Implementation Pearls and Resources
By Amy Berlin, MD
If you are thinking about adopting an EHR in your practice, there is one thing you cannot do enough of: plan. Here are some (free) resources to get you started.
The American Academy of Family Physicians Center for HIT (health care information technology) has a host of online tutorials and articles created with the office-based physician in mind. Topics include workflow redesign, EHR vendor selection, and implementation. Other AAFP articles of interest include:
Practicing Without Paper Charts: One Clinic’s Experience
Strategies for Better Patient Flow and Cycle Time
How to Select an Electronic Health Record System
The California Health Care Foundation publishes thoughtful articles and reports on a wide variety of health care IT issues and strategies. Highlights are:
Electronic Medical Records: A Buyer’s Guide for Small Physician Practices
Physician Practices: Are Application Service Providers Right for You?
Clinical Documentation: EHR Deployment Techniques
Open-Source EHR Systems for Ambulatory Care: A Market Assessment
AMA Practice Management resource center including worksheet “15 questions to ask before signing an EMR or EHR agreement”
MIEC’s (Medical Insurance Exchange of California) publication on important questions to ask EHR vendors
For more on the HITECH Act…
Dr. David Blumenthal’s article in the February 4, 2010 edition of the New England Journal of Medicine
The Centers for Medicare and Medicaid Services’ (CMS) fact sheet on meaningful use
CMS fact sheet on Medicare Incentive Program
CMS fact sheet on Medicaid Incentive Program
CMS HITECH FAQs (sign up for updates when answers change)
Office of the National Coordinator for Health Information Technology blog – HealthIT Buzz
CalHIPSO – California’s Regional Extension Center
KLAS publishes independent research on EHR and other HIT vendors. Practicing physicians can obtain selected reports at discounted rates.
Resources provided courtesy of Amy Berlin, MD
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Really, could not agree more on this topic. Great post, flushed out many of the certification , cost and implementation issues in this incentive era.
I feel today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines.. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.
Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the ‘safe EHR vendor’ challenge as discussed by many critics.
Sorry to have diverted a bit from the topic but I feel this HITECT act and the REC’s are going to play an important role, as discussed above in the successful EHR implementation in the medical practices in our country.
As far as implementation challenges goes, the federal guidelines for certification and usability are pretty much clear. Useful improvisation on these lines can make ones EHR’s friendly to most practices of varying specialties.
I was sitting in my doctor’s office yesterday reading the series of articles on the electronic health record in the sf medical magazine may 2010 issue.
As a data analyst, I was shocked that none of the articles mentioned the medical advantages of having electronic access to historical data on a patient. I’m 57 and I’ve been to the same internist for about 10 years. He does not have an electronic system, and my file folder is many inches thick. He often has to flip through the paperwork trying to find basic information — what medications I used successfully or unsuccessfully in the past, when I had a particular exam and what the results were, etc., and often he cannot find the information quickly. In fact, he is more likely to rely upon my memory for historical information, because my memory is a quicker source. given the availability of electronic data systems, this approach — this lack of immediate access to historical information — particularly with long, complex medical histories — is beginning to look unethical.
To a statistician, it seems as if most of today’s doctors were not trained to be able to access (or even analyze?) historical data, because at the time of their education today’s data systems were not in place. It thus seems that not only the practice, but medical training, has to evolve. A doctor should be able to easily access an entire history of diagnoses, medication utilization, lab and examination results. My doctor, for instance, would be unable to tell you how much my weight or blood pressure had increased or decreased in a 5 or 10 year period and by how much. To someone like myself, who has historical access to every other piece of personal data online (banking, investments, phone and utility bills), the doctor’s realm is seeming defensive and medieval. And sadly health information is much more critical to me than the rest.