Author: Chandresh Shah

Chandresh Shah specializes in Healthcare IT and Medical Billing. He knows the market inside out; what works, what doesn’t. He advises and works with small business owners.

How Do You Know it’s Time for a New EMR?

EMR (Electronic Medical Record)

I read this blog from Seth Godin (New Times Call for New Decisions) and it struck a chord.

Remember when you bought your first EMR? Perhaps you’re still on it, or you may have changed. Each has its reasons. Here is what Seth wrote:

“New times call for new decisions
Those critical choices you made then, they were based on what you knew about the world as it was.

But now, you know more and the world is different.

So why spend so much time defending those choices?

We don’t re-decide very often, which means that most of our time is spent doing, not choosing. And if the world isn’t changing (if you’re not changing) that doing makes a lot of sense.

The pain comes from falling in love with your status quo and living in fear of making another choice, a choice that might not work.

You might have been right then, but now isn’t then, it’s now.

If the world isn’t different, no need to make a new decision.

The question is, “is the world different now?””

— Seth Godin

Nothing has changed more than Healthcare and in particular, Healthcare IT, EMR, and EHR. We persist because Change is Fear!

In the world of EMR/EHR, implications are more than just fear. They have to do with real costs of change – the cost of moving data from one system to another.

Cost of Change

  • Cost of Training Everyone
  • Cost of productivity – (it takes an average of 3 months before a practice becomes productive on one EMR/EHR system)
  • Cost of Transition – moving data from one system to another

Cost of No Change (Status Quo)

How do you determine if you need to change your EMR/EHR? Here are things that determine if you need to change your system:

  • Seeing less patients per day than you did before EMR/EHR
  • Drop in Revenue (not because of overall healthcare changes)
  • Unhappy staff. Listen to everyone, even if you are happy with the system
  • Inefficient workflow

How do you determine the cost of the Status Quo?

This may require some detailed financial analysis. Compare the cost of change and the cost of no change. If this cost is just incremental, do not change. Think of the analysis you do when you think of re-financing a house. Money saved per month versus the cost of re-financing.

But most important, do not remain stagnant.

How Do You Buy an EMR/EHR System?

Buy an EMR/EHR System

Most providers and practices buy EMRs with Fear. Fear holding you back from asking the right questions. If you are a Physician, you know the fears – I don’t need to write an essay about that.

Here is what goes on in our minds when we think of EMR.

  • How should I select the EMR that is good for me and my practice?
  • How much should I pay?
  • Aren’t all EMRs the same?
  • How to get proper reimbursement? Will the EMR help?
  • How to maximize my time with patients?
  • Will I lose productivity?

Instead, step up and ask Why.

  • Why get an EMR?
  • Why Bother with something that I fear?
  • Why should I be scared of CMS?

I urge all Providers to keep on asking WHY until they get to the core of the issue. What is the real fear? Where is the fear?

  • Am I afraid of computer technology?
  • Am I afraid that ‘Big Brother’ will watch the data and try to tell me how I should treat my patients?
  • Am I afraid of my ‘freedom’ and becoming a ‘data processor’?
  • Am I afraid Computer busywork will kill my practice?
  • Am I afraid I will be forced to choose between time with my patients and all the mandatory records we have to input into the computer?

We need to step up and ask the right questions. Buy EMR for the right reasons.

EMR is NOT a Commodity and let’s stop asking the question – How much?

Instead, focus on what the system and the vendor can do for me and my practice. Will it allow me to grow my practice, and go home on time? Will it/they help me regain my life?

Wrong Reason Not to Choose Cloud EHR

A Doctor mentioned today he does not want to use cloud EMR.

Reason? A colleague ‘lost data on the cloud’.

I’m not really sure what that means, but I have a sneaky suspicion that the vendor of that particular cloud EMR system did not provide data when the doctor wanted it, or that the EMR vendor was holding data hostage for a large fee.

In fact, client/server systems are more prone to losing data in the traditional sense. The solution to that problem of not getting the data from a cloud EMR vendor is not to use client-server systems but to do a better job of negotiating upfront and incorporating associated data extraction fees into the contract.

I have seen too many cloud EMR vendors holding doctors’ data hostage and demanding a large sum of money if the doctor wants to switch their EMR system.

What should you do?

Don’t jump from the frying pan to the fire. If you think cloud systems are a problem with your data, client-server systems are even worse – unless you spend a lot of resources managing the infrastructure internally.

Apple and Healthcare IT – Fuzzy Scary Lines

Apple and Healthcare IT

“Apple Could Lead In Healthcare. Here’s Why It Won’t.”

— Dan Munro, Forbes

In his Forbes article, Dan is very clear – Apple will NOT lead in Healthcare.

The choice of words is important. He uses ‘healthcare’, not ‘health’ as in hundreds of health, fitness, and wellness apps such as Fitbit. Real healthcare is in the realm of health monitoring such as blood glucose.

Once we understand this distinction, the implication becomes apparent. Healthcare is highly regulated. Just ask traditional healthcare players how difficult is the environment when it comes to providing products and/or services.

I think Apple is getting heady by trying to control and ‘own’ an entire ecosystem rather than being a part of it and facilitating the system.

