Fifty-eight percent of U.S. physicians who don’t use electronic medical records (EMRs) intend to purchase an EMR system within the next two years, according to a new report from Accenture (NYSE: ACN).

“If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

Today, just six percent of U.S. office-based physicians use a fully functioning system.

Accenture’s Innovation Center for Health and Institute for Health & Public Service Value worked with Harris Interactive to survey 1,000 U.S. physicians from practices of fewer than 10 practitioners to measure their views of EMRs. Approximately 15 percent of respondents were users of EMRS and 85 percent were non-users.

The survey’s primary objective was to determine concerns and perceptions of EMRs and gauge motivating factors at a time when U.S. federal legislation includes incentives for physicians who implement and use EMRs and penalties for those who do not adopt EMRs by 2015. The New York Academy of Medicine assisted with the qualitative survey and analysis.

Among the key findings:

• 58 percent of non-users intend to purchase an EMR system within the next two years;
• About 80 percent of physicians under the age of 55 plan to implement an EMR system within the next two years;
• Three-quarters of non-users are intrigued by the idea of purchasing an EMR system from a local hospital - if the purchase is at least partially subsidized by the hospital;
• On average, non-users would expect a hospital/health network to subsidize about half the cost of an EMR system;
• The key driver of EMR adoption is federal legislation - 61 percent cited federal penalties for non-adoption and 51 percent cited federal incentives;
• Non-users underestimate the cost and time requirements to implement an EMR system, but also have an exaggerated perception of difficulties in using EMR systems, compared to the actual experiences of EMR users; and
• The vast majority of current EMR users – 90 percent – believe that their EMR system has brought value to their practice, in particular “changing the way their practice works for the better.”

The 90 percent of users who feel their EMR system has been beneficial to their practice cited the following reasons:

• Their EMR system provides an effective overview of patients’ relevant history, records and information; and,
• Their EMR system allows quick and accurate data entry.

“Our research indicates that, as intended, federal legislation is an important driver of EMR adoption among U.S. physicians,” said Dr. Kip Webb, who leads Accenture’s clinical transformation practice. “If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

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By, Rich Silverman

The two most important aspects of any electronic medical records system have been meaningful use and certification. Meaningful use, as we discussed in an earlier post, has finally been defined. Now the certification process is being clarified.

The Office of the National Coordinator (ONC) has announced the release of the National Proposed Rulemaking (NPRM) related to how certification will work. The NPRM, published in the Federal Register on March 9th, came through at a mind-boggling 186 pages.

When you read between the lines, what seems to be happening is this: The Office of the National Coordinator is setting up a temporary certification process. This will enable providers to finally be sure they are getting certified systems, and begin establishing meaningful use so they can qualify for the incentive payments. The ONC is also asking for organizations that want to be approved to perform the certifying and testing of EMR products to send in applications.

Once the temporary system is up and running, ONC will work to create a second, separate and permanent certification system for use moving forward. While the processes of certification and testing will require separate approvals from ONC, it looks as though an organization can be authorized by ONC to do both.

The rulemaking sets forth 30- and 60-day periods for public comment, after which ONC will make decisions as to the final form the testing and certifying bodies will ultimately take. The Certification Commission for Health Information Technology (CCHIT), which has been certifying EHRs since 2004, has already announced that it is ready to apply.

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Emergency Physician’s have relied on electronic medical records, in some form, for decades now. From stat laboratory data and patient locator software to integrated Zoll monitors that streamline the recording of codes, the accuracy and reliability of these data systems are paramount for delivering high quality emergency care. The sophisticated technology is undermined, however, when power failures hit and communication channels are compromised. Fortunately, contingency programs can be integrated into Electronic Medical Records Systems (EMRs).

