Has your vendor met expectations?
Shuwarger: No—our vendor exceeded our expectations. We had experience with technology vendors before—“We’ll overpromise and underdeliver” was their mantra! With our EMR vendor, however, our preparation was outstanding, the training was thorough, and implementation went better than any we had experienced. Our uptime has exceeded expectations. Enhancements have been well thought out.
And customer support was good at first but now is even better.
Hall: The program is extremely powerful, with an excellent architecture, but its flexibility is also its main limitation. Recently, core clinical content for primary care medicine has been added, but specialty content remains severely limited. Value-added vendors have developed—at additional cost—excellent form-editing tools and specialty forms, and a vigorous users’ community is generous in sharing forms and workflows. But untold hours were required to develop clinical and office workflows, document templates, and just to discover all the options in the system. The learning curve was huge, and further automation requires the skills of a computer programmer.
Our EMR and practice management systems are interfaced but not integrated—even though the same vendor developed them. The problem is that the interface requires several translation programs and multiple servers to implement. Our dependence on our network engineering firm to maintain our bank of servers and interfaces is worrisome— and costly.
Training on our system was inadequate. The basics of the system were covered but, beyond that, we are just now able to shift into second gear. Much of the system’s potential remains untapped.
What is your approximate return on investment?
Shuwarger: We’ve grown receipts by 20%, year over year, since going with our ObGyn-specific EMR system. The rise in revenue is related directly to increased productivity, a reduction in lost charges, and improved collection from third-party payers because we can provide better documentation. At the least, our EMR system has returned $3 for every $1 spent, not counting intangibles.
Hall: Charge capture is much more complete and accurate, with readily available codes and guidelines. The greatest savings are in chart transcription, management, and storage.
Ongoing maintenance and upgrade costs, including hardware and networking software, have gone far beyond our initial investment, however. Problems with training and initial workflow design have slowed our return on investment. But we’re making progress in that direction.
- Streamlined history-taking and complaint-reporting may mean greater productivity in a practice—and a resulting ability to see more patients in a day
- A so-called patient portal gives patients easier access to providers and the varied resources and services of a practice, which boosts satisfaction
- Caveat emptor! Shop carefully when selecting a system vendor—the experiences of practices from installation through system maintenance range very widely
- Interconnectivity between an EMR system and other databases is not a given
- For a large, multisite practice, the cost of hardware alone may have a chilling effect on implementing an EMR system
- All physicians in a practice must buy into an EMR system that’s being put into place—and a range of ages, attitudes, and practice patterns may be a cause for disagreement on how the system is to be best used
- There is concern among some that the federal government may shape the future of EMR by mandating that all systems in private practices interface with hospitals, insurers, and other providers.
Are features lacking that would bring greater efficiency?
Shuwarger: Our labor suite wants data from our ACOG obstetric record to flow into its system to avoid the need to reenter data manually. And our practice’s physicians want the labor and delivery summary to populate our EMR. These issues of interconnection will be worked out as CCHIT certification (see “EMR certifying body arises from the private sector,” page 62) brings disparate systems into proximity.
Hall: Physicians aren’t computer programmers. We practice medicine, not EMR system development, and we are rarely on top of the “best practices” in practice workflow. Many of us who work with EMR may wish to customize a system to the way we practice, but that is not the best way to proceed. A robust and comprehensive specialty-specific set of clinical content that can be loaded as a unit and easily updated is going to provide far greater efficiency than an infinitely customizable basic program.
I look forward to being able to integrate our private medical record with a central data repository, in which interactions with other specialists and medical centers—not the faulty memory of patients—provide a more accurate background and reduce costly duplication of our increasingly stretched medical resources.
In 2004, President George W. Bush set a goal: nationwide adoption of EMR—to include all medical practices—within a decade. Subsequently, the US Department of Health and Human Services (HHS) established the Office of the National Coordinator for Health Information Technology and the American Health Information Community. The sweeping goal of these bodies? Better health care by application of information technology and creation of standards for certifying EMR systems that provide core functionality.
In response, three private-sector health information management groups jointly formed the Certification Commission for Healthcare Information Technology (CCHIT; www.cchit.org). In 2005, this independent private-sector entity entered into a contract with HHS, to, in the commission’s words, “develop and evaluate certification criteria and create a voluntary inspection process for healthcare information technology” in three areas:
- Ambulatory EMR for offices
- Inpatient EMR for hospitals and health systems
- The network components through which EMR share information.
The work of CCHIT is ongoing; the commission provides voluntary certification of EMR systems, publishes a list of certified EMR systems, provides consultative services to providers and payers through its Web site, and even offers a bank of resources for patients on the intricacies and legalities of medical-record-keeping.