Best Practices

The March to EMR – Long Overdue?

By Derek Preece

I remember the day when airline tickets were often written by hand, with three or four carbon copies. The original would get me on the plane, and I suppose the copies went to various departments at the airline. Today I can buy a ticket in minutes from my computer with no human intervention,and I can check into the flight from home, manage my frequent flyer account and track the progress of my flights, all digitally. I can even have the airline send my boarding pass to my smartphone so that no paper ticket gets printed.

Banks have also made great technological progress in the past two decades. I just transferred gas money to my college student's account with a few clicks of a mouse. Technology has so fundamentally changed the financial business that some banks have been able to reduce the number of rick-and-mortar locations they maintain. Grocery store checkout lines are much quicker today than they were in my youth because technology has taken the place of price tags that had to be read and punched into a cash register. Virtually every part of our lives has been radically changed by the technological advances of the past half century.

Except doctors' offices.

While much of the clinical technology in ophthalmology offices has kept pace with the digital revolution, and medical claims billing has converted from paper forms to electronic communications, documenting the patient's history, assessment and plan is done the same way today as it was 100 years ago in the majority of practices — by writing on paper.

Mandatory, But Worth The Effort

The US government sees that practice as terribly antiquated and expensive. The view from Washington is that paper charts in doctors' offices do not allow for the extensive exchange of information between providers that could dramatically reduce the cost of care by eliminating duplication of effort, unnecessary tests, unneeded procedures and poor coordination of care for patients.

While arguments can be made as to whether that view is accurate or not, what is not debatable is that there is tremendous pressure on doctors at the federal government level to adopt electronic medical records. Incentive payments of up to $44,000 per doctor ($63,750 for those who qualify under the Medicaid plan) are available, paid over five or six years. In addition, under current law, practices that do not show meaningful use of an electronic health record program by 2015 will begin to see their Medicare reimbursements drop as penalties for noncompliance kick in.

What does this mean for ophthalmology practices? We are in a time when the human and financial capital required to operate a practice successfully is increasing dramatically. The cost of buying an EHR system can be staggering, especially for small practices, and the management time and resources that must be deployed in selecting and implementing a new system can be daunting. The implication of the forced march to electronic medical records (along with other government-imposed costs) is that more and more practices will be tempted to merge into larger entities so that capital investments are spread over increased numbers of providers.

At present, about a quarter of ophthalmology practices have implemented or purchased an electronic health records program. According to a Medical Group Management Association survey, almost three quarters of medical practices that have EHR systems are satisfied with their overall system, and of those who have optimized their systems, over 80 percent report either increased or equal productivity after adding EHR.

It's very common to hear from those who have used these systems for a year or more that they would never return to paper charts, so the common fear that an EHR system is more trouble than it is worth seems to be fading as systems improve and practices apply better diligence to their purchasing decisions and implementation efforts.

Although it may be galling to feel coerced into purchasing a software system, it does seem inevitable for most practices, given the government's carrot-and-stick approach. However, there are other reasons for carefully considering the modernization of your medical records, not the least of which is the promise of better and more accessible information about your patients, which should lead to better overall care. And, of course, there will come a time when writing notes about your patients will seem to them almost as antiquated as writing an airline ticket on four-part carbon paper. OM

Derek Preece is a senior consultant and principal with BSM Consulting, an internationally recognized health care consulting firm. For more information and resources, visit www.bsmcafe.com.