Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Healthcare Document Management Infographic

Posted on April 2, 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’m always a fan of the various healthcare infographics that are put out and the same is true from the healthcare document management infographic that was published by Globodox. The infographic highlights one of the myths that exists in healthcare that once you go EHR that you’ll be done with paper. Unfortunately, you’ll still have a lot of paper to deal with in the process of going paperless. So, document management of some sort is a really important part of any EHR implementation.

I find the HIPAA violation section interesting, but I’m not sure I think going electronic actually helps solve a lot of the breach problems that they list. I don’t personally believe that electronic records makes more HIPAA breaches happen, but I do believe that the size of the breaches increases dramatically in an electronic world. 10,000 charts could be stored on a small thumb drive that can be easily lost. Try losing 10,000 paper charts. You get the idea.

Now, without further ado, the healthcare document management infographic:
Healthcare Document Management Infographic

Paper vs EMR – Learning from Each Other

Posted on March 19, 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.

For those of you who read this site and don’t read EMR and HIPAA, you should go and read this post called Paper Has Healthcare Spoiled. While some might see it as an anthem for paper in healthcare, as I said in the comments of the post, it’s really an attempt to help EHR vendors see some of the advantages of paper and hopefully they’ll find ways to get those same benefits from EHR.

A Davis (who I believe is a doctor) also offered these insights in response to the post:

There’s no doubt that for one patient, in one office, paper is the absolute leader over EMRs in terms of ease of use. When considering multiple patients in multiple locations, the potential advantage of the EMR is easily seen.

The challenge is to transfer the benefits of paper to the EMR. That challenge has gone largely unmet, and it is the primary reason why uptake of EMRs among physicians has been so poor.

Medicine is a very personal undertaking. Physicians treat patients one at a time, and that’s how patients want it. That treatment is detailed, can be very personalized/customized, and documentation of that treatment varies to meet those individualized demands. EMRs, in their current state, are not user friendly to that type of documentation. While the government, insurers and hospitals are interested in aggregate data, physicians are not – at least not in the exam room, where their documentation occurs.

For an ever-shrinking number of physicians, typing is a problem. The problem is self-resolving over time.

For every physician, the “hunt and peck” mode of documentation is a problem. There are many variants – check boxes, radio boxes, drop down lists, “type ahead” automatic completion, etc – but there are hundreds, if not thousands, of locations in any EMR where the physician is required to choose among multiple options in a list. And there is no efficient way to do it. In a paper chart, the required entry simply flows from the tip of the pen. In an EMR, the physician’s attention must shift to the appropriate entry field, the mode of selection must be determined, the proper entry must be found and selected and, often, it must be confirmed, by clicking, by tabbing to the next field, etc. It takes a few seconds longer than simply writing the word and, when multiplied by the dozens or hundreds of times it must be done in a single patient encounter, the time lost becomes significant. Despite this limitation, it isn’t the method of data entry which is the primary problem.

The issue is how much data is required. Because hospitals and physicians are forced to accept fixed payments from the government and insurers, the natural evolution of EMRs as patient care tools has been altered. Rather than innovating to meet the needs of doctors and patients in the exam room, EMR vendors were forced to focus on the billing aspects of the EMR in order to justify their fees in a fixed-price economy. Therefore, EMRs are designed to elicit the information needed to justify the highest allowable payment rate from any given patient encounter. This is good for office and hospital economics, but is actually counterproductive to patient care.

For a given patient problem, the EMR doesn’t change the physician’s diagnosis and treatment decisions, but it does slow down the visit process by asking, typically, for more information than the physician needs for those decisions in order to get the required billing justification info needed to maximize the “billing code” for the patient encounter. This process is not only counterproductive to efficient care, but also increases the cost of medicine overall.

This problem is not inherent to the difference between paper and EMRs; rather, it is the result of the development of EMRs in a government-constrained environment. But it matters, because it is the basis of the very real fact that most physicians would prefer to use paper over an EMR. Until EMR vendors are able to innovate with the goal of improving the documentation needs of patients and their physicians, rather than government and insurers, paper will remain the medium of choice in the exam room.

As I’ve said for years, the biggest problem with legacy EHR software is that they’re big EHR billing engines.

Watch for more posts on EMR and HIPAA covering how healthcare is spoiled in other ways as well.

EMRs and the Paperless Medical Office

Posted on October 31, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

From the American Medical Association comes a recent story on EMRs and the paperless medical office. I think it touches quite effectively on the issue facing medical offices today – transitioning new patients to the new EMR has proved a lot easier than turning older paper records electronic. In one of my earlier posts, I’d written about this topic. This article provides some clever strategies in identifying which paper records to convert earlier than others.

Among the points discussed:
EMR use does not equal paperless: And yet, these two ideas somehow seem conflated in people’s minds. A doctor I spoke to recently said he had assumed that the EMR vendor would convert older paper records to electronic as part of the EMR purchase package. Well, the vendor might – for a fee. Electronic conversion ranges from simple paper scans to character/word recognition. For truly rich use of your data, say for report generation purposes, you’ll want something that populates a database. In fact, “data transfer probably is going to be a significant line item in the EMR budget.”

Not all data is equal: Having an EMR doesn’t mean that every little scrap of paper from the patient’s records needs to go into it. Doctors can make the call on the kind of data that they find most useful. It would however need some amount of planning and insight, not to mention time, to make this happen. What’s important depends on specialty as well.

Not all patients are equal: If a small proportion of patients you see tend to be the ones that come for repeat consults, it might make more sense to get the entirety of their paper records into the EMR.

Don’t make a beeline for the shredder immediately: Really, this should be self-intuitive. Unless you’re sure that every important piece of information you need has been transferred to the EMR, and the EMR data matches what’s on paper, don’t shred the patient’s records.

The only real quibble I have with the article was where it mentions that one company found that “having the doctors enter the data ensured the integrity of the information and helped them learn the new system.” Seriously? Have your $200+ per hour physician enter older records into an EMR, when you can get a temp or third-party vendor to do it for a fraction of the cost?

The statistics at the end of the article are quite interesting. The first statistic is especially encouraging.

A survey of 200 health IT professionals found that hospitals are taking varied approaches to digitizing their records. (Respondents could give more than one answer.)
49% have scanned what they need and stayed within their budget.
23% are within budget but still have a backlog of records to scan.
54% are scanning records onsite.
29% are using a centralized scanning location.
72% are relying on full-time employees to scan.
9% are using third parties.
6% are using part-time staff.
44% are not explicitly measuring the effectiveness or productivity of their scanning process.
58% plan to shred paper records once scanning is complete.
38% plan to store paper files in onsite records rooms or offsite storage facilities.

Source: Survey by information management company Iron Mountain, July