Nov

30

EMRs and ICD-10

Filed Under EMR Software, Medical Software | 1 Comment

We all know the advantages of  the electronic medical record – improving access to critical information, eliminating errors, automating tasks, improved accuracy and legibility of documentation and improving coding for better billing and reporting. The government is offering financial incentives to physicians that implement EMR software soon.

There are over 330 electronic medical record software systems for physicians to choose from today.  To complicate the decision process further, in order for physicians to qualify for the financial incentives promised by the HITECH act, “meaningful use” of such a system, (to be defined by the end of 2009,) must be achieved by 2011 for the incentives to be realized to their fullest.  In addition, there is the threat that penalties will be levied  against practices if a compliant system is not implemented by January 2011.

The latest Health IT Policy Council Recommendations to National Coordinator for Defining Meaningful Use Final  
( http://health.state.mn.us/e-health/standards/mufinalrecs102609.pdf ) stipulates that EMRs must maintain problem lists in either ICD-9 or SNOMED.  As of today, the meaningful use definition does not include compliance with the two final rules to continue the transformation of the US healthcare delivery system to an electronic environment through adoption of the next generation of diagnosis and procedure codes and updated standards for electronic exchange of healthcare data announced January 15, 2009 by the U.S. Department of Health and Human Services (HHS).

The first rule adopts the ICD-10 medical data code sets standard for use in exchanging diagnoses and inpatient hospital procedures information replacing and greatly expanding the ICD-9-CM code sets, developed nearly 30 years ago effective 10/1/2013.

The second rule replaces the 4010A1 standards for electronic health care transactions with Version 5010 on 1/1/2012.

The American Medical Informatics Association (AMIA), American Health Information Management Association (AHIMA), and AdvaMed, have issued a summary of their joint position on the adoption of the International Classification of Diseases, tenth revision (ICD-10) which includes the following points:

  1. The ICD-9 CM (International Classification of Diseases, ninth revision, clinical modification – a U.S. version of ICD-9 developed by the World Health Organization) is obsolete. Its continued use will adversely impact the value of healthcare data as well as hinder medical decisions based on imprecise data. Further delay adds to the cost of modification and the investment in electronic medical records (EMRs).
  2. CD-10 is needed to improve the quality of health information. It is designed to provide better data to meet the needs of today’s electronic healthcare environment and of an increasingly global healthcare system. ICD-10 will enable more accurate and improved information to be captured. ICD-10 will provide better data to support improved public health and bio-terrorism monitoring, more accurate reimbursement rates, patient safety improvement, medical error reduction, quality measurement, and pay-for-performance initiatives.
  3. ICD-10 is needed to support interoperable EMRs and a National Health Information Network (NHIN). EMRs and NHIN networks require a modern classification system in order to accurately summarize and report healthcare data. EMR system benefits cannot be achieved fully by utilizing the 30-year-old ICD-9 classification system. ICD-10 must be incorporated into medical software systems with SNOMED-CT in order to realize the benefits of a NHIN and interoperability. SNOMED-CT and ICD-10 will allow data to be shared between EMR systems in their common medical language.

ICD-10 increases the sheer number of diagnostic codes ten fold.  There is not a one-to-one mapping between ICD-9 and ICD-10.  Adding choices and complexity can only help achieve improved health and more accurate payment if the systems and people are capable of codifying data properly.

Doesn’t it make sense to look for an EMR vendor who has a rock solid plan to remediate their EMR solution to utilize ICD-10 codes? To achieve real interoperability and, therefore, meaningful use, you must have a plan in place to train your physicians and staff responsible for coding in the use of ICD-10.  Make ICD-10 part of your criteria for vendor selection and meaningful use.

- Sandra Schafer
President, Turning Point Advisors

About the Author
Sandra Schafer has over twenty five years experience in healthcare IT.  Prior to forming Turning Point Advisors, a healthcare IT vendor consulting firm specializing in product commercialization and strategic marketing, she was Senior Vice President of Marketing and Product Direction at CareMedic, Vice President of Marketing and Product Marketing at NDCHealth, Vice President of Strategic Business Development at Healthcare.com.  Sandra began her career at HBOC, now McKesson where she spent 17 years in various management positions.  Ms. Schafer holds a B.A. degree in Business Administration and a Masters in Healthcare Administration from the University of Iowa.

