The 10 Most Common EMR Questions

Some are based on myths and misinformation.

PETER J POLACK , MD

As the writer of the long-running “Path to Paperless” column in Ophthalmology Management, I always provide my e-mail address at the end of the column and invite questions from readers. Because the selection, implementation and operation of an electronic medical records system can be a complex and confusing process for ophthalmology practices, I receive a number of questions from readers.

Some of the questions come from doctors or practice administrators who have clearly done a great deal of homework on the implementation of EMR. These readers usually ask advice on a specific decision they have to make within the context of the overall process. However, I also receive questions from readers who have only the most rudimentary understanding of the implementation process. In many of these instances, their “knowledge” is based upon myths and misinformation.

Here, I will answer the 10 most common questions on EMR that I have been asked in recent years. Some of them require only simple responses. Others display a degree of sophistication about EMR implementation. Given the space limits of this article, I will attempt to provide the clearest, simplest and most direct responses.

1. Do I really need an EMR system to qualify for meaningful use?

► For those practices in the midst of EMR implementation trying to achieve meaningful use (MU) incentives, this might seem like a silly question. But it is a common one nevertheless. Meaningful use specifically refers to the “meaningful” use of an EMR system in a medical practice, as opposed to simply owning an EMR system. The MU stages have certain criteria that a provider must meet for the practice to receive federal financial incentives that are paid out over time, $44,000 maximum per provider.

2. Will EMR be able to save me money?

► A study a few years ago at UCLA calculated startup costs of $15,0000 to $50,000 per physician. In return, a practice can see a range of savings from none up to $20,000 a year on such things as transcription, medical records, data entry, billing and reception. Increased revenue due to better documentation or coding, or both, has been less universal. And the study also did not take into account the MU incentives, which can add up, especially in a group practice.

3. Will EMR make me more efficient?

► Numerous studies have found improved efficiencies in hospitals, clinics, and practices that use EMR systems. But as I have written previously, a practice with bad work-flow processes will find an electronic system only amplifies those inefficiencies. Practices should give those processes a hard look and improve upon them before going paperless.

4. I’m thinking of using a Web-based EMR. Who owns or controls the data?

► Technically the data belongs to the practice. But it is incumbent on the practice to vet the company or entity that is hosting the EMR system and its data, and ask some tough questions: Is the data comingled with other practices? What security processes are in place? Are there redundancies in case of server failure? What contingency is there if the hosting company goes out of business?

5. If the EMR creates coding errors and a resulting fraud and abuse investigation ensues, who is responsible?

► The jury is still out on this one. Most software companies have lengthy contracts with fine print — which nobody really reads — that indemnifies them against most liability. And EMR software vendors are no different. The real issue is when the EMR system starts making decisions, such as diagnoses or coding. As it stands, in most cases, the physician or hospital would ultimately be responsible. Unfortunately, CMS still has not established national E/M guidelines, so physicians are wise not to rely extensively on their EMR system for decision-making and to have expert legal counsel review their software agreements.

6. What is the best way to implement EMR: Overnight or a phased rollout?

► Every practice has its own unique situation and culture, so no one-size-fits-all approach applies here. However, I have seen and heard of more fiascos regarding EMR projects that were implemented on a fast track. We can count just too many moving parts in the typical medical practice, and doctors and staff embrace a misguided tendency to treat EMR like any other piece of medical equipment. As I have written before, the failure usually occurs on the people side of the equation, and that should never be rushed.

7. I’m a solo practitioner in my mid-50s. Is it even worth implementing EMR at this point?

► A few colleagues close to retirement have written that it is not worth the expense and heartache for them to convert to EMR and that they would never recoup their investment, even with the federal incentives. On the flip side, practices that use EMR are considered to be more state of the art and thereby more attractive for potentially new associates. But ultimately this is a personal decision.

8. Does EMR really make the practice of medicine better?

► The answer to this question depends on who is asking. From the perspective of insurance companies and the government, the answer would be an unqualified “yes.” The ability to cull information on the treatment of patients, not just at the practice level but also regionally and nationally, could significantly reduce the cost of health care. And most physicians who have successfully implemented EMR would also agree that it has helped them practice medicine better. Others, however, fear that this granular degree of oversight allows those large entities to control the way physicians practice medicine in a way they could never imagine.

9. Doesn’t EMR negatively affect the doctor-patient relationship?

► This question comes up as a frequent reason not to use EMR. Picture a physician with his back to the patient while he pecks away at this computer, they say. But how is this different than writing notes in a paper chart while facing away from that same patient? The bottom line is that EMR is just a tool and one must have a little foresight when planning how the EMR system will be used in the clinic setting. Our practice, founded 40 years ago, has always used scribes because it makes our physicians more efficient and enables them to give their patients their complete attention. And our process is no different now that we use EMR.

10. Is EMR less secure than paper records?

► Some high-profile news stories have reported large data breaches from stolen laptops, thumb drives or lax Internet security. And in those cases, a significant amount of private patient information has been compromised. Recent legislation has put some real teeth into HIPAA-related violations. But in most practices with paper records, this information is readily accessible by anyone who walks into the usually unsecured area that houses the charts. The reality is that, in the pre-HIPAA era, nobody really worried much about personal health information security. EMR systems allow for this critical collective information to be secured in a way that paper records cannot — but only if properly set up and continuously overseen. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators. He can be reached via e-mail at ppolack@ocalaeye.com.