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EHR Certification Bodies – Weno Healthcare To Enter the Fray

Posted on August 31, 2010 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 we got news of the new ONC-ATCB EHR certifying bodies: CCHIT and Drummond Group. However, this is really just the start of the EHR certifying bodies. ONC released that “Applications for additional ONC-ATCBs are also under review.”

One of those possible additional ONC-ATCB EHR certifying bodies is Weno Healthcare. This EMR Daily News guest blog post (Thanks Michelle for pointing it out) asserts that Weno Healthcare has submitted their application to be an ONC-ATCB EHR Certifying body. They also offer this interesting insight:

Until recently, only one body was promoted to do this testing and certification. Because of no competition, their prices were out of the ballpark for smaller technology companies who may have built the better and cheaper mouse trap for doctors and hospitals, but could not afford the fees for certification. The technology companies that certified their products earlier are not considered certified by the new rules today, so all technology vendors must go through an ONC-ATCB in order to be re-tested and certified, if they choose to do so.

If Weno is approved as an ONC-ATCB, more technology vendors can afford the testing and certification fees. Weno savings can be as much as $19,000 for complete EHRs. These savings will certainly provide physicians and hospitals with more cost effective certified technology options to choose from. Again, competition is a good thing because it brings prices down and quality up.

Comparing the Weno Healthcare EHR certification price above with the CCHIT and Drummond Group EHR Certification prices, it’s going to be really interesting. That puts the costs of EHR certification (not counting software development costs) at:
Weno Healthcare: $14,000-18,000
Drummond Group: $19,500
CCHIT: $33,000

Of course, this assumes that Weno Healthcare becomes an ONC-ATCB and that the prices don’t change. I won’t be surprised if they do change. Plus, there could be other EHR certifying bodies.

Documentation Requirements are the Enemy of EMR

Posted on August 30, 2010 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

After 5 successful years with electronic medical records (EMR) I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real.  If that is true, why is adoption of EMR currently limited to only 5 – 10% of medical practices?  Why is there so much resistance?  As folks who work in heath care IT so often ask, why don’t doctors “get it?”  I don’t mind the question but I do object to some of the sinister explanations that are offered.  Physician resistance to EMR is legitimate.  This post will explore one of the reasons for doctor resistance to EMR.
A few years ago one of our best referring physicians came to see me as a patient.  After we took care of his medical issues, I asked him how he liked our new EMR and the notes we were sending him through it.  His answer floored me: “I hate it.”  That is NOT what you want to hear from one of your best referring physicians.  After a moment of drop-dead silence he added, “nothing personal.  I hate all the EMRs out there, including the one our practice just bought.”
He went on:  “Notes that come from an EMR have so much extra stuffing in them that it takes me forever to figure out what you guys really had to say about the patient I referred to you.  I have to wade through lines and lines of empty verbage to finally find a meaningful sentence or two that tells me what I need to know.  Our own EMR notes are no better.  But there’s nothing we can do about it, we just have to accept it.”
Except for that last part, he is absolutely right.  Why did things get so bad?  
Doctors used to document their work with concise handwritten notes.  (See my last blog).   Then came CPT codes, which brought elaborate documentation requirements that medical records must fulfill in order to receive payment from the insurance provider.  These requirements measure the documentation, not the care itself.   Fear of documentation errors often force providers to code and bill at a lower level than their work truly deserves.  Physician revenues are thus limited not by the amount of real work performed, but by the sheer number of words one must write to properly document that work.  As long as chart notes had to be handwritten or manually dictated and transcribed, CPT effectively limited physician billing.  Providers became as much servants to documentation as they were caregivers.
This situation inspired the first marketing efforts by EMR vendors to physicians.  Recognizing the need, vendors promised improved, automated documentation and monitoring of charts for CPT compliance.  Doctors could finally bill safely at the appropriate CPT level.  With just a few mouse clicks the chart note can fulfill all the requirements to be CPT-compliant.  Now the physician can concentrate on the patient again.  In my experience this has worked well. 
But sometimes it’s the side effects that kill.
EMR shows us what fully CPT-compliant documentation looks like. And it’s awful. The folly of carrying CPT documentation requirements into the information age has been exposed. The relevant data are buried in a sea of white noise – patient demographics, irrelevant historical data, normal physical findings, and diagnosis / billing codes.  Each mouse click generates a bland, repetitive phrase in order to hit a CPT-mandated “bullet point.”  The result is a multipage, single-spaced, small font monster of a chart note with very little substance relative to its size.   This obsession with documentation is distracting both EMR vendors and users from pursuing the real benefits of EMR – automation of workflow, rapid data exchange, reduced costs and improved efficiency.
Want a real incentive for docs to get EMR?  Forget HITECH.  Few doctors I know believe those incentive payments will ever happen.  All but the largest practices and major institutions will be defeated by “meaningful use” criteria.  Instead offer EMR users freedom from CPT documentation requirements.  Replace CPT with a system that is appropriate for the information age.  Leverage the power of EMR and create a system that rewards quality of care rather than volume of documentation. 
Easier said than done.  But recognizing the problem is the first step.
Thanks for reading.
MK

