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The biggest benefit of technology for providers is that EMR software can have automated Alerts.
The biggest negative of technology for providers is that EMR software can have automated Alerts.

I will not forget. Software remembers and therefore lets the provider know when something is due, something needs to be done, or something needs to be taken care of.

On the other hand, it can be a nagging ‘spouse’ that reaches a point of ‘diminishing returns’. Initially, it feels good that the software alerts you of things that need to be taken care of. Pretty soon, you get into a mode of – I know I know, and impulsively click on the ‘x’ button to cancel the alert.

I remember when I wanted to start exercising. So, I put a reminder on my smartphone calendar. At the set time, it alerted. The first day, I ‘x’ed it – “Not today, I’ll start tomorrow”. This went on for 3 days. Then, I actually exercised for 2 days. The weekend arrived, and I got up late, I did not see the alert. Next week, I instinctively just canceled the alert every time. After 3 weeks, I just removed it from my calendar.

What is interesting however, is that after one month of this trial and tribulation, I started exercising without an alert reminding me what to do.

There’s a similar story here for Alerts/Pop-Up reminders in EMR software.

It is about following a proper workflow in your practice. There are so many places where you have a choice of asking the EMR software to alert you or internalizing and training properly to follow a workflow.

In a paper-based environment, you get things done, but there are no alerts popping up. I understand the argument that in a paper-based environment, you may miss things, and something can fall through the cracks. By implementing technology and proper software, you can plug these holes and cracks. But you don’t need pop-up alerts, you just need a good workflow.

Some of the most efficient practices I have seen have mastered the process, workflow, and discipline using EMR software. These practices do not allow pop-up alerts, because they slow them down, distract them from doing what they need to do and from being efficient.

Next time you see an EMR software system that has a lot of alert pop-ups, be wary. At first glance, it looks impressive, but do this every day, an Alert Fatigue will set in.

http://www.emrandhipaa.com/emr-and-hipaa/2013/02/27/an-interview-with-mitochon-about-their-recently-launched-emo-electronic-medical-office/
Good Marketing – nice Coining of a new term EMO – Electronic Medical Office… but…

http://www.emrandhipaa.com/katherine/2013/02/26/one-fifth-of-physician-practices-might-switch-emrs/comment-page-1/#comment-171759
This is a topic I have been aware of and following since last year when I saw a rise in ‘switchers’. The reasons cited are all true of course, but for the most part, that is the ‘logic’ cited when asked for reasons for switching.

John as you have rightly said, no one offers everything, and these are issues faced by everyone. Yet, only a few switch.

In the majority of the cases I surveyed informally, it is an emotional decision based on dissatisfaction with how their Vendor handled the situation.

I have actually seen practices switch from Vendor A to Vendor B and from Vendor B to Vendor A – for the EXACT SAME REASON!

Message for Vendors:

You may have a good web-based EMR system, focus on Customer Service

Message for Physicians:

Chances are Switching will not solve your problems. Make your Vendor a Partner and work with them. Switching will be expensive, painful, and perhaps not solve the problems.

I saw this news this past week and was mulling over the implications.
http://www.emrandehrnews.com/2013/02/20/kareo-buys-epocrates-ehr/

Is this a game-changer?

I think the biggest company that will be affected is Practice Fusion. Why? Many of the web-based EMR software from Practice Fusion users are on Kareo for billing. A tighter interface to EMR and ‘no ads’ will make it attractive for providers to switch, unless Practice Fusion does something about it fast.

But, Providers beware.

I have written earlier, all that Glitters is NOT Gold!

As a provider, and a ‘business owner’, I would be extremely skeptical. I must look for the following three things:

• Speed – not just of a clinical encounter, but for the entire practice. Providers tend to look at the speed of doing their part.
• Focus on Business Enterprise. What about the entire business; front desk, check-in check-out, patient wait times in the clinic, claims processing, reporting, collections, and so on…
• Is the Enterprise System a truly Integrated Platform with a single database? Does that matter? Perhaps not on the surface, but as any experienced healthcare technologist will tell you, ‘interfaced’ is not the same as ‘integrated’. Only Integrated Systems preserve data integrity.

Last week’s article – “All EMR Software is the Same” got a very good response. I got interesting feedback, one of which is about training. They asked me about the different approaches various vendors take on the subject of training.
I’m assuming we are talking about Web-based EMR software that is based on a monthly subscription fee. I have seen two models – one where a vendor does not charge any ‘upfront’ fee, and another where a vendor charges an upfront fee for training but their monthly fee is lower. Which one is better?

Before we look into “which one is better”, I’d like to talk about the fundamental differences in approaching Training that have a profound effect on how training is imparted.

No Upfront Fee model

If there is no upfront fee involved, a business tends to look at Training as a ‘cost center’ – an expense that a company has to deal with. We know that financial accountants and business owners try to minimize expenses. By direct implication, they cut corners. The quality of training tends to suffer. There is a general lack of ‘incentive’ for the management as well as employees since there is no ‘accountability’.

