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The Real Problem with ICD-10 Delay or ICD-10 #NoDelay

Posted on December 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, AHIMA put together a really interesting Twitter campaign (they called a Twitter chat, but it wasn’t as much of a chat as a Twitter campaign in my book) where they tweeted about the need for no more delay to ICD-10. You can see what they did by checking out the #nodelay and #ICD10Matters hashtags. They were hitting a number of congressmen really hard. No doubt, their social media people will have seen these messages. We’ll see if that trickles up to the senators and representatives themselves.

On the opposite side is the AMA which is pushing congress for a 2 year delay to ICD-10. Modern Healthcare just published a story that the ICD-10 delay bill was “dead on arrival.” However, that seemed like a link bait headline. When you read the actual story, they suggest that the ICD-10 bill might be dead when it comes to the lame duck session of congress (now through the end of the year). However, it doesn’t address whether congress will choose to incorporate another ICD-10 delay into the SGR fix in 2015 like they did in 2014. That story is still waiting to be played out.

The real problem with all of this is a topic that we’ve discussed over and over here on EMR and EHR. It applied to meaningful use and EHR certification and now it applies just as well to the implementation of ICD-10. No doubt there are proponents and opponents on each side of the ICD-10 debate. Personally, I’ve seen both arguments and I think both sides have an interesting case to make. I don’t think the decision is as clear cut as either sides makes it out to be. If you delay ICD-10 many organizations will be hurt. If you move forward with ICD-10 many organizations will be hurt.

Uncertainty around ICD-10 is the real problem.

What’s worse than going ahead with ICD-10? Uncertainty about whether ICD-10 is going forward or not. What’s worse than delaying ICD-10? Uncertainty about whether ICD-10 is going forward or not. ICD-10 uncertainty is costing healthcare much more than either an ICD-10 delay or a hard and fast ICD-10 go live date.

The US government (yes, that includes all parts of the US government) needs to make a firm decision on whether ICD-10 should be implemented or not. If ICD-10 is going to be the US medical coding future, then we should bite the bullet and implement ICD-10 on schedule. Another delay won’t improve that implementation. If ICD-10 is not of value, then let’s offer some certainty and do away with it completely. Either way, the certainty will be more valuable than our current state of uncertainty.

I’ll admit that I’m not an expert on DC politics. However, I’ve wondered if there’s something the US government could do that would provide this certainty. In 2014, CMS had done everything they could do to provide that certainty. It turns out, they didn’t have the power to make such a promise. Congress undercut them and they got left with egg on their face.

Could Congress pass a bill that would either set the ICD-10 implementation in stone or banish ICD-10 forever? Would that provide healthcare organizations the certainty they need to plan for ICD-10? Or would they just be afraid that the President would do some executive order to delay ICD-10 again? Is there anything that can be done to communicate a clear message on ICD-10’s future?

My gut tells me that if ICD-10 isn’t delayed in the SGR Fix bill next year, then ICD-10 will probably go forward. You’ll notice that probably was the best I could say. Can anyone offer more certainty on the future of ICD-10? I don’t think they can and that’s the problem.

What I do know is that ICD-10 uncertainty is costing healthcare a lot!

Meaningful Use #HITsm Twitter Chat

Posted on October 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I had the honor today to host the #HITsm Twitter chat. For those not familiar with the #HITsm chat, you just join every Friday at Noon ET and watch the tweets that are sent using the #HITsm hashtag. There are usually 4-5 questions that are discussed over the hour chat. Since I was the host, I created the questions this week. I chose to focus the chat on the latest happenings with meaningful use. The transcript of the chat is found here.

I just took a look at the stats for the chat on Symplur and saw that the chat had 68 participants that sent out 474 tweets which had 3,196,079 impressions. You have to be a little careful looking at impressions since that’s potential impressions, but it’s still interesting to consider the possible reach of a chat.

There were some really interesting tweets during the chat, so here are the questions and a few (ok, more than a few since I got carried away) of my favorite tweets: Read more..

EHR Usability: Is There a Right Path?

Posted on December 9, 2013 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The following is a guest post by Carl Bergman from EHR Selector.

