The $1.7 trillion healthcare industry has been slow to adopt technology capable of streamlining the medical records process. Though hospitals and HMOs have spent billions of dollars upgrading and consolidating backend systems, the front end interface between physicians, patients and support staff is still largely paper based.
Paper based workflow processes are a source of inefficiency in the medical office that contribute to the overburdened state of clinical staff and introduce potential sources of inaccuracy and error. Medical offices could potentially reduce costs and increase staff availability for additional patient interaction with the implementation of electronic medical records (EMR) systems.
Appropriate use of existing technology can alleviate some of the burden on medical staff, allowing focus to return to patient needs. Moving to digital records management can provide staff with immediate access to charts, history and current treatment. Information updates can quickly replicate to a central repository which can be seen by all those connected to the system. Digitized prescriptions can be sent immediately from a physicians handheld PC to a dispensing pharmacy. Medical information systems can reduce errors and improve input accuracy. Databases that can analyze complex drug interactions may reduce the estimated 7,000 deaths each year caused by medication errors[1].
A cost benefit analysis was performed analyzing impacts per physician in a small office setting. Over a five year period, the total costs to implement EMR would be $112,500 and the anticipated benefit would be $186,390. The present value of these numbers is $109,159 and $157,770 respectively. The ROI over the five year period is 45%. The break even point would be reached in year four.
We cautiously recommend moving towards implementing the technology for a small practice. We suggest the office first take some time to prepare for the implementation and then take a modular approach in implementing EMR. Small steps spread over time will ease users into the changes in work flow process.
[1] Wilson, 2005
Tuesday, April 17, 2007
Problem Statement
Healthcare providers are under increasing pressure to manage costs. The fiscal environment facing the industry is undergoing dramatic change. Insurance companies that once issued blank checks for reimbursement are now moving to fixed payment systems. Managed care providers that dominate the industry in many states, along with Federal programs, are instituting capped expenditure models. Hospitals that could once charge whatever their full costs were and expect total reimbursement are feeling the pinch. In California, two-thirds of hospitals are losing money, bleeding red-ink because of cost over-runs.[1]
Hospitals are slowly coming to the realization that they must institute systems to streamline workflow processes and reduce internal costs in order to price their products and services competitively while maintaining commitment to a quality level of service.
Due to decreasing compensation from insurers and rising costs, medical providers are taking on more patients to raise revenue. At the same time medical insurers and hospital networks are requiring more paperwork for every patient visit and procedure. Over the last 20 years time spent on administrative paperwork has more than doubled for physicians and nursing staff. One-third of physicians report spending over 10 hours each week filling out forms, up from 4 hours in 1980[2].
A healthcare provider’s primary obligation is patient care. Appropriate use of existing technology can alleviate some of the burden on medical staff, allowing focus to return to patient needs. Moving to digital records management can provide staff with immediate access to charts, history and current treatment. Information updates can quickly replicate to a central repository which can be seen by all those connected to the system. Digitized prescriptions can be sent immediately from a physicians handheld PC to a dispensing pharmacy. Medical information systems can reduce errors and improve input accuracy. Databases that can analyze complex drug interactions may reduce the estimated 7,000 deaths each year caused by medication errors[3].
Though far from a panacea for all that troubles the healthcare industry, adoption of electronic medical records systems can provide some solutions to the issues described previously.
[1] Winn, 2002
[2] Wilson, 2005
[3] Wilson, 2005
Hospitals are slowly coming to the realization that they must institute systems to streamline workflow processes and reduce internal costs in order to price their products and services competitively while maintaining commitment to a quality level of service.
Due to decreasing compensation from insurers and rising costs, medical providers are taking on more patients to raise revenue. At the same time medical insurers and hospital networks are requiring more paperwork for every patient visit and procedure. Over the last 20 years time spent on administrative paperwork has more than doubled for physicians and nursing staff. One-third of physicians report spending over 10 hours each week filling out forms, up from 4 hours in 1980[2].
