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An EHR is like a good pair of shoes – you want them to fit right or you are going to feel the pain. And let’s face it, selecting the right electronic health record (EHR) for your practice is not an easy task – particularly for practitioners who may not have IT expertise. Plus, there are more than 400 providers of EHR/EMR products on the market today. It’s important to exercise caution and perform a thorough due diligence, but where should you start?

Nuesoft Technologies believes we have an amazing product that will truly improve your practice’s efficiencies and profitability, but we only want you to buy our software if it’s the “right fit” for you. We’ve got the insight of nearly 20 years of experience in the field of health information technology. But don’t just take our word for it. We encourage you to follow the suggested outline provided by Dr. Robert Lamberts in the Nov. 2009 issue of Physician’s Practice magazine. Lamberts successfully implemented an EHR in his office. Although he recognizes the fears and concerns of his peers, he also describes the positive impact the software has had on his practice.

Lamberts’ recommends that those considering purchasing an EHR start by first identifying any broken processes in their practice. What causes the most frustration to staff? To patients? Where is the most time wasted? Where is the greatest exposure to malpractice risks? Where is your office losing money? Improperly coded claims? Under-billing? Low volume? Over-staffing? Look at the whole practice – front and back office, not just at the providers.

Next, Lamberts recommends that you visualize what your “fixed” processes would look like. This is where you will develop your shopping list for that perfect pair of shoes! So what were your “fixes”? Never needing to search for lost charts – with an EHR, your charts are always a click away. Answering telephone inquiries – with charts immediately available, response times are much quicker. Improperly coded claims causing a delay in payment – with claim scrubbing capabilities you can get paid more quickly.

Now you are ready to start approaching vendors and looking for the practice management and EHR solution that best fits the needs of your practice. If the vendor does not suit you, cross them off your list and continue to the next vendor. And don’t forget to demo the software. Have a vendor representative walk you through how the software works, and ask lots of questions! Once you have a shortlist of vendors, consider the following and make your decision.

1. What is involved in product implementation?
2. Is the implementation process disruptive to your day-to-day operations?
3. What kind of training is available?
4. What is the response time if you have problems next week or next year?
5. How long has the company been around?
6. What are the hardware requirements – will it require you to buy new systems?
7. Who is responsible for data back-ups?
8. How will the data be securely stored to protect your patients’ privacy?
9. How often will the software/hardware need to be upgraded and what will this cost?
10. Is the solution scalable as your practice grows?

By now, you have a couple of vendors who are standing out from the rest. You like their graphic user interface, the functionality meets the needs of your practice and you are starting to get excited about how the new practice management and EHR solution can help your practice. Now it’s time to get references and ask your peers what they think about the software. Here are some questions you can ask:

1. How smooth was the implementation?
2. How well was training conducted?
3. What do you like best about the software?
4. What do you like least about the software?

Hopefully this has helped to further narrow your selection. The last bit of advice that Lamberts provides is to look at the purchase as a chance to improve your practice rather than an unwelcome expense. Remember that you get what you pay for and you shouldn’t waste your time on products that don’t meet the needs you identified at the beginning of the process. Focusing on cost first could rule out some of the best products and minimize your chance to find the best solution that maximizes your potential gains – giving you a shoe that just doesn’t fit.

Reference Link:
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1425.htm

Source: November 2009 issue of Physicians Practice.

Drs. Kibbe and Klepper this week posted a characteristically thoughtful post on The Health Care Blog concerning the uncertainty surrounding EHR adoption and its role n health care reform. Their argument: that physicians do not know what level of Medicare reimbursement to expect next year as the SGR, which calculates Medicare reimbursement rates in an eccentric way, was not part of the package that was voted on earlier this month. Additionally, critical terms for ARRA incentive payments such as “meaningful use” and “certified EHR” have yet to be defined, plus there is a general lack of confidence about whether adopting an EHR is going to bring a sustainable return on investment, no doubt partially due to the still-evolving technology and the much publicized challenges of creating a nationwide system that is truly interoperable.

