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Small, Solo-Provider Practices Lag in EHR Adoption

By Amanda Guerrero on May 22, 2013 in , , ,

EHR implementation raceAt the beginning of May, the Centers for Medicare and Medicaid Services (CMS) announced that more than half of all eligible healthcare providers had received federal incentive payments for participating in the EHR Incentive Programs and successfully attesting to Meaningful Use. Yet despite these impressive numbers, there is still a large percentage of the healthcare population that’s getting left behind when it comes to EHR adoption and Meaningful Use.

According to a recent study by the Deloitte Center for Health Solutions, only 31 percent of solo practitioners have an EHR system that meets the requirements for Meaningful Use Stage 1, compared to 62 percent of mid-sized practices and 82 percent of larger healthcare facilities.

Of those practices that do not have a Meaningful Use-ready EHR, many say they plan to implement one within the next 12 months (12 percent) or sometime thereafter (23 percent). Meanwhile, 45 percent have no plans to adopt an EHR for Meaningful Use. Not surprisingly, the majority of EHR holdouts are solo practitioners (71 percent).

Among the reasons for not having an EHR system capable of meeting Meaningful Use requirements include, providers cite:

  • Upfront financial investment (72 percent)
  • Additional burden to an already complex delivery process (70 percent)
  • Ongoing maintenance costs (56 percent)

Having to bear the cost alone of implementing an EHR is much more intimidating for solo practitioners than for those who can split the cost among several providers. When an EHR is implemented, however, physician practices tend to see positive results. According to Deloitte’s report, the majority of physicians who have attested to Meaningful Use report better communication and improved care coordination thanks to their EHR, as well as faster and more accurate billing.

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7 OIG Compliance Tips to Protect Your Practice Against the False Claims Act

By Guest Contributor on May 13, 2013 in

Compliance planCreating a compliance plan is probably the most robust way to protect yourself against the overpayment penalties brought about by the Affordable Care Act’s expansion of the False Claims Act. The ACA already requires a wide range of providers to establish compliance and ethics programs if they want to continue in the Medicare and Medicaid programs. The Office of the Inspector General’s (OIG) “Seven Fundamental Elements of an Effective Compliance Program” is an incredible place to start.

These are the seven elements. Let’s look at how they can help you more effectively engage your team.

  • Implement standards and procedures: When establishing a compliance program, it’s essential to accommodate the practice’s unique risks. The key is to not shelf the program – they should be an everyday part of practice operations. The OIG will take note.
  • Designate a compliance officer: This officer must have extensive knowledge of your practice’s operations and should educate other employees, update doctors and correct violations.
  • Train and educate: Compliance education should be provided for every employee, from initial and new employee training to annual ‘update’ courses.
  • Monitor and audit: Periodic chart audits do wonders to ensure your practice’s documentation supports the levels of service billed. Documenting audit results should also be integral to your compliance plan.
  • Respond: Document any problems you’ve identified and take engaging, decisive approaches to correcting them.
  • Open lines of communication: Create an easy process to reporting fraudulent behavior at your practice. These reports should be anonymous on both ends, and communication mechanisms for filing a compliant should be very specifically delineated.
  • Enforcement through discipline: Make public disciplinary standards to your employees and document disobedience. You should be prepared to take disciplinary actions on violators, including reprimands, probation, demotion, suspension and possibly termination.

How Can You Engage Your Staff?

The OIG’s tips to creating a compliance program promotes transparency at your medical practice, which is an obvious plus for keeping lines of communication open among staff members. Using your compliance program is an excellent way to communicate expectations to your staff as well, discussing goals for individual employees and the practice as a whole. Or you can incentivize the most cooperative employees at your practice, perhaps via expanded responsibilities and a possible title change. A compliance program can even help you spot problems you may not have noticed among staff members before, e.g., avoidable miscommunications, dishonesty or clunky work processes.

Have you created a compliance program yet? What do you think of the ACA in general? Share your thoughts in the comments below.

Ahmed Mori is a content writer specializing in Meaningful Use certification, EHRs and mHealth. He enjoys researching and reporting on innovative healthcare technologies. You can read his work on Power Your Practice, where this article was originally published, and the CareCloud blog.

