Health Information Technology

1. Health Information Technology “Helping Physicians Navigate the Maze”

2. EMR 101: Analyzing the Physician Practice Environment for EMR Adoption Discuss adoption and implementation of EMR in the medical office practice Discuss how implementation of an EMR affects the medical practice Discuss the process and tools for implementing an EMR, as well as realistic expectations

3. Entering the Maze of Information: A Beginner’s Guide to Electronic Medical Records in the Medical Office Setting

4. Medicine is a very information-intensive profession Every patient interaction with any level of healthcare, every day involves collecting information and putting it into the patient’s medical record The patient record directly impacts the daily mission of medical practice: Delivering patient care The patient record should reflect the patient’s complete medical/health history Doesn’t it make sense that this should be an electronic medical record? Doctors and everyone in healthcare need to take advantage of advances in information systems technology that other aspects of our society have been using for years Since the patient’s health and medical history is dynamic, Since the patient’s health and medical history is dynamic,

5. Transitioning to an EMR can and will impact the lives of the health care providers, the administrative staff behind the scenes and the patients themselves

6. Successfully making the transition to electronic medical records may be the most important project that a medical practice can undertake The stakes are high as physicians and the medical practice start their journey through this maze

7. A successful electronic medical records implementation project has the potential to significantly improve the clinical and administrative efficiency of medical practices, as well as enhance the overall quality of care An unsuccessful project can be frustrating and expensive

8. Why is it important to go through this implementation process?

9. Why is this important for patients? Patients want better access and more convenience Same-day appointment Online scheduling of appointments Online access to medical records and test results E-mail access to a doctor Website providing information about health conditions, quality of doctor care and prices of services Educational classes and meetings Assistance from a care coordinator Assistance from a patient billing representative Versel, Neil. “Technology for Patient and Practice: Enhancing Practice Effectiveness.” Doctor’s Digest 4, no. 4 (July/August 2008) 20.

10. Why is this important for doctors? Doctors want to streamline use of time and resources Improve workflow Reduce the potential for errors in patient care Improve the quality of care provided to the patient Population-based disease management Generate data to support quality scores and compare to accepted standards of care. Use the data to negotiate contracts with insurance companies streamline: e.g., reduce redundancies reduce errors: e.g., automate more in order to remove the human error from the process generate data ..: we can track P4P metrics such as blood pressure, cholesterol and HgA1c levels of diabetes and use the data to demonstrate qualitystreamline: e.g., reduce redundancies reduce errors: e.g., automate more in order to remove the human error from the process generate data ..: we can track P4P metrics such as blood pressure, cholesterol and HgA1c levels of diabetes and use the data to demonstrate quality

11. Using an EMR can make a difference Chart Management Better Documentation Improved Quality of Care Cost Reduction Increased Revenue Universal Access to Data Better Security Faster Retrieval of Information Automatic Reminders Compliance with Regulations

12. Technology can help!

13. Technology that can improve patient care Electronic medical record/Electronic health record Electronic practice management system Clinical decision support Electronic charge capture Lab ordering and interface with outside labs Electronic Prescribing (e-Prescribing) Personal health record Secure Web portal for communications Remote monitoring devices Smart phones and PDAs

14. What is an electronic medical record (EMR)? EMR is software that allows you to create, store, edit and retrieve patient charts on a computer Simply put, an EMR allows you to replace the racks of chart folders with a computer Simply put, an EMR allows you to replace the racks of chart folders with a computer

15. Is it EMR? or is it EHR? EMR: Electronic Medical Record EHR: Electronic Health Record Electronic Medical Record=A record of patient history and encounters within a single institution or organization Electronic Health Record=a more encompassing medical record, it may represent a patient’s medical history and health status across the continuum of care However, a true EHR remains an as-yet-unattained goal because full electronic connection between health systems does not yet exist in our region or in the United States Electronic Medical Record=A record of patient history and encounters within a single institution or organization Electronic Health Record=a more encompassing medical record, it may represent a patient’s medical history and health status across the continuum of care However, a true EHR remains an as-yet-unattained goal because full electronic connection between health systems does not yet exist in our region or in the United States

