Archives : EMR

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: Where are the malpractice risks?

As a follow up to the April 21st post by Tannus Quatre, “Electronic health records: Panacea or problematic?“ the push is on to move our country’s health-care documentation system into the electronic age. The recently passed American Recovery and Reinvestment Act, allows for federal subsidies of up to $44,000 for physicians who demonstrate meaningful use of EMR by 2011.  When the financial incentive is there, it will get done.

A recent  article by Steven I. Kern, Esq. entitled Hidden Malpractice Dangers in EMR’s outlines some of the dangers in using electronic systems for documentation. However, the real issue is the current shift in the ”standard of care” which creates more risk for practitioners notto use EMRs in the future. Linking clinical practice, documentation, and billing procedures will become the standard of care. Those practices that do not have such linkages may face increased scrutiny from payers and potential demands for repayment.

The malpractice risk associated with the use of EMR’s tend to result from misuse of template driven documentation. Provider complacency and a push for shortcuts always tends to create malpractice concerns. Proper training and ongoing efforts by physicians and other providers using EMR’s to avoiding misuse of templates should mitigate these malpractice risks.

The primary risk that is left is not using EMR’s as it will soon become the “standard of care”.

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.

Massachusetts healthcare policy gets a shot in the arm – actually, it gets three

How’s this for a healthcare policy trifecta? – Gift bans for pharma reps, $25 million in EMR incentives for private practices, and university requirements to boost primary care graduates.  Three big issues in healthcare today…one clean law to deal with them.

Tackling major issues in healthcare policy isn’t easy, and tackling three large ones with one fell swoop is quite ambitious.  Pushed forward by Senate President Therese Murray, the new Massachusetts law was signed into law yesterday by Governor Deval Patrick.

The law is just the beginning however, and much more planning will be required to achieve what the law intends over the coming years.  Read more about the law at the Boston Globe.

Patrick’s Human Services Secretary JudyAnn Bigby said that while universal health insurance is an important goal, the current system is lacking if everyone cannot get access to quality care, or premiums and out-of-pocket costs become too costly for patients.

“We have to make sure that people have access to high quality care and that we are being efficient in the way we pay for that care and that we are paying for the right things,” Bigby said in an interview. The law Patrick signed yesterday “puts the challenge to those of us who have to implement it to do more planning.”

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.

Change Management Key to EMR Implementation

I have assisted with Electronic Medical Records (EMR) roll-out into a number of small to medium sized healthcare clinics.  Careful planning and management of these projects is important for successful EMR implementation and seems to become even more critical as the number of employees in a practice rises.  I came face-to-face with this recently as I assisted with the implementation of an IT infrastructure and a software package into a 7 physician practice with 33 employees.  Planning, management, and communication at all levels of an organization is a lot simpler when you are dealing with a handful of employees – you can actually get them all in the same room for at least a short period of time.  But, increasing this number to a clinic the size of 33 employees is quite another thing to plan for and manage.  Communication has to be more formally planned out so that it reaches all levels of the practice.  Furthermore, the skill sets and culture of the entire organization needs to be carefully analyzed (i.e. you can’t assume that everyone knows basic computer skills or that they even want to know).

Peter Polack, in his recent post on Medical Practice Trends, offers that applying the principle of “change management” will make EMR implementation much more successful.  He includes ten principles that should be considered for anyone that will be managing the implementation of a new EMR system.  These principles include such things as “addressing the human side”, “involving every layer”, “creating ownership” and “communicating the message”.  Glancing through these principles one might think that they are simple common sense considerations.  They are.  However, omiting any or not creating a plan to effectively use these principles could be the difference between success and failure.

Many “failures” of EMR systems have as much to do with poor planning and implementation as with deficiencies in the software itself. This is especially true when it comes to the changes that occur on the human side. Planning how a new EMR system will integrate within a specific practice before actually installing the software will be time well spent and, ultimately, will benefit the bottom line.

