Chances are, if you’re using an EMR in your practice, you’re hoping for some type of benefit for your investment of time and money. While the reasons you have an EMR may vary, regardless of why you have it, making it work for you and your practice is essential. Knowing where to focus your efforts can mean the difference between a successful system and a failed investment.
Understanding where tangible benefits from an EMR can be gained is, in itself, a confusing endeavor. Much of the literature available is either created by politicians or marketing executives. For example, on the www.healthit.gov website, they tout benefits like better health care, better health, improved efficiencies, lower health care costs and better clinical decision making. They get more specific by stating EMR provides more accurate, up-to-date and complete patient information, improved productivity and life balance, and enhanced privacy and security. These are possible and worthy goals, but hardly tangible realities for most EMR users. In fact, one could argue they’re not proving to be accurate at all. Who today can say, when they see a patient, they are presented with a complete and current record for that patient? The age of interoperability is in the works, but it’s not here yet.
Legislation requiring EMRs to create their own patient portals has only hindered those efforts by encouraging vendor data silos to be extended further. Additionally, one would be hard-pressed to make the case that today’s electronic records are safer than yesterday’s paper charts. Once again, legislation requiring electronic medical records be made available to patients has opened many systems to Internet access which, if not done properly and professionally, could expose a practice’s database to the outside world.
Not to be outdone is the glorification of EMR—marketers have touted things like greater patient volumes, revenue gains, increased provider satisfaction, and improved patient health and loyalty. To be fair, many physicians have experienced these benefits, but the majority have not. Instead, most providers have seen EMRs cost them efficiency, time and money in the aggregate.
Five Tangible Benefits of EMRs
Despite the mixed real world performance and the altruistic accolades of EMRs, tangible benefits can be achieved. Here’s a breakdown of where tangible benefits can be yielded by your practice with your EMR:
1. Increased communication with staff – Listed first for a reason, efficient communication between staff and medical professionals should be one of the easiest, most tangible benefits to achieve. Provider and staff communication throughout the day—tied to a patient chart or separately—greatly improves office workflow and efficiency. Many EMRs allow for communication enhancements like alerting providers when a patient is ready for them, or alerting staff when a provider orders patient instructions. In addition to patientoriented communications, some EMRs offer internal instant messaging. This feature allows for seamless and immediate contact with staff and providers. If your EMR doesn’t offer this feature, there are independent, HIPAA compliant solutions like Acentec’s Intranet Messenger that are available.
2. Electronic prescribing – A good EMR system, once set up properly for an individual provider, should serve up a tailored list of commonly prescribed medications and instructions sorted by presenting conditions. In short, creating a prescription should be a minimal number of clicks, should instantly cross-reference allergies and interactions, and ideally make recommendations based upon the insurance formularies. The net result should be a significant improvement in time and accuracy, and should be an easy benefit to achieve. Although there is still work to be done in the area of medication reconciliation, using e-prescribing in your office will benefit you and your patient today.
3. Computerized order entry – Although listed third, achieving this benefit typically requires providers to use their EMR at or during a patient encounter. The advantages are worth the effort. Instructing staff of followup instructions—like an order for the nurse to return upon your exit from the encounter to administer a treatment or lab draw, or the front desk to dispense patient education and to schedule a follow-up appointment in two weeks—eliminates the need for the provider to physically share these instructions.
4. Improved patient communication – This benefit is listed fourth because it requires the use of a patient portal. While this is required for Meaningful Use (MU) Stage 2—or “2014” as we’re supposed to call it now—if you’re not pursuing MU, then chances are you haven’t yet implemented an integrated patient portal. There are good reasons to add one to your EMR: 1) patients can complete registration and clinical information prior to their visit; 2) patients can request and, in some cases, schedule appointments; 3) patients can make payments; 4) providers can choose to communicate with their patients through secure messaging. In truth, the last benefit needs to have a well thought-out policy to be beneficial. Too many providers have learned the hard way that patient expectations can be high when they believe they can now correspond with their physician electronically. Despite the downside, a patient portal can reduce phone traffic, reduce patient wait times and improve patient payment velocity.
5. Improved coding accuracy and increased evaluation and management (E/M) coding – We listed this benefit fifth because there is increasing controversy and federal scrutiny over the use of EMRs and the corresponding increases in E/M coding. The simple fact is many EMRs make it easier to meet the documentation thresholds required in the antiquated E/M coding matrix. We’re not interested in weighing in on the validity either way, but the reality is most providers see an overall increase in their E/M coding when using an EMR with coding assistance.
That benefit aside, a true improvement is the ability of an EMR to sort, based upon a documented patient presentation and proper diagnosis codes. This is something a paper super bill can never do. While many offices rely on skilled billers to effectively manage this part of their business, many others, due to geography or other factors, don’t have access to this level of employee talent. Making accurate coding tangible for providers that aren’t interested in becoming billing experts is a practical and tangible benefit you should be getting from your EMR.
This is only a partial list of what we consider to be concrete and tangible benefits that are within reach for most EMR users. We’re not pretending most or all EMRs don’t have their shortcomings, but we do want to point out that EMRs can offer real advantages for relatively little (additional) investment. In an era of decreasing reimbursements and increasing costs, striving for altruistic benefits just isn’t practical. So, while EMRs, and more specifically the use of an EMR, will ultimately deliver on their lofty promises, focusing on making yours work for you today will help your bottom line and your peace of mind.