16. In 2003, the IOM identified eight “core functions” of an EHR Patient-specific health data Current and past test results for the patient Prescription and test order management Clinical decision support Secure Communications, between patient and physician, as well as everyone involved in the healthcare of that patient Tools to allow patients access to records and educational materials to help manage chronic conditions Administrative tools to improve efficiency of healthcare delivery Reporting of data stored electronically The IOM core functions are very realistic and as I previously mentioned are areas that can be achieved by the use of an EMRThe IOM core functions are very realistic and as I previously mentioned are areas that can be achieved by the use of an EMR

17. Areas in the medical office where an EMR can make a difference Improved clinical efficiency, patient care, and service Better documentation Improved quality of care Automatic reminders Improved administrative efficiency Better chart management Universal access to data Faster retrieval of information Better security and compliance with regulations Cost reduction Productivity and efficiency gains may translate into savings Revenue enhancement Electronic charge capture Real time claims adjudication Better documentation: legible progress notes, organized and complete means the visit is more thoroughly documented and will help with more accurate coding; improved medication management, can check drug to drug and allergy interactions; built-in protocols and reminders, can flag overdue lab results; easier patient and telephone triage and better patient education & involvement. Improved..efficiency: there’s never a “lost” chart; access imformation from home, hospital & office, multiple staff members can view same chart at the same time; there’s instant access to patient data (past notes, lab data, medications, hospital records) and reduction in “phone-tag”; there are multiple security levels to protect patient data and easier compliance with increasingly complex health laws and requirements. Cost reduction: you can cut down on staff-to-provider ratio (successful EMR offices are more efficient than traditional offices, fewer FTEs to support physicians (2.0-2.5 s MGMA of 4.0) Revenue enhancement.. You can have Electronic charge capture: ability to have a billing system capable of sending transactions without the need for a claims clearinghouse Real time…adjudication: this is offered by a small but growing number of national and regional payers (eg BCBSF’s CareCalc) and allows patients to know at the time of service exactly what they owe; this enables practices to collect payments in full at the time of service and improves cash flow and collections. With the improvement in clinical efficiency, administrative efficiency this may allow you to increase the number of visits per day: some physicians report seeing 10-15% more patients per dayBetter documentation: legible progress notes, organized and complete means the visit is more thoroughly documented and will help with more accurate coding; improved medication management, can check drug to drug and allergy interactions; built-in protocols and reminders, can flag overdue lab results; easier patient and telephone triage and better patient education & involvement. Improved..efficiency: there’s never a “lost” chart; access imformation from home, hospital & office, multiple staff members can view same chart at the same time; there’s instant access to patient data (past notes, lab data, medications, hospital records) and reduction in “phone-tag”; there are multiple security levels to protect patient data and easier compliance with increasingly complex health laws and requirements. Cost reduction: you can cut down on staff-to-provider ratio (successful EMR offices are more efficient than traditional offices, fewer FTEs to support physicians (2.0-2.5 s MGMA of 4.0) Revenue enhancement.. You can have Electronic charge capture: ability to have a billing system capable of sending transactions without the need for a claims clearinghouse Real time…adjudication: this is offered by a small but growing number of national and regional payers (eg BCBSF’s CareCalc) and allows patients to know at the time of service exactly what they owe; this enables practices to collect payments in full at the time of service and improves cash flow and collections. With the improvement in clinical efficiency, administrative efficiency this may allow you to increase the number of visits per day: some physicians report seeing 10-15% more patients per day

