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| Implementing an electronic medical record (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved. |
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| ADA for exchanging data processing standards to the dental services of the health care industry... |
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| Barack Obama: In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging... |
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For the past several years, Physicians and
their staff have been "going
paperless" or implementing various forms
of electronic medical records (EMR) in increasing
numbers.
Changing the workflow in your office is not
without risk. From the cost of an EMR system,
to the time involved to get up to speed, adopting
EMR is a big decision.
On the other hand, the promises of EMR are
significant. Indeed, the stated goals of EMR
are to reduce your overhead and cut costs while
simultaneously increasing your revenues, and
all while enhancing patient care.
So, what is the best way to analyze EMR? How
do you weigh the risks of changing the way you
do business against the possibility of a better
bottom line and higher quality care from workflow
improvements?
In the following sections, we'll examine the
three major objectives of EMR and offer some
experience-based analysis of the reasons behind
the claims, real-life examples, and the factors
affecting your likelihood of success. |
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Objective
#1: Reduce Overhead and Improve Efficiency
There are several
ways EMR can reduce overhead. The most
significant improvements are from savings
in both physical and human resources.
Physical Resources
Chart materials
Physical resources include the costs
of buying chart materials, copying,
and storing paper records. Within the
medical records industry it is estimated
that the cost associated with maintaining
a paper record averages $3 per medical
chart and that is the least of the physical
factors. In addition to the file folders,
there is the paper and printer toner,
not to mention the cost per square foot
to store filing cabinets.
EMR eliminates medical
record storage costs
The physical space required for record
storage is usually one of the more significant
costs associated with keeping paper
files. The cost of office space is always
a significant part of overhead, and
off-site storage costs must be counted
as well. When a physician office does
not have to store physical records,
office space, normally rented for record
storage, can be used for revenue-generating
examination rooms and offices. Or the
extra square footage doesn't have to
be rented at all, thus allowing the
same size office staff to fit into a
less expensive office.
Human Resources
EMR saves time and
increases efficiency
In addition to the physical costs of
materials and storage, EMR saves a lot
of time. For example, the time wasted
searching for charts is eliminated,
and the increased efficiency can be
significant. With EMR, the familiar
scenario of staff members frantically
searching the office for a particular
chart is completely eliminated.
Time is also wasted by the singularity
of paper records, because only one person
at a time may physically handle a paper
chart. For instance, if a pharmacy calls
while the chart is being used, or waiting
to be filed, the person taking the call
cannot access the information ??in the
timeliest, most efficient, manner. With
EMR, all appropriate staff members can
access the information whenever and
wherever they need it—even from home.
Pulling charts, undoing them, copying
them, and putting them back together
requires both physical resources and
time. Some offices also use outside
copy services. In EMR-enabled offices,
staff members just click and print whenever
records are requested.
EMR allows fewer
employees to do more
Many EMR offices are able to do more
with fewer people. Human resource costs
including staff salaries and outsourced
transcription expenses are typically
a large part of office overhead. Cost
savings in this area are often a significant
factor in achieving a positive return
on investment (ROI) from implementing
EMR.
In fact, some offices that rely on staff
or outsourced transcriptionist devoted
solely to medical records discover a
50% to 75% reduction of medical records
expenses after adopting EMR. Where transcription
costs typically range from $300 to $1000
per month per physician, savings from
EMR can be significant.
Transcription costs
can be lowered significantly or eliminated
altogether
Indeed, some offices eliminate transcription
costs altogether as the Physicians enter
all data directly into the EMR system.
However, even if some or all of a practice's
Physicians continue to use transcription,
these costs can still be lowered, because
EMR makes in-house transcription much
more efficient. For example, documents
can even be imported in a fast batch
mode. It's also simple to drop Word
documents into a chart note or letter,
or save a letter that was sent to a
patient right in that patient's electronic
chart.
Of course, the savings your office could
expect depend on the amount you are
currently spending on staff dealing
with medical records, including outside
transcriptions. Even if you do not downsize
immediately, you may find as many offices
have, that you can grow without increasing
the number of staff members. Likewise,
as employees leave by attrition they
may not need to be replaced.