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Three Ways to Minimize the Impact of an EHR

By Amanda Guerrero on May 7, 2013 in , ,

Implementing an EHR for Meaningful Use can affect physicians, staff and patients, but risks can be minimized through careful planning.

3 EMR tipsIt’s not uncommon for an electronic health record (EHR) implementation to be met with some resistance by physicians, staff and even patients. After all, transitioning from a paper-based environment to one reliant on an electronic system for all clinical and administrative data can be daunting. However, converting to an EHR doesn’t have to be a dreaded matter, considering the benefits that doing so can provide.

Healthcare practices looking to go digital to participate in Meaningful Use can try the following three suggestions to ease the transition from paper charting to EHR.

1. Promote change, but make it gradual. One of the biggest mistakes that practices make when it comes to implementing an EHR is assuming that workflow can remain the same. The thing is many of the processes that worked well with paper won’t function efficiently anymore when it comes to a using an EHR. This means that change is unavoidable. The key to getting staff to accept those changes is to be open about them and to explain how workflow modifications will benefit both them and patients. Of course, it is also important that those changes not be sudden and all at once. People need time to get used to new ways of doing things, and rushing them isn’t going to help with staff morale.

2. Ask the people using the EHR for feedback. We mentioned that workflow changes should be gradual – but how do you choose which modifications to take on first? Practice administrators can work with physicians and staff to identify the processes that slow things down the most. Doctors, nurses, and even front desk and billing staff should all be involved in this process, as all aspects of workflow can potentially be affected by the EHR. Once problem areas have been identified, they should be arranged by order of importance so that the most important processes can be tackled first. Taking changes on one step at a time will help people adapt to the EHR more easily and ensure that patient care doesn’t suffer along the way.

3. Educate patients to avoid confusion. One of the biggest benefits that Meaningful Use provides to patients is putting their own health data easily within their reach. Having access to this data can encourage patients take a more active role in their care, possibly improving treatment outcomes and overall health. However, providing so much information to patients can also be overwhelming, especially when it comes to interpreting data from labs and other test results. To avoid confusion, explain to patients what the data means and let them know that you are available to answer questions.

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“The Year of the Great EHR Vendor Switch” – Q&A

By Amanda Guerrero on April 18, 2013 in ,

EHR switchBlack Book Rankings recently pegged 2013 “the Year of the Great EHR Vendor Switch” after 17 percent of surveyed doctors reported wanting to switch their medical record software. To find out what it is exactly that is creating discontent among healthcare professionals using EHRs, I talked to Medical Web Experts National Sales Manager, Ron Shoop.

Ron comes into contact with physicians and practice administrators every day – and many of them share their experiences with him about their EHRs and patient portals. Of those looking to switch vendors, says Ron, early EHR adopters are a majority. When they see how their software systems regularly underperform compared to newer products on the market, the obvious decision is to want to upgrade.

To find out the other reasons Ron says physicians are unhappy with their EHR software and want to switch, read my interview here.

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Why Is EHR Interoperability So Difficult?

By Guest Contributor on April 10, 2013 in ,

EHR interoperabilityIn the health IT world, interoperability between electronic health record (EHR) systems is more popular than Led Zeppelin’s 2007 London reunion concert. It was the focus of discussion at this year’s Healthcare Information and Management Systems Society (HIMSS) Conference in New Orleans, and it is considered the main criteria for Meaningful Use stage 2 attestation.

Interoperability refers to the architecture or standards that make it possible for different EHR systems to exchange information between providers. It allows for better workflows, reduced ambiguity and improves the quality of care by making the right data available at the right time to the right doctor. However, due to a lack of collaboration between suppliers, true EHR interoperability is far from fruition.

Why Is It Important?

Without complete and seamless interoperability, the great promise of electronic health records, meant to enable patients, lead to better coordinated care and lower healthcare costs, will never be achieved. Even if every medical practice in the country were to switch over to an EHR, the uses for patient information would be very limited if it couldn’t be easily accessed by different physicians. This is why the Department of Health and Human Services has made interoperability one of the most important requirements that hospitals and physicians must meet as they prepare their systems for attestation in Meaningful Use Stage 2.

Dr. Farzad Mostashari,  the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, said the agency wants to ensure that, “information follows the patient regardless of geographic, organizational, or vendor boundaries.” At the moment, though, government interoperability criteria still far exceed the capabilities of most providers today.

