Practice Pearls
What You Should
Know About EMRs
January 2006
E lectronic medical records (EMRs). Just simply seeing this term evokes a wide range of thoughts and feelings among physicians. Many are enthusiastically jumping on the bandwagon and implementing EMRs in their practices; others are doing the opposite and have never even considered an EMR, and some have been scared away from the idea of an EMR system because they’ve heard the systems are very expensive or are a huge implementation nightmare. So what is the big deal with EMRs and are they right for the average dermatologist?
Positives vs. Negatives
Some physicians love their EMRs and are satisfied with the benefits received. They are able to save costs by reducing the amount of space previously required for storing paper charts. Reducing or eliminating the need for transcriptionists and/or medical records clerks brings additional cost savings.
Frequently, EMRs can help improve practice efficiency and record accessibility. For example, with a push of a few buttons, the physician is able to review a patient’s chart and refill a prescription — rather than locate, pull, review, re-file a paper chart and, finally, direct a medical assistant to call the refill into the pharmacy. Additionally, the electronic chart can be customized with standardized data entry fields, which can improve chart review efficiency, documentation and quality.
On the other side of the coin, EMRs can have drawbacks. There is the initial cost of purchasing a system or the on-going expense of a lease. There are also costs of implementation, maintenance and upgrades to your system.
Transferring your current paper charts to the new EMR system can also be a huge cost, consisting of wages for staff to complete the transfer, technical assistance costs and possible office downtime. You may even have to hire temporary employee(s) to complete this project in a timely fashion.
Moreover, do EMRs really help with overall practice and physician efficiency? Some doctors believe that they are not able to see patients as quickly with an EMR as with paper charts. Overall, some physicians report they spend more time in the room per patient encounter, which has both positive and negative implications.
Pressure for Implementation
The pressure to implement EMRs in physician practices continues to build from vendors, organized medicine, insurance companies, the government, and even malpractice carriers. While EMRs can be a very useful tool for achieving efficiencies and improved monitoring of patients and their care, they can also be costly and problematic to the practice.
To compound the situation further, there are many competing systems available in the marketplace offering a range of capabilities from basic EMR charting to entire practice management software systems that incorporate the EMR system. There has yet to emerge a single standardized, uniformly compatible, common interface software design. Choosing an appropriate EMR is fraught with decision-making challenges.
Even if you plan to continue using paper charts, you might want to at least consider being open to the idea of EMRs. President George W. Bush is a major advocate of the EHR, the federal government’s idea of national electronic health records for patients.
In an Executive Order issued Apr. 27, 2004, President George W. Bush called for widespread deployment of health information technology within 10 years. He then appointed David J. Brailer, M.D., Ph.D., as National Coordinator for Health Information Technology. On Aug. 19, 2005, the formation of the Office of the National Coordinator for Health Information Technology was published in the Federal Register.
This government push for health information technology is not going to go away. Dr. Brailer’s goals are to work toward developing the EHR by transferring all physicians to an EMR system within 10 years; have national interoperability of these records; have patient access to their electronic records and to use the data for anonymous gathering for assistance in public health issues.
He is working with the private sector to develop standardized formats for EMRs so that the various systems will be compatible. Currently, there are no standardized formats for EMRs, although the Certification Commission for Healthcare Information Technology (CCHIT) is currently working toward standardization. The goal is to have a certification process for EMRs that will identify standards and minimum requirements to allow the systems to share important data across settings of care and perform the most important functions of the system while maintaining privacy and security of data. More information may be obtained by visiting www.cchit.org.
Points to Consider
Before deciding to implement an EMR into your practice, you should think about some practical considerations.
• Costs. Can you afford an EMR? If the initial purchase price of an EMR is a deterrent, but you still want to implement an EMR, consider using a software vendor who will lease a system. There are now application service providers (ASPs), or hybrid ASPs, who essentially lease the software to the physician and provide database storage on their offsite server, which is accessed through a secured Web site. Using an ASP’s server eliminates the acquisition, maintenance and upgrade costs associated with purchasing your own server for your EMR.
• Features. What is important to your practice, and how valuable are the benefits of specific features relevant to their cost? Are your paper chart processes working and efficient enough, or do you think your practice will benefit from implementing an EMR?