This increased efficiency, a result
of generating the same revenue with
fewer salaries and overhead, is a common
result of implementing EMR – for both
large and small offices. Although the
smaller offices must have a minimum
number of support staff, on average,
EMR-equipped offices simply require
fewer full-time employees to support
the same number of Physicians. Specifically,
practices with an EMR system in place
report two to 2.5 full-time employees
per physician, compared with an industry
average of four.
Enhanced communication
increases office efficiency
In terms of efficiency, better communication
marks an entirely separate area of office
improvement. Medical practices with
EMR see a marked reduction in "phone
tag" (leaving messages and waiting to
hear back, or waiting to look-up the
information and calling back) because
the charts are always instantly available,
and much of the critical messages are
handled electronically, without a need
to be on the phone at the same time.
Additionally, EMR offices have fewer
callbacks from pharmacies; significantly
reducing staff time spent handling those
calls.
The potential areas of cost savings
from EMR are summarized below. For many
physician practices, the improved efficiency
and actual cost savings are more than
enough to justify the investment in
EMR. From an economic perspective, many
doctors find that their bottom line
is a net positive in the very first
year following an EMR investment.
Physical resource
costs
. Cost of materials to create and maintain
paper charts
. Storage costs, including extra real
estate and other costs eliminated without
the need to store physical medical records
. Costs of copying requested medical
records
Human Resource Costs
. Full-time employees devoted to medical
records
. Pulling, disassembling, reassembling,
filing charts
. Time spent looking for charts
. Transcription costs
. Communication inefficiencies, e.g.,
phone tag
Objective #2: Increased Revenue
Confidence
in Coding—EMR decreases lost revenue
EMR can improve the accuracy and documentation
for coding. In order to avoid payment
disputes due to documentation disputes,
many providers and offices are conservative
regarding coding. Industry research
indicates that inaccurate coding often
causes lost revenues ranging from 3%
to 15% of a practice's annual revenue.
On an annual basis, decreasing this
lost revenue percentage can have an
enormous impact on the bottom line of
any practice.
EMR increases reimbursements because
it facilitates complete documentation
for every patient visit. With the use
of templates and auto-text insertion,
Physicians can easily and fully document
every note. EMR can help ensure that
chart notes are compliant by mapping
the templates to the appropriate coding
rules.
Increase Services
with Health Maintenance Reminders
Adopting an EMR system also provides
a powerful tool to help maximize the
number of services offered for health
maintenance. EMR systems often allow
practices to search for all patients
who are overdue for recommended services,
or who are coming up on their annual
check-ups. As a result, offices can
send timely reminder letters to ensure
better patient care while at the same
time increasing service volume and revenue.
Increase Physician
Productivity
With EMR, many Physicians are able to
see more patients in a day. As a result,
practices are able to generate more
revenue with the same fixed costs in
the same amount of time. Alternatively,
many technology-enabled doctors use
the additional free time to improve
their lifestyle or work-life balance.
Other efficiency improvements(upgrading)
improve the quality of life for the
doctors using EMR as well. For example,
in order to sign paper-based charts,
each doctor must be physically present
to sign the chart. With EMR, any component
can be signed electronically from home
or work, with no pulling or filing of
charts.
Objective #3: Improve Patient Care
An EMR system can
positively impact patient care in several
ways. Some advantages involve increased
efficiency and higher quality documentation
while others involve automated checks
and reminders to assist a physician
in providing optimum care.
Improve Chart Quality
EMR helps improve chart quality across
an entire practice. All notes, documentation
and prescriptions are perfectly legible
in electronic form. Problems that result
from poor handwriting or inconsistencies
in documentation are virtually eliminated.
And most EMR systems can automatically
flag unsigned notes to make sure that
all the charts are maintained across
all providers in the practice.
Optimize Health
Maintenance
Computerized checks and reminders serve
to optimize health maintenance because
relevant items can be either automatically
flagged or even searched across the
entire patient database.
