emr and the news

news article of emr in 2011 http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals news article of emr in 1999 http://news.google.com/newspapers?id=kTwdAAAAIBAJ&sjid=KqYEAAAAIBAJ&pg=2984,970734&dq=electronic+health+records&hl=en the difference is that in 1999 a news article stated doctors were chasing their fortune with the internet and online medical records....now in 2012 it is a requirement.

support from the emr company

EMR support is very important and can come from the company itself or other vendors that support multiple companies. Below I will list a few of the services described by some different companies. What is important to note is that some companies charge extra for 24 hour service, and if the system is in house or out house. http://www.vcpi.com/Portals/96686/docs/2011-02-cioc-emr-cost-study-final.pdf is a website that shows some of the estimated costs. Welcome to Acentec support services. We take great pride in the services that we offer to our customers. Our highly skilled and experienced support team is dedicated to making sure your problem is resolved expeditiously. We offer different support options (email, online remote support, phone support, and onsite) to ensure that you get help when you need it. Emergency support is available 24/7 via email or by phone. Whether you need help implementing or supporting your Cerner EHR or making sure that your computers and servers operate smoothly, MD Tech Pro can assist you. MD Tech Pro has a team of experienced Cerner experts to assist your practice with: Transitioning and implementation support for Cerner Hardware sourcing, installation and setup to support an Cerner implementation Configuration services to interface with lab orders and results, medical billing systems or other interface requirements Managing support tickets within your practice and engaging Cerner support for issues. IT management within your practice including the installation and maintenance of all Cerner software upgrades and patches. Setup and configuration of a Cerner patient portal

Not meeting deadline of emr

If the deadline of the emr is not met, than penalties ensue: No EMR /EHR Implementation Has a Price For physicians who either have not adopted certified EHR / EMR systems or cannot demonstrate “meaningful use” by 2015, Medicare reimbursements will be reduced by 1%. The deduction rate increases in subsequent years by 2% in 2016, 3% in 2017, 4% in 2018, and up to 95% depending on future adjustments. This works out to: According to EMRandHipaa.com, an average AAFP user is reimbursed 20% by Medicare. This means that overall, a private practice with $500,000 of annual income that fails to meet the electronic medical records mandate will lose $1000 in payments in 2015, $2000 in 2016, and so on. and you can't wait until the last minute because: Since each physician’s digital medical records needs and requirements are different, the lead-time for a certified EMR software provider to plan, install, and implement a system is around 2-4 months. There is also 6-8 months of training so each physician in a practice qualifies as a “meaningful EHR user.” This does not include the time it takes to select an EMR software provider that is effective and efficient for the physician.

failure to implement an EMR

Some hospitals and clinics have failed in their effort to implement an EMR system. Some of the common reasons include stakeholder and process requirements, change management, vendor failures, failures in existing processes, and clinical informatics culture. This is an important point to remember since if an EMR attempt fails, that is lost of funds since the company has to implement an EMR system to prevent Medicaid penalties.

physician loans for emr

Many EMR companies offer low or no interest loans for physicians to buy their product. This may be through their own finance operations or through third party vendors. The problem is that if a disagreement occurs or you are not happy with the software, you are stuck. It is important to go with a lending company that is not invested in the software to avoid repossession of the EMR. Banks such as Bank of America and Wells Fargo are now offering EMR loans to physicians.

informatics officer

Chief Informatics officers help ensure that the hospital fully leverages their assests and capabilities to provide safe and high quality and cost effective care. As opposed to a chief medical information officer, the clinical informatics officer focuses on the technology itself, not necessarily the clinical dispersal of information. They also report directly to the CEO or chief information officer. They tend to be in charge of the informatics team. This is the in house EMR support that works directly with the vendors. This team can do more build to help the workflow of the different hospital areas and also troubleshoot any EMR issues. This team is in charge of the updates and upgrades that the system requires.

