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Editor's Notes

• #2: Image obtained from: http://www.senecamedical.com/wps/portal/en/our-markets/physician-and-surgery-center/programs-and-services/electronic-medical-records
• #3: “About $19.2 billion of the $787 billion American Recovery and Reinvestment Act ARRA that President Obama signed in 2009 is directed as an electronic medical records EMR stimulus” ( Medical Records.com, 2012 ). What this means for private practices who are not already implementing EMR  ”The electronic medical records stimulus will provide incentives for conversion to the paperless electronic medical record systems” (MedicalRecords.com, 2012), What’s more when taking the incentives out of the equation, there are other substantial benefits of EMR implementation. The ability to file EMR digitally reduces the cost of storage for documents that are not frequently accessed or are being held for a specific time period. We can all appreciate the value of time in a medical practice; saving the physician time benefits the entire staff as well as the patients. When physicians finish their charting faster the office is able to schedule more patients. The efficient way EMR reduces and organizes medical records enables a more effective medical practice. The ability to have instant access to EMR allows physicians and nursing staff the ability to chart in real time, the information is being recorded as it happens as opposed to hours later after many other patients have been seen as well, resulting in a blur of information when charting. Thereby significantly improving accuracy of the health record. It is nearly impossible at times to read and transcribe physician handwriting. Another issue is medical abbreviations; there are many that are commonly misused or mistaken. This can indicate significant confusion and complications; for example, LLL could mean a few different things such as left lower lung, left lower lip, left lower lid, or left lower lobe. If this patient was given orders to biopsy the “LLL”, what would be the outcome? This is the reason why any use of abbreviations is no longer tolerated in hospitals. EMR does not allow for abbreviations without specific clarification by the system. While implementation does reduce some medical errors, it is not full proof. Nevertheless, there are fail safes in place that can double check and flag errors in the system.
• #4: Choosing software or a vendor provider can be quite the arduous task. There are many providers to choose from and many considerations to review with each one. I recommend evaluation the current system in the office and finding a software or vendor that offers close to what may already be in place. Weighing out costs and advantages with ease of use and implementation are very important when choosing a system that would work best for any specific practice. One company doing very well in the market is Nextgen. One client testimonial states, “With NextGen’s 8 Series, it’s easier for me to communicate with patients and other providers—everyone has the same information. It’s been huge for building patient trust and confidence“(Nextgen.com, 2012). Once the system is in place testing the system to ensure it works well for the practices needs is very important before investing in training staff to use the wrong software or vendor, only to have to do the same all over again after trying a new provider. Once the practice has decided on their software and tested the system it is time to train staff on its use. Once the practice feels secure in the new system it is time to make the complete switch from paper to digital and go live with the system. The medical field is ever changing, so it technology therefore times when training refreshment will be needed.
• #5: The federal government and other agencies are aware of the benefits of EMR implementation as a whole. They are also well informed on the costs of implementation. For that reason, some financial safety nets are awarded from the government for executing EMR. Federal grants funding also aides in reducing the immense cost of implementation. Medicare provides lucrative incentives from 44,000.00 to 63,750.00 to relieve the stress of the financial burden. The increased accuracy in coding benefits third party payer as well. Deductions and Tax credits for 2011 alone are around a quarter of a million dollars. If that isn’t enough good old Uncle Sam throws in a depreciation bonus of fifty percent.