A healthcare provider’s primary obligation is patient care. Appropriate use of existing technology can alleviate some of the burden on medical staff, allowing focus to return to patient needs. Moving to digital records management can provide staff with immediate access to charts, history and current treatment. Information updates can quickly replicate to a central repository which can be seen by all those connected to the system. Digitized prescriptions can be sent immediately from a physicians handheld PC to a dispensing pharmacy. Medical information systems can reduce errors and improve input accuracy. Databases that can analyze complex drug interactions may reduce the estimated 7,000 deaths each year caused by medication errors[3].
Though far from a panacea for all that troubles the healthcare industry, adoption of electronic medical records systems can provide some solutions to the issues described previously.
[1] Winn, 2002
[2] Wilson, 2005
[3] Wilson, 2005
Vendors
- Wide Range of Solution Providers
- Application Service Providers – Web Based
eClinicalHealth; eMed; UniCharts - Traditional Vendors - Client/Server
IBM; Microsoft; Oracle; Xerox; - Government Providers
Vista, VA Developed promoted by Medicare - Open Source
tkFp; OpenLogic; Plone
Key Features
EMR systems, regardless of platform or vendor, share several key features, displayed in the diagram below. At the heart of the system is the digital patient record which holds patient identification information, medical history and serves as the linking element to other modules. Workflow modules provide services previously conducted using paper based files, including scheduling, billing and charting. EMR systems provide staff and patient access to medical information and manage information exchange with external systems like insurance claims, prescription drug databases and other heath institutions. Most systems are modular and allow organizations to add functionality as the group grows, changes needs or becomes more comfortable with the digital solutions.
Implementation
Technology Components for a Small Office. A small office needs to have a means to input patient information in both paper and new digital formats, some way to view and query records and a storage system that includes backup.
Document input devices for inputting existing paper records. Usually a high-end scanner that can handle the large volume of existing records.
Data access devices that staff can use to pull up electronic charts and medical records for viewing. These include desktops, Tablet PCs, notebooks, and handheld computers. Medical office workflow and usability studies show that in deploying an EMR, it is essential to have an access device in every examining room, if not for every staff member. Mobile devices are especially useful for accessing electronic records anywhere.
Printing devices to output patient records and other information. Wireless printers can be easily moved to wherever they are needed.
Server and/or storage devices to store the electronic medical records and/or to run specialized EMR software. Depending on the size of organization, may be necessary to have storage dedicated specifically to storing all electronic records. Not necessary for ASP solutions.
Client/Server Solution Example
· Enterprise Records Management: Xerox-Fujitsu Docushare technology for scanning and content management
· Data Storage: Dell PowerVault Storage Area Network System
· Data Backup: Offsite Data Storage Remote Replication; Onsite RAID 50 Implementation
· Relational Database Management System: Microsoft SQL Server 2005
· Custom Integration: Vendor provided services - Xerox
Application Service Provider Example
· Desktop Client: Citrix Thin Client
· EMR Service: Unicharts Web Based Application
· Integration services provided by EMR vendor
Implementation Steps
1. Determine needs. Conduct a requirements analysis.
2. Select EMR solution based on analysis.
3. Set up the network with devices for scanning, storing, and accessing medical records.
4. Install and configure EMR software.
5. Work with your EMR vendor's protocol for workflow design, training for your people and preparedness of your practice to transition to the new system
6. Begin using EMR system for all new patient and medical records.
7. Begin scanning/digitizing process for legacy records.
Document input devices for inputting existing paper records. Usually a high-end scanner that can handle the large volume of existing records.
Data access devices that staff can use to pull up electronic charts and medical records for viewing. These include desktops, Tablet PCs, notebooks, and handheld computers. Medical office workflow and usability studies show that in deploying an EMR, it is essential to have an access device in every examining room, if not for every staff member. Mobile devices are especially useful for accessing electronic records anywhere.
