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EMR Overview
What is an EMR?
Why an EMR?
Features of EMR
Integrated EMR Software
Optimizing your EMR
Types of EMR
Hardware requirements for EMR
 
Tips For Buying An EMR
Implementing an electronic medical record (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved.
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Standards Organizations
ADA for exchanging data processing standards to the dental services of the health care industry...
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Testimonials
Barack Obama: In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging...
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Why an EMR?

For the past several years, Physicians and their staff have been "going paperless" or implementing various forms of electronic medical records (EMR) in increasing numbers.

Changing the workflow in your office is not without risk. From the cost of an EMR system, to the time involved to get up to speed, adopting EMR is a big decision.

On the other hand, the promises of EMR are significant. Indeed, the stated goals of EMR are to reduce your overhead and cut costs while simultaneously increasing your revenues, and all while enhancing patient care.

So, what is the best way to analyze EMR? How do you weigh the risks of changing the way you do business against the possibility of a better bottom line and higher quality care from workflow improvements?

In the following sections, we'll examine the three major objectives of EMR and offer some experience-based analysis of the reasons behind the claims, real-life examples, and the factors affecting your likelihood of success.

 
Objective #1: Reduce Overhead and Improve Efficiency
There are several ways EMR can reduce overhead. The most significant improvements are from savings in both physical and human resources.

Physical Resources

Chart materials
Physical resources include the costs of buying chart materials, copying, and storing paper records. Within the medical records industry it is estimated that the cost associated with maintaining a paper record averages $3 per medical chart and that is the least of the physical factors. In addition to the file folders, there is the paper and printer toner, not to mention the cost per square foot to store filing cabinets.

EMR eliminates medical record storage costs
The physical space required for record storage is usually one of the more significant costs associated with keeping paper files. The cost of office space is always a significant part of overhead, and off-site storage costs must be counted as well. When a physician office does not have to store physical records, office space, normally rented for record storage, can be used for revenue-generating examination rooms and offices. Or the extra square footage doesn't have to be rented at all, thus allowing the same size office staff to fit into a less expensive office.

Human Resources

EMR saves time and increases efficiency
In addition to the physical costs of materials and storage, EMR saves a lot of time. For example, the time wasted searching for charts is eliminated, and the increased efficiency can be significant. With EMR, the familiar scenario of staff members frantically searching the office for a particular chart is completely eliminated.

Time is also wasted by the singularity of paper records, because only one person at a time may physically handle a paper chart. For instance, if a pharmacy calls while the chart is being used, or waiting to be filed, the person taking the call cannot access the information ??in the timeliest, most efficient, manner. With EMR, all appropriate staff members can access the information whenever and wherever they need it—even from home.

Pulling charts, undoing them, copying them, and putting them back together requires both physical resources and time. Some offices also use outside copy services. In EMR-enabled offices, staff members just click and print whenever records are requested.

EMR allows fewer employees to do more

Many EMR offices are able to do more with fewer people. Human resource costs including staff salaries and outsourced transcription expenses are typically a large part of office overhead. Cost savings in this area are often a significant factor in achieving a positive return on investment (ROI) from implementing EMR.

In fact, some offices that rely on staff or outsourced transcriptionist devoted solely to medical records discover a 50% to 75% reduction of medical records expenses after adopting EMR. Where transcription costs typically range from $300 to $1000 per month per physician, savings from EMR can be significant.

Transcription costs can be lowered significantly or eliminated altogether

Indeed, some offices eliminate transcription costs altogether as the Physicians enter all data directly into the EMR system. However, even if some or all of a practice's Physicians continue to use transcription, these costs can still be lowered, because EMR makes in-house transcription much more efficient. For example, documents can even be imported in a fast batch mode. It's also simple to drop Word documents into a chart note or letter, or save a letter that was sent to a patient right in that patient's electronic chart.

Of course, the savings your office could expect depend on the amount you are currently spending on staff dealing with medical records, including outside transcriptions. Even if you do not downsize immediately, you may find as many offices have, that you can grow without increasing the number of staff members. Likewise, as employees leave by attrition they may not need to be replaced.

This increased efficiency, a result of generating the same revenue with fewer salaries and overhead, is a common result of implementing EMR – for both large and small offices. Although the smaller offices must have a minimum number of support staff, on average, EMR-equipped offices simply require fewer full-time employees to support the same number of Physicians. Specifically, practices with an EMR system in place report two to 2.5 full-time employees per physician, compared with an industry average of four.

Enhanced communication increases office efficiency

In terms of efficiency, better communication marks an entirely separate area of office improvement. Medical practices with EMR see a marked reduction in "phone tag" (leaving messages and waiting to hear back, or waiting to look-up the information and calling back) because the charts are always instantly available, and much of the critical messages are handled electronically, without a need to be on the phone at the same time. Additionally, EMR offices have fewer callbacks from pharmacies; significantly reducing staff time spent handling those calls.