18. What are advantages to the use of EMR technology? Physicians with comprehensive electronic records systems reported greater benefits in all aspects of the medical practice Real-time access to all the information about the patient at the point of care can translate into better patient care and improved patient encounter Versel, Neil. Doctor’s Digest 4, no. 4 (July/August 2008) 37: “Rates of positive Surgey responses on the effect of Adoption of Electronic-Health-Records Systems (DesRoches C et al. N Engl J Med. 2008; 10:1056/NEJMsa0802005 Quality of clinical decisions: Clinical decision support systems helps guide the care of patients who have multiple chronic problems such as high blood pressure and diabetes. Reminders and prompts help keep all the medical conditions foremost in the clinician’s mind and make the most of the patient encounter Quality of communication with other entities involved in the patient’s care: via a secure communication portal to allow communication with other providers and with patients Less time-consuming prescription refills Timely access to medical records Avoiding medication errors Delivery of preventive care and chronic-illness care that meets best-practice guidelines Check recommendations for management of a medical problem via the Internet, look up outcomes of studies or scientific information regarding that patient; medication interactions, etc Sounds familiar: recall the IOM’s desired core functions and how areas where EMRs already are making a difference. Allow a true Patient-centered medical home with patients full partners in their own care Quality of clinical decisions: Clinical decision support systems helps guide the care of patients who have multiple chronic problems such as high blood pressure and diabetes. Reminders and prompts help keep all the medical conditions foremost in the clinician’s mind and make the most of the patient encounter Quality of communication with other entities involved in the patient’s care: via a secure communication portal to allow communication with other providers and with patients Less time-consuming prescription refills Timely access to medical records Avoiding medication errors Delivery of preventive care and chronic-illness care that meets best-practice guidelines Check recommendations for management of a medical problem via the Internet, look up outcomes of studies or scientific information regarding that patient; medication interactions, etc Sounds familiar: recall the IOM’s desired core functions and how areas where EMRs already are making a difference. Allow a true Patient-centered medical home with patients full partners in their own care

19. Other advantages to the use of EMR technology? Everyone involved in patient care who needs access to the patient information has it at their fingertips whenever it is needed Makes the office appear more professional Staff spends less time chasing down information and more time interacting with patients Easier to “squeeze in” last-minute, same-day appointments, which helps patients The EMR’s in-office communication system allows for decreased noise in the office The EMR and PMS are integrated: information is entered only once More professional appearance: (don’t have stacks of charts, papers and sticky notes lying around) Decreased noise in office: (the office is quieter and runs more smoothly), staff members know what to do and they’re doing it instead of shouting to each other. EMR/PMS information: (demographic data, insurance information, diagnoses, billing codes) More professional appearance: (don’t have stacks of charts, papers and sticky notes lying around) Decreased noise in office: (the office is quieter and runs more smoothly), staff members know what to do and they’re doing it instead of shouting to each other. EMR/PMS information: (demographic data, insurance information, diagnoses, billing codes)

20. What are the disadvantages of EMR Technology? Computers disrupt the patient-physician dynamic Technology slows doctors down, means decreased volume Technology might increase liability risk Nothing is standardized Electronic information vulnerable to hackers Technology is too expensive Providers foot the bill for clinical information technology, yet payers, reap the greatest financial benefit ..dynamic..: Using the computer while listening to and talking to patient, doctor will sometime have to break eye contact and this may be a problem for some, but is generally acceptable to patient, if they feel you are capturing their concerns accurately Decreased..: There’s usually a period of slowdown in patient volume (about 6-months productivity decline). Can choose to transition in small bits; start e-prescribing, then practice management system with electronic charge capture, then online reference tools, automatic generation of referral letters, etc. Technology..standardized: If you cut & paste patient information from previous office notes, this can magnify and perpetuate errors instead of recording detailed notes at the time of the patient encounter ..Expensive: HIT costs money, and healthcare providers dealing with dwindling reimbursement do not have extra money or time to invest in technology…. The reimbursement system currently rewards volume of service, not necessarily quality of service, so providers may not see any financial reward for their investment. Reducing duplicate testing because earlier records can’t be found and preventing complications from errors save money for payers, not necessarily providers. ..dynamic..: Using the computer while listening to and talking to patient, doctor will sometime have to break eye contact and this may be a problem for some, but is generally acceptable to patient, if they feel you are capturing their concerns accurately Decreased..: There’s usually a period of slowdown in patient volume (about 6-months productivity decline). Can choose to transition in small bits; start e-prescribing, then practice management system with electronic charge capture, then online reference tools, automatic generation of referral letters, etc. Technology..standardized: If you cut & paste patient information from previous office notes, this can magnify and perpetuate errors instead of recording detailed notes at the time of the patient encounter ..Expensive: HIT costs money, and healthcare providers dealing with dwindling reimbursement do not have extra money or time to invest in technology…. The reimbursement system currently rewards volume of service, not necessarily quality of service, so providers may not see any financial reward for their investment. Reducing duplicate testing because earlier records can’t be found and preventing complications from errors save money for payers, not necessarily providers.

