For Providers, EHR Technology Minimizes Pain and Maximizes Gain
A recent editorial in The New York Times noted that electronic health records (EHRs) could “save substantial money” because they will “help eliminate the costly repetition of tests, and prevent medication errors that harm patients and lead to costly hospitalization.”1 At the same time, the paper not
USA (September 01, 2009) –
For Providers, EHR Technology Minimizes Pain and Maximizes Gain
September 01, 2009
GraphA recent editorial in The New York Times noted that electronic health records (EHRs) could “save substantial money” because they will “help eliminate the costly repetition of tests, and prevent medication errors that harm patients and lead to costly hospitalization.”1 At the same time, the paper noted, “it takes money to get started.”2
With these goals – and challenges – in mind, the federal government has already taken steps to help physicians implement EHR technologies. The American Recovery and Reinvestment Act of 2009 allocates $19 billion for health care information technology,3 including up to five years of Medicare incentive payments – which range from $42,500 to $63,7504- to eligible physicians who meet “meaningful use” criteria for integrating EHRs into their practices. These carrots, however, are soon followed by sticks. The Act imposes escalating reductions in reimbursements for non-adoption of meaningful use-compliant EHRs after the end of the five-year period.
The National Coordinator of Health IT is charged with defining meaningful use, and has asked the HIT Policy Committee to develop recommendations. On July 16, the Committee proposed that EHRs meeting meaningful use guidelines would support as clinical decision making, facilitate electronic transmission of prescriptions to pharmacies and electronic submission of claims to payers, as well as enable greater access and sharing of clinical information with patients.
“Providers need to understand that the stimulus funds being offered will make the financial implications of EHR implementation easier to manage, and that they need to get moving today in order to earn those incentives,” said Bill Scatchard, vice president, Ingenix.
Physicians taking another look at EHRs
Russell KeeneMost health care providers already recognize that use of EHRs can bring benefits to administrative functions, patient care and overall safety, but they have been reluctant to invest in client-server-based EHR systems because these systems are often cost prohibitive and labor-intensive. With new financial incentives now available, many physicians are taking a fresh look at their EHR options.
“It’s not really a matter of whether physicians will implement EHRs, but when they are going to do it, because the paper system is broken and the government is driving all of us to go electronic,” said Pablo Rodriguez, M.D., CEO and president, Women’s Care, in Providence, R.I. “I never realized that our practice was spending close to $40,000 a year for new patient charts, which covered such supplies as files, liners and paper clips,” he said. “Paper pushing is costly and the federal stimulus money is limited, so the time to act is now.”
With many factors in play, “there is no question that the EHR ball is gaining momentum as it rolls down the health care reform and quality improvement hill,” Scatchard noted. “Physicians need to quickly find a system that they can fund, learn and connect.”
Overcoming cost, connectivity roadblocks
EHR systems are supposed to improve a physician’s quality of life and his or her ability to provide better patient care. A 2009 survey conducted by the eHealth Initiative on the state of health information exchange (HIE) found that HIE has had a positive impact on physician practices by improving access to test results, improving quality of practice life, and reducing staff time spent on handling lab and radiology results and on clerical administration and filing activities.5
Despite this potential, physicians continue to have concerns related both to the initial investment in an EHR system and the possible negative effects EHR implementation may have on the practice’s productivity. Connectivity also is a concern, because a provider encounters multiple stakeholders – e.g., hospitals, labs, radiology vendors, etc. – in a given day. Managing the adoption of an EHR system and the integration of its stakeholders’ systems can be both expensive and frustrating using a client-server-based system.
“Providers are not going to achieve successful deployment if they are operating as an island,” Scatchard said. “As they move from their present state to an automated, electronic environment, they are learning a new language and need to manage the challenges within their own setting. But physicians can’t achieve their goals if core functionality is not present and if their office is so burdened by managing the system that they have less time for patients.”
Further, under the meaningful use provision, just being connected is not enough to qualify for stimulus reimbursements, explained Russ Keene, vice president, Ingenix. “Doctors who invested in server-based systems have found that they are expensive, are only used by a portion of the market and haven’t moved the needle on quality and cost, which means they may not achieve that benchmark.”
Web-based solutions offer enhanced functionality, flexibility
To ensure that the practice’s and the government’s goals for an EHR system are met, physicians should adopt a web-based solution that is more likely to serve their personal, practice and patient care needs, instead of a server-based application according to Scatchard. Web-based EHRs build on a common set of data and functionality that providers can tap into from any location – through a secure and centralized gateway – without having to build, maintain or manage the system on their own.
