Author: Chandresh Shah

Show me one Web EMR that is so dramatically different that you will scream – “Wow – I’ve never seen that anywhere before“. I’m not talking about bells and whistles or small features, I’m talking about game-changing solutions.
Do this – make a list of ‘features’ of these Web EMR systems. Write them all out in Column A of an Excel spreadsheet. In columns B, C, D, … write the names of vendors/products.

I guarantee most Web EMR systems will have most of the features you list out.

How do I Choose the EMR System?

So here are some basic dos and don’ts. First thing – Don’t focus on features, unless there are one or two features that you believe are critical to you, but then that can be done in 2 minutes, or during the presentation you can ask that the vendor show you.

Show Me

Here’s how to determine if a system is good for you and if you can see yourself using it.

Make a list of routine activities and desired outcomes. For example, a provider’s desired outcome can be –

1. A good final note that is not bloated with unwanted information so that you don’t have to sift through paragraphs of text to find the real assessment and details of an exam including abnormalities.
2. How to chart during the encounter in front of the patient and what will it do to the patient perception?
3. What does it take to ‘finish’ the encounter after the visit? Can you finish portions of the encounter afterward and if so, what are the exact steps involved?

A front desk person’s desired outcomes can be –

1. How quickly can you check in a patient?
2. How to handle interruptions; someone calls for an appointment when you are talking to a patient who just walked in for an appointment?
3. How to handle co-pays, as well as past payments due from a patient who just walked in?

A back office or billing person’s desired outcomes can be –

1. What are the actual steps for working on an aging report?
2. How to address claim rejections?
3. How to create claims and reconcile them with the provider’s notes and superbill?

Don’t just ask ‘Can you do this’, ask ‘How’ and ‘Show Me’.

Again, before you are able to ask the appropriate questions, you should do your homework. Step back and look at your day-to-day tasks and try to write them down along with your desired outcome.

This will help you find a system that you will want to live with for a long time.

Understanding the two questions is extremely important. Let me repeat:

• Is your EMR Ready for ICD-10?
• Are you Ready for ICD-10?

In order to succeed, both must be ready and work in unison. If either one is not, you are set for failure.

A popular misconception is, ‘My vendor is ready for ICD-10, so I don’t have to do anything.’ Continue reading “Is Your EMR Ready for ICD-10? Are You Ready for ICD-10?”

I was at a Michelin Star Restaurant in Manhattan yesterday with my family. We wanted to go to this place since one year, something or the other prevented us from making it happen. Lots of expectations were built up.
For me, I just found the food mediocre. My expectations were not met. It is not the first time this has happened. I’ve gone to places with great expectation, simply to be let down.

Big Promises – Unmet Expectations

Sometimes, Big promises can lead to mediocre, if not poor experiences. Big promises by who? The restaurant did not make that promise to me explicitly, but it was my mind that made the promise to myself.

This Expectation was a culmination of it’s ‘rating’ by a respected body (Michelin, in this case), my friends, peer, online reviews etc. built up that expectation. This expectation changes the way we experience a product and/or service.

So, Big expected promises can sometimes fall short leading to experiences that are not up to mark, even if in our own minds. If the company does not live up to that expectation we tend not to trust that Company quickly and broken trusts are hard to mend.

Companies will therefore be afraid of laying out grandiose expectation and promises. It is obvious – if we make these promises, we are afraid of owning them and then afraid of the ‘what-if we fail in delivering’? When we create our own Big Goals in life, we sometimes keep them to ourselves afraid that if we fail, we don’t want our loved ones to perceive us as a failure.

Expect Better – Experience Better

On the flip side,  We have better experiences when we expect to have better experiences.

An expensive wine tastes better because we paid a lot for it. That’s just how our mind works. Classic Coke just tasted better because we wanted it to taste better.

So, it would be unwise for companies to hold back from laying out high levels of standards and expectations. The expectations don’t have to be pretentious. You don’t need to make huge statements and buffer them with fine print. Experiences are just those small things – one step at a time. How you are greeted and treated by your salesperson, by every employee of a company, the way a customer service representative answers the phone, or even the look and feel of an email you receive from the company.

Customer Delight

Finally, customer service is not a ‘milestone’, it is an ongoing experience. Once you get started on a relationship and journey with your client it must get better with every encounter. Even if it does not get better, at the very least it must not deteriorate. Customer experience must continue to delight and sometimes even surprise. Only then you will have your client do the ‘selling’ for you by using social media to spread the word for you and build a level of expectation for your next prospect.