“I want there to be no question about the seriousness of our intent on this issue. [The] bottom line is it’s what’s right for the patient and it’s what we have to do as a country to get to better healthcare and lower costs,” Dr. Mostashari added.

It’s Complicated

So why is interoperability so difficult? The fragmentation among vendors, for one.

The industry is controlled by a handful of relatively large companies with EHR systems aimed at specialized providers. Some accommodate to large hospital groups while others to small physician practices. By helping the smaller players, interoperability is a direct threat to the larger companies’ business models. There aren’t many businesses that want to facilitate their customer’s ability to look for services at another company.

Large hospital systems and physician practices have their own motives for idling on interoperability as well. Allowing access to all medical records through a health information exchange makes it easier for patients to transfer records and care instructions to other providers.

Government Intervention

Even though the U.S. has already spent more than half the $22.5 billion earmarked for automating medical records, there has been painfully slow progress in creating a manageable, interoperable system that works for patients and doctors. The government could, however, facilitate the process by creating a performance standard for interoperability.

The payment system would be simple: If your system plays well with others, you get paid. Otherwise, you don’t. In an attempt to address the issue, the federally funded Direct Project allows for secure communication of encrypted health data among health care participants over the Internet. Although still in its infancy, this pilot program is gaining traction from providers across the U.S.

If you’re in the market for a new EHR, make sure to ask potential vendors about their interoperability capabilities looking forward. You don’t want to be stuck with a silo system that can’t transfer data and doesn’t help you attest to Meaningful Use Stage 2.

Shopping for a new EHR? Check out these EHR software reviews from other healthcare professionals.

Xavier E. Martinez is a content writer specializing in medical billing, medical coding, denial management, practice management system, revenue cycle management and business analytics. He has a strong background in print journalism and medical collections. Read his work on Power Your Practice, where this article was originally published, and the CareCloud Blog.

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2013: CMS to Focus on EHR Education, MU Stages 1 & 2

By Amanda Guerrero on April 9, 2013 in ,

Meaningful Use thumbs upStage 3 rulemaking will be put on hold this year as the Centers for Medicare and Medicaid Services (CMS) shifts their focus on increasing EHR adoption and educating physicians on Meaningful Use.

CMS Acting Administrator Marilyn Tavenner made this announcement at the annual meeting of the Healthcare Information Management and Systems Society (HIMSS) last month, adding that officials will take the rest of the year to learn more about how physicians are implementing and using electronic health record technology. This is meant to make things easier for physicians as they work to achieve Meaningful Use, but is also meant to help officials figure out what direction to go in with Stage 3 and how to proceed.

Though officials have made it clear that major goals for 2013 include reaching out to smaller practices and increasing educational initiatives related to EHRs and Meaningful Use, other areas of focus for the coming months include:

  • Addressing EHR features that allow physicians to over-bill for services
  • Focusing on healthcare interoperability
  • Promoting the use of Blue Button for patients to download their health records

According to SearchHealthIT, the Department of Health and Human Services (HHS) has also set the following goals:

  • Get 50 percent of physician practices using EHR technology.
  • Ensure that 80 percent of hospitals receive EHR incentive payments by December.

Recent data from CMS shows that 44 percent of hospitals currently have at least a basic EHR and more than 85 percent possess a certified EHR system, meaning HHS’ goal is not far-flung.

How exactly do you think CMS will go about reaching physician practices and educating providers on Meaningful Use?

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Up to 10% of EPs Will Be Subject to Meaningful Use Prepayment Audits

By Amanda Guerrero on April 3, 2013 in , ,

Meaningful Use audits will be conducted on 5 to 10 percent of eligible professionals prior to their EHR incentive payments being doled out.

Meaningful Use auditThe Centers for Medicare & Medicaid Services (CMS) announced that, beginning with Meaningful Use attestations submitted during and after January 2013, eligible providers may be subject to audits before they can receive their EHR incentive bonuses. Most audited physicians are being selected at random, though CMS has noted that physicians who have submitted “suspicious or anomalous attestation data” are also being targeted.