Nov

20

EMR/EHR Software Implementation: Project Planning

Filed Under EMR Software, Medical Software | 1 Comment

Overview

The decision to implement an electronic health record (EHR) is one of the most important decisions for your health care organization or physician practice. The transition to an EHR system changes everything. Nearly every business process is impacted with the EHR implementation from registration/admission, scheduling, documentation, billing, patient follow-up, and communication within and external to your organization. Considering the profound change this implementation generates, your organization needs a clear road map to ensure a successful transition that will capitalize on the quality, safety, financial, and process benefits of the implementation.

Getting It Done Right

Successful and effective implementation requires hard work, careful planning, and diligence. In 20 years of implementing EMR and clinical information systems, we see patterns in the successful deployments. There are key elements to successful implementation from adoption approach, change management, process redesign, testing of the application, hardware, and interfaces. This article focuses on one area crucial to success, project planning.

Project Planning – What Should You Do?

Best practice in management of an EMR implementation has a vendor project manager with broad knowledge of the EMR application working with a project manager (PM) from your organization to develop a comprehensive project charter, project plan, and communications plan. Both PMs should have experience with multi-department implementations. If the PM skill is not available in your organization, often, a third-party consultant project manager is hired to plan and manage the effort. When leveraging a consultant always identify an internal leader in your organization that will be mentored through out the implementation.

At the end of the EMR project, someone in your organization will need to own the support and management of the application. A consultant project manager that mentors an internal resource puts your organization on track for success. Too often, we see organizations struggle after an implementation because much of the knowledge walks out the door with the vendor team and the consultant.

What Can Happen to Your EMR Project?

So what happens in this scenario? Your organization does not have a clear understanding of the scope of effort, complete project plan or a clear implementation roadmap. You do not understand the logical order of tasks, how your organization can most effectively prepare.

The various vendor implementation specialists connect with identified key contacts in your organization and these resources follow their plan or task list to complete configuration of functional areas. You can have multiple application specialists asking for information from many areas of the organization to complete master file and table builds. The vendor usually has an engagement manager (EM) who is overseeing your implementation. The vendor EM manages the overall effort of the various application specialists and can be the one-team member who understands the big picture surrounding the implementation. Often the individual vendor team members do not have a broad understanding of the overall EMR application or understand other functional application areas. There tend to be few team members knowledgeable about the whole application and implementation process.

You begin to wonder how the various decisions made for configuration work together. How do the decisions affect workflows? Is the vendor defining and documenting future state workflows with clinical areas? Often little attention is paid to this critical area of EMR implementation. You can be left wondering if the infrastructure, interfaces, and hardware needed will be ready at the right time. If you have an internal leader for your EMR project, they can struggle to comprehend and manage all of the moving parts of the project without a clear and complete plan and the right tools to manage the project. A well-defined project charter, project plan, and communications strategy are the best way to know your EMR initiative is on time, on budget, and being implemented using best practices.

Take Charge and Do It Right!

Documentation of a project charter defines the project. It documents the what, how, who, when, where, and why of the project. The project charter articulates scope, approach, and clearly defines measures of success that help to manage expectations for the initiative. Project risks are defined, analyzed and mitigation strategies developed and implemented. Typical EHR project risks are expectation, resource, acceptance, solution, and impact.

Communication planning is a critical component to the success of large projects. It involves determining what information needs to be communicated to whom, when, and how. The types and frequency of communication will vary depending on the audience, as different groups of people have differing levels of need or want to be informed. Understanding the needs of all project stakeholders and effectively communicating pertinent data is one of the keys to a project accomplishing its goals.

Communication techniques and technology will also differ based on the type of information. There will be formal documents that outline policies, requirements, and processes. There will also be informal communication via e-mail, phone, and meetings. Designing an organized approach to manage all these differences will enhance the team’s ability to make decisions, share data, educate, influence, and resolve issues.

The communications plan defines the various meetings, communications, reports and documents used over the course of the project. It is important to be clear about the intent or intended yield of the various forms of communication. Will the communication inform, educated, or influence the reader? For example, when you provide communication to a particular audience, is the communication meant to be one-way or two-way? Are you looking to inform the audience or do you want feedback? Is action optional or required by the reader? The plan should coincide with change management strategy. An effective communications plan can help to establish expectations and increase acceptance for the project and new software tools being implemented.

