No one can promise you that Implementing an EMR, however good, can be easy and without false starts and problems. The changes you are planning to make – both in the way your practice does business, the workflow, and the change from paper trail to electronic documentation – are so major. Finding the right intersect between the needs of your medical practice and the features and strengths of a particular EMR/EHR will make this implementation go more smoothly. But it helps to know which EMR implementation problems you can surely anticipate, and which you can hope to avoid .

Here are some ideas to help avoid major disasters within your implementation:

1. Plan to Implement in Phases: no one can hope to integrate all functions and modules of an EMR at once. Identify an easier function for starters — some functions that are close to stand-alone — and implement that first. Think out the order for implementation of modules, so that the successful outputs from one modules can feed another. The nature of your practice or medical group will determine what makes most sense.
2. Flow chart your medical practice functions, as the programmers of old used to do, so that the visual presentation will help you make sense of the order of implementation. Look at your employees – your doctors, your nurses, your technicians, your medical billing specialists. See where their functions intersect and overlap. Look at the modules available, and see how they can be divided up according to your workflow chart.
3. Map staff into your flowchart and implementation plan, so that you know who will be involved in each stage of the EMR implementation and who will need the most extensive training in the use of your EMR.
4. Think about how you will get “free text” into your EMR/EHR– that is, data that is not sitting in a database somewhere. Notes that you take via speech recognition software will not be discrete fields that can easily be picked up and “reported” on by an EMR’s report writing function.. Some EMR’s are beginning to use AI (artificial intelligence functions) to capture free text data, convert it to discrete and “reportable” data to come out of the EMR’s reporting functions.
5. Have end-users involved in the design and implementation phase of the EMR. For instance, the technicians most involved with processing and handing over x-rays need to be involved in the design of the scan and capture of x-rays, MRI results, etc. into the EMR. The end users are the people who will actually use the modules and the reports from the EMR. Design decisions must be reviewed by the end users to make sure interfaces are workable and practical. Make sure that your medical billing specialists are on-board in the use of the system, and the importing of codes from your clinical information to your billing modules.
6. Allocate plenty of time for training your medical end-user staff. That time should be broken up, rather than administered in one serious “gulp”. People need time to assimilate and test out what they have learned about using the EMR. Give staff time and a place to practice methods so that they are not rushed through procedures that they do not feel confident using.
7. Provide good local computer support. Not everything can be resolved using remote help desks. Make sure there is someone physically available for hard/ware software issues on a regular basis. This person does not have to be available 24 / 7 but must be available on a daily basis, even if it is for an hour a day.
8. Keep a close eye on the system interfaces before you commit to using them: This is the likeliest place for gross problems to crop up. Interfaces between different medical software systems must be examined before the EMR/ EHR goes anywhere near live: Have your I T person , whether in-house or hired, investigate the interfaces between your EMR or EHR and any external systems very carefully. Do not make assumptions about system compatibility. Do not believe the vendor literature without testing the interface.

There are so many critical planning and training factors to keep in mind in planning for your EMR/EHR, but these are critical ones. Look at the CTS Demos Scorecard to help you compare EMR/EHR software and find the right fit for your practice. Your practice – and your patients – stand to gain the most from a good EMR/HER fit and a semi-calm implementation.

Come back to this blog for additional EMR implementation and integration ideas and planning issues

Should you consider integrating your current Medical Practice Management System with a new EMR, or must you shift to an EMR that includes medical practice management functions?

Practices which are relatively new to software as a management tool sometimes do not realize the very different functions that a PMS (medical practice management system) and an EMR system offer:

A PMS is used for managing administrative, billing, scheduling, and budget related (financial) information, and an EMR is used for managing clinical, patient related information How feasible is it to integrate these two functions to produce reliable information for your practice, and to fulfill government reporting requirements.

Let us assume that you are a practice ahead of the wave, and you transitioned long ago to a medical billing software and medical scheduling system. You are very happy with it. It works for you and for your patients. Now the world, and the government, are at your door, and is pushing for a more total solution: an EMR / EHR.

Do you have to ditch the practice management system that you worked so hard to install and to customize to your needs and replace it with a total solution – an EMR that incorporates financial and billing capabilities? Or is there a way to keep you medical Practice Management System and integrate it safely with an EMR minus its billing and scheduling capabilities?

