As EMR advisors to many Independent Physicians Associations, nothing is more important to us than the success of our physician clients.

In the ever-changing world of healthcare, we are your advocates, assisting you in the selection, implementation, training, service and support of the technology required for improved patient care and relief of margin compression. We take a holistic approach to assisting your medical practice. In addition, we include change management, work flow analysis, financing, revenue cycle management and more. We are advocates of bilateral performance–success breeds success–failure is not an option.

The difference at HIT is not just our people, our training, our technology or even our solution-based creativity. The difference is our philosophy of leadership that defines our work and the relationships that we build. Your success is our priority!

Medical practices are under extreme pressure to improve quality of care and become more efficient. The challenge is to find and apply technology (automate) that is:

• Sufficiently robust to:

• Achieve meaningful use as determined by regulators
• Allow clinical trials to increase revenue
• Strongly comply with HIPAA to hedge that newly increased liability

• Affordable in view of the practices financial capacity.
• Will qualify for stimulus reimbursement
• Be most applicable to the technology needs of the practice.

Our mantra is “change is good.” We see three factors as critical to the success of an HIT implementation:

• Strong physician leadership,
• Sufficient resources for both physician and staff education, and
• The patience to allow everyone in the practice to overcome the learning curve.

Additional factors are important in the transition to the public:

• Engaging the patients as part of the global solution.
• Working with the patients and us to develop a meaningful patient portal

An enduring axiom about electronic medical record (EMR) implementations remains unchanged: “If no physician champion, then don’t implement”. The physician champion’s role in an EMR implementation is to keenly focus on strategic implementation decisions, education of colleagues on the EMR, process/work flow redesign and on the design, configuration, build and testing of the EMR.

In a recent symposium by Cleveland Clinic, when asked what the greatest problem in implementing and ambulatory EMR, they stated that it was the inability to engage the physician early in the process. This results in a much rougher process in having to redo things which could have been completed properly in the first place with physician involvement.

In our role as advocates we have designed an EMR Readiness Questionnaire/Interview as a tool to engage physician and staff alike so we can work together as a performance driven team to accomplish the common goal. With our support the physician champion can keep everyone in the practice pointed in the same direction and clearly communicate to the entire practice that although increasing efficiency is a major goal in an HIT purchase, at first the practice will have to slow down so that both physicians and staff can gain proficiency in using the software. Then the practice can integrate necessary information from the paper medical record into the electronic system. With our emphasis on training much of the slowdown can be mitigated.

Healthcare Information Technology, LLC (HIT) has contracts in place with banks as well as healthcare specific hedge funds to bring you the financial facilities necessary for a painless move forward into automation. A needs assessment is available to determine exactly what to expect and exactly what will be needed so that there are no surprises or hardships. These resources include but are not limited to standard loans, leases, lines of credit, working capital and more.

Assessing data from paper medical records is time-consuming because it involves reviewing information manually—record by record. By contrast, an EMR makes data easily accessible and enables physicians to use their own data to improve quality of care. With efficient electronic access to clinical data, practices can systematically improve the quality of care in a number of areas:

• Improved access to patient records. EMRs improve access to patient information that is both legible and up-to-date. EMRs can provide the physician electronic access to patient records from remote locations whenever needed.
• Improved diagnostic process. The availability of decision support at the point of service fosters a consistent, evidence-based diagnostic process.
• Quicker turnaround times for results of lab tests and imaging studies. Connectivity between practices and the clinical laboratories and imaging centers shorten the time necessary for diagnostic information to reach the practice and the patient. Physicians can initiate therapy more quickly and reduce patient waiting time.
• Streamlined health maintenance and chronic disease management. EMR systems can generate automated appointment reminders for periodic checkups and for monitoring chronic diseases and conditions. Monitoring patient responses to these reminders enables practices to follow up with patients who need medical attention but are not responding to the practice’s automated messages.
• Protocol-based treatment. EMRs have the capability to incorporate treatment protocols so that physicians can track the care of individual patients within an evidence-based framework.
• Reduced medical errors. Intelligent e-prescribing alerts physicians to problems resulting from drug interactions and allergies. It also can help physicians avoid errors caused by the very large number of prescription drugs that have similar names.
• Improved outcomes. The sum of all these individual parts is process improvement that leads to better outcomes. The incorporation of evidence-based protocols, decision support, and e-prescribing into the EMR gives the physician diagnostic and treatment-relevant information during the patient encounter. The tools for improving practice and self-monitoring are immediately at hand.
• Enhanced patient education materials. Practices can customize information packets and Web site referrals for patients so that patients receive essential information about their health at the point of care and guidance from reputable, scientific sources.