Project planning should be done using industry standard project management software such as MS Project, thereby leveraging many timesaving features for planning, tracking, and reporting project status. The project plan must document all of the project tasks: tasks for the vendor team, provider team, and other vendors involved in the project. The plan should encompass the entire project life cycle, from kickoff to transition of support services, and identify critical project milestones. The project plan identifies key dependencies among the various tasks. The plan is analyzed to identify risks and mitigation strategies developed. Tasks and responsibilities need to be defined within the project plan to review and manage the quality of deliverables for various project areas.

Clearly defined project governance is critical to the success of an EHR implementation and a well-managed project. A RACI diagram is well suited to identify the various project functions, roles, and responsibilities. The diagram documents who is responsible, accountable, consulted, and informed (RACI) for decision making and getting the work of the project completed in various areas. A project organizational chart clarifies who is in what role and articulates reporting responsibilities. Numerous decisions are made over the course of an EMR project, a well thought, and communicated governance structure facilitates this process. Review of successful EHR implementations point to complete and rigorous project planning as a crucial area to ensure successful implementation of your EHR. Further, building knowledge, skills, and ability in your internal resources is vital for ongoing user support and system maintenance after the implementation is complete.

About the Author
Janice Ahlstrom, CPHIMS, RN, BSN, is a partner in Wipfli’s health care practice. She has over 28 years of experience in the health care selecting, implementing and integrating enterprise information systems. She has helped a variety of organizations develop technology strategies, implement EMR applications, define business processes, enact operational performance improvements, and implement information systems. Contact Janice at 414.431.9352 or email her at jahlstrom@wipfli.com.

About Wipfli LLP

With more than 800 associates and 15 offices across the Midwest, Wipfli ranks among the largest accounting and business consulting firms in the nation. Serving businesses and individuals since the firm’s start in 1930, Wipfli has one of the region’s strongest healthcare practices, with an extensive list of clients across the Midwest.

For more information, visit www.wipfli.com.

Oct

28

EMR Options for the Smaller Practice

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The type of EMR and medical software platform that will work best for you depends on the size and complexity of your medical practice or organization.

If you are a smaller practice or a solo practitioner, one of the most daunting aspects of buying and implementing EMR is the price: purchasing, licensing, implementation, and training can cost a true fortune. This outlay can make sense and save money for a large medical organization. If the system is implemented carefully, it will cut the number of man hours you need, perhaps reduce the number of employees, and help your practice comply with government reporting requirements.

However, if you are a solo-practice, or part of a small practice, this financial investment would be overwhelming. But you certainly need to make headway into the world of EMR and medical billing software, if you haven’t already. Is this feasible at a modest price?

The answer is, very feasible indeed, depending on how you make your choices.
There are two basic types of EMR software configurations available: Each software model has its upside and downside.

1. Client/server based software is housed and maintained on your own server.
Most of the large, well known EMR software packages are client/server based. This means that you and the developer – whether you buy the package customized, or whether you provide customization in-house — totally control the environment and can be tailor exactly to your needs. Most of the specialized practice packages are client/server based. Many client/server EMR models are web-enabled, meaning users can connect to their EMR via the internet on a standard web browser from a remote location – but the software will still reside in-house. Web-enabled software packages sometimes offer the option of handling security issues “elsewhere” by offloading the maintenance issues to a third-party host .

If you are not concerned about Stimulus payments, and whether the US government views you as making “meaningful use” of your EMR software, there are inexpensive client/server based options available at more reasonable prices. While these are not the CCHIT certified packages, they may be able to serve your basic EMR needs very well. There is even “open source” EMR software available free of charge, but it will require customization. If you are willing to go with a basic EMR / medical billing software package which performs basic functions reasonably well, and if you are willing to dedicate resources to customization and maintaining system and data security, open source software may work for you.

If you go with an off-brand EMR package, there is training and customer service available. If you decide to go with “open source” software, there is no customer-training or customer service division to call when you are desperate for help. You have to make your own security and backup arrangements, and there is no one to reassure you when there are data problems. If you are technically savvy, you may be able to make these arrangements yourself, but talk to others who have used this software before committing yourself to it!

2. Software as a Service (SAAS) EMR, offers a web-based model.
SAAS software does not live on your computer or server, but in cyberspace. For SAAS EMR software, you the user log onto a website from any internet-accessible computer hosted by a software provider to whom you pay periodic fees.