EMR costs

This blog will focus on the costs of EMR. The things to consider are hardware, software, implementation and training and support and maintenance. Hardware- most physician offices need to upgrade existing hardware such as computers and a network server. It may be necessary to check with the EMR vendor being considered to get a list of recommended hardware. The cost of future upgrades will also need to be considered. It is possible to get deals with EMR vendors that have set up deals with certain companies. Software-EMR vendors sell licenses based on the number of physician users in the practice and give discounts for mid level providers. Office employees are granted free access through the providers. Each license can range from $1000-$25000. The average cost is $10000. Training- Can be done through remote training sites or on site training. The average time for a first time user is 45 hours. Training fees are about $75-150 per hour. Support and maintenance- These are typically in the annual contract and include software updates, technical support and scheduled maintenance. However, it is a good idea to hire an in house technician.

Sorry about the delay in my posts, I am now in New York. The hospital I will be working at has the eclipse system. A change from the cerner system, but as learned in a previous post, there are many types of EMR systems. So in this post I will talk about the eRx system. One of the features of an EMR is the ability to send prescriptions directly to the pharmacy of choice. Right now all scripts except for narcotics can be prescribed online. There are penalties from Medicare and Medicaid if prescribers do not meet the set number. There are exceptions for physicians who work in a field where they prescribe mostly narcotics, like anesthesiologists. This was a recent major breakthrough, since previously only physicians who were in rural areas without internet, or had few pharmacies in the area where exempted. The next major breakthrough will be when narcotics are able to be prescribed electronically. Right now, federally you are allowed to erx narcotics with a program that fits the requirements. Many states, however, have not yet approved narcotic erx because they don't have the correct system.

CMIO and EMR

Today I am going to talk about the role of the chief medical information officer and their importance with EMR. In this post, I have posted a copy of what Wikipedia says about CMIOs.I found it very informative. I work very closely with our CMIO since I am involved in the EMR. I was more involved in the education, training and curriculum design and some systems development. Our CMIO does pretty much everything the article says. He continues to practice emergency medicine in the same hospital. He already had experience in programming and was approached my the CMO to work in this position.He was involved in the making of policies, which we heavily rely upon for new builds. I find it interesting that the position came into existence around 1992. In 2012, we are still just starting out in implementing these EMRs to many hospitals. This job is vital to any organization. I was amazed at how knowledgeable our CMIO was to all of the cerner EMR functionality. Seeing how he was involved in the policy building, the executive meetings, the informatics team and programming himself has made me understand how this position keeps the EMR running. And also keeps funding in the hospital with all the reporting going into the meaningful use. Another thing the article mentioned was keeping up credibility with other physicians and this is very true. Many of the physicians I worked with were not pleased with the system because they felt they had no voice. Having a peer who still understands what they are going through and is playing an active roll in programming yields much faith, respect and patience. A chief medical informatics officer (CMIO, also sometimes referred to as a chief medical information officer) is a healthcare executive generally responsible for the health informatics platform required to work with clinical IT staff [1] to support the efficient design, implementation, and use of health technology within a healthcare organization. Typically the CMIO is a physician[2] with some degree of formal health informatics training or a working equivalent thereof, who often works in conjunction with, or helps to manage other physician, nurse, pharmacy, and general informaticists within the organization. According to the 2012 CMIO Survey, 60% had salaries higher than $200,000 per year.[3] While historically there have been physicians and others filling this role, the more formal CMIO position started around 1992 [4] to help hospitals support the adoption and implementation of health technologies such as electronic medical records (EMRs), electronic health records (EHRs), computerized physician order entry (CPOE), electronic documentation, health information exchanges (HIEs), and other technologies used in the clinical setting. The trend for healthcare organizations to have a CMIO has continued to grow, and accelerated as technology use in the clinical setting has been stimulated by programs such as the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act. CMIOs generally report to either the chief medical officer (CMO), chief information officer (CIO), chief operations officer (COO), or chief executive officer (CEO). The exact roles and responsibilities vary widely [5][6][7], from organization to organization, often depending on the reporting structure [8], but they typically include at least one of the following: Strategic planning EMR Governance and Policy development Systems development and implementation Stakeholder engagement Capacity Building [9] Informatics education and platform development[10] Data mining and quality reporting Education, Training and curriculum design Some CMIOs continue to practice clinical medicine, to some degree, to help maintain credibility with other physicians, but this is not essential.