Their post was not anti-EHR exactly; more of a jumping-off point for a discussion about whether these factors can be corrected and what the major industry players should do, given the environment. Kibbe and Klepper are right on the money in their description of the current climate, but what they fail to note is that this confusion and uncertainty is short-term and is likely to be resolved (for the most part) in a matter of months. While it is regrettable that Medicare reimbursement is up in the air at the same time as some important definitions upon which ARRA incentives rely, let’s not forget that these definitions should all be hammered out by the second quarter of 2010.

Whether you see an intrinsic value in EHRs, interoperability is really the facet of health IT that will make them almost indisputably worth using, bringing better quality of care to the nation at the very least, with or without the cost savings for physicians that many say will also follow. Yes, interoperability is a big challenge, but there are a lot of parties invested in making it happen, from the government to hospitals to vendors such as GE, who this week announced they were launching technology to aid with setting up health information exchanges. This is encouraging because if interoperability is an issue attractive to businesses, progress is likely to be a lot quicker .Added to this, the price of EHRs is almost certainly going to decrease, driven by software as a service (SaaS) vendors, who can offer a lower-cost, lower-risk option to smaller practices. This will in turn aid interoperability, because these Internet-based solutions tend to be designed using data standards such as XML, and it will also help confidence in the security of EHRs.

In short, now may indeed be, as Kibbe and Klepper say, an uncertain time for physicians; but big changes are difficult to bring about without such a period of flux. While it may mean in the short term that physicians are slower to adopt EHR technology, there are too many players involved with too much invested for things to simply revert to the paper-based status quo. When the dust settles, we can only hope the nation’s health care will be the better for it.

Privacy and security concerns are one of the many hurdles that the health care industry needs to overcome before EHR adoption catches on properly. Unfortunately, the sensible goal of making electronic health record systems interoperable (itself a complex task due to the huge variety of software solutions currently on the market) adds to these security headaches, because systems have differing levels and types of security, and security breaches in one system could, in an interoperable world, be even more serious and potentially compromise the whole nation’s records.

HIPAA (The Health Insurance Portability and Accountability Act) goes a long way to address many privacy and security concerns, but it leaves some important holes, which the Health IT Standards committee is currently seeking to address. Today, it endorsed a set of standards covering a range of security and privacy factors from access control and authentication to data integrity and document exchange. The full list of recommendations can be found here.

The idea is that these regulations are setting baselines that can be improved upon over the next few years, thus walking the fine line between being so stringent that they prevent development of compliant EHRs and hamper adoption, and yet still preventing widespread security breaches. For example, Kerberos/EUA authentication will not be allowed after 2011. This type of authentication is flawed because all users’ secret keys are stored on a central server, meaning a compromise of that one server will compromise all users. The reason it is allowed until 2011 is because some systems don’t even have enterprise-user authentication set up at the moment.

This prompts the obvious concern that hackers won’t do the sporting thing and wait till security is ramped up several years from now before trying to hack into systems. There are systems out there right now that contain patient data that are simply not secure, even by basic standards.

All of this rather worrying information provides a compelling argument that the industry should move away from the client-server model where physician practices are keeping patient information and charts on a server in the back room, to one in which technology professionals whose very job is to keep massive amounts of data safe are managing it all “in the cloud”.

Such technology companies – including Nuesoft – are likely to have security and privacy guidelines far in excess of what is mandated, because they have far more at stake in the event of a security breach. For a more technical discussion of what the HITSP standards mean and whether they are sufficient, you can read this balanced post written by a member of the HIT Standards Privacy and Security Committee.

Privacy and security concerns are one of the many hurdles that the health care industry needs to overcome before EHR adoption catches on properly. Unfortunately, the sensible goal of making electronic health record systems interoperable (itself a complex task due to the huge variety of software solutions currently on the market) adds to these security headaches, because systems have differing levels and types of security, and security breaches in one system could, in an interoperable world, be even more serious and potentially compromise the whole nation’s records.

HIPAA (The Health Insurance Portability and Accountability Act) goes a long way to address many privacy and security concerns, but it leaves some important holes, which the Health IT Standards committee is currently seeking to address. Today, it endorsed a set of standards covering a range of security and privacy factors from access control and authentication to data integrity and document exchange. The full recommendations can be found here.

