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Generally speaking, we buy cars with emotion, not logic. If logic alone prevailed we would buy the cheapest and safest transportation to get us from point A to point B.

We evaluate –

• Convenience
• Looks
• Safety
• Value
• Something that matches our Status (and more)
• Comfort of passengers

There are two important similarities I want to highlight.

1. When you get an EMR, don’t just look at your comfort and convenience. Don’t evaluate just from a clinical charting perspective. Involve ‘passengers’ – your staff. In fact, they will be driving more than you.
2. The old adage – you get what you pay for holds even for EMR systems just as cars. Look at your value, convenience, and overall workflow benefits. Buying the cheapest is not always a good idea.

And as with anything else, look at recommendations from peers and third parties.

A lot has been written about the benefits of an integrated system versus ‘best of breed’ as some vendors like to call it. Best of Breed is really a loose term for ‘we don’t have other components, so we’ve partnered with another company’.

Interfaced System

An Integrated System does not mean an ‘interfaced’ system. Applications may be owned and perhaps developed by the same company. But if they were developed as standalone applications, they may be connected by interfaces or bridges. Applications may not share a single database or development platform.

To an end-user, the workflow and process may appear seamless because the vendors pass data from one application to another behind the scenes automatically and the user does not have to do anything.

Integrated System

Systems and applications designed to and developed from the ground up on a single database are considered truly integrated systems.

Which is Better?

From an end-user perspective, it should not matter; at least theoretically. Vendors on both sides of the fence have written about the benefits of each.

Consultants have always favored the Integrated system approach. However, they have not successfully been able to convince me from an end-user perspective. From a software and database integrity point of view, I agree it makes absolute sense.

Benefits of Integrated System

I was sitting with a Doctor’s friend at his office. His biller walked in and said, ‘Doc, you just saw patient Jones and I think you under-coded. I saw the note, I believe this would be a 214-level coding.’

The doctor just opened that patient’s visit note in his EMR and updated the chart.

The biller saw that the claim was updated with the new code.

I suddenly realized something and asked the biller, how did you know or see the visit note? Do you have access to the EMR system?

My friend said we have an ‘integrated’ system, so she can view my notes on the same screen where she creates and views the claim. She does not have to go to another ‘app’ or module or software. It is all in the same system and database.

Now it suddenly came together – A single database Integrated system. This is also the reason why when the Doctor updated his note with the new code, the claim was immediately updated.

It took a real-world example to be finally convinced of what consultants have been saying all along.

A lot of companies are waiving upfront fees because there is so much pricing pressure. I know owners of several EMR companies, and most of them have their support and training staff offshore. That is not necessarily bad, but then you don’t get the quality of training you deserve.

Plus, many studies have shown that successful implementation has to do with the level of training and support.

Rather than zero upfront costs, what you should be asking for is –

• One day of Onsite Training during ‘Go-Live’.
• Unlimited Remote Training
• Dedicated Phone support number for you.

Rather than compromise on a bit of upfront cost, it is imperative that you focus on making your practice more efficient and profitable.

This is not a Trivial System you are going for – EHR and Health IT have business implications. If not done right, it can slow you down, create chaos and you end up suffering.

If cash flow is really a concern, work out creative ways to spread it out. I’m sure your vendor will work with you.

If you think you can train yourself and your staff (assuming you have a lot of time on your hands), and set up the system yourself, why not go with the Free software Practice Fusion? Of course, if you add up your time and cost of time, you will conclude very soon that the free system was actually more expensive.

I was going through some notes from 2008. Eric Schmidt of Google announced Google Health at HIMSS 2008. Google pulled the plug in 2011. What happened?

“In the Google implementation, your personal health information will not be given to anyone without their explicit permission, which is not true completely for HIPAA-compliant systems. If we get a subpoena, we always check our judgment as to whether the subpoena is narrow enough. If we think it’s a fishing expedition, we will fight it in court. That has worked well for us so far.”

At that time, Google Health and Microsoft’s HealthVault were the two PHRs that decided to fight it out. Google quit, and HealthVault still chugs along.

Among several reasons why Google Health did not work out:

• It did not involve Physicians (and EMR systems).
• Google found it tough to partner with Insurance companies – Insurance companies tend to be a walled garden.
• Poor Marketing and Poor support for users. Even an EMR pioneer like me struggled to use it.
• Perceived waste of time by users. Young people did not care to enter data themselves, and those that PHR mattered most just couldn’t do it. It was too cumbersome.
• Google could not find a way to popularize it or figure out a way to bring in partners to monetize somewhere.

I think HealthVault will probably go down the same route as Google Health.

The main reason is that EHR systems now have sophisticated Patient Portals built in. Secondly, with MU2 and beyond, interoperability will eventually become a reality, making true secure data exchange possible, irrespective of the PHR platform.

Transition to ICD-10 is not about being Compliant. It is an ongoing Transformation.
Everyone is affected – Payers, Providers, and Vendors. But physicians would be on the losing end because they are the ones submitting claims. If not submitted accurately, physicians don’t get paid, plain and simple.

Getting Ready for ICD-10 means two things:

• Planning
• Training

Your vendors can only help by providing the right tools to help plan and eventually submit claims but ultimately you are responsible. If claims are not done right, you don’t get paid which means you lose 100%.

A lot has been written about ICD-10, its complications, etc. so I will not harp on it here.