learning styles

Today I am going to talk about learning styles. An important aspect as I have already mentioned is training, but we will talk about the kind of learners there are in the hospital. There is an age gap in the technology of EMR. There are physicians,(estimates on age) who are above the age of 60 who have spent their entire lives doing paper charting, and did not jump into the computer world. These providers may be a bit hesitant on learning the new EMR system. First, they do not have much experience with computers and still peck at the keyboard. Not being familiar with computers in general already expands the amount of time they will need to use the system. Their patient workload is dramatically increased as they have to fiddle around looking for orders, etc. The next group of learners are around the 40-60 age group. The have dabbled in computers. Some have grasped the computers and have become tech savy while others still peck around. This group is a little more flexible in their learning, since they have had more of their lifetime surrounded by this new technology. They have probably jumped on board some of the new fads such as iphones, etc. The last group are the under 40 who have been immersed in the current innovations. This group has either seen the changes and were able to learn along with it or they were born with it. In this group, the computers are usually second nature. The reason for splitting in these groups are that it helps the trainer identify what strategies are needed. The over 60 group may need guidance in computers in general before going into the EMR details, while the other groups may not. This is of course a generalization. Another thing is being able to relate to some of the groups what things in the EMR are similar to the paper chart. That each electronic encounter can be seen as a new sheet of paper for a new visit in the charts. Some of these comparisons are helpful. However, some medical schools are now fully electronic so some providers will not have experience with the paper chart at all only EMR.

types of EMR

The confusing thing for providers and hospitals is choosing which EMR to buy. In this blog I will talk about the types of EMR systems available. In another blog I will talk about how to actually choose. This website had some valuable rankings: http://www.providersedge.com/ehdocs/ehr_articles/2004_EMR_Survey_Summary_Report.pdf There is Meditouch, Allscripts,eclinical works,Greenway Primesuite2011, Aprima, 2011 Waiting Room Solutions, Vitera Intergy, NueMDComplete,ADP Advanced MD EHR Software,Care Cloud charts EHR, Cerner, and over 80 more. I was shocked to learn about so many different companies. I had no idea. I thought maybe there were 10 main companies, but obviously, I was wrong. I now understand how this can be confusing. There are some types of EMRs that are better for clinics, or hospitals. Below is an example chart from http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison/

At our hospital we use Cerner for inpatient and outpatient services. It is interesting because I have heard people say it is not bad for inpatient but not outpatient. And I believe Cerner was originally designed for inpatient. The chart also list Cerner for inpatient. I have heard very good reviews about eclinical works for primary care clinics. Also, my former hospital used Epic. It was cool to see how these EMRs are organized. Another thing is that there are many systems that are built for specific specialties. It will be interesting to see how all these systems will eventually merge or talk to each other.

Incentive funding-physician owned clinics

Incentive funding for physician owned clinics is harder than for hospitals because of the limited resources. Doctors can get up to a maximum of $44,000 over 5 years per provider in funds from the economic stimulus Act. How much they actually get depends on the percentage of Medicare/Medicaid patients that make up their clinic. Unfortunately, for many physicians this alone is not enough for start up and lot end up with out of pocket expenses. Starting an EHR can cost around $60,000 up front. Some physicians have started looking toward hospitals for help in establishing an EHR. Some hospitals have the physicians share the subsidies or repay the entire subsidized amount. These clinics would make sure their EMR communicates with the hospital EMR. Beginning in 2015, physicians who do not use EMR will be penalized starting with a 1% Medicare fee reduction, 3% by 2017 and 3% in 2019. As a physician who would like to start her own clinic, I didn't realize the actual dollar numbers, I had just heard that the incentive funding was not enough. Another topic is having any EMR and having one that is fully functional. This will be addressed at another time. But some physicians fear that with using hospital subsidies to fund an EMR system, they will lose control over their clinic. I have seen this happen where physician clinics are taken over by huge corporations like HCA, yet the inner dynamics of the clinic is in array. Those close to the situation can't do anything and the process of going through corporate takes a long time and may not result in changes. At the moment, I do not want to be associated with a hospital, so i will have to keep in mind the startup costs. I also may see if I want to have other physicians involved in my practice as well. Would I be able to accomplish more with more providers? Interesting things to ponder.

