Questions To Consider When Changing EHR And/Or Practice Management Software Vendors
I have been thinking about changing my electronic health record (EHR) and practice management software vendors. Currently, I have a system that requires two vendors, one for the practice management portion for claims submission and patient billing and another for the EHR or documentation part. Although my system has served me well over the past eight to 10 years, I feel there is a solution that may be more cost effective and would improve the work flow of my office, staff and myself.
While researching new vendors, many questions came to mind, especially in regard to the Merit-based Incentive Payment System (MIPS). I thought I would share them here.
I asked the staff at my current EHR vendor if the system is certified by the 2014 or 2015 Centers for Medicare and Medicaid Services (CMS) guidelines so that as we continue to participate in value-based care, we would be assured that the vendor is staying current. However, for MIPS, electronic health records are not required to be certified by the 2015 CMS guidelines. Here are some additional questions to consider.
Does the EHR system contain 2017 and or 2018 Advancing Care Information Transition Objectives and Measures? Does the EHR company help me successfully participate in MIPS by having features such as a built-in MIPS composite score and benchmarking reports that will document my performance in real time? Does the EHR system offer patient engagement tools such as a patient portal and kiosk without additional costs? Can the EHR vendor provide resources, advice or coaching regarding this data collection process?
Which of the clinical practice improvement activities are built into the EHR? Does it have features that are podiatry-related options?
Do you have to collect the data and send the data manually to a third-party registry or is the EHR vendor a qualified registry that can submit the MIPS quality data? Will the EHR vendor provide reports that you can send electronically to a registry such as the American Podiatric Medical Association (APMA) podiatry registry, which is available to all APMA members? If the EHR prints a report out in the format that APMA can accept, then from the EHR you can submit the report to the APMA registry, and/or there may be a way to enter this information into the APMA registry manually.
Will the EHR capture MIPS data in real time (point of care)? Is there a dashboard or scorecard that shows you how you are performing in MIPS to alert you as you go along?
After researching all of this, I also found that not all measures are created equal as the quality category scoring. This is how CMS will compile the MIPS score, by a special benchmarking or scoring system. The CMS will crunch the numbers in such a way that some measures get a higher score based on how it is submitted. The exact same performance for two measures that meet both the case minimum and data sufficiency criteria could assign you different scores, even if you are using the same submission method.
An example of this is a 90 percent performance for EHR submission method earns 10 points for MIPS Measure 236 (controlling high blood pressure) but it will only give you 4.4 points for MIPS Measure 130 (documentation of current medications in medical record). It is also important for the submission method you have chosen (Measure 130) for if you had a 95 percent performance, you earn 3 points when you use claims submission of this measure but you get almost double the points if you submit using a registry or submit directly through your EHR. Since you can only use one submission method per category, it would make sense that you enter data for as many measures as you can and compute the scores for all available measures for all submission methods before selecting the six measures you will submit. You can only do this if your EHR calculates a running score for you so you can make the best business decision for your practice.
My other consideration in regard to changing to a system that provides both practice management solution along with the EHR is that the work flow in my office will be improved through one package. A one-package system provides a kiosk for patients to check in and also pay their copay at the time of check in or check out. The kiosk and patient portal will process the intake information directly from the patient into the EHR, reduce paperwork and cost to the practice. Also, with the integrated system, I should be able to set up health maintenance types of reminders for selected parameters, such as yearly diabetic foot exams for all my patients who have diabetes, etc.
My current system of two different vendors, although integrated through an HL7 interface, is still inferior. This is because the vendors did not share databases and doing searches in one system does not yield all of the information I needed to optimize services and/or the experience patients, my staff and myself were having when interacting with my current system. Also, the larger picture of data crunching needed for MIPS will become more of an issue as we continue to face the changes that CMS introduces in the coming years. At this time, I feel the need to have a more robust system in place. Change can be difficult, and at first it is disruptive, but ultimately the changes made will allow for a smother functioning practice for everyone who comes in contact with my practice.