Meaningful Use Resource

Posted on 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.

There are a TON of meaningful use resources for those physicians and clinics interested in showing meaningful use of an EMR in order to get the EMR stimulus money. Here’s one such resource that I thought gave a nice summary of what’s required. Here’s a small sample of the content they offer about meaningful use:

Core Set Measures

  • Use CPOE (Computerized Physician Order Entry) to order medications for more than 30% of all unique patients with at least one medication in their medication list.
  • Enable drug-drug and drug-allergy interaction check functionality on the EHR for the entire reporting period.*
  • Maintain an up-to-date problem list of current diagnoses for 80% of all patients. If there are no problems, indicate no problems are known.
  • Maintain an up-to-date list of active medications for 80% of all patients.
  • Maintain an up-to-date problem list of medication allergies for 80% of all patients.
  • Generate and transmit prescriptions electronically for 40% of prescriptions written by the provider.
  • Record demographics for at least 50% of patients.*
  • Record and chart changes in vital signs for at least 50% of patients.*
  • Record smoking status for 50% of patients 13 and older.*
  • Report ambulatory clinical quality measures to CMS.*
  • Implement one clinical decision support rule relevant to the provider’s specialty.
  • Provide at least 50% of patients with an electronic copy of their health information, upon request, within 3 business days.*
  • Provide at least 50% of patients with clinical summaries of their office visit within 3 business days.*
  • Perform at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information.*
  • For the EHR and its related IT network, conduct a security risk analysis and implement security updates as necessary; correct security deficiencies.*

Menu Set Measures

  • Enable drug-formulary checking functionality and have access to a formulary for the EHR reporting period.*
  • Incorporate clinical lab-test results into the EHR as structured data for at least 40% of all lab test results.*
  • Generate at least one report listing patients with a specific condition.*
  • Send reminders to 20% of all patients, 65 years or older, per patient preference for follow-up care.*
  • Provide at least 10% of all unique patients timely access to health information within 4 business days of the information being available to the provider.*
  • Provide patient-specific education resources to at least 10% of all unique patients.*
  • Perform medication reconciliation at least 50% of the time for patients transitioned from another setting of care.
  • Provide a summary care record for at least 50% of patients for patients being transitioned to another setting of care.
  • Perform at least one test of the certified EHR’s capability to submit electronic data to immunization registries.*
  • Perform at least one test of the certified EHR’s capability to submit syndromic surveillance data to public health agencies.*

*These functions may be performed by nursing, administrative or IT staff

It is expected that EHR vendors will provide the capability to generate much of the above mentioned information within their software and they will also assist physicians in conducting data exchange testing.

8 Pictures That Tell an Interesting EHR Story

Posted on August 25, 2010 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.

Anthony sent me the following slides which I think tell a really interesting story about EHR (or maybe I should say lack of EHR). I’m sure many of you will enjoy it.

EMR Stimulus Counterproductive

Posted on August 23, 2010 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.

The Washington Times recently had an article by Tevi Troy and Dr. Jason D. Fodeman about the EMR Stimulus program which talks about how the program might be counterproductive to its goal. The final paragraphs are an interesting perspective:

Unfortunately, Congress and the administration have decided to prioritize “getting it done” over “getting it right.” Other than being able to bring those signs saying “Project funded by the American Recovery and Reinvestment Act” that pop up across the nation’s highways to our hospitals sooner, there does not appear to be much benefit from this approach.

It will take much more than bombarding hospitals with extra computers and complicated, expensive software for health information technology to attain its true promise. It will require the right computers with the right software with properly trained support staff and physicians who know how to use them. All this takes time to establish and time to work out the kinks.