In addition, EMR systems give physician
offices important information at the
time of documentation. For example,
diagnosis-specific templates and checklists
can guide and remind providers of relevant
protocols and tests for certain conditions.
Additionally, EMR includes age, sex,
and disease-specific health maintenance
reminders each time a chart is accessed.
Finally, Physicians find it easier to
engage patients more actively using
EMR. Graphical representations can aid
in-office education while patient handouts
can be printed right at the point of
care for less cost and delivered to
the patient immediately.
Medication Management
EMR ensures accuracy as you select medications
from a drug database. Any prescription
is automatically updated in the patient's
chart note. Some EMR vendors use a drug
utilization review feature to screen
for potential drug therapy risks and
print patient education information.
Any potential drug-to-drug or allergic
reactions are automatically flagged.
In the case of a drug recall, the entire
patient database can be searched for
all affected patients in a few seconds.
Example: In
the Event of a Drug Recall, it's easy
to run a report showing all the effected
patients
Objective #4: Improve Clinical Decision
Making
EMR software is packed
with many tools to help doctors make
better decisions. These tools range
from diagnosis, prescribing medications
to treatment plan recommendations. Most
EMRs have built in PDR-based medication
dictionaries providing doctors with
Adverse Drug Event (ADE) alerts, generic
drug and dosage recommendations. EMRs
also provide decision support to make
treatment recommendations based off
of a patient's diagnosis. Health maintenance
reminders become easy to manage, thanks
to EMR's automatic health maintenance
reminder systems.
Conclusion
The advantages of EMR provide compelling
reasons to consider the switch from
paper charts. Decreasing practice expenses
while simultaneously increasing revenues
has been the real life experience of
many Physicians and Practice groups.
Likewise, it is possible to simultaneously
improve quality of care for patients
and quality of life for the Physicians.
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| EMR
BENEFITS |
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| A)
FINANCIAL BENEFITS |
| Increased
Revenues |
Avoid lost charges: Electronic
Medical Records (EMR) software can increase revenues
by capturing charges for all services performed
and avoid lost revenues. Using the traditional
paper charts, many services performed in a Physician’s
Office become lost and never get billed for.
Maximize Billings: Providers who use advanced
Electronic Medical Records (EMR) software can
increase revenues by maximizing E&M billing
codes that the Electronic Medical Records (EMR)
software will suggest based on the service being
accurately documented, without the fear of an
audit. Using paper charts, to be on the safe side
of the law, many Physicians down code (use a lower
billing code), rather than proper coding. Medical
Economics magazine has estimated that Physicians,
who routinely down-code to avoid audits, lose
an average of $40,000 annually.
Increase sources of income: Electronic
Medical Records (EMR) software can allow providers
to apply for enhanced sources of revenue from
various payers associated with higher quality
of care, such as DOQ-IT (Doctors’ Office Quality-Information
Technology. Reduced
Expenses Lower
labor cost: A typical medical office employs
billing and clerical staff such as appointment
schedulers, medical billers, collectors, file
clerks, etc. While labor costs are soaring, Electronic
Medical Records can significantly reduce the labor
needed for the functions mentioned above. For
example, office staff time will no longer be necessary
to hunt down records or file patient charts. Data
entry for billing purposes is minimized.
Avoid transcription costs:
Many Physicians pay hefty fees for transcription
of their medical charts. Electronic charting virtually
eliminates transcription costs, since all medical
charts are created electronically at the time
of patient’s visit. No
more paper charts: Once an office successfully
converts to Electronic Medical Records, all costs
associated with purchasing, storing or destroying
paper charts can be eliminated. Additionally,
the space typically used for patient paper charts
can be utilized for additional exam rooms, or
increased office space, resulting in a more profitable
use of resources. Reduced
Malpractice Costs
The cost of malpractice insurance is constantly
rising. Healthcare providers may be able to save
on their malpractice insurance costs if they are
using Electronic Medical Records (EMR) software.