The efficiency benefits of an EMR derive from three changes that occur in practices as they move from paper to electronic records:

• The reduction in expenses associated with the management of paper records.
• Significantly more efficient and accurate coding and billing of claims as a result of template-based documentation.
• Redesign of workflow so that practice staff can become more productive users of the practice’s health information technology (HIT) system.
• Real-time access to a patient records from multiple computers and locations, including remote access beyond the office, without physically retrieving a paper chart.
• Multiple people simultaneously accessing a single patient record from multiple locations, improving work flow in some situations.
• Greater time management freeing the provider to increase revenue generating tasks with the confidence that the front desk and “back office” are running smoothly.

Typically, practices report a $25 savings per chart by eliminating the supply, copying, printing, and storage of paper charts. Transcription costs generally drop by a range of 50 to 100 percent. Staff efficiency is greatly improved because the time-consuming task of physically moving paper charts around the office is eliminated, and the time needed for ordering and tracking lab tests, imaging studies, and prescriptions is greatly reduced. Put simply, the less time the file has to be touched in any cycle, the greater the incremental bottom line revenue for that patient encounter.

EMRs encourage structured documentation. Commonly, EMRs are able to accommodate user-developed templates to capture services that a practice most frequently provides quickly, accurately, and in detail. In turn, the EMR influences the coding process in two ways:

• Because electronic documentation is structured, it captures the Current Procedural Terminology (CPT) criteria that define levels and types of services more accurately than paper records. As a result, it reduces the number of coding disagreements between practices and payers. In practical terms, the increased accuracy of coding equals a shorter revenue cycle, as payers dispute fewer claims. Also, whenever payers do request additional documentation, the practice easily can send the relevant portions of the patient’s EMR.
• As physicians gain confidence in the accuracy of coding developed on the basis of the EMR, they begin using the full range of E&M codes. In particular, many practices have underutilized the higher-level E&M codes out of fear that payer coding profiles would identify them as “outliers”. But with the more solid EMR documentation in hand, physicians are willing to bill based on the accuracy of their records. This can obviously result in increased revenue. One study of a number of family practices that installed HIT systems found that the combination of more accurate coding and additional office visits (due to increased efficiencies) generated an additional $23,000 per physician in annual revenue.
• Your EMR+PM solution should be able to demonstrate a 98% “1st time” pass rate on the revenue cycle.

As practices migrate from paper records to EMRs, change is constant. Everybody in the office, including physicians, will perform a major portion of their day-to-day work differently. Much of the economic benefit of HIT derives from the reorganization of daily tasks, as staff and physicians substitute time-consuming, manual processes for technology. The implementation of HIT combined with a major redesign of workflow can reduce practice expenses. According to the MGMA 2008 Cost Survey, less than one quarter of a practices cost are on operating expenses while 78% are related to staff expenses. This necessitates the proper implementation and use of a fully integrated automated system for the practice to compete in today’s environment.

The incentive payments under ARRA’s Health Information Technology for Economic and Clinical Health (HITECH) Act are available to physicians who demonstrate “meaningful use” of an EMR. On December 30th, the definition was released (568 pages) which we are reviewing and will clarify in later newsletters. The public has 60 days to comment, the committee then has 30 days to review comments and the definition will be adapted in early April. You will have to qualify each year for the specific year’s stimulus payment and can be summarized in the attached chart. Please keep in mind that this is not final and is based solely off of earlier communication of the committee.
In summary: to demonstrate meaningful use, a provider must be able to:

• Use certified EMR technology,
• Engage in e-prescribing (physicians must use an e-prescribing system; computer-generated faxes of prescriptions to pharmacies do not qualify),
• Participate in health information exchange in accordance with law and standards, and
• Produce quality reporting measures according to HHS specifications.