Unfortunately, for whatever reason, the administration is unwilling to devote the time and would prefer to roll the dice and pick up the pieces later. The administration’s rush to establish an interoperable health information technology network may very well prove counterproductive. It easily could waste money, endanger patients and, possibly, do irreparable harm to the technology’s reputation.

I’ve been preaching some of these things for a while, but it’s interesting that the mainstream media is finally starting to pick up the story.

I’d only caution that we not confuse the EMR stimulus with EMR. EMR is no doubt the future of healthcare IT. It’s just important to consider if EMR stimulus is the right approach to getting people to use as the article says “the right computer with the right software.”

From Notecards to RAC’s: The Evolution (and Nightmare) of Medical Records

Posted on August 21, 2010 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Medical record keeping used to be simple. 
I was born in the early 1960’s and saw my pediatrician for regular checkups and common illnesses until going to college in 1980. The first 18 years of my medical care were completely summarized on five 5 X 7 notecards contained in a manila packet. Each of my visits was documented by a 1 to 5 line handwritten note.  There were no wasted words.  My pediatrician also set the standard for illegible doctor’s handwriting!


How could my pediatrician get away with such a thing? In those days medical records served only one purpose: they were the physician’s personal notes taken to assist him or her in future care.  The only outside request for my medical records was made to show I had my immunizations.
Things began to change in 1966 when the American Medical Association created Current Procedural Terminology codes, or CPT codes. The original set of codes addressed medical procedures only and did not include office visits.  A physician’s bill to an insurance company for an office visit instead contained a narrative of the patient’s symptoms and the care that was given.
Over the next three decades events conspired to make medical records far more complex. The emergence of comprehensive health insurance, including Medicare and Medicaid, separated the consumer of health services (the patient) from the payor of health services (the insurer). Because the payor for health services no longer directly witnessed the patient encounter, the medical record became a necessary instrument of proof that service was delivered. A single phrase record such as “severe tonsillitis” no longer sufficed.  CPT was revised to include codes that covered office visits ranging from simple level 1 visits to complex level 5 visits. Each level specified a set of documentation criteria that medical notes had to meet in order for the doctor to bill at that level.
Then medical liability was created.  The medical malpractice lawsuit, once considered inconceivable, became commonplace. Physicians were compelled to add even greater detail to their medical records in order to defend themselves against potential accusations of inadequate care. In training I was taught, “if you didn’t document it, you didn’t do it.”  Thus defensive medicine and defensive record keeping was born.
Next came managed care.  Under the guise of cost control insurers came up with a variety of tricks in order to delay and decrease payments to physicians. One of the most popular games was to use the minutia of CPT coding requirements as a means to reduce and/or deny payments. A physician can spend 45 minutes working up a complex, very ill patient, compose an extensive clinic note, and have payment denied because the “review of systems” in the note was technically (but not clinically) inadequate.   In more recent times CPT coding and the supporting medical record documentation have become so complicated that an entire industry has formed for the sole purpose of understanding CPT coding and training / certifying individuals in this new body of knowledge.
Another popular managed-care technique, still in use today, is pre-certification. In most insurance plans a surgeon cannot expect to be paid for an operation unless he gets prior approval from the insurer prior to performing the procedure.  Pre-certification is often not given unless the medical record documents the need for the procedure. This puts yet another burden on the medical record.
Finally, we have the ever-increasing threat of practice audits coming mostly from the federal Office of the Inspector General.  An audit includes an exhaustive review of the physician’s billings to Medicare and a comparison of those billings to the corresponding medical records to be sure the records support the level of billing. Even the most conscientious physician fears the OIG audit, knowing that even the best documentation occasionally fails to meet the minutia of CPT coding requirements.   In some states these audits are now being performed by privately contracted firms (called recovery audit contractors or RAC’s) that are incentivized to find problems and levy fines.  RAC auditors are not held accountable for their actions.
The future promises further obligations on medical record keeping.  Pay for performance, benchmarking, outcomes research and other similar plans will raise the bar even higher.
  