Printing devices to output patient records and other information. Wireless printers can be easily moved to wherever they are needed.
Server and/or storage devices to store the electronic medical records and/or to run specialized EMR software. Depending on the size of organization, may be necessary to have storage dedicated specifically to storing all electronic records. Not necessary for ASP solutions.
Client/Server Solution Example
· Enterprise Records Management: Xerox-Fujitsu Docushare technology for scanning and content management
· Data Storage: Dell PowerVault Storage Area Network System
· Data Backup: Offsite Data Storage Remote Replication; Onsite RAID 50 Implementation
· Relational Database Management System: Microsoft SQL Server 2005
· Custom Integration: Vendor provided services - Xerox
Application Service Provider Example
· Desktop Client: Citrix Thin Client
· EMR Service: Unicharts Web Based Application
· Integration services provided by EMR vendor
Implementation Steps
1. Determine needs. Conduct a requirements analysis.
2. Select EMR solution based on analysis.
3. Set up the network with devices for scanning, storing, and accessing medical records.
4. Install and configure EMR software.
5. Work with your EMR vendor's protocol for workflow design, training for your people and preparedness of your practice to transition to the new system
6. Begin using EMR system for all new patient and medical records.
7. Begin scanning/digitizing process for legacy records.
Benefits
Why make the move to electronic medical records? Electronic medical record (EMR) systems solve a range of problems faced by small healthcare providers and allow the organization to run more quickly, more accurately, and more efficiently.
- Improved Accuracy eg. Prescriptions
- Efficiency Gains Through Streamlined Digital Workflow
- Reduced Staff Time Spent on Manual Data Entry
- Protect Information. Control Access to Sensitive Info
- Improve Access to Information. Simplify Data Management
- Reduce Costs Associated with Information Transfer
- Centralize Information
Analysis 1
State of Development
In many respects, EMR is in early stages of development, an emerging technology, with respect to real world applications. At the same time, there are many software companies providing solutions for clinics and physician practices. Due to a lack of standards, there is no guarantee that any one of them will be able to support the emerging standards. Also, due to specialized nature of the software, providers are often small and future support is threatened due to the instabilities inherent in small businesses.
Larger companies are geared to providing solutions for larger operations that require sophisticated data storage, customized architecture, and distributed technology. VistA [Hardhats] based solutions seem to be a safe route due to its support by the Veteran's Administration and Medicare. Unlike the majority of players in the EMR market VistA is mature software and has a long track record. At the moment its adoption is somewhat hampered by its use of the little used M programming language and complex installation, though these issues seem to be being addressed. A recent and notable effort is that of Steve Case of AOL fame. He is proposing to revolutionize EMR by providing a Web 2.0 type solution [Clark 2005].
As technology continues to improve and become less expensive it becomes more likely that complete and usable EMR solutions are possible. Wireless networking, portable computers, high resolution displays, and efficient interfaces are near requirements for effective EMR systems. These technologies are becoming easier to use, more secure, and less expensive.
There are an ever growing number of standards that directly and indirectly effect EMR. Currently there are many standards organizations writing standards that compete or overlap with each other [Goedert 2007]. While the situation will improve, this confusing array of requirements makes developing complete and sustainable solutions difficult.
In many respects, EMR is in early stages of development, an emerging technology, with respect to real world applications. At the same time, there are many software companies providing solutions for clinics and physician practices. Due to a lack of standards, there is no guarantee that any one of them will be able to support the emerging standards. Also, due to specialized nature of the software, providers are often small and future support is threatened due to the instabilities inherent in small businesses.
Larger companies are geared to providing solutions for larger operations that require sophisticated data storage, customized architecture, and distributed technology. VistA [Hardhats] based solutions seem to be a safe route due to its support by the Veteran's Administration and Medicare. Unlike the majority of players in the EMR market VistA is mature software and has a long track record. At the moment its adoption is somewhat hampered by its use of the little used M programming language and complex installation, though these issues seem to be being addressed. A recent and notable effort is that of Steve Case of AOL fame. He is proposing to revolutionize EMR by providing a Web 2.0 type solution [Clark 2005].