The potential areas of cost savings from EMR are summarized below. For many physician practices, the improved efficiency and actual cost savings are more than enough to justify the investment in EMR. From an economic perspective, many doctors find that their bottom line is a net positive in the very first year following an EMR investment.

Physical resource costs

. Cost of materials to create and maintain paper charts
. Storage costs, including extra real estate and other costs eliminated without the need to store physical medical records
. Costs of copying requested medical records

Human Resource Costs

. Full-time employees devoted to medical records
. Pulling, disassembling, reassembling, filing charts
. Time spent looking for charts
. Transcription costs
. Communication inefficiencies, e.g., phone tag
Objective #2: Increased Revenue
Confidence in Coding—EMR decreases lost revenue

EMR can improve the accuracy and documentation for coding. In order to avoid payment disputes due to documentation disputes, many providers and offices are conservative regarding coding. Industry research indicates that inaccurate coding often causes lost revenues ranging from 3% to 15% of a practice's annual revenue. On an annual basis, decreasing this lost revenue percentage can have an enormous impact on the bottom line of any practice.

EMR increases reimbursements because it facilitates complete documentation for every patient visit. With the use of templates and auto-text insertion, Physicians can easily and fully document every note. EMR can help ensure that chart notes are compliant by mapping the templates to the appropriate coding rules.

Increase Services with Health Maintenance Reminders

Adopting an EMR system also provides a powerful tool to help maximize the number of services offered for health maintenance. EMR systems often allow practices to search for all patients who are overdue for recommended services, or who are coming up on their annual check-ups. As a result, offices can send timely reminder letters to ensure better patient care while at the same time increasing service volume and revenue.

Increase Physician Productivity

With EMR, many Physicians are able to see more patients in a day. As a result, practices are able to generate more revenue with the same fixed costs in the same amount of time. Alternatively, many technology-enabled doctors use the additional free time to improve their lifestyle or work-life balance.

Other efficiency improvements(upgrading) improve the quality of life for the doctors using EMR as well. For example, in order to sign paper-based charts, each doctor must be physically present to sign the chart. With EMR, any component can be signed electronically from home or work, with no pulling or filing of charts.
Objective #3: Improve Patient Care
An EMR system can positively impact patient care in several ways. Some advantages involve increased efficiency and higher quality documentation while others involve automated checks and reminders to assist a physician in providing optimum care.

Improve Chart Quality

EMR helps improve chart quality across an entire practice. All notes, documentation and prescriptions are perfectly legible in electronic form. Problems that result from poor handwriting or inconsistencies in documentation are virtually eliminated. And most EMR systems can automatically flag unsigned notes to make sure that all the charts are maintained across all providers in the practice.

Optimize Health Maintenance

Computerized checks and reminders serve to optimize health maintenance because relevant items can be either automatically flagged or even searched across the entire patient database.

In addition, EMR systems give physician offices important information at the time of documentation. For example, diagnosis-specific templates and checklists can guide and remind providers of relevant protocols and tests for certain conditions. Additionally, EMR includes age, sex, and disease-specific health maintenance reminders each time a chart is accessed.

Finally, Physicians find it easier to engage patients more actively using EMR. Graphical representations can aid in-office education while patient handouts can be printed right at the point of care for less cost and delivered to the patient immediately.

Medication Management

EMR ensures accuracy as you select medications from a drug database. Any prescription is automatically updated in the patient's chart note. Some EMR vendors use a drug utilization review feature to screen for potential drug therapy risks and print patient education information. Any potential drug-to-drug or allergic reactions are automatically flagged. In the case of a drug recall, the entire patient database can be searched for all affected patients in a few seconds.

Example: In the Event of a Drug Recall, it's easy to run a report showing all the effected patients
Objective #4: Improve Clinical Decision Making
EMR software is packed with many tools to help doctors make better decisions. These tools range from diagnosis, prescribing medications to treatment plan recommendations. Most EMRs have built in PDR-based medication dictionaries providing doctors with Adverse Drug Event (ADE) alerts, generic drug and dosage recommendations. EMRs also provide decision support to make treatment recommendations based off of a patient's diagnosis. Health maintenance reminders become easy to manage, thanks to EMR's automatic health maintenance reminder systems.

Conclusion

The advantages of EMR provide compelling reasons to consider the switch from paper charts. Decreasing practice expenses while simultaneously increasing revenues has been the real life experience of many Physicians and Practice groups. Likewise, it is possible to simultaneously improve quality of care for patients and quality of life for the Physicians.
 
