Implementing EHR not as easy for practices as shown in theory…

In order to promote the adoption of an EHR system, the government is honoring EHR Incentive Program for both Medicare and Medicaid participating program. Qualified professionals for the Medicare EHR Incentive Program receive up to $44,000 per physician which adds $8,800 per year for over the period of five years into the practice and qualified professionals for the Medicaid EHR Incentive Program receives up to $63,750 per physician which adds $10,625 per year for the over the period of six years into the practice.

As a member of an EHR Consultant Project Team, I got the opportunity to speak to physicians and practice/office manager at Port St. John (PSJ) Family Practice who chose to go with the Medicare EHR Incentive Program; we got an impression that does not match with what it says neither in theory nor in the books. Looking from the physician’s perspective, implementing EHR includes initial investment in:

·         Cost: includes cost of hardware, software, additional personnel, training the staff, implementation, contingencies, etc.

·         Hardware: require buying or leasing of additional hardware’s including computers, laptops, tablets, printers, scanners, faxes, servers, backup hardware, etc.

·         Software: require application software (EHR, Imaging), e-prescription

·         Personnel: may require hiring additional computer savvy staff for scanning purposes, operational purposes, etc.

·         Training: the entire practice staff needs to be trained on the EHR system

·         Change in the entire workflow: the entire workflow changes when using an EHR system starting from the point of check-in through check-out

The transition from paper-based charting to using an EHR system can be rewarding in later years however at the same time it can be very frustrating and time consuming initially. In this situation, Medicare incentive money of $44,000 per physician for 5 years into the practice covers about one third of the yearly cost of migrating to the new EMR which is not sufficient enough from what has been invested initially by PSJ Family Practice. Being said that, is the incentive money really worth transforming from paper-based system to an EHR system?

No going back to paper charting

Transforming from paper chart to electronic health record (EHR) not only involves money but also time and commitment. As we all know that people resist to changes, however to make our lives easier, people should learn to be committed and adopt the changes. Even though it seems harder to use an EHR system, it is not that bad once you start using it. The reason it makes it harder is because medical staff are not trained or used to using electronic devices such as computer, laptops or tablets but once staff gets used to these devices it makes their job a lot more easier and faster.

The advantages are not some that are just listed in the books; they are also working in the real world. A physician at Port St. John Family Practice was interviewed, who said that even though it takes time to adapt to an EHR system, they are never going back to paper charting as EHR is far better with lots of advantages. EHR systems have also proven to be a better system than practice management system (PMS) as EHR systems can be used by all medical staff – administrative staff, financial staff, clinical staff as well as physicians. Some of the noticeable advantages pointed out by the physician are:

· Reduce office staff
· Flowsheets are customizable
· Easily customizable templates
· Patient history was easily accessible in fractions of seconds
· Patient charting is completed during the visit, the physicians don’t have to spend extra time on completing the chart after the patient has left
· Legibility when documenting
· Disaster recovery is possible now

The above mentioned advantages are just few identified by the physician; however there are a lot more advantages that come with implementing an EHR system. Even though some practices are against implementing an EHR system for their practice, I believe that they should look at the pros of implementing an EHR, talk to other practices who have already implemented and are using a system or are in the process of implementation. I believe that the benefits are to improve and increase overtime.

Importance of a Healthcare Informatics Professional in EMR implementation!

As a part of an EMR Consultant Project Team, today we met with Port St. John (PSJ) Family Practice’s Office/Practice Manager to understand and discuss the scope of implementing a new EMR system. While developing the project plan – cost, IT uncertainties and lost productivity were defined as the three largest barriers in the implementation/adoption of an EMR system. However, after today’s meeting with the Office/Practice Manager, I realized that having a healthcare informatics professional who understands both health care and information technology aspects is critically important.

Before being enrolled into the program, I always viewed things from an IT perspective. Having a background in computers, my thinking was that everybody knows the basics – how to use a computer, how to open up a browser, how to access a website, etc. However, this is not the case in the real world. Similarly not every healthcare professional knows how to operate a computer since everything was paper-based prior to EMR system.

Prior to the agreements with our team, PSJ Family Practice already had an EMR system implemented, however, because of the EMR system being bought out by another company, PSJ Family Practice was left with no choice either to buy the company’s new EMR or to go with a completely new EMR system. So, PSJ Family Practice chose to go with a new EMR system. Having bad experience with prior EMR system, the Office/Practice Manager and other staff are aware of what to expect during the implementation of new EMR system. Bad experience also included misunderstandings as the practice did not know how IT world works, nor did the implementation team have enough knowledge on how the health care industry works. For example, when giving user’s access, the implementation team categorized all receptionists into one set of users (regardless of how long they have worked at the practice or their location or their positional category), all physicians as another set of users (regardless of them being a primary care physician, or a surgeon, etc.) and so on. On the other hand, looking at it from a health care professional’s point of view, the general receptionist at the main desk needs different access than the receptionist at the patient check-in desk than the receptionist at the patient check-out desk. And this is where the bad experience and misunderstandings even in a thing like role access could come in place.

Therefore, I believe that having a Healthcare Informatics Professional role in an implementation of an EMR system is critical as they understand both the worlds. And, not only would bad experiences or misunderstandings be cleared, but a transition or conversion would take place very smoothly as well as barriers like cost could be eliminated. Now, being enrolled into the program and getting real world experience I see the importance of a Healthcare Informatics Professional. 

Noticeable improvement in the Healthcare Industry

When it comes to quality healthcare, the United States is considered one of the best in the world. It is also true that with almost one fourth of the population uninsured in the Unites States more money per person is spent on healthcare in this country than anywhere else in the world. United States also faces disputes when it comes to delivering healthcare to the general public. Recently, the government has been working on identifying problems with the healthcare system in order to make necessary improvements. One of the problems with the healthcare system is the inability to share the information among different organizations. On one hand hospitals, clinics, etc. uses advanced tools, equipments, machineries, beds, etc. and on the other hand the old fashioned paper-chart system for record keeping and flow of information is still in use.

The unique combination of Healthcare and Information Technology (IT) will prove to be a plus to our Healthcare System. This combination of IT and Healthcare will allow to collect health information of an individual or population electronically also known as Electronic Health Record (EHR). By mandating EHR, the US Government is trying improve quality and efficiency of healthcare via Healthcare Information Technology (HIT). Doctor's visit that used to vary from an hour to two hours or even more has just changed with the adoption of Electronic Heath Records (EHRs). 

My recent visit to the doctor's office who has already adopted EHR system was unbelievably fast.  

• First was the check-in process where they printed out my history from last year and the only thing that I had to do was to just verify the information from last year, make necessary changes and sign the paper. The check-in process that used to take about 15-30minutes where the patient had to fill out the paper work again beginning of the year, took me 5 minutes only.
• Secondly, a couple minutes later I was called as was escorted to the examine room where the nurse came with a laptop (no paper-chart) the very next minute. Questioning me, the nurse updated my medical record electronically by just check marking the boxes and typing additional comments for the doctor. 
• Within the next 5 minutes the doctor arrived, who already had my latest information on her laptop.
• Once the doctor completed the visit, the nurse came with electronic prescriptions prescribed and signed by the doctor. The prescriptions and the appropriate dosages were typed legibly. 
• Soon, was escorted to the check-out desk. In spite of the appointment being beginning of the year, the entire process from check-in to check-out was just 30 minutes long.

EHR is a great improvement to our healthcare industry. Soon, the US will have a healthcare system that will be much faster and reliable.

Jikal Patel