What began in the mid-20th century as simple professional note keeping has grown into a regulatory and liability behemoth, creating a burdensome obligation for the 21st century physician.  The medical record serves not only as the provider’s reference but also as documentation of service, support for billing, support of proposed future care, defense against lawsuits and as a data capture instrument for outcomes research and future pay for performance initiatives.  The medical record must often face hostile audiences such has malpractice attorneys seeking liability or managed care providers looking for reasons to deny payment to the physician.  With the possible exception of RAC audits I don’t regard any of the above concepts as inappropriate.  But they do make record keeping much more difficult. 
Into this complex and rapidly changing environment comes the electronic medical record (EMR), trying to hit a poorly defined, rapidly moving target.  And EMRs have additional hurdles made just for them, including CCHIT certification and the ever changing / growing “meaningful use” criteria.
In the next post I will review how the regulatory burdens on medical record keeping distract the EMR from its best, most noble goals: improving efficiency, lowering costs and improving quality of care.
Thanks for your time and interest.  Comments and corrections are welcome.
MK

EMR Blogging Rules

Posted on August 19, 2010 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 I came across a post on Neil Versel’s blog where he talks about staying up late and early morning to meet the deadline for the stories he was writing for FierceEMR. When I first starting blogging about EMR, I came across Neil’s blog and it was interesting to see the perspective of a real healthcare IT journalist. I learned a lot from him (both things I wanted to do and things I didn’t).

The one thing that I love most about blogging is that there are no such things as deadlines. Certainly, I’ve kind of created some self imposed rhythms and expectations with readers (especially over on EMR and HIPAA), but I don’t really have any fixed deadlines. There’s something satisfying about the freedom to post whenever I want about whatever I want. I’m only really beholden to my readers. It’s a beautiful thing.

I actually can’t imagine my life without blogging now. I’m currently working on a new website to help sports organizations fundraise, but even then I have a couple blogs built in to help with the marketing of the site. Blogs are an amazing way to communicate. Plus, there’s something really satisfying about putting your thoughts in writing. This is even more true when others read it and find value from it.

EMR Buying Guides

Posted on August 18, 2010 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.

It seems like about every 6 months some new organization comes out with a new EMR buying guide. Physicians are looking for every way possible to narrow down the search amongst the 300+ EMR vendors.

Today David Swink sent me this new EMR Buyer’s Guide that InformationWeek is planning to put together. Unfortunately, they don’t really say how much they plan to charge for the EMR buyer’s guide or whether they’re going to get paid by the EMR vendors for the referral or what. We’ll see what they actually put together.

It’s just amazing the prices that many of these EMR buying guides charge for the information or even to be listed in the EMR buying guide. I’m not against people applying a business model to get paid for the work they do. It’s just that far too many of these guides charge a lot more than the value they actually provide to the user.

Plus, there are a number of free EMR selection services which I think do a better job than all of the EMR buyer’s guides I’ve seen. EMR Consultant and Medical Software Advice being 2 examples. They have a larger (often MUCH larger) database of EHR vendors to choose from, and they narrow that list down better than most of the EMR buying guides. Oh yes, did I say they’re FREE.

Just be careful what you buy. You don’t always get what you pay for.

Microsoft Shuts Down Amalga HIS – Lesson for EMR Selection

Posted on August 16, 2010 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.

It’s been a couple weeks since the news came out that Microsoft was shutting down its operations and sales for Amalga HIS. It always felt awkward for me to see Microsoft purchasing a software that was so specific. It just didn’t make sense to me for Microsoft to go after this type of specific product.

John over at Chilmark Research has a good post with his reasons why Amalga didn’t work well for Microsoft. I’m still pondering his comment that the EMR market is mature. However, his take away is a very good one:

Performing a viability assessment on a potential vendor may not reduce one’s risk. Even a big, viable company such as Microsoft may change its mind on occassion and chose to exit a market.

The only clarification I’d make is that a viability assessment does not equal evaluating if the company is big and viable. I cover this topic in my EMR selection e-Book and in these two posts. Not to mention this post on open source (free) EMR software viability.

I think the viability assessment is useful and essential. Just don’t make the simple assumption that large means viable. Ask Misys users about that one.

Why did I create this blog?

Posted on August 14, 2010 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Electronic medical records is getting lots of attention these days, especially with the Federal Government’s incentive program regarding “meaningful use” implementation of EMR.  In our practice, ENT of Georgia we are in our 6th year of EMR, so we are far ahead of most.

Over the past 5+ years we have learned a great deal about bringing a medical practice into the information age – not just EMR but a host of other functions as well.  I hope to share what we have learned.

MK