EMR BENEFITS
 
A) FINANCIAL BENEFITS
Increased Revenues
Avoid lost charges: Electronic Medical Records (EMR) software can increase revenues by capturing charges for all services performed and avoid lost revenues. Using the traditional paper charts, many services performed in a Physician’s Office become lost and never get billed for.

Maximize Billings:
Providers who use advanced Electronic Medical Records (EMR) software can increase revenues by maximizing E&M billing codes that the Electronic Medical Records (EMR) software will suggest based on the service being accurately documented, without the fear of an audit. Using paper charts, to be on the safe side of the law, many Physicians down code (use a lower billing code), rather than proper coding. Medical Economics magazine has estimated that Physicians, who routinely down-code to avoid audits, lose an average of $40,000 annually.

Increase sources of income:
Electronic Medical Records (EMR) software can allow providers to apply for enhanced sources of revenue from various payers associated with higher quality of care, such as DOQ-IT (Doctors’ Office Quality-Information Technology.

Reduced Expenses

Lower labor cost: A typical medical office employs billing and clerical staff such as appointment schedulers, medical billers, collectors, file clerks, etc. While labor costs are soaring, Electronic Medical Records can significantly reduce the labor needed for the functions mentioned above. For example, office staff time will no longer be necessary to hunt down records or file patient charts. Data entry for billing purposes is minimized.

Avoid transcription costs: Many Physicians pay hefty fees for transcription of their medical charts. Electronic charting virtually eliminates transcription costs, since all medical charts are created electronically at the time of patient’s visit.

No more paper charts: Once an office successfully converts to Electronic Medical Records, all costs associated with purchasing, storing or destroying paper charts can be eliminated. Additionally, the space typically used for patient paper charts can be utilized for additional exam rooms, or increased office space, resulting in a more profitable use of resources.

Reduced Malpractice Costs

The cost of malpractice insurance is constantly rising. Healthcare providers may be able to save on their malpractice insurance costs if they are using Electronic Medical Records (EMR) software. Industry sources indicate that certain insurance companies may reduce malpractice premiums as much as 10 percent for use of Electronic Medical Records (EMR) software, due to lower exposure to medical errors.
Increased productivity
Organizations see improved productivity as a result of the many processes that become automated through the use of EMR technology. Tasks like pulling/filing paper charts become replaced by simply clicking a patients name in the EMR system. End-of-day reporting becomes much easier as reports can be generated directly from the EMR system. Lab and imaging results can be placed directly into the EMR, thereby making it easier for users to access. Integration with diagnostic devices enables users to input results/findings directly into the EMR, eliminating the need to manage the many types of forms used in today’s offices. Though it is clear that EMR can make our offices more productive; what we do with this new time doesn’t necessarily translate into financial benefit.
 
Increased revenue
EMR can increase your revenue by providing Physicians with better coding recommendations and the ability to offer new services to patients. E/M level coding assistance can be an incredible financial benefit, especially in Family Practice, Pediatric and Internal Medicine practices. EMR also enables offices to reduce their physical storage space by drastically reducing the amount of paper used for each patient. This can translate into having more office space available for treatment, possibly providing room for an additional associate. Improved insurance re-imbursement as a result of better coding and billing procedures can also increase your revenue. Being in closer touch with patient’s treatment plans and filing documentation at the right time can help maximize reimbursement. This helps the physician run the practice more like a business.
 
Avoidance of costs
EMR can help you reduce the many expenses such as paper charts, poor documentation and high malpractice premiums, but can also create new expenses as a result of support contracts, computer maintenance and product updates. Reducing paper chart costs including purchasing stationary (folders, paper, tabs), copying, management (pulling/filing) and storage (office space, cabinets) are few of the most obvious benefits of EMR. Transcription costs can also be reduced as EMR can provide you with an easier means for patient documentation and report writing. This can be a big savings as many offices spend as much as $1500 per month per provider. When an office becomes busier, they can avoid the cost of hiring new staff by becoming more efficient with the EMR system. EMR Systems can help offices reduce to an even 1 to 1 ratio of assistant to provider. Offices can avoid expensive medications by offering patients more cost effective alternatives. They can help keep malpractice premiums lower as a result of higher quality documentation and drug prescription alerts. A long-term implementation plan and commitment to eliminate paper charts is crucial if cost avoidance benefits are to be realized.
 
