Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

35. CPOE is important, but every EMR will have it.
I think that the CPOE discussion hit a head for me when I saw the CPOE requirements that were baked into meaningful use. Then, I heard someone from the often lauded (appropriately so) IHC in Utah who said that IHC didn’t have CPOE and it would be hard for them to meet that benchmark. Ok, so I’m more of an ambulatory guy than I am hospital, but this surprised me. In the clinics I’ve helped with EHR, CPOE is one of the first things we implemented. No doubt that every EMR has CPOE capabilities.

34. Make sure adverse drug events reporting is comprehensive
Yes, not all drug to drug, drug to allergy, etc databases are created equal. Not to mention some EHR vendors haven’t actually implemented these features (although, MU is changing that). I’d really love for a doctor and an EMR company to go through and rate the various drug database companies. How comprehensive are they? How good can you integrate them into your EHR? etc etc etc.

33. Make certain drug interactions are easy to manage for the physician
I won’t go into all the details of alert fatigue in detail. Let’s just summarize it this way: You must find the balance between when to alert, what to alert, how to alert and how to ignore the alert. Plus, all of the opposites of when not to alert, what not to alert, and how to not ignore the alert.

32. Ensure integration to other products is possible
Is it possible that you could buy an EMR with no integration? Possibly, but I have yet to see it. At a bare minimum clinics are going to want to have integration with lab software and ePrescribing (pharmacies). That doesn’t include many of the other common interfaces such as integration with practice management systems, hospitals, radiology, etc. How well your EMR handles these integration situations can really impact the enjoyment of your EHR.

31. Ensure information sharing is easy
This tip could definitely be argued, but I believe we’re headed down the road of information sharing. It’s going to still take a while to get to the nirvana of information sharing, but we’ve started down the road and there’s no turning back. Kind of reminds me of Splash Mountain at Disneyland where the rabbit has a sign that says there’s no turning back now. My son didn’t like that sign so much and I’m sure many people won’t like that there’s no turning back on data sharing either. However, it’s going to happen.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

40. Do NOT let the finance department drive the EMR choice or deployment
I’m far too much of a physician advocate to even imagine a finance department driving the EMR choice and deployment plan. Ok, I understand that it happens, but it’s a travesty when it does. Considering the finance department will almost never use the system, it should make sense to everyone to have the users of the system help drive the EMR choice and deployment. After all, they will have to use the system once deployed.

Let’s not confuse what I’m saying. I’m not saying that finance shouldn’t be involved in the EMR choice. I’m not saying that finance can’t provide some great insights and an outside perspective. I also am not saying that users of the EMR should hold the hospital hostage with crazy demands that could never be met. It’s definitely a balance, but focus on the users of the EMR will lead to happy results.

39. Ensure work flow can be hard coded when necessary, and not hard coded when necessary
Related to this EHR tip is understanding when the EHR company has chosen to hard code certain fields or work flows. You’ll be surprised how many EHR have hard coded work flows with no way to change them. In some cases, that’s fine and even beneficial. However, in many other cases, it could really cause you pain in dealing with their hard coded work flows.

Realize which parts of the EHR can be changed/modified and which ones you’re stuck with (at least until the next release..or the next release….or the next release…).

38. You can move to population based medicine
You’re brave to do population based medicine on paper. Computers are great at crunching and displaying the data for this.

37. Safety is created by design
Just because you use an EHR doesn’t mean you don’t need great procedures that ensure safety. Sure, EHRs have some things built in to help with safety, but more often than not it’s a mixture of EHR functionality and design that results in safety. Don’t throw out all your principles of safety when you implement your EHR.

36. Medication Reconciliation should be a simple process
I’m not sure we’ve hit the holy grail of medication reconciliation in an EHR yet, but we’re getting closer. It’s worth the time to make this happen and will likely be required in the future.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

45. Think about ICD-10 compliance sooner than later
ICD-10 goes into effect October 1, 2013. (barring them postponing it again). Can you imagine if you’ve implemented an EHR and then find out that the EHR isn’t ready to support ICD-10? Sure, we’re still a little ways out, but ICD-10 has been on the docket for a long time coming.

44. Make sure your revenue cycle process is as clean as possible
Cleaner processes are easier to implement. Your revenue is going to take a hit when you first implement an EHR in your office just based on the learning curve of EHR. You don’t want to add to the changes by having to change any issues with revenue cycle at the same time.

