Every day, people invent new ways to use technology to make life easier, better and safer, and the medical field is no different. In fact, one of the many ways that technology has improved health care is through electronic practicemanagement(PM) software, which deals with the day-to-day operations of a medical practice. The software allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks and generate reports.
Technology also improves the practice of medicine through electronic health record (EHR) systems, which feature patients' health record information in digital format. From government initiatives to private payer incentive programs, physician practices and hospitals are feeling a strong push to more rapidly embrace EHRs. In fact, in 2004, the Bush administration publicly urged the federal government to promote the development of a secure and nationwide health information technology infrastructure to boost the quality and efficiency of health care in America.
Despite the increased attention on EHRs, however, fully 90 percent of private physicians still use pen and paper to take notes during patient visits. For physicians, knowing that they must implement EHRs is one thing, but figuring out which program strategically fits their needs is another — especially if they have to successfully integrate a new EHR system with PM solutions already in place.
The first and biggest decision for physician practices really comes down to their level of satisfaction with current PM software. Based on that assessment, when making the decision to move to an EHR, potential customers can then look at all-in-one or best-of-breed software offerings.
While in many cases, a physician's office is likely to be working with existing PM software, decision-makers might be displeased with the product and looking for a way to upgrade at the same time as they investigate EHR product options. In this case, an all-in-one product offering may be the best bet. Think of it as one-stop shopping for both a PM and EHR solution, with one vendor offering a fully integrated software package.
The caution here is that some vendors market all-in-one solutions that are actually multiple applications with multiple databases, bolted together and given a single name. The vendor's claim to being a single source rests on its ability to install and integrate the systems. A potential weakness of the all-in-one approach is that some products lack flexibility and expansion capabilities. Note, too, that with best-of-breed applications, practices can pick and choose each component to meet the specific needs of their practice; all-in-one solutions sometimes package the good with the mediocre. Careful selection ensures that a comprehensive package truly offers everything a practice needs.
For physician offices already well-acquainted and pleased with their PM software, a standalone EHR solution that can smoothly integrate with existing software is a better bet. This approach enables the practice to embrace the move toward — and the benefits of — the EHR without having to learn an entirely new PM system at the same time. For many, the thought of changing or adopting both systems at once can be daunting.
A best-of-breed solution generally involves multiple systems such as an EHR, a PM system and separately purchased specialty applications. Vendors work collectively to tie together applications and pass required fields between multiple databases. One potential drawback: Some buyers may worry that a newly purchased EHR system will not fully integrate with the practice's current technology systems. However, as long as the customer chooses a product with proven integration partnerships, this should not be an issue.
With the best-of-breed choice, physicians will not be dissatisfied with having a top-quality EHR system and a second-quality PM system; both systems will meet quality standards.
If you'll be involved in decisions on EHR and/or PM systems, consider the following points essential to your basic due-diligence and planning efforts:
- Audit the practice for good processes. Instead of merely automating paper processes, revise workflows and optimize processes for the type of system being implemented.
- Decide which functions and components are most critical to the practice and the staff.
- Educate business decision-makers on the differences between all-in-one and best-of-breed strategies; understand the value proposition for each strategy.
- If moving toward an all-in-one solution, discuss with staff how to manage the simultaneous and pervasive change without negative impact to the practice.
- If moving toward a best-of-breed solution, talk with the EHR vendor to make sure the new system will smoothly integrate with current systems.
- Solicit opinions from staff on which functions they'll need to make a successful transition.
Making an impact
Health care practices and hospitals continue to migrate to EHR and PM systems. And while perhaps frustrating at first, the end result will be extremely worthwhile. In fact, even for small- to medium-sized doctors' offices, it doesn't take long for an EHR to pay for itself in terms of increased efficiency and improved quality of care, truly allowing doctors to determine how they want to run their practice.
Mr. Smyth is president and CEO of Spring Medical Systems.
EMR Trends and Usage
The Medical Records Institute (MRI) published its most recent survey of EMR trends and usage in October 2007. (Philips Speech Recognition Systems co-sponsored the survey.) According to MRI, 1,011 individuals responded to the survey. To increase relevance and diminish bias, MRI eliminated vendor and consultant responses, reducing the total response database to 819.
Nearly 64 percent of the respondents described themselves as either final decision-makers or having strong influence in EMR decision-making. That percentage increased to 89 percent when including respondents who said they have some influence in EMR decision-making. According to MRI, the role categories most represented among respondents were IT managers/ professionals and physicians/ nurses.
Drivers and barriers
Based on survey responses, here's what MRI concluded about EMR implementations:
- From a strategic IT perspective, EMRs are being implemented to improve clinical processes or workflow efficiency and to improve the quality of care.
- In the hospital segment, the factors driving the need for EMR systems are patient safety considerations, efficiency and convenience, and satisfaction of physicians and clinician employees.
- In the medical practice segment, the factors driving the need for EMR systems are improved patient documentation, efficiency and convenience to physicians through workflow benefits, and remote access to patient information.
- Barriers to implementation plans include lack of adequate funding or resources; anticipated difficulties in changing to an EMR system; difficulty in creating a migration plan from paper to electronic documentation and recordkeeping; and an inability to find an EMR solution or components at an affordable cost.
Current and planned usage
Survey respondents named the following EMR data-capture, review and update applications as most in use:
- patient demographics;
- allergies and adverse reactions; and
- lab results.
Reported as least in use:
- problem knowledge couplers;
- pre-visit health screenings, evaluations or assessments; and
- post-visit patient education.
Cited as the most-planned applications:
- pre-visit health screenings, evaluations or assessments;
- alerts, warnings or reminders generated by decision support;
- problem knowledge couplers; and
- post-visit patient education.
Effect on the organization
In terms of the EMR's effect on their respective organizations, respondents reported the following:
- Almost two-thirds rated quality of care as improved by EMRs.
- Over half rated patient safety as improved by EMRs.
- More than half rated efficiency in health care as improved by EMRs.
- Over 90 percent expect that EMRs will help improve quality of care, patient safety and efficiency 10 years from now.
Source: Medical Records Institute
Source: Vol. 12 •Issue 2 • Page 47, EHR & PM Solutions, How happy are you with your current practice management system? Your answer will determine your approach to choosing an EHR system.,