Originally published in Pain Medicine News; reprinted with permission
– Paul Lynch, MD, Tory McJunkin, MD, Tina Sebring, MS, MPA, Ryan Tapscott, MS
Dear Arizona Pain Specialists,
We are considering purchasing an electronic health record (EHR) system for our pain practice. We’re not sure how to get started or if it’s even worth the headache. Can I get some advice please?
Bravo! You have taken the first step, which is to simply begin the conversation. In today’s environment of costly paper charts, lost time searching for patient records, undecipherable scribbles and high document storage fees, there is no question as to whether you should purchase an electronic health record (EHR) system. The question is, which EHR is the best fit for your practice?
Pain management services are crucial to the well-being of patients and the entire health care system. A clinic that is focused on the needs of its patients should be as efficient and secure as possible; it is fundamental to improving the quality of life for those living with pain. In this scenario, medical records software solutions are a must.
Selecting an appropriate EHR for a pain practice requires significant financial and time investments. No shortcuts can be taken during the EHR selection process; it is too costly, in terms of both software and manpower, to rush such a decision. One must spend the time and resources to properly screen medical software vendors. Once an EHR system is purchased, a dedicated, ongoing effort is required to set up and implement it. Unfortunately, there are no perfect software solutions or implementation shortcuts, regardless of what any charismatic EHR salesperson might tell you.
As pain specialists, our practices can be quite complex; robust software may be required to perform many of our duties, including the following:
The ability to monitor multiple ordered and performed services.
The ability to submit different coding/bills as required by different settings (offices, ambulatory surgery centers
The ability for physicians to set-up “bundled” services; an EHR allows the provider to select the applicable injection with one click of a mouse. All related items automatically appear on the encounter form.
The ability to review each visit and note clinical trends.
The ability to thoroughly track referral sources, both incoming and outgoing, for purposes of sharing patient information and to grow business.
The ability to bill claims and track denials, and respond appropriately.
A fully functional EHR system gives physicians, nurses and technicians a patient’s comprehensive medical history at the point of care, whether in the doctor’s office, ASC or emergency room. It also is remotely accessible to providers who are on call, allowing them to make informed decisions to expedite patient care.
EHRs also have the potential to increase efficiency and contain costs by reducing duplication and improving patient safety. Their ability to calculate, network, automatically check facts and provide targeted research results is remarkably powerful. Applied to medical care, EHRs provide the patient and physician with current, accurate information.
The federal government supports EHR development and implementation. Veterans hospitals nationwide share an electronic system that allows for all veterans’ health records to be shared. Health care workers treating veterans in the system are able to see current medical records for any patient treated in any VA facility.
Additionally, President Obama signed the American Recovery and Reinvestment Act in February 2009, which initially included $26 billion toward the Health Information Technology for Economic and Clinical Health Act (HITECH). This is an unprecedented investment in health information technology, with the goal of establishing an EHR for each person in the United States by 2014.
Things To Know
To make the best selection of an appropriate, effective EHR for your practice, consider the following:
An EHR is a marriage. Think of an EHR selection as a relationship between your practice and the EHR product/vendor. Implementing an EHR for your practice will dramatically change the workflow for every area and process of your practice. Think about this choice as you would think about any major decision. You will be tied to the EHR software, support team company and product idiosyncrasies for a long time.
Make a top 10 list. The first step in selecting an EHR is to identify the most important items/services for your practice. This would include your most profitable services and any goals for the future (e.g., adding pain services, new locations). Consider your immediate needs and then include future objectives. It is better to grow into your software over time than replace the costly system whenever your practice expands. As you create this list, determine what specific workflows are vital to your practice.
Review medical software vendors. To narrow the lengthy list of medical software vendors, identify those who offer products for your practice size and specialty. The size and specialty of your practice typically indicate the features you will most likely use. Regardless of features and support, it would not make sense to purchase an enterprise application designed for 200-plus physicians if you are a sole practitioner. Do not base your decision on price alone. The EHR software will in essence run all important aspects of your business, and a good decision can be invaluable. A few thousand dollars in savings at the beginning may cost the practice much more later in both upgrades and manpower. Avoid this classic mistake by considering the growth of your business before purchasing.