43. Don’t underestimate the time necessary to be compliant with 5010
This won’t be as bad as ICD-10 for most practices, but you want to be ready for it.

42. Keep transcription in mind
Make sure you have a good understanding of the costs associated with cutting out transcription. Notice that I said costs and not savings. I already know that you’re aware of the savings of cutting transcription. What you might not have taken into account is the costs of ending transcription. If you’re doing voice recognition then you’re going to need the software, a great microphone, and possibly faster/newer computers. If you’re doing voice recognition there will be more manual corrections that you’ll have to do than in transcription. If you’re cutting out all voice input of data, then just be aware that you may hate “all the clicks” and want to go back to transcription in some form. Is your EMR conducive with that change if you decide to go back to transcription?

41. Watch your insurance claim denials
Of course, most clinics are doing this already. However, a whole new set of claim denials will happen because of how your EMR files those claims. You don’t want to miss out on the insurance money because you can’t handle the claim denials in a timely manner.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Everyone probably realizes by now that I love to read first hand experiences with EMR and EHR. I guess I’ve always loved stories and I’ve always loved to tell stories, so maybe that’s where that comes from. I guess this is why I loved Katherine Rourke’s post called “Would An EMR Have Improved My Son’s ED Care?” on the Hospital EMR and EHR website. It’s a great read if you love first hand experiences with EMR as I do.

Katherine does raise a challenging question, “Does an EMR improve patient care?”

In past presentations, I’ve always put the idea of an EMR improving patient care under the “possible EHR benefits.” (See a full list of EMR and EHR Benefits) As many things in life there’s a big “Depends!” that is the b est answer to that question. The answer to this question depends on what kind of care you were offering previously, the type of care you offer, the EMR you chose, the features you chose to employ in that EMR, the match between your workflow and the EMR workflow, and I’m sure another dozen other depends as well.

What’s more important to point out is that an EMR can improve patient care. I certainly can’t guarantee that an EMR will improve patient care in your clinic, but I’ve seen many cases where it has improved patient care and so I know it’s possible. The biggest determining factor in whether an EMR will improve patient care in your clinic is your desire to have it do so.

Many times in life, you get what you want. Do you want an EMR to improve your patient care? Or were you too focused on wanting to get the EHR Incentive money? Not that these and other benefits are mutually exclusive, but the focus of your EHR implementation matters a lot. Make sure you’re focused on the right things and your EMR selection and implementation will go 100 times better. In fact, it will even improve patient care if you want it to.

In celebration of National Health Information Technology Week –  proclaimed by President Obama earlier this week in an effort to “urge all Americans to learn more about the benefits of Health IT by visiting HealthIT.gov, take action to increase adoption and meaningful use of Health IT, and utilize the information Health IT provides to improve the quality, safety, and cost effectiveness of health care in the United States – I’m hitting the road and heading to North Carolina.

Actually, it’s pure coincidence that my annual Fall road trip to Charlotte and Chapel Hill coincides with this newly official week of celebratory activities. (You can view a list of events here.) But it did prompt me to ponder the state of North Carolina’s EMR and overall healthcare IT utilization. My first stop was the HIMSS State HIT Dashboard, a handy resource that provides an overview of all 50 states’ utilization of healthcare IT.

According to HIMSS, as of September, 2011, North Carolina has six Health Information Exchanges (HIEs):

•  NC Healthcare Information and Communications Alliance Inc. (NCHICA)
•  Carolina HIE
•  Coastal Connect
•  Western NC Health Network (WNCHN Data Link)
•  Southern Piedmont Partnership for Public Health (SoPHIE)
•  Sandhills Community Care Network

The state’s regional extension center, which assists the state’s physicians with selecting and implementing EMRs, has at this point recruited 50% of the providers in its target group of 3,500 priority primary care providers, according to the NCHICA website. The NCHICA seems to be the main governing/advisory body over the state’s HIT activities. Its 239 member organizations will converge in just over a week at the Grove Park Inn in Asheville for its annual conference and exhibit. The lineup of sessions looks pretty interesting, especially “So You’ve Decided to Implement an EHR, Now What?” I’m sure conference attendees will have a great time at the Brews Cruise as well.