If you decide to consider an EMR, carefully take into account your current and long-term needs and look for systems that are able to evolve as your practice changes. Examples include: wireless technology, voice recognition, summary page with pertinent information for the patient, the ability to complete, submit and track pathology requests for biopsies, digital photographs displayed and stored, or workflow page showing pending appointments and calls.
• Integration. Would your EMR and practice management systems be able to integrate? What about other applications such as Word, Excel and Access — can these files transfer in as well?
Other points to consider are for purged charts. Do you continue (or convert) to store as paper, or in a different type of electronic format, or do you convert these to the new system as well?
• Compliance. Are your current processes compliant or would an EMR system help in bringing your practice into compliance with relevant state and federal laws, especially HIPPA?
Finding a System
Unless you plan to retire within the next 10 years, the question is not if, but when and how you will incorporate an EMR into your practice. Thankfully, there are a wide variety of EMR systems available, including the ASP option. Every practice, regardless of size or focus (general medical dermatology, cosmetic/aesthetic, Mohs/surgical, or some blended combination), should be able to find a system that works for their needs.
How do you start? Begin by asking colleagues if they are using an EMR, and if so, what type, how do they like it, does it serve their needs well, etc. Plan on attending (or better yet, sending
your practice administrator and key administrative personnel) to as many conferences as possible to learn about the systems available, costs, user base, system architecture, etc.
When you are ready to purchase, consider asking a practice consultant (unrelated to the vendor(s) being considered) to give an independent second opinion. You may find it money (and time) very well spent. Good luck!
E lectronic medical records (EMRs). Just simply seeing this term evokes a wide range of thoughts and feelings among physicians. Many are enthusiastically jumping on the bandwagon and implementing EMRs in their practices; others are doing the opposite and have never even considered an EMR, and some have been scared away from the idea of an EMR system because they’ve heard the systems are very expensive or are a huge implementation nightmare. So what is the big deal with EMRs and are they right for the average dermatologist?
Positives vs. Negatives
Some physicians love their EMRs and are satisfied with the benefits received. They are able to save costs by reducing the amount of space previously required for storing paper charts. Reducing or eliminating the need for transcriptionists and/or medical records clerks brings additional cost savings.
Frequently, EMRs can help improve practice efficiency and record accessibility. For example, with a push of a few buttons, the physician is able to review a patient’s chart and refill a prescription — rather than locate, pull, review, re-file a paper chart and, finally, direct a medical assistant to call the refill into the pharmacy. Additionally, the electronic chart can be customized with standardized data entry fields, which can improve chart review efficiency, documentation and quality.
On the other side of the coin, EMRs can have drawbacks. There is the initial cost of purchasing a system or the on-going expense of a lease. There are also costs of implementation, maintenance and upgrades to your system.
Transferring your current paper charts to the new EMR system can also be a huge cost, consisting of wages for staff to complete the transfer, technical assistance costs and possible office downtime. You may even have to hire temporary employee(s) to complete this project in a timely fashion.
Moreover, do EMRs really help with overall practice and physician efficiency? Some doctors believe that they are not able to see patients as quickly with an EMR as with paper charts. Overall, some physicians report they spend more time in the room per patient encounter, which has both positive and negative implications.
Pressure for Implementation
The pressure to implement EMRs in physician practices continues to build from vendors, organized medicine, insurance companies, the government, and even malpractice carriers. While EMRs can be a very useful tool for achieving efficiencies and improved monitoring of patients and their care, they can also be costly and problematic to the practice.
To compound the situation further, there are many competing systems available in the marketplace offering a range of capabilities from basic EMR charting to entire practice management software systems that incorporate the EMR system. There has yet to emerge a single standardized, uniformly compatible, common interface software design. Choosing an appropriate EMR is fraught with decision-making challenges.
Even if you plan to continue using paper charts, you might want to at least consider being open to the idea of EMRs. President George W. Bush is a major advocate of the EHR, the federal government’s idea of national electronic health records for patients.
In an Executive Order issued Apr. 27, 2004, President George W. Bush called for widespread deployment of health information technology within 10 years. He then appointed David J. Brailer, M.D., Ph.D., as National Coordinator for Health Information Technology. On Aug. 19, 2005, the formation of the Office of the National Coordinator for Health Information Technology was published in the Federal Register.