21. How will patients respond? Even if most doctors are not ready to implement an EMR, the public is ready! Public is ready: a survey commissioned by the Blue Shield of California Foundation (called “Healthy @ Home”) and conducted by the AARP (results released in March 2008) found that 95 percent of respondents 65 and older wished their doctors had a device to check insurance coverage and medication history.” From DD, p. 13: “…Similarly, 92 percent would like their physicians to transmit prescriptions electronically to the pharmacy of their choice.” From Versel, Neil. “Technology for Patient and Practice: Enhancing Practice Effectiveness.” Doctor’s Digest 4, no. 4 (July/August 2008) 8, 13. Public is ready: a survey commissioned by the Blue Shield of California Foundation (called “Healthy @ Home”) and conducted by the AARP (results released in March 2008) found that 95 percent of respondents 65 and older wished their doctors had a device to check insurance coverage and medication history.” From DD, p. 13: “…Similarly, 92 percent would like their physicians to transmit prescriptions electronically to the pharmacy of their choice.” From Versel, Neil. “Technology for Patient and Practice: Enhancing Practice Effectiveness.” Doctor’s Digest 4, no. 4 (July/August 2008) 8, 13.

22. Here we are: Considering Electronic Medical Records adoption and implementation

23. How will EMR adoption and implementation impact the day-to-day flow of the office? Improve work flow by eliminating the time-consuming process of creating, finding, and re-filing paper charts Many of the day-to-day activities of the practice are much easier Patients can move smoothly from the check-in process to the nurses’ station for vital signs and into the exam room without staff ever having to carry a paper chart Administrative staff (billers or transcriptionists) benefit from universal access Activities..easier: (prescription refills or refill authorizations, patient call-backs, and outside requests for charts) Administrative staff…: As I previously mentioned, there’s Real-time claims adjudication and electronic charge capture, as well as integration of the EMR and PMS systems This enables practices to collect payments in full at the time of service, thus accelerating cash flow and improving collectionsActivities..easier: (prescription refills or refill authorizations, patient call-backs, and outside requests for charts) Administrative staff…: As I previously mentioned, there’s Real-time claims adjudication and electronic charge capture, as well as integration of the EMR and PMS systems This enables practices to collect payments in full at the time of service, thus accelerating cash flow and improving collections

24. Prepare the organization for Electronic Medical Records Both the office and the staff must be prepared for the transition to a new system

25. Questions to consider as you proceed through the maze of information about EMR adoption and implementation The next series of slides contain Questions to consider…, however in the interest of time, I’ll skip ahead and leave these for you to read on your own.The next series of slides contain Questions to consider…, however in the interest of time, I’ll skip ahead and leave these for you to read on your own.

26. How long does it take from signing the contracts to going live with the EMR? The EMR adoption and implementation project is a cooperative effort between the software and hardware vendors and the practice; it will require completion of certain tasks The amount of time depends on the EMR software, size of the practice and quality of the project management (by both the vendor and the practice) Typically this is 3-6 months, depending on the size of the installation ..Completion certain tasks: Mobilization of clinical and administrative staff Acquisition and installation of hardware and network Configuration of the EMR to meet the individual practice’s needs Completion of special interface projects On-site training..Completion certain tasks: Mobilization of clinical and administrative staff Acquisition and installation of hardware and network Configuration of the EMR to meet the individual practice’s needs Completion of special interface projects On-site training

