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)