Industry sources indicate that certain insurance
companies may reduce malpractice premiums as much
as 10 percent for use of Electronic Medical Records
(EMR) software, due to lower exposure to medical
errors. |
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Increased
productivity
Organizations see improved productivity as a result
of the many processes that become automated through
the use of EMR technology.
Tasks like pulling/filing paper charts become
replaced by simply clicking a patients name in
the EMR system. End-of-day reporting becomes much
easier as reports can be generated directly from
the EMR system. Lab and
imaging results can be placed directly into the
EMR, thereby making it easier for users to access.
Integration with diagnostic devices enables users
to input results/findings directly into the EMR,
eliminating the need to manage the many types
of forms used in today’s offices. Though it is
clear that EMR can make our offices more productive;
what we do with this new time doesn’t necessarily
translate into financial benefit. |
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Increased
revenue
EMR can increase your revenue by providing Physicians
with better coding recommendations and the ability
to offer new services to patients. E/M level coding
assistance can be an incredible financial benefit,
especially in Family Practice, Pediatric and Internal
Medicine practices. EMR also enables offices to
reduce their physical storage space by drastically
reducing the amount of paper used for each patient.
This can translate into having more office space
available for treatment, possibly providing room
for an additional associate. Improved insurance
re-imbursement as a result of better coding and
billing procedures can also increase your revenue.
Being in closer touch with patient’s treatment
plans and filing documentation at the right time
can help maximize reimbursement. This helps the
physician run the practice more like a business. |
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Avoidance
of costs
EMR can help you reduce the many expenses such
as paper charts, poor documentation and high malpractice
premiums, but can also create new expenses as
a result of support contracts, computer maintenance
and product updates. Reducing paper chart costs
including purchasing stationary (folders, paper,
tabs), copying, management (pulling/filing) and
storage (office space, cabinets) are few of the
most obvious benefits of EMR. Transcription costs
can also be reduced as EMR can provide you with
an easier means for patient documentation and
report writing. This can be a big savings as many
offices spend as much as $1500 per month per provider.
When an office becomes busier, they can avoid
the cost of hiring new staff by becoming more
efficient with the EMR system. EMR
Systems can help offices reduce to
an even 1 to 1 ratio of assistant to provider.
Offices can avoid expensive medications by offering
patients more cost effective alternatives. They
can help keep malpractice premiums lower as a
result of higher quality documentation and drug
prescription alerts. A long-term implementation
plan and commitment to eliminate paper charts
is crucial if cost avoidance benefits are to be
realized. |
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Increased
profit
In order to increase profit one needs to take
into account all these possible benefits and compare
them to the new costs that will be incurred as
a result of an EMR implementation. Many benefits
however, are difficult to quantify such as, improved
care, patient satisfaction, and office image.
These all contribute to higher profits as a result
of increased patient referrals and better patient
retention. |
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| B)
CLINICAL BENEFITS |
| Reduced
medical Errors |
| Sophisticated
Electronic Medical Records (EMR) software can
reduce medical errors in many areas including
the following: |
- Misdiagnosis associated with improper documentation,
lost medical records, etc.;
- Treating outside of current clinical guidelines;
- Medication conflict with allergies, other
medications or medical conditions;
- Illegible handwriting which can result in
interpretation errors;
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| Improved
Quality of Care |
| Using
Electronic Medical Records (EMR) software, quality
of care could be improved in numerous ways. Consider
the following: |
- Electronic Medical Records (EMR) softwares
can provide decision support at the point
of care;
- Electronic Medical Records (EMR) softwares
can be used to track patient’s follow-up activity,
patient’s compliance with provider’s orders,
and patient’s progress;
- Conditional clinical alerts can be set to
notify the providers of drug interactions,
allergies, latest disease management protocols,
etc.,
- In the event of a drug
recall, Electronic Medical Records
(EMR) would allow healthcare providers to
immediately contact each of their patients
who is currently taking the recalled medication;
- Electronic Medical Records (EMR) facilitates
disease management activities by features
such as “Outcomes’ Analysis”, which is the