Easier said than done, this is the hardest act to follow for a company, but worth every penny and drop of sweat. Effort well worth spending on.

The Obamacare HIT Website noise has reached a deafening level. So much, so that news media had dedicated special sections to this. I don’t know what the issues really are, perhaps it will take a long time to figure that out.

What matters though is the implication and perception. Because this is what can make or break the success of a Project – not the real issues. Because real issues can be fixed. We are a nation of the best technical skills.

I see a direct correlation between the Obamacare website and any EMR or EHR Implementation success or failure.

Consider this quote from an article in MedCity News. ‘… the myth of Obamacare’s “failure” is a product of the same Republican noise machine that has been working to undermine this crucial reform since Day One.’

For your EMR / EHR software project, if you do not bring your entire team, and all members of staff on board fully committed to its success, you will quickly find hidden noise machines that will guarantee the failure of your EMR Implementation. Bringing everyone on board can ensure the success of your implementation, no matter what EMR system you choose.

Photo by Charles Fettinger via Flickr

I am amazed at the number of calls I get from small practices and physicians that are not happy with their current EMR / EHR system and are looking for something better.
I started talking to them and tried to probe them a bit more about the real reasons. As with any ‘disease’, the outward manifestation of symptoms can be different from the disease itself. This is exactly what I found. At the top of the list was something that surprised me.

They all invested in EMR for the wrong reason!

This is what I heard –

• Wanted to get the stimulus money
• We have to do it anyway, might as well…
• If we don’t do it, there will be penalties

These are all the negative reasons for making an investment. Among practices that were not happy with their choice, I did not hear a single person give me a ‘positive’ reason for making an investment in EHR.

So, I went ahead and interviewed Physicians that were not only happy, but thought their systems actually made their practice more efficient, and improved their quality of life. When asked the same question – ‘Why did you buy an EMR/EHR system?’, I got completely different reasons –

• I wanted to eliminate waste and make my staff more productive
• I was looking for ways to automate certain functions that were time consuming
• We wanted to go paperless and become more efficient
• We wanted to reduce errors in billing and have our processes optimized
• I want to run my Practice like a Real Business

So, there you have it – Don’t Buy EMR for the Wrong Reason.

I have heard this so many times – not going to implement EMR because provider is not sure what will happen to ‘Obamacare’.
What has Obamacare to do with EMR?

Nothing, yet, everything if you think about it.

Scenario 1: It all depends on what happens to Obamacare

As far as providers are concerned, if he/she is worried that Obamacare will reduce reimbursement levels to make them so low that they can’t sustain their private practice, then of course investing in anything does not make sense. It does not matter what you and I say or think. I don’t think that will happen but then it is the perception of the provider that matters.

So, if the real fear is – will I remain in practice, then nothing matters.

Scenario 2: Nothing to do with Obamacare

If a provider is convinced no matter what, they will stay in business, then they should look beyond incentives. Look beyond penalties. Look for these tools to help improve your practice and business.

Will these tools slow you down?

Only, if not implemented, used and executed properly.

How much does YOUR EMR Cost?
I get this question ever so often. I’m not bothered by this question, but I worry.

I worry for the person that asks this question, because the person asking this question is usually the Provider, Physician, Doctor. He/She is usually the owner of a small practice – the quintessential ‘Small Business’ that drives the US Economy. This is typically the class that watches the bottom line so carefully.

But I wonder – do they really watch the bottom line?

Bottom line is falsely attributed to costs. In a Medical Practice revenue is very complicated. Ask any biller. The Revenue is based on so many variable factors:

• Proper Coding
• Reimbursement levels set by CMS
• Number of Patients seen per day/week/month
• Growth of new patients
• Number of ‘no shows’ – i.e. patients setting up appointments and not turning up, resulting in loss of revenue
• Non payment of patient responsibility, which is under tremendous pressure.
• Patients returning for exams, tests, procedures done.
• And then, there are those soft/quality variables that are linked to
  • Provider and Staff’s ‘Likeability’
  • Patient Referrals
  • Perception of ‘modern’ practice
  • (believe it or not) Patient’s perception that Practice is in the modern age of technology, connectedness, internet and email

Cost is extremely important, but you all know how important it is to have good staff that cares – whether it is Front Desk personnel, medical assistants and back office staff. In fact, front office personnel can make or break a practice.