To provide physicians with a flexible solution with expanded connectivity at a reasonable cost, Ingenix offers CareTracker EMR, a CCHIT-certified,6 web-based EHR application. Upon installation of the system, CareTracker EMR instantly connects physician offices to thousands of lab testing providers and hospitals, as well as pharmacies and prescription benefit manager programs across the country. The capabilities and connectivity offered by CareTracker EMR allows physicians to access patient records and review medications, patient history, recent orders and lab test results, and to identify lower-cost medication options. The system fuses clinical, billing and administrative workflows together and integrates them with Ingenix coding and compliance solutions, enabling users to work with greater speed, agility and efficiency.
“From the first minute Ingenix delivers the system to the end user, it is content-rich, with thousands of pieces of data, including insurance company names and addresses, referring physicians, CPT and ICD codes, modifying dictionaries, etc.,” according to Scatchard. “At no point in time are providers expected to create or manage this content.”
Because practices do not have to create their own systems or make large equipment purchases, physicians choosing to implement CareTracker can go live within 60 days of entering into a contract with Ingenix. During that time, Ingenix staff works with the practice to personalize the content with, for example, a drop down list of the providers and facilities they interact with, a subset roster of the codes they use the most, or modifications of the note structure.
“We work closely with the provider to make sure we get things right, because we believe it is critical to support the client with the customization they need,” Scatchard said.
In addition, CareTracker EMR’s web-based approach “accelerates the amount of change we can bring to our application,” he said. “Under a server model, if the government makes a small change on a form it is very labor-intensive to affect that change in a timely manner. By serving software to clients via the Internet, it’s easy for us to make changes, and disseminate them quickly to all CareTracker end users,” he explained. “CareTracker EMR is always new, always changing and always keeping pace with what’s happening in the industry.”
Unlike the pay-in-full upfront server financing, Ingenix bills providers monthly – as low as $360 per month – for its services. “We like to think that every month we have to earn our clients’ business, which means we’ll do whatever it takes to make sure our product works for their specific situations,” Keene said.
Preparing to make the EHR leap
Scatchard advised physicians who are ready to make the transition to an EHR to spend some time – in advance of working with a vendor – examining their environment, analyzing their workflow and establishing some consistency among practice partners. “For example, doctors in the same practice likely have very different ways of documenting information, so it is in their best interest to come to some sort of agreement on what they want to capture in the note structure before they sit down with a vendor to customize that template,” he said. Scatchard also advises physicians to consider an incremental approach to EHR adoption, starting with pain points that plague the practice, such as lab result faxes.
“There is a temptation to just go for it, persevere and be happy on the other side,” Scatchard said, “but a more segmented on-boarding approach that starts with only specific encounters, such as new patient visits, and specific processes, such as pharmacy refill requests, likely will be more satisfactory.”
Rodriguez reports that his practice’s gradual approach to adopting CareTracker worked well. “You do not want to go through this cold turkey, because you will take a significant productivity hit,” he commented. “If you choose to start with the segments of your practice that are more predictable and easier to manage, you’ll be much better off.”
Rodriguez also recommended that there be a physician champion of the EHR solution within the practice to help smooth out issues and staff complaints that may emerge during the transition. “You need someone on point to say, ‘I know this is different and we have to learn a new process, but this is going to work and we are going to see efficiencies,'” he said.
For Rodriguez, there is no question that the transition was worthwhile. “Most people look at EHRs as money savers or something that will add value to their practice, which they are,” Rodriguez added. “But in reality, CareTracker has allowed me to be a better doctor.”
“Curbing Runaway Health Inflation,” The New York Times (Aug. 2, 2009).
Id.
American Recovery and Reinvestment Act of 2009, H.R. 1, Title XXX, Sec. 3001.
“H.R. 1, the ‘American Recovery and Reinvestment Act of 2009’ explanation of Health Information Technology (HIT) Provisions,” American Medical Association.
“Migrating Toward Meaningful Use: The State of Health Information Exchange, eHealth Initiative’s Sixth Annual Survey” (released July 22, 2009).
CCHIT (The Certification Commission for Healthcare Information Technology) confirms that Ingenix CareTracker, Version 6.2 from Ingenix is a CCHIT Certified Ambulatory EHR.
Source: Ingenix