analysis of data collected from a group of
patients;
- Electronic Medical Records (EMR) provide
better flow of information and enhanced communication
with patients, providers and staff, all resulting
in improvement in quality of care;
- Electronic Medical Records (EMR) software
improves Physician’s efficiency, so that more
quality time can be spent with the patient
rather than on paperwork;
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| Improved
Documentation and Accuracy |
- Test and Lab results, ECGs/EKGs, and X-rays
can all be entered into an Electronic Medical
Records (EMR) software, and become part of
the patient’s record, reducing the risk of
data entry error and omissions;
- Electronic Medical Records (EMRs) remove
the problem of illegibility of patient notes
and prescription as the information is stored
electronically;
- More comprehensive documentation can be
provided to referring sources;
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| Better
Access to Medical Information |
- With Electronic Medical Records (EMR) software
in place, a clinician can have access to a
patient’s file remotely from home, another
office, hospital’s emergency room, etc. This
improved access to a patient record can be
invaluable, especially when the clinician
is away from the office or when an emergency
access is needed;
- Around the office, patient information is
immediately accessible, which can save every
doctor hours per week that would normally
have been spent waiting for charts to be delivered;
- Multiple staff can access the patient chart
simultaneously, where paper charts can only
be in one place at given time;
- With an Electronic Medical Records (EMR)
software, lost or misplaced charts are a problem
of the past;
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| Enhanced
Security |
| The
issue of HIPAA (Health Information
Portability and Accountability Act) compliance
has become more and more important. Violations
can be costly, with penalties running into thousands
of dollars. Electronic Medical Record (EMR) software
can assist with HIPAA compliance and security
concerns as follows: |
- Electronic Medical Record (EMR) softwares
can restrict access to specific portions of
the medical record;
- Electronic Medical Record (EMR) softwares
can be programmed to have multiple levels
of access for office personnel based on job
function;
- Electronic Medical Record (EMR) softwares
can have audit trails that identify anyone
who has accessed, added to or changed a medical
record;
- Exposure due to charts left inadvertently
in accessible areas is minimized;
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| Increased
Time Efficiency |
| Once
clinical workflow is automated, most tasks are
done in a fraction of the time previously required.
Thus, more patients are rendered better care in
less time. |
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| Electronic
Medical Records Improve Clinical Decision Making |
FACT:
Adverse Drug Events (ADE) is responsible for 2.1
million injuries and 100,000 deaths every year,
equivalent to two 737s crashing everyday. 4 American
Medical Association.
Health maintenance reminders help keep the doctor
and his/her staff updated on what treatments or
checkups the patient is due for through an automatic
alert or report in the EMR. By providing providers
with more information about the patient through
integration of external sources (labs, pharmacies,
imaging centers, hospitals) the provider is capable
of making better, educated decisions. |
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| EMR
Software-an Enhanced Documentation |
| Through
the use of computer network technology Electronic
Medical Record Software allows more than
one user to access a patient's chart at the same
time. This helps ensure a more complete and accurate
chart as all the information can be entered in
real-time. With the new HIPAA laws, many offices
using paper charts are exposing themselves to
unnecessary risks, including losing charts, loss
of all charts due to natural disasters, theft,
etc. Most EMRs come equipped with a security administration
module enabling administrators to manage access
to patient records through user permissions. One
of the greatest advantages to having patient documentation
computerized is the ability to manipulate data
for reporting capabilities. This becomes very
useful for research reports, statistics, health
maintenance reminders, drug recalls and patient
marketing. |
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| Electronic
Medical Records Enhance Patient Care |
| Finally,
the benefit of offering better patient care, though
difficult to quantify may be the greatest benefit.
Many doctors are now taking advantage of the Internet
to conduct web consultations. Being able to access
patient data from anywhere in the world via a
secure connection even allows the doctor to conduct
web consultations or generate reports from home.
Health maintenance reminders that can be automatically
generated from an EMR system
also contribute to providing improved patient
care. |
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