Archives : electronic medical records

Time to throw in the towel on private practice…or is it?

I don’t buy it.

An article in the New York Times today titled, “More Doctors Giving Up Private Practices,” told the story of an increasing number of physicians who are finding their “bliss” through employed, salaried positions, rather than at the helm of their own private practice.  The reason – increased costs, decreased pay, and ultimately unhappier doctors in the private practice environment.  Again, I don’t buy it.

The article spoke of the increasing financial burden on physicians who, in order to keep up with the demands of today’s healthcare arena, must invest heavily into expensive electronic medical record systems (EMR) and practice management softare (PMS), along with the staff required to collect payment from a growing number of patients who lack the financial wherewithal to pay their bills.  Sure, the challenges are real, but it’s still bullhonkey.

The silver lining in this shift toward larger, safer, and inevitably more monopolized healthcare practice – if there is one – the article goes on to say, is the continuum of care that is far facilitated by larger, more integrated systems which employ large numbers of physicians from a variety of specialties.  Not convinced.

The Medical Group Management Association (MGMA) reports - according to the article - that in 2005 more than 67% of medical practices were physician owned, however three short years later this number had dropped to below 50%.  With admitedly disturbing facts such as this, and the industry knowledge that is near and dear to my heart – that private practice owners are, in fact, struggling in pockets across the country – how could I possibly scoff at the fact that an article in the New York Times suggests that quite possibly it is time to throw in the towel by the physician masses?

Because it’s short sighted, cowardly, and undermines the creative and entrepreneurial fabric from which many of our country’s greatest practices are woven.

In a nutshell, it’s the wrong way to go.

I’ve been around healthcare my entire life, and my professional career has known nothing else.  I care deeply about people, and understand that passion, freedom, autonomy, and creativity are the inspiration behind the greatest care that our country can offer.  I also understand that in order to attain autonomy, passion, freedom, and creativity requires risk, hard work, and often times, failure.

I’ve worked salaried positions and have spent much of my life in a risk averse bubble, looking fondly at the status quo and fearing anything that risked upsetting it.

But I’ve also lived the other side.  The side that guarantees nothing, but promises everything.  The side that allows me to be exactly who I’ve been created to be, and to relish in failure as it is a means by which I will improve my service to others.  It is this side about which I am passionate, and about which I know I can change my life, the lives of others, and through my current mission with Vantage Clinical Solutions, change healthcare.

I don’t think the healthcare industry is going to benefit from bigger companies who can promise the world to its salaried professionals, while placing handcuffs on the passion and creativity that comes only with the ability to chart one’s own professional course.  I don’t think the continuity of care is going to suffer if small town doctors have to refer to one another rather than down the hall in order to provide the specialty care that is needed of their patients.  And I don’t think that failure is inevitable to those who try to make it work.

There are challenges, yes.  We, at Vantage Clinical Solutions help private practice owners deal with them everyday.  We feel the pressures of the economy just like the next guy.  The difference is that we see the challenges as an opportunity to look to entrepreneurship, creativity, and innovation as the tool from which our problems will be fixed.

We understand that the “corporate” way which benefits from huge economies of scale and infrastructural efficiencies does indeed have merit – but more importantly we know that it is not the only answer.  We work with numerous private practice owners every day who are delivering healthcare their way, doing it profitably, and changing their patients’ lives in the process.

At the risk of belaboring my diatribe of a post, I do want to make clear that I understand that entrepreneurship indeed is not for everyone, and the thousands upon thousands of professional, caring, and excellent healthcare providers who do thrive in the corporate, structured environment, need not change a thing.  Indeed, consolidation and centralization is a viable solution to many of the challenges we face in the healthcare industry.

My point, however, is to suggest that it is not the only solution, and to those who’s fuel does come from a burning passion to create, be different, and deliver care in their own way – bear down and get after it.

The system that the NY Times article speaks of is not for you.

Electronic health records: Panacea or problematic?

I’m a big supporter of electronic health records (a.k.a. EHR, electronic medical records, EMR, personal health records, PHR, and on and on).  The benefits are too many to do it justice in this short post, but efficiency, error control, speed, automation, and interconnectivity are among some of the most desirable aspects of the technology.

But is EHR / EMR all it’s cracked up to be?  Are there reasons NOT to adopt?  Are electronic health records for everyone?

The answers to these questions depend on who you ask, but in an effort to persuade you that I am [attempting to be] unbiased in my opinion, let me disclose to you that our company is, in fact, in the EHR business – yes, we provide EHR / EMR solutions for healthcare practices.  And, no – we don’t think it’s for everyone (at least not right now).

First off, electronic health records can be expensive.  And while the long term savings associated with EHR / EMR implementation overwhelmingly pencil out very much in favor of the technology, cash flow is undisputably a more real issue over the short term.  Hence, regardless of the long term advantages to EHR / EMR, if the numbers don’t support it over the short term, it simply won’t work. 

Now, this is not to say that many web-based and/or software-as-a-service (SAAS) models out there don’t mitigate this issue quite effectively – they do.  But you get the point – if you don’t have the cash, you can’t benefit from the technology.

Second, and perhaps much less understood, electronic health records can be painful. 

What, you say?  The Obama Administration has included greater than $20 billion for EHR adoption in the stimulus package, and EHR’s are painful? 

Yep, absolutely.

