Living comfortably without an EHR system

Despite their benefits, our practice maintains a “wait and see” approach.

By Vance Thompson, MD & Matthew Jensen, MBA

Our practice has never shied away from investments. We were initial investors in lasers for cataract surgery and saw the immediate potential in LASIK. But, so far, we haven’t invested in an EHR system.

Our patients may not understand why our old-school, paper chart room has not evolved along with the rest of our high-tech facility. Using EHR systems certainly has benefits, such as increased accuracy with coding and billing, along with avoiding Medicare reimbursement penalties. But we feel the costs, which can approach $250,000 for the software alone, outweigh the current upside of available systems.

Here are the reasons why our practice has decided to postpone investing in an EHR system.

MEANINGFUL USE REGULATIONS NOT ENOUGH

Will the system remain useful?

The primary motivation for many practices to purchase EHR systems is to comply with MU regulations. Eligible professionals who do not demonstrate MU are subject to reduced Medicare payments starting in 2015. However, approximately nine of 10 EHR industry insiders say the majority of EHR vendors currently implemented will fail to sustain operations by the time MU stage 3 is fully implemented, according to a 2013 Black Book Rankings poll. Considering EHR systems’ price tags, the potential need to replace such a costly investment, not to mention the two to three months to template and acclimate the staff with another system, is significant.

We know we’ll soon be penalized with reduced Medicare payments, but we have to look at the overall finances involved, not just this potential lost revenue. When researching EHR systems, we analyzed all of our reimbursements, then determined how these reductions would impact our bottom line. When measuring this against the cost of the system and all other costs associated with implementation, such as reduced patient flow and the costs of additional staff, we felt the impact on our bottom line is not enough of a driving force.

PERCEIVED INCREASED PRODUCTIVITY

Will it slow us down?

EHR system manufacturers say automated systems reduce paperwork while saving time and energy. However, I’ve talked to colleagues regarding their EHR systems, and very few rave about EHR the way one might about a new equipment purchase, a renovated building or an all-star staff member. In fact, many colleagues claim EHR slows down practice processes and patient flow.

Colleagues report a reduction in patient flow during the implementation as their processes slow while they learn the new system. Many operated at about 15% below normal capacity for at least the first 90 days, and some feel they may never return to their pre-EHR full capacity.

In addition, EHR systems are more than simple electronic solutions due to government regulations and monitoring through CMS MU requirements. If EHR standard requirements weren’t so stringent, we’d feel a little less encumbered about adopting them.

Another perceived benefit of EHR is accuracy. Paper records come with the chance of human error, either incorrectly filling out the forms or losing them altogether, which may result in significant loss of time. However, even after hiring an EHR manager, mistakes happen, and information can be misplaced.

Coordinating care

Currently, our dictation team records findings during appointments, uses paper records and coordinates plans with referring providers, often by sending and receiving faxes or by printing and mailing letters. Coordinating care this way may not be the optimal method, but we don’t see much improvement in current electronic solutions.

Among the seven states and 400 ophthalmologists who connect with South Dakota, I’d estimate more than 10 EHRs are currently in use. Our EHR programs would have to sync and talk with one another, which is no small endeavor.

Also, we still receive faxes from providers that already have EHR, showing these practices have not given up on older technology.

We see the potential upside in electronic communication, but the technology is not quite as seamless as it could be.

PORTALS POSSIBLE WITHOUT EHR

Increasing patient participation

Patients in EHR practices enjoy the convenience of patient portals to access their personal health information, schedule visits or pay bills. We recognized the value of adding electronic forms and patient portals long ago, but these features are not solely tied to EHR systems. Even without EHR, we can provide the benefits of these features to improve the overall patient experience.

ACKNOWLEDGING THE BENEFITS OF EHR

It has advantages

Admittedly, EHR systems have perks that we can’t experience with a paper file system. EHR’s increased accuracy of billing and coding remains one of the biggest upsides to a practice’s bottom line. Offices without EHR face compliance issues and may undercharge patients for fear of error and potential audits. EHR systems allow autocoding based on chief complaint and assistance with correct coding based on the patient’s electronic record to help avoid billing errors — reimbursements go up while decreasing compliance risks.

Additionally, cloud-based EHR allows the ease of transferring files and accessing patients’ information from home. We can’t experience this level of flexibility without EHR.

FUTURE ADOPTION

When we’ll transition

We know that our eventual transition to EHR is inevitable, but not until the benefits of adopting them outweigh the capital investment required for current EHR systems and all other costs.

Also, I expect a lot of consolidation among EHR companies through the next few years. We feel it’s better to wait for this to take place to avoid investing a second system. To us, the EHR industry hasn’t made it obvious that the current offerings will stand the test of time.

We don’t consider ourselves EHR bashers — we’re pro bottom line. In the future, if EHR greatly enhances the customer experience (and we think it will), it has the potential to be very special.

However, at this point, we still have trepidation and don’t see enough incentive to make it a worthy investment. OM

About the Author
	Vance Thompson, MD, is principal at Vance Thompson Vision in Sioux Falls, S.D., and assistant professor at the University of South Dakota School of Medicine. Disclaimer: The author reported no relevant financial disclosures.
	Matthew Jensen, MBA, is the CEO of Vance Thompson Vision in Sioux Falls, South Dakota, and he is a certified Experience Economy expert. Mr. Jensen may be reached at (605) 371-7120; matt.jensen@vancethompsonvision.com.