The EHR: It's a Hard Road to Implementation, But Well Worth the Trip

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Electronic medical records have been the wave of the future for more than 20 years now. The future is now for many facilities and practices that have implemented the systems and begun to reap the numerous benefits we've all been hearing about: increased efficiency, fewer medical errors and therefore better patient care, better documentation and billing, cost savings, and much more.

With Congress recently authorizing into statute the Office of the National Coordinator of Health Information Technology (ONCHIT) within Health & Human Services and President Bush recently reiterating that electronic records are a national priority, it seems the number of clinicians moving to electronic records will only increase, and quickly. ONCIT's mission - and that of its leader, David Brailer, MD, PhD - includes providing grants to help providers implement technology and the Centers for Medicare and Medicaid Services have been considering financial incentives for the use of electronic records. With more than 100 vendors currently in the market, there's a system to meet almost every provider's needs and budget.

Early adopters reap rewards

Drs. Joel N. Diamond and Bill Fera had a vision to incorporate technology into Deer Lake Medical Association (DLMA), their seven-physician, one nurse-practitioner office, with five locations throughout the Cheswick, Pa., area. Diamond, however, admits it was "a bold step to take at the time." In 2002, "it was not clear that there would be a return on our investment. It was the right thing to do for quality and it turned out to be a financially viable move."

Diamond wanted to move forward with electronic records for several reasons. Having multiple sites became frustrating because some patients started demanding the ability to visit any of the five locations at their convenience. As a result, staff were constantly faxing parts of charts between offices. "It made me realize that if this is a problem locally, imagine patients traveling," Diamond says. "If we couldn't accomplish this on a local level, then the whole idea of portability of medical records on a grander scheme was an absolute nightmare."

Diamond was very involved in his hospital's quality efforts regarding the National Patient Safety Goals established by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Diamond says those goals set the bar "pathetically low. We need to start putting these in practice in a much more standardized way. Doctors want to set the bar much higher but they have no means of utilizing their own data. Once they can start looking at their own outcomes data in a way that means something to them not just arbitrary, we will all start setting the bar much higher."

One scenario that really brought this home was when Diamond put the preventive health maintenance module of his Misys EMR to work. Within a week of turning the module on, Diamond ran out of pneumonia vaccines because so many patients had been overlooked. "And I thought I was doing a good job with that," he admits. "That convinced me of the value of the electronic record as a quality tool."

Diamond also saw the value the system brought to his billing and coding. After implementation, the practice's higher-paying level four evaluation and management coding compared to level three coding almost doubled automatically. The co-morbidities and complications features within the system's software provided them with confidence that the coding rate was accurate. In fact, a payer audit determined that their reimbursement rates were more than accurate, Diamond says.

He also was able to eliminate several full-time employees, primarily those performing billing functions. The doctors were able to choose the right CPT code level and ICD-9-CM diagnosis code for every patient encounter and the information passed through the system efficiently. "We don't need personnel to do that anymore. And, the information going through is clean and we do not get rejected claims."

The improved coding, reduction in staff, and ability to eliminate dictation alone almost paid for the electronic record system. DLMA saved almost $34,000 the first year after implementation. Diamond has since moved on to a three-member practice in one location where he again implemented an electronic records system.

Growth, efficiency for one department

Rockingham Memorial Hospital in Harrisonburg, Va., implemented Picis CareSuite in 2004 to improve the quality and efficiency of patient care