27. What is the typical EMR configuration? Most common: PCs in exam rooms, doctors’ offices, nurses’ stations, check-in desk; networked together, linked to a common server Other: wireless laptops; typically used by the physician in conjunction with networked PCs

28. What will I need to purchase? EMR software and related accessories Hardware and Networks Services Support Usually sold by number of users logged on to the system (the Provider + support staff). Software provider will help determine the needs of the specific site. EMR software accessories such as Patient Education, drug to drug / drug to food / drug to allergy checking, Formulary checking. These are typically sold on a subscription basis as the information is dynamic and routinely updated Office will need to install a network of PCs that seamlessly communicate with each other. Consists of individual PC workstations; a server; the operating system; various hubs, network cards, wiring that connects everything together. Printers, scanners and backup devices Most EMRs require implementation and training services: project planning, customization, education on the application to prepare the office for the new software (usually offered by the software vendor). Ongoing hardware and network services to ensure the successful deployment of the network. The hardware and software will need to be maintained by technical support Technical support software is usually sold and renewed on an annual basis and typically priced as a percentage of the total price of the software. The support contract is typically the help desk function and software updates. Usually sold by number of users logged on to the system (the Provider + support staff). Software provider will help determine the needs of the specific site. EMR software accessories such as Patient Education, drug to drug / drug to food / drug to allergy checking, Formulary checking. These are typically sold on a subscription basis as the information is dynamic and routinely updated Office will need to install a network of PCs that seamlessly communicate with each other. Consists of individual PC workstations; a server; the operating system; various hubs, network cards, wiring that connects everything together. Printers, scanners and backup devices Most EMRs require implementation and training services: project planning, customization, education on the application to prepare the office for the new software (usually offered by the software vendor). Ongoing hardware and network services to ensure the successful deployment of the network. The hardware and software will need to be maintained by technical support Technical support software is usually sold and renewed on an annual basis and typically priced as a percentage of the total price of the software. The support contract is typically the help desk function and software updates.

29. How are progress notes created? This is variable according to the software vendor: Clinical templates Dictation Voice recognition

30. Is there a way to save clinical information before going live with an EMR? For practices that use transcription for clinical documentation, there is a way to format transcribed notes so they can be downloaded into some EMR software When the EMR project is ready to go live, the stored information can be downloaded and the practice will be up and running with a significant amount of clinical data already in place

31. How much interaction do physicians actually have with the EMR? The EMR is the focal point of all clinical documentation The EMR will be the most commonly used computer application by physicians during their normal workday The amount of keyboard and data entry required is variable depending on the EMR software At the very least, physicians will be required to directly use the computer to open and view patient charts and to write prescriptions (these are basic computer or typing skills)

32. What happens if the system goes down? What is used for backup? All EMR installations have system backup Involves copying patient charts to specialized storage medium (digital archive tape or DAT) that is stored offsite If the system goes down, patient information can be restored from the tape backup.

33. How does the EMR interact with the billing and scheduling products? If your practice has an existing medical billing and appointment scheduling functionality that is satisfactory, the EMR will function with these applications with the establishment of an interface between the practice management software and the EMR to transfer patient demographics If you do not have an existing practice management program or if this is a new practice, plan on purchasing billing, scheduling and the EMR from the same vendor

34. How secure is the EMR? EMR security is ensured by network access limitations and EMR access levels when individuals are logged on The system administrator defines access and privileges according to the respective roles of the office staff

35. Is the EMR legally valid? All CCHIT approved software programs are complete, medically legal records with an audit trail Allows practices to track all changes to any textual record (progress notes and other clinical documents) This ensures document integrity within the organization and validates the record for medical legal purposes

36. What organizational leadership is required to make the project successful? For an EMR implementation project to be successful, physician leadership is required! Build support from the doctors who are reluctant to use an EMR For a larger multi-physician group, this will require a physician leader/advocate who can effectively communicate the goals of the project and be a liaison to the group on technical or user issues In a smaller office, the leadership will be provided by the physician in the office and/or office manager Build support: At first, try to minimize the amount of change required in daily work flow patterns, then gradually increase the changes required as the new work flow patterns develop For a larger multi-physician group, this will require a physician leader/advocate who can effectively communicate the goals of the project and be a liaison to the group on technical or user issues In a smaller office, the leadership will be provided by the physician in the office and/or office manager Build support: At first, try to minimize the amount of change required in daily work flow patterns, then gradually increase the changes required as the new work flow patterns develop