As technology continues to improve and become less expensive it becomes more likely that complete and usable EMR solutions are possible. Wireless networking, portable computers, high resolution displays, and efficient interfaces are near requirements for effective EMR systems. These technologies are becoming easier to use, more secure, and less expensive.
There are an ever growing number of standards that directly and indirectly effect EMR. Currently there are many standards organizations writing standards that compete or overlap with each other [Goedert 2007]. While the situation will improve, this confusing array of requirements makes developing complete and sustainable solutions difficult.
Analysis 2
Analysis of Application
Limitations. In theory, there are few limitations. Problems such as document storage and retrieval, and data entry and access have good solutions. It is the practical implementation of these solutions in the medical environment that is difficult, especially in larger and extended environments. Providing an electronic medical records solution for a mostly isolated private practice office is difficult and becomes even more so as the scale of the operations and interoperability demands increase.
At a basic level EMR systems must store simple patient information that can be neatly stored in traditional databases. In order to be even slightly practical, they must also be able to manage older paper documents. Further, they need to integrate with various other outside organizations, not least of which are government and private insurance providers. Together with useful human interfaces in complicated work flows, these requirements add complexity to the systems which is difficult to manage.
Interaction and data sharing remains a difficult problem. Standards for information storage and interchange continue to evolve. Until these standards are well developed each vendor may have unique requirements. Supporting each of these magnifies the resources required to develop and maintain these systems.
Risks. Risks for medical organizations include: ability to interact with existing internal and external systems, cooperation from staff who have little buy-in, and geographical distribution.
As an emerging technology, the benefits are poorly characterized, the implementation is usually painful and difficult, and the costs are high. Clinics and physician's offices have been operating for a long time with paper records and have developed efficient work flows within the paper records frame work. These existing paper-based work flows are exercised many times every day and have become ingrained as habits. Digital records require different work flows to which employees may or may not adopt. The digital systems may or may not be able to manage all of the requirements satisfied by the traditional systems. It may be difficult or impossible to work around problems in the digital system, where as work-a-rounds in the paper systems can be implemented in the physical world which we all know how to manipulate.
On top of such issues is the cost of these systems, which tend to be quite high. The bottom line here is: the current systems work, and generally work well; the benefits of digital systems are, at best, going to be realized slowly; and the costs are high.
Not implementing EMR systems also has risks. Government and insurance providers are requiring levels of compliance which, in some cases, are only achievable with EMR systems. Also, a medical organization risks missing out on what may soon become a competitive necessity.
Issues. As alluded to in the Risks section, change management is particularly important in the implementation of digital solutions in the medical field. Health care providers have developed strategies for working as efficiently as possible in existing paper based systems. After all, their main work is supposed to be medicine, not record keeping. Asking them to change their routine, much less, adopt an entirely new way of working, while, at the same time, practicing medicine is asking a lot. Unfortunately, for digital solution providers, this means providing efficient and usable systems that are immediately usable. At the same time, record keeping requirements are a moving target. For various reasons, including liability and insurance reimbursement, physicians are being forced to adopt EMR.
Cultural barriers can be a challenge when implementing EMR. Implementation requires an organization wide commitment. It represents a major cultural change for most medical organizations. This transformation must be the strategy of the entire organization, not just one physician or manager. The system is only valuable if staff is willing to use it. Many organizations that have moved to implement EMR with out preparing staff for the change saw quite of bit of resistance, primarily from physicians. Many of these physicians had been using paper charts and manual processes through out their entire career. EMR implementation has revised their work flow considerably.
When considering implementing EMR it is important to consider how technology savvy the staff is, including everyone from physicians, nurses to administrators. Also an important consideration is how the organization makes decisions. Are the decisions made by one or two people or does a consensus need to be reached? Do the physicians in the group value working closely with the other physicians or are they more individualistic? Will the staff be willing and able to cope with the change?