Look for consistent success and stability. Has the vendor been in existence for many years with a significant customer base and a vested interest in the industry? Ten-plus years of experience provides a long-term reputation and track record you can research. These companies invest a significant amount of money to stay current by employing large programming teams to increase product functionality.
Take several test drives. At first glance, vendors may appear to be similar. However, there are differences in how and to what degree the software accomplishes your goals. Have each vendor illustrate how its product functions for each of the items you have listed as your top 10 priorities. Also, ask about tracking hospital rounds, off-site visits and procedures in remote locations. Make sure your practice has a record of service to compare with what a hospital billing department is sending. There is no gray area on this feature; the system will either be able to track this, or not. Create a scorecard to keep track of results. This will help you narrow the vendor list. Make sure you do not make the EHR decision based solely on how well the system performs for a clinician; instead think about billing, scheduling, authorization and every other process that occurs in your office.
Cost of ownership. Most software vendors have a preferred payment structure that can range from full payment at software delivery to a pay-as-you-go plan. Consider the financing plan carefully. No upfront costs and a monthly rental fee may not actually be a better financial choice. Compare the purchase of licenses and professional services upfront with a one-time capital outlay to a monthly rental fee. Negotiate the final payment after you have gone live to maintain leverage for any remaining issues. There is always pain as the dust settles in any new endeavor. It is nice to have a financial safety net.
Existing customer references. Obtain two to three references from each shortlisted vendor. Ensure references are from a practice of similar size and specialty. It is preferable to have the references in your geographic location so that you and your staff can visit the facility and see the system being used in day-to-day operation. Diligence with this step is imperative. Unfortunately, it often is skipped. You would not hire a physician without calling references first. Consider this the same type of homework; it is critical to avoiding a classic EHR purchasing mistake.
What about meaningful use? In order to participate in the HITECH EHR incentive program, the EHR software system must be certified by one of three certifying organizations. This ensures the features are in the system for your practice to use in order to demonstrate Meaningful Use Attestation for a 90-consecutive day period. For the official list of certified EHR products, visit http://onc-chpl.force.com/ehrcert.
Assistance. Selecting the right medical software solution for your office can be a daunting task. The good news is you have options for additional assistance. The Internet provides a flurry of information at no additional cost. There also are consulting firms available for hire in every major city.
As more organizations adopt EHRs, physicians will have greater access to patient information, allowing faster and more accurate diagnoses. Complete patient data helps ensure the best possible care. Patients too, will have access to their own information. They will have the choice to share it with family members securely over the Internet, to better coordinate care for themselves and their loved ones.
Digital medical records make it possible to improve the quality of patient care in numerous ways. For example, doctors can make better clinical decisions with ready access to full medical histories for their patients, including new patients, returning patients or patients who see several different providers. Laboratory tests or x-rays downloaded and stored in the patient’s EHR make it easier to track results. Automatic alerts built into the systems direct attention to possible drug interactions or warning signs of serious health conditions. E-prescribing lets doctors send prescriptions electronically to the pharmacy, so medications can be ready and waiting for the patient.
Although EHR systems require ongoing investments of time and money, clinicians who have implemented them have reported long-term savings. With the efficiencies that EHRs promise, their widespread use has the potential to result in significant cost savings for our health care system.
The best advice we can give is to take your time. Despite the fervor for EHRs in government and the press, now is the time to be sure you have conducted a thorough evaluation, taking into account the specific functional needs of pain medicine and your practice.
Drs. McJunkin and Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, 10 mid-level providers, three chiropractors, onsite research and behavioral therapy. They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine. Through their partner company, Boost Medical, they provide practice management and consulting services to other pain doctors throughout the country. For more information, visit ArizonaPain.com and BoostMedical.com.