EMERGENCY MEDICINE-SPECIFIC EMRS

The EMR System you choose needs to interface with the various systems in place throughout the hospital. From the time a patient sees the Triage Nurse and is put into a room, an ideal system would have a single interface that integrates these data with the patient’s medical history, imaging, and patient records from regional hospitals. The dozens of small steps in the process of patient care in your unique Emergency Department should be able to seamlessly integrate into a user-friendly experience. For example, if you do physical exams, x-rays and ultrasounds all in different rooms, you need your EMR to be able to automatically migrate all of the patient’s data so that it is accessible from any computer. Therefore, we will begin here with the assumption that all patient records will be easily accessible from one user interface, not multiple software programs for different types of records.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

Many trauma transfers and referral patients bring CD-ROM’s and documentation from hospitals and physicians that use different machines and software than your hospital. Choosing an EMR based on the myriad of consultant’s and referral hospitals’ equipment is difficult at best. For example, if you use the Siemens AR Star CT Scanner, but an outside hospital transfers a trauma patient with CT images on a CD-ROM from a Toshiba Asteion ER004, you need to make sure that your department’s software will be able to read the disk. The days of needing a double-dose of IV contrast to repeat a CT scan because of incompatibility are nearing an end.

BUILDING TRUST IN YOUR EMR SYSTEM

In addition to software and equipment compatibility, the right EMR for your Emergency Department should make your workflow easier, not harder. Your daily operations and patient flow through the department should not have to adapt to accommodate an antiquated EMR. It should be the other way around.

In the event of a disaster, make sure you have contingency plans for power and communications failures. Investigate the EMR you’re considering thoroughly to determine if it has the ability perform data recovery and system backup. Be sure you have a system in place that you can trust to alert you to critical developments.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

Verify that your EMR will seamlessly integrate triage notes, ER visit history, previous elopements, as well as all past medical history. Automatic visual and/or auditory notification of critical laboratory tests and contraindications for medication administration will improve outcomes. From documenting triage decisions and patient contact times, to tracking which personnel log into the EMR, many repetitive tasks can be integrated into an EMR system that curbs human error and improves department efficiency.

DICOM COMPATIBILITY

Digital Imaging and Communications in Medicine (DICOM) is a standard construct used increasingly by Health Information Systems, but it is not universal. Specifically, DICOM covers handling, storing, printing, and transmitting information in medical imaging.

Typically, different imaging systems and software are used to render different modalities, such as ultrasound, CT, and MRI. The danger of putting all imaging modalities in one viewing system is that it could fail. Therefore, redundancy and parallel backup systems are needed. Because you will view color video of Doppler ultrasounds along side plain x-rays and graphical data, the EMR System you choose will likely need to meet the DICOM standard with PACS compatibility.

Above article publish on http://www.emrconsultant.com/education/emergency-physicians-guide

By Eric Fishman, MD

It is unlikely that you will find the process of implementing an Electronic Medical Record in your office to be an easy one. However, there are a variety of activities that you can do to simplify and streamline the process, and increase the probability of success.

First, please understand that not only do you need to learn a new complicated and sophisticated software program, but you also need to undertake a significant modification of your current workflow.

We believe that we have realized a mechanism to split these two processes, thereby significantly increasing the probability of a successful implementation.

Assuming that you have made a decision that you will be implementing an EMR in the ‘not too distant future’, but are not ready to purchase one immediately, we have found that modifying your workflow to one which will more closely model the workflow that will be imposed upon you by the EMR can be very helpful during the extended implementation process.

Our current recommendations are that, again assuming you have not yet chosen which EMR you will be utilizing, are that you start to modify your workflow by utilizing a Tablet PC, and voice recognition software, so that you can get used to the process of keeping a portable computer by your side, and completing as much of the patient documentation as possible during the actual encounter.

Our current specific recommendations in this regard are that you utilize a Motion Computing LE1600 Tablet PC, with 1 GB of RAM. If you know that you will be utilizing an ASP model EMR eventually, you can save a few dollars by purchasing one with a 30 GB hard drive. If you are unsure, or if you know that you’ll be utilizing a client server model, we would then recommend that you purchase the tablet with a 60 GB hard drive.

It is our opinion that this hardware / software combination will be compatible with the overwhelming majority of EMR software packages that you are likely considering as your final choice.