EHR / EMR use is different than using paper.  It’s better in a number of ways, but for anyone who’s ever made the quick decision to write a phone number down on a Post-It Note rather than logging into their smartphone, navigating to the contacts menu, creating a new contact, and then punching in the number on tiny little keys, you’ll know what I’m getting at. 

Using EHR / EMR in many circumstances – especially those in which the provider has to peek over the top of a computer screen in a cramped little office just to make eye contact with their patient – is awkward.  It’s often not as fast as jotting down a note, and it’s certainly not as natural.  Hence, it’s often difficult to get buy-in from providers.  And hence, the pain.

If not managed well, the transition to electronic medical records can be an outright disaster.  In my opinion – the opinion of a web-based EMR provider – if the transition is not going to be managed correctly, EMR / EHR is not for you…at least not now. 

Managing the transition correctly means educating the staff on which aspects of care WILL be different, getting buy-in from EVERYONE in the office, and having the technical support AVAILABLE to deal with issues as they inevitably come up.

OK, enough of my short little rant on the topic.  Here is an insightful post from the Wall Street Journal that takes a look at the issue, citing other problems with EMR / EHR usage, including mention of a study that explored a rise in the death rate for certain patients after the adoption of an EMR / EHR system at a pediatric hospital.  Scary, but true.

At the risk of sounding contradictory, I’d like to end with this thought – electronic health records ARE our future.  We will all have them, use them, and rely on them more and more each year.  Are they a panacea?  No – not in my opinion.  Should we adopt them now?  Yes – if we can find the financial and operational resources required to keep the doors open to our practices while administering a safe and organized transition to the technology.  EMR / EHR has too many benefits to count, but it MUST be done correctly.

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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO.  Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.

Standards: The answer to widespread adoption of personal health records

As much as electronic medical records (EMR’s) have been the topic of conversation in the healthcare profession over the last 10 years, most of the buzz has been around the “potential” rather than “impact” of the technology. 

One of the main reasons for this is that there exists a lack of standards that allow for the transfer of information between EMR systems.  There are some great EMR systems out there, but for EMR’s to really catch on, they need to be both cost effective and efficient for providers.  For all users of EMR’s to achieve this, one of two things needs to happen: (1) Everyone needs to get on board with the same system, or (2) we agree to, and abide by development “standards” that will allow systems to communicate with each other.  Since getting all providers on board with one EMR platform is unrealistic, the answer to widespread adoption likely lies with the development of standards that will allow systems to integrate together, and that will lower the switching costs associated with moving from one system to the next.

With regard to personal health records (PHR’s), the same is true, and the battle between Microsoft and Google to become the preferred PHR system by consumers and providers has recently brought the issue of “standards” to the forefront.  This article from WashingtonPost.com discusses how Microsoft, Google, and some other PHR developers have agreed to move forward with privacy standards in the development of electronic personal health records – an important step toward widespread adoption by healthcare consumers.

In a move designed to prompt more people to store their medical records online, Microsoft (NSDQ: MSFT), Google (NSDQ: GOOG) and several others have agreed on privacy standards to protect patients’ information. The list includes WebMD (NSDQ: WBMD), MedicAlert, AARP,Consumer Reports publisher Consumers Union, BlueCross BlueShield, and other insurers.

Choosing the right practice management software for your practice

I wrote this article for the April 2008 issue Impact magazine, a professional journal that is read by owners of private practice physical therapy clinics throughout the U.S.  The information is applicable to all types of healthcare practices with regard to choosing a practice management software package that is the right fit.

We all know that practice management software is here to stay. And while this is the case, there are still challenges associated with the use of management software in today’s physical therapy practices. It is not inexpensive to implement a comprehensive software or service, and practice owners can be left with a feeling of buyer’s remorse if expectations are not fully met.

Having a clear understanding of the benefits and exactly how they will affect your practice is of paramount importance when choosing practice management software or service that is right for you.

This article will focus on (1) the benefits of using practice management software, (2) a process that can help determine if a software or service is right for your practice, and (3) recommendations to consider in your personal pursuit of the right practice management solution for your facility.

Value in finding the right IT person

More often than not, a medical practice will hire the IT “guru” or “specialist” down the street to handle their information technology infrastructure, deployment and ongoing maintenance.  In addition, they may rely on this person to help make decisions for a new electronic medical records system or a clinically-related piece of electronic hardware.  What often is missing in these processes is the person (or group) that has knowledge of efficient, integrated IT systems AND understands provider needs, medical practice workflow issues, cost-effective purchasing, cash flow analysis and long-term business strategies.  These things are all tied together and should be handled as such in the decision making processes – whether it be to purchase all new workstations for the clinic or to roll out an entirely new electronic medical records system.  This is where the decision to hire an IT consultant with medical facility experience can make all the difference.  Yes, this person may be more expensive than the IT “guru” down the street, but wouldn’t you be willing to pay $10,000 more now to save $50,000+ in the years to come.

Just as a layperson is impressed by someone introduced as “Dr. Jones”, who may be anything from a neurosurgeon to a chiropractor to an economist, an “IT specialist” may be a high-school graduate (if that) who has decided to hang his computer shingle out for business. And don’t rely on someone with no technical training who is considered “computer-savvy” by friends or colleagues.

In his article, Peter Polack lists some additional thoughts for consideration in finding the right IT consultant.

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