What Are You Waiting For?
Implementing Electronic Medical Records Delivers Clinical, Administrative and Financial Advantages
By Ed Katz
Throngs of Americans embraced President Obama’s message of change when he took office. For healthcare providers (e.g., physician practices, ambulatory care, hospitals, and healthcare systems) one change the new administration is promoting is the movement from paper-based medical records to electronic medical records (EMR). As part of the 2009 American Recovery and Reinvestment Act, the government will pay out $17 billion in incentives beginning in 2010 for hospitals and in 2011 to doctors that implement electronic health record systems. While physician practices can receive up to $64,000 per doctor and hospitals can receive as much as $8 million in incentives, and — even with the knowledge that they will be penalized beginning in 2015 for not implementing a certified solution — it may not be enough on its own to fuel adoption of EMR systems. For that to happen there needs to be a mindset shift among practitioners and hospital administrators.
EMR technology has been available for more than a decade, yet members of the medical community have been slow to adopt it due to the perception of EMRs being disruptive, expensive and hard to implement. The latest data from the Centers for Disease Control and Prevention indicates only 38.4 percent of doctors are using EMRs. In a new study by the American College of Physician Executives (ACPE), which polled 1,000 members, physicians argued that current EMR systems were clunky, hard to use and not far enough along in their development. However, when the process is outsourced, doctors and hospitals are more likely to experience less disruption and frustration because they have access to expertise and specialized skills in implementing such systems and realize a greater return on their investment.
Advantages of Electronic Medical Records
One reason the government is putting incentives in place to encourage physicians and hospitals to move to EMRs is to reduce the cost of healthcare. According to The New England Journal of Medicine, nearly 31 cents of every U.S. healthcare dollar goes toward administrative and other similar costs. Not only can EMRs alleviate some of the costs and administrative burdens of managing patient care, but they can also help doctors provide higher quality patient care.
While the majority of doctors have practiced for years with a paper chart, a paper record is inherently inefficient. Paper records are hard to retrieve, require additional time and money for document management (in addition to sufficient storage space), prohibit the ability for real time access by multiple parties and can delay or compromise patient care.
Although doctors may seem set in their ways of using paper to capture information during the medical encounter, research firm Kalorama Information projects that the EMR market will grow 14.1 percent each year over the next few years, up from $9.5 billion in 2007. This is because electronic medical records are critical in meeting today’s high health care standards. Looking at the administrative, clinical and financial advantages of replacing paper records with EMR:
EMRs can improve patient diagnostics. With a paper-based record, only one medical professional is able to have access to that paper at any point in time. In addition, the time it takes to search for and retrieve that record is also elongated. With an EMR, multiple people can have simultaneous access to the same medical record in real time.
For example, let’s say an individual presents themselves in the emergency room with a complaint of chest pains. They inform the nurse taking their vital signs that they were seen a week prior, prompting the nurse to request a copy of the medical record from that previous visit. Depending on how busy the ER and Health Information Management department is, it could take hours to retrieve a paper file from the storage room. The attending physician also needs to wait for that paperwork and upon its receipt he/she might also want the opinion of a cardiologist, who needs to wait for the file to be forwarded to them.
With an EMR, that paper record is imaged and digitized ideally within 24 hours of the initial visit and electronically made available thereafter. In the scenario above, while the ER doctor was viewing the file, the cardiologist could be looking at it at the same time. By facilitating multiple care access to records in real time, doctors can speed diagnostics and therefore treatment and ultimately improve clinical performance.
EMRs can eliminate the need for duplicate or unnecessary procedures. Many times, paper records are lost or misfiled. Going back to the patient who returns to the ER with chest pains, if the doctor can’t get to the original record, he may order the same tests that were performed during the initial patient encounter. With an EMR, the physician could have immediate access to patient information, perform duplicate procedure checks and evaluate prior encounters to ensure they are not ordering unnecessary – and expensive – tests. In addition to reducing costs, this can save valuable time, lessen frustrations and increase patient satisfaction with the level of personalized medical care.
Hospitals and doctors will also be able to data mine clinical and financial with an EMR in place. This will enable them to have more predictive power and a process that rewards positive clinical outcomes. For example, doctors and hospitals relying on paper-based records might not be able to see trends across their complete pool of patients with high blood pressure. Instead, they are only able to see data based on each individual patient. However, by mining data across their patient population they can identify which treatments, interventions, drugs or services are most beneficial and consistently produce the best results. The insurer will then be able to develop claim reimbursement schedules for healthcare providers based on performance or positive patient outcomes as used in the industry.
Administrative functions are improved as a result of digitized records. While lost or misfiled records may subject patients to unnecessary or duplicate tests and procedures, they can also be a serious liability for hospitals and physician practices. Without records to prove exactly what the doctor did and why, hospitals and practices can increase exposure to malpractice claims. Paper records that aren’t processed and filed properly may also create inaccuracies in billing – or result in complete failure to invoice insurance companies and/or patients, potentially costing millions each year in lost revenue.