It is vitally important to thoroughly explain to staff how the implementation will make them more efficient and productive and to sell them on the strategy to transition to EMR.
Privacy is a typical concern that comes up whenever information is centralized and access to a single record could mean access to thousands [Winn 2002]. While security systems continue to improve, such concerns will likely never be entirely eliminated. Electronic record keeping has allowed for solutions that were previously impractical. For example physicians in India can be contracted to analyze medical imagery, and records administration can be performed in China. This remote access to records by outfits working in countries with privacy laws that are different from those in the US and that are subject to changing without consideration of such issues contribute to privacy concerns.
Another issue that comes up when centralizing information is data loss. As with any centralization effort, all access to the centralized resource can be disrupted by a single failure. Fortunately, these issues have been successfully addressed in various other applications. Techniques such as backing up to remote sites and distributed replicated data centers have gone a long way to solving these and related issues.
The lack of uniform and comprehensive standards for the health care IT industry is another significant issue [Winn 2002]. There are a growing number of standards, but they typically cover only specialized areas [Goedert 2007]. HIPAA, Health Insurance Provider and Accountability Act, provides a basis for building unifying records standards and is also a driving force to implement EMR. At this time compliance with HIPAA is the only EMR related practice that is required.
Limitations. In theory, there are few limitations. Problems such as document storage and retrieval, and data entry and access have good solutions. It is the practical implementation of these solutions in the medical environment that is difficult, especially in larger and extended environments. Providing an electronic medical records solution for a mostly isolated private practice office is difficult and becomes even more so as the scale of the operations and interoperability demands increase.
At a basic level EMR systems must store simple patient information that can be neatly stored in traditional databases. In order to be even slightly practical, they must also be able to manage older paper documents. Further, they need to integrate with various other outside organizations, not least of which are government and private insurance providers. Together with useful human interfaces in complicated work flows, these requirements add complexity to the systems which is difficult to manage.
Interaction and data sharing remains a difficult problem. Standards for information storage and interchange continue to evolve. Until these standards are well developed each vendor may have unique requirements. Supporting each of these magnifies the resources required to develop and maintain these systems.
Risks. Risks for medical organizations include: ability to interact with existing internal and external systems, cooperation from staff who have little buy-in, and geographical distribution.
As an emerging technology, the benefits are poorly characterized, the implementation is usually painful and difficult, and the costs are high. Clinics and physician's offices have been operating for a long time with paper records and have developed efficient work flows within the paper records frame work. These existing paper-based work flows are exercised many times every day and have become ingrained as habits. Digital records require different work flows to which employees may or may not adopt. The digital systems may or may not be able to manage all of the requirements satisfied by the traditional systems. It may be difficult or impossible to work around problems in the digital system, where as work-a-rounds in the paper systems can be implemented in the physical world which we all know how to manipulate.
On top of such issues is the cost of these systems, which tend to be quite high. The bottom line here is: the current systems work, and generally work well; the benefits of digital systems are, at best, going to be realized slowly; and the costs are high.
Not implementing EMR systems also has risks. Government and insurance providers are requiring levels of compliance which, in some cases, are only achievable with EMR systems. Also, a medical organization risks missing out on what may soon become a competitive necessity.
Issues. As alluded to in the Risks section, change management is particularly important in the implementation of digital solutions in the medical field. Health care providers have developed strategies for working as efficiently as possible in existing paper based systems. After all, their main work is supposed to be medicine, not record keeping. Asking them to change their routine, much less, adopt an entirely new way of working, while, at the same time, practicing medicine is asking a lot. Unfortunately, for digital solution providers, this means providing efficient and usable systems that are immediately usable. At the same time, record keeping requirements are a moving target. For various reasons, including liability and insurance reimbursement, physicians are being forced to adopt EMR.