Earlier this fall, the AMA sponsored a Rand Corporation study on physician’s professional satisfaction. Based on interviews with physicians in 30 practices, the study covers a variety of topics from workplace setting to quality of care, EHRs and health reform, etc. At the time, the report generated discussion about dissatisfaction in general with EHRs and MU in particular.

Usability, Part of MU?
Overlooked in the discussion was a new and important recommendation on usability. Here’s what is says:

Physicians look forward to future EHRs that will solve current problems of data entry, difficult user interfaces, and information overload. Specific steps to hasten these technological advances are beyond the scope of this report. However, as a general principle, our findings suggest including improved EHR usability as a precondition for federal EHR certification. (Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, p.142) Emphasis added.

It would be overkill to say that this represents adopted AMA policy, however, it’s not overkill to say that the recommendation is part of a project that the AMA initiated and supports. As such, it is most significant that it recognizes the need to bring some coherence to EHR usability and that the MU system is the logical place to put it.

Changing the Vendor – User Relationship
One commentator who did notice the recommendation was EHR Intelligence’s Robert Green. In his review, Green took a different tack. While agreeing that usability needs improvement, he saw a different way to get change:

Usability remains an enigma in many clinic-EHR vendor relationships because it hasn’t been nearly as important in the recent years’ dialogue as “meaningful use.” But among the competing priorities, usability among physicians and their EHR vendor is a real opportunity to develop shared expectations for a new user experience.

As a patient, I would rather not see the delegation of the “usability” dialogue of EHR to those in the roles of meaningful use certification. Instead, physicians who have spent many years of their lives learning how to “take care of patients” could seize the moment to define their own expectations with their EHR vendor of choice within and beyond their practice. (How connected is EHR user satisfaction to vendor choice?) Emphasis added.

I think these two different paths put the question squarely. They agree that usability needs increased action. Users have gotten their message across with alacrity: all systems fail users in some aspect. Some fail catastrophically. Though some vendors take usability to heart, the industry’s response has been uneven and sporadic.

Where these two approaches differ is tactics. Rand looks at usability, and sees an analog to MU functions. It opts for adding usability to MU’s tests. Green sees it as part of the dialogue between user and vendor.

As a project manager and analyst, my heart is with Green. Indeed, helping users find a system that’s a best fit is why we started the Selector.

Marketplace Practicalities
Nevertheless, relying on a physician – vendor dialogue is, at best, limited and at worst unworkable. It won’t work for several reasons:

  • Nature of the Market. There’s not just one EHR market place where vendors contend for user dollars, there are several. The basic divide is between ambulatory and in patient types. In each of these there are many subdivisions depending on practice size and specialty. Though a vendor may place the same product name on its offerings in these areas, their structure, features and target groups differ greatly. What this means is that practices find themselves in small sellers’ markets and that they have little leverage for requesting mods.
  • Resources. Neither vendors nor practices have the resources needed to tailor each installation’s interface and workflow. Asking a vendor, under the best of circumstances, to change their product to suit a particular practice’s interface approach not only would be expensive, but also would create a support nightmare.
  • Cloud Computing. For vendors, putting their product in the cloud has the major advantage of supporting only one, live application. Supporting a variety of versions is something vendors want to avoid. Similarly, users don’t want to hear that a feature is available, but not to them.
  • More Chaos. Having each practice define usability could lead to no agreement on any basics leaving users even worse off. It’s bad enough now. For example as Ross Koppel points out, EHRs record blood pressure in dozens of different ways. Letting a thousand EHRs blossom, as it were, would make matters worse.

ONC as Facilitator Not Developer
If the vendor – buyer relationship won’t work, here’s a way the MU process could work. ONC would use an existing usability protocol and report on compliance.

Reluctance to put ONC in charge of usability standards is understandable. It’s no secret that the MU standards aren’t a hands down hit. All three MU stages have spawned much criticism. The criticism, however, is not that there are standards so much as individual ONC’s standards are too arcane, vague or difficult to meet. ONC doesn’t need to develop what already exists. The National Institutes of Standards and Technology usability protocols were openly developed, drawing from many sources. They are respected and are not seen as captured by any one faction. (See NISTIR 7804. And see EMRandEHR.com, June 14, 2012.)