This government push for health information technology is not going to go away. Dr. Brailer’s goals are to work toward developing the EHR by transferring all physicians to an EMR system within 10 years; have national interoperability of these records; have patient access to their electronic records and to use the data for anonymous gathering for assistance in public health issues.
He is working with the private sector to develop standardized formats for EMRs so that the various systems will be compatible. Currently, there are no standardized formats for EMRs, although the Certification Commission for Healthcare Information Technology (CCHIT) is currently working toward standardization. The goal is to have a certification process for EMRs that will identify standards and minimum requirements to allow the systems to share important data across settings of care and perform the most important functions of the system while maintaining privacy and security of data. More information may be obtained by visiting www.cchit.org.
Points to Consider
Before deciding to implement an EMR into your practice, you should think about some practical considerations.
• Costs. Can you afford an EMR? If the initial purchase price of an EMR is a deterrent, but you still want to implement an EMR, consider using a software vendor who will lease a system. There are now application service providers (ASPs), or hybrid ASPs, who essentially lease the software to the physician and provide database storage on their offsite server, which is accessed through a secured Web site. Using an ASP’s server eliminates the acquisition, maintenance and upgrade costs associated with purchasing your own server for your EMR.
• Features. What is important to your practice, and how valuable are the benefits of specific features relevant to their cost? Are your paper chart processes working and efficient enough, or do you think your practice will benefit from implementing an EMR?
If you decide to consider an EMR, carefully take into account your current and long-term needs and look for systems that are able to evolve as your practice changes. Examples include: wireless technology, voice recognition, summary page with pertinent information for the patient, the ability to complete, submit and track pathology requests for biopsies, digital photographs displayed and stored, or workflow page showing pending appointments and calls.
• Integration. Would your EMR and practice management systems be able to integrate? What about other applications such as Word, Excel and Access — can these files transfer in as well?
Other points to consider are for purged charts. Do you continue (or convert) to store as paper, or in a different type of electronic format, or do you convert these to the new system as well?
• Compliance. Are your current processes compliant or would an EMR system help in bringing your practice into compliance with relevant state and federal laws, especially HIPPA?
Finding a System
Unless you plan to retire within the next 10 years, the question is not if, but when and how you will incorporate an EMR into your practice. Thankfully, there are a wide variety of EMR systems available, including the ASP option. Every practice, regardless of size or focus (general medical dermatology, cosmetic/aesthetic, Mohs/surgical, or some blended combination), should be able to find a system that works for their needs.
How do you start? Begin by asking colleagues if they are using an EMR, and if so, what type, how do they like it, does it serve their needs well, etc. Plan on attending (or better yet, sending
your practice administrator and key administrative personnel) to as many conferences as possible to learn about the systems available, costs, user base, system architecture, etc.
When you are ready to purchase, consider asking a practice consultant (unrelated to the vendor(s) being considered) to give an independent second opinion. You may find it money (and time) very well spent. Good luck!
E lectronic medical records (EMRs). Just simply seeing this term evokes a wide range of thoughts and feelings among physicians. Many are enthusiastically jumping on the bandwagon and implementing EMRs in their practices; others are doing the opposite and have never even considered an EMR, and some have been scared away from the idea of an EMR system because they’ve heard the systems are very expensive or are a huge implementation nightmare. So what is the big deal with EMRs and are they right for the average dermatologist?
Positives vs. Negatives
Some physicians love their EMRs and are satisfied with the benefits received. They are able to save costs by reducing the amount of space previously required for storing paper charts. Reducing or eliminating the need for transcriptionists and/or medical records clerks brings additional cost savings.
Frequently, EMRs can help improve practice efficiency and record accessibility. For example, with a push of a few buttons, the physician is able to review a patient’s chart and refill a prescription — rather than locate, pull, review, re-file a paper chart and, finally, direct a medical assistant to call the refill into the pharmacy. Additionally, the electronic chart can be customized with standardized data entry fields, which can improve chart review efficiency, documentation and quality.
On the other side of the coin, EMRs can have drawbacks. There is the initial cost of purchasing a system or the on-going expense of a lease. There are also costs of implementation, maintenance and upgrades to your system.
Transferring your current paper charts to the new EMR system can also be a huge cost, consisting of wages for staff to complete the transfer, technical assistance costs and possible office downtime. You may even have to hire temporary employee(s) to complete this project in a timely fashion.