Some simple steps you should take are:

• Start off with your existing superbill.
• Map out the relevant ICD-9 to ICD-10 codes. Your technology partner – EHR/Billing platform should help with that.
• At the very minimum, your biller should be formally trained. I recommend the entire staff, including physicians attend training.
• For a small practice, your Biller or Office Manager should spearhead the transition effort and guide the rest of the staff, coordinate with vendors and clearinghouse.
• Explore possible boosts in overall revenue. Overall, ICD-10 has the potential to boost revenue.
• Testing – work with your technology partner and clearinghouse to send test claims.
• Most importantly, budget for the transition cost including the cost of training so that you don’t get caught with unplanned expenses.

Seth Godin was on the mark in this blog ‘Done to us vs. things we do‘. There are changes that we withstand, that are beyond our control as Seth says, like Malaria, the atomic bomb, the McCarthy hearings, television’s ubiquity, the decay of the industrial base–these are mammoth changes, changes that came from all around us, changes we had to withstand.

Yet, thinking about today and all the changes in just a few short years from the inception of cellular phones to smart phones, from Internet to facebook and from Paper charts to EMR. No one forces us. We think we are forced but we choose to accept most of these.

Sure there are cultural pressures that indirectly force us to accept change because we want social acceptance but that is a different kind of pressure – not a gun held to hour heads.

EMR adoption is going from Carrot to Stick. Initially there was the incentive and now it is shifting to penalty. Most providers somehow think of it as a forced or thrust change rather than a welcome change to improve and get better.

SMD – Slow Me Down – Factor

The fundamental shift in thinking comes because we can’t accept change. The most common statement I hear as a resistance to this change is ‘it slows me down’. The problem is that ‘it’ does not slow you down, the attitude slows you down.

Instead of looking for EMR to help you overcome SMD, think about your current workflow (see my recent article on this here), method of working, and use of various available technologies within and outside of EMR to help you overcome SMD factor.

A good partner – vendor, reseller, or consultant will help you find what works for you and your way of working, your comfort level.

Change is never easy, but as the cliche goes, it is inevitable. In many ways, choice makes change ever more difficult, doesn’t it?

The future isn’t so much about absorbing or tolerating change, it’s about making change.

Connecting Smart Mobile Devices to the EHR | EMR and HIPAA.
A very Hilarious Video. Watch it.

I agree with John – linking to EMR, EHR is probably a bad idea at this time. Providers using any EMR software – web based EMR or Client server EMR are just not ready for it.

Get Your Medical Practice Ready for 2014: Review These Three Areas | Physicians Practice.
Pay particular attention to the third one.

Marketing Plan

Marketing does not necessarily mean only new patient recruitment. It also means keeping your patients happy and informed. It means keeping your patients ‘in the loop’ regarding their health and letting them know about your practice and what’s going on in your practice.

One area that is not mentioned is that of Patient Engagement promulgated by Meaningful Use of EMR. There are new requirements in Meaningful Use II that mandate a certain percentage of your patients use your Patient Portal. Newsletters are an excellent way of creating awareness.

And, of course, happy ‘customers’ spread the word for you and will recommend you to their friends and relatives.

What do you think? Email me/call me.

The healthcare landscape is changing rapidly. We moved from the age of Physicians visiting patients’ homes to corner clinics to group practices to ACOs and Hospitals.
Now what? Is the Small Private Practice a relic of the past? Here is some research:

• Healthcare Reform and the Decline of Physician Private Practice – Whitepaper and survey conducted on behalf of The Physicians Foundation by Merrit Hawkins.
• Collaboration is the key to small practice survival – Medical Economics, July 25, 2013
• Is it R.I.P. for Solo and Small Physician Practices? – The Lund Report, by Paul. R. DeMuro, April 24, 2013
• “The Decline of Solo and Small Medical Practices” – Testimony before the United States House of Representatives

The jury is still out. What is clear however is things are changing and the American ingenuity will reinvent the Small Practice – again.

I should not be surprised when I read an article in FastCompany Magazine of all places, related to a healthcare paradigm shift. I would urge every one of you to read this article.

The Doctor’s Office Of The Future: Coffeeshop, Apple Store, And Fitness Center

Patients – us – are also consumers. As the article says, ‘As Americans try to figure out what changes the Affordable Care Act will bring to their lives and pocketbooks (and politicians continue wrangling over the rollout), here’s one that probably missed everyone’s radar: the new experience that could be waiting for people in their primary care doctor’s waiting room.’

Starbucks became a ‘destination’ rather than just a coffee shop. It became a place for us to relax, congregate, read, whatever we connected with. We know we want to stay healthy, but dread going to the lowly ‘waiting room’ of a doctor’s office. It is dreary, it is downright depressing in most cases.

If my Physician’s office was designed as the Article says, it would certainly become a ‘destination’ for me, it would actually motivate me to stay healthy.

A US Patent application has been filed for a ‘System for Targeting Advertisements based on Patient Electronic Medical Record Data‘.
This is so Wrong on so many levels.

I have written about EMR Data sales in the past as also how some free EMR models work. There are also some downright illegal activities like this one involving Prozac.

This particular Patent application is about ‘a patient specific informational material distribution system, that comprises of at least one repository or informational material items associated with corresponding particular medical conditions and an individual item is associated with at least one medical condition.’

Where is this going?

On one extreme why not allow a doctor to give full access to the practice’s patient database to a pharma company? I can see people saying, this will not happen, there are regulations in place. But, we all know how it starts. One isolated instance, then another and another. People start discussing mainstream, and then it just happens.

As EMR adoption increases, hospitals and academia start focusing on big data in the name of better analysis for greater good. The downside effect is bound to happen. I do expect such things to happen. While people say there is no good system to match offers and demand in healthcare,  with increasing adoption of EMR, it is just a matter of time.

I do not know what the real intent of this patent filing was but at least for now, there are regulatory responsibilities to ensure everything is legal.

Is it certainly something I will be watching with a keen eye in the months/years to come.