Before deciding to purchase any medical record management system, I believe it is incumbent upon physicians to thoroughly understand the underpinnings of electronic medical record(EMR) management fundamentals. The first thing a medical office administrator needs to understand is the three basic elements which constitute a paperless medical office.
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1. Clinical Electronic Medical Record System(CEMR)
The clinical EMR is basically a computer-based solution to assist physicians with medical coding issues such as ICD-9, CPT coding and super bill generation. The CEMR(clinical EMR system) has built-in logic and programming functionality which is specific to your medical specialty. Generally, these systems enable physicians to customize their coding practice, assist with ICD-9 to CPT coding relationships, provide edits, electronically manage clinical and prescription records ,etc. I think it’s fair to say that a clinical EMR is like a super bill on steroids.
2. Standard Medical Record EMR
This is a system which generally keeps track of medical reports such as x-ray reports, operative reports and other general paperwork pertaining to the functionality of your medical practice. This type of software is generally database driven. Super bills, patient demographic information, insurance ID cards, medical reports and can be scanned into computer systems and retrieved later. Information properly read through your digital scanner is converted through a process called optical character recognition(OCR) into text which is easily stored within a database. Later, your office staff “should easily” be able to retrieve paperwork which was previously scanned. This type of system will save your staff a great deal of time because it avoids your billing office, nursing staff, or other physicians from having to physically go to the paper-based filing system which is always a drudgery.
3. Practice management system
The third element of this equation is your practice management system which handles your billing and scheduling information.
I go into great detail about points 1., 2.,and 3 later later in this article if you’re interested.
At this point I’d like to offer my professional opinion after nearly 20 years experience as the owner/operator of a medical billing service. My entire business hinges on the ability to keep track of medical, billing and clinical records. Currently, Medi Bill Inc. has millions of digital records which have been stored over the past eight years.
A.Unless you’re willing to spend $100,000 on a system capable of managing all three elements of the billing, clinical and medical record aspects of your practice, You should keep three distinct EMR systems. Initially this may sound complicated but in reality it actually simplifies matters. Medi- Bill Inc. processes large volumes of medical records, much more than a typical physician group. Currently, we find keeping three separate subsystems for handling our medical record needs to be less complicated and much less risky than one single comprehensive database.
B.There are very few, if any systems on the market today capable of handling all three elements in tandem.
C. Unless your practice can afford a full-time IT personnel or have no other options available, I’m strongly in favor of keeping all three EMR systems completely separate.
The Paperless Medical Office in Today’s Digital Environment.
Recent reports show that while only 5% to 9% of American physicians use electronic health record systems on a regular basis. The core of the paperless medical office is a system that integrates electronic medical records with physician practice management and patient scheduling software. Such software has the ability to facilitate many critical practice functions, including patient record-keeping, scheduling and communication, insurance bills and tracking of claims, ordering the receipt of diagnostic test information, generation and tracking of physician referrals, measurement of physician and staff productivity and performance, and internal administrative workload and budget control. In its fully realized form, the paperless office can increase quality of care, decrease costs while simultaneously offering an array of other benefits. Some of these benefits include;
- Instant access to patient health data from any location with a computer and Internet access;
- Real-time medical decision support:
- Updating of the electronic medical record while the patient is being seen
- Digital transmission and receipt of all patient laboratory and results, physician consult reports and patient prescriptions;
- Medication and formulation information and advice, aimed at avoiding errors in drug interactions and keeping drug costs as low as possible;
- Coding advice to physicians to assure accurate documentation of a visits level of complexity;
- generation of patient bill and patient take-home medical summaries, condition-specific report information, and treatment instructions for patients before leaving the office;
- kept scheduling patient appointments and sending reminders to patients about important treatment items and upcoming tests and appointments;
- Digital transmission and tracking of claims sent to insurers;
- Physician performance measurement and healthcare outcomes research:
The technology and software are currently in existence which would allow physicians to spend much more time treating patients and less time on awkward paperwork; however typical physicians in the United States have been very slow to embrace the new technology. Eventually the US healthcare system will be wired to send and receive all patient information in a digital format and will be required to do so in a common and accepted language by all health care providers. Part of the apprehension on physicians to purchase electronic medical record systems stems from horror stories by colleagues who’ve been ripped off in the past by shaky vendors and serious technology implications. Medi Bill inc. fully understands this apprehension because we face the same problems.
I believe it is possible to avoid pitfalls that can undermine successful conversion to a paperless system by learning from the mistakes of offices who have unfortunately already failed. The goal of this article is to help physicians ask the right questions about whether or not investing in a paperless office is a worthwhile endeavor.
1. What are the central issues, costs and obstacles physicians must address before going paperless?
The software/hardware costs for an electronic filing system depend on a wide array of factors. These factors include the number of physicians, and overall size of the practice and deciding whether to purchase EMR/practice management software and install new servers and workstations or to lease software and or servers from an application service provider or to maintain separate subsystems for accomplishing this task.
I. What are the key obstacles physicians will experience when setting up a paperless medical office.
- The time and cost of system testing and customization before implementation of your new electronic filing system and practice management software.
- The cost of designing and building or redesigning the office’s physical layout to accommodate a paperless office
- the cost and time of training staff to use the new electronic filing system and practice management software and related updated office protocols.
- The time and cost for existing practices to upload paper medical records in to the electronic filing health record format.
- Short-term loss of productivity and practice revenue while the new system is being implemented and debugged.
- The ongoing costs of system maintenance, upgrading technical support and staffing.
- The temporary loss of system due to computer crashes or power failures is possible and should be noted.
II. potential benefits of the paperless office.
- Improving quality of care
- Improving the time spent with patients
- Improved practice profitability
- Eliminating the need for paper lab orders, paper physician referrals, and paper medication prescriptions and speed results back to the referring physician
- Improving practice revenue through more accurate software assisted coding
- Decreasing risk of medical errors
- Increasing patient satisfaction, education and public compliance
- Ensuring compliance with security and transaction provisions of HIPPA
- Electronic billing is faster and can result in less rejected claims, higher revenue and faster payment turnaround patients can communicate with physicians by secure e-mail, a limiting phone calls and assuring that patient visits are appropriate and necessary while more minor problems can be handled remotely.
- Physician performance measurement and healthcare outcomes research
- Electronic health records may help lower liability insurance costs