As I’ve written elsewhere, NIST’s protocols aren’t perfect, but they give vendors and users a solid standard for measuring EHR usability. Using them, ONC could require that each vendor run a series of tests and compare the results to the NIST protocols. The tool to do this, TURF, already exists.

Rather than rate each product’s on a pass – fail basis, ONC would publish each product’s test results. Buyers could rate product against their needs. Vendors whose products tested poorly would have a strong incentive to change.

EHRs make sense in theory. They also need to work in practice, but don’t. The AMA –Rand study is a call for ONC to step up and takes a usability leadership role. Practice needs to match promise.

AmedNews.com and AMA News Magazine Shutting Down

Posted on August 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was sad to read the news that the AMA is shutting down both it’s news magazine and AmedNews.com. I’ve always been fond of the EHR articles I’ve found on AmedNews.com. They were always a great in depth look at an important topic. It’s unfortunate that on Sept 9th AM News will stop publication. Word is that the website is also shutting down, but the content will be available until the end of the year.

The report says that the AMA news magazine has a print circulation of 230,000. I checked Compete.com for stats on the website and it has AmedNews.com at ~30,000 unique visitors per month with spikes to 50,000 unique visitors. The shutdown effects 20 employees and per the article linked above, publishing brought in $55.8 million in revenue.

I’m a little torn by this announcement. I’m always sorry when a news organization goes under. I prefer having many voices covering what’s happening in healthcare and healthcare IT. However, as a blogger in this space, I’m also amazed that a $55.8 million budget isn’t enough to support the organization. Of course, I’m sure I’m not taking into account the crazy expense of creating and distributing a print magazine. It’s too bad the AMA wasn’t able to make the switch from print circulation to some sort of online publication with much lower costs of distribution. Where’s the AmedNews.com app?

The majority of revenue for AM News came from pharmaceutical advertising. The fact that pharma advertising is moving away from these publications is interesting to note. I’m not sure exactly where all the pharma marketing money is headed, but there’s definitely a shift happening with those dollars. My gut tells me that their still in search of the next wave of pharma marketing options.

I also found it interesting that AM News is being replaced by two email lists. One is called AMA Morning Rounds and is a daily email with links to news stories and the other is a weekly newsletter called AMA Wire. I’m not discounting the power of email like many people do, but is this really the best that the AMA can offer its members?

In some ways, I’m sorry to see something that was started 55 years ago in 1958 go away. On the other hand, the evolution of publishing is changing rapidly. The cost to deliver great content to someone is so much lower than before. However, one thing will never change. People want great content. It’s just how we deliver it and how they discover it that will change.

Are Cloud-Based Health Record Banks Better Than HIEs?

Posted on March 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This week a group of researchers published an opinion in the Journal of the American Medical Association suggesting that cloud-based record banks are a better way to share patient health data than HIEs. I think their view is interesting and sensible, and so here’s a short recap.

The authors argue that cloud-based health record banks are a more logical way to share such data than HIEs, reports MedCityNews. After all, as they note, interoperability challenges make it “inefficient” to share patient data, as every organization has to be able to communicate with every other organization where a patient has been treated.

But cloud-based health record banks wouldn’t pose the same challenges, they note.  These record banks would be more scalable and easier for end institutions to use, according to the authors.  Though local providers could keep copies of a patient’s health record, the electronic health record would be stored in a cloud-based bank in the patient’s community, they say.  When patients moved, their records would travel to a different community health data bank.

This approach isn’t just a theoretical discussion. It’s backed by a group called the Health Record Banking Alliance, which was founded by one of the article’s authors, Dr. William Yasnoff, MD, PhD, FACMI, former senior advisor for the National Health Information Infrastructure. The group has developed white papers outlining a proposed architecture and a business model for community health record banking.

My take on all of this is that the cloud-based community health record bank is a very worthwhile idea. After all, in theory it can greatly reduce the amount of infrastructure build out and interoperability issues providers face in connecting to HIEs.

That being said, the HIE concept is firmly planted in the industry’s mind, and despite all of the issues involved in building out HIE networks, I don’t see providers changing gears to embrace a completely new model. What about you?

