As a writer of both this blog and the long-running “Path to Paperless” column in Ophthalmology Management (where this article originally ran), I often receive emails on a wide range of questions regarding EMR.
Sometimes I am asked to recommend a specific EMR product which I politely decline, since I am not an expert on the specific functionalities of these systems as they pertain to their particular specialty. Other times I am asked questions about the actual implementation of the EMR system into their practice – on this, I have more of an opinion since I feel that this is usually where these projects fail.
But, most of the time, questions can be quite basic in nature. And, so as not to take anything for granted, I have listed what are probably the ten most common questions on EMR that I receive, in no particular order. As always, I welcome any comment on these – the discussion is always helpful to the reader as well as to the author.
10 Most Common EMR Questions
1) “Do I need EMR for Meaningful Use?” For those practices in the midst of EMR implementation trying to achieve Meaningful Use (MU) incentives, this might seem like a silly question. But it is a common one nevertheless. Meaningful Use specifically refers to the ‘meaningful’ use of an EMR system in a medical practice, as opposed to simply owning an EMR system. The MU stages have certain criteria that must be met in order for the practice to receive federal financial incentives that are paid out over time, $44,000 per provider in total.
2) “Will EMR save me money?” A study a few years ago by UCLA calculated startup costs of $15k-50k per physician. In return, a practice can see savings that range from 0 to $20k per year on such things as transcription, medical records, data entry, billing and reception. Increased revenue due to better documentation and/or coding has been less universal. And this also did not take into account the MU incentives which can add up, especially in a group practice.
3) “Will EMR make me more efficient?” There are numerous studies which have found improved efficiencies in hospitals, clinics, and practices that use EMR systems. But as I have written previously, a practice with bad workflow processes will only see those amplified by an electronic system. Those processes should be given a hard look and improved before going paperless.
4) “I’m thinking of using a web-based EMR – who owns/controls the data?” Technically the data belongs to the practice. But it is incumbent on the practice to vet the company or entity that is hosting the EMR system and its data, and ask some tough questions: Is the data co-mingled with other practices? What security processes are in place? Are there redundancies in case of server failure? What contingency is there if the hosting company goes out of business?
5) “If the EMR screws up coding and there is a resulting fraud and abuse investigation, who is responsible?” The jury is still out on this one. Most software companies have lengthy contracts with fine print – which nobody really reads – that indemnifies them against most liability. And EMR software vendors are no different. The real issue is when the EMR system starts making decisions, such as diagnoses or coding. As it stands, in most cases, the physician or hospital would ultimately be responsible. Unfortunately, CMS still has not established national E&M guidelines, so physicians are wise not to rely extensively on their EMR system for decision-making and to have expert legal counsel review their software agreements.
6) “What is the best way to implement EMR – ‘overnight’ or phased roll-out?” Every practice has its own unique situation and culture, so there is no one-size-fits-all approach. However, I have seen and heard of more fiascos regarding EMR projects that were implemented on a fast-track strategy. There are just too many moving parts in the typical medical practice and there is a misguided tendency to treat EMR like any other piece of medical equipment. As I have written before, the failure usually occurs on the people side of the equation, and that should never be rushed.
7) “I’m a solo practitioner in my mid-50s – Is it even worth implementing at this point?” There have been a few colleagues close to retirement who have written that it is not worth the expense and heartache for them to convert to EMR and that they would never recoup their investment, even with the federal incentives. On the flip side, practices that use EMR are considered to be more ‘state of the art’ and thereby more attractive for potentially new associates. But ultimately this is a personal decision.
8) “Does EMR really make the practice of medicine better?” The answer to this question depends on who is asking it. From the perspective of insurance companies and the government, the answer would be an unqualified ‘yes.’ The ability to cull information on the treatment of patients not just at the practice level but also regionally and nationally could significantly reduce the cost of healthcare. And most physicians who have successfully implemented EMR would also agree that it has helped them to practice medicine better. Others, however, fear that this granular degree of oversight allows those large entities to control the way physicians practice medicine in a way they could never imagine.
9) “Doesn’t EMR negatively affect the doctor-patient relationship?” This is a question that comes up as a frequent reason not to use EMR. Picture a physician with his back to the patient while he pecks away at this computer, they say. But how is this different than writing notes in a paper chart while facing away from that same patient? The bottom line is that EMR is just a tool and one must have a little foresight when planning how the EMR system will be used in the clinic setting. Our practice, founded 40 years ago, has always used scribes because it makes our physicians more efficient and able to give their patients their complete attention. And our process is no different now that we use EMR.
10) “Is EMR less secure than paper records?” Some high profile news stories have reported large data breaches from stolen laptops, thumb drives, or lax internet security. And in those cases, a significant amount of private patient information has been compromised. Recent legislation has put some real teeth into HIPAA-related violations. But in most practices with paper records, this information is readily accessible by anyone who walks into the usually-unsecured area that houses the charts. The reality is that, in the pre-HIPAA era, nobody really worried much about personal health information security. EMR systems allow for this critical collective information to be secured in a way that paper records cannot – but only if properly set up and continuously overseen.