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For other articles and previous issues click here. May 6, 2002 OFF
THE CHARTS By making the switch from paper to electronic medical records, physician practices and hospitals can streamline processes, cut costs, and improve patient care. Electronic medical records (EMR) are a hot topic in the healthcare industry. It seems everyone is talking about the benefits, the problems, and the solutions surrounding this new frontier of HIM. But once medical practices and healthcare organizations decide to take the plunge and spend the money and time necessary to implement an EMR system, how can they tell if it was worth the effort? How can they determine if they are getting a sufficient return on investment (ROI)? Compared with the speed and efficiency of EMR systems, paper-based medical records systems seem outdated. They can potentially slow office workflow patterns, costing time and money, as they pass through the hands of everyone who needs to reference them in order to provide care or to obtain payment for services rendered. In addition to disruptions caused when charts need to be physically located to refill prescriptions and answer patient questions via telephone, paper records take up more space, which, especially in urban practices, is at a premium. In addition, EMR use is especially valuable in the acute care setting, providing physicians, nurses, pharmacists, and other clinicians with instant access to information on each patient’s progress. Given the drawbacks of working in a paper-based system, it makes sense to transition to EMRs, according to Bruce Kleaveland, senior vice president of sales and marketing for Physician Micro Systems Inc., in Seattle, Wash. “Much of the inefficiency of paper-based systems is due to the labor and management required to deal with them,” he explains. “One of the most immediate benefits of a successful EMR project is that you are not expending that time and labor, and the charts are available for those who need to access them to make administrative or clinical decisions.” However, implementing an EMR system alongside a paper-based system can impede savings, reducing both labor efficiency and improvements in workflow, he adds. “It’s very costly to run dual paper and electronic systems,” Kleaveland notes, “so, from the outset, the goal of the project should be to replace your paper-based system with an electronic one.” Maintaining dual systems can also result in decreased accuracy, according to Kleaveland, who explains that consistency of information between the paper-based and electronic systems is critical. “Ultimately, there should be one primary record which both physicians and administrative staff can rely on to make their decisions.” Existing practices relying on paper-based records will probably require a six to 12-month transition period to create a single electronic source of data, he adds. “If, as a physician, you want to get the highest return on investment, totally electronic records should be your goal.” When a practice establishes the goal of implementing EMRs, there is a variety of areas in which the ROI can be measured, including HIM, staffing, medical transcription (MT) costs, and clinical efficiency. Together, these improvements can result in a happier staff, more free time for physicians, and improved patient care, according to Jerry Shultz, vice president of sales and marketing at NextGen Healthcare Information Systems Inc., a division of MicroMed Healthcare Information Systems Inc., in Horsham, Pa. “Medical transcriptionists are in short supply, so many physicians pay high transcription bills,” he says. “The primary motivation for determining the efficiency of EMRs is increasing quality, not just saving dollars and cents.” Most physicians are interested in both quality and cost and want tools that allow them to practice better medicine at a lower cost, according to Shultz. “Reimbursements are not growing at the same rate they once were,” he explains. “Now, not only are physicians often reimbursed based on productivity, but many groups are also sharing the costs of expenses back to the physicians.” Shultz explains that, in many practices, MT bills are divided according to usage, in the same way that roommates might split a telephone bill based on the actual calls each makes. Increased MT costs and reimbursement issues are compounded by rising staffing and coding expenses, he adds. Improvements in coding accuracy resulting from EMRs can potentially lead to increased revenue, according to Kleaveland. “Often, doctors code at a level below what [procedures] they actually performed during a visit because there is a burden of documentation associated with certain codes,” he says. By assisting with documentation, EMRs save time and may also help physicians feel more comfortable with the coding process. “Giving physicians that support and reducing what I call ‘defensive coding’ is an important part of the return on investment for an EMR system,” Kleaveland says. Because patient information can be entered directly into the system by the physician, EMR systems can increase administrative efficiency and improve workflow. Historically, when patients call a medical office with questions or for prescription refills, their medical charts are pulled by a secretary and given to a nurse, who passes it on to the doctor. The doctor then calls the patients or refills their prescriptions and sends their charts back through the chain to the front office staff, according to Shultz. Implementing an EMR system can reduce this time-consuming paperwork and “telephone tag” by automating the process. “A large number of chart pulls in a practice throughout the day are not related to patients coming in for appointments, but to patient phone calls and lab results,” Shultz says. “EMR systems can provide easy access to medical records without adversely affecting how the physician works on a daily basis, while giving him some financial wins along the way.” Patients also benefit from the implementation of EMR systems because they can reduce the amount of time patients need to wait for prescription refills or answers to questions. The systems can also improve the accuracy of the charts themselves and reduce preventable medical errors, according to Rick Taylor, director of benefits realization for Seattle, Wash.