Moreover, do EMRs really help with overall practice and physician efficiency? Some doctors believe that they are not able to see patients as quickly with an EMR as with paper charts. Overall, some physicians report they spend more time in the room per patient encounter, which has both positive and negative implications.
Pressure for Implementation
The pressure to implement EMRs in physician practices continues to build from vendors, organized medicine, insurance companies, the government, and even malpractice carriers. While EMRs can be a very useful tool for achieving efficiencies and improved monitoring of patients and their care, they can also be costly and problematic to the practice.
To compound the situation further, there are many competing systems available in the marketplace offering a range of capabilities from basic EMR charting to entire practice management software systems that incorporate the EMR system. There has yet to emerge a single standardized, uniformly compatible, common interface software design. Choosing an appropriate EMR is fraught with decision-making challenges.
Even if you plan to continue using paper charts, you might want to at least consider being open to the idea of EMRs. President George W. Bush is a major advocate of the EHR, the federal government’s idea of national electronic health records for patients.
In an Executive Order issued Apr. 27, 2004, President George W. Bush called for widespread deployment of health information technology within 10 years. He then appointed David J. Brailer, M.D., Ph.D., as National Coordinator for Health Information Technology. On Aug. 19, 2005, the formation of the Office of the National Coordinator for Health Information Technology was published in the Federal Register.
This government push for health information technology is not going to go away. Dr. Brailer’s goals are to work toward developing the EHR by transferring all physicians to an EMR system within 10 years; have national interoperability of these records; have patient access to their electronic records and to use the data for anonymous gathering for assistance in public health issues.
He is working with the private sector to develop standardized formats for EMRs so that the various systems will be compatible. Currently, there are no standardized formats for EMRs, although the Certification Commission for Healthcare Information Technology (CCHIT) is currently working toward standardization. The goal is to have a certification process for EMRs that will identify standards and minimum requirements to allow the systems to share important data across settings of care and perform the most important functions of the system while maintaining privacy and security of data. More information may be obtained by visiting www.cchit.org.
Points to Consider
Before deciding to implement an EMR into your practice, you should think about some practical considerations.
• Costs. Can you afford an EMR? If the initial purchase price of an EMR is a deterrent, but you still want to implement an EMR, consider using a software vendor who will lease a system. There are now application service providers (ASPs), or hybrid ASPs, who essentially lease the software to the physician and provide database storage on their offsite server, which is accessed through a secured Web site. Using an ASP’s server eliminates the acquisition, maintenance and upgrade costs associated with purchasing your own server for your EMR.
• Features. What is important to your practice, and how valuable are the benefits of specific features relevant to their cost? Are your paper chart processes working and efficient enough, or do you think your practice will benefit from implementing an EMR?
If you decide to consider an EMR, carefully take into account your current and long-term needs and look for systems that are able to evolve as your practice changes. Examples include: wireless technology, voice recognition, summary page with pertinent information for the patient, the ability to complete, submit and track pathology requests for biopsies, digital photographs displayed and stored, or workflow page showing pending appointments and calls.
• Integration. Would your EMR and practice management systems be able to integrate? What about other applications such as Word, Excel and Access — can these files transfer in as well?
Other points to consider are for purged charts. Do you continue (or convert) to store as paper, or in a different type of electronic format, or do you convert these to the new system as well?
• Compliance. Are your current processes compliant or would an EMR system help in bringing your practice into compliance with relevant state and federal laws, especially HIPPA?
Finding a System
Unless you plan to retire within the next 10 years, the question is not if, but when and how you will incorporate an EMR into your practice. Thankfully, there are a wide variety of EMR systems available, including the ASP option. Every practice, regardless of size or focus (general medical dermatology, cosmetic/aesthetic, Mohs/surgical, or some blended combination), should be able to find a system that works for their needs.
How do you start? Begin by asking colleagues if they are using an EMR, and if so, what type, how do they like it, does it serve their needs well, etc. Plan on attending (or better yet, sending
your practice administrator and key administrative personnel) to as many conferences as possible to learn about the systems available, costs, user base, system architecture, etc.
When you are ready to purchase, consider asking a practice consultant (unrelated to the vendor(s) being considered) to give an independent second opinion. You may find it money (and time) very well spent. Good luck!
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