A Practice’s View of ICD-10

Posted on January 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In our recent article about AMA’s call to Halt ICD-10, we got a really interesting practice perspective on ICD-10 that I thought I’d share. The comments come from Sue Ann Jantz who works at a medical practice. Sue brings up some really interesting points that I think are on the minds of many practices and doctors. The final one about 3rd party payer systems is an important one.

In your recent article
The American Medical Association’s most recent call to halt implementation of ICD-10 codes brings to light an interesting angle to the coding story – one that I hadn’t recognized until I read up on just why the AMA has consistently made it known that the switch is a bad idea.

My two cent’s worth:
See, all of the coding changes are going to fall on the physicians — they won’t be able to pawn it off on anyone else, like a nurse or a coder/biller or an administrator. Remember, they do MEDICINE, not transcription, billing, personnel or business.

This is especially true of docs in large organizations such as hospitals and multispecialty clinics (MSC), who believe they have to do all the extra preventative care things because the government tells them to — not realizing that the incentive payment has some administrator licking their chops. As far as most Admins are concerned, getting the docs to do extra work doesn’t cost the hospital or MSC anything, so, why not?

Add to that the perfect storm that’s brewing: HITECH act —> electronic records and meaningful use (MU), ACA —> ACOs and reconfiguration of alliances, and then ICD-10 —-> total rearrangment of charting/documenting (plus the unknown).

And you are surprised there’s smoke coming out of the AMA’s ears? Personally, I am concerned there will be meltdown in the medical community. As far as most of them are concerned, this is all Obama’s fault, and they are furious and busy telling everyone who comes in that Obama is the devil. Granted, those that blame Obama are the one I’ve heard — so that’s probably a limited group in Kansas.

At a coding seminar recently, the presenter asked how many were going to get out before ICD-10 kicked in. Most of the room of 50 people raised their hands – about 80 percent. Further, they said their physicians were going to retire before that happened as well. ICD-10 is slated to go into effect Oct. 1, 2014. Everyone is supposed to be signed up for health insurance by Dec. 31, 2014, bringing anywhere from 15 million to 30 million people into the health care system looking for a provider.

Do you think this might be a problem?

That said, individually, all three of these things are long overdue. Had each been done when they needed to happen, we wouldn’t be in this fix now. Plus, ICD-10 will go into effect and a few months later, ICD-11 will be implemented everywhere else in the world — some think we should skip to ICD-11 … but we probably have enough on our plates at the moment.

Politically, Sebelius has to get this done before the end of Obama’s term. I hope it doesn’t crash us. I am working on it all as if it’s all going to happen. We are not part of an ACO, we probably won’t get to MU1 even though we are working on it because there isn’t enough money in it, although we did do the Adopt/Implement/Upgrade part of the HITECH act. So, that only leaves ICD-10. and I am working on our templates, those instruments of the devil by Sebelius’ standards. Without templates, we wouldn’t have a prayer.

And none of this addresses the 3rd party payer systems … which will probably crash if the early tests are indicative. That means we will not get paid. So I am stockpiling money for that time now.

Call to Halt ICD-10 Puts New Angle on Demand for Physicians

Posted on January 12, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

The American Medical Association’s most recent call to halt implementation of ICD-10 codes brings to light an interesting angle to the coding story – one that I hadn’t recognized until I read up on just why the AMA has consistently made it known that the switch is a bad idea.

The association believes transitioning to the new, 68,000 codes will place too much of a financial and administrative burden on physicians (especially small practices), and will ultimately force many of them to shut their doors.

Attending education sessions at AHIMA last fall left me with the impression that though learning the new codes and suffering through dual coding wouldn’t be fun, they would ultimately help physicians and hospitals receive proper reimbursement for their services. Yes, there were vendor cheerleaders on many panels, but the logic made sense even to a novice like me.

I realize that physician practices are quite a different kind of beast when it comes to handling administrative tasks, and I can certainly understand how a small practice would feel completely overwhelmed when, as the AMA stated in a letter to CMS, overlapping federal regulations combined with predicted Medicare pay cuts will make switching to ICD-10 a huge difficulty for them.

But I feel as if there’s a catch 22 here. If physicians don’t make the switch, they won’t see the potential financial benefits of more accurate coding. If they do make the switch, they’ll likely face such huge financial strains that they’ll opt to go out of business. Are there any physician readers out there who are cheerleading the ICD-10 switch?