My next stop was Google, where a quick search yielded the fact that North Carolina, and the Duke Center for Health Informatics in particular, is home to MindLinc, an EMR for behavioral health. It is now the world’s largest codified behavioral health database, and provides information for research and benchmarking purposes.

My last stop was YouTube, where I found an interesting video created by Janet Apter, an RN and member of the faculty at the Duke School of Nursing, for Duke’s Doctor of Nursing Practice Program. Entitled “Electronic Health Record – a Promising Solution,” the video shares the perspective of one nurse/patient’s frustration with a lack of interoperability between facilities in the same health system, and makes a simple case for the need for a nationwide EHR system.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

50. Determine how complete the financial reporting is
Don’t assume they have the reports that you want because they have other doctors using their EHR. Have your practice manager or business person figure out the types of financial reports your office will need to run and make sure that your EHR vendor does them out of the box. If they have develop new reports for you, it either won’t ever get done or is likely to cost you a bunch of money.

49. Take a close look at financing your EHR vs. paying straight cash for it
I’ll leave most of this conversation to your accountant. Plus, the decision is quite different in a hospital vs ambulatory setting. In the ambulatory setting we’re seeing a big shift to purchases that don’t require a huge up front fee and/or a bunch of financing. I think this is a healthy change for the EMR industry and one that more doctors should embrace. Also, get a good lawyer that’s knowledgeable of EMR contracts before you pay too.

48. Plan for a rollout gap
The idea of a rollout gap refers to the loss of productivity which is almost certain to come with the rollout of an EHR. The key is to plan for this loss of productivity. Ask other doctors that have implemented that EMR how long it took them to get back to full productivity However, you can also do things to minimize the loss of productivity by having a well thought out implementation plan and good training.

47. Plan for staffing surges
This suggestion is more apt for a hospital environment. In that case, you’re likely going to need a lot more staff during a go live. in the ambulatory setting, you might have a consultant or two around to help. You’ll also want your IT support somewhere close by, but otherwise you won’t have the same surge of staff as a hospital EMR implementation.

46 Know where your charges flow
Don’t underestimate the change in how charges will be captured and reconciled during an EHR implementation. EHR’s often significantly change your charging process. Much of the workflow planning that I do for an EHR implementation is around entering, collecting and billing the various charges. You’d think it would be easier than it is, but it always seems to be more work than we realize.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

55 Discover how easy it is to interface to the EMR.
One good indication of how easy an EMR system is to interface is to look at how many companies they interface with. Another is to talk with other users of that EMR that have had to have an interface created with said EMR. As I mentioned in a recent comment response, just because they say they “can” or “could” do an interface doesn’t mean that they actually will. Add interface requirements in your contract if they’re needed. Be sure to include the expenses related to the interface in there as well.

54. Make sure to understand the licensing model
There are a lot of ways for an EHR vendor to make you pay. So, be sure you’re aware of all the expenses related to buying and implementing an EHR. Instead of recounting all the possible EHR costs here, I’m just going to link you to my pretty comprehensive list of unexpected EHR costs. Going through that list will help make sure you know what you’re getting into cost wise. You can be sure the EHR salesperson won’t be giving you this list.

53. Does your product handle billing?
Many people love the integrated billing in an EHR. Some can get away without it, but most people I know prefer some billing component as part of the EHR.

52. How is licensing managed?
While related to #54, I see this EHR tip as understanding when and how they’ll charge for licenses. Do you have to buy a whole group of licenses which you may or may not use or can you add licenses later as you grow your practice? As Shawn suggests in this tip, it’s best if you can do “just in time licensing.”

51. Make certain you know what upgrades for license expansions cost
Understand the costs related to expanding into a new line of service. Do you have all the modules you need? What’s the cost to add new modules? Will your server support that new module?

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

How would you respond if someone asks you, what makes a great EMR?

There are plenty of answers that come to mind. However, at a recent conference I attended, I was struck by a simple description a doctor made about a feature he liked in his EMR.

He described how a new patient portal they implemented would ask the patient a bunch of important questions. Then, the output to the doctor would display a list of those questions and responses. However, he loved how the so called “incorrect” answers were in a different color.

I’m sure many of you might be thinking, well isn’t that an obvious feature? Some of you might also be thinking, is John really trying to tell me that this feature is what makes that EMR great? The answer is Yes on both accounts. Although with one caveat.