Cultural barriers can be a challenge when implementing EMR. Implementation requires an organization wide commitment. It represents a major cultural change for most medical organizations. This transformation must be the strategy of the entire organization, not just one physician or manager. The system is only valuable if staff is willing to use it. Many organizations that have moved to implement EMR with out preparing staff for the change saw quite of bit of resistance, primarily from physicians. Many of these physicians had been using paper charts and manual processes through out their entire career. EMR implementation has revised their work flow considerably.
When considering implementing EMR it is important to consider how technology savvy the staff is, including everyone from physicians, nurses to administrators. Also an important consideration is how the organization makes decisions. Are the decisions made by one or two people or does a consensus need to be reached? Do the physicians in the group value working closely with the other physicians or are they more individualistic? Will the staff be willing and able to cope with the change?
It is vitally important to thoroughly explain to staff how the implementation will make them more efficient and productive and to sell them on the strategy to transition to EMR.
Privacy is a typical concern that comes up whenever information is centralized and access to a single record could mean access to thousands [Winn 2002]. While security systems continue to improve, such concerns will likely never be entirely eliminated. Electronic record keeping has allowed for solutions that were previously impractical. For example physicians in India can be contracted to analyze medical imagery, and records administration can be performed in China. This remote access to records by outfits working in countries with privacy laws that are different from those in the US and that are subject to changing without consideration of such issues contribute to privacy concerns.
Another issue that comes up when centralizing information is data loss. As with any centralization effort, all access to the centralized resource can be disrupted by a single failure. Fortunately, these issues have been successfully addressed in various other applications. Techniques such as backing up to remote sites and distributed replicated data centers have gone a long way to solving these and related issues.
The lack of uniform and comprehensive standards for the health care IT industry is another significant issue [Winn 2002]. There are a growing number of standards, but they typically cover only specialized areas [Goedert 2007]. HIPAA, Health Insurance Provider and Accountability Act, provides a basis for building unifying records standards and is also a driving force to implement EMR. At this time compliance with HIPAA is the only EMR related practice that is required.
Cost Benefit 1
Implementation of an EMR system is tremendous task no matter what the size of your practice, medical group, hospital or HMO. Demonstrating the financial benefit and potential return on investment for EMR implementation is not an exact science. As a manager or administrator, it is difficult to decide to commit hundreds of thousands to millions of dollars, on a project with out a guarantee of a positive return on investment with in a reasonable amount of time. Many of EMR’s benefits are not financial and other can be difficult to quantify. This is one of the primary reasons why EMR implementation has not proliferated beyond 15% of hospitals and medical groups while most in the health care industry are still using paper charts and manual systems and processes.
Depending on the size and scope of an organization, every EMR implementation is going to be different. Costs will vary from installation to installation. Yet, for the cost-benefit analysis several basic assumptions will be made in regards to costs and benefit of the system. Our costs will be based upon a one physician practice, which can be used as a benchmark for multiple physician practices (economies of scale could affect the numbers 10-30%) . This practice sees 30 patients a day. The assistant to physician ratio will be 3 to 1. The office receives 100 phone calls a day for appointments, prescriptions, billing inquiries and other reasons.
Depending on the size and scope of an organization, every EMR implementation is going to be different. Costs will vary from installation to installation. Yet, for the cost-benefit analysis several basic assumptions will be made in regards to costs and benefit of the system. Our costs will be based upon a one physician practice, which can be used as a benchmark for multiple physician practices (economies of scale could affect the numbers 10-30%) . This practice sees 30 patients a day. The assistant to physician ratio will be 3 to 1. The office receives 100 phone calls a day for appointments, prescriptions, billing inquiries and other reasons.
