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ACP Offers Recommendations On Reducing MD Administrative Overload

Posted on March 30, 2017 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.

As everyone knows, physicians are being overwhelmed by outsized levels of administrative chores. As if dealing with insurance companies wasn’t challenging enough, in recent years EMRs have added to this burden, with clinicians doing double duty as data entry clerks after they’re seen patients.

Unfortunately, streamlining EMR use for clinical use has proven to be a major challenge. Still, there are steps healthcare organizations can take to cut down on clinicians’ administrative frustrations, according to the American College of Physicians.

The ACP’s recommendations include the following:

  1. Stakeholders responsible for imposing administrative tasks – such as payors, government and vendors – should analyze the impact of administrative tasks on physicians. If a task is found to have a negative effect on care quality, needlessly questions a clinician’s judgment or increases costs, it should be challenged, fixed or removed.
  2. If an administrative task can’t be cut, it must be reviewed, revised, aligned or streamlined to reduce stakeholders’ burden.
  3. Stakeholders should collaborate with professional societies, clinicians, patients and EMR vendors to develop performance measures that minimize needless clinician burden and integrate performance reporting and quality improvement.
  4. All key stakeholders should collaborate in reducing, streamlining, reducing and aligning clinicians’ administrative tasks by making better use of health IT.
  5. As the US healthcare system shifts to value-based payment, stakeholders should consider streamlining or eliminating duplicative administrative demands.
  6. The ACP would like to see rigorous research done on the impact of administrative tasks on healthcare quality, time and cost; on clinicians, staff and healthcare organizations; patient and family; and patient outcomes.
  7. The ACP calls for research on best practices for cutting down on clinicians’ administrative tasks within both practices and organizations. All key stakeholders, including clinician societies, payors, regulators, vendors and suppliers, should disseminate these evidence-based best practices.

It appears that even the federal government has begun to take these issues to heart. According to Modern Healthcare, late last year CMS announced a long-term initiative intended to reduce physicians’ administrative burdens.  Then-acting CMS Administrator Andy Slavitt said the initiative would hopefully make it a bit easier for practices to meet the requirements of the Quality Payment Program under MACRA.

But other sources of administrative frustration are likely to linger for the foreseeable future, as they’re deeply ingrained in stakeholder business processes or simply difficult to change.

For example, the American Academy of Family Physicians notes that some of the biggest aggravations and time wasters for its members include the need to get prior authorizations from health plans and outdated CMS documentation guidelines for E/M services which don’t leverage EMR capabilities. Sadly, I wouldn’t hold my breath waiting for either of those problems to be solved.

Still, it seems some healthcare organizations want to take on the administrative overhead problem. The University of Pittsburgh Medical Center has launched an initiative aimed at reducing the number of computer-related tasks doctors have to perform. According to the Pittsburgh Post-Gazette, UPMC is partnering with Microsoft to minimize physicians’ need to do electronic paperwork. Executives with the two organizations say this effort should result in tools for both doctors and patients.

Physicians Ask New HHS Head For Health IT Help

Posted on February 28, 2017 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.

The American Academy of Family Practitioners has written to new HHS Secretary Tom Price with a list of areas in which health IT could use a helping hand.  In its letter, the group outlines issues with physician use of health IT that the new leadership could tackle.

According to the AAFP, the top issues policymakers need to tackle include:

  • Lack of healthcare data access undercuts care: Without interoperability, it will be hard for doctors to ensure continuity of care, care coordination and a learning and accountable health system, the group says. It names the Direct protocols as an example of progress on this front.
  • HIT functions are too business-oriented: According to the AAFP, the healthcare industry has spent too much time focused on automating the business of healthcare, particularly documentation. The letter argues that it’s time to flip the focus from business functions to delivery of appropriate care.
  • HIT reduces physician satisfaction: The group argues that current health IT solutions are “extinguishing the joy of practice” for physicians and contributing to physician burnout and frustration.
  • EHR certification standards are undercutting clinicians: The AAFP contends that existing standards for EHR certification are causing problems physicians, as they don’t do much to push vendors to meet user demands or improve their technology.

This is certainly a reasonable summary of issues in physician HIT adoption. And they deserve to be addressed Unfortunately, it’s not likely that that the AAFP will get much satisfaction from HHS, CMS or any other government entity. I’ve reluctantly come to the conclusion that agencies like ONC aren’t going to get much more done.

I do have hope that current waves of technology will allow health IT issues to self-heal to some extent. In particular, as healthcare technology becomes more decentralized, connected and mobile, providers won’t have to manage clumsy, ugly EMR interfaces on the desktop. In part due to some chats with vendors, I’ve become convinced that next-gen HIT solutions will present data via lightweight clients (perhaps even lighter than existing apps) which create an EMR-on-the-fly. One example of a company working on this approach is Praxify which Healthcare Scene recently saw at HIMSS. This lightweight client approach could make existing concerns about HIT usability and architecture obsolete.