The idea is that these regulations are setting baselines that can be improved upon over the next few years, thus walking the fine line between being so stringent that they prevent development of compliant EHRs and hamper adoption, and yet still preventing widespread security breaches. For example, Kerberos/EUA authentication will not be allowed after 2011.

This type of authentication is flawed because all users’ secret keys are stored on a central server, meaning a compromise of that one server will compromise all users. The reason it is allowed until 2011 is because some systems don’t even have enterprise-user authentication set up at the moment.

This prompts the obvious concern that hackers won’t do the sporting thing and wait till security is ramped up several years from now before trying to hack into systems. There are systems out there right now that contain patient data that are simply not secure, even by basic standards.

All of this rather worrying information provides a compelling argument that the industry should move away from the client-server model where physician practices are keeping patient information and charts on a server in the back room, to one in which technology professionals whose very job is to keep massive amounts of data safe are managing it all “in the cloud”.

Such technology companies – including Nuesoft – are likely to have security and privacy guidelines far in excess of what is mandated, because they have far more at stake in the event of a security breach. For a more technical discussion of what the HITSP standards mean and whether they are sufficient, you can read this balanced post written by a member of the HIT Standards Privacy and Security Committee.

A recent study by the Massachusetts Medical Society found that about 83 percent of doctors surveyed reported practicing defensive medicine as a way to avoid lawsuits, and cited other research suggesting the current tort system has a $124 billion annual impact on medical expenditures. In his recent address to Congress about health care reform, President Obama proposed authorizing demonstration projects in individual states to test out various solutions for malpractice reform. Details have yet to be announced, but another initiative of the administration that may impact malpractice claims is part of the American Recovery and Reinvestment Act:  that of EHR adoption.

Another Massachusetts study, this time published in the November issue of “Archives of Internal Medicine”, found that only 6.1 percent of physicians who were EHR users paid liability claims, compared to 10.8 percent of physicians who did not use an EHR.  Additionally, some insurance carriers offer a decrease in liability insurance premiums for EHR users. Considering that opponents of EHR adoption have argued that electronic health records could increase liability, the findings that in fact they may lead to fewer diagnostic errors, better adherence to guidelines and improved follow-up is encouraging. What’s more, this study suggests that electronic health records may also help provide a better defense to any claims that do occur, due to their clearer documentation of medical history, and built-in audit controls.

EHRs may not be a single solution for eliminating defensive medicine; but combined with anticipated tort reform efforts, they offer another step down the path toward a more efficient – and less expensive – health care system.

While the government’s incentives for adopting an EHR have been cautiously welcomed by many in the health care industry, providers and software vendors alike are struggling to come to grips with one key term: “meaningful use”. A practice must show meaningful use of an EHR before it is eligible to receive the incentives, and finding a definition that applies to all sizes or practices and hospitals seems to be no mean feat . The Medical Group Management Association (MGMA) is one organization hoping to modify the HIT Committee’s definition before it is finalized by the Office of the National Coordinator (ONC). MGMA sent a letter to the ONC at the end of June that recommended that, among other things, a broader set of administrative requirements be included as an integral part of the definition of meaningful use: essentially, that there is a focus on billing and practice management efficiencies as well as EHR efficiencies. In particular, it suggested eligibility verification, real-time claims adjudication and electronic payment remittance, all things that users of robust practice management software are already enjoying.

Additionally, MGMA is concerned that the definition of “meaningful use” as it currently stands has been developed with larger provider groups and hospitals in mind, and will prove too burdensome for smaller practices. In another letter sent last month to the ONC, MGMA listed ten recommendations to combat this.

A recent article in the Washington Post suggests that practices may be more willing to automate their offices if they can find a truly integrated practice management and EHR system. So far, the EHR adoption rate has been only 21 percent, but Nuesoft Technologies CEO Massoud Alibakhsh believes the answer lies in interfaces between what are known as “rich Internet applications”, which allow smaller offices to go paperless without having to invest in hardware for both EHR and practice management systems, or rely on potentially less secure remote applications that use Citrix-based “terminal server” technology.

Read more about the evolution of technology and what makes rich Internet applications different from terminal server-based applications in this fact sheet.