Why an EHR Solution Is a Must-Have for 2018

Diane Beatini

Diane Beatini

Vice President, Sales at SRS Health
Diane Beatini is the Vice President of Sales. She oversees the Sales, Account Management, and Sales Operations teams. She works to promote the complete SRS product suite of HCIT solutions to medical practices of varied sizes and specialties. Diane’s background includes an MBA in marketing and finance with 15 years of executive sales and customer service management experience in the radiology, medical device, and pharmaceutical industries.
Diane Beatini

Looking back at 2017 as we head into 2018, the resounding theme in healthcare has been the push to bring down costs and drive up quality by increasing efficiency and improving care coordination. As the healthcare landscape shifts and evolves with groundbreaking alliances such as the proposed CVS Health/Aetna partnership, it is interesting to note that the percentage of office-based physicians using an EMR/EHR solution is a significant 86.9%, with only a small percentage of medical practices still using traditional paper charts. (Health IT Dashboard)

Reasons cited by physicians for remaining on paper include failed implementations, fear of a loss in productivity, and security concerns. While these are valid concerns, practicing medicine using traditional paper charts is becoming increasingly difficult as the industry moves to a value-based payment model, with more emphasis placed on patient engagement, interoperability, and shared patient data.

Typically, physicians spend 30–40 hours per week interacting with their patients. In a paper-based office, each patient visit results in approximately 10–13 pieces of paperwork, detracting from the time spent on patient care. (Benefits of Modern EMR vs. Paper Medical Records) Even if the physicians themselves do not handle the paper, their staff must, and a paper-driven staff results in an unproductive office. Since paper charts can only be in one location, clinical and administrative staff spend valuable time locating and providing charts. When there are multiple office locations, the additional chart transport compounds the problem and the practice becomes even more unproductive. Most practice administrators estimate the cost of a chart pull at $5.00 in lost productivity. Multiplied across hundreds and thousands of active charts, the numbers become staggering.

To remain competitive in the ever-changing healthcare environment and to attract patients and physician recruits, an EHR solution is a must-have for 2018 and beyond. As the penalties increase and reimbursements decline year by year, EHRs play a critical role in helping to preserve and drive revenue and reduce costs. Significant benefits of adopting an EHR include:

  • Reduced Administrative Burden An EHR can eliminate redundancies in documentation, provide fast and accurate record transmission, and drive efficiencies throughout the clinic, inclusive of patient intake. This can be accomplished while mimicking the traditional paper chart, which allows for an easy transition from paper to an electronic system.
  • Heightened Cost Efficiencies – An EHR can drive productivity, saving physicians and clinical staff valuable time and reducing the need and/or cost of transcription services, chart rooms, and record clerks. Regulatory resources through a reputable HCIT partner can assist the practice in penalty avoidance and meeting the requirements for MACRA/MIPS.
  • Patient Referrals/Community Presence – A 2006 Harris Interactive Poll reported 55% of adults believed that the use of EHRs would reduce the number of medical errors, and 60% believed the use of EHRs would lower their healthcare costs. (Benefits of Modern EMR vs. Paper Medical Records). Since that time, patients have come to expect electronic access and communication with their providers through the use of a patient portal. In addition to medical records access, secured messaging, and appointment and refill requests, an integrated patient portal embedded in the EHR allows patient-entered information and demographics to automatically populate the chart and the note, saving critical time and expense.
  • Patient Safety – EHRs improve patient safety by providing an organized, all-inclusive electronic chart that houses reminders, messages, and alerts in addition to exam notes, diagnostic images, and medical, medication, and allergy history. Each chart is readily accessible from any office location as well as remotely so providers have the complete information when responding to messages from inside or outside the office.

So why do some practices continue to hold out? The most common reason cited for not making the transition is the inability to obtain a physician consensus—there are differing opinions as to the best EHR, and even as to the best approach, including how much or little interaction they want with the solution, and the degree of elimination of paper from the practice.

