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1. Why are EMR solutions not widely used?
To date EMR's have not been utilized to
a great extent because they have not offered a
solution that is very helpful to the physician's
practice. Products have been focused on finding
ways to capture information faster, but the end result
is still text which is useless to the computer because
it cannot aggregate and analyze the information.
Thus, EMR's have presented little value to the
physician. The majority of EMR solutions offer a
way to manage records, but not analyze data in those
records. In effect they become document
management systems which are valuable to an extent,
but do not genuinely help in disease and patient
management which is what most physicians want to see
in an EMR.
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2. What is the difference between Text-based and
Fully Encoded EMR Solutions?
When a text-based EMR
solution saves a blood pressure such as "120/80" in a
system, it is saved as the text "120/80" and not a lot
can be done with it other than searching for it and
recalling it. A next generation EMR would save
the blood pressure "120/80" as codified data, such as
"0006753246" which can then be recognized and utilized
by the program for a number of operations, such as
graphing a patients vitals over a period of time, and
analyzing what medications have made a marked
difference in the patient's blood pressure.
Text-based data severely limits the ability of any
program and EMR solutions are no exception. Coded
data, however, allows a myriad of uses, limited only by the
programmer's imagination and the needs and suggestions of the
physician and his or her practice.
The Next Generation of
EMR
encodes all data, thereby allowing aggregate functions that can
facilitate charting, billing, research and inter-facility
communication, including instant online lab results and
prescription ordering. With encoded data, transcription is
no longer necessary because the EMR dynamically charts with each
selection of the physician throughout the patient visit.
E&M coding is automatically selected and fully supported by the
charting, thereby eliminating concerns about chart audits.
Such a solution would also appropriately prompt for additional
exam options, such as a Review-of-Systems (ROS), and would
accurately calculate the proper code for every procedure,
thereby increasing the coding substantially. There would
no longer be a need to "under code" to make certain the coding
matched the charting, nor for "coders" to check coding and up
code appropriately. The EMR solution that is fully
codified also allows for advanced disease management and patient
history options.
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3. What should a physician look for in an EMR solution?
What a physician needs
determines what he or she should look for in an EMR solution.
Need alone should not be the only driving force in choosing a
solution, however. In the rapidly changing technology and
medical environment, physicians need to plan for new
developments and make certain that their current systems can
handle loads that may arise. Along with examining the
current and future needs of their practice, the physician should
also develop (and budget for) a technology plan that includes
computer systems, maintenance of those systems, and software
packages that augment their practice.
Document management which may be
handled effectively with a lower cost text-based EMR solution
may suit the needs of the practice as it currently operates, but
fail to meet future needs or future developments. A
physician may save a few dollars in implementing a lower cost
EMR now, but wind up paying much more in the long run by not
planning for future developments. If the physician is
looking for document management only and will never progress
past document management, then a text-based EMR could handle
their needs sufficiently.
If, however, a physician wishes
to implement a complete solution with a maximum Return-On-Investment (ROI) that will not only pay for their
EMR solution,
but also their network infrastructure, then a fully encoded
EMR
solution is the only choice. Cognecy Solutions typically recommends this solution over a text-based solution
for the simple fact that the ROI is high enough for the
physician to pay for their product in 12 to 18 months with
increased revenue as a direct result of the EMR solution.
This offers the best possible solution in that the physician
gets the best possible product and pays for it and the network
to run it in a very short time. The only reason a
physician might choose a text-based solution over a fully
encoded EMR solution would be if the physician is cash or credit
deficient and unable to work out terms on the more expensive but
vastly superior product. Even if this is the case, Cognecy Solutions recommends that the new office or
physician revisit the fully encoded solution as soon as they are
able.
Other factors a physician should
be aware of is the ease of use of the product they decide on,
particularly the user interface and how long it will take to
learn the product once it is implemented. The physician
should also examine what the product does in relation to his or
her practice and if templates are available or easy to build for
his or her particular type of practice, if the product uses
templates.
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4. How will an EMR effect the way a physician has always
practiced medicine?
Whether a physician chooses a
text-based or fully encoded EMR solution, there will be a
change in the way the physician runs his or her practice.
Anytime new technology is introduced there is a learning curve
which also effects patient care. An EMR solution is
especially this way by design. Paper charts will no longer
be utilized, drastically affecting the way office staff go
about the physician's business. This will inadvertently
effect patient care. The way the physician charts will be
affected, thus altering the doctor-patient relationship.
These changes are positive changes, however.
A physician who takes a step
forward technologically should anticipate changes in their
practice and patient care. By choosing the appropriate
EMR
solution for their practice they will minimize negative results.
In general, however, a step forward also means improvement in
patient care, and the trust of the patient toward the physician,
thereby enhancing the doctor-patient relationship.
Fully encoded EMR's also add the
advantage of intelligent prompting, which offers a failsafe that
helps prevent entering data incorrectly. Intelligent
prompting may also help in finding the right diagnosis for
specific symptoms.