Cost Benefit 2
| Cost -Benefit Single Provider | Initial Costs | Y1 | Y2 | Y3 | Y4 | Y5 | Total |
| Costs | |||||||
| Software Licensing | $10,000 | ||||||
| Implementation @ $100/hr | $3,500 | ||||||
| Network Setup | $1,000 | ||||||
| Hardware | $7,500 | $7,500 | |||||
| Service Contract | $2,000 | $2,000 | $2,000 | $2,000 | $2,000 | $2,000 | |
| Help Desk | $1,000 | $1,000 | $1,000 | $1,000 | $1,000 | $1,000 | |
| Temp Productivity Loss | $20,000 | ||||||
| Scanning Existing Documents | $45,000 | ||||||
| Total Annual, Cost | $90,000 | $3,000 | $3,000 | $3,000 | $10,500 | $3,000 | $112,500 |
| Present Value @ 5% Disc | $109,159 | ||||||
| Benefit | |||||||
| Improved Charge Capture | $7,500 | $15,000 | $15,000 | $15,000 | $15,000 | ||
| Transcription Savings | $1,500 | $3,000 | $3,000 | $3,000 | $3,000 | ||
| Chart Management | $5,625 | $11,250 | $16,875 | $22,500 | |||
| Lab and Radiology Savings | $5,460 | $10,920 | $10,920 | $10,920 | $10,920 | ||
| Total Savings | $14,460 | $34,545 | $40,170 | $45,795 | $51,420 | $186,390 | |
| Present Value @ 5% Disc | $157,770 | ||||||
Cost Benefit 3
Over a five year period, the total costs to implement EMR would be $112,500 and the anticipated benefit would be $186,390. The present value of these numbers is $109,159 and $157,770 respectively. The ROI over the five year period is 45%. The break even point would be reached in year four.
Recommendation
There are still many obstacles to be overcome in regards to EMR systems and implementation. The temptation to wait for newer, better and less expensive software is significant. However, due to our research and cost-benefit analysis, we cautiously recommend moving towards implementing the technology for a small practice. We suggest the office first take some time to prepare for the implementation and then take a modular approach in implementing EMR. Small steps spread over time will ease users into the changes in work flow process. These steps might include starting with transitioning to charting on a tablet PC instead of a paper chart, then accessing previous patient records via computer or tablet PC. Later introduce medication management solutions with radiology and laboratory electronic solutions to follow.
Prior to vendor selection, the office should begin to prepare staff, including physicians for the work flow changes and begin to educate them on the benefits and efficiencies created by EMR. Upon selecting a provider, the practice should look for a solution that can be tailored to the specific needs of the practice. The vendor should provide scalable solutions with user friendly processes. Another consideration is finding a vendor that will be around to service practice once EMR is implemented.
The practice should begin to interview vendors who have many successful implementations under their belt. Ask about the ROI the previous organizations have seen since implementation and ask for contact numbers to follow up with the practices that have experienced the return on investment with EMR to verify their success.
The practice should then begin to budget for the eventual implementation or look into financing options. They should also budget for the loss of revenues during the implementation period when a reduced amount of patients will be taken in order to give staff time to become accustomed to the system.
Prior to vendor selection, the office should begin to prepare staff, including physicians for the work flow changes and begin to educate them on the benefits and efficiencies created by EMR. Upon selecting a provider, the practice should look for a solution that can be tailored to the specific needs of the practice. The vendor should provide scalable solutions with user friendly processes. Another consideration is finding a vendor that will be around to service practice once EMR is implemented.
The practice should begin to interview vendors who have many successful implementations under their belt. Ask about the ROI the previous organizations have seen since implementation and ask for contact numbers to follow up with the practices that have experienced the return on investment with EMR to verify their success.
The practice should then begin to budget for the eventual implementation or look into financing options. They should also budget for the loss of revenues during the implementation period when a reduced amount of patients will be taken in order to give staff time to become accustomed to the system.
Conclusion
The health care industry is currently saddled with much inefficiency and is primed for change. Many believe that EMR is the solution to provide the answer to this problem. At the heart of the EMR revolution is the elimination of antiquated paper based and manual processes and the transition to electronic solutions.