incentive funding-hospitals

So today I will talk about incentive funding. This was one of the main reasons I went into the EMR area-I wanted to learn more about the requirements involved with meaningful use and EMR.In this blog I will focus on incentive funding and hospitals. The next blog will be about incentive funding and physician owned clinics. Following ares some articles I looked up: http://www.practicefusion.com/pages/healthcare_stimulus_center.html http://www.practicefusion.com/pages/HITECH.html http://www.healthleadersmedia.com/content/TEC-254762/CMS-EMR-Incentive-Funding-Reaches-73-Million.html http://www.ama-assn.org/amednews/2009/11/23/bisa1123.htm First, some background. The American recovery and investment act, aka the stimulus bill of 2008, has a provision called the HITECH act. This Act allows the Center for Medicare and Medcaid services to issue annual payments to providers who demonstrate meaningful use of a certified electronic medical system. Meaningful use has 15 criteria that must be met.

At my hospital, I saw a glance of the incentive funding. For my part I went around the hospital and obtained CME usernames/passwords for NP providers and obtained signatures for attestations to meaningful use. All providers, because they worked in our hospital used meaningful use because the criteria was built into our system. In the hospital, providers were shocked that someone else was doing the paperwork for them, but they also wanted to be able to use the money toward areas they thought were needed. The money went into the hospital fund it was distributed individually based on specific providers.There was a lot of holding on the phone for passwords/usernames, but otherwise the process from my point of view did not seem painful. But I was not working with making sure we fit the proper percentages. The resources of the hospital made it a lot easier as opposed to the physician owned clinics we will talk about in the next blog. "Under the American Recovery and Reinvestment Act, hospitals participating in the Medicare program can qualify for up to $2 million in base incentive pay per year for implementing EMR systems. Plus, they can get additional incentive money under a complicated formula that includes $200 per discharge, multiplied by the hospital's Medicare Share and a transition factor that starts at 1.0 and declines to 0.25 over the course of the program. But to qualify, hospitals must meet three basic requirements: They must use a certified or qualified EMR; they must use the EMR to do quality reporting; and they must exchange data with affiliated physicians. To qualify for the highest eligible amount, hospitals must be meaningful users of EMRs by fiscal 2011." (http://www.ama-assn.org/amednews/2009/11/23/bisa1123.htm)

messaging in the hospital

http://medcitynews.com/2012/04/the-electronic-medical-record-as-healthcares-yelp-opentable-and-skype/ In relation to the article above, I have heard talks of this and find it very interesting. Creating a way to instant message other people through the EMR system. Practice Fusion has released chart share which is HIPPA compliant in the messaging. I think this would be very helpful. A lot of hospitals still rely on the pager system. Many providers do not like to use the voicemail associated with pagers. The text page means that a computer has to be found to send the message. With EMR systems being accessed on phones, the instant message will be...instant. and allow for providers to respond away from computers. My concern would be with the wireless network. In our hospital we use sprint and have their network installed in our hospital, yet the signal has been horrible and messages have been delayed for hours. We need to have a reliable system to use in the hospital setting. How to ensure that a technological instrument is reliable...that I am not quite sure. But it would be nice to instantly have access to providers and for providers to not have to go on the "great search for a phone." This could increase response time in patient care.

