incentives into contracts with vendors: promise them a small bonus for a successful implementation, but also seek a similar-sized penalty if they let you down.
• Be aware and beware. Get a knowledgeable technology attorney to review any agreements with a vendor. Your general legal counsel may not have the expertise needed to review software licensing clauses, limitations, and other unique aspects of an EHR agreement, Lazarus says.
Worried about the Medicare or Medicaid reimbursement penalty you’ll suffer if you don’t hit the government’s EHR targets? Sit down and figure out what a maximum 3 percent penalty on your Medicare income comes out to in dollars. Then run the numbers at 5 percent, which is what HITECH allows the government to remove from Medicare reimbursement starting in 2019. Maybe there’s no need to panic.
In the long run, practices still using old-fashioned paper will become the analog outsider and experience a significant competitive disadvantage in the world of digital medical communications. So it’s time to get moving on your EHR transition, if you haven’t already.
You should not rush. But you should hurry.
View all survey results here.
Bob Redling is a freelance writer based in Tacoma, Wash. He has been practice management editor for Physicians Practice, Web content editor and senior writer for the Medical Group Management Association, and a speechwriter for the American Academy of Family Physicians. He can be reached via [email protected]
More than half of respondents to the 2010 Physicians Practice Technology Survey told us that the federal government’s Medicare and Medicaid EHR incentives have them shopping for a system. If that’s you, or you already have an EHR, here’s what’s needed to get the promised reimbursement bonuses:
• Use an EHR that meets standards and certification criteria set by the Office of the National Coordinator for Health Information Technology (ONC).
• Meet CMS’s 15 mandatory requirements (14 for hospitals) for meaningful use during 2011 and 2012 (and 2010 if starting early).
• Select at least five additional measures from the 10 provided by CMS.
• Prepare for criteria to expand in 2013 and subsequent years of the program.
• Stick with the program for the full five years (Medicare) or six years (Medicaid) to earn the full reimbursement bonuses.
Start now looking into systems, vendors, and sources of expert help because thousands of other physicians may also be EHR shopping.
Read More About It
Need more information about EHR adoption and the rules of the government’s EHR stimulus program? Check out these additional sources:
• A list of the 15 mandated meaningful use criteria, and the “menu” of 10 criteria from which physicians must select five:
• Technical fact sheets and FAQs about CMS’s incentive programs
• A technical fact sheet on ONC’s standards and certification criteria final rule
• A fact sheet about the HITECH Regional Extension Program
• A list of Health Care Technology Regional Extension Centers (RECs)
• CDC Survey on EHR adoption
View all survey results here.
This article originally appeared in the September 2010 issue of Physicians Practice.