The Benefits Of Transitioning To A New EMR

In the last quarter of 2018, I decided to switch to a new electronic medical record (EMR) system. Being fairly savvy, I thought the process would be relatively fast and easy. Well, I must admit that we are eight months into the transition and it is just now feeling like we are making headway.

While there is added cost for the new software in comparison to the previous product, I love “my new” software. I can complete my documentation every day by the end of the workday and we see the normal patient load. There are days here and there when I stay 15 to 30 minutes after my staff has left at 5 p.m.

We are able to send e-mail and/or text reminders to new patients to complete their paperwork on the portal, and remind all new or established patients about their upcoming appointments. These reminders are automatically logged with date and time when completed. So, if patients say they did not get the reminder, either it went into their SPAM folder or perhaps we have the wrong e-mail or cell phone number. It serves as an opportunity for my staff to confirm this information.

One of the greatest opportunities with this new software is the ability for the patient to complete or update the medical history online from home before he or she even comes into the office. This information directly populates when I or my medical assistant starts a note template. This saves a tremendous amount of time with patients only needing to arrive five to 10 minutes earlier than their scheduled appointment. Then the staff can scan the patient’s insurance card if he or she did not upload this on the portal. However, patients can input insurance information along with completing their HIPAA notification and signature online as well.

Patients can enter their current medications from home but we prefer to download the list from their pharmacy. The software requests permission from the patient and if this provided, my staff or I can, with a click of a button, complete this task. If the patient does not provide permission, we can ask the patient and enter the medications ourselves. Once my medical assistant downloads the information, she then confirms with the patient if he or she  continues to take a medication or has discontinued doing so. When I see the patient, I confirm that his or her medical history correlates to the medications and this gives me credit for checking their medications under the Merit-based Incentive Payment System (MIPS).    

By now, you may be thinking that your patients won’t do this. They may not have access to the Internet or don’t want to provide their e-mail to sign up for a portal. This is true for a few of our patients but most new patients will find a way rather than come in one hour prior to their appointment to complete the paperwork. If patients are somewhat elderly, their family member may do this for them. 

I bought a few iPads and Samsung tablets that are set up with the patient portal to complete documentation when a patient arrives one hour prior, so this information does not have to be transcribed by my staff. This improves efficiency and patients are seen earlier than scheduled since there is faster completion of the paperwork. If a patient can’t use either of the tablets, then my staff uses the tablet to ask the patient these questions, again saving time and energy over the typical paper document process. Since implementation of this portal, we have saved more than expected on printing and paper costs.

My notes are done within three to five minutes of the patient leaving the office. Once I am done with the note, the summary is available for my staff to send to the primary or referring physician by either e-mail or fax. Printing the note is not necessary. My referring doctors are surprised to receive a note so quickly, and I have set up the note template to only contain the chief concern, exam findings, assessment and plan. The PCP or referring doctor does not need to see the past medical history, social history or the medication list. They have all of that information already. It takes my staff exactly three clicks and less than one minute to send this note. Sometimes I do this myself when I close out the note.

Standardizing Common Paperwork Forms And Reducing Wasted Paper

There is one area within this system that we are still working on. This entails other forms, including consents, advance beneficiary notices (ABN), receipt of instructions and financial policies that patients need to sign. These are the pesky business forms that help support billing and maintain compliance. During the EMR transition, we queried our patients to see if they want copies of these forms they are signing. Most patients decline to take copies so we just waste time and money printing them, getting them signed and scanning them only to turn around and shred them.

Speaking of shredding, I have scheduled a shredding company to take 58 storage boxes of old medical charts, X-rays, explanations of benefits (EOBs), superbills, etc., that our office had from patients seen over 10 years ago. In 10 years, I won’t have anything to shred since the EMR we have now allows all forms to be signed digitally on the tablets we have recently implemented. These signed documents can be made available to the patient on the secure portal and can be printed at his or her leisure. Did I tell you? I love my software!

It took some time to get to this point but this gave me an opportunity to review my forms and handouts to make changes that I always wanted to make before converting to a digital format. Now when I want to change a sentence in a form, I can do it on the fly and I only have to do it once. Then it is saved and the changes are reflected the next time I use it.  I think that we will be virtually paperless by the end of next month. There will be a few patients who will want a hard copy of documents and we are happy to print these for them. I also think with durable medical equipment (DME); we will continue to need hard copies until I can confirm that digital signatures will be accepted.

Improving Patient Engagement And Inventory Management Through Your EMR

This EMR system also enables you to stay in touch with patients. The software has a built-in customer relationship management (CRM) program. This can help us perform our health maintenance recall reminders as well as ramp up our internal marketing efforts.

The EMR also has a robust inventory management system. This not only counts down inventory as you dispense items, but when I put orders or a treatment plan in the note, it will bill these items automatically into the ledger. This enables my billing staff to send an insurance claim if it is a DME item covered by insurance. If it is a retail product, the EMR documents what the patient received and my front office staff can collect the charges for the non-covered items.

Not only does the item get removed from your inventory, you set the minimum you want on hand and when you run the report (which is scheduled to run once a week), it will tell you what you need to replenish and where to order from. This is a great help for the staff. The system also generates a purchase order that the staff can have the manager approve before submitting or placing the orders. When items are received, they can be scanned into the system to update the inventory, or it can be done manually. We can also generate our own bar codes to track our inventory. The greatest feature for me is that when I connect the cost of the items purchased and I run the report on that DME code or the item code, it gives me a list of patients who received the item and the net profit made from that item. This is extremely useful to be able to track exactly which items are profitable and which are not, and it does so by provider. So, if you have associates that get bonuses, the system easily identifies which doctor is responsible for the income.

I fully implemented the inventory control system at the end of August. We have been using the inventory portion and we plan on adding the ordering and reporting soon. I can even track non-sale inventory so we don’t run out of stock.

Next month, we will start using the patient education platform, which allows us to visually show patients while they are in the office web sites relating to their condition, or we can send this information to their portal, including personalized video clips. These actions will again apply toward patent engagement under MIPS. 

Final Notes

I am not a consultant to the EMR company that I am currently using (Compulink Advantage, Compulink Healthcare Solutions). If you read my previous blog on my decision to change systems, I chose to do so because I was using two different software companies for the practice management and EMR. This is an integrated software platform which makes getting reports and keeping an eye on the business that much easier. I did try another system in the interim, for four months before finally deciding on this EMR. That EMR, which I thought was my best choice at the time and I thought was going to be my “forever EMR”, was absolutely the worse experience I have ever had. That EMR was new to the market and offered a nominal entry fee. It seemed like it was a complete package but it was just show. It could never give me reports of how the practice was doing like I have now. In fact, that previous EMR vendor required you to call its IT department to start a ticket in order for the vendor to build the report you wanted. 

I tried it for several months. I had to call it quits when it felt like it was “taking the life out of me” every time I called to get a report or to work on the template. It is true that you do get what you pay for. Don’t get me wrong. I have to call IT to help with this software as we implement different aspects. However, I get knowledgeable people, who are easy to communicate with and who understand what I need the EMR to do. I get answers or solutions to my issues, which often turns out to be due to operator lack of knowledge as opposed to problems with the software.

Dr. Aung is Chief of the Podiatry Section of Tenet Health System/St. Joseph’s Hospital and a Panel Physician at Tenet Health System/St. Mary’s Hospital Outpatient Wound and Hyperbaric Center in Tucson, Ariz. She is a member of the APMA Coding Committee, the APMA MACRA/MIPS Task Force and is on the Exam Committee of the American Board of Wound Management. Her website is www.healthy-feet.com.