Training and reaching the masses

So one of the question we have is how to reach our users of the EMR system for training/updates. At our hospital there are two email systems, the university email and the hospital email. The hospital has access to the hospital email not university email, but most physicians check only the university email. So email is not as efficient. We could use the mass paging system, but everyone would not be so happy being pages when they were home and off from a long night of call. We have tried fliers, but people become over- stimulated with to so many fliers and don't really pay attention to them anymore. There was a website but it became un-organized and filled with too much information, that people do not trust it anymore. An idea was to use facebook. If facebook was pushed out as a site that employees could go to to find videos on training and important updates, maybe that would be a way to keep people updated. Especially, with everything going into the feeds. However, facebook can't be reached on campus so it probably isn't a good idea to have a program people can't access at their workplace. The question is how do we find a peaceful combination between security and social medias? The other question is how do really reach people with all of the different types of medias we have? With having too many communication choices, are we actually not able to communicate at all?

facebook in healthcare

http://www.hcca-info.org/Portals/0/PDFs/Resources/Compliance%20Today/0512/CT_0512_Entin.pdf The above link is a good article about what I am going to talk about. One of the social medias- facebook and the role it has played in the hospital/clinic setting. In this blog I will touch on venting and advertising/communication. Venting. One of the top uses of facebook. However, where is the line crossed. Can health care professionals vent about their patients, take pictures of interesting cases and post them online? These things have happened and unfortunately found their way back to the patient. One thing about facebook is that you are linked to other accounts. One story that happened in Kansas was when a nursing student posted pictures of a cadaver on facebook. She was suspended but the courts overruled it and allowed her back into school. In our hospital, our security currently prohibits the use of facebook. However, everyone has it on their cell phones, and a lot of people still talk about their day/patients about it. In the article above, if there is a group of people talking about their work situation that is okay, however in health care we still have to be aware of HIPPA. I agree that we need to be aware of what we say on facebook because it involves other people in very sensitive situations. However, I do think facebook is good for advertising and communication. Facebook is now like an email that multiple people have access too. For some people it is the first thing they check in the morning. I do think we need to incorporate a way to use this massive communication system in healthcare. If we advertise programs, events and services that are valuable to patients on facebook, then we may reach more people. Sending results to the message center may be too complicated, but we can continue/start with using emails. Right now, I think it would be cool to have a page on our training for EMR on the facebook. I will talk more about training in my next blog. But these are my thoughts on facebook and uses with healthcare.

Dragon

Yesterday at work, I had a request for the Dragon. Dragon is a voice activated software that allows physicians to dictate directly into the electronic note. We had a trial of Dragon at our 2nd campus ER site. The trial went well but we had a couple of bumps since those physicians had previously just dictated and were not familiar with using the electronic note at all. They had to learn the electronic note and the Dragon software. The reason we started with that area was because they had the highest transcription cost within both hospitals. Physicians at our primary site are barking at the door to get the Dragon software. We recently had a meeting where we are debating over MModal or Dragon for a voice activation service. In the meantime, physicians who want to use this have to purchase it on their own, which is about 1300 dollars. - I learned that money plays a big role in decisions. The voice activation systems provide a compromise where physicians can still dictate and hospitals save on transcription costs. Also there is better accuracy with the physician being able to correct live in dictation. This is also supposed to be a time saver- one of the big obstacles in using EMR.

Introduction

Welcome to my blog!!! This blog will be exciting as I get to talk about my job as a physician development coach, which is just filled with technology. First, my name is Nina Hicks, M.D. and I am a family medicine physician. Right now I am working at Truman Hospital with the electronic medical record system. I am involved in the build, feedback and training of the Cerner system that we use. Just so everyone is on the same page, hospitals and clinics are required to move to electronic records instead of paper charts. There is a lot involved with this, and I was and am able to play a major role as a physician. Even with training other physicians how to use the system, we have tried to implement many types of social media since these are the times we are living in. Stay tuned for more about the days of my EMR life!!! nina m. hicks