There are a number of advantages to utilizing this model during the extended implementation procedure. You will have spread out the costs associated with implementing an EMR by months. The above configuration is likely to cost less than $6000.00, and you will start saving money from the onset, as your transcription costs will either be significantly diminished or altogether eliminated, thereby allowing you to save toward what will be the larger expense of the software licenses and implementation fees.

Above article publish on http://www.emrconsultant.com/education/emr-implementation

The medical community has had quite a challenge to convert to entirely medical records and, in many ways, is still in transition. Dermatologists frequently enjoy straightforward practice settings that integrate patient data on surgical procedures, patients’ historical data, and newer technologies that continue to emerge. Any more, the accuracy and reliability of these data systems are improving and high quality dermatology care is being increasingly streamlined. The sophisticated technology is undermined, however, if each piece of the dermatologist’s arsenal isn’t integrated into a comprehensive Electronic Medical Records (EMR) system.

DERMATOLOGY-SPECIFIC WORKFLOW

The term “workflow” refers here to an EMR that adapts to the way you conduct your office activities. Instead of being a cumbersome addition to your workload, the right EMR System for you can and should easily integrate into your unique office setting. For example, if you do physical exams, laser treatments and phlebotomy all in different rooms, you need your EMR to be able to automatically migrate all of the patient’s data so that it is accessible from any computer throughout your office. The days of manually scanning, uploading, and transferring patient data are over. Therefore, we will begin here with the assumption that all patient records will be easily accessible from one user interface, not multiple software programs for different types of records. This includes drawings you use to identify the locations of lesions with respect to anatomy. As you will read in a moment, all of this information can be housed within one EMR System.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

Many dermatologists acquire new patients from a host of community referral locations, with physicians that use different machines and software than they own in their office. You need to be able to verify their previous imaging for the best possible patient care and to avoid repeating any tests, particularly for staging various cancers. The problem is that trying to choose an EMR based on the myriad of consultant’s equipment is difficult at best. For example, if you use the DicomWorks viewer for viewing radiographic images, but a patient brings you a CD-ROM from a consultant that used CT Scanner from Toshiba, the Aquilion 16-Slice, you need to make sure that the EMR you choose to grow your practice will be compatible.

If you consult on patients in the hospital or another setting separate from your primary office, the right EMR can really help increase your efficiency. First, being able to view the patient’s record remotely while your taking the consulting physician’s phone call can be extremely helpful. Second, you can synchronize the data on your laptop or handheld device directly into your EMR. Taking your laptop of portable digital assistant with you on your visit to the away patient can save you time by not having to type notes a second time after the consult is finished.

DRAWING DERMATOLOGIC IMAGES IN YOUR EMR

A growing trend is for physicians to use tablet PC’s at bedside. This lends itself very easily to using EMR’s that allow you to draw on anatomical diagrams directly in the patient’s record. Traditional desktop computers also allow this feature. For example, you can outline a nevus and the EMR software will convert that to an image file that is saved with the patient record. This can be particularly useful when tracking growth. You will need to put specific notes in the text areas of the EMR for it to be searchable later.

BUILDING TRUST IN YOUR EMR SYSTEM

Dermatologists are known to conduct rather extensive excisions of carcinomas in the clinic setting. Your EMR should record vital signs in real time and trigger audible and visual notifications in the event of abnormal readings. You shouldn’t have to watch the monitor continually; rather you can control all the parameters and alarms exactly how you want them to behave.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

Appointment reminders and recurring laboratory studies frequently require valuable time from your staff. An EMR System that could integrate automatic emails or phone calls one week prior to an appointment would improve efficiency.

In addition, your EMR should timestamp and track every authorized user’s activities. From ordering special materials prior to nuclear studies, to tracking who logs into the EMR, a lot of repetitive tasks can be integrated into an office system that curbs human error and improves your practice’s measurable outcomes.

Above article publish on http://www.emrconsultant.com/education/dermatologists-guide

In the beginning there was memory. The physician’s memory was the original repository of the patient medical record. Memory was supplemented by handwritten notes on papyri in ancient Egypt and Babylon and on paper from medieval times to the 20th century. With the advent of recording devices in the 20th century, handwritten notes gave way to the infinitely more time effective practice of dictating patient notes into a recorder which were then transcribed into a typewritten or word processed document. Of course, that practice introduced an extraneous third party into the medical record keeping process: the transcriptionist with the attendant additional expense to the physician and loss of privacy for the patient.