However, I’m realistic enough to know that no matter how nifty emerging HIT approaches are, we still have to get from here to there. And as long as clinicians remain something of an afterthought when EMRs are designed – something which despite vendor denials, remains a big issue – we’re likely to keep struggling with today’s HIT issues. Let’s hope the revolution comes before we’ve exhausted our issues fighting current health IT demons.

Drop In Clinics: Another EHR Quandary

Posted on March 5, 2014 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.

If you go to a walk in health clinic, you’re in good company. These clinics and their users are growing rapidly. So, too, is their using EHRs to document your stay. That EHR use is both good and bad news.

 Clinic Types

There are two basic types of these no appointment, walk in clinics: Retail Health and Urgent Care:

  • Retail Health. These treat minor problems or do basic prevention that usually doesn’t require a physician visit. For example, they give flu shots, treat colds, ear infections, and strep throat, etc. The clinics are often one person operations staffed by a nurse practitioner. You can find them in stand alone settings, but more frequently now they are in major, retail chains such as Target, Wal-Mart, CVS, etc. In addition to their location accessibility, these clinics usually have evenings and weekend hours.
  • Urgent Care Clinics. These perform all the services of retail clinics, and also have extended hours. Importantly they add physician services. For example, they will treat burns, sprains, or run basic lab tests. These clinics usually are part of a clinical chain or may be associated with a local hospital. Unlike retail health clinics, they generally are in their own store fronts.

While their services and settings differ, both accept health insurance. With the projected growth of the insured population under the ACA, their managers are expanding their networks.

Clinic EHR to PCP EHR Problem

Unlike practices and hospitals that have undergone, often painful, transitions from paper to EHRs, these clinics, skipped that phase and have, by and large, used EHRs from the start.

EHRs give them a major advantage. If you visit Mini-Doc Clinic in Chamblee, Georgia and then go to one in Hyattsville, Maryland, the Maryland clinic can see or electronically get your Georgia record. This eliminates redundancy and gives you an incentive to stay with a service that knows you.

If you only go to Min-Doc for care, then all your information is in one place. However, if you use the clinic and see you regular doctor too, updating your records is no small issue. Coordination of medical records is difficult enough when practices are networked or in a HIE. In the case of a clinic, especially one that you saw away from home, interface problems can compound.

With luck, the clinic you saw on vacation may use the same EHR as your doctor. For example, CVS’ Minute Clinic uses Epic. However, your clinic may use an EHR tailored to walk ins. Examples of these clinic oriented, tablet, touch optimized EHRs are:

Your physician may not have the technical ability to read the clinic’s record. Getting a hospital to import the clinic’s data would require overcoming bureaucratic, cost and systems problems for what might be a one time occurence. Odds are the clinic will fax your records to your doctor where they will be scanned or keyed in, if at all.

This is not a hypothetical issue, but one that clinic corporate execs, patient advocates and physicians are concerned about. There is no easy solution in sight.

Recently, on point, NPR’s Diane Rehm show had a good discussion of the clinic phenomena, and included the clinic to PCP EHR record issue. You can hear it on podcast. Her guests were:

  • Susan Dentzer. Senior Policy Adviser, The Robert Wood Johnson Foundation and on-air analyst on health issues, PBS NewsHour.
  • Dr. Nancy Gagliano. Chief Medical Officer, CVS MinuteClinic.
  • Dr. Robert Wergin. Family Physician, Milford, Neb., and President-elect, American Academy of Family Physicians, and
  • Vaughn Kauffman. Principal, PwC Health Industries.

All the actors in this issue know that the best outcome would be transparent interoperability. However, that goal is more honored in the breach, etc., for EHRs in general. The issue of clinic to PCP EHR is only at a beginning and its future is unknown.

EHR Incentive Increases Medicare Costs

Posted on September 25, 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.

There is a major trend happening in healthcare that was covered pretty well in The New York Times. That’s right. EHR doesn’t often get much play in the major journals, but this is a really big deal. Plus, I’ve had doctors write into me about the subject as well.

The key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This is happening because doctors are upcoding more than they’d done previously. It’s a bit ironic to me that this is going to be a major problem for Medicare since 6 years ago when I first started writing about EHR software one of the major reasons to implement an EHR was to increase your revenue by upcoding.

I’ll never forget the first time I saw the challenge of coding first hand. I was at AAFP sitting at a table of physicians who were there to discuss EHR. This older lady and a gentleman shared with the group that they were chronic under coders. It felt a bit like an AA meeting where these doctors were finally coming clean on their habits. The rest of the doctors in the group just nodded their head since they knew that under coding was a major issue in healthcare.

What Medicare or the administration didn’t seem to realize is that the cost of Medicare is based on this under coding. Doctors have been under coding for so long that it just became part of the cost structure. Little did those in Congress think that by spending $36 billion on EHR (or whatever number you prefer) they’d actually cost Medicare billions of extra dollars. I bet the CBO didn’t plan for that in their budget projections.