As they say, there is no free lunch. In spite of the ‘no upfront’ fee label, guess what, you’re paying for it- financially by raising the monthly fee or in terms of quality.

What I fail to understand is why providers fall for this.

In fact, I venture to say that Training and implementation are more important than the software system itself. A bold statement, yes, but I want to stress the importance of not compromising Training because Quality and Quantity are both important.

Upfront Training Fee model

I urge you to look into this model because of two very simple reasons.

1. The company is accountable and responsible for doing adequate training within a timeframe. Since this is a source of ‘revenue’, they are liable to hold their employees accountable for the quality of training satisfaction.
2. Second, it holds you and your staff accountable – you have a set number of hours to get trained in. You and your staff better pay attention and learn as much as you can.

Another Model

Seek out unlimited training options if available. I guarantee that not many companies will offer it. In fact, try to do this – put a ‘penalty clause’ if training is not scheduled within a stipulated timeframe.

The next best thing is, to have the option to buy training ‘on demand’.

How much Training?

Here’s a guideline that I have created and found useful after many years of experience. This is based on practice sizes of 1-5 providers. There is variability in individual experience with technology, tech savviness, etc.

What this means is that in the first year, you need between 44-56 hours of training, however,

Training works best if…

The Vendor and your Practice work in the spirit of ‘Partnership’ rather than an adversarial ‘client/customer/supplier’ relationship.

What does this mean? How do you determine whether or not a relationship is a true ‘Partnership’?

A good partnership begins with the first call to your web-based software system supplier (prospective partner). Here are some examples of indicators:

• When you call and leave a message, how are you treated? How soon is your call returned?
• Does the company attempt to answer your questions, ask you about your concerns, or just try to sell you their system?
• Do you answer their questions in a professional manner? Do you return the salesperson’s calls? If not, why not?
• Do you show up on time for online demos and meetings? If not, why not? Don’t some practices charge patients for ‘no-shows’? So, let’s treat each other equally.
• When trainers are there in your office or online, do you spare time for them and really give them full attention?
• Does the Company support staff give you their best attention and care as you would to your patient?

Now you know what I am talking about.

So, don’t skimp corners when it comes to training and, please, strive to establish a true partnership. If there are genuine financial reasons why you can’t afford a system that you truly like, tell them. They may work out something for you. But at the very least, have the courtesy of telling them why you can’t partner with them. No one is going to hound you for your decisions. There may be a few ‘used car salespeople’ out there, but by large, they want to help you.

Must the EHR operating instructions be so complicated?

http://www.ehrwatch.com/blog/must-operating-instructions-be-so-complicated

Segmenting and dissecting implementation and product operating instructions in isolation is not appropriate. It all starts with product design, which you alluded to in the beginning. The easier and simpler the product, the more difficult it is to design and build on the backend. Ask any engineer and software designer. Ask Apple. But, once you design a truly simple product, simplicity in operating instruction and therefore implementation is an extension of that philosophy.

The most confusing element of the Stage 2 Meaningful Use Final Rule has to do with a ‘mandatory’ requirement for patients to access their records online.
In stage 1, the objective was the following:

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and medication allergies), upon request.

The key here is ‘upon request’. In my experience, I have not a single instance where patients have requested an electronic copy of their health information.

Stage 2 objective now states the following:

Provide patients the ability to view online, download, and transmit their health information within four business days of the information being
available to the EP.

If you notice here, the words ‘upon request’ have been eliminated. Let’s examine and dissect what the Stage 2 Measure states. The measure is split into two parts:

1. More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information.
2. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized 4 representatives) view, download, or transmit to a third party their health information.

This Measure will be left to individual interpretation by both the certifying authority as well as the EHR Vendor. Every vendor has a unique way of presenting information and the implementation will vary. It will be easiest for vendors that have an integrated Patient Portal system. This way, the entire measure can be ‘automated’ without requiring the provider to do anything at all.

The second part of this measure will be tricky. How do you require and ensure that at least 5% of patients view, download, or transmit to a third-party their health information? What if your patient population does not have online access? Who can be defined as a ‘third party’?

The first bit of clarification may come from the certifying authorities. In any case, seek clarification from your vendor.

I just read this headline today “Recruiting Firm Says Solo Physician Practice is Dead”. I’m not sure if I agree. Read this article here.
The reason why I don’t agree is very simple.

1. Inquiries from Solo Physician Practices looking for Web-based EMR systems are up. If what this report says is true, why would solo practices want to invest in new technologies?
2. Inquiries from Physicians starting New Practices and looking for Web-based EMR are also up.

I was actually surprised when I analyzed some data of incoming inquiries for web-based EMR systems and tried to figure out how many of them were from solo practices and how many were actually starting new solo practices. It has actually been up in the last two years.

While I think there may be a trend, American Entrepreneurship is not dead, in spite of what is going on in the healthcare world.