At the current time, 21st Century technology offers physicians and health care providers a medical record paradigm that will not only vastly upgrade the process of producing, maintaining and safeguarding medical records but will, in a direct and fundamental way, actually improve the quality of medical care. The technology is Electronic Medical Records (EMRs). EMRs produce the most accurate and complete patient health record possible to date and help physicians practice better medicine as well. EMR technology is available in a plethora of shapes and sizes with a great variety of possible features. The technology can change the way you interact with your patients, from before they make their first appointment to after they’ve left your office, and have questions about their visit in your office.

As a practicing physician you are aware of the repetitive nature of some aspects of your practice, specifically with regard to patient diagnosis. It is very likely that you and/or your staff have asked the same or at least very similar questions to each of the thousands of patients you have treated. Unless you are practicing in a tertiary referral center, and never see the same condition twice, the patient answers likewise tend to be repetitive. Similarly, physical examination findings fit into certain categories that are seen over and over again. For this reason, most of the current high-end Electronic Medical Record products very capably utilize ‘pick lists’ or ‘click and point’ methodology to complete large portions of the patient medical record.

These point and click systems are particularly adept at documenting, for instance, allergies to medications, medications that are currently being taken, past medical history, family history, social history, and major portions of the physical exam. This is the case because of the narrow range of options which are available as patient responses. For instance, your patient either smokes or doesn’t smoke. And if he/she smokes, it is probably 1 ppd, or 2 ppd, or some other value that can reasonably easily be foreseen by the experts who have designed the point and click system for your office.

However, the historical portion of the patient medical record typically has a great deal of information that cannot be easily foreseen by the developers of the point and click templates. For instance, as an Orthopedic Surgeon, my patients frequently find themselves in automobile accidents. It is not likely that the author of whichever EMR may find its way into my office has contemplated the various street names and intersections in my community. Therefore, in a typical point and click system, there will be a scarcity of relevant information concerning the specifics of the accident. And I find that these specifics are important for a wide variety of reasons, not least of which is that they remind me of the particulars regarding this patient when they return to the office. Utilizing templates for the historical portion of the report, while feasible, tends to produce extraordinarily repetitive reports, each of which sounds not only vaguely similar to the previous patients, but in many cases essentially identical to other patients. This certainly makes it difficult to recall the characteristics of this particular patient.

One of the advantages of an EMR is that it allows physicians, hospitals, insurance companies, pharmaceutical companies, medical societies, and other parties entitled to view the patient data for legitimate, permissible purposes, to do so. Legitimate, permissible purposes include coordinating patient treatment, accessing diagnostic procedures and results, preventing adverse drug reactions, and ensuring medical practice within clinical practice guidelines. One particularly high priority purpose from the physician’s standpoint is that the data be accessed by third party payors to streamline reimbursement for services.

Above article publish on http://www.emrconsultant.com/education/voicerecog

By Eric Fishman, MD

There is a lot of discussion concerning which is the “best” Electronic Health Record for any individual entity. There are a variety of parameters which should be considered prior to embarking upon what will undoubtedly be one of the most important decisions in the life of a healthcare organization.

One of the most important issues is “Should I purchase an EMR designed for my specific specialty?” We will attempt to address some of the pros and cons of each option.

If you are involved in a multi-specialty clinic I would strongly advise against purchasing multiple different EMRs, one for each specialty. One of the major difficulties with this plan, and it may be all but insurmountable, is the interconnectivity between the various programs. Yes, they may all be HL7 compatible, but you will find yourself in an almost endless quagmire of interfaces.

The question is a bit more difficult to answer if you practice in a single specialty environment. There are a large number of specialty specific EMRs for a variety of specialists, including Oncology, Ophthalmology, Orthopedics, Cardiology, etc. In this instance, if you have a very sophisticated workflow, often seen in larger single specialty medical groups, then a specialty specific EMR may be most appropriate. I find that Oncologists, in particular, do well with EMRs designed specifically for their specialty. This is, in part, because many of their workflow issues are entirely foreign to almost all other specialties. This would include, of course, dosing issues concerning their cancer curing pharmaceuticals.