Increased profit
In order to increase profit one needs to take into account all these possible benefits and compare them to the new costs that will be incurred as a result of an EMR implementation. Many benefits however, are difficult to quantify such as, improved care, patient satisfaction, and office image. These all contribute to higher profits as a result of increased patient referrals and better patient retention.
B) CLINICAL BENEFITS
Reduced medical Errors
Sophisticated Electronic Medical Records (EMR) software can reduce medical errors in many areas including the following:
  • Misdiagnosis associated with improper documentation, lost medical records, etc.;
  • Treating outside of current clinical guidelines;
  • Medication conflict with allergies, other medications or medical conditions;
  • Illegible handwriting which can result in interpretation errors;
Improved Quality of Care
Using Electronic Medical Records (EMR) software, quality of care could be improved in numerous ways. Consider the following:
  • Electronic Medical Records (EMR) softwares can provide decision support at the point of care;
  • Electronic Medical Records (EMR) softwares can be used to track patient’s follow-up activity, patient’s compliance with provider’s orders, and patient’s progress;
  • Conditional clinical alerts can be set to notify the providers of drug interactions, allergies, latest disease management protocols, etc.,
  • In the event of a drug recall, Electronic Medical Records (EMR) would allow healthcare providers to immediately contact each of their patients who is currently taking the recalled medication;
  • Electronic Medical Records (EMR) facilitates disease management activities by features such as “Outcomes’ Analysis”, which is the analysis of data collected from a group of patients;
  • Electronic Medical Records (EMR) provide better flow of information and enhanced communication with patients, providers and staff, all resulting in improvement in quality of care;
  • Electronic Medical Records (EMR) software improves Physician’s efficiency, so that more quality time can be spent with the patient rather than on paperwork;
Improved Documentation and Accuracy
  • Test and Lab results, ECGs/EKGs, and X-rays can all be entered into an Electronic Medical Records (EMR) software, and become part of the patient’s record, reducing the risk of data entry error and omissions;
  • Electronic Medical Records (EMRs) remove the problem of illegibility of patient notes and prescription as the information is stored electronically;
  • More comprehensive documentation can be provided to referring sources;
Better Access to Medical Information
  • With Electronic Medical Records (EMR) software in place, a clinician can have access to a patient’s file remotely from home, another office, hospital’s emergency room, etc. This improved access to a patient record can be invaluable, especially when the clinician is away from the office or when an emergency access is needed;
  • Around the office, patient information is immediately accessible, which can save every doctor hours per week that would normally have been spent waiting for charts to be delivered;
  • Multiple staff can access the patient chart simultaneously, where paper charts can only be in one place at given time;
  • With an Electronic Medical Records (EMR) software, lost or misplaced charts are a problem of the past;
Enhanced Security
The issue of HIPAA (Health Information Portability and Accountability Act) compliance has become more and more important. Violations can be costly, with penalties running into thousands of dollars. Electronic Medical Record (EMR) software can assist with HIPAA compliance and security concerns as follows:
  • Electronic Medical Record (EMR) softwares can restrict access to specific portions of the medical record;
  • Electronic Medical Record (EMR) softwares can be programmed to have multiple levels of access for office personnel based on job function;
  • Electronic Medical Record (EMR) softwares can have audit trails that identify anyone who has accessed, added to or changed a medical record;
  • Exposure due to charts left inadvertently in accessible areas is minimized;
Increased Time Efficiency
Once clinical workflow is automated, most tasks are done in a fraction of the time previously required. Thus, more patients are rendered better care in less time.
Electronic Medical Records Improve Clinical Decision Making
FACT: Adverse Drug Events (ADE) is responsible for 2.1 million injuries and 100,000 deaths every year, equivalent to two 737s crashing everyday. 4 American Medical Association.

Health maintenance reminders help keep the doctor and his/her staff updated on what treatments or checkups the patient is due for through an automatic alert or report in the EMR. By providing providers with more information about the patient through integration of external sources (labs, pharmacies, imaging centers, hospitals) the provider is capable of making better, educated decisions.
 
EMR Software-an Enhanced Documentation
Through the use of computer network technology Electronic Medical Record Software allows more than one user to access a patient's chart at the same time. This helps ensure a more complete and accurate chart as all the information can be entered in real-time. With the new HIPAA laws, many offices using paper charts are exposing themselves to unnecessary risks, including losing charts, loss of all charts due to natural disasters, theft, etc. Most EMRs come equipped with a security administration module enabling administrators to manage access to patient records through user permissions. One of the greatest advantages to having patient documentation computerized is the ability to manipulate data for reporting capabilities. This becomes very useful for research reports, statistics, health maintenance reminders, drug recalls and patient marketing.
 
Electronic Medical Records Enhance Patient Care
Finally, the benefit of offering better patient care, though difficult to quantify may be the greatest benefit. Many doctors are now taking advantage of the Internet to conduct web consultations. Being able to access patient data from anywhere in the world via a secure connection even allows the doctor to conduct web consultations or generate reports from home. Health maintenance reminders that can be automatically generated from an EMR system also contribute to providing improved patient care.
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