• #6: Unfortunately, it is costly when implementing a paperless system; the practice will require sufficient capital. The decision to purchase an EMR system is quite the noteworthy investment resolution for any medical practice. “The cost of implementing a EMR system can vary anywhere from 50,000 to $100,000 or more per physician" (Medical Records. com, 2012). The purchase of an EMR system can signify a momentous economic burden for any medical practice. Because EMR is such a costly expenditure to implement, as with any entirely new office system, budgeting and planning needs to be extensive. Conversely, “Title IV of the Health Information Technology for Economic and Clinical Health Act of 2009 (the HITECH Act) provides financial incentives up to $63,500 per health care provider who implement an EMR system that is certified by an Office of the National Coordinator for Health IT (ONC) Authorized Certification Body (ONC-ATCB)” (Medical Records.com, 2012) The financing an EMR system can be found in the practice’s cash flow and specialty lenders who aide with healthcare financing. Additionally some vendors offer benefits such as postponed payments and leasing programs. One reduction of capital expenditure is the lowered risk for errors and expensive lawsuits. In some instances, patients will be displeased with switching over to EMR in fears that access to their medical records may be compromised. The privacy and security of the patient’s amount to growing concerns associated with EMR. EMR however, does follow HIPAA guidelines. This in turn also prevents medical errors, thereby decreasing hassles of expensive lawsuits. The Electronic Medical Records allows the practice to provide patients with the latest technology in the field while saving time and increasing accuracy. In summary the overall expense can be countered by more security from legal complications in the long run.
• #7: Annual expenditure totals or outflow is the price tag per year. Let us assume Dr. Feel Good is planning on implementing Nextgen’s EMR system in his county clinic. The initial expense is going to cost him about 2,000.00 in software, another 4,000.00 on hardware, 1,800.00 training and implementing the new system, 1,500.00 on annual support from Nextgen. Unfortunately, Dr. Feel Good also is expecting a substantial loss in productivity and has to see very few patients, very slowly. He estimates a 3,000.00 loss. Therefore the annual outflow the first year is 10,300.00. “Financial benefits however, include avoidance of expenditures and amplified revenues” (Wang, 2010). Furthermore the study Wang conducted shows, “Implementing EMR provided 86,400.00 in annual savings for the practice on an average in 5 year time period” (Wang, 2010). These funds were saved from expenses in drugs, due to the fact the EMR prevented over 47,000 undesirable drug reactions or events. Addition saving were derived from “reduction in expenses in radiological testing, reduction in errors in billing and improved billing charge capturing system” (Wang, 2010). Technology is always changing, developing, and outdating therefore depreciating. Every few years’ new hardware may need to be purchased or upgraded because of depreciation.
• #8: Intelligent, technological software enables the medical practice staff with accurate and up to the minute medical records when and where they need them. A midnight phone call to the physician is now much more beneficial to the patient with complete access to their records from the comforts of home. This same stored information is available to the physician as he is making rounds on the patient in the hospital as well. Other advantages coinciding with the implementation of EMR is the elimination of chart overflow storage. EMR increases revenue through a superior evaluation and management coding software. These system double checks for accuracy ensuring highest possible payment for services rendered. Increased revenue and reduction of many operational costs can be witnessed at early as the end of the first year. According to Wang’s article projected revenue falls around approximately 8.2 million in savings over the 5 year time period” (Wang, 2010).
• #9: It is imperative to pay close attention to the Return of Investment in EMR prior to devoting large sums of money to the new system. Let’s assume Dr. Feel Good’s practice has an estimated 1,500 total patients with active status. On a regular business day in Dr. Feel Good’s practice an estimated 30 patients will be seen more or less depending on the season. Dr. Feel Good’s practice sees a patient/provider ratio of 3:1, the practice often receives a hundred or more calls a day for various reasons. The EMR system carries a cost of 10,000.00. The implementation training costs he practice by the hour anywhere from 75.00 to $150.00. The initial implementation stage and training time is right around 35 hours. For instance, take the average hourly rate of 100.00 an hour and the patient/provider ratio of 3:1. Additionally the cost of hardware for Dr. Feel Good’s practice is 1.500.00, and the ISP charges of around 3,000.00 annually. All of these charges and, the recurring annual vendor fees for IT and maintenance will present a significant return of investment in the long run.
• #10: Let’s Review..
• #12: The assortment of benefits and recompense of the realization of an EMR system in the practice, will outweigh the few but hefty negatives and disadvantages coupled with EMR implementation. EMR improves the quality of care along with the accuracy in documentation and billing.