SAAS EMR can be accessed from anywhere. You do not need a dedicated IT person taking care of your computers, because security, back-ups, and updates are taken care of by the hosting company. Your up-front costs are usually much smaller than they would be for a client/server model since you don’t have to worry about hardware or network infrastructure. Your up-front costs are usually much smaller than they would be for a client/server model since you don’t have to worry about hardware or network infrastructure.

The disadvantages of SAAS EMR are that it may be difficult to configure specifically for your practice – sort of like buying suits off the rack instead of bespoke tailoring. Web-hosted software does not currently afford exact customer-tailored customization, although that will likely change.

Another possible problem: the smaller up-front costs may be deceptive. A host or vendor of SAAS can always up the rates. You don’t own any more of the systems two years into using it than you did on Day One, so you are basically a “renter “and the tax advantages and deductions afforded by a major corporate purchase are not there for you.

In summary, just because you are small does not mean that you cannot have excellent and extremely useful EMR software. But look carefully before you leap.

Sep

30

EMR Software Offering Transcription Services

Filed Under EMR Software, Medical Software | Leave a Comment

A great benefit that substantial EMR software can offer is integrated medical transcription software – and the associated cost savings it will bring.  Many doctors in solo or small practices spend a lot of time and money on (a) writing their notes on paper charts for patients and (b) on a medical transcription service or using a dedicated person to get those notes into a decent format and on disk.  Letters have to be sent to the patient and to other doctors for referrals, and to insurance companies. Poor medical transcription, of the lack of efficient medical transcription, can cost a medical practice a lot of money for a number of reasons:

  1. Medical notes and correspondence are the face and the front desk of the medical practice to patients, other doctors, insurance companies, and government agencies overseeing Medicare and Medicaid. A poor and inaccurate job on notes and correspondence will mean slow turnaround in claims processing as well. The inability to quickly access patient notes will also cut into a practice’s ability to counter claims denials. Sometimes an insurance company will audit a doctor’s  claims and call his decisions into questions. Medical transcription software linked to a good EMR can save the day in such situations.
  2. Medical practice management software / EMRs can shave a salary – or half a salary — off your expenses by automating your transcription.  If you have an in-house person spending much of his time on your notes, good medical software will free him to work on other practice management functions.
  3. In addition, paper correspondence calls for lots of square footage to house those charts and letters.  Renting space is expensive, and not needing to pay for the extra storage space can be a significant savings as well.

Many EMR packages contain excellent medical transcription software, or allow interoperability with well- known medical transcription packages.  If you already have good transcription software and do not want to lose it when you purchase an EMR, talk to the EMR vendors about interoperability. If the medical transcription software and / or medical billing software you are using are supported by reputable vendors, there is a good chance it can be integrated with your new EMR system.

Here are some valuable features to look for in medical transcription software:

  • Speech and voice and speech recognition software has been used for medical transcription for many years.   This can save literally hundreds of hours of work per year for a doctors office.  After a little practice, turnaround time for medical dictation is almost instantaneous.
  • Good medical transcription software usually comes with a medical dictionary and spell checker,  to save time for accuracy checks
  • Many software utilities that come with medical transcription software are HIPAA compliant, and are thus suitable for using to send files to other computers and to insurance companies.
  • Electronic signature software allows for signatures and audit trails for those signatures. Pulling files for signatures becomes a trivial matter with signature software and electronic notes to post them on.
  • Time and date stamps for notes and letters make for good audit trails, reporting, and HIPAA compliance.
  • Management reports to handles the status of medical correspondence. Monthly reports, status of dictated files, etc.
  • HIPAA compliance for notes, which means encryption features and backup and security procedures are in place.
  • Interoperability with handheld electronic devices such as PDAs, as well as laptops and notebooks
  • Electronic attachment of transcribed reports to a patient’s Health Record
  • Searchability of all documents: letters, notes, and prescription records
  • Predefined templates for letters, prescriptions, and other correspondence make for major time saving

If you are about to buy medical software, make sure you invest in an EMR that has good transcription software or supports the use of good transcription packages.  Read the reviews, talk to other users, and have a vendor demonstrate the software along with a prepared list of questions to ask. And be sure to try it yourself before you buy. Good medical transcription software can make a real difference in the bottom line for your practice.