Successful adoption of a solution, therefore, can be ensured by working with a vendor who can tailor the implementation to the needs of the practice and its providers, addressing individual physician workflow preferences and providing flexibility and ease of use. Further, practices can ensure that the solution will support their preferred clinical workflows by choosing an established and recognized EHR partner with proven experience in their medical specialty. The right partner will also be able to provide testimonials and client references documenting its ability to implement, train, and transition practices from paper charts without any impact on either patient volume or productivity. Is your practice still on paper and if so, what’s holding you back?

The Case for Centralized Quality Reporting: A Perfect Example

The Case for Centralized Quality Reporting: A Perfect Example’ TimeQuality measure reporting is one of the 3 basic tenets of the EHR Incentive Program—the other 2 being ePrescribing and data sharing (interoperability)—as identified in ARRA, the program’s defining legislation. It is a key component to improving the quality of patient care. In a recent EMR Straight Talk post—“A Waste of Physicians’ Money and Vendors’ Time”—I proposed a more cost-effective method of analyzing clinical quality measure (CQM) data that would deliver more useful information for quality improvement than the approach currently in place for meaningful use. I suggested that rather than requiring each of the 472 vendors of certified EHRs to program the same CQMs (no longer 125 as initially proposed, but still a burdensome 64), EHRs should simply collect and report the data, and CMS or its designate should provide the analytics. Such a centralized approach would not only be more efficient, but it would produce more consistent and reliable data. Most importantly, it would allow for the immediate implementation of any changes to measure specifications as necessitated by the availability of new medical information.

Recently, I confronted a perfect example of the ineffectiveness of the current system and the opportunities that a centralized approach would afford. A physician informed me that a new CVX (immunization) code was created for the influenza vaccine—CVX code 144. While I told this client that we could easily add this code to the EHR for his use in documenting vaccinations (which we did), these vaccinations would unfortunately still not be reflected in the numerator for NQF 0041 (Preventive Care and Screening: Influenza Immunization for Patients over Age 50)—a fact validated by CMS. New electronic specifications for CQMs will not be implemented until 2014, and the current specifications remain in force for 2012 and 2013.

As an EHR vendor, I certainly appreciate the fact that we are not subject to the expectation that we will reprogram measures off-cycle. That would wreak havoc with our development roadmap and resource planning. Furthermore, changing the calculations to accommodate the new codes would compromise data comparability. So now we have comparable—but incorrect—data that does not reflect actual vaccination status. Under this system, how will we ever stay current as medicine constantly evolves?

Just imagine if everyone could begin using the new CVX codes immediately because the electronic specifications were updated in one centralized location with one effort. This is just one example from a potential 64 CQMs. How much more value would we derive from all the work that we demand of physicians in capturing the CQM data? How can we accelerate healthcare improvement if we are always 2–3 years behind?

Stage 2 Meaningful Use: The Public Has Spoken

CMS asked for comments on its Proposed Rule for Stage 2 Meaningful Use, and it got them—1,131 of them, to be exact. While the comments that have drawn media attention are those from major stakeholder organizations, the vast majority of comments were submitted by individuals—and CMS is obligated to read and consider each and every one of them as they formulate the Final Rule.

 

I thought it would be interesting to see whether the comments from those in the trenches—those whose everyday lives are impacted by the meaningful use regulations—are in line with the sentiments expressed by groups like the AMA, AHA, MGMA, EHRA, etc. In a review of the first 25% of the comments by individuals, (over 250 comments), a consensus clearly evolved around a few major points, and the results remained fairly consistent as we read. The graph above illustrates the prevailing sentiments.

