EMR

EMR: Good For Your Patients And Good For You

When it comes to electronic medical records, think less about stimulus money and more about your practice.

APRIL JASPER, O.D., West Palm Beach, Fla.

If you're considering the purchase of an electronic medical records (EMR) system for your practice based on all you've heard about federal stimulus money, then ask yourself this question: While stimulus money is an attractive incentive today, what are the real long-term benefits of EMR in your practice?

Three years ago when I adopted EMR in my office, it wasn't about government incentives. It was about better patient care and practice efficiency. Granted, such claims about EMR systems and efficiency may appear vague, so I challenge you to look at your own office's business statistics. For example, in my 900-square-foot office, revenue per square foot is an important number. It is unacceptable for paper charts to take up even 100 square feet of space. With an EMR system in place, that space can be put to better use for my patients and for the practice.

The task of choosing and implementing an EMR system may appear more formidable than anything you have done since you took your state boards. However, I can tell you it is no different than anything else you've accomplished. Follow these 10 rules for success in implementing EMR just as you have with other goals in life:

1. Make the decision.
2. Stay focused.
3. Write down your goals.
4. Plan thoroughly.
5. Involve others, including vendors, colleagues and staff.
6. Welcome challenges.
7. Take purposeful action.
8. Evaluate your process.
9. Evaluate your progress.
   And finally:
10. Reward your practice for your accomplishments.

Why EMR?

There are several reasons to implement EMR, but the most compelling is that the system will benefit your patients. And if it's good for the patient, it's good for the practice. Think in terms of the specific advantages that an EMR system can provide your office. The features that my practice found most beneficial follow:

► With EMR, you can quickly pull up test results on your computer screen. Many of the EMR systems even chart results in a way that improves doctor/patient communication, and thereby patient adherence to recommendations. You or your staff can quickly identify which tests have been completed and when. The ability to look up medications prescribed and refills is quick and easy as well.

► The use of EMR typically reduces exam time by five minutes per patient. This savings allows more time for doctor/patient communication, which can advance the level of care and improve patient loyalty. You can also use this time savings to schedule more patients. If you scheduled three patients per hour without an EMR system (20 minutes per patient), with EMR you now have the ability to see four patients each hour (15 minutes). Even if your patient visits last as long as 45 minutes without EMR, you would still be able to see one additional patient each day with an EMR system.

► EMR improves accuracy in your office dramatically. For example, EMR systems that are equipped with an e-prescribing feature minimize data entry errors in spectacle prescriptions sent to the optical laboratories and in medication prescriptions sent to the pharmacies. The transfer of information, from patient record to prescription is electronic (so, there is no double entry). Many of the e-prescribing systems also generate a list of all medications the patient receives from participating pharmacies.

The e-prescribing system also informs you of patient allergies and drug interactions as well as errors in dosage or route of administration before you complete the electronic transmission of the prescription. Eventually these e-prescribing systems will also inform you of lower cost alternatives for medications and which medications are covered on the patient's insurance.

► Billing and coding is easier than ever. Electronic medical record systems can send your codes directly from the medical record to the patient fee slip and then directly to the insurance companies through a clearing house so that you no longer have to enter patient information into a second website to send electronic claims. This system results in a faster payment of claims and improved collections on unpaid amounts because of the speedy transmission of the electronic explanation of benefits.

► The implementation of EMR will energize your staff. Of course, there are always exceptions — those who resist change. But in general, staff members are the first to acknowledge how costly paper charts are in terms of material costs and staff time. EMR allows your office to eliminate the tasks that are not of value to your patients or your employees, such as pulling charts, filing charts, preparing charts, locating lost charts, organizing charts and purging charts. This increases both patient and staff loyalty.

As an added bonus, surveys from my practice show that patients value our team's use of technology as well as the savings in time and improved efficiency that EMR provides.