Here are some issues you must consider before you can answer this question:

1. Your Practice Management System is a business system, and your EMR will be essentially a clinical system (although a full EMR will include Practice Management functions). Unless you are looking for hardships, you need the 2 systems to talk to each other in a transparent manner, and you need the possible upgrades to work in tandem. One thing this might suggest: if you are interfacing a PMS with an EMR, you had best be dealing with well known systems that are very regularly upgraded, and whose interaction with other systems are constantly monitored.
2. A single database for financial and clinical patient data would, theoretically, provide the best and most reliable data-mining capabilities for your practice. But what if your Medical PMS is very effective? Perhaps you can live with the two databases, or you have a way to periodically reconcile the two databases. Or perhaps the functional users of your databases are so different that you can live with the minor incompatibilities? Evaluate these issues closely before making a decision. Don’t throw away the baby with the bathwater.

Read the complete article at CTSGuides.com.

Here are some important considerations regarding ease of use, security, and other factors when comparing medical billing software options:

1. When you start using the medical billing software, moving from one screen or one function to another should be intuitive and make sense to you, the user.  Do transitions from screen to screen proceed logically?
2. Is there a simple graphical interface between different modules of the medical billing software?
3. What about data security and HIPAA compliance?  Is it easy to make backups of your software? Can you password-protect sensitive data from unwanted users?
4. Can the medical billing software track insurance policies and data?
5. Are there customizable templates for standard functions within the medical billing software modules?
6. Can several staff members access the medical billing software program simultaneously?
7. Is there a web-based component to your system, so that users can have  password-protected access to your  system from different locations?
8. Are the templates easy to customize for a specialty practice?  For instance, if yours is a cardiology practice, you will need different types of templates than a dermatology practice: hypertension templates, cardiac cath templates, etc.
9. How easy is it to import data from outside sources, such as HHS and other government agency sites?
10. How easy is it to fill out standard forms?  Are HCFA forms easy to fill out?  What about easy access and analysis of CPT and CDT codes ?
11. Are interfaces with external sources easy to set up from within the billing and scheduling system?
12. How difficult will it be to import data from simple software sources, like Microsoft access spreadsheets (with xls extensions)?
13. How difficult will it be to import data from paper sources?  Is there any OCR facility available for scanned data?
14. Data conversion: how difficult will it be to convert data that is already on some other medical practice or medical billing system (perhaps one that you practice has outgrown)?
15. Does the software allow for multimedia attachments, such as pictures, scanned documents, x-rays, and even voicemails and files?
16. Does the software have a “free-trial” option so that you are not locked in to the system before you have seriously tried it out?
17. What are the training options that come with the software you are considering?  Is there a human tech-support contract option that comes with the software, or is training available only online?  Is there a person that is assigned to your company to provide tech-support?  How expensive is it to buy additional tech support time for you and your staff?

No one likes to think about everything that can go wrong, but you do need to do serious planning so that things will go smoothly with your medical software implementation.  Invest the time in comparing systems up front, so that you will eventually choose a medical billing system to fit the needs of your practice.

Large Practice
If you run a large medical practice or health-related organization, you probably have to meet many regulatory rules, provide scheduling at multiple locations and manage different coding requirements for Medicare.  In that case you should be evaluate a medical practice management software that covers both an electronic medical records or EMR and medical billing.

A good medical software package that handles all of these function – can be used to full advantage by a well trained staff, and  can improve your bottom line.

Small Practice
But what about a small medical practice  — how much medical software do you really need?  The answer may be – at least for the short term – very little.  What a small practice really needs is medical billing software – and a good stand-alone package will do. Here is why:

• If your practice is small, you do not need all the bells and whistles of medical practice management software, but you do need the medical billing function. Full-featured medical practice management software may have many more features than you need, and can use effectively. There’s a risk that you’ll pay too much and it’ll be underutilized.
• Performing in-house medical practice billing without decent software can cripple the medical billing process for your practice. Since denial of claims by insurance companies, Medicare, and other health care payers are common.  It’s critical that you have the ability to submit and update claims electronically and check for viable codes.  Without it, you can create an unending traffic jam in your bill processing which can affect your cash flow.
• Unless you outsource to an inexpensive medical billing service, you’ll pay top dollar – and middleman service charges – for something that a small scale medical billing software package can do for you very efficiently.  As a category, Medical billing software is now a pretty mature product.

Do proper due diligence when purchasing a stand-alone medical billing software package.  Most good medical billing software have easy-to-use interfaces and upgrade paths to fully featured EMR software and medical practice management software.

Consider a web-based medical billing software rather than client/server.  As a small practice, it’s much easier to have someone else worry about data security and backups.  Plus you won’t have to make the up-front investment in buying the hardware and the software.

Sometimes, the choice of which EMR system to use is less important than the “change management” and training plan an organization chooses.

Implementing even the best-designed medical practice management software changes the manner of doing business significantly for a medical practice. It can entail a fairly steep learning curve.

Here are some critical training issues to keep in mind:

1. Make sure that everyone who will use the system gets adequate training.  Good training – or lack thereof – can affect the success of the EMR software within your organization. Both clinical and administrative staffs need to be trained to use the same modules since they will need to exchange relevant information.  If the software is underutilized, it can wind up costing you time and money.
2. Try to get everyone on board and positive about your new EMR software.  If key members are grumbling and not committing to learning their parts of the system, the implementation might not go smoothly. Make it fun.
3. Assess everyone’s general computer skills (the younger employees are probably more able than the older employees – even though they are less sophisticated professionally).  If needed, get training to bring everyone up to basic computer skills level – everyone should be comfortable with use of the mouse, basic graphic interface, hierarchical file structures, password use, etc..
4. Develop your training plan to as part of your overall implementation plan. The plan will have to be driven in part by the skills of the staff.  Appreciate that even the most brilliant and senior physicians may need significant ramp-up time to use the system well. Don’t overwhelm users with too much change and detail too soon.
5. Implementation in phases – rather than overnight – is a preferable so employees can learn at their own pace and feel confident about the software. A functional modular approach to training allows change to happen more gradually.  For instance, you may choose to train and implement a medical billing system first before the full EMR is introduced.
6. Practice makes perfect. After training, dedicate time to letting staff practice what they’ve learned.  If you hire an outside company to train, have them on-site post training to answer staff questions and work through problems.

In short, take the long-term view:  if you view your EMR training time as part of your medical practice management software investment, and you plan your training to fit the needs of your particular staff, your migration to EMR is likely to succeed.

In February 2009, the American Recovery & Reinvestment Act was signed into law.  The HiTech Act is the health IT component of that bill. It provides significant dollar incentives for physicians to move from paper-based medical information tracking to computerized Electronic Health Records, that medical practice management software and patient information management systems.

If you are a physician contemplating this major change, you can appreciate how much EHR system will change how your day is structured, and the costs associated with such making this change.  You and your staff will have to  transition from your current method of storing data to the electronic medical records (or, as the government would prefer to call it “health records” system). You will have to train yourself and your staff to use this new system. You may well have to pay outside consultants to help you implement such a system.

The HiTech Act allocates $36 billion for incentive payments to healthcare providers who demonstrate use of Electronic Health Records (EHR). There are two allocation programs, one for physicians who have many Medicaid patients, and a second program for those who accept Medicare.

Medicaid providers: Doctors in practices where 30% percent of their patients pay via Medicaid, are eligible for a payment of $64,000 over five years. (for pediatricians, the required percentage of Medicaid patients is only 20%)

Medicare providers: Doctors who accept Medicare patients (even if they do not accept Medicaid) can receive payment of up to $44,000 over five years.

In addition, doctors who make use of ePrescribing initiatives that are part of the Medicare Improvements for Patients and Providers Act of 2008 and PQRI incentives, can earn between $6,000 and $8,000 without moving over to the Electronic Health Records System.

In order to qualify for the Stimulus incentive payments, doctors have to demonstrate three things:

• Purchase /use of a “certified” EHR product (meeting HHS standards) that has an ePrescription capability
• Connected access to a patient’s full health history via electronic connectivity to other health providers
• The ability to report on the providers technology use to HHS

There are also incentives to implement EHR very quickly. Incentives include payment for up to 5 years, but the bulk of the payments come in the first years,  In addition, physicians receiving payments must demonstrate that they are making use of the medicare component of the EHR.  If a physician accepts payments, but does not demonstrate use of the system, penalties can be assessed.

If you as a physician have been contemplating the move to an all –software medical practice management system, perhaps the time is now.  Healthcare legislation will be pushing your practice in the direction of EMR and EHS.  Investigate and compare certified EHR and EMR software now, and see what medical software makes sense for you.