Purchasing an EMR

     So you have decided that it is time to purchase an EMR for your practice.  You are tired of the paper charting process and are ready to step into the 21st century, but what EMR do you buy?  So many practices are hurt financially and become frustrated from buying into the wrong type of equipment.  It is imperative that you take several factors into consideration before buying this costly piece of equipment, and find the system that is best for you.

     The first option you have is to hire a consulting firm to help you pick and set up the EMR. Consultants are well versed on all kinds of EMR equipment and can help you decide what type will help your practice the most.  More importantly than the guidance through the purchasing process, is the fact that many firms will help you set up the system and set it up correctly the first time.  With any technology, there will be bugs that need to be fixed and many consulting firms provide around the clock diagnostic service to help fix any problems that may arise with the software. The most important advantage of hiring a consulting firm to set up your EMR is the fact that they will teach you how to use the technology and get the largest benefit for your practice.

    Maybe you've decided that hiring a firm is ludicrous and you want to take on the task yourself.  If you decide to go this route, you have to first analyze what problems you want EMR to solve for you.  Do you want to cut down on the number of employees? Do you want to increase the productivity in your practice and eliminate the large volume of paperwork that you use? EMR can solve these problems but you must read unbiased reviews and do the research on each product to find the smartest option for the practice.

     You have to realize that buying an EMR is all about increasing your productivity which leads to increased profits for your practice.  Take this into account before purchasing your equipment because that swanky technology that one EMR might have may not help you accomplish your goals as well as a more basic and no-frills system will. The main idea in the article is "DO YOUR HOMEWORK", the same idea that carried you through medical school and got you to the position that you are in today.

 

Role of EMRs in Accountable Care Organizations

As the final rule on ACOs ( Accountable Care Organization) has come out, it is apparent that that the value that EMRs (electronic medical records) bring is unprecedented.  Under the Medicare Shared Savings Program, ACO participants (which may include medical practices, hospitals and payers) are graded and paid based on 4 domains of care quality: 1) patient experience;  2) care coordination and safety;  3) preventative health; 4) at-risk populations.  The program consists of a 3 year performance period in which the performance of the ACO mapped against thresholds set by CMS. To reap financial benefits from this program, providers must report on 23 of 33 quality measures spanning these 4 domains during the second year and 33 out of 33 in the third. Some of the measures, like # 20, which asks for the percentage of providers that have received Meaningful Use money are easy to satisfy if you have a Certified EMR.

ACO participants are incented to work together and efficiently because if they don’t meet the CMS thresholds they must pay money back. Data is key when trying to coordinate care and the exchange of clinical data must be done properly to meet the quality measures set by CMS.

Now it must be apparent to medical providers that if they want to join an ACO it is very important that they are comfortable using an EMR. The good news is that there are certain features of the software that allow providers to capture the necessary data for ACO quality measures easily. For example, in the Preventative Health domain there are measures such as Adult weight screening and follow-up and Tobacco Use Assessment. Both of these are Meaningful Use criteria and any certified EMR has screens and buttons to record this information. 

In another example, the domain of at-risk population contains a diabetes composite measure in which the number of diabetics who BP is less than 140/90 must be recorded. To do this, it may necessary to setup a report in which there are fields to search for a patient’s diabetic status and their blood pressure level concurrently. For instance, in Patagonia Health’s EMR, there is a section called “My Reports” where users can fully customize search criteria for certain disease conditions, procedures and demographic characteristics.

Finally, the exchange of health information between providers and entities requires ability for the system to send and receive data securely and in a format that the receiving end would be able to decipher. Exchange of clinical data is a Meaningful Use criterion and is done through CCR (care of continuity record) which generates a summary of the usually about the patient’s medication, laboratory, immunizations, provider names, vital signs, alerts. Providers simply need to press the CCR button and it generates a file. This file can then be sent in encrypted format through email currently (and through Health Information Exchanges later) to the other provider’s EMR.

EMRs have become a powerful tool that has empowered medical providers to collect the necessary data in order to provide medical care with a sense of accountability and level of quality in the form of an ACO. The Meaningful Use Program has further enabled different EMRs to have the standard features important for this data collection.

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Patient Portals: What are they and how can they be important?

A Patient Portal is a software functional feature that enables patients to view or to send their own health data without the need of medical provider or staff. Screens are available where patients can see their medication list, allergy list, labs and schedule appointments. It can be described as a "window looking into their electronic patient chart" Some portals allow patients to also see their visit bill, fill out of their initial intake form, email their providers and send data from medical devices (ie. glucose, BP values, etc).

Patient portals can be part of an EMR or be used standalone or be linked to an EMR, PM system, etc. This a tool that has been important in getting patients engaged in their own care. Also, it helps organizations cut costs. For example, lab results don't need to be mailed, staff time is not wasted to help patients schedule appointments or answer simple questions about their bill.

Patient benefits include cutting down time filling paperwork on a new patient visit, more freedom in accessing certain health data (ie. labs, med list) on demand and an ability to contact their medical provider directly without having to depend on the practice staff.

One study revealed that 75% of patients wanted to email their physicians, 2/3 rds wanted to lab results online and at least were very to upload data from their home monitoring device into the EHR. These days it is easy for a practice to get a patient portal. In fact, Meaningful Use certified EMRs come with patient portals. Some have basic features only (results viewing), while others allow you to schedule appointments, refill meds and send messages.

Screenshot of a patient portal

(reference: omedix blog)

However, there are a few important points to what features to make available.

1. Consider the implication that the patient portal feature will have on practice workflow. For example, you may want to include lab results as a feature as most are normal and don't take away time from the provider to explain (as an abnormal result would do).

2. Getting reimbursed for the work it creates. For example, in some organizations providers don't get paid for responding to emails from patients or the pay may not be worth the time it takes. Therefore, you may not want to offer a secured messaging feature to your patients.

3. IT issues may take time or expense. Being software, patient portals are amenable to technical problems. You must decided if your practice or organization has the resources to deal with that. Once you introduce a new service to your patients, it's too late to back out. Especially, if people like using it and patient portals are becoming more and more popular.

If you want Jitesh Chawla's advice, set up a trial period with your patients in which you ask them all to utilize the patient portal for certain funcationalities such as booking appointments, requesting med refills.

I hope this has given you some basic information about patient portals and how they can be used.
Patient portals have a tremendous potential from improving practice efficiency to exchanging data with health information exchanges.Will patient portals stay or suffer the fate of some of the PHRs (like Google Health)? I am not sure and only time will tell. But, one thing is for sure - healthcare consumers want more charge of their health and health information. Patient portals serve as one of these tools.