This new trend in upcoding begs the question on whether doctors are doing this legitimately or if this is a form of fraud and abuse that’s being made possible by EHR. In a completely unscientific way, I suggest that probably 95% of the upcoding that’s happening is legitimate. Plus, a large portion of the 5% upcoding fraud and abuse would have been happening regardless of EHR. Why do I believe that so little of the upcoding is legitimate?

It goes back to that experience at AAFP where I heard doctors talk about their under coding habits. There was an underlying tension in their statements that they would love to bill more, but they had a number of underlying fears that made them choose not to code higher. First was fear of audit. The last thing any doctor wants is an audit and if under coding will avoid the dreaded audit, then it is the price to pay for that comfort. Second, I’ve heard doctor after doctor talk about times a patient examination should have been at a higher coding level, but their documentation didn’t match that higher level code. The doctors chose to under code the visit as opposed to documenting the normal findings in the visit which would allow them to code at a higher level.

EMR doesn’t do much for the first fear described above. However, EMR often makes it possible for a doctor to code a normal finding in the EMR that they wouldn’t have taken the time to code in a paper chart. I expect that this accounts for a good portion of the upcoding we’re seeing. Combine that with easy chart reviews and EMR coding engines and you see Medicare costs increasing by billions of dollars thanks to EHR. Oh the unintended consequences of government intervention.

Two More ONC-ATCB EHR Certification Bodies

Posted on December 10, 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, HHS announced two more organizations that have been approved as ONC-ATCB for EHR certification:
SLI Global Solutions – Denver CO
Date of authorization: December 10, 2010.
Scope of authorization: Complete EHR and EHR Modules.

ICSA Labs – Mechanicsburg PA
Date of authorization: December 10, 2010.
Scope of authorization: Complete EHR and EHR Modules.

I’ve actually met with both of these organization. I met with SLI Global Solutions in Denver when I was attending AAFP. I wrote this blog post about SLI Global Solutions as an ONC-ATCB EHR Certification body after my visit with them. I’ll be getting more information from them which I’ll post on this or EMR and HIPAA as I get it.

ICSA Labs is an Independent Division of Verizon Business. I met with the CMO of Verizon at last year’s HIMSS where he told me that ICSA labs would become a certifying body (sorry I can’t find the post right now).

Both are very legitimate organizations with some definite interest and expertise in the healthcare space. For example, Verizon is making a big play with their Verizon HIE product offering.

I’ll see about getting more details on each of these new EHR certifying bodies so that we can see how they compare against the other ONC-ATCB. 5 EHR Certifying bodies. That’s probably enough to keep it competitive.

EMR Selection Services

Posted on October 21, 2009 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 everyone is trying to get in on the EMR selection game. At the end of the game, I think this is actually a really good thing. I’m all about lots of competition which drives people to provide better service and quality at a lower cost.

The latest entrant I’ve seen to this arena seems to be basically an EHR Selection Consultant group. It’s being run through the wholly-owned subsidiary of the American Academy of Family Physicians, TransforMED.

There are three consulting paths that they offer as follows:

EHR Prep-Select is a 10-step project that is further broken down into nearly 40 individual assignments. The program includes four hours of consulting with an experienced industry expert and provides access to a Web portal that contains electronic worksheets, templates, surveys and tables designed to streamline the process of capturing, analyzing and disseminating EHR project data between internal staff and EHR vendors.

EHR Prep-Select “Plus” provides additional consulting time to help supplement the internal resources required to complete a full EHR selection project, and the Prep-Select “Premier” offers consulting from start to finish.

No doubt there’s a need for doctors to have some help in selecting from the 300+ EMR vendors that exist out there. The problem today is that doctors need to hire a consultant to tell them which EMR consultants are good and which ones are smoke and mirrors. For example, I find the above program interesting, but I have no clue how good it really is.

If I were starting the EMR selection process today, I’d go and check out EMR Consultant first. Hard to get better than a free service.

A Great EMR Survey from AAFP

Posted on August 11, 2009 I Written By

Some of the best and most objective information about EMRs comes from the Center for Health IT at the American Academy of Family Practice. Real doctors who have purchased EMRs rate their EMR in 5 different categories: Quality, Value, Usability, Productivity and Support.

This report is ONLY available to members of the AAFP. I think if the AAFP really wanted to do all of us a big favor, they would release this report to anyone who is interested in seeing it. I don’t understand why they are keeping it secret.

It is going to be very difficult for doctors to find a good EMR because there are so many EMRs and so many “bad” EMRs (hard to use, reduce productivity, expensive). Starting with this survey can help doctors start their EMR search on the right foot.

Contact the AAFP and ask them if you can get a copy of their report.

Center for Health IT

Hopefully they will have our great Healthcare System’s best interest at heart. By making this report available to all doctors, they can help us all get “good” EMRs that are usable and high in quality.

If you are a doctor looking for an EMR, start your search with a few EMRs that get good ratings in this survey.