Those selected for an audit will receive a letter in the mail from Figliozzi & Company, the accounting firm chosen by CMS to conduct all Meaningful Use reviews. The letter, which begins, “This…is to inform you that your organization has been selected by the CMS for an audit of your facility’s meaningful use of certified EHR technology for the attestation period,” also includes an information request list. However, physicians are reminded that auditors may request additional information not included in the initial request.

What kind of information is being requested?

In most cases, audited physicians are given a two week deadline to supply requested information either electronically or by mail. Information being requested can vary from physician to physician and may include:

  • Proof that the physician is using a certified EHR system
  • Documentation that proves that, during the reporting period, at least 50% of patient encounters were entered into the EHR
  • Supporting documentation used during the attestation for both Core and Menu Set Objectives/Measures
  • Proof that a security risk analysis of the certified EHR was performed prior to the end of the reporting period
  • Proof that certain features (i.e. drug-drug/drug-allergy interaction checks) were available, enabled and active in the EHR system for the duration of the reporting period

In addition to prepayment audits, CMS will continue to conduct postpayment Meaningful Use audits on another 5 to 10 percent of eligible professionals. These audits are meant to detect fraudulent activity, as well as inaccuracies in eligibility, reporting and payment.

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Four Tips for Carrying Out a Successful EHR Implementation

By Amanda Guerrero on March 21, 2013 in , ,

The success of an IT endeavor hinders greatly on the make-up of the project management team, as well as how the task is planned and carried out.

EHR implementation teamIn the last few years, hospitals, physician practices and other medical facilities have adopted electronic health record software in record numbers. Many of these organizations have struggled with the implementation process, and some continue to face ongoing difficulties with the daily use of their EHRs. According to a report about healthcare IT insights from nonprofit trade association CompTIA, this is due to the fact that few physicians truly understand what implementing an EHR entails; and many implementations are carried out haphazardly.

With the following useful tips, healthcare organizations can ensure successful EHR implementations and a seamless transition from paper charts to EHR:

1. Appoint a responsible project manager. Your project manager doesn’t necessarily have to be an implementation expert. After all, your software vendor will handle most aspects of installation and initial setup. They do, however, need to be organized and responsible, trustworthy, and capable of communicating effectively with the EHR vendor and the rest of the implementation team. The project manager will serve as a liaison between your organization and the software vendor; and they will be responsible for making sure that certain tasks get done.

2. Outline important tasks and set deadlines for each one. Implementing an EHR will require making several changes; but it can be overwhelming for doctors and staff if they are all carried out at the same time. In order to maintain productivity and prevent frustrations, work with your implementation manager and at least one employee from each department to come up with a list of important tasks. Decide which tasks are more of a priority (i.e. scanning paper records into the EHR), and establish a deadline for when each one should be completed.

3. Hold weekly meetings to go over progress made. Once deadlines are established, make time each week to meet with the project manager and important team members about the progress being made on tasks that have approaching deadlines. If team members are having problems accomplishing certain goals, assign someone to help them.

4. Celebrate accomplishments. Implementing an EHR can be as frustrating for staff as it is for doctors and administrators. Therefore, it can be important for morale to celebrate big achievements. For example, buying cake and ice cream to celebrate your “go live” date is a great way to reward employees for their patience and hard work.

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8 considerations for integrating a third-party patient portal with your EHR

By Ron Shoop on March 18, 2013 in , , ,

EHR-patient portal interfaceBeing involved as a Project Manager in 5 mid-tier accounting & electronic health record (EHR) software conversions, I know first-hand the challenges of integrating a patient portal with an EHR. Software integrations, in general, are a very complicated matter; and setting up an interface between two pieces of medical software can be even trickier. One reason for this is that healthcare organizations (HCO) – and even health IT solutions – are unique in so many different aspects, meaning no two EHR-patient portal integrations will be exactly alike. With proper planning and know-how, however, complications can be avoided.

Here are eight factors to consider when planning a patient portal integration to ensure that the process goes exactly as planned:

1. Cost analysis/ROI
Meaningful Use reimbursements under the federal EHR program are one of the main reasons physician practices are considering patient portals. With reimbursements approaching $44,000 (Medicare) and $64,000 (Medicaid), there is certainly enough of an incentive for practices to institute a patient portal. Many physicians who aren’t participating in the EHR Incentive Programs have found reasons of their own for wanting to adopt EHR and patient portal technology – and they are able to justify the investment by conducting a return on investment (ROI) cost analysis. Cost analyses allow physicians to quantify the time and cost savings that they are likely to gain by implementing the software systems. ROIs of 12 to 24 months or less can help justify a decision to move forward with a patient portal and an EHR.