37. What additional staff is needed to support the EMR? Perhaps none, but it will be necessary to allocate the responsibility for basic system administration to someone in the practice An EMR system requires routine maintenance, backups and someone to troubleshoot problems as they occur.

38. A successful EMR project will allow a practice to replace its paper charts with electronic charts

39. What are the steps to accomplish the transition? Use the EMR as the primary means of clinical documentation Establish interfaces (especially labs) Establish scanning protocols Use clinical tools that support a paperless environment; e.g., PC-based 12 lead ECG machines Retire the existing charts in a steady and methodical fashion Use …documentation: enter progress notes, prescriptions, vital signs, nurses’ notes and all other handwritten or transcribed documentation Establish… labs): this allows information from either clinical or administrative sources to be loaded directly into the electronic medical record Establish .. Protocols: There will be some relevant clinical documentation will still be on paper; using optical character recognition software, these documents will need to be scanned and converted to text and then loaded to the chartUse …documentation: enter progress notes, prescriptions, vital signs, nurses’ notes and all other handwritten or transcribed documentation Establish… labs): this allows information from either clinical or administrative sources to be loaded directly into the electronic medical record Establish .. Protocols: There will be some relevant clinical documentation will still be on paper; using optical character recognition software, these documents will need to be scanned and converted to text and then loaded to the chart

40. Summarize the salient points of the paper chart for entry into the EMR These summaries can either be transcribed and then downloaded into the chart or entered into the chart directly as they are summarized. Be selective about which charts to summarize: summarize paper charts as patients make appointments; or select your high frequency patients and summarize their chart Use a methodical process to accomplish this and it will probably take 6-12 months, depending on patient volume I will be about 6-12 months before you’ll no longer need or use the paper chart.I will be about 6-12 months before you’ll no longer need or use the paper chart.

41. Make the adoption and implementation project a success Defining the goals of an EMR implementation project and preparing a plan to achieve these goals are critical to the success of the project The success of an EMR implementation project will depend on the ability of a practice to effectively transition the majority of their clinical documentation from paper-based systems to electronic systems while still maintaining physician productivity Creating a “paperless office” is not the goal – Gaining efficiencies in the office and providing high-quality patient care should be the goal. You may use various types of tools, electronic or paper-based but plan a step-by-step approach to get from where you are now to more efficient and effective delivery of patient care. Plan well; have a clear understanding of where your practice is going and how the work flow will change. Make sure all staff members have the same understanding of how each step in the change process will affect their area in the office. Many practices have laid out plans and made many mistakes in implementing an EMR: seek help from others who have traveled this path. Creating a “paperless office” is not the goal – Gaining efficiencies in the office and providing high-quality patient care should be the goal. You may use various types of tools, electronic or paper-based but plan a step-by-step approach to get from where you are now to more efficient and effective delivery of patient care. Plan well; have a clear understanding of where your practice is going and how the work flow will change. Make sure all staff members have the same understanding of how each step in the change process will affect their area in the office. Many practices have laid out plans and made many mistakes in implementing an EMR: seek help from others who have traveled this path.