First, it’s an obvious feature, but there are hundreds and possibly thousands of obvious features that EMR companies haven’t had the time or the foresight to put into their EHR package. Maybe they were working on a legacy EHR where such an obvious feature was difficult to implement, so they put it off. Maybe they were trying to get the software release out the door and so they didn’t take the time to add such an obvious feature. Maybe they just haven’t had “the time” to add it. The point being that there are many “obvious” features that never make it off the development list.

Second, these subtle features are what makes an EMR great. No, not one subtle feature. I’m talking about hundreds of subtle features that are done throughout the entire EMR system. The compilation of many subtle features creates a beautiful symphony of EMR greatness.

How then do you measure hundreds of small but great features in an EMR?

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

60. Reporting, reporting, reporting, reports
What’s the point in collecting the data if you can’t report on it? I’ve before about the types of EMR reports that you can get out of the EMR system. The reports a hospital require will be much more robust than an ambulatory practice. In fact, outside of the basic reports (A/R, Appointments, etc), most ambulatory practices that I know don’t run very many reports. I’d say it’s haphazard report running at best.

Although, I won’t be surprised if the need to report data from your EHR increases over the next couple years. Between the meaningful use reporting requirements and the movement towards ACO’s, you can be sure that being able to have a robust reporting system built into your EHR will become a necessity.

59. Are the meaningful use (MU) guidelines covered by your product?
Assuming you want to show meaningful use, make sure your EHR vendor is certified by an ONC-ATCB. Next, talk to some of their existing users that have attested to meaningful use stage 1. Third, ask them about their approach for handling meaningful use stage 2 and 3. Fourth, evaluate how they’ve implemented some of the meaningful use requirements so you get an idea of how much extra work you’ll have to do beyond your regular documenting to meet meaningful use.

58. It they aren’t CCHIT certified take a really really hard look
Well, it looks like this tip was written pre-ONC-ATCB certifying bodies. Of course, readers of this site and its sister site, EMR and HIPAA, will be aware that CCHIT Has Become Irrelevant. Now it’s worth taking a hard look if the EHR isn’t an ONC-ATCB certified EHR. There are a few cases where it might be ok, but they better have a great reason not to be certified. Not because the EHR certification provides you any more value other than the EHR vendor will likely need that EHR certification to stay relevant in the current EHR market.

57. What billing systems do you interface with?
These days it seems in vogue to have an integrated EMR and PMS (billing system). Either way, it’s really important to evaluate how your EMR is going to integrate with your billing. Plus, there can be tremendous benefits to the tight integration if done right.

56. How much do changes and customizations cost?
In many cases, you can see and plan for the customization that you’ll need as part of the EHR implementation. However, there are also going to be plenty of unexpected customizations that you don’t know about until you’re actually using your EHR (Check out this recent post on Unexpected EHR Expenses). Be sure to have the pricing for such customizations specified in the contract. Plus, as much as possible try to understand how open they are to doing customizations for their customers.

Check out my analysis of all 101 EMR and EHR tips.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

65. Don’t forget LEAN and Six-Sigma
I can’t say I’ve ever heard of someone in the ambulatory EHR market using LEAN or Six-Sigma. Maybe it could apply. I’m not sure since I’ve never done it. So, I can’t really comment on it either way. Although, I’ve heard some people who love both. I’d be interested to hear readers thoughts on this tip.

64. Remember the EMR is not the end-all, be-all of quality
EMR is just an EMR. It’s what you do with your EMR that matters. I always to suggest deciding what you want to accomplish with your EMR before you implement it. Then, you have a measure to select an EMR. Goals when you’re implementing the EMR and measures when you’re evaluating your EMR implementation.

63. Ensure the product has expandability for other service lines
Are you planning to expand? Is there any possibility to expand? Make sure your EMR can expand with you. Switching EHR is terrible.

62. What are the reporting skill sets necessary
Making sure the EMR you select has the reporting you need is a given. Knowing how many people on the planet have the skills needed to run those reports is even more important. It’s never fun to be at the whim of the EMR vendor to get the data that you need.

61. Don’t be afraid of low cost or open source products
Open source EMR has come a long way and is a reasonable option to consider for many. Just be sure to calculate the other costs related to using open source software since you won’t have to pay for the software itself, but you might have to pay for other development, integration and/or support.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.