|
by: C. Peter Waegemann
The beginning of the 21st century heralds a major evolution driven by new technologies and the integration of computers into professional practice. In healthcare, the evolution is dramatic as it involves new approaches.
Healthcare delivery has been and continues to be widely inconsistent because medicine has traditionally been considered an art. The practice of medicine is often uninformed because physicians and other clinicians sometimes must provide patient care blindly, that is, without knowing what has been done previously and by whom. This results in wasteful duplication and clinical decisions that do not take into account critical data related to patient health. Further, memory-based decision making cannot keep up with the ever-growing scientific body of medicine.
The move to electronic medical record systems also marks the change to computer-supported and computer-guided healthcare. The benefits of widespread adoption of EMRs are clear and have been widely acknowledged: increased patient safety, higher efficiency, improved quality of patient care and lower costs.
But these benefits are far too broad to justify a practice to embark on the investments for an EMR. What are the real advantages among providers who have implemented EMRs? The Medical Records Institute is conducting a series of EMR Road Shows that allow us to speak with thousands of physicians who either have implemented an EMR system or are about to do so.
Benefits of an EMR System
A major insight gained through these Road Shows is that there is not one way to success with EMR systems. Depending on specialty, workflow and other factors, each practice has a different experience when implementing an EMR. But in general terms, providers have experienced financial gains, better competitiveness, better decision making through computer guidance and higher efficiency in workflow by implementing EMRs.
EMR systems can reduce costs and bring in more revenues. Ways to cut costs are numerous and range from saving transcription costs through more effective computer input and speech recognition to savings from eliminating paper charts and their filing and storage costs. On the revenue side, there are many examples that show how EMR systems can capture otherwise lost charges and even up-code as documentation-driven charge capture can bring higher revenues.
A healthcare provider might want to improve the competitiveness of her practice. This can be done through electronic communication with external care providers, easier connectivity with hospitals, and the creation of routine and customized reports. Integration of the Continuity of Care Record (CCR), which is a core data set informing a provider of all relevant health information of a patient, can also be a major benefit.
There is no question that EMR-based information systems can provide much better support for decision making. Whether it is through formularies that assist in medication selection or by providing information regarding potential adverse reactions, computing systems delivering real-time decision support can help. And beyond medication issues, decision support for diagnostic information and a range of other areas can contribute to improved quality of care.
When we asked hundreds of people who have implemented an EMR system during the last year what they thought the most important benefit of an EMR system was, the great majority responded, “It is the workflow and having total control of my workflow.” This is difficult to explain to physicians who have not taken the step toward electronic medical records. Having total control over the practice means that the physician does not have to wait for a support person to find a chart, can answer phone calls immediately with the information available on screen, can facilitate a patient’s flow through the intake, exam, and follow-up process, can access test results instantly, and much more.
Analyzing Workflow Efficiency
The Medical Records Institute often gets requests to identify “the best EMR vendor”. Our response is that the EMR system is just a workflow tool. Success and failure of an EMR system depends on the workflow, and each system is different in the same way as each practice has a different workflow model. There is a wide range of available systems and not every EMR system offers the efficiencies described below. The Medical Records Institute follows some 316 vendors of EMRs. Not only do the services provided by vendors differ, but so do their features and prices, e.g., software may cost from $300 per physician to $60,000 or more per physician.
EMR systems can bring benefits to the registration process. In a few years, a patient on the way to a doctor’s appointment might call in his CCR that includes all payer data including co-payments. The CCR also provides the pertinent health history, a comprehensive medication list, and all other relevant health status information. More than 50 companies include the CCR in their EMR system today, and others are working toward doing so.
Many providers today are benefiting from direct patient entry. To avoid the time-consuming process of a physician asking the patient questions, computers in the waiting room enable patients to input their health status. The physician only validates the answers patients given to the computer-generated questions. This saves time and efforts and can improve the accuracy and completeness of patient information.
When orders are done on the computer, a “clarification call” is less likely to be needed. And if there is such a call, let’s say, from the pharmacist, the physician does not have to wait for the chart to be pulled but can access information instantly on the computer. Prescription refills are also much easier and time-saving. Another great benefit is automatic results management. When test results arrive, they usually are color coded. Normal test results are green and do not require any action, not even filing. The provider can focus on the problematic ones, usually color-coded in orange and red.
Workflow changes are necessary in the documentation process so that documentation can be done at the point-of-care, that is, when the clinician is in the exam room with the patient. This can be achieved through alternatives to medical transcription, such as front-end speech recognition and structured data entry alternatives such as templates and efficient and user-friendly point-and-click systems.
EMR systems also offer better time management through remote computing. Rather than finishing documentation in the office at the close of appointments where there is access to paper charts, physicians with EMR systems can go home before 6 o’clock, join their family for quality time, and then remotely document the day’s visits, when the children are in bed, or on weekends. And one should not forget that with real-time documentation there is no need to review transcribed notes and affix one’s signature at a later time.
Electronic communication also affects workflow and office practices. Instant communication with other providers, such as hospitals, makes life much easier. Also, patient communication is more efficient when done by secure email. Many payers accept charges at specific rates for a virtual visit that involves an email-based encounter. Patients are also attaching digital photos or videos to their email messages, providing the physician with an image-based documentation of the symptom or complaint.
Some surveys show that up to 65 percent of physicians obtain guidelines electronically and approximately 50 percent exchange clinical data through computer networks. The benefits to workflow are significant.
Computer-generated patient education also saves time, improves efficiency, and affects workflow. The provider is able to generate guidance sheets for medication, exercises, or other patient activities with the touch of a computer key. This saves time previously used for explaining and enables the patient to review the material later as well. Often, patients are given Web addresses where they can read more about their medication. This reduces call backs and improves patient compliance.
When implementing EMRs, many providers report that the documentation and e-prescribing processes take a little longer with an EMR than with handwritten notes or transcription. Such additional time can be balanced with the savings and benefits achieved by workflow changes. As mentioned, not every system has all the workflow features described above. Therefore, it is important to determine in advance which workflow features are most desirable for a provider. Staff considerations are a key element in workflow changes. There is the example of a physician who was part of an eight-partner practice with a support staff of 4.5 full-time employees per physician. He was very unhappy because he did not have enough time with his patients, did not have sufficient time with his family, and felt underpaid. By establishing his own practice and workflow, he now has only one medical assistant, more time for his patients and a better quality of life as he spends more time with his family, and he makes more money. He achieved this by a dramatic change in workflow and the inclusion of speech recognition for himself and his assistant.
This is just one example how EMR-based workflow changes can provide better income, a better quality of life and better health care.
C. Peter Waegemann is the chief executive officer of the Medical Records Institute (www.medrecinst.com) based in Boston. The institute conducts up to 70 educational events for physicians throughout the year. Waegemann was the Chair of American National Standards Institute’s Healthcare Informatics Standards Board, which coordinates all standards activities for healthcare.
|
