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Kanagaraj Shanmugam,
Introduction: Electronic Medical record and you:
 The subject of EMRs has captured its share of headlines recently, yet the concept of a paperless practice is 20 years old. Ed Crowell, founder and president of Medformix Ophthalmic, says that his company developed the first paperless office in 1982. At the time, EMR systems didn't gain widespread acceptance among optometrists. But that's all changing. EMR vendors abound these days, each with a unique package of offerings that range from draw programs to instrument interfaces to the tracking of coding. This article will cover some EMR basics as well as provide a buyer's guide for those of you who are serious about adopting this technology and its merits and demerits. What is EMR? EMR refers to the use of software to medical record information in an electronic format. It means that every work corresponding to medical record, which has been done in papers, will be done with the help of computers. EMR Software is being adopted by medical clinics, hospitals and other health organizations Why EMR? Traditional paper medical records have many drawbacks: they can be incomplete, torn, worn, misplaced, or lost. They also require a lot of storage space in addition to requiring extensive administrative time from your staff. Many physicians maintain this system, because the alternative would be to adopt an electronic format, which many physicians are either uncomfortable or unfamiliar with. However, there are many advantages to utilizing an electronic medical record (EMR) for your practice. In adapting to EMR the key is Efficiency, Cost and Time savings. Even if one of these is not satisfied then all the positive aspects of a program will not carry. Increased Efficiency: Improved Documentation: One of the greatest efficiencies comes from eliminating handwriting. A IBM study found that ". . . Poor handwriting is said to contribute to 25% of all prescription-related medical mistakes. Simply computerizing the order-writing process (making the orders more legible) reduced medication errors by 55% at one hospital. ." EMRs provide a consistent, legible and searchable database. Records are easier to organize and alphabetize. You can also append digital exam data (digital photographs, results from visual fields, etc.) to the EMRs. It facilitates to enter Test and lab results, X-rays automatically reducing the risk of data entry errors and missing the information altogether. Health maintenance prompts alert physicians and office staff to missing or required patient information that has not been completed. EMR can improve the accuracy and documentation for coding. This 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. Improved Patient Care& Satisfaction: 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. This also helps to improve the patient satisfaction, since there wont be any incidence of lost documents and forms and also it reduces the waiting time. Quality of Care: EMRs can provide decision support at the point of care, which has been shown to reduce adverse antibiotic reactions by 85%. EMRs can also be used to track patient follow-up activity, patient compliance, and patient progress. Security: EMRs can be configured to restrict access to only portions of the medical record or have multiple levels for office personnel that are restricted based on job function. In addition, in cases where a malpractice suit is filed, you are better defended with an EMR, which automatically documents patient progress and visits with a clearly legible audit trail. Many EMRs have audit trails that identify anyone who has accessed or added to the record. Be sure the EMR you choose has this feature! Enhanced communication increases office efficiency In terms of efficiency, better communications marks an entirely separate area of service 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 call-backs from pharmacies; significantly reducing staff time spent handling those calls. Medication Management EMR ensures accuracy as you select medications from a drug database. Any prescriptions are automatically updated in the patients 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. Cost and Time saving: Cost: Physical Resources Chart materials Physical resources include the costs of buying chart materials and storing paper records. Within the medical records industry it is estimated that the cost associated with maintaining a paper record average $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. 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. This office can be used as examination rooms and for other administrative purpose. Human Resources EMR allows fewer employees to do more. Many EMR offices are able to do more with fewer people. Human resource costs including staff salaries 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 from implementing EMR. Transcription costs (if any) 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 practices physicians continue to use transcription, these costs can still be lowered, because EMR makes in-house transcription much more efficient Time: As we all know time is very crucial and when it comes to health care it becomes more crucial and every patient will be looking for immediate response. EMR plays a vital role in saving your patients valuable time. The time wasted in retrieving, arranging and filing a medical record can be eliminated, and the increased efficiency can be significant. While it is easy to jot down notes on paper, paper records are easy to misplace or misfile, and the recovery process may be long and arduous. EMRs eliminate any paper chase. With EMR, the familiar scenario of staff members frantically searching the office for a particular file is completely eliminated. As of EMRs is that you can quickly search through thousands of records. Some software programs have word recognition, so when you type the first three letters of a patient's name, for example, that patient's file will pop up into view. EMRs facilitate an effective management process because you can run a wealth of reports against the patient database. They're also great if you want a profile of your practice, the relative return/follow up rate, or if you want to pull up a list of patients who have a particular condition. Meeting EMR Challenges There are many good reasons to change from paper records to Electronic Medical records. However, there also are significant challenges involving staff, technology and money in actually selecting and implementing an EMR system. Implementation of an EMR system requires active participation by management, physicians, nurses and clerical staff and each group will have its own viewpoints and opinions that must be reconciled if you are to arrive at a system that best meets everyones needs. Balancing what people want with the resources available is likely to be the biggest challenge youll face. In addition, you should understand that some people who have used paper records to perform their jobs for some time may have a certain level of comfort with those records. In some cases, they may fear that an EMR system will eliminate the need for their jobs. You must address these concerns if you expect to implement an EMR system effectively. So all these can be done if you involve office management, physicians and nurses. Others who may provide valuable input include health information management and information technology personnel, billers and coders, transcriptionists, and clerical staff members. Also identify key people in the organization who can elicit the maximum level of support by championing the cause to colleagues. These people should be technologically savvy, enthusiastic about the project and well respected particularly with regard to physicians. Once you have identified the needs of your organization and staff, you must select the technology that will best meet those needs. For example, what types of devices will the system employ? What types of security procedures will be required? You then will need to find a vendor who can deliver a system that offers those characteristics within your financial capabilities. When selecting a vendor, be sure it is one who will best enable you to meet your clinical, operational and financial goals. A system that doesnt support those goals wont provide all the benefits youre seeking from an EMR system. Finally, you must decide whether you have the resources to proceed with the full implementation, or whether to phase the system in over a period of time. Also, be prepared to spend a significant amount on training, in addition to the cost of technology and IT services. And invest as many resources as possible in training, and develop a method of training that will maximize those resources. It may be most efficient, for instance, for you to train certain key employees and have those employees train others. Or it may be a better use of resources to have a vendor representative on site for the first couple of weeks after implementation. What to watch for There are many EMRs that are flooding the market. So once you have decided to transform your paper record practice to EMR then you will have to take some time to analyse which would best fits your system in practice because EMR is not strictly a numbers game - it's a matter of patient care. It is a function not only of finance, but also of the quality of services provided, such as reduction in medical errors and patient education. To choose the EMR that is best for your practice, consider the following: Know what you need the system to do. Don't pay for the bells and whistles that your practice will never actually use but also look for systems that will expand to meet your needs. Carefully review the technical support and clinical updates the vendor provides. Your vendor should be able to provide training and staff support for your system. If they can't, find another vendor who can. Check that the vendor has experience working with your specialty or similar practice size as well as how existing sites feels about their experience with that vendor. Your EMR should interface with your practice management software. Be sure to consider what new hardware and equipment interfaces you will need to buy and negotiate the service agreements in advance of purchasing the program. Are you ready for implementation? Expecting to have your EMR up and running within a week without having systems in place is not feasible. Whether you are running a networked system for your office or a single install, take the time to assess what you need to do to make your implementation successful. Chances are, the more effort you put into the implementation, the quicker and more effective your implementation will be. 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. After all if you want to enjoy all these benefits of EMR, then intense study and analyses should be done in order to find the appropriate software which meets all your requirements and in training the in house staffs. |