-based IDX Corp., a provider of integrated solutions to the acute-care environment. These effects can be enhanced by implementation of computerized physician order entry (CPOE)—wireless systems that enable physicians to enter their orders at the time of the examination. Because some physicians may be hesitant to make the transition to CPOE, it is essential that a facility has a “physician champion” on staff to educate his or her peers on the benefits of CPOE, Taylor says. “Unless physicians are persuaded that they should make the entries themselves—instead of having nurses or pharmacists enter them—they will not see the alerts and rules that help them make the safest decisions and, therefore, realize the benefits. This involves changing the attitudes of physicians toward something that has become a part of their everyday lives, but it is critical because patients’ lives could be at risk.” The release of the Institute of Medicine’s report on medical errors and the subsequent media coverage has public awareness at an all-time high. By implementing EMR and CPOE systems, healthcare practitioners and hospitals are taking a necessary step in ensuring customer (patient) satisfaction, according to Taylor. “Research proves that these systems can reduce preventable medical errors by more than 50% at the prescribing stage,” he says. “We measure that as a quality benefit as well as a cost-reduction benefit because errors cost hospitals money in the time and treatment needed to help patients recover from them.” He adds that, in the foreseeable future, insurance companies may require these systems to be in place before allowing their members to be treated at a specific hospital. Many of the ways in which EMR systems save medical practices and hospitals money also translate to benefits for HIM personnel. By reducing the amount of time spent carrying out traditional HIM activities, EMRs offer staff members an opportunity to develop new skills and move into information management, which can improve job satisfaction, Taylor says. “This will involve some retraining of HIM personnel,” he adds, “but it should release their time to perform other duties, such as overseeing data repositories and data warehousing.” By offering training in EMRs, healthcare providers may be able to better recruit and retain quality personnel, Kleaveland adds. “The evidence is purely anecdotal, but EMR systems are considered a positive marketable aspect of any practice,” he says. “They eliminate many mundane tasks that employees need to perform and spark interaction with cutting-edge software that can do some really cool things.” Many of his clients also tell Kleaveland that EMR systems make their practices seem calmer and less chaotic, which adds to the overall quality of the work environment. “That,” he adds, “is a good thing for patients as well as employees.” Patients may also appreciate the fact that EMR systems can generate reminders for important age- and gender-specific health maintenance procedures, such as mammograms and pap tests. Kleaveland comments, “Theoretically, this will translate into increased volume because those patients will be scheduling additional visits, but it also ensures that patients are following through on the things they need to stay healthy. It really is a win-win situation.” Increased volume is another measurable ROI an EMR system can provide, not only through additional visits resulting from system-generated mailings, but also from the potential to treat more patients in a day because of improved efficiency, Shultz explains. He cites the example of a New Jersey practice that implemented an EMR system approximately three years ago. “They not only save money each month on MT costs, but, because they don’t have to send charts out to be transcribed, they also have complete access to them at all times,” he says. Physicians at the practice also noticed that they save approximately 10 hours each week due to increased office efficiency, including the time they used to spend dictating referrals, he notes. “The doctors went from spending hours dictating and handwriting charts at the end of the day to being able to go home at 5 o’clock and spend time with their families,” Shultz continues. Others may opt to schedule additional office visits during that hour or two each day, he adds, which results in a significant financial ROI. In order to ensure that an EMR system delivers the best return, in terms of quality of care, cost savings, and increased revenue, a strong partnership between the hospital or practice and EMR vendor is important, according to Taylor. “It helps if the EMR firm can bring some reality to the purchasing process,” he says. “While vision is important, people really want to see a product that works and delivers benefits now vs. a wonderful vision about what might happen in the future.” Taylor believes value is dependent on “process- and people-based improvements,” as well as the the latest technology, which makes forming a strong partnership with clients essential. “You can’t just drop the system in and expect it to be a magic bullet,” he explains. “The value of partnership is more important than ever. Unless it exists, the vendor will not succeed in delivering value to the customer, and the customer will not get the most value out of the system.” Once a partnership is established between the healthcare provider and the EMR firm, the next step is to set targets and goals before implementing the system, Taylor advises. “If you don’t set targets, you’ll never know if you achieved the full benefit,” he says, “because you won’t know what the baseline was or what it is you are trying to achieve.” By measuring where a practice stands before implementation, it is possible to set realistic goals based on the expertise of both the vendor and the physician. “The vendors know what the software can achieve,” he adds, “and the clients know how much their employees are prepared to change to get the best value from the software.” The team later performs audits and measures those targets in order to verify the areas in which the system is benefitting the client, as well as to set new targets. How long before a practice or healthcare organization can expect to see an ROI in an EMR system? While Shultz notes that lower MT costs may be noticed immediately, Kleaveland believes physicians can expect to see more overall improvements between 90 and 180 days. “When first installing an EMR, it’s not realistic to expect productivity to be the same in the second month as it will be at the end of a year,” he adds, “but we have seen some clients realize within three months that this is a much better way of doing things.” ROI is also affected by the goals of an individual practice and how the staff implements the system, he adds. “It may be 18 months to three years before they realize the full potential, depending on how they manage the project.” In the long run, if the project is well managed and the healthcare provider is committed to working toward a paperless environment, the EMR system may be one of the best investments a practice can make, Kleaveland says. “It impacts the entire practice, both on the clinical and administrative sides.” While EMRs can potentially improve quality of care, he continues, they should also improve the overall productivity and efficiency of the practice. “Based on experience—and most physicians agree—I think it is the best business decision a physician can make.” — Hannah Fiske is a staff writer at For The Record. |
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