The 30-day learning curve

Many of the optometrists who have implemented EMR will agree that there is a learning curve of approximately one month. After that first month, I've discovered that these practices have found the entire implementation process, from reception to pre-testing to optical and pre-appointing, much more efficient than before and as a result, a real time saver. The savings translate into additional appointments, and the staff efficiencies result in one less staff position required per staff of six.

Statistics from the Mayo Clinic, one of the first medical facilities to adopt EMR, show that for each physician requiring seven staff, the number could be reduced to six after the learning curve had passed. According to doctors at the Mayo Clinic, one of the most significant benefits of EMR is that all the patient tests (such as lab work and x-rays) are available at the touch of a button.

In an optometric office, this is an awesome feature as well. Many EMR systems offer direct interfaces with your digital diagnostic equipment so that when the patient has completed a test, the results flow seamlessly into the software where they can be accessed from within the patient record. With this integration, staff no longer have to enter patient demographic data into each of the software programs native to each piece of digital diagnostic equipment. This feature also allows your office to establish a broader electronic health records (EHR) system. (See Getting the Picture for definitions of EMR and EHR.)

Tips for buyers

The process of selecting EMR software can be intimidating, but you can streamline this decision by asking prospective vendors the following questions:

► How many optometric practices does this company already serve?
► How long has the company been in business?
► What kind of reputation does the company have with your equipment customers?
► Does the vendor's software integrate seamlessly with your digital equipment so that you do not have double entry of data?
► Does the vendor have the financial backing to weather the storm of government certification?
► Does the vendor have a training system in place to get you up to speed during non-business hours?

You should also consider the system that your closest colleagues use so that you can help each other with concerns and issues as they arise. Conduct research to find out whether your present office system can be converted to the new system and how difficult the process will be.

Unfortunately, not many people have experience with several EMR systems, so it's difficult for them to make comparisons between one system and another. When colleagues or vendors tell you that one is better than another, ask them to support their statements with research. I think all EMR users will tell you (as does Mayo Clinic) that there is no perfect system at this time.

Cost issues

Cost is always a concern. So, when you look at a system, make certain you uncover the costs of the products and services that you'll need, which may not be included in the cost of the initial installation. For example:

► What is the cost of the conversion of your data from one system to another?
► How much will your yearly maintenance agreement cost?
► What is the cost of the e-prescribing module?
► How much does the equipment integration package cost?

One place you will find the largest discrepancy in costs is in the yearly maintenance agreements. Depending on the number of workstations, this can range from about $1,000 to $25,000. There are some doctors who want to be able to customize the software completely and don't want a program that uses templates (which are like pre-printed exam forms). If you're one of these doctors, then spend more time evaluating each system with a sales consultant to ensure the vendor will set up the EMR system that's “ready to go,” meaning that you will not have to spend a lot of time customizing the system.

Make certain the EMR software is compatible with your practice size and number of locations. It's always best to have your information technology company evaluate these issues with you and the vendor as well. Most of the vendors post the hardware requirements and information regarding number of workstations and software requirements on their website, and they post with their partner vendors. Look for training videos on the software vendors' website as well so you can see the software in action.

The final step

My purchasing decision boiled down to these criteria:

1. The company was looking to the future.
2. The company and the software had a good reputation with my most respected colleagues.
3. The cost was reasonable relative to other systems.
4. The software had the ability to integrate with my office's digital equipment.

If you're still not sure which program to buy, obtain references from the vendor, and visit an office that uses the software to its fullest capacity.

Once you make the purchase decision, put all your energy into making it happen. Don't look back or second guess yourself. Move full speed ahead. OM

Dr. Jasper is in private practice in West Palm Beach, Fla. She graduated from Nova Southeastern University and completed a residency in ocular disease at the Brockton/West Roxbury VA Medical Center in West Roxbury, Mass. She is a fellow of the American Academy of Optometry, trustee for the Florida Optometric Association and a Vision-Source administrator. E-mail Dr. Jasper at drjasper@aeswpb.com.