According to ARRA, “certified technology” means that a qualified EMR:

• Includes patient demographic and clinical health information,
• Can provide clinical decision support to physician order entry,
• Has the capacity to capture and query information relevant to health care quality, and
• Exchanges and integrates electronic health information with other sources.

The physician’s EMR must be able to exchange health information to achieve several aspects of meaningful use, including improvement in care coordination. This will be the function of the Regional Extension Centers (REC). These are currently under planning and development. Click here for table.

Under the ARRA of 2009 the government will incentivize or penalize “eligible professionals” (MD, DO, OD, DPM, DMD or DC) for either adopting or not adopting respectively a robust Electronic Medical Record system and using it in conformance with Meaningful Use. Eligible professionals do not include hospital based or long term care physicians. The incentives are stimulus dollars that can be “applied for” in the fall of 2010 after showing six months Meaningful Use with first payments due to begin in the 1st quarter of 2011. The penalties (which apply to Medicare Providers – there are no penalties under Medicaid) will begin in 2015. Click here for charts.

PQRI is a voluntary program that provides financial incentives to physicians who successfully report on a specified set of quality measures for the services that they provide to patients under the Medicare Part B Physician Fee Schedule. In 2009, the incentive increased to two percent (2%). Click for White Paper.

The HITECH Act brings with it expanded privacy and security laws that could significantly affect any practice. Changes have already been set in motion to begin this year (2010) with some beginning later. The application of these new regulations are rigorous and merit a full a understanding. Click for White Paper.

In general, out of the box EMRs have only web based training; the quality of that training is notoriously bad as has been noted in many trade organization articles. After customization, your EMR system will be somewhat foreign to these vendors, which is why we work directly with the developers for a smooth adoption into your workflow to which our team is sensitive. Our team has a keen eye on assuring that the revenue cycle is not interrupted. Our team’s experience counts. The quality of training from the EMR vendors is notoriously bad.  Many articles in trade journals address this issue. After customization, your EMR system will be somewhat foreign to these vendors. They are not sensitive to workflow and the cash dependence of medical practices. Because HIT, LLC has customized your system, we know it. Because of our experience with change management and workflow analysis we work with you to understand your needs. Training will be specific to your practice, your product and your database.

Out of the box, EMR systems are only marginally usable. They are not as immediately useful as vendors claim. All of these systems need some customization prior to full configuration, training, implementation and release to providers.  HIT, LLC understands this, is experienced with customization, and with our ensemble of experts can do it quickly, effectively and efficiently. We understand the need that providers have for custom application and look forward to working with them. As we say in our project dynamics “we can’t direct the wind but we can readily adjust the sails!”

Once all stakeholders are tested and fluent we “Go-Live”.  We do this in phases to coincide with the needs of patient flow as well as cash flow. Return to productivity in a reasonable and acceptable time is critical.  In addition, our typical client receives a healthy return on investment.  Payback is achieved; even with no government funding or additional P4P incentives.

Providers are busy seeing patients. They do not have time to call a help desk if their system is crashing. That is why HIT, LLC creates “Level I” support within every practice site. Each of our client’s practices has its own super-user who can answer simple questions so providers can continue their daily routines without interruption. Super-users can always “bump” a technical problem or system question to us – we are always available and easy to reach. We specialize in providing assistance specific to each of our clients’ customized EMR system. With HIT, LLC there will be no need to wait in long EMR vendor help desk queues only to get non-specific answers to your questions.

Your system and its implementation will be orchestrated where it is updated and maintained automatically. In most cases this will occur in the background, seamlessly and without the user’s awareness.  We provide necessary user acceptance testing, education and training for the upgrades and any other significant changes to the EMR. We continually manage your hosting services to ensure that your EMR and data are safe and available to you whenever you need them.