42. Is the process of implementing an EMR worth the effort in terms of efficiency and quality of care? Issues of Cost: Purchasing IT is expensive. How do you insure getting the most for what you budget/spend? Making the transition to an EMR is a major undertaking for any office practice. Does it make sense from a business perspective? The EMR is a tool with a broad set of features and capabilities that are optimized when the practice is able to fully transition to the electronic chart Issue of Cost: … Too high a cost is really relative to the buyer and the perceived value in evaluating the investment required to jump into the medical electronic technology pool And that’s what it may take: a leap of faith. Sometimes you just have to recognize that you have to make sacrifices, invest in the technology, use it and identify the measures you will track to determine if value is present and if there is a return on investment. “A report from the Medical Group Management Association indicates that the most successful practices spend only slightly more on HIT than the typical practice. Many successful practices credit technology as a major factor in the improved quality of care and the efficiency of their operations.” (3.) Making the transition … Determining whether an EMR makes sense in a medical office is not just a “numbers game”. More importantly, it is about quality of services provided as well as the effect it will have on the clinical and administrative staff. Issue of Cost: … Too high a cost is really relative to the buyer and the perceived value in evaluating the investment required to jump into the medical electronic technology pool And that’s what it may take: a leap of faith. Sometimes you just have to recognize that you have to make sacrifices, invest in the technology, use it and identify the measures you will track to determine if value is present and if there is a return on investment. “A report from the Medical Group Management Association indicates that the most successful practices spend only slightly more on HIT than the typical practice. Many successful practices credit technology as a major factor in the improved quality of care and the efficiency of their operations.” (3.) Making the transition … Determining whether an EMR makes sense in a medical office is not just a “numbers game”. More importantly, it is about quality of services provided as well as the effect it will have on the clinical and administrative staff.

43. Are we there yet? No, but you’re closer to the end of the maze of Information

44. How do you decide which system to buy? Narrow the focus of the search using online resources: Buy a product that is certified by Certification Commission for Health Information Technology (CCHIT) The CCHIT was established to help set standards for EMR Products and works toward a goal that allows systems to communicate with each other Fearless EMR Selection by Robert Lamberts, MD, online Physician Practice Pearls, Oct 9, 2008, vol. 9, no. 40

45. The American Academy of Family Physicians’ Center for Health Information Technology and the American College of Physicians both have websites with tools to help member physicians make a purchase decision for an EMR Check with your specialty society

46. Ask colleagues and other neutral advisors DOQ-IT is a federally funded program, but administered through state quality improvement organizations, to help primary care practices choose and implement an EMR HIMSS is a professional IT organization that has programs to promote EMR adoption

47. Compare products in terms of: Implementation process Cost Disease management E-prescribing Online communication tools Past track record and future health of the vendor And Any other measurements that are important to you.And Any other measurements that are important to you.

48. See the system functioning in an office similar to your own. If the EMR vendor cannot show you an actual practice using its product, be very wary about buying that system Salespeople make any product look good Only by visiting another medical practice will you see it all: the good, the bad and the ugly! Ask Questions Questions: Does this EMR technology help me improve delivery of care to my patients? Does this EMR technology help me deliver better quality of care and do so more efficiently, thus helping my ability to generate more revenue? Will this EMR technology keep up with the changes occurring in medical HIT, so I will be able to continue to upgrade and maintain “best practice” quality measures?Questions: Does this EMR technology help me improve delivery of care to my patients? Does this EMR technology help me deliver better quality of care and do so more efficiently, thus helping my ability to generate more revenue? Will this EMR technology keep up with the changes occurring in medical HIT, so I will be able to continue to upgrade and maintain “best practice” quality measures?

50. Conclusions An Electronic Medical Record is the inevitable next step in the continued progress of healthcare An EMR is one of the best business and quality of care investments that a practice can make The electronic medical record is one of the few technologies that has an impact on both the clinical and administrative aspects of the practice Successfully implementing an EMR allows a practice to replace its paper charts, offering tremendous productivity and efficiency benefits The business case for the EMR is based not only on its ability to lower costs, increase revenue and improve the efficiency of a practice, but also on its role as a tool to enhance the quality of services provided

51. Additional benefits can accrue when the system is fully integrated with the scheduling and billing functions of the practice While the decision to transition to an electronic medical record requires a commitment of significant resources (time, money and people) and leadership at the physician level, there are very few investments that offer a greater return If a deliberate path is outlined from the project’s inception, with the clear goal of a paperless and more profitable office, then a more efficient staff and a healthier patient population will attest to the fact that you made the right decision in implementing an EMR