  • By far, the predominant concern is that the proposed requirements are far too demanding, i.e., the bar is being set too high. An overwhelming 82 of the comments identified the sheer number of measures and components, challenging thresholds, the cost of compliance, and overly aggressive timetables—even in light of the delay to 2014—as being unrealistic.
  • On a similar note, another 14 addressed the complexity of the requirements, describing them as difficult to understand, ambiguous, and overly complicated. When combined with the above, approximately 40% of the 250 comments reviewed maintained that the Stage 2 requirements are simply too demanding.
  • As anticipated, there was a resounding concern (56 comments) about holding physicians responsible for actions by any third parties over whom they have no real control. Most comments referred to the requirement that patients view or download their charts and communicate to the physician by secure e-mail, but some asked that providers be insulated from any failure by vendors to meet the requirements or the client upgrade schedules.
  • The limited relevance for specialists remains an issue in Stage 2, as the program is still viewed as primary-care focused. There were 23 comments that addressed the paucity of meaningful use measures and clinical quality measures that are relevant to specialists, and some went so far as to claim that trying to meet requirements that are geared towards primary care could actually distract specialists from their own priorities and be detrimental to the quality of care they would be able to deliver.
  • Some comments addressed the penalties and suggested that the rules provide for a broader range of exemptions and more leeway. The suggestion that the first year of Stage 2 only require 90 days of reporting—which was suggested for other reasons as well—was supported by providers concerned with the penalties.
  • In response to a plea from CMS that people report what they like in the proposal, in addition to what they don’t, some commenters expressed general support for the Stage 2 recommendations, and a small number argued that the bar wasn’t raised high enough. Some—likely specialists—applauded the change in exclusions for reporting of vital signs; several approved of ensuring patient access to their clinical information; and there was support for the proposed harmonization of clinical quality measure reporting under the various government programs (meaningful use and PQRS).

Perhaps what is most interesting about the comments is the emotion and passion behind many of them—whether expressing favorable or unfavorable opinions. If you would like to browse through the public comments yourself, go to www.regulations.gov and enter “CMS-2012-0022” in the search bar.

Are EHRs Being Oversold?

I am a firm believer in the tremendous value that the right EHR can deliver to physicians, so the historic dissatisfaction with the EHR industry—as reported in studies and anecdotal conversations—has long disturbed me. The alarming intensity of this dissatisfaction was brought home by visitors to my company’s booth during the recent AAO (American Academy of Ophthalmology) meeting.

I was truly appalled by the abject frustration and anger expressed by numerous physicians about their EHRs. One visitor described his experience by saying, “It has taken the joy out of practicing medicine.” Another said that he felt like he should put a picture of his face on the back of his head so that his patients could see him—because he was forced to focus on the computer and enter data while the patient provided information. Physicians universally complained about the “productivity-killing” impact.

From AAO - Are EHRs Being Oversold?Why is this so? I know there are good EHR products in the market that physicians enjoy using and that enhance, rather than reduce, their productivity. Why are physicians not more successful in finding these?

The answer is that EHRs are being oversold. There are many EHRs that are marvels of software, capable of doing incredible things, but the selection process that physicians typically employ is flawed, and the sales process capitalizes on this shortcoming. The salesperson dazzles them with a demo, or they take prospective purchasers to see a physician—typically just one or two—who adeptly uses the software. This creates a false sense of ease-of-use, and the physician prospect leaves the site visit expecting that he or she will be able to use the EHR just as successfully. But not all physicians are alike—they may all be very intelligent and have tremendous medical expertise, but they are not all equal in technological inclination or skills. Their success—or lack thereof—with a particular EHR will vary significantly.

This brings us back to the importance of doing due diligence—something I have talked about before. Call and/or visit a variety of physicians who represent a wide spectrum of proficiency. Go to the reference practice’s website and select physicians on your own—don’t rely on the vendor’s selection. Ask the kind of questions listed in the last EMR Straight Talk. This is the only way to increase the odds of a successful EHR experience, and to avoid making a painful and costly mistake.

EMR Ratings: A KLAS Act

This week, KLAS released its first EMR Performance Report that organizes results according to the specialty of the rating provider. Although the publication of “Ambulatory EMR by Specialty” came on the heels of my posts last week—titled “One Size Does Not Fit All” in EMR Straight Talk and HIStalk—the timing was purely coincidental.

I want to commend Mark Wagner and Kent Gale for taking on this new approach to analyzing and reporting the data they collect. I have had numerous conversations with KLAS on this subject over the years, urging them to report by specialty for all the reasons identified in my posts, and they clearly recognize the value of this type of information. This effort by KLAS was a major undertaking, and the result represents a significant breakthrough in the way the EMR industry provides access to information.