Would you compromise a few Dollars to get someone that wants the lowest salary? I know you wouldn’t.

Yet, why do people shop for the lowest cost EMR? The reason is very simple.

The Perception that all EMR are equal.

Final Thought

If you have liked something that you believe will be good for your practice, then would you compromise a cost variable that is less than 1% of your revenue?

Here we go Again – Practice Fusion.
It was a Burning Sensation to read this Article.

Seems to me that Practice Fusion is revealing its ugly head over and over again. I have been saying this – This company is making money by selling data. Doctors, not only your data but your patient’s data. These ‘boo-boos’ just reveal what they really do. Most of it is under the covers and no one knows what or how much data is being ‘mined’.

Please, before you consider the Free EMR Software from Practice Fusion, don’t sell your integrity and your patient’s privacy.

CareCloud announced the appointment of R. Scott Lentz as Chief Financial Officer. What does this mean for CareCloud and for the rest of the EHR industry?
Scott has a history of working with Healthcare IT companies – Aprima, and PracticeOne – among others. So, what is common among those companies?

Chop! Chop! Chop!

I see him as a Chop Financial Officer. He’s been great for the company shareholders and investors, but bad news for customers. I’m sure some may not like this bold statement.

• Look at what happened with Aprima. Product sold to Allscripts. Allscripts botched it up because the entire financial model did not work out, and decided to kill the product.
• PracticeOne – is now AdvancedMD, which was sold to ADP. Clients of PracticeOne complain they lost the support they used to get.

Two things are clear to me.

1. The EHR Industry is financially overrated, over overvalued. Yet, investors keep plowing money into companies like CareCloud and Practice Fusion. I’ve written many times on my blogs, that there is just not enough return on investment from organic sales. Everyone is banking on sales of ‘big data’ or being acquired.
2. When someone starts pumping too much money into an EHR company, and hires a high-powered CFO, I run away from it. What you need as a provider, is a company that believes in providing great products and services rather than doing financial engineering. I don’t see high profile announcements – ‘we hired a CCO – Chief Client Officer’, that will focus on providing the best product and services to our clients.

If I am considering buying an EHR, I’d be skeptical of CareCloud. If I am a client of CareCloud already, I would watch very closely and have a Plan B in place, just in case.

EMR Templates – A topic of heated discussion keeps on popping up in meetings and blogs, and rightly so. Studies have been published and we have also heard of CMS audits revealing how templates are sometimes used mindlessly.
There are various issues pushing and pulling in opposite directions.

Here’s an interesting post from the Society of Teachers of Family Medicine – “Are we teaching Template-based Medicine?”

• You want speed of charting but you don’t want each to look similar as the previous one.
• You want to code ‘just right’ but you don’t want to over-code.
• You want to automate charting as much as you can, but you don’t want to order tests and procedure where not required.
• You want to give enough attention to the patient and you want to document their ‘story’ and ‘narrative’.

Where is the balance?

You need to understand what a template really is. Every vendor has their own definition of ‘template’. It could mean anything from a single button template for a condition to sub-templates of every part of a SOAP note. You can have sub-templates for HPI, ROS, Physical Exams, Assessments, Plans, Orders and Procedures, and Medications. There cannot be one-size-fits-all templates.

The first step is to understand your own office workflow. What happens when a patient comes in? Who does the initial triage? Who does what part of the patient encounter? For example, your MA could be collecting initial data such as:

• Chief complaint
• Asking related questions and getting answers that could go into the HPI section
• Review of Systems and Medical history
• Current medications
• Vitals

When you see the patient, you must have quick access to previous notes as well as what the MA collected so far. This was easy in a paper-based system because you just flipped the pages in the patients’ folder – assuming everything was there. Then you engage the patient and elaborate on the ‘narrative’. Then you do the physical exam. At that time, you are ready to chart assessment, plan, order, procedures, and medication.

If you examine closely, the single element that is most difficult to ‘templatize’ is the HPI Narrative.

Trying to build a template that can capture every patient’s unique narrative, is extremely difficult if not impossible. Technologists will tell you it is possible and perhaps it is, but as a provider, you also want to say it in your (and the patient’s) words. My personal opinion is that this is best done by typing or dictation.

Use various forms of templates your vendor offers for everything else.

This guideline will make things easy, keep the workflow smooth, speed up your process, and most importantly, avoid audits because your templates look exactly the same. Ask your vendor how you can do all this and do it fast.