EMR Productivity Conundrum – What if?

There is no doubt about the benefits of EMR to everyone. Public Health, Government, Patients and Providers – private practice as well as hospital based.

Yet, why do Providers continue complaining about EMR?

What if there was a way to continue working with paper the same way as providers did in the exam room with patients?

 

EMR Productivity Conundrum

There is no doubt about the benefits of EMR to everyone. Public Health, Government, Patients and Providers – private practice as well as hospital based.

Yet, why do Providers continue complaining about EMR?

There is one very simple reason.

Inefficiencies at Point of Care. This is a collection of following:

  • Reduces eye contact with patient
  • Too much attention to computer, software and clicking
  • Spending too much time on inefficient software than paying attention to patients.

In other words, the weakest link is the first one – data entry, data collection. What if this single point of contention had a solution? What if we removed the weakest link and made it stronger? I am not suggesting getting rid of or eliminating EMR at all, because we all know the benefits of EMR downstream.

What if there was a way to continue working with paper the same way as providers did in the exam room with patients AND figure out a way to get all the data into EMR without an exorbitant expense? (I am not suggesting scribes in case you are wondering)

I would like to know your views.

What Happened to My Family Doctor?

Bonefide Physician

I had an interesting conversation with a friend of mine. He is (was) a solo practitioner in New York. He is a Pulmonologist / Internist. 5 years ago he started his own practice, getting away from a group practice. I have to mention, that he’s my family doctor too. He was skeptical but entrepreneurial.

Suddenly he decided to go and work for a hospital. What happened?

He was very successful in his practice. Successful in the sense that patients loved him, he had no problem attracting patients and he was busy. So what was the problem?

He was plagued by problems with rising co-pays, co-insurance, and deductibles, he was not collecting enough money. His insurance payments were fine though. With rising patient responsibility, he saw declining revenues. Just at that point, a local hospital he was affiliated with called him and made an offer.
Should he accept this offer or continue to enjoy his freedom with a good practice where not only his revenues were declining but more importantly, his wife was going nuts trying to get patients to pay their outstanding balances?

He found out that the hospital had come to him bypassing other providers in his neighborhood because they knew he was a good doctor who had a great asset – happy patients who referred others to him.

He did his homework of course. He was part of the ‘second wave of recruits’ to the hospital. A few years ago, the hospital approached and hired some good doctors away from their practice. 80% of them were still working there. So, he felt the odds were good. Hospital administration (which he knew) can’t be that bad as goes popular wisdom. So his chances of success would be at least 80%.

Here’s the most important thing – the hospital made a very good competitive offer that was close to what he was netting at his practice.
So, he took the offer. I’m sure his wife had a role to play – she wanted peace and more time to themselves.

Is this the trend? Are we losing independent practitioners? Are we losing our family doctors to the ‘Walmarts’ of medicine?

EMR Differentiator / EMR Success – It is All About Implementation

EMR Differentiator/EMR Success

For those of you who are looking for an EMR software, the number one question you should ask the vendor is, ‘Why is your EMR software different’?

For those of you who have already chosen an EMR software, do you consider your implementation successful?

By various counts, anywhere from 50-70% of clinics are considering switching their EHR software. Some Electronic health record implementations are on schedule with all stakeholders of the practice fully involved in achieving their set goals. Others struggle at the onset and eventually stall; leading to partial or no success.

What is the reason for Failure?

Is it the people involved or the implementation process, or is something wrong with the product? My extensive experience working with providers and clinics for the last 18 years has taught me – it is not that simple.

People, Processes, and Tools

Processes are the binding agent. You need to have the right people, starting with leadership in the practice and having the best Tool (EMR software) for your clinic. Best EMR Software is one that works with your workflow, and technological comfort.

Where it fails most of the time, however, is Processes. I am not going to write in detail about how to do implementation here, but I am going to point out a very important aspect of the Implementation process.

Vendor Involvement.

Too many times, vendors allow practices to dictate the process, whereas practices look for guidance and best practices from the vendor. Vendors should be leading this. I was speaking with a company recently that had decided to take this head-on by putting money where its mouth is. They decided to refund part of the implementation fee if the practice works with the vendor to do proper implementation within an agreed-upon time frame. This simple assertion means that people and tools have to be excellent and someone is willing to take the bull by the horns to project-manage the entire process.  I like this proactive approach and will be eager to learn the outcomes.

How to Select the Perfect EMR / EHR Software?

When you want to select an EHR System or EMR system for your practice, don’t get tied up into small details of functionality, features, etc.

There is really only ONE thing you need to evaluate all systems against.

WILL THIS SYSTEM ALLOW ME TO GO HOME – HALF AN HOUR, 45 MINUTES, ONE HOUR  EARLY EVERY DAY?

Of course, it goes without saying that going home early does not mean taking work home.

There are 3 reasons why providers have to stay back.

1.       Finish Charts – paper or Electronic

2.       Financial worries – pending accounts receivables, accounts aging. … and third

3.       Staffing worries and stress.

Of course, we can’t do much about staffing issues, although, some vendors will be able to help you with that – which you should keep in mind.

So, benchmark all your EMR software systems with respect to this simple criteria – can I go home early?