Thursday, December 1, 2011

Balancing the Scales ~ Selecting the Right EHR for the Life of Your Practice and Your Patients

If we are at or approaching a technological tipping point in the history of healthcare, then it has never been more important for physician practices to select the right electronic health record (EHR) – and there are tangible reasons to believe so.
A recent survey of 400 providers by KLAS found that 35 percent are replacing existing systems, including one third of small practices within that number and 43 percent with 100 physicians or more ("
Ambulatory EMR: Win Rates, Replacements, and Provider Loyalty," Feb. 23).
The industry is regularly updated with financial analyses forecasting growth in the EHR market, such as the June, 2011 report from MarketsandMarkets expecting the U.S. EHR market to reach approximately $6 billion by 2015, up from about $2.2 billion in 2009.
At the same time, patients are increasingly becoming discerning consumers of healthcare and desiring more from technology, meaning they also will be seeking best practices. A recent Dell survey, for example, found 74 percent of patients share the expectation that EHRs should be able to link providers, healthcare institutions, labs and other facilities.
Taken together, as the implementation impact of the meaningful use initiative increasingly becomes evident, it is equally important to approach EHR selection as a starting point or a foundational aspect of long-term business strategy to navigate the future of healthcare and certainly accountable care, payment reform and new payer models yet to come.
So as meaningful use stages progress, PQRS and other quality reporting programs evolve, ICD10, HIPAA 5010 and accountable care take hold, there are foundational criteria for selecting the right EHR solution that can set the right course even before the research begins or an RFP is sent out the door.
At the outset:
• Bring all parties in your practice together into the discussion. Physicians, practice administrators, physician assistants, nurses, medical assistants, billers, schedulers and other staff important to your institution should be heard.
• Assess practice goals that you want to achieve by adopting an EHR:
- Meaningful use incentives capture?
- Improved internal workflows and practice efficiency?
- Improved patient communication, engagement and satisfaction rates?
- The ability to better exchange data with referring physicians and other health facilities?
- The ability to exchange data with immunization registries and public health agencies?
- The ability to participate in clinical trials and research?
- A system that integrates clinical, financial and administrative tasks for operational simplicity?
- A premise-based or hosted solution?
- How best to position the practice for the future of accountable care and reimbursement model variances?
- All of the above?
It’s also important to ask yourself questions before they are asked of you. For example, do you have an equipped, in-house IT staff or do you require increased levels of support by your EHR solution provider? If you are replacing a system as many are, was it due to insufficient technology – the interfacing of legacy EMR and practice management systems, for example – or that the right system for your needs was not fully investigated on the front end during your last purchase?
Once you have an internal game plan underway, it’s time to start the external process:
• Seek site visits and references only from practices where more than 70 percent of care providers use the EHR solution daily.
• And of those EHRs that are in use widely, make sure they are being used at the point of care with patients.
• Seek like practices, specialties and workflows using the solution in the above manner.
• In accordance with specialty considerations, seek a solution’s ability for customization.
• Also during site visits, seek demonstrations where the exact software and version you are considering is in use.
• Usability is extremely important, so ensure you look for a system that can be flexible to your specific workflows.
• Examine the EHR provider’s long-term business plan, ensuring that a five-year or more outlook is in place providing a strategy and vision that is inclusive of your own growth and technological goals.
• Review independent assessments of EHR providers and technology in the areas of training, installation, go-live monitoring and support, service and certification:
- KLAS Research. The above-noted KLAS conducts a range of customer-driven evaluations and awards based on more than two dozen criteria such as sales and contracting, implementation and training, functionality and upgrades, service and support, again as ranked by healthcare providers and administrators.

- Certification Commission for Healthcare Information Technology A long-time independent certification entity in comprehensive and specialty functionality, which also evaluates usability, CCHIT is also a certification entity specific to EHR meaningful use criteria.
- Industry membership organizations such as the Medical Group Management Association ( and the Health Information Management Systems Society ( also provide independent assessments in selection priorities and recommendations.
If the meaningful use incentives program and its provisions for up to $44,000 per eligible provider in the Medicare pathway and up to $63,750 in the Medicaid pathway is a motivating factor, then also begin with some foundational review:
• Assign a meaningful use assessment leader within your practice or facility.
• Make sure the EHRs you are researching are certified for meaningful use Stage 1.
• Use the core and menu criteria from Stage 1 as a checklist for a system’s functionality.
• Ensure that the meaningful use Final Rule data exchange language standards of CCD and CCR data are in place.
• Critically assess the knowledge base of the EHR provider as to future meaningful use readiness for Stages 2 & 3.
• Seek an EHR solution that includes a Meaningful Use Dashboard to easily track allowable and quality measures met.
• Ensure the product you are being demonstrated during the Sales process is the exact, Certified product you will be purchasing and installing.
Keep in mind there is still time to take advantage of the program. You can start quality measure reporting and attestation by Oct. 1, 2012 and still receive maximum incentives in the Medicare pathway, and by 2016 to maintain maximum funding in the Medicaid pathway, if you start the process today. I do not recommend you wait anywhere near that long to implement a Certified EHR because of unforeseen hurdles that occur in life that could cause you to miss your maximum incentive allotment but that timeline is good to know.
And there are tangible reasons to find confidence in the long-term availability of incentives, which are drawn from the Medicare Trust Funds held by the U.S. Treasury, and are therefore not subject to annual Congressional budget appropriations. However, with the debt ceiling debate, and as our wise forefathers and foremothers taught us, gather what is yours today as you never know what tomorrow holds. The EHR adoption incentives are flowing today and they are all front-loaded so you can achieve well up to half or more of the total incentive allotment in just the first two years.

But whatever your motivation for implementing an EHR, the process can and arguably should be time consuming, but does not have to be intimidating. On your side is a wealth of EHR adoptions available for clinical, workflow, usability and ROI outcomes evaluation.
Once you make the right EHR selection for your practice, you will realize returns well beyond the incentives, and will be providing your patients with the most advanced care possible while helping to create a smarter, more sustainable healthcare system in America and globally.
This tipping point is not a tripping point, but by definition a point at which what is previously rare becomes common, and therefore an opportunity to balance the scales of practice and patient needs.
By: Justin Barnes is chairman emeritus of the national Electronic Health Record Association (EHR Association), and is vice president of marketing, industry affairs and government affairs for Greenway Medical Technologies, Inc.

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