It occurred to me, reading recently about the predicted banner year for physicians seeking hospital employment, that physicians that do decide to close their doors as a result of ICD-10 may contribute to this glut of MDs looking for work.

Perhaps there’s a domino effect waiting to happen – CMS stands firm on the ICD-10 deadline / Physicians work incredibly hard to try and make it happen. / Physicians fail and go out of business, or decide early on that it’s just not worth the trouble and close up shop. / Said physicians seek hospital employment. / There aren’t enough hospital jobs to go around and many MDs are left in the unemployment line.

That’s just one scenario I’ve been mulling over, and of course doesn’t take into consideration the large amount of other challenges facing physicians right now. What’s your take on the ICD-10 and physician staffing situation?

EMR-EHR Safety Watchdog Unlikely To Emerge Soon

Posted on August 13, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Yesterday, we at HealthcareScene.com got a letter from the organization behind EHREvent.org, a patient safety organization allowing people to anonymously report EMR-related safety events, stating that the site was shutting down.  PDR Secure LLC gave little information on the closure, other than to say that it was relinquishing its PSO status.

Curious, John and I took a closer look at the matter. The only other organization which seemed to allow for reporting of EMR-related safety incidents, EHREventS.org (“S” capitalized for clarity), seems to have disappeared since it was first launched late last year.

So while Google searches aren’t perfect, it does appear that at the moment, there’s no official source to which providers, hospitals or other interested parties can report patient safety incidents related to problems with an EMR/EHR.

It’s worth noting that the FDA seems quite concerned about establishing EMR safety regulations. In fact, agency members have been in discussion for years on the topic, spurred by reports of HIT-related malfunctions. “Because these reports are purely voluntary, they may represent only the tip of the iceberg in terms of the HIT-related problems that exist,” Dr. Jeffrey Shuren of the agency’s Center for Devices and Radiological Health told Congress in 2010.

But so far, the agency hasn’t issued any regs. My feeling is that FDA leaders are stalling (prompted in part, I’m guessing from indirect lobbying pressure) on getting such a system started, as it’s definitely going to irritate some very deep-pocketed HIT players out there.

As FierceEMR editor Maria Durben Hirsch noted in an excellent recent column, there’s more than one way the private sector could take up the role of EMR safety watchdog, such as:

*  Creating a one-stop site where users and others can report on their experiences with EMR systems, a step the AMA has apparently considered

*  Launching a new watchdog agency, run by HHS, which would oversee EMR registration, monitor for health IT-related mistakes and investigate adverse event reports.  According to Durben, Congress likes this idea — which was proposed by the Institute of Medicine — but that there’s been no action yet.

Bottom line, it seems that reporting on adverse EMR events is a very unpopular idea in many quarters, or at least a political hot potato.  I suspect someone, perhaps HHS or even the POTUS, is going to have to hammer EMR reporting into place if it’s going to happen anytime soon.

Most Doctors Manually Code Despite EHR Automated Coding

Posted on July 17, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Pamela Lewis Dolan has a great article in AMA’s American Medical news about the automated E&M coding using an EHR versus manual E&M coding. Here’s a quote which sums up the article:

The Dept. of Health and Human Services Office of the National Coordinator for Health Information Technology asked the Office of the Inspector General to prepare a report looking at how Medicare physicians use EHRs to assign and document codes for E&M services. The report found that 57% of Medicare physicians use an EHR, and 90% of them use their systems to document E&M services. But most physicians still assign those codes manually, which could mean they are undercoding services that could qualify for a higher pay rate.

I’ve started seeing more and more people talk about this subject. It’s an amazing switch since one of the initial selling points of EHR software was this powerful E&M engine which would help them to ensure that they’re coding their office visits properly. In fact, many argued that with an EHR they were able to code at much higher levels than they could on paper.

In some ways, I think this can still the case if done right. The rationale is that many times a doctor would evaluate something on a patient, but not take the time to document it in the paper chart. Since they didn’t document it on the paper chart they couldn’t code for it. I’ve heard doctors say that thanks to quality EHR templates they’ve been able to document more of those “extra” items and so they can properly justify the higher code.