At the other end of the spectrum would be Internal Medicine and/or Family Practice. Most “general” EMRs are fully capable of handling most of the workflow and reporting issues found in those practices, and therefore a more general EMR would be most appropriate.

Cardiology, Ophthalmology and Orthopedics, and many others, fall somewhere in the middle. If you find yourself using a substantial number of activities that are not performed by any other specialists, such as in office arthroscopy for Orthopedists, you’ll likely find generic EMRs to be lacking in functionality. If, however, your office based practice is more standardized, by which I mean closer to the activities performed by other specialists, then the problems which may be associated with single specialty EMRs may not be worth encountering.

What are some of these problems? First of all, many single specialty EMRs are provided by companies which are both small and unlikely to grow much larger because of their limited potential user base. Certainly this is not the case of all single specialty EMRs, and there are some multi-billion dollar companies producing fine software in this arena. However, many of them are products which were started by a physician in that specialty. Their longevity in the marketplace must be considered when acquiring software of that nature.

So, in short summary, I would encourage you to take a careful look at the workflow in your office and consider how similar or different it is to other physicians of different specialties. If it is not extraordinarily different, I would go with a more general EMR. For your specific installation, that of a multi-specialty clinic, I would strongly recommend purchasing a general EMR from a company which is large enough to have developed the different workflows for each relevant specialty.

Above article publish on http://www.emrconsultant.com/education/single-multi

The new requirement for all physicians to use electronic medical records has challenged today’s Family Physicians, who already rely heavily on electronic data. This guide is intended to help you navigate this increasing complex area without losing site of your priority – patient care. From patient monitors and new patient surveys of medical history, to the sophisticated imaging and records systems your consultants use, the accuracy and reliability of these data systems are paramount for delivering safe, high quality primary care. Failure of your Electronic Medical Records (EMR) system is not an option, nor can you allow files to be lost or consultant records to be incompatible with the EMR you choose for your busy practice.

FAMILY MEDICINE-SPECIFIC EMR’S

The EMR System you choose needs to be able to integrate into your office setting. For example, if you do physical exams, EKG’s, and x-rays all in different rooms, you need your EMR to let you view updates to the patient record immediately, from any computer. Improved efficiency for your daily operations will help your office run more smoothly and with less interruptions, allowing your to spend more time with your patients and see more of them each day. The ideal EMR for you will depend on your specific office’s workflow, the equipment you and your consultants use, and the types of procedures and capabilities you plan to add to your practice as you grow. Therefore, we will begin here with the assumption that to allow for your next level of efficiency and capabilities, your ideal EMR will let you view all patient records from one user interface, not multiple software programs for different types of records.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

When you send your patients to a consultant, you frequently don’t get the benefit of viewing their ultrasounds, CT scans, or electrophysiological data to help you best interpret the test for your specific patient. As the patient’s primary physician, only you take the time to understand all of their circumstances and an EMR System that can let you see all the data that the specialists see will better equip you to do just that. The trouble is that, for example, many imaging centers and radiologists use different machines and software, so even if they send you a CD-ROM your computer can’t read it. This prolific problem is getting dramatically worse over time, as more and more technologies hit the market and you can’t predict which direction your consultants will choose. For example, if your favorite cardiologist uses iCardia Holter Monitors you may have no way of seeing the EKG tracings of your patient’s arrhythmias for yourself. If you figure out how to see the EKG tracings and then the cardiologist switches brands to Braemer you have to start all over again. Solving the endless technology challenges is not, we suspect, why you went to medical school.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

The last thing your EMR System should be is a burden to those that use it the most – your office personnel. Verify that your EMR will integrate automatic patient appointment reminders, preventive health maintenance protocols and other scheduling details unique to your practice. Mammograms, Pap smears, follow-up stress tests, and immunizations are a few issues that your new EMR System can address. This will ensure that no tests are forgotten and no one slips through the cracks on your busiest day, thereby improving compliance.