For any specialists looking to adopt an EMR, the KLAS report “Ambulatory EMR by Specialty” is a must-read. It contains information that is vitally important to informed EMR decision-making.

The data raises some interesting questions and implications. In next week’s EMR Straight Talk, I will share some initial observations.

Enterprise EMR: One Size Does Not Fit All

In my recent post on the industry-leading EMR blog HIStalk, I discussed the impossibility of one type of EMR ever meeting the needs of all the disparate types of providers. Among the arguments I presented was that it is impossible for the same EMR product to satisfy both hospitals and private-practice physicians. Enterprise EMRs simply do not work in high-volume ambulatory settings, and it is unrealistic to expect that they would.

Apparently, this hit a nerve, given the passion and intensity of the comments, most of which addressed Epic. (You can read the comments by clicking here.) In response to Peppermint Patty’s claim that “tens of thousands of happy specialists use Epic,” Epic Mythology replied, “The idea that all specialists, or users in general, are happy with Epic is a flat-out lie. My own academic specialty clinic rebelled against Epic’s ambulatory interface as long as we could, and we switched only by force. It destroyed my clinic workflow, and I now see fewer patients while spending longer documenting. . . . I have yet to meet any doctor who really likes Epic.”

There you have it—the basic problem in our industry identified very simply by the argument between Peppermint Patty and Epic Mythology. How do we know who is right? These and several of the other comments beg the question of how a specialist—or any physician—can ferret out the truth about the potential of Epic (or any other enterprise EMR) to satisfy his or her practice’s needs? This is becoming an increasingly critical issue, given the growing pressure hospitals are putting on physicians to adopt the enterprise system by subsidizing the cost. Are physicians who succumb to this pressure getting what is right for their practices?

The following is the comment I added to HIStalk following the initial set of responses to my “Reader’s Write” post:

Judging by the comments to my post, the implementation of enterprise EMRs in ambulatory practices is a major issue confronting physicians. Most of the comments focus on Epic, the dominant player in that market. Peppermint Patty and Epic Mythology sum up the two positions—the former claims that there are many happy users of Epic, while the latter argues the exact opposite. Who is right? And how do we find out for sure? My experience speaking with thousands of physicians over the years supports Epic Mythology’s position—like him, I have not met many specialists satisfied with using enterprise EMR systems in their private practices.

Given the revived interest in EMR purchases, it’s critical for the physician community to know the truth.

Please continue the conversation by commenting on EMR Straight Talk (below) or by joining the dialogue on HIStalk.

Preserving Physician Income in a Low-Margin Environment: EMR Strategy

A frequent concern I hear in my conversations with physicians is that they are challenged by increasingly harsh economic pressures. Healthcare reform, lower—or at best stagnant—reimbursement rates from government and private payers, and the higher proportion of lower-paying Medicare patients are reducing or capping practice revenue. At the same time, overhead costs are escalating unrelentingly, since employees still expect raises and other operating costs continue to rise. While the common perception is that physicians are not businessmen/women, they are in fact running small businesses; and now, more than ever, they need to focus on ways to maintain business viability in light of lower margins.

Physician Income Calculator

The above graph illustrates the economic challenges. Click on it to enter your own practice data and assumptions concerning anticipated growth or decline in reimbursement and expenses, and observe the effect on physician income—the green line. Given that physicians have no control over reimbursement rates, the only way to positively impact that green line is by effecting fundamental changes to practice operations—and the right EMR is critical to this end.

First, it is imperative to significantly reduce overhead—the orange line. Government programs that may, or may not, deliver short-term financial incentives do not address cost structure. What is needed is an EMR that delivers sustainable and significant reductions in the staff-to-physician ratio and more efficient management of all resources—depressing the orange line. Increasing revenue—the blue line—requires increases in physician productivity and patient volume. The challenge here is to wade through EMR marketing hype to identify the EMR that will actually shift the orange line down and the blue and green lines up.