Obviously there are a lot of questions and risks associated with what I describe above. The most important being that many achieved the above result by using blanket templates which even included things that they never actually evaluated. There is a lot of talk about these blanket templates being a high risk during an audit.

Although, what I think the above quote highlights is something that I’ve seen regularly in healthcare. Many doctors are chronic under coders. I think this other quote from the article linked above explains why many doctors under code:

“If you do a cost-benefit analysis, it might be less expensive to undercode than try to deal with an investigation,” she said. But Fenton has found that there doesn’t have to be a large increase in coding levels to see a significant bump in revenue.

I’m sure there are many reasons that doctors under code, but this could be the largest one: fear. The fear of an audit uncovering over coding is real and palpable. Plus, an EHR automated E&M coding engine doesn’t solve this problem for a physician. At the end of the day the physician is still responsible for the coding, not the EHR software.

Guest Post: The Case for Modular EHR Over Complete EHR

Posted on November 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Dr. Sullivan is a practicing cardiologist who joined DrFirst in 2004, just after completing his term as President of the Massachusetts Medical Society. He is known throughout the healthcare industry as the father of the Continuity of Care Record (“CCR”) and a leader on the future of healthcare technology. He is assisting DrFirst in ensuring that Rcopia continues to add the functionality necessary to maintain its leadership position both in electronic prescribing and in the channel of communication between various sectors of the healthcare community and the physician. Dr. Sullivan is active in organized medical groups at the state and national level, and is both a delegate to the AMA and the Chairperson of their Council on Medical Service as well as past Co-Chair of the Physicians EHR Consortium.

The buzz surrounding Electronic Health Records (EHR) is nothing short of constant.  The daunting task of selection, purchase and implementation is quite confusing, technical, and expensive, with many physicians, clinics and health systems uncertain of their needs and questioning how the technology is going to impact the way they practice medicine and their bottom line. It’s all about workflow and productivity.

More recently, Providers are faced with the intimidating task of deciding which kind of system to install. There are all inclusive systems, often referred to as fully paperless or standard EHRs and there are so called a la carte systems known as modular EHRs.

The Case for Modular

Modular EHR systems allow providers to take a stepping stone approach to health IT clinical documentation and order writing, by choosing the tools and functions which make the most sense in their practices and clinics; improving specialized workflow and efficiency.  Going the modular route can gradually ease the provider and the office staff into a more paperless environment without having to make a full and often-times difficult transition to a fully paperless workspace.

There is need for caution however. The sheer volume of modules available can make selecting appropriate ones an overwhelming task.  Not only do clinicians need to be wary of which modules they are choosing, but also what functions have been certified by an authorized organization.

By combining specific modular systems, it can become “qualified,” making the user eligible for the monetary reimbursements set forth by Title IV of the American Recovery and Reinvestment Act of 2009 (ARRA).

At DrFirst, our Rcopia-MUTM has taken all of the guess work out of this process and is a completely certified Modular EHR that physicians can implement and start earning incentive money directly out-of-the-box.

The implementation of a complete EHR system can be confusing and time consuming.  Herein lays some distinct advantages of implementing a modular EHR.  Practices that have already implemented e-prescribing or registry modules may not need to relearn a different system, or move their data from one to another (as long as the current module is certified).

Providers who are considering going the modular route can check the certification status of their options at Certified Health IT Products List. The cost for a modular approach is often much less expensive and providers can select the modules from various vendors to meet their financial and practice-based needs.  Upon implementation, providers must show they’re using certified EHR technology in measureable ways to receive their incentive monies from the Federal Government.  With this very high ROI, many providers see the advantage of using the modular approach to postpone the decision process in selecting a complete EHR and yet at the same time earn Meaningful Use incentive money to put towards the cost of  the much more expensive system.

According to the Centers for Medicare and Medicaid Services, doctors who have not adopted an EHR (either modular or complete) by 2015 will be penalized by Medicare — a 1% penalty to begin, then up to 3% within three years. Many providers are banking on the reimbursement that has been made available by the ARRA to help offset the initial costs.

What is your practice considering, complete EHR or modular? Do you see benefits of one over the other?