Special tests such as fasting oral glucose challenges often require that your staff spend time sending out reminders and tracking down results prior to their appointment with you. An EMR System that could integrate automatic emails or phone calls one week prior to an appointment would improve efficiency. Suffice is to say that many repetitive tasks can be integrated into an office system that curbs human error and improves your practice’s measurable outcomes.

DOCTORS OFFICE QUALITY – INFORMATION TECHNOLOGY (DOQ-IT)

The Centers for Medicare and Medicaid Services created the DOQ-IT program to encourage of adoption of EMRs and focuses on improved patient outcomes for small and medium-sized physician practices. Choosing an EMR that is compliant with DOQ-IT will provide effective billing practices, optimum pay-for-performance reporting, and improved patient outcomes.

DICOM COMPATIBILITY

Digital Imaging and Communications in Medicine (DICOM) is a standard construct used increasingly by Health Information Systems, but it is not universal. Specifically, DICOM covers handling, storing, printing, and transmitting information in medical imaging. A popular imaging viewer is the PACS system, but it does not have the best interface for some media such as video loops of Doppler ultrasounds. You will want to make sure that the EMR you choose will allow you to view imaging from your own office and that from your consultants.

Above article publish on http://www.emrconsultant.com/education/family-physicians-guide

Today’s cardiologists rely heavily on electronic data. From echocardiogram and stress test machines to catheterization suites, the accuracy and reliability of these data systems are paramount for delivering high quality cardiology care. The sophisticated technology is undermined, however, if each piece of the cardiologist’s arsenal isn’t integrated into a comprehensive Electronic Medical Records (EMR) system.

CARDIOLOGY-SPECIFIC EMR’S

The EMR System you choose needs to be able to integrate into your office setting. For example, if you do physical exams, echocardiograms and stress testing all in different rooms, you need your EMR to be able to automatically migrate all of the patient’s data so that it is accessible from any computer. The days of manually scanning, uploading, and transferring patient data are over. Therefore, we will begin here with the assumption that all patient records will be easily accessible from one user interface, not multiple software programs for different types of records.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

Many cardiologists send their patients for tests that use different machines and software than they own in their office. Choosing an EMR based on the myriad of consultant’s equipment is difficult at best.

BUILDING TRUST IN YOUR EMR SYSTEM

Besides equipment compatibility, the right EMR for your office should make your life easier, not harder. The daily operations of your cardiology practice should not have to adapt to accommodate an antiquated EMR. It should be the other way around. For example, if a patient is in your Philips Integris Cath Lab suite and their latest potassium result is 7.4, a combination of audible and visual notifications should be triggered. You shouldn’t have to wait in the Emergency Department to receive all of your laboratory results before taking the patient to the cath lab; rather you should have a system in place that you can trust will alert you to critical developments.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

The last thing your sophisticated cardiology suite and EMR System should do is be a burden to those that use it the most – your office personnel. Verify that your EMR will seamlessly integrate patient appointments, reminders, and other scheduling details. Special tests such as fasting lipid profiles often require that your staff spend time sending out reminders and tracking down results prior to their appointment with you. An EMR System that could integrate automatic emails or phone calls one week prior to an appointment would improve efficiency. From ordering special materials prior to nuclear studies, to tracking who logs into the EMR, a lot of repetitive tasks can be integrated into an office system that curbs human error and improves your practice’s measurable outcomes.

DICOM COMPATIBILITY

Digital Imaging and Communications in Medicine (DICOM) is a standard construct used increasingly by Health Information Systems, but it is not universal. Because you will view color video of echocardiograms, roentgenograms, and graphical data, the EMR System you choose will likely need to meet this standard.

Specifically, DICOM covers handling, storing, printing, and transmitting information in medical imaging. To ensure that all of the equipment and software you use can be accessed and viewed within your EMR interface, it will be important to navigate the technical areas of licensing fees versus free viewers and custom integration programming.

Above article publish on http://www.emrconsultant.com/education/cardiologists-guide