2. Better patient care experience
A better patient care experience can certainly justify the costs of an integration and can help maintain or even attract new patients through the use of a patient portal. Online portals allow patients to have instant access to their health records and even let them schedule their own appointments. This not only benefits patients, but staff as well. Patient portals can help cut down on phone calls, reducing staff workload, and further justifying the investment.

3. Prioritizing feature integration
Costs will vary depending on the extent of the interface and number of features that you want integrated between the EHR and patient portal. Consider prioritizing which features will benefit your practice the most, and start with just those first. An HCO should try to minimize the adverse effects of an EHR-patient portal integration by phasing in prioritized functionalities over a scheduled period of time.

4. Integrating multiple EHRs
Having more than one EHR to integrate into a patient portal will make for a more complicated process, as each integrated data set has to be “mapped” to its proper place within the EHR. Multiple EHR-patient portal interfaces will add additional time and cost to your overall budget, but it’s not impossible. Just remember that it is critical to have an open line of communication between all parties involved. You should also consider, as with feature integration, doing a separate “phase in” for each EHR that you need to interface.

5. Cooperation from the EHR vendor
As many EHR companies have or are developing their own patient portals, they are very reluctant to allow a third party to integrate with their EHR. This is often a major sticking point, and it can delay or even prevent an integration from occurring at all. Many practices in this position have considered switching to another EHR. Though it can bring up additional challenges, it can also result in a positive ROI in a short period of time, in addition to an improved patient experience.

6. Integration fees
Many EHR companies will charge a fee to take part in the development of an interface between their EHR and a third-party patient portal. The EHR company will have to test and ensure that everything is working properly between the portal and the EHR. The patient portal company will typically charge an integration fee as well and will be in charge of building the interface.

7. Project management
Although the patient portal company will typically lead the interface project, it’s important that you assign a Project Manager within your organization to make sure that deadlines are being met and the project meets its objectives. Regardless if the patient portal company’s experience integrating their patient portal with other EHRs, the project will still require coordination by all parties involved.

8. Time
Don’t plan on being able to use a fully integrated EHR and patient portal within a few weeks. Setting expectations and timelines will aid in the process; however, setbacks are inevitable – so plan accordingly. It’s realistic to shoot for a two-month or six-month timeline depending on the size and scope of integration. The larger the practice and the more EHRs, the longer the timeline. Keep in constant communication with each of the parties involved, and make sure the Project Manager guides the process to completion.

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Survey Finds Growing Discontent among EHR Users

By Amanda Guerrero on March 14, 2013 in , ,

Doctor frustrated with EHRThe Meaningful Use program and the quest for incentive payments has led countless practices to implement EHR technology without fully considering the implications of switching from paper to an electronic system. In fact, in the rush to qualify for federal incentives, many physicians are finding that they are not as satisfied with their electronic health record software as they were a few years ago. According to a survey by the American College of Physicians (ACP) and AmericanEHR, 39 percent of physicians would not recommend their EHR to a colleague and 40 percent would not purchase the same system again if given the choice.

Reasons physicians are unhappy with their EHRs:

  • They haven’t fulfilled their promise of increasing productivity.
  • They haven’t succeeded in decreasing workload.
  • They make it difficult to attest to Meaningful Use.

In a press release from the ACP, the head of the organization’s Medical Practice, Professionalism & Quality division stated: “These findings highlight the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability to help reduce inefficient work flows, improve error rates and patient care, and for practices to recognize the importance of ongoing training at all stages of EHR adoption.”

The survey findings fall in line with another recent survey from Black Book Rankings, which found that up to 17 percent of physician practices plan to switch to a different EHR system in 2013. Black Book Rankings even speculated that 2013 could be the “Year of the Great EHR Vendor Switch.”

A major reason for this is that physicians are becoming more knowledgeable when it comes to EHR technology, particularly with regards to the features and functionalities that they need their electronic health record software to have. As users figure out what they want from their software, they become more likely to want to trade up to a different system.

Are you dissatisfied with your EHR? Share your thoughts with us in the comments section.

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