EHR’s: We’re on the right track, but it is going to take a while

Electronic health records (EHR’s) are of obvious benefit to the long term plan for reducing costs and improving delivery of healthcare services worldwide.  To achieve the ultimate end result of a healthcare record system that will facilitate communication between providers, allow for quick entry of data, and that will be provided on a large enough scale to impact the healthcare industry as a whole is going to still take some time however.

Currently, EHR consumers (hospitals, medical practices, physical therapy clinics, and dental offices) benefit from significant competition within the EHR market which has been effective in bringing the price of such systems down over recent years.  This is of obvious benefit, however the market is so ripe for competition that the lack of unified standards that allows for communication between systems has posed implication to practices that have made leap into EHR’s, but whose systems don’t necessarily communicate well with other providers in their community.

This article from Ars Technica refers to this issue as illegible handwriting in the digital age, and comments on some of the main players involved with bringing forward the standards necessary to make EHR a safe, effective, and cost-efficient tool for private practices and hospitals in the United States.

Doctors’ poor handwriting might be a cliché, but being able to accurately read medical records can often be a matter of life and death. The ubiquity of the personal computer has allowed the clinic to enter the digital age, and given that computers excel at managing information, the development of electronic health records (EHR) has been a no-brainer. Despite this, EHR adoption in the US and elsewhere has been slower than some might like, and at least one presidential candidate has made their widespread adoption a healthcare policy platform plank, promising widespread savings through increased efficiency.

Unlike other software markets, where a single player controls the market (such as Microsoft with Office), or where there are but a few solutions, the EHR field is one of byzantine complexity. There are dozens of different software packages and competing products. In this article, we’ll look at the state of the EHR field, along with some of the benefits and problems associated with their use.

Preventing “peeking” into electronic medical records

For large healthcare organizations employing hundreds, if not thousands of staff, it is clear that there must be in place the ability to audit what staff see in regard to patient medical records.  In small private practices HIPAA requirements are the same, so shouldn’t the ability to audit the eyes of curious staff be the same?  Certainly.

Borrowing from the hype caused by the recent snooping of Britney Spears’ medical record by UCLA staff and physicians, this article from MedBlogger.net provides commentary on the audit trail capacity of EHR systems, and how it can deter and detect unauthorized entry into the medical record – regardless of practice size.

An EHR must be able to create an audit trail to comply with the security requirements of HIPAA. Accordingly, the Certification Commission for Healthcare Information Technology, or CCHIT, won’t certify an EHR unless it has this capability.

Audit trails play less of a security role in solo offices, where a handful of trusted employees eyeball virtually every record, notes Marlene Jones, vice president for group operations at the consulting firm PivotHealth in Brentwood, TN. However, as practices grow in size, says Jones, the need to police recreational record-reading increases.

Your patients may not include a headline-making entertainer, but it’s likely that you have some lower-level VIPs whose records might tempt a nosey employee—the mayor, a partner’s wife, or a high school football star. If you use an EHR, you can detect snooping by checking the audit trails of select records on a monthly or quarterly basis. Some EHRs even allow you to study the audit trail of a particular employee across multiple records, as opposed to zeroing in on a particular record.

The ups and downs of adopting EMR

I believe the most recent statistic I read regarding the number of medical clinics in the U.S. that have adopted EMR was between 30-40%.  Considering the push toward full adoption of EMR from government agencies and from third party payers with deadlines in the next 2-7 years, we have quite a ways to go in a short amount of time.

For the minority that have already converted to EMR, we can learn a lot from their stories – both positive, negative, and often a mix of both.  Here is a recent post from a physician that speaks to some of the ups and downs that she experienced during the process.  Ultimately, she feels that the positives outweigh the negatives; the outcome was worth the bumps and bruises along the way.

It’s been 21 months since I was forced to convert to an electronic medical record, and I have just now reached the point where I can say that the EMR has had a positive impact in my practice.

Converting to the EMR is not easy. This conversion is not like getting dunked in the river and seeing the light. It’s more like going through Dante’s Inferno. It’s taken me almost 2 years to ascend through the Circles of Hell and I am in Purgatory right now – things aren’t perfect, but I can see Paradise in the distance, and I’m glad I’m here.

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