By moving to an EMR, all the documentation is complete and in one place. Documentation and coding are streamlined through the system, which results in faster and more accurate billing. When billing is timely and accurate, physicians and hospitals can optimize medical cash flow.
EMRs deliver financial gains. Instead of a room with file boxes stacked floor to ceiling, space dedicated to file storage can be transformed to revenue generating space such as additional exam rooms. EMRs deliver improved records retrieval times and, as noted above, accelerate cash flow due to enhanced processing. Without the need to manage excessive amounts of paper files, savings can also be realized in reduced staff hours or staff members, through attrition or termination.
EMRs deliver a flexible and effective records storage system that saves storage space, staff time, money and improves cash flow. Unfortunately, many implementations fail because hospitals and doctors are ill equipped to install, support and maintain the system. While there are some barriers to a successful implementation and transitioning from paper medical records to electronic medical records, taking a best practice approach can help ensure success.
Pitfalls and Remedies for Implementing EMR
Because of the perception in the marketplace, many physicians and hospital administrators are struggling with the decision to implement EMRs. One of the biggest reasons for system failure is the struggle to convert paper files to digital. To overcome the concerns that block a successful EMR implementation it’s important to have the right people, process and product to navigate from paper to the digital world.
One pitfall many environments fall prey to is underestimating resource requirements and taking a do-it-yourself approach – and then finding they’re ill-equipped to manage the conversion. Hospitals and physician practices aren’t geared for large scale scanning operations; their expertise is in medical care. The remedy is to partner with a provider that specializes in records management and scanning solutions and has the skill set to fluidly convert paper files to digital within an optimal 24-hour window from the medical encounter. This fuels efficiencies, ensures medical staff focuses on patient care, operations and financial services that keep the practice or hospital running smoothly.
Not having a plan for implementing and deploying EMRs is another pitfall many practices and hospitals encounter. Issues they need to think about are interoperability with other systems as well as how the solution should be phased in. Will scanners be networked or local? Where will they be placed? An ideal EMR will be transportable and not hospital or health system-based. Establishing the right technical and process orientation will ensure the return on investment of implementing an EMR solution is realized.
Part of the plan needs to include deciding how much of the back file should be converted. Be sure to clearly define what you want to scan and the timing for scanning. For instance, you may want to start by scanning a few months or one to two years of patient records prior to a go-live date. A pitfall of many implementations is working in a hybrid environment of part paper, part electronic records. This creates operational inefficiencies and results in poor physician and user adoption. The remedy is having a back file plan as well as ensuring records are converted as quickly and accurately as possible following a medical encounter. In addition to improving adoption, delivering timely electronic access to records enhances patient care.
Many physician offices and hospitals migrate day forward records to digital, but are not prepared to manage back file conversion due to time and resource constraints. In some cases, even day forward scanning is not up to metrics for optimal productivity. To realize a return on investment, it is imperative paper is converted in a timely and accurate manner. Best practice is converting that record in less than 24 hours post discharge. Depending on the process and environment, this is difficult for a majority of hospitals to manage.
By outsourcing the medical records conversion process, hospitals and doctors can remedy the pitfalls encountered when implementing EMR. A provider with expertise in large scale conversion and scan operations delivers operational savings and process improvement, ensuring hospitals and doctors are able to derive the intended value from an EMR solution while providing the highest quality patient care.
Succeed with an Outsourcing Provider
Going digital and implementing EMRs can be a large capital investment and is disruptive to workflow — especially for those institutions that try to go it alone. By working with an experienced outsourcing provider, physicians and administrators can tap into expertise that address interoperability concerns, ensure back file conversion is done in a timely manner and that day forward records get converted within that ideal 24-hour window with high quality and is cost effective.
A vendor that specializes in electronic medical records can deliver the service onsite in a more productive, efficient and cost-effective manner. Because their core competency is in records management, they possess the relevant skill set required and have better recruiting, training, management and certification of employee practices. As a result, conversion time is faster than when done by hospital or physician practice staff. In addition, with a depth and breadth of experience, they are able to establish processes that ensure high quality, consistent performance and accuracy.
EMRs facilitate access to patient data and alleviate the time needed to search for records, enabling medical professionals to spend more time with patients and less time waiting for information. With complete records, there is less room for error because all test results and medical history are in one place. Coding and billing is performed via the image and reduces the cycle time from discharge to coding, adding speed and accuracy to billing to improve medical cash flow.
Regardless of any incentives to implement EMR, the time is now to replace antiquated paper record keeping with a modern electronic system that delivers clear financial, clinical and administrative advantages. By working with the right provider, having the right records management strategy and the right preparation in place, hospitals and physicians will gain the most benefit from the solution, save time and money and reduce administration to be able to provide the best quality healthcare to patients.
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Ed Katz is the senior vice president, Healthcare Services at HOV Services in Troy, Mich.