However, the transition to EMR has been challenging, as the technology continues to mature. When a medical practice is approaching an investment decision like EMR implementation, it is important to carefully weigh the costs and risks verses the potential financial gain and determine whether the investment aligns with the business’ mission and objectives. A detailed understanding of the technology, the organization and its culture are necessary. There is no doubt that EMR will eventually become the standard in the health care field. In the mean time, a practice must carefully weigh its options, look internally to identify its needs, make sure the staff are prepared and committed to the transition and select a solution that is a good fit.
However, the transition to EMR has been challenging, as the technology continues to mature. When a medical practice is approaching an investment decision like EMR implementation, it is important to carefully weigh the costs and risks verses the potential financial gain and determine whether the investment aligns with the business’ mission and objectives. A detailed understanding of the technology, the organization and its culture are necessary. There is no doubt that EMR will eventually become the standard in the health care field. In the mean time, a practice must carefully weigh its options, look internally to identify its needs, make sure the staff are prepared and committed to the transition and select a solution that is a good fit.
References
Cliff Dodd (CIO Kaiser) on Transforming Healthcare
http://www.cioleadershipnotes.com/p/kaiser.htm
Clark, Kim, "The Case for Healthcare", _U. S. News & World Report_, 2005 10 09, http://www.usnews.com/usnews/biztech/articles/051017/17case.htm
EMR Open Source http://tkfp.sourceforge.net/links.html
EMRWorld http://www.emrworld.net/emr-vendors/
Goedert, Joseph, "The Evolution of EMR Standards", Health Data Management, 2007 04 17,
http://www.healthdatamanagement.com/html/current/CurrentIssueStory.cfm?articleId=13354
Hardhats http://www.hardhats.org/
How To Buy An EMR http://www.emrexperts.com/emr-ebook/client-server-vs-asp-comparison.php
Kaiser Provides Web Based Document and Content Services Using Xerox Docushare
http://docushare.xerox.com/docs/docushare_kaiser_justintimedocs.pdf
Kaiser Sun and BEA Weblogic partner on Clinical Information Website
http://www.sun.com/third-party/global/bea/success/kaiser.html
Steve Case's Revolution Health Unveils Preview of New Health Care Web Site
http://www.medicalnewstoday.com/medicalnews.php?newsid=61430&nfid=crss
Wilson, Donald, “Growth of Electronic Medical Records”, Physician News, May 2005
http://www.physiciansnews.com/cover/505.html
Winn, David, "EMR Not Just a Question of When But a Question of How", Group Practice Journal, March 2002
http://www.cioleadershipnotes.com/p/kaiser.htm
Clark, Kim, "The Case for Healthcare", _U. S. News & World Report_, 2005 10 09, http://www.usnews.com/usnews/biztech/articles/051017/17case.htm
EMR Open Source http://tkfp.sourceforge.net/links.html
EMRWorld http://www.emrworld.net/emr-vendors/
Goedert, Joseph, "The Evolution of EMR Standards", Health Data Management, 2007 04 17,
http://www.healthdatamanagement.com/html/current/CurrentIssueStory.cfm?articleId=13354
Hardhats http://www.hardhats.org/
How To Buy An EMR http://www.emrexperts.com/emr-ebook/client-server-vs-asp-comparison.php
Kaiser Provides Web Based Document and Content Services Using Xerox Docushare
http://docushare.xerox.com/docs/docushare_kaiser_justintimedocs.pdf
Kaiser Sun and BEA Weblogic partner on Clinical Information Website
http://www.sun.com/third-party/global/bea/success/kaiser.html
Steve Case's Revolution Health Unveils Preview of New Health Care Web Site
http://www.medicalnewstoday.com/medicalnews.php?newsid=61430&nfid=crss
Wilson, Donald, “Growth of Electronic Medical Records”, Physician News, May 2005
http://www.physiciansnews.com/cover/505.html
Winn, David, "EMR Not Just a Question of When But a Question of How", Group Practice Journal, March 2002
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