Achieving the True Value of EMR

The real benefit is found beyond charting.

BY BILL MCCANN WITH CONTRIBUTIONS FROM JOHN MCCANN, M.D., Ph.D.

Documenting exam findings electronically not only saves time but improves profits and patient care. However, it is our experience that an electronic medical record (EMR) system can deliver value well beyond charting exam findings. This article will discuss some items that you may want to consider when shopping for an EMR system.

The Basics

It is important that the user is comfortable with the basic process for entering exam findings.

Programming interfaces or forms to accommodate your needs for entering exam findings are the simple parts. An EMR should have forms already built for your specialty or the vendor should be willing to create customized forms based on your current paper process. The EMR should make it relatively simple to enter demographics, history, findings and diagnoses. This information should be entered via a simplified manual process or automatically transferred by integrating with your other software or diagnostic equipment.

We have identified several outcomes that a good EMR should provide:

► Improve office experience by automation and removal of redundant non–value-added work.

► Strengthen staff accountability and development. Use your EMR system to set, track and monitor goals.

► Expand financial management via automation and auditing the chart. Your EMR should enable you to maximize billing opportunities and guide you to compliance.

► Develop and complete marketing and research projects that are effective and take very little time or effort.

► Impress your patients with cutting-edge technology and education materials.

► Use time- and task-management tools to quickly identify and complete critical assignments.

Improve Your Office Experience

An EMR system should be able to automate tasks and remove redundant non–value-added work. This will improve your work environment and reduce your overhead costs. Some examples include:

■ Customized charting with defaulting. If you have an EMR vendor tell you how wonderful it is to customize your own templates, kick them out of your office as fast as you can. Do you construct your own house? Probably not. You may pick high-level options, but you rely on experts to get the job done. The same can be said about your EMR. Your EMR vendor should have a solid understanding of your specialty and you should expect them to deliver customized solutions with little direction from you.

You should demand some type of default coding to help you document findings quickly and accurately. Default coding makes it possible for you to click on one button and view all exam findings on that screen, which are documented as normal (i.e., default all vision findings to normal). You can then change any findings that were not normal to actual. Also, if your practice has patients who make recurring visits, demand a default record function. For example, by clicking the "default record" button, you make that particular set of exam findings the default for future exams. This is a big time-saver.

■ Summary/review. One of the great benefits of moving to EMR is the ability to peruse the patient chart quickly for critical information. Your EMR system should have some type of review or overview section where you can view all-important facts for the patient on one screen (i.e., key exam findings, diagnoses, procedures, prescriptions, dictated summaries). This is particularly important if you determine patient care based on a chronological progression of key exam findings.

■ Document management. Until health care is 100% electronic, you will have to deal with incoming paper. Your system should have a quick and simple method for archiving and retrieving these documents in the patient chart. Also, you may have diagnostic instruments enabling you to either print and scan findings into the patient chart, or it may be possible to integrate the instruments with your EMR so findings are populated in the patient chart.

■ Image management. Use of images can be helpful in educating the patient. Also, you may be able to use images as attachments to automated consult and insurance authorization letters, along with billing for external photographs. Your EMR system should make images available in ways that fit your practice, and the archiving and retrieving process should be quick and simple.

■ Automated forms. Your EMR database stores most, if not all, information needed to complete the litany of forms required by healthcare administrators. You should be able to hand your forms into your EMR vendor and it should be able to program the forms so that information is automatically populated on the forms (i.e., patient name, doctor's name, ICD9 code/description, CPT code/description, details related to surgery). This will be a big time saver and will result in fewer errors.

■ Automated prescriptions. Most physicians in most specialties are prescribing the same 10 to 20 medications to treat their patients. This is another opportunity to automate. Your EMR should allow a standard list of prescriptions to be saved to avoid retyping. At the same time, you should be able to make quick adjustments to the standard. Prescriptions should be automatically archived in the patient chart for easy retrieval.

■ Surgery management. Many practices earn most of their revenue through surgical procedures. Very few EMRs have features specific to the surgery-preparation process. If your practice does surgery, demand features that help streamline the process. Insurance authorization letters should be automated with the ability to quickly attach images and documents. All of your forms related to surgery and specific surgery centers should be automatically populated with information from the patient chart. Surgery quotes with specific surgeon, facility and anesthesia fees should be readily available. Patient handouts and surgery instructions should be available in a library customized for your practice.

■ Automated consult letters. Much of what is contained in a consult letter can be electronically stored in the patient chart. EMR should offer you a flexible method for dictating a concise impression and plan into the chart and batch printing (or faxing) should be an option. The process should result in reduced transcription costs, reduced physician time and reduced staff time.

■ Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant messaging. Your EMR can result in more autonomy and accountability by allowing multiple staff members to view the same chart at the same time. Patient phone calls and messages to the physician or other staff that are recorded in the EMR will ultimately result in fewer questions bouncing around the practice and up the chain of command.

Financial Management

While your EMR does not replace the need for billing software, it can and should make the billing process simpler. The system should guide you through the charting requirements and make recommendations based on evaluation and management (E/M) code standards. Many practices that "downcode" using a paper system find themselves more confident in billing the appropriate CPT when using a well-designed EMR. Also, EMR should make it simple to bill for "nickel and dime" services that you may have overlooked in the past (e.g., conveyance of specimen to lab and billing for external photos).

If at all possible, you should make sure your EMR software integrates with your practice-management software. For example, you do not want your staff to duplicate data entry of basic patient demographics. It may cost slightly more for the interface to be developed, but it is well worth the investment.

In some cases, you may even be able to receive customized reports that pull information from both your EMR and practice management software. For example, these reports should provide a list of all patients referred by other physicians (and one click to each patient chart) and how much revenue was generated from each referring physician.

Marketing and Research

The longer you utilize your EMR system, the larger and more valuable your database becomes. Your EMR should offer creative marketing and research features to help you capitalize on your investment. Here are a few examples from Dr. McCann's EMR solution that you can probably translate into your own practice:

■ E-mail follow ups. Capture the patient's e-mail address and get their permission for follow-up (required by HIPAA compliance). Create a variety of automated follow-ups via e-mail, such as satisfaction confirmation with a menu of other services, special birthday offers or e-newsletters.

■ Identifying patient grouping. Search your patient records to identify lists of patients based on any combination of criteria. With a few clicks, you could identify gender, age group, diagnosis and treatment, along with images stored in the system. For researchers, this tool is valuable for evaluating outcomes analysis. For marketers, this tool is valuable for promoting new procedures and services.

■ Marketing reports. Reporting features enable you to quickly track the results of your various marketing efforts. For example, you may find you are spending too much on your yellow page ads relative to the number of patients reached via this method. Conversely, you may find that your radio or newspaper ad had a significant impact. Also, you can get very specific information related to your referring physicians. These reporting features enable you to adjust your marketing plan accordingly.

Training and Education

You cannot afford to learn your EMR system through trial and error. Any software requires a training period. Your EMR company should offer on-location training. The physician has to be a leader in learning the system, and staff training should be mandatory, so expect to devote time away from your schedule.

Ask your EMR vendor to map out and put in writing what its plan is for training and ongoing service. Ask for a dedicated account representative.

Return on Investment/Cost of Ownership

Look at cost, but do so within the context of return on investment (ROI). You can find plenty of inexpensive options, but they will likely do nothing toward increasing profits. Ask prospective vendors to put together an ROI analysis specific to your practice. You should expect them to ask you questions to determine ROI results. The vendor should be able to give you detailed results based on past experience.

Total cost of ownership requires you to evaluate some of the more hidden costs of EMR. For example, you should have a good understanding of how much time you will have to devote to the process. Also, if the software is not customized prior to implementation, the customization process will drag on your practice revenue. Finally, evaluate the company itself. Do they understand the needs for health care and specifically, ophthalmology?

Good EMR = Higher Standards

Like many advances in technology, a well-designed EMR system should ultimately improve your bottom line, your patient care and your overall quality of life. Most of us would pay a high premium to find more discretionary time to do the things we truly value (e.g., spend time with family, improve our golf game, improve our expertise level). If you find the right EMR system, you will be rewarded with a precious commodity — more discretionary time. OM

Bill McCann is the vice president of sales and marketing for McCann Medical Matrix. John McCann, M.D., Ph.D., is the author, founder and CEO of McCann Medical Matrix and is a practicing oculoplastic surgeon.