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5. How does an EMR effect the doctor-patient relationship?
The doctor-patient relationship
will be effected regardless of the EMR solution the physician
chooses. It is up to the physician to insure that the
patient understands that technological advancement improves
patient care. Generally, patient trust level increases
when they know their physician is pursuing the latest and best
solutions, just as a patient's trust level increases when they
know their physician is keeping up with the latest research that
effects their treatment.
Very few patients would be
uncomfortable with seeing their doctor carry a notebook pc into
the exam room with them, and certainly would not if the
physician explains that they are implementing a new
EMR solution
that will enhance their care.
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6. What's the learning curve on implementing a new
EMR
Solution?
Do not be mistaken, there
will be a learning curve on any solution implemented.
The physician will have to learn how to use the program, if not
to its fullest capability, certainly well enough to meet the
needs of his or her practice. Depending on the complexity
of the product, what the product does, the ease of the user
interface, and the needs of the practice, the physician can
count on an initial training phase of at least one to two weeks.
He or she may also count on an implementation phase that should
be drawn out as long as the physician feels he or she needs it.
Typically, in this implementation phase the physician begins to
use the product but also continues to use old paper chart
methods until he or she feels comfortable with the product.
Ideally, the physician over a period of 1 to 6 weeks, would use
the product more and more and the old paper chart methods less
and less, until paper charts are completely phased out.
EMR solutions with more difficult user interfaces, such as
Text-based EMR's, may take as long as 6 months or more to
implement.
The above implementation
scenario is typical, but Cognecy Solutions has seen one
surgical clinic fully implement MEDCIN®-based EMR
solution in as little as three weeks. This solution was a
high-end, completely encoded EMR solution. The first week included training and some
hands-on live work. The second week, the physicians
decided to abandon paper charts completely which created some
serious patient backlog in the second week. The third week
caught up the backlog by scheduling fewer patients, and by the
end of the third week the clinic was completely up to speed on
the EMR and had abandoned paper charts except for some reference
usage. Cognecy Solutions does not recommend this grueling
schedule for implementation, but it worked very well for this
surgical clinic. The physicians were forced by necessity
to learn the software and use it to it's fullest capacity.
They learned the product very quickly and fully
implemented in less than one month. Again, this is not the
norm for training and implementation, but illustrates what can
be done.
For smaller specialty and family practice clinics,
MEDCIN®-based software solutions are now being fully
implemented with all staff members trained and functional with
the software in as little as 7-10 days. Efficiency with
this system, or any other system for that matter, comes from
learning to be faster with the software which can take anywhere
from 1-3 months depending on the user.
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7. Why are the best EMR's so expensive and what can I do
to offset the cost?
The question should never be, "How much does it cost?" but
rather "What is the Return on Investment of implementing this
solution?" The cost of an EMR solution really doesn't
matter, as long as there is a return on investment for
implementing the product. The physician must examine each
product's ROI before purchasing it. If it does not produce
a return in increased revenue for his or her office that is
sufficient to pay off the cost of the product and the
infrastructure to run it in under two years, he or she should
reject it as not a wise purchase.
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8. Will an EMR integrate with the physician's Practice
Management Solution?
EMR solutions and Practice Management Solutions are rarely made
by the same companies, due to the complexity of each product.
To facilitate communication between the two different solutions
there are many interfaces available. In some cases a
Practice Management or EMR solution endeavor to integrate
without interfaces, in which case the physician would have a
totally integrated system. Even with the addition of an
interface, however, the result is seamless. To the office
worker, nurse or physician the integration between systems would
not be noticed.
An interface between two products is nothing more than a
translator which translates the language of one product into the
language of another. In the case of EMR and Practice
Management solutions this is usually as easy as remapping tables
and column names to coincide. An interface might be
equated to a translator standing between someone who speaks only
English and another who speaks only Spanish. The
translator speaks both English and Spanish and can therefore
interpret for both.
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9. How Can I get a quality EMR and Practice Management
solution from the same company?
EMR solutions and Practice Management solutions are inherently
different, though they may use the same database engine such as
SQL or Oracle. For example, there are many different
operating systems that all work on the same server, such as
Unix, Linux, Windows 2000 or .Net, or Sun Solaris. They
rest on the same platform, but they are very, very different in
how they process data. They may speak to each other using
a common language such as XML or even direct connections like
TCP/IP protocol to share files.
Likewise, EMR solutions and Practice Management Solutions are
focused on their particular expertise and often ignore other
important aspects of a practice. A physician may find a
suitable EMR that has an unsuitable Practice Management module,
or a very good Practice Management solution with a mediocre or
poor EMR solution. Functionality should be the weight and
measure of an EMR and Practice Management solution, not whether
they were produced by the same company. Many EMR solutions
purchase a Practice Management solution and integrate it with
their product with an interface and then sell it as a complete
bundle. Whether a product is produced by the same company,
